CONTRACT_ID	ROLE	TITLE	PREFIX	LAST_NAME	FIRST_NAME	MI	PHONE	PHONE_EXT	ALT_PHONE	ALT_PHONE_EXT	FAX	EMAIL	STREET_ADDRESS	STREET_ADDRESS2	CITY	STATE_CODE	ZIP	LAST_UPDATED	CONTRACT_YEAR	CONTRACT_NAME	ORG_TYPE	MARKETING_NAME	CONTRACT_PLAN_TYPE	EMPLOYER	PARENT_ORGANIZATION_NAME	PARENT_ORGANIZATION_ID	PARTD_OFFERED	CONTRACT_STATUS	TOLLFREE_PHONE	TOLLFREE_EXT	ALT_TOLLFREE_PHONE	ALT_TOLLFREE_PHONE_EXT	NEW_PAYMENT_BILL_OPTION	DEMO_TYPE_FLAG	BILL_OPTION_CODE	REGION_RESPONSIBLE
90091	Backup User Access Contact	Director of Systems	Mr	Wilsey	David		2025212264				2025304064	DWilsey@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	05/05/2021	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	CAP Report Contact for Public Website	Director of Operations and Eligibility Services	Mr.	Crouch	Jeffery		2025212304				2025212260	JCrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	12/10/2018	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	CEO - CMS Administrator Contact	Executive Director	Ms.	Lewis	Lorraine		2025212390				2025212394	LLewis@UMWAFUNDS.ORG	UMWA Health & Retirement Funds	2121 K Street, NW	Washington	DC	20037	03/19/2009	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	CEO - Senior Official for Contracting	Executive Director	Ms.	Lewis	Lorraine		2025212390				2025212394	LLewis@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	07/31/2007	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Chief Financial Officer	Director of Finance	Ms.	Amselle	Anna		2025212295				2025212291	aamselle@umwafunds.org	2121 K Street,  NW	Suite 350	Washington	DC	20037	08/08/2023	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Chief Operating Officer	Director of Operations and Eligibility Services	Mr.	Crouch	Jeffery		2025212304				2025212260	JCrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	12/10/2018	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Chief Information Officer	Director of Systems	Mr.	Wilsey	David		2025212264				2025304064	DWilsey@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	08/24/2016	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Chief Information Security Officer	Director of Systems	Mr.	Wilsey	David		2025212264				2025304064	DWilsey@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	08/24/2016	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	CMS Casework Communication Contact	Senior Program Manager, Quality/Compliance	Ms	Blackburn	Kimberly		2025212293				2025304035	KBlackburn@UMWAFunds.org	160 Heartland Drive		Beckley	WV	25802	10/21/2016	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Complaints Tracking Contact	Senior Program Manager, Quality/Compliance	Ms	Blackburn	Kimberly		2025212293				2025304035	KBlackburn@UMWAFunds.org	160 Heartland Drive		Beckley	WV	25802	10/21/2016	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Contact for Fraud Investigations	Director of Operations and Eligibility Services	Mr.	Crouch	Jeffery		2025212304				2025212260	JCrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	12/10/2018	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Corporate Mailing						2025212394					LLewis@umwafunds.org	UMWA Health and Retirement Funds	2121 K Street, NW       Suite 350	Washington	DC	20037	05/05/2021	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Cost Report Contact	Director of Finance	Ms.	Amselle	Anna		2025212295				2025212291	AAmselle@umwafunds.org	2121 K Street,  NW	Suite 350	Washington	DC	20037	08/11/2023	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Customer Service Operations Contact	Senior Mgr, Claims Admin & Beneficiary Relations	Ms.	Bailey	Kelly		3042562633				3042562604	KBailey@umwafunds.org	UMWA Health & Retirement Funds	160 Heartland Drive	Beckley	WV	25802	05/05/2021	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Encounter Data & Risk Adjustment Operations Contact	Senior Mgr, Claims Admin & Beneficiary Relations	Ms.	Bailey	Kelly		3042562633				3042562604	KBailey@umwafunds.org	UMWA Health & Retirement Funds	160 Heartland Drive	Beckley	WV	25802	05/05/2021	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Enrollment Contact	Deputy Director, Eligibility Services	Ms.	Bratcher	Jennelle		2025212320				2027284701	JBratcher@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	08/22/2023	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	General Contact	Director of Operations and Eligibility Services	Mr.	Crouch	Jeffery		2025212304				2025212260	JCrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	12/10/2018	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Government Relations Contact	Director of Operations and Eligibility Services	Mr.	Crouch	Jeffery		2025212304				2025212260	JCrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	12/10/2018	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Interoperability Contact	Does not apply to Funds		able to the Funds	Not applic		2025212304					jcrouch@umwafunds.org	2121 K St.,  NW	Suite 350	Washington	DC	20037	09/02/2022	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	MA Appeals/Grievances Contact	Senior Program Manager, Quality/Compliance	Ms	Blackburn	Kimberly		2025212293				2025304035	KBlackburn@UMWAFunds.org	160 Heartland Drive		Beckley	WV	25802	10/21/2016	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	MA Claims Processing Contact for Public Website			Service	Customer		8888655290				2145743599	Funds.CustomerService@HealthSmart.com	UMWA Health & Retirement Funds Claims Processing Center	PO Box 211551	Eagan	MN	551212751	09/01/2023	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Marketing Contact	Does not apply to Funds		able to the Funds	Not Applic		2025212304					jcrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	09/02/2022	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Medical Director	Medical Director	Dr.	Dixon	Karen		2025212296				2025212260	KDixon@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	09/02/2022	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Medicare Compliance Officer	Director of Operations and Eligibility Services	Mr.	Crouch	Jeffery		2025212304				2025212260	JCrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	12/10/2018	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Medicare Coordinator	Director of Operations and Eligibility Services	Mr.	Crouch	Jeffery		2025212304				2025212260	JCrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	12/10/2018	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Part C Application Contact	Director of Operations and Eligibility Services	Mr.	Crouch	Jeffery		2025212304				2025212260	JCrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	12/10/2018	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Payment Contact	Director of Finance	Ms.	Amselle	Anna		2025212295				2025212291	AAmselle@umwafunds.org	2121 K Street,  NW	Suite 350	Washington	DC	20037	08/11/2023	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Plan Directory Contact for Public Website			Call Center	Health		8002911425				3042562626	Health1@umwafunds.org	UMWA Health and Retirement Funds	160 Heartland Drive	Beckley	WV	25802	10/21/2016	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Quality Contact	Senior Program Manager, Quality/Compliance	Ms	Blackburn	Kimberly		2025212293				2025304035	KBlackburn@UMWAFunds.org	160 Heartland Drive		Beckley	WV	25802	10/21/2016	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Surveillance Contact	Does not apply to Funds		able to the Funds	Not Applic		2025212304					JCrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	09/02/2022	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	System Contact	Director of Systems	Mr.	Wilsey	David		2025212264				2025304064	DWilsey@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	08/24/2016	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	User Access Contact	Mgr Eligibility Processing Appeal & Monitoring Svs	Ms.	Kruse	Krystal		3042562618				3042562604	KKruse@umwafunds.org	UMWA Health and Retirement Funds	160 Heartland Drive	Beckley	WV	25802	05/05/2021	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Utilization Management Contact	Director of Operations and Eligibility Services	Mr.	Crouch	Jeffery		2025212304				2025212260	JCrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	12/10/2018	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
90091	Utilization Review Contact	Director of Operations and Eligibility Services	Mr.	Crouch	Jeffery		2025212304				2025212260	JCrouch@umwafunds.org	2121 K Street, NW	Suite 350	Washington	DC	20037	12/10/2018	2023	UNITED MINE WORKERS OF AMERICA HLTH & RETIREMENT	HCPP - 1833 Cost	United Mine Workers of America Health & Retirement	HCPP - 1833 Cost		UMWA Health and Retirement Funds	306	No	Active					HCPP		1	Philadelphia
E3014	Automated TrOOP Balance Transfer Contact	VP of Operations- HOP Administration Unit		Natalie	Jennifer		7173917141				8774114921	Jnatalie@hlthben.com	1280 N. Plum Street		Lancaster	PA	17601	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Backup User Access Contact	Senior Health Plan Services Consultant		Miller	Greg		7172697202					gmiller@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Best Available Evidence Contact	HOP Eligibility Supervisor		Dixon	Ivy		7173917158				8774114921	PSERShopeligiblityteam@hlthben.com	1280 N. Plum Street		Lancaster	PA	17601	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Bid Primary Contact	Vice President & Health Actuary		Noonan	Mark		2675131788				2023305694	mnoonan@segalco.com	500 Office Center Drive	#400	Fort Washington	PA	19034	12/11/2017	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	CAP Report Contact for Public Website	Senior Health Plan Services Consultant		Winters	Carmen		5033143388					cwinters@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	CEO - CMS Administrator Contact		Mrs.	Mills	Jennifer		7177204805					jenmills@pa.gov	5 N 5th Street	PO Box 125	Harrisburg	PA	171080125	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	CEO - Senior Official for Contracting	Director, Health Insurance Office	Mr.	Camacci Jr	Peter	P	7177204859				7177728760	pcamacci@pa.gov	5 N 5th Street		Harrisburg	PA	171011905	01/02/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Chief Financial Officer	Chief Financial Officer	Mr.	Carl	Brian		7177204905					bcarl@state.pa.us	5 N 5th Street	PO Box 125	Harrisburg	PA	171080125	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Chief Operating Officer	Director, Health Insurance Office	Mr.	Camacci Jr	Peter	P	7177204859				7177728760	pcamacci@pa.gov	5 N 5th Street		Harrisburg	PA	171011905	01/02/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Chief Information Officer		Mr.	Goldstein	Steven		7177204697					sgoldstein@pa.gov	5 N 5th St		Harrisburg	PA	17101	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Chief Information Security Officer	Chief Information Security Officer	Mr.	Hocker	Steve		7177204699					shocker@pa.gov	5 N 5th Street		Harrisburg	PA	17108	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	CMS Casework Communication Contact	Senior Health Plan Services Consultant		Winters	Carmen		5033143388				8473782989	cwinters@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Complaints Tracking Contact	Senior Health Plan Services Consultant		Winters	Carmen		5033143388				8473782989	cwinters@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Contact for Fraud Investigations	Senior Health Plan Services Consultant		Miller	Greg		7172697202					gmiller@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Coordination of Benefits Contact	Business Analyst		Zeiset	Sheril		7173917108					szeiset@hlthben.com	1280 N. Plum Street		Lancaster	PA	17601	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Corporate Mailing						7177204859				7177838760	pcamacci@pa.gov	5 N 5th Street		Harrisburg	PA	171011905	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Coverage Gap Discount Program (CGDP) Payment Contact	Staff Accountant		Kupres	Angela		7173994277	12435				akupres@hlthben.com	1280 N. Plum Street		Lancaster	PA	17601	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Customer Service Operations Contact	VP of Operations- HOP Administration Unit		Natalie	Jennifer		7173917141				8774114921	Jnatalie@hlthben.com	1280 N. Plum Street		Lancaster	PA	17601	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	DIR Contact	Client Health and Welfare Consultant		Hays	Ronald		7272231678					rhays@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	DIR Contact (Secondary)	Vice President & Health Actuary		Noonan	Mark		2675131788				2023305694	mnoonan@segalco.com	500 Office Center Drive	#400	Fort Washington	PA	19034	12/05/2018	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Emergency Part D Contact	Senior Health Plan Services Consultant		Miller	Greg		7172697202					gmiller@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Emergency Part D Contact (Secondary)	Senior Health Plan Services Consultant		Winters	Carmen		5033143388					cwinters@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	12/15/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Employer Direct Contact	Director, Health Insurance Office	Mr.	Camacci Jr	Peter	P	7177204859				7177728760	pcamacci@pa.gov	5 N 5th Street		Harrisburg	PA	171011905	01/02/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Enrollment Contact	HOP Eligibility Supervisor		Dixon	Ivy		7173917158				8774114921	idixon@hlthben.com	1280 N. Plum Street		Lancaster	PA	17601	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	EOB Transfer Contact	Senior Health Plan Services Consultant		Winters	Carmen		5033143388				8473782989	cwinters@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Financial Audit Contact	Assistant Audit Executive, Benefits & Fin Rptg	Mrs.	Lanius	Stephanie		7177204640				7177831741	slanius@pa.gov	5 N 5th Street		Harrisburg	PA	171011905	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Financial Reporting Contact	Associate Consultant		Bearden	Suzanne		6783063131				6783063190	sbearden@segalco.com	2018 Powers Ferry Road	Suite 850	Atlanta	GA	30339	08/23/2010	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Formulary Contact	Clinical Consultant		Page	Lorry		6126427887					lorry.page8@optum.com	17310 Wright Street	Suite 100	Omaha	NE	68130	01/08/2021	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Formulary Contact (Secondary)	Vice President & Senior Pharmacy Consultant		Pincay	Eileen		2122515279					epincay@segalco.com	333 West 34th St.		New York	NY	10001	02/23/2018	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	General Contact	Director, Health Insurance Office	Mr.	Camacci Jr	Peter	P	7177204859				7177728760	pcamacci@pa.gov	5 N 5th Street		Harrisburg	PA	171011905	01/02/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Government Relations Contact	Director, Health Insurance Office	Mr.	Camacci Jr	Peter	P	7177204859				7177728760	pcamacci@pa.gov	5 N 5th Street		Harrisburg	PA	171011905	01/02/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	HIPAA Privacy Officer	Deputy Director, Health Insurance Office		Charlesworth	Sonya		7177204875				7177726780	scharleswo@pa.gov	5 N 5th Street		Harrisburg	PA	17101	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	HIPAA Security Officer	Chief Information Security Officer	Mr.	Hocker	Steve		7177204699					shocker@pa.gov	5 N 5th Street		Harrisburg	PA	17108	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Hospice Contact	Senior Health Plan Services Consultant		Miller	Greg		7172697202					gmiller@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Interoperability Contact	Senior Project Manager		Roman	Doug		7637977183					doug.roman@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	06/09/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Marketing Contact	Vice President and Actuary		Clark	Melanie		2028336489				2023305694	mcclark@segalco.com	1800 M Street, NW	Suite 900 S	Washington	DC	20036	01/02/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Medical Director	Senior Medical Director		Curtis	Bradford		9492526866					brad.curtis@optum.com	2300 Main St	MS CA 134-1000	Irvine	CA	92614	03/09/2021	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Medicare Compliance Officer	Assistant Audit Executive, Benefits & Fin Rptg	Mrs.	Lanius	Stephanie		7177204640				7177831741	slanius@pa.gov	5 N 5th Street		Harrisburg	PA	171011905	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Medicare Coordinator	Director, Health Insurance Office	Mr.	Camacci Jr	Peter	P	7177204859				7177728760	pcamacci@pa.gov	5 N 5th Street		Harrisburg	PA	171011905	01/02/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Medicare Part D Opioid Overutilization Contact	Senior Health Plan Services Consultant		Miller	Greg		7172697202					gmiller@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Medication Therapy Management Contact	Clinical Consultant		Page	Lorry		6126427887					lorry.page8@optum.com	17310 Wright Street	Suite 100	Omaha	NE	68130	01/08/2021	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Part D Appeals	Senior Health Plan Services Consultant		Miller	Greg							gmiller@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active	7172697202				Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Part D Appeals Contact (Secondary)	Clinical Consultant		Page	Lorry							lorry.page8@optum.com	17310 Wright Street	Suite 100	Omaha	NE	68130	01/07/2021	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active	6126427887				Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Part D Application Contact	Director, Health Insurance Office	Mr.	Camacci Jr	Peter	P	7177204859				7177728760	pcamacci@pa.gov	5 N 5th Street		Harrisburg	PA	171011905	01/02/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Part D Benefits Contact	VP of Operations- HOP Administration Unit		Natalie	Jennifer		7173917141				8774114921	Jnatalie@hlthben.com	1280 N. Plum Street		Lancaster	PA	17601	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Part D Claims Submission Contact	Strategic Account Executive, Account Management		Guzan	Sarah		7637972594					sarah.guzan@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	06/10/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Part D Exceptions Contact	Senior Health Plan Services Consultant		Miller	Greg							gmiller@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active	7172697202				Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Part D Exceptions Contact (Secondary)	Vice President & Senior Pharmacy Consultant		Pincay	Eileen							epincay@segalco.com	333 West 34th St.		New York	NY	10001	02/23/2018	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active	2122515279				Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Part D Price File Contact (Back-up)	Director, Health Insurance Office	Mr.	Camacci Jr	Peter	P	7177204859				7177728760	pcamacci@pa.gov	5 N 5th Street		Harrisburg	PA	171011905	01/02/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Part D Price File Contact (Primary)	Vice President & Health Actuary		Noonan	Mark		2675131788				2023305694	mnoonan@segalco.com	500 Office Center Drive	Suite 400	Fort Washington	PA	19034	12/11/2017	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Part D Quality Assurance Contact	Senior Health Plan Services Consultant		Winters	Carmen		5033143388					cwinters@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Part D Reporting Contact	Associate Consultant		Bearden	Suzanne		6783063131				6783063190	sbearden@segalco.com	2018 Powers Ferry Road	Suite 850	Atlanta	GA	30339	08/23/2010	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Patient Safety Contact	Senior Health Plan Services Consultant		Miller	Greg		7172697202					gmiller@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Payment Contact	Health Care Accounting		Dandapat	Manaswita		7177204827					mdandapat@pa.gov	5 N 5th Street	PO Box 125	Harrisburg	PA	17108	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Pharmacy Director	Vice President & Senior Pharmacy Consultant		Pincay	Eileen		2122515279					epincay@segalco.com	333 West 34th St.		New York	NY	10001	02/23/2018	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Pharmacy Network Management Contact	Director, Pharmacy Networks		Luby	Dwayne		9492526813				9494744268	dwayne.luby@optum.com	PO Box 9742		Minneapolis	MN	55440	03/12/2018	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Pharmacy Network Management Contact (Secondary)	Senior Health Plan Services Consultant		Miller	Greg		7172697202					gmiller@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Pharmacy Technical Help Desk Contact	Pharmacy Technical Help		Technical Help	Pharmacy						9494744268	michael.erbe@optum.com	3515 Harbor Blvd		Costa Mesa	CA	92626	03/12/2018	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active	8007979791				Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	PHR Beneficiary Contact																	03/31/2015	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP	OptumRx	Commonwealth of PA Pub Schools Retirement System	61	Yes	Active	8882391301				Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Plan Directory Contact for Public Website			Administration Unit	PSERS HOP		7173057388					PSERShopeligiblityteam@hlthben.com	1280 N. Plum Street		Lancaster	PA	17601	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Plan to Plan Reconciliation Contact	VP of Operations- HOP Administration Unit		Natalie	Jennifer		7173917141				8774114921	Jnatalie@hlthben.com	1280 N. Plum Street		Lancaster	PA	17601	05/08/2023	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Processor Contact	Processor Contact		Contact	Processor		8007979791				9494744268	michael.erbe@optum.com	3515 Harbor Blvd		Costa Mesa	CA	92626	03/12/2018	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Reconciliation Contact	Vice President & Health Actuary		Noonan	Mark		2675131788				2023305694	mnoonan@segalco.com	500 Office Center Drive	#400	Fort Washington	PA	19034	03/23/2018	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Reconciliation Contact (Secondary)	Client Health and Welfare Consultant		Hays	Ron		7272231678					rhays@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Recovery Audit Contact	Vice President and Actuary	Ms.	Clark	Melanie		2028336489				2023305694	mcclark@segalco.com	1800 M Street, NW	Suite 900 S	Washington	DC	20036	01/02/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Surveillance Contact	Senior Health Plan Services Consultant		Miller	Greg		7172697202					gmiller@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	System Contact	Vice President and Actuary	Ms.	Clark	Melanie		2028336489				2023305694	mcclark@segalco.com	1800 M Street, NW	Suite 900 S	Washington	DC	20036	01/02/2020	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	Third Party Administrator (TPA) Liaison	Senior Health Plan Services Consultant		Winters	Carmen		5033143388					cwinters@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
E3014	User Access Contact	Senior Health Plan Services Consultant		Winters	Carmen		5033143388					cwinters@bluepeak.com	2850 Golf Road		Rolling Meadows	IL	60008	08/30/2022	2023	PSERS HOP PROGRAM	Employer/Union Only Direct Contract PDP	Pennsylvania Public School Employees Retirement Sy	Employer/Union Only Direct Contract PDP		Commonwealth of PA Pub Schools Retirement System	61	Yes	Active					Employer/Union Only Direct Contract PDP		5	Philadelphia
H0022	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	05/08/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/10/2020	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	05/02/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	05/02/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	05/04/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Interoperability Contact	Staff VP, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	05/06/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	05/06/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	04/25/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Medical Director	Chief Medical Director	Dr.	Lucas	Brad		8662464356					blucas@centene.com	3700 Embassy Parkway, Suite 200		Akron	OH	44333	03/30/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	MMP Reporting Requirements Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/30/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	MMP Point of Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/30/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	05/02/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	05/03/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	05/03/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	05/03/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	05/03/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	05/25/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	05/13/2020	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	PHR Beneficiary Contact																	09/27/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8665498289				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	03/31/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/25/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	05/06/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/24/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/06/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/18/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0022	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	05/25/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Demo	Buckeye Health Plan - MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0028	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	03/22/2018	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	04/15/2013	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	05/19/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	06/17/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	06/17/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	06/21/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	05/29/2019	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	06/21/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	09/29/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	02/11/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	06/21/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	11/17/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	09/29/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	06/21/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	12/28/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	06/21/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	09/29/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	06/21/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/27/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	12/27/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	09/29/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	06/21/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	10/29/2019	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H0028	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H0028	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	06/21/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	09/24/2020	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	12/29/2022	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	05/26/2021	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0028	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	01/02/2020	2023	CHA HMO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0029	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	05/08/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/10/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H0029	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/10/2020	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/10/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	11/30/2018	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/14/2017	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/10/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/10/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/10/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/10/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	04/25/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Medical Director	Sr. VP, Medical Affairs	Dr.	Nelson	Vincent		3145056872					vincent.nelson@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/17/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/10/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/10/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/10/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/10/2020	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8663990928				HMO - Health Maintenance Organization		C	Dallas
H0029	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0029	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Plan Directory Contact for Public Website			Net	Health		8008676564				8009778226	CorporateMedicareComplianceDept@Centene.com	PO Box 419069		Rancho Cordova	CA	95741	08/14/2017	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/10/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0029	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	09/21/2022	2023	COORDINATED CARE OF WASHINGTON, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0034	Agent/Broker Compensation Data Contact	Director, Human Resources	Ms.	Schlesinger	Chaya		8455030504					cschlesinger@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/05/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Automated TrOOP Balance Transfer Contact	Senior Data and Reporting Analyst		Arinsburg	Valerie		4806249349					arinsbergv@magellanhealth.com	Magellan Rx Management	2520 Industrial Row Drive	Troy	MI	48084	10/05/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Backup User Access Contact	Director, Compliance	Ms.	Adler	Blimy		8455030507					badler@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/05/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Best Available Evidence Contact	VP, Compliance and Regulatory Affairs	Mr.	Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Bid Audit Contact	Chief Financial Officer		Brach	Joel		8455030925					jbrach@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Bid Audit Site Contact	Chief Financial Officer		Brach	Joel		8455030925					jbrach@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Bid Primary Contact	Chief Financial Officer		Brach	Joel		8455030925	570				jbrach@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	CAP Report Contact for Public Website	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	05/19/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active	8334262774				HMO - Health Maintenance Organization		C	New York
H0034	CEO - CMS Administrator Contact	Executive Director	Mr.	Bernath	Yoel		8455030228					ybernath@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	CEO - Senior Official for Contracting	Executive Director	Mr.	Bernath	Yoel		8455030228					ybernath@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Chief Financial Officer	Chief Finance Officer	Mr.	Brach	Joel		8455030925					jbrach@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	02/19/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Chief Operating Officer	Chief Operating Officer	Mr.	Friedman	David		8455030901					dfriedman@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Chief Information Officer	Chief Information Officer	Mr.	Zelik	Judah		8455030921					jzelik@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/05/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Chief Information Security Officer	Chief Information Security Officer	Mr.	Steinberg	Lipa		8455030930					lsteinberg@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	CMS Casework Communication Contact	VP, Compliance and Regulatory Affairs	Mr.	Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Complaints Tracking Contact	VP, Compliance and Regulatory Affairs	Mr.	Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	01/27/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Contact for Fraud Investigations	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Coordination of Benefits Contact	Comptroller, Medicare	Ms.	Hammelburger	Rivka		8455030990					rhammelburger@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	04/26/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Corporate Mailing						8453881199					efisch@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Compliance	Mr.	Adler	Blimy		8455030507					badler@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Customer Service Operations Contact	VP, Operations	Ms.	Manning	Emily		8455030535					emanning@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/05/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	DIR Contact	Vice President, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	02/16/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	DIR Contact (Secondary)	Chief Financial Officer		Brach	Joel		8455030925					jbrach@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	02/16/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Emergency Part D Contact	VP, Operations	Ms.	Manning	Emily		8355030535					emanning@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/05/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Encounter Data & Risk Adjustment Operations Contact	Chief Financial Officer		Brach	Joel		8455030925					jbrach@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Enrollment Contact	Director, Intake and Enrollment	Ms.	Fliegman	Simi		8455030910					sfliegman@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	EOB Transfer Contact	Vice President, Finance	Mr.	Ornstein	Mendy		8453881199	570			8455031570	mornstein@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	03/09/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Financial Audit Contact	Chief Finance Officer	Mr.	Brach	Joel		8453881199					jbrach@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/05/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Financial Reporting Contact	Comptroller, Medicare	Ms.	Hammelburger	Rivka		8455030990					rhammelburger@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Formulary Contact	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Formulary Contact (Secondary)	Formulary pharmacist, Part D		Swearengin	Kevin		5088876299					swearengink@magellanhealth.com	360 NW Island Cir. Apt A4		Beaverton	OR	97006	01/06/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	General Contact	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Government Relations Contact	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	HIPAA Privacy Officer	Director, Compliance	Ms.	Adler	Blimy		8453881199	507				badler@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/05/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	HIPAA Security Officer	Chief Information Security Officer	Mr.	Steinberg	Lipa		8455030930					lsteinberg@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Hospice Contact	VP, Operations	Ms.	Manning	Emily		8455030535					emanning@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Interoperability Contact	Chief Information Officer		Zelik	Judah		8455030921					jzelik@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	MA Appeals/Grievances Contact	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	05/09/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	MA Claims Processing Contact for Public Website	Vice President, Finance		Ornstein	Mendy		8453881199	570				mornstein@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	01/27/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Marketing Contact	Chief Business Development Officer	Ms.	Schwartz	Tziporah		8455030125					tschwartz@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Medical Director	Medical Director		Rizvi	Hammad		8482289959					hrizvi@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	01/25/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Medicare Compliance Officer	VP, Compliance and Regulatory Affairs	Mr.	Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Medicare Coordinator	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Rizvi	Hammad		8453881199					hrizvi@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	02/13/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Medication Therapy Management Contact	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Online Enrollment Center Contact (Back-up)	Director of Medicare Enrollment	Ms.	Fliegman	Simi		8455030910					sfliegman@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Online Enrollment Center Contact (Primary)	Vice President, Compliance and Regulatory Affairs	Mr.	Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/05/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Part C Application Contact	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Part C Reporting Contact	VP, Compliance and Regulatory Affairs	Mr.	Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	09/13/2023	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Part D Appeals	VP, Compliance and Regulatory Affairs	Ms.	Dehm	Karl							kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	09/13/2023	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active	8455030569				HMO - Health Maintenance Organization		C	New York
H0034	Part D Appeals Contact (Secondary)	VP, Utilization Management		Shteierman	Devora							dshteierman@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	09/13/2023	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active	8455030564				HMO - Health Maintenance Organization		C	New York
H0034	Part D Application Contact	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Part D Benefits Contact	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Part D Claims Submission Contact	Comptroller, Medicare	Mr.	Hammelburger	Rivka		8455030990					rhammelburger@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Part D Exceptions Contact	Director, Compliance	Ms.	Adler	Blimy							badler@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active	8455030507				HMO - Health Maintenance Organization		C	New York
H0034	Part D Exceptions Contact (Secondary)	Dir, Clinical Pharmacists		Brauner	Lyle							braunerld@magellanhealth.com	Magellan Rx Management	2520 Industrial Row Drive	Troy	MI	48084	02/20/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active	4012398035				HMO - Health Maintenance Organization		C	New York
H0034	Part D Price File Contact (Back-up)			Simmons	Brenda		8164352295					PCompare@dsthealth.com	Magellan Rx Management	2520 Industrial Row Drive	Troy	MI	48084	02/20/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Part D Price File Contact (Primary)	Senior Data and Reporting Analyst		Nieves	Jaime		4012398035					jnieves@magellanhealth.com	Magellan Rx Management	2520 Industrial Row Drive	Troy	MI	48084	02/20/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Part D Quality Assurance Contact	VP, Operations	Ms.	Manning	Emily		8455030535					emmanning@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Part D Reporting Contact	Director, Compliance	Mr.	Adler	Blimy		8455030507					badler@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Patient Safety Contact	Medical Director	Dr.	Rizvi	Hammad		8482289959					hrizvi@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	02/20/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Payment Contact	Comptroller, Medicare		Hammelburger	Rivka		8455030990					rhammelburger@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Pharmacy Director	Medical Director		Rizvi	Hammad		8482289959					hrizvi@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	01/25/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Pharmacy Network Management Contact	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Pharmacy Network Management Contact (Secondary)	Sr Director Network Ops		Gimm	Joy		4806249346					JGimm@magellanhealth.com	Magellan Rx Management	2520 Industrial Row Drive	Troy	MI	48084	02/20/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Pharmacy Technical Help Desk Contact	Manager, Clinical Pharmacy Operations		DiBiase	Joe							JDiBiase@magellanhealth.com	Magellan Rx Management	2520 Industrial Row Drive	Troy	MI	48084	01/06/2020	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active	8004244437				HMO - Health Maintenance Organization		C	New York
H0034	Pharmacy Technical Help Desk Contact (Secondary)	Service Operations Manager, Medicare Part D		Bragg	Sarah							Sbragg@magellanhealth.com	Magellan Rx Management	2520 Industrial Row Drive	Troy	MI	48084	02/20/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active	8045480494				HMO - Health Maintenance Organization		C	New York
H0034	Plan Directory Contact for Public Website	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Plan to Plan Reconciliation Contact	Comptroller, Medicare		Hammelburger	Rivka		8455030990	570				rhammelburger@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Processor Contact	Comptroller, Medicare		Hammelburger	Rivka		8455030990					rhammelburger@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Quality Contact	VP, Operations	Ms.	Manning	Emily		8455030535					emanning@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Reconciliation Contact	Chief Financial Officer		Brach	Joel		8455030925					jbrach@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	02/16/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Recovery Audit Contact	Chief Financial Officer	Mr.	Brach	Joel		8455030925	506				jbrach@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	SNP Application Contact	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Surveillance Contact	VP, Compliance and Regulatory Affairs		Dehm	Karl		8455030569					kdehm@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/18/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	System Contact	Chief Information Officer	Mr.	Zelik	Judah		8455030921					jzelik@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Third Party Administrator (TPA) Liaison	VP, Medicare Operations	Mr.	Manning	Emily		8455030535					emanning@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2021	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	User Access Contact	Director, IT Systems	Mr.	Lowy	Alex		8455030543					alowy@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	10/24/2019	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Utilization Management Contact	Director, Utilization Management	Ms.	Shteierman	Devora		8455030564					dshteierman@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0034	Utilization Review Contact	Director, Utilization Management	Ms.	Shteierman	Devora		8455030564					dshteierman@hamaspikchoice.org	58 Route 59, Suite #1		Monsey	NY	10952	12/07/2022	2023	HAMASPIK, INC.	Local CCP	Hamaspik, Inc.	HMO/HMOPOS		Hamaspik of Rockland County, Inc.	522	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0035	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Backup User Access Contact	Chief Information Officer		Babachicos	Cara		7209746739					cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Best Available Evidence Contact	Finance and Compliance Analyst	Mr.	Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Bid Primary Contact	Finance and Compliance Analyst	Mr.	Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	CAP Report Contact for Public Website	VP Clinical Compliance Audit Management		Teter	Lezlie		7206829848				3039961600	Lteter@innovage.com	3870 Rosin Court		Sacremento	CA	95834	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending	9096779517				PACE - Nat		C	San Francisco
H0035	CEO - CMS Administrator Contact	President & CEO	Mr.	Blair	Patrick		7209746704				3039961600	PBlair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	CEO - Senior Official for Contracting	President & CEO	Mr.	Blair	Patrick		7209746704				3039961600	PBlair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Chief Financial Officer	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Chief Operating Officer	COO	Ms.	Bent	Christine		7209742356				3039961600	cbent@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Chief Information Officer	CIO	Ms	Babachicos	Cara		3037202994					cbabachicos@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Chief Information Security Officer	Chief Information Security Officer	Mr	Smith	Alvin		7207896084				3039961600	ASmith2@innovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	CMS Casework Communication Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Complaints Tracking Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Contact for Fraud Investigations	Chief Legal Officer		D'Amato	Nicole		3038694664				3039961600	ndamato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Coordination of Benefits Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Corporate Mailing						3038694664				3039961600	bgutierrez@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Customer Service Operations Contact	Regional VP Operations COO	Mr.	Lohr	Clint		7209829868				3039961600	clohr@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	DIR Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	DIR Contact (Secondary)	Finance and Compliance Analyst	Mr.	Kizewski	Alex		3038694664				3039961600	akizewski@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	06/07/2021	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Emergency Part D Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Emergency Part D Contact (Secondary)	Finance and Compliance Analyst	Mr.	Kizewski	Alex		3038694664				3039961600	akizewski@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	06/07/2021	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Encounter Data & Risk Adjustment Operations Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Enrollment Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	EOB Transfer Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Financial Audit Contact	Director of Finance	Ms.	Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Financial Reporting Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Formulary Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Formulary Contact (Secondary)	Finance and Compliance Analyst	Mr.	Kizewski	Alex		3038694664				3039961600	akizewski@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	06/07/2021	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	General Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Government Relations Contact	Executive VP Government Relations		Steckel	Carol		7207896157				3039961600	CSteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	HIPAA Privacy Officer	Associate General Counsel	Mr.	Moxon	Jeff		7206613727				3039961600	crobertson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	HIPAA Security Officer	Chief Information Security Officer		Smith	Alvin		7207896084					asmith2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Interoperability Contact	SVP, Application Systems		Zierolf	Kris		7209742380					kzierolf@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	MA Appeals/Grievances Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	MA Claims Processing Contact for Public Website	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Marketing Contact	SVP, Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Medical Director	Chief Medical Officer	Dr.	Feifer	Rich		7206827305				3039961600	RFeifer@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Medicare Compliance Officer	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Medicare Coordinator	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Medicare Part D Opioid Overutilization Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 E. Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Medication Therapy Management Contact	SVP of Clinical Strategic Partnerships	Mrs.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Online Enrollment Center Contact (Back-up)	Finance and Compliance Analyst	Mr.	Kizewski	Alex		3038694664				3039961600	akizewski@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	06/07/2021	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Online Enrollment Center Contact (Primary)	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	06/07/2021	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Part C Application Contact	Executive VP Government Relations	Ms.	Steckel	Carol		7207896157				3039961600	CSteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Part D Appeals	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending	7206663817				PACE - Nat		C	San Francisco
H0035	Part D Appeals Contact (Secondary)	Managing Legal  Counsel	Mr..	Robertson	Cody						3039961600	crobertson@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	06/07/2021	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending	7209742459				PACE - Nat		C	San Francisco
H0035	Part D Application Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Part D Benefits Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Part D Claims Submission Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Part D Exceptions Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending	7206663817				PACE - Nat		C	San Francisco
H0035	Part D Exceptions Contact (Secondary)	Finance and Compliance Analyst	Mr.	Kizewski	Alex						3039961600	akizewski@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	06/07/2021	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending	3038694664				PACE - Nat		C	San Francisco
H0035	Part D Price File Contact (Back-up)	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Part D Price File Contact (Primary)	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Part D Quality Assurance Contact	SVP of Clinical Strategic Partnerships		Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Part D Reporting Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Patient Safety Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Payment Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Personal Health Record Contact	Corporate Counsel, Legal		Robertson	Cody		3033006930				3039961600	crobertson@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	06/07/2021	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Pharmacy Director	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Pharmacy Network Management Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Pharmacy Technical Help Desk Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending	7206663817				PACE - Nat		C	San Francisco
H0035	PHR Beneficiary Contact																	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE	Total Longterm Care, Inc.	Total Community Options, Inc.	230	Yes	Pending	8772776163	732			PACE - Nat		C	San Francisco
H0035	Plan Directory Contact for Public Website	Director of Marketing		Stavros	Sarah		3033006904				3039961600	sstavros@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Plan to Plan Reconciliation Contact	Financial and Compliance Analyst		Kizewski	Alex		7207896171				7209173390	AKizewsk@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Processor Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Quality Contact	Vice President of Quality		Curry	Jill		2153782123					JCurry@innovage.com	2000 Market Street	Suite 780	Philadelphia	PA	19103	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Reconciliation Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Reconciliation Contact (Secondary)	VP of Pharmacy	Ms.	Chase	Darla		3038694664				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	06/07/2021	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Recovery Audit Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817					mcinque@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Surveillance Contact	SVP, Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	System Contact	Director, PACE Finance		Hewitt	Jessica		7209746767					jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Third Party Administrator (TPA) Liaison	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	User Access Contact	Corporate Director of Compliance		Dickerson	Anzio		7208687356					adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Utilization Management Contact	Chief Quality & Population Health Officer	Dr.	Wells	Ann		7206827305				3039961600	awells@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0035	Utilization Review Contact	Chief Quality & Population Health Officer	Dr.	Wells	Ann		7206827305				3039961600	awells@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-LOS ANGELES, LLC	National PACE	InnovAge	National PACE		Total Community Options, Inc.	230	Yes	Pending					PACE - Nat		C	San Francisco
H0062	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H0062	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	05/06/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	05/06/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	05/06/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	05/06/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Medical Director	Chief Medical Director	Mr.	Harmon	David		5124163782	22182				dharmon@centene.com	5900 E. Ben White Blvd.		Austin	TX	78741	03/30/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8186766477					Heather.B.Starks@CENTENE.COM	21281 Burbank Blvd		Woodland Hills	CA	91367	05/06/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	05/06/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	05/06/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		hou	TX	77027	05/06/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E Commerce Way		Sacremento	CA	95834	05/06/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0062	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0062	PHR Beneficiary Contact																	09/27/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8447966811				HMO - Health Maintenance Organization		C	Dallas
H0062	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Plan Directory Contact for Public Website			Services	Member		8779358023					CorporateMedicareComplianceDept@CENTENE.COM	5900 E. Ben White Blvd.		Austin	TX	78741	03/31/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065741					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	05/06/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/10/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/06/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/25/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0062	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	05/25/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0074	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	01/29/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	01/29/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Contact for Fraud Investigations	Counsel, Special Investigations Unit		Fisher	Haley		3145056804					hfisher@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	01/29/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	DIR Contact (Secondary)	Senior Director, Predictive Analytics		Lamour	David		8132067536					david.lamour@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	05/11/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/26/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	05/11/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/27/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H0074	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H0074	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	05/11/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H0074	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H0074	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	05/26/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/26/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H0074	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Makram	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H0074	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H0074	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/26/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0074	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF MISSISSIPPI, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	DIR Contact (Secondary)	Senior Director, Predictive Analytics		Lamour	David		8132067536					david.lamour@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	05/11/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H0088	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H0088	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H0088	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H0088	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	2868 Prospect Park Dr		Rancho Cordova	CA	95670	05/11/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775					Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H0088	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	05/11/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H0088	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H0088	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/11/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/11/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0088	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/11/2022	2023	WELLCARE HEALTH INSURANCE OF NEW YORK, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0104	Agent/Broker Compensation Data Contact	Department Mgr Comp & Benefits		Vollenweider	Laurie		2052207486					lvollenweider@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/15/2011	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Automated TrOOP Balance Transfer Contact	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Backup User Access Contact	Compliance Analyst I		Goodlett	Dominique		2052207984					dgoodlett@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Best Available Evidence Contact	Sr. Business Analyst		Johnson	Geraldine		2052206077					gejohnson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	01/05/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Bid Audit Contact	Dept Manager Internal Audit		Echols	Molly		2052207036					mechols@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	12/10/2014	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Bid Audit Site Contact	Dept Manager Internal Audit		Echols	Molly		2052207036					mechols@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	12/10/2014	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Bid Primary Contact	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	CAP Report Contact for Public Website	Director Internal Audit/Corp Compliance		Miller	Keith		2052206123					kbmiller@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	12/03/2013	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	CEO - CMS Administrator Contact	President and Chief Executive Officer	Mr	Vines	Tim		2052206363					TVines@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	07/14/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	CEO - Senior Official for Contracting	Executive Vice President	Mr.	Briggs III	Dick	D	2052206952					dbriggs@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	07/01/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Chief Financial Officer	SVP & Chief Financial Officer	Mr.	Carden	Noel		2052207741					ncarden@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/18/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Chief Operating Officer	SVP Business Operations	Mr.	Hill	James	S	2052202196					Jim.Hill@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/24/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Chief Information Officer	SVP and CIO	Mr.	McGlaun	Scott		2052207300					SMcGlaun@bcbsal.org	450 Riverchase Pkwy East		Birmingham	AL	35244	02/26/2016	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Chief Information Security Officer	Chief Info Security Officer	Mr.	Parton	Chris		2052207421					cparton@bcbsal.org	450 Riverchase Pkwy East		Birmingham	AL	35244	02/26/2016	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	CMMI Model Point of Contact	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	CMS Casework Communication Contact	Senior Compliance Analyst		Jones	Kimberly		2052207077					kwjones@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	03/30/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Complaints Tracking Contact	Senior Compliance Analyst		Jones	Kimberly		2052207077					kwjones@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/01/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Contact for Fraud Investigations	Network Integrity Operations Manager		Ellison	Amy		2052202573					aellison@bcbsal.org	450 Riverchase Parkway		Birmingham	AL	35244	11/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Coordination of Benefits Contact	Manager Claims Processing		Cole	Jason		2052202490					Jason.Cole@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	05/02/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Corporate Mailing						2052205915					O65ProdMgmt@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/26/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant		Lambert	Christophe		2052206593					CLambert@bcbsal.org	450 Riverchase Pkwy East		Birmingham	AL	35244	04/19/2016	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Customer Service Operations Contact	Dept Manager Customer Service		Pearson	Latreta		2052207905					llpearson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	01/13/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	DIR Contact	VP Controller		DeLawrence	Jennifer		2052207282				2052202795	JDeLawrence@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/12/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	DIR Contact (Secondary)	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	03/04/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Electronic Health Record Contact	Senior Compliance Analyst		Richardson	Misty		2052204366					misty.richardson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Emergency Part D Contact	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Emergency Part D Contact (Secondary)	Pharmacy Services Manager		Matthews	Ginny		2052206558					Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Employer Waiver Contact	Manager Enrollment Service		Sexton	Missy		2052206589					Melissa.Sexton@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Encounter Data & Risk Adjustment Operations Contact	MAQM Department Manager		Pruitt	Gwendolyn		2052202418					Gwendolyn.Pruitt@bcbsal.org	450 Riverchase Pkwy East		Hoover	AL	35244	04/18/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Enrollment Contact	Manager Enrollment Service		Sexton	Missy		2052206589					Melissa.Sexton@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/18/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	EOB Transfer Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558				2052200803	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Financial Audit Contact	Dept Manager Internal Audit	Ms.	Echols	Molly		2052207036					mechols@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	12/10/2014	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Financial Reporting Contact	Dept Mgr Accounting/Reporting		O'Neal	Keith		2052206202					Keith.ONeal@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	01/13/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Formulary Contact	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/13/2018	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	04/08/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	General Contact	Manager Corporate Compliance		Gregg	Roger		2052207480					RGregg@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/01/2017	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Government Relations Contact	Manager Product Management	Mrs	Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	HIPAA Privacy Officer	Manager Corporate Compliance		Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	03/28/2012	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	HIPAA Security Officer	Manager Corporate Compliance		Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	11/24/2009	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Hospice Contact	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					WStevens@BCBSAL.ORG	450 Riverchase Parkway East		Birmingham	AL	35244	04/16/2019	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Interoperability Contact			Gregg	Roger		2052207480					rgregg@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	01/06/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	MA Appeals/Grievances Contact	Health Management Unit Mgr		Mattioli	Jared		2052205315					jmattioli@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/15/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	MA Claims Processing Contact for Public Website	Manager Claims Operations		Corley	Jeff		2052206367					jcorley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	01/13/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Marketing Contact	Department Manager Marketing		Glass	Carol		2052204124					Carol.Glass@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	09/17/2012	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Medical Director	Associate Medical Director	Dr.	Darden	Barry		2052206605					James.Darden@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	12/11/2018	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Medicare Compliance Officer	Manager Corporate Compliance	Mr.	Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	11/24/2009	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Medicare Coordinator	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacist		Anderson	Ally		8554570763					partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	04/05/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Medication Therapy Management Contact	VP Pharmacy Services		Cale	Dorinda		2052202655					dcale@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/12/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	OffShore Subcontractor Contact	Senior Compliance Analyst		Richardson	Misty		2052204366					misty.richardson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	11/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Online Enrollment Center Contact (Back-up)	Sr. Business Analyst		Johnson	Geraldine		2052206077					gejohnson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/08/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Online Enrollment Center Contact (Optional)	Manager Enrollment Service		Sexton	Missy		2052207276					Melissa.Sexton@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/18/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Online Enrollment Center Contact (Primary)	Sr Business Analyst		Hurst	Terri		2052202695					Terri.Hurst@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Part C Application Contact	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Part C Reporting Contact	Senior Compliance Analyst		Parham	Andrea		2052207206					aparham@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	11/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Part D Appeals	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	8006936651				PPO - BBA		C	Atlanta
H0104	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936651	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	8006936651				PPO - BBA		C	Atlanta
H0104	Part D Application Contact	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Part D Benefits Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558					Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Part D Claims Submission Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558					Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Part D Exceptions Contact	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	04/08/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	8006936651				PPO - BBA		C	Atlanta
H0104	Part D Exceptions Contact (Secondary)	Pharmacy Services Manager		Matthews	Ginny							Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	2052206558				PPO - BBA		C	Atlanta
H0104	Part D Price File Contact (Back-up)	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593				2052202939	Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/13/2018	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Part D Price File Contact (Optional)	Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	04/08/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Part D Price File Contact (Primary)	Pharmacy Services Mgr		Matthews	Ginny		2052206558				2057337486	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Part D Quality Assurance Contact	MAQM Clinical Analyst		Davis	Janice		2052204066					jddavis@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	01/13/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Part D Reporting Contact	Senior Compliance Analyst		Parham	Andrea		2052207206					aparham@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	11/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Patient Safety Contact	VP Pharmacy Services		Cale	Dorinda		2052202655				2052208739	dcale@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/12/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Payment Contact	VP Controller		DeLawrence	Jennifer		2052207282					JDeLawrence@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/12/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Pharmacy Director	VP Pharmacy Services		Cale	Dorinda		2052202655					dcale@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/12/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Pharmacy Network Management Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558				2054034052	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Pharmacy Network Management Contact (Secondary)	VP Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	04/08/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Pharmacy Technical Help Desk Contact	Pharmacy Services Mgr		Matthews	Ginny							Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	8778788668				PPO - BBA		C	Atlanta
H0104	Pharmacy Technical Help Desk Contact (Secondary)	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	8778788668				PPO - BBA		C	Atlanta
H0104	Physician Incentive Contact	SVP Health Care Networks		Weaver	Darrel		2052207007					darrel.weaver@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/08/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Plan Directory Contact for Public Website	Manager Claims Operations		Corley	Jeff		8005176425					jcorley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	01/13/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Plan to Plan Reconciliation Contact	Sr. Analyst-Cash Management		Buford	Julie		2052207316					julie.buford@bcbsal.org	450 Riverchase Parkway		Birmingham	AL	35244	12/08/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Processor Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558				2052208739	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Quality Contact	Quality Improvement Manager		Chancy	Cortney		2052207251					Brooke.Kendrick@BCBSAL.ORG	450 Riverchase Parkway East		Birmingham	AL	35244	01/02/2020	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Reconciliation Contact	Manager Financial Accounting		Williamson	Amanda		2052207289					Amanda.Williamson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	03/20/2018	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Reconciliation Contact (Secondary)	Sr. Accountant		Lambert	Christophe		2052206593				2052202795	CLambert@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/15/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Recovery Audit Contact	Manager Corporate Compliance	Mr.	Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	03/27/2012	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Surveillance Contact	Consumer Sales Manager		Carter	Brent		2052207681					bcarter@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	System Contact	Manager Corporate Compliance		Gregg	Roger		2052207480					RGregg@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/01/2017	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Third Party Administrator (TPA) Liaison	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/13/2018	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	User Access Contact	Regulatory Compliance Manager		O'Dell	Laney		2052206655					Laney.ODell@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Utilization Management Contact	Health Management Unit Mgr		Wadsworth	Bonita		2052207437					bwadsworth@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/15/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0104	Utilization Review Contact	Health Management Unit Mgr		Wadsworth	Bonita		2052207437					bwadsworth@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/15/2021	2023	BLUE CROSS AND BLUE SHIELD OF ALABAMA	Local CCP	Blue Cross and Blue Shield of Alabama	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H0105	Automated TrOOP Balance Transfer Contact	Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Backup User Access Contact	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Best Available Evidence Contact	Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct.		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Bid Primary Contact	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	CAP Report Contact for Public Website	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P.O.Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	CEO - CMS Administrator Contact	CEO	Mr.	Fowler	Clay		7705002705				8032685302	clay.fowlerhealthcareenterpise@gmail.com	PO Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	CEO - Senior Official for Contracting	CEO	Mr.	Fowler	Clay		7705002705				8032685302	clay.fowlerhealthcareenterpise@gmail.com	PO Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Chief Financial Officer	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	PO Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Chief Operating Officer	COO	Mrs.	Kornegay	Allie		8032685315	5315			8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct.		Orangeburg	SC	29118	09/08/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Chief Information Officer	IT Manager	Mr	Rast	Chip		8035341212	7301			8032685302	chip@theoakssc.com	P.O. Drawer 327		Orangeburg	SC	29116	03/20/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Chief Information Security Officer	IT Manager	Mr	Rast	Chip		8035341212	7301			8032685302	chip@theoakssc.com	P.O. Drawer 327		Orangeburg	SC	29116	03/20/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	CMS Casework Communication Contact	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Complaints Tracking Contact	Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct.		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Contact for Fraud Investigations	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Coordination of Benefits Contact	Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct.		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Corporate Mailing						8032685315				8032685302	allie.kornegay@orangeburgshcpace.org	153 Founders Ct		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Customer Service Operations Contact	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	DIR Contact	Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct.		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	DIR Contact (Secondary)	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Emergency Part D Contact	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Emergency Part D Contact (Secondary)	Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct.		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Encounter Data & Risk Adjustment Operations Contact	Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Enrollment Contact	COO	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct.		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	EOB Transfer Contact	CFO	Ms	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P.O. Drawer 327		Orangeburg	SC	29118	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Financial Audit Contact	CFO	Mrs.	Phillips	Tricia		8035341212	1712			8035351540	tricia.phillips@theoakssc.com	1000 Methodist Oaks Drive		Orangeburg	SC	29115	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Financial Reporting Contact	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Formulary Contact	Pharmacist/Owner  Grove Park Pharmacy	Mr	Thompson	Charles		8035360007					grovepark@earthlink.net	1324 Chestnut Street		Orangeburg	SC	29118	04/25/2016	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Formulary Contact (Secondary)	Pharm D	Mrs.	Wimberly	Jennifer		8035360007					thadjen@aol.com	1324 Chestnut Street		Orangeburg	SC	29118	04/26/2016	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	General Contact	PACE Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Court		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Government Relations Contact	PACE Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Court		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	HIPAA Privacy Officer	PACE Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Court		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	HIPAA Security Officer	PACE Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Court		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Interoperability Contact	Pace Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Court		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	MA Appeals/Grievances Contact	Program Director	Mrs	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Court		Orangeburg	SC	29118	08/23/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	MA Claims Processing Contact for Public Website	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Marketing Contact	Marketing Outreach	Mrs.	Hudson	Cindy		8035345301				8032685302	Cindy.Hudson@orangeburgshcpace.com	153 Founders Court		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Medical Director	Medical Director	Dr	Guest	Ketih		8035341212	5304			8032685302	keith.guest@orangeburgshcpace.com	153 Founders Court		Orangeburg	SC	29118	08/15/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Medicare Compliance Officer	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	PO Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Medicare Coordinator	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Medicare Part D Opioid Overutilization Contact	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Medication Therapy Management Contact	Pharm D	Mrs.	Wimberly	Jennifer		8035360007					thadjen@aol.com	1324 Chestnut Street		Orangeburg	SC	29118	04/25/2016	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Online Enrollment Center Contact (Back-up)	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Part C Application Contact	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Part D Appeals	CFO	Mrs.	Phillips	Tricia						8035351540	tricia.phillips@theoakssc.com	PO Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active	8668849856	1573			PACE - Nat		C	Atlanta
H0105	Part D Application Contact	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Part D Benefits Contact	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Part D Claims Submission Contact	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Part D Exceptions Contact	Program Director	Mrs.	Kornegay	Allie						8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active	8032685315				PACE - Nat		C	Atlanta
H0105	Part D Price File Contact (Back-up)	Program Director	Mrs.	Kornegay	Allie		8032685315				8035351540	allie.kornegay@orangeburgshcpace.com	153 Founders Ct		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Part D Price File Contact (Primary)	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Part D Quality Assurance Contact	Pharm D	Mrs.	Wimberly	Jennifer		8035360007					thadjen@aol.com	1324 Chestnut Street		Orangeburg	SC	29118	04/25/2016	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Part D Reporting Contact	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Patient Safety Contact	Center Operations Director	Mrs	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangburgshcpace.com	153 Founders Court		Orangeburg	SC	29118	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Payment Contact	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Pharmacy Director	Pharmacist/Owner  Grove Park Pharmacy	Mr	Thompson	Charles		8035360007					grovepark@earthlink.net	1324 Chestnut Street		Orangeburg	SC	29118	04/25/2016	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Pharmacy Network Management Contact	Pharmacist/Owner  Grove Park Pharmacy	Mr	Thompson	Charles		8035360007					grovepark@earthlink.net	1324 Chestnut Street		Orangeburg	SC	29118	04/25/2016	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Pharmacy Technical Help Desk Contact	Pharmacist/Owner  Grove Park Pharmacy	Mr	Thompson	Charles						8032685302	grovepark@earthlink.net	1324 Chestnut Street		Orangeburg	SC	29118	12/18/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active	8775053131				PACE - Nat		C	Atlanta
H0105	Pharmacy Technical Help Desk Contact (Secondary)	Pharm D	Mrs.	Wimberly	Jennifer							thadjen@aol.com	1324 Chestnut Street		Orangeburg	SC	29118	04/25/2016	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active	8775053131				PACE - Nat		C	Atlanta
H0105	PHR Beneficiary Contact																	12/18/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE	The Methodist Oaks	Orangeburg Senior Helping Center, LLC	796	Yes	Active	8668849856				PACE - Nat		C	Atlanta
H0105	Plan Directory Contact for Public Website	Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Plan to Plan Reconciliation Contact	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Processor Contact	IT Manager	Mr.	Rast	Chip		8035341212	7301			8032685302	chip@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	03/20/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Quality Contact	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	06/12/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Reconciliation Contact	CFO	Mrs.	Phillips	Tricia		8035341212	1573			8035351540	tricia.phillips@theoakssc.com	P O Drawer 327		Orangeburg	SC	29116	11/30/2022	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Recovery Audit Contact	Program Director	Mrs.	Kornegay	Allie		8032685315				8032685302	allie.kornegay@orangeburgshcpace.com	153 Founders Ct		Orangeburg	SC	29118	09/10/2023	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Surveillance Contact	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	System Contact	IT Manager	Mr	Rast	Chip		8035341212	7301			8032685302	chip@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	03/20/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Third Party Administrator (TPA) Liaison	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	User Access Contact	IT Manager	Mr	Rast	Chip		8035341212	7301			8032685302	chip@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	03/20/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Utilization Management Contact	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0105	Utilization Review Contact	LPN, Quality Improvement Coordinator	Mrs	Nichols	Kathy		8035341212	5326			8032685302	kathy.nichols@theoakssc.com	153 Founders Court		Orangeburg	SC	29118	11/06/2020	2023	Orangeburg Senior Helping Center, LLC	National PACE	Orangeburg Senior Helping Center: A PACE Healthcare Program	National PACE		Orangeburg Senior Helping Center, LLC	796	Yes	Active					PACE - Nat		C	Atlanta
H0107	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Chief Operating Officer	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/03/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	CMMI Model Point of Contact	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/03/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	11/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Blue Cross Blue Shield of Texas	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	General Contact	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/03/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	12/04/2018	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	03/25/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/04/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Medicare Coordinator	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/03/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H0107	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H0107	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	08/09/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H0107	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H0107	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/11/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	11/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/22/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active	8772777898				PPO - BBA		C	Denver
H0107	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active	0000000000				PPO - BBA		C	Denver
H0107	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	07/26/2018	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Services Corporation	1001 E. Lookout Drive	Richardson	TX	75082	08/14/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	04/26/2016	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0107	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	07/26/2018	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of Montana	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H0111	Agent/Broker Compensation Data Contact	Senior Director, Reporting & Business Analytics		Williams	Michael		8132062356					michael.williams@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					Denethia.Steadman@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Contact for Fraud Investigations	Counsel, Special Investigations Unit		Fisher	Haley		3145056804					hfisher@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	05/17/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Employer Waiver Contact	Senior Director, Product Owner		Peters	Katie		8132065774					katie.peters@wellcare.com	8725 Henderson Road	Ren 1	Tampa	FL	33634	05/31/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	05/17/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	05/17/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Part D Appeals	Sr Manager, Pharmacy Operations		Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H0111	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians		Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H0111	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Part D Benefits Contact	Director, Pharmacy		Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	05/17/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H0111	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H0111	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	05/31/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775					Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H0111	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	05/17/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H0111	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8668928340				PPO - BBA		C	Dallas
H0111	Physician Incentive Contact	Sr. Director, Contracting & Network Development	Mr.	Figueroa	Jaime	J	3145056543					Jaime.J.Figueroa@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/31/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/31/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/17/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0111	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		3144450457					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/17/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0112	Automated TrOOP Balance Transfer Contact	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@morselife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Backup User Access Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack  Dr.		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Best Available Evidence Contact	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Bid Primary Contact	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	CAP Report Contact for Public Website	Director of Information Technology		Schultz	Michael		5616875765				5616834556	Michaels@MorseLife.org	4847 David S. Mack Dr.		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	CEO - CMS Administrator Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr.		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	CEO - Senior Official for Contracting	Prssident/CEO	Mr	Myers	Keith	A	5616875744				5616834556	Keithm@MorseLife.org	4847 David S. Mack  Dr.		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Chief Financial Officer	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616834556	rwolan@MorseLife.org	4847David S. Mack  Dr.		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Chief Operating Officer	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr.		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Chief Information Officer	Director Information Technology	Mr	Schultz	Michael		5616875765				5616834556	MichaelS@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Chief Information Security Officer	Director Information Technology	Mr	Schultz	Michael		5616875765				5616834556	MichaelS@MorseLife.org	4847 David S. Mack  Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	CMS Casework Communication Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack  Dr.		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Complaints Tracking Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr.		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Contact for Fraud Investigations	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr.		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Coordination of Benefits Contact	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack  Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Corporate Mailing						5614715111					ppnisbett@MorseLife.org	4847 David S. Mack Dr.		West Palm Beach	FL	33417	01/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Coverage Gap Discount Program (CGDP) Payment Contact	Controller	Mr	Wolan	Randy		5612096108				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Customer Service Operations Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	DIR Contact	Controller	Mr	Wolan	Randy		5612096108				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	DIR Contact (Secondary)	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Emergency Part D Contact	Controller	Mr	Wolan	Randy		5612096108				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Emergency Part D Contact (Secondary)	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Encounter Data & Risk Adjustment Operations Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Enrollment Contact	Regional Dir, Enrollment	Ms	Barreto-Najarro	Nadia		5615426579				5616834556	nbarreto-najarro@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	EOB Transfer Contact	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Financial Audit Contact	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Financial Reporting Contact	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Formulary Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Formulary Contact (Secondary)	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	General Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Government Relations Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	HIPAA Privacy Officer	Director of Information Technology		Schultz	Michael		5616875765				5616834556	Michaels@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	HIPAA Security Officer	Director of Information Technology		Schultz	Michael		5616875765				5616834556	Michaels@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Interoperability Contact	Director of Information Technology		Schultz	Michael		5612349515					michaels@morselife.org	4847 David S Mack Drive		West Palm Beach	FL	33417	06/03/2022	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	MA Appeals/Grievances Contact	Senior VP Home & Community Based Services	Ms	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr.		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	MA Claims Processing Contact for Public Website	Plan Management Specialist	Ms.	Pridgeon	Shawna		8663864447				3149613456	spridgeon@peakpacesolutions.com	Peak PACE Solutions, LLC	345 Marshall Ave, Ste 101	St. Louis	MO	63119	12/19/2016	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Marketing Contact	Regional Dir Enrollment	Ms.	Barreto-Najarro	Nadia		5615426579					nbarreto-najarro@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Medical Director	Medical Director	Dr.	Merkelj	Ivan		5612825386				5616834556	imerkelj@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Medicare Compliance Officer	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr.		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Medicare Coordinator	Regional Dir Enrollment	Ms	Barreto-Najarro	Nadia		5615426579					nbarreto-najarro@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Medicare Part D Opioid Overutilization Contact	Medical Director PACE	Dr.	Merkelj	Ivan		5612825382				5616898718	Ivanm@morselife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Medication Therapy Management Contact	Medical Director	Dr.	Merkelj	Ivan		5612825386				5616834556	imerkelj@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	OffShore Subcontractor Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Online Enrollment Center Contact (Back-up)			Camacho	Angie		5613036882					acamacho@MorseLife.org	4847 David S. Mack Dr.		West Palm Beach	FL	33417	01/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Online Enrollment Center Contact (Optional)	Regional Dir Marketing	Ms.	Barreto-Najarro	Nadia		5615426579					nbarreto-najarro@morselife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Online Enrollment Center Contact (Primary)	Senior VP Home & Community Based Services	Dr.	Sadowsky	Alan	D	5616875745				5616834556	ASadowsky@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Part C Application Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Part D Appeals	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola						5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active	5616875745				PACE - Nat		C	Atlanta
H0112	Part D Appeals Contact (Secondary)	Chief Financial Officer	Mr	Wolan	Randy	T					5615781173	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active	8886160707				PACE - Nat		C	Atlanta
H0112	Part D Application Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Part D Benefits Contact	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Part D Claims Submission Contact	Chief Financial Officer	Mr.	Wolan	Randy		5612096198				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	09/25/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Part D Exceptions Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola						5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active	5616875745				PACE - Nat		C	Atlanta
H0112	Part D Exceptions Contact (Secondary)	Chief Financial Officer	Mr	Wolan	Randy	T					5615781173	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active	8886160707				PACE - Nat		C	Atlanta
H0112	Part D Price File Contact (Back-up)	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Part D Price File Contact (Primary)	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Part D Quality Assurance Contact	Medical Director	Dr.	Merkelj	Ivan		5612825386				5616834556	imerkelj@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Part D Reporting Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Patient Safety Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Payment Contact	Plan Management Specialist	Ms.	Pridgeon	Shawna		8663864447				3149613456	spridgeon@peakpacesolutions.com	Peak PACE Solutions, LLC	345 Marshall Ave, Suite 101	St. Louis	MO	63119	12/19/2016	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Personal Health Record Contact	Director of Information Technology		Schultz	Michael		5616875765				5616834556	Michaels@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Pharmacy Director	Medical Director	Dr.	Merkelj	Ivan		5612825386				5616834556	imerkelj@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Pharmacy Network Management Contact	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Pharmacy Network Management Contact (Secondary)	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Pharmacy Technical Help Desk Contact	Chief Financial Officer	Mr	Wolan	Randy	T					5615781173	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active	8886160707				PACE - Nat		C	Atlanta
H0112	Pharmacy Technical Help Desk Contact (Secondary)	Medical Director	Dr.	Merkelj	Ivan						5616834556	ivanm@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active	5612825386				PACE - Nat		C	Atlanta
H0112	Plan Directory Contact for Public Website	Director of Information Technology		Schultz	Michael		5616875765				5616834556	Michaels@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Processor Contact	Director of Information Technology		Schultz	Michael		5616875765				5616834556	Michaels@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Quality Contact	Medical Director	Dr.	Merkelj	Ivan		5612825386				5616834556	imerkelj@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Reconciliation Contact	Controller	Mr	Wolan	Randy		5612096108				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Reconciliation Contact (Secondary)	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr.		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Recovery Audit Contact	Chief Financial Officer	Mr	Wolan	Randy	T	5615781173				5616898718	rwolan@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	05/02/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Surveillance Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	System Contact	Senior VP Home & Community Based Services	Ms.	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Third Party Administrator (TPA) Liaison	Peak PACE Solutions, LLC CEO	Ms.	McGarrigle	Mike		7202043214				3149613456	mMcGarrigle@peak.cpstn.com	Peak PACE Solutions, LLC	345 Marshall Ave, Ste 101	St. Louis	MO	63119	10/15/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	User Access Contact	Senior VP Home & Community Based Services	Ms	Pouponneau-Nisbett	Paola		5616875745				5616834556	ppnisbett@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	08/10/2023	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Utilization Management Contact	Medical Director	Dr.	Merkelj	Ivan		5612825386				5616834556	imerkelj@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0112	Utilization Review Contact	Medical Director	Dr.	Merkelj	Ivan		5612825386				5616834556	imerkelj@MorseLife.org	4847 David S. Mack Dr		West Palm Beach	FL	33417	01/08/2021	2023	MORSE LIFE HOME CARE, INC.	National PACE	Palm Beach PACE	National PACE		Morse Life Home Care, Inc.	550	Yes	Active					PACE - Nat		C	Atlanta
H0137	Agent/Broker Compensation Data Contact	Manager, Sales Operations	Mr.	Demos	John		6174260600					jdemos@commonwealthcare.org	30 Winter Street		Boston	MA	02108	04/22/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment and Eligibility		Sherman	Mandy		9202214083				9202214583	Relay.Health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Backup User Access Contact	Director, Health Plan Compliance		Dwinnells	Mark		6174260600	1239				mdwinnells@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/17/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Best Available Evidence Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931				randrade@commonwealthcare.org	30 Winter St		Boston	MA	02108	02/05/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Bid Audit Contact	Sr. Director, Actuarial Services		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Bid Audit Site Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Bid Primary Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/26/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	CAP Report Contact for Public Website	General Manager, Market Lead - Massachusetts		Waggoner	Mark		6174260600	51606				mwaggoner@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Palmieri	Chris	D	8572468897					cpalmieri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/05/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	CEO - Senior Official for Contracting	President of Markets	Ms	Murphy	Courtney		6174260600	53892				cmurphy@commonwealthcare.org	30 Winter Street, 12th Floor		Boston	MA	02108	03/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Chief Financial Officer	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/12/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Chief Operating Officer	Chief Operating Officer	Mr.	Mudunuri	Sesha		6178757140					smudunuri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/05/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Chief Information Officer	SVP & Chief Information Officer	Ms.	O'Rorke	Beth		6174260600	2485				bororke@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/21/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Chief Information Security Officer	VP, IT Governance and Cyber Security	Mr.	Jacobs	Tim		6174260600	52258				tjacobs@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	CMMI Model Point of Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/17/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	CMS Casework Communication Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320				8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Complaints Tracking Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573271953	1652			8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Contact for Fraud Investigations	Director, FWA Program and SIU		Vasconcelos	Nadia		6174260600	52733				nvasconcelos@commonwealthcare.org	2 Lafayette	5th Floor	Boston	MA	02111	08/08/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Coordination of Benefits Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931			6174263109	randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/05/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Corporate Mailing						6174260600	1991				elgray@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/24/2016	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Customer Service Operations Contact	Director, Contract Center		Cuevas	Sabrina		6174260600	51004				scuevas@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/05/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	DIR Contact	Sr. Director, Actuarial Services		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	DIR Contact (Secondary)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Electronic Health Record Contact	Director Clinical Informatics		Phan	Phuong		6174260600	52247				pphan@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	11/04/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Emergency Part D Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Emergency Part D Contact (Secondary)	Manager, Pharmacy Operations		Lee	Annie		6174263109					alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Encounter Data & Risk Adjustment Operations Contact	Manager, Encounters and Risk		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter St		Boston	MA	02108	11/13/2019	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Enrollment Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931			6174263109	randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/05/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	EOB Transfer Contact	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194			6174260600	elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Financial Audit Contact	Director, Regulatory Audit	Ms	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Financial Reporting Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Formulary Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Formulary Contact (Secondary)	Medicare Team Lead, Formulary Services		Paddock	Deanna		6087291628				6087292628	deanna.paddock@navitus.com	361 Integrity Drive		Madison	WI	53717	07/01/2019	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	General Contact	General Manager, Market Lead - Massachusetts		Waggoner	Mark		6174260600	51606				mwaggoner@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Government Relations Contact	VP, Government Relations		Preede	Ken		6174260600	51412				kpreede@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	HIPAA Privacy Officer	VP, Chief Privacy & Security Officer		Burgess	James		6174645274					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	HIPAA Security Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Hospice Contact	Palliative Care Medical Director		Ragland	Julia		7815254203					JRagland@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	10/04/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Interoperability Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	MA Appeals/Grievances Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320				8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	MA Claims Processing Contact for Public Website	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194				elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Marketing Contact	SVP, Marketing		Kubilus	Melissa		6174260600	52448			6174263019	mkubilus@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/03/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Medical Director	Medical Director		Chittenden	Eva		6174260600	56924				echittenden@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Medicare Compliance Officer	Director, Medicare Compliance Officer	Ms.	Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/01/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Medicare Coordinator	Contract Manager		Belec	Steven		6174260600	1870				sbelec@commonwealthcare.org	30 Winter Street		Boston	MA	02108	04/16/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/17/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Medication Therapy Management Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	MMP Reporting Requirements Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	MMP Point of Contact	Contract Manager		Belec	Steve		6174260600	1870				sbelec@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	OffShore Subcontractor Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Online Enrollment Center Contact (Back-up)	Manager, Member Enrollment and Retention		Taylor	Lena		6174260600	51126				ltaylor@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Online Enrollment Center Contact (Primary)	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931			6174263097	randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part C Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part C Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02111	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Appeals	Director, Appeals & Grievances		Schenk	Tyrone						8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8573273320				Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Appeals Contact (Secondary)	Manager, Clinical Appeals and Grievances		Mancuso	Jeremiah							jmancuso@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6082985781	51222			Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Benefits Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Claims Submission Contact	Manager, Technical Operations		Derks	Bob		9202214176				9202214676	DL-TO-PDE@navitus.com	1025 West Navitus Dr		Appleton	WI	54913	05/04/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Exceptions Contact	Sr. Manager, Clinical Prior Auth		LeClair	Christophe						9202214676	Christopher.LeClair@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8662703877				Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Operations		Lee	Annie						6174263109	alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/09/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600				Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Price File Contact (Back-up)	Manager, Pharmacy Operations		Lee	Annie		6174260600					alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/09/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Price File Contact (Optional)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Price File Contact (Primary)	Navitus Plan Finder		Finder	Plan		6087291578					Plan.Finder@Navitus.com	2601 West Beltline Highway	Suite 600	Madison	WI	53713	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Quality Assurance Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Part D Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Patient Safety Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Payment Contact	VP Revenue Cycle Management		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/20/2020	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Personal Health Record Contact	Mgr, Health Information Management		Lopez	Robin		6174260600	5235				rlopez@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Pharmacy Director	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688				6087292688	Jan.Robinson@Navitus.com	361 Integrity Drive		Madison	WI	53713	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Pharmacy Technical Help Desk Contact	Sr. Mgr, Customer Care Accounts		Nett	Danielle						9202214724	Danielle.Nett@navitus.com	1025 West Navitus Drive		Appleton	WI	53713	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8662703877	4224			Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	PHR Beneficiary Contact																	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS	Commonwealth Care Alliance	Commonwealth Care Alliance, Inc.	60	Yes	Active	8666102273				Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Physician Incentive Contact	VP, Provider Network Strategy	Mr.	Tirimacco	Robert		6174260600	1013				rtirimacco@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Plan Directory Contact for Public Website			Services	Member		8664209332					memberservices@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/16/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Plan to Plan Reconciliation Contact	Manager, Accounts Payable		Reeves	Jennifer		6174260600	51632				jreeves@commonwealthcare.org	30 Winter St		Boston	MA	02108	05/08/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Processor Contact	VP, Claims and Provider Network Operations		Breen	Donna		6176804446					dbreen@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/17/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Quality Contact	VP, Quality		Feierstein	Anne		6174260600	56868				afeierstein@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/10/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Reconciliation Contact	Director, Actuarial Service		Jesik	David		6174260600	1808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/01/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Reconciliation Contact (Secondary)	VP Revenue Cycle		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/20/2020	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Recovery Audit Contact	Director External Audit	Ms.	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	SNP Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	SNP State Contact	Contract Manager		Belec	Steve		6174260600	1870				sbelec@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Surveillance Contact	VP, National Sales		Spartano	Michael		6174260600	52179				mspartano@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/17/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	System Contact	Manager, Encounters and Risk Adjustment		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter Street		Boston	MA	02108	11/13/2019	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Third Party Administrator (TPA) Liaison	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	User Access Contact	Director Medicare Compliance Officer		Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	190 White Ave		Warwick	MA	02108	08/09/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Utilization Management Contact	VP UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0137	Utilization Review Contact	VP UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Demo	Commonwealth Care Alliance Massachusetts	Medicare-Medicaid Plan HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H0154	Agent/Broker Compensation Data Contact	Manager of Medicare Sales Retention and Retail		Hey	Lisa		2055583341					lhey@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	04/23/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Management		Tressler	Damon		4803914702				4803146023	Damon.tressler@caremark.com	9501 E Shea Blvd.		Scottsdale	AZ	85260	01/10/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Backup User Access Contact	Director of Privacy and Vendor Oversight	Ms.	Evans	Teresa		2055587544				2054497626	temevans@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	02/10/2020	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Best Available Evidence Contact	Supervisor Medicare Enrollment	Ms.	Stevenson	Chelsea		2055583274				2054497628	ccstevenson@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	09/15/2023	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Bid Audit Contact	CFO	Ms.	Watkins	Letitia		2055587480				2059391748	lwatkins@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Bid Audit Site Contact	CFO	Ms.	Watkins	Letitia		2055587480				2059391748	lwatkins@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Bid Primary Contact	Chief  Administrative Officer	Ms.	Yates	Libba		2055587406				2059391748	lyates@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/30/2015	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	CAP Report Contact for Public Website	Compliance Officer	Mr.	Cutcliffe	Charles		2055587606				2054497626	ccutcliffe@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/19/2016	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	CEO - CMS Administrator Contact		Mr.	Rollow	Brad		2055587409				2059391748	brollow@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	01/03/2023	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	CEO - Senior Official for Contracting	CEO	Mr.	Rollow	Brad		2059391718				2059391748	brollow@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Chief Financial Officer	CFO	Ms.	Watkins	Letitia		2055587480				2059391748	lwatkins@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Chief Operating Officer	Chief Operating Officer	Mr.	Feagin	Cardwell		2055587436				2055587571	cfeagin@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Chief Information Officer	VP of Information Systems	Mr.	Cannon	Doug		2055587432				2059391748	dcannon@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	11/11/2016	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Chief Information Security Officer	VP of Information Systems	Mr.	Cannon	Doug		2055587432				2059391748	dcannon@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	11/11/2016	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	CMS Casework Communication Contact	Supervisor, Appeals and Grievances	Mr.	McReynolds	Nia		2055587410				2055587414	niamcreynolds@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	02/10/2020	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Complaints Tracking Contact	Assoc. Director, Member Appeals and Grievances	Ms.	Gardner	Marquetter		2055587583				2055587414	mgardner@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	11/17/2017	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Contact for Fraud Investigations	Compliance Manager	Mr.	Peterson	Matt		2055583266				2054497626	mpeterson@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	11/07/2017	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Coordination of Benefits Contact	Director of Claims	Ms.	Jones-Marshall	Beverly		2055587690				2055587546	bjmarshall@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/31/2015	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Corporate Mailing						2059391718				2055587538	lyates@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant		Johnson	Tish		2055587411				2055587546	ldjohnson@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	09/11/2018	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Customer Service Operations Contact	Manager, Medicare Member Services	Ms.	Mize	Tracy	B	2055587591				2055587414	tmize@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	02/10/2020	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	DIR Contact	Supervisor of Pharmacy Operations	Mr	Parker	Matthew		2055587178				2059331232	mparker@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	03/21/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	DIR Contact (Secondary)	Controller	Mr.	Yeatman	Wes		2055587404				2055587546	jyeatman@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	03/19/2018	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Emergency Part D Contact	Pharmacy Help Desk		Help Desk	Pharmacy		8006934620					no.email.address.available@caremark.com	9501 E. Shea Blvd MC 019		Scottsdale	AZ	85260	12/09/2011	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Emergency Part D Contact (Secondary)	Director Pharmacy Benefit Management	Ms.	Harris	Paula		2055583244					pgharris@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35242	01/03/2023	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Employer Waiver Contact	Chief  Administrative Officer	Ms.	Yates	Libba		2055587406				2059391748	lyates@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/30/2015	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Encounter Data & Risk Adjustment Operations Contact	Assoc Director Risk Adjustment	Ms.	Powell	Denise		2055587661				2054497971	dwpowell@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	09/15/2023	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Enrollment Contact	Supervisor Medicare Enrollment	Ms.	Stevenson	Chelsea		2055583274				2054497628	ccstevenson@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	09/15/2023	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	EOB Transfer Contact	Supervisor of Pharmacy Operations	Mr.	Parker	Matthew		2055587178				2054499765	mparker@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	06/10/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Financial Audit Contact	CFO	Ms.	Watkins	Letitia		2055587480				2059391748	lwatkins@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Financial Reporting Contact	CFO	Ms.	Watkins	Letitia		2055587480				2059391748	lwatkins@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Formulary Contact	Supervisor of Pharmacy Operations	Mr.	Parker	Matthew		2055587178				2054499765	mparker@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	06/10/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Formulary Contact (Secondary)	Chief  Administrative Officer	Ms.	Yates	Libba		2055587406				2059391748	lyates@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/30/2015	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	General Contact	Chief  Administrative Officer	Ms.	Yates	Libba		2055587406				2059391748	lyates@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/30/2015	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Government Relations Contact	Chief  Administrative Officer	Ms.	Yates	Libba		2055587406				2059391748	lyates@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/30/2015	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	HIPAA Privacy Officer	Privacy Officer	Ms.	Evans	Teresa		2055587544				2054497626	temevans@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	HIPAA Security Officer	Data Security Officer	Ms.	Murphree	Lynn		2055582026				2059391748	lmurphree@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	11/11/2016	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Hospice Contact	Supervisor - Clinical Pharmacy Administration		Popwell	Chris		2055587621				2059331232	cpopwell@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	06/10/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Interoperability Contact			Velasco	Anna		2055587641				2054497626	avelasco@uabmc.edu	417 20th St N	Suite 1100	Birmingham	AL	35203	11/15/2021	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	MA Appeals/Grievances Contact	Assoc. Director, Medicare Mbr Appeals & Grievances	Ms.	Gardner	Marquetter		2055587583				2055587414	mgardner@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	11/17/2017	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	MA Claims Processing Contact for Public Website	Supervisor of Medicare Claims	Ms.	McGee	Treasure		2055587697				2055587571	tmcgee@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Marketing Contact	Director of Marketing, Communications & Comm Sales	Mr.	Ceasar	Tony		2055587558				2053931748	tceasar@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	09/29/2015	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Medical Director	Medical Director	Ms.	Bryant	Tara		2055587403				2059331232	tmbryant@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Medicare Compliance Officer	Compliance Officer	Mr.	Cutcliffe	Charles		2055587606				2054497626	ccutcliffe@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35205	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Medicare Coordinator	Executive Director of Operations	Mr.	Owens	John		2055587564				2055587414	jaowens@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	11/17/2017	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Medicare Part D Opioid Overutilization Contact	Supervisor Clinical Pharmacy	Ms.	Collins	Katy		2055582878				2054492209	kfisher@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	01/19/2021	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Medication Therapy Management Contact	Clinical Pharmacist		Collins	Katy		2055582878				2054495867	kfisher@uabmc.edu	417 20th Street N	Suite 1100	Birmingham	AL	35203	02/10/2020	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	OffShore Subcontractor Contact	Director of Privacy and Vendor Oversight	Ms.	Evans	Teresa		2055587544				2054497626	temevans@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	02/10/2020	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Online Enrollment Center Contact (Back-up)	Executive Director of Operations	Mr.	Owens	John		2055587564				2055587414	jaowens@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	02/10/2020	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Online Enrollment Center Contact (Optional)	Executive Director of Operations	Mr.	Owens	John		2055587564				2055587414	jaowens@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	11/17/2017	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Online Enrollment Center Contact (Primary)	Supervisor Medicare Enrollment	Ms.	Stevenson	Chelsea		2055583274				2055587414	ccstevenson@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	09/15/2023	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Part C Application Contact	Director of Privacy and Vendor Oversight	Ms.	Evans	Teresa		2055587544				2054497626	temevans@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	02/10/2020	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Part C Reporting Contact	Compliance Officer	Mr.	Cutcliffe	Charles		2055587606				2054497626	ccutcliffe@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Appeals	Director, Appeals & Grievances	Ms.	Gardner	Marquetter						2059331239	mgardner@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	01/05/2021	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active	8006331542				HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Appeals Contact (Secondary)	Supervisor, Appeals and Grievances	Ms.	McReynolds	Nia						2059331239	niamcreynolds@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	01/05/2021	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active	8006331542				HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Application Contact	Director of Privacy and Vendor Oversight	Ms.	Evans	Teresa		2055587544				2054497626	temevans@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	02/10/2020	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Benefits Contact	Supervisor of Pharmacy Operations	Mr.	Parker	Matthew		2055587178				2054499765	mparker@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	06/10/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Claims Submission Contact	Supervisor of Pharmacy Operations	Mr.	Parker	Matthew		2055587178				2054499765	mparker@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	06/10/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Exceptions Contact	Supervisor - Clinical Pharmacy Administration		Popwell	Chris						2059331232	cpopwell@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	06/10/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active	8006331542				HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Exceptions Contact (Secondary)	Supervisor of Pharmacy Operations	Mr.	Parker	Matthew						2054499765	mparker@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	06/10/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active	8006331542				HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Price File Contact (Back-up)		Mr.	Loveland	Chet		8018363750					chet.loveland@cvshealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	11/05/2021	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Price File Contact (Optional)	Advisor		Pertgen	Richard		8018363750					richard.pertgen@cvshealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	11/05/2021	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Price File Contact (Primary)	Pharmacy Oversight Coordinator	Ms.	Carr	Julie		2055582013				2054499765	Juliecarr@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	10/27/2021	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Quality Assurance Contact	Exec Dir - Pharmacy and Performance Improvement	Ms.	Beasley	Nancy		2055587684				2059331232	nbeasley@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	06/10/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Part D Reporting Contact	Compliance Officer	Mr.	Cutcliffe	Charles		2055587606				2054497626	ccutcliffe@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Patient Safety Contact	Supervisor - Clinical Pharmacy Administration		Popwell	Chris		2055587621				2059331232	cpopwell@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	06/10/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Payment Contact	CFO	Ms.	Watkins	Letitia		2055587480				2059391748	lwatkins@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	10/25/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Pharmacy Director	Supervisor of Pharmacy Operations	Mr.	Parker	Matthew		2055587178				2054499765	mparker@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	12/28/2020	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Pharmacy Network Management Contact	Director, Network Systems		Tressler	Damon		4803914702				4803146324	Damon.tressler@caremark.com	9501 E. Shea Blvd., MC080		Scottsdale	AZ	85260	01/10/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Pharmacy Technical Help Desk Contact	Advisor/Project Manager, Medicare D	Mr.	Horner	Bob						4803146077	doug.halbert@caremark.com	9501 E Shea Blvd., MC 005		Scottsdale	AZ	85260	02/19/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Atlanta
H0154	Physician Incentive Contact	Chief  Administrative Officer	Ms.	Yates	Libba		2055587406				2059391748	lyates@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/30/2015	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Plan Directory Contact for Public Website	Assoc Director - Network Operations		Traynham	Amanda		2058079399				2054497407	agtraynham@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	02/17/2023	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Plan to Plan Reconciliation Contact	Pharmacy Analyst	Ms.	Holsombeck	Susan		2055587551				2059331232	sholsombeck@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	01/07/2016	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Processor Contact	Claims Supervisor	Ms.	McGee	Treasure		2055587697					tmcgee@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Quality Contact	Supervisor RN and Quality Improvement	Ms	Burnett	Stephanie		2055587765				2054497853	sdburnett@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	03/21/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Reconciliation Contact	Supervisor of Pharmacy Operations	Mr	Parker	Matthew		2055587178				2059331232	mparker@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	03/21/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Reconciliation Contact (Secondary)	Controller	Mr.	Yeatman	Wes		2055587404				2055587546	jyeatman@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Recovery Audit Contact	Compliance Officer	Mr.	Cutcliffe	Charles		2055587606				2054497626	ccutcliffe@uabmc.edu	417 20th Street North	1222 14th Avenue South	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	SNP Application Contact	Director of Privacy and Vendor Oversight	Ms.	Evans	Teresa		2055587544				2054497626	temevans@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	02/10/2020	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	SNP State Contact	Chief  Administrative Officer	Ms.	Yates	Libba		2055587406				2059391748	lyates@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/30/2015	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Surveillance Contact	Compliance Officer	Mr.	Cutcliffe	Charles		2055587606				2054497626	ccutcliffe@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	System Contact	Vice President, Information Systems	Mr.	Cannon	Doug		2055587432				2054497626	dcannon@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Third Party Administrator (TPA) Liaison	Supervisor of Pharmacy Operations	Mr.	Parker	Matthew		2055587178				2054499765	mparker@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	06/13/2019	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	User Access Contact	Compliance Officer	Mr.	Cutcliffe	Charles		2055587606				2054497626	ccutcliffe@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	07/01/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Utilization Management Contact	Director of Medical Management	Ms.	Thomas	Donna		2055587446				2059331232	donnathomas@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	11/22/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0154	Utilization Review Contact	Director of Medical Management	Ms.	Thomas	Donna		2055587446				2059331232	donnathomas@uabmc.edu	417 20th Street North	Suite 1100	Birmingham	AL	35203	11/22/2013	2023	VIVA HEALTH, INC.	Local CCP	VIVA Medicare	HMO/HMOPOS		Triton Health Systems, L.L.C.	237	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0169	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	07/05/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H0169	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H0169	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H0169	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H0169	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/06/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0169	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0174	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Contact for Fraud Investigations	Counsel, Special Investigations Unit		Fisher	Haley		3145056804					hfisher@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	05/18/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/15/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/15/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	05/18/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/15/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	05/31/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H0174	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	05/18/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H0174	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H0174	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/15/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/31/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/18/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/18/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0174	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/18/2022	2023	WELLCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0192	Agent/Broker Compensation Data Contact	VP, Medicare Integrated Health Plans & Revenue Mgt	Mr.	McDade	Chris		4844971892					cmcdade@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	09/08/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Automated TrOOP Balance Transfer Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	12/30/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Backup User Access Contact	Medicare Compliance Sr Operations Analyst		Morris	Ms. Gail		2158178922					gpmorris@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	300 Stevens Drive, Suite 201	Philadelphia	PA	19113	11/19/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Best Available Evidence Contact	Medicare Enrollment Manager	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/27/2019	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Bid Audit Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	07/04/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Bid Primary Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Lovin	Dan		2676085073					dlovin@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive, 2nd flr.	Philadelphia	PA	19113	01/05/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	CEO - CMS Administrator Contact	VP Integrated Health Plan	Mr.	McDade	Chris		4844971892					cmcdade@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	04/07/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	CEO - Senior Official for Contracting	VP Medicare Integrated Health Plans	Mr.	McDade	Chris		4844971892					cmcdade@ameriHealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	04/07/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Chief Financial Officer	Chief Financial Officer	Mr.	Burgoyne	Michael		2159378875					mburgoyne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive	Philadelphia	PA	19113	06/20/2019	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Chief Operating Officer	VP Medicare Integrated Health Plans	Mr.	McDade	Chris		4844971892					cmcdade@ameriHealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	07/26/2023	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Chief Information Officer	Exec. Vice President, Chief Information Officer	Mr.	Dickson	Fred		2158636570					fdickson@amerihealthcaritas.com	Amerihealth Caritas	2 International Plaza, Suite 440	Philadelphia	PA	19113	11/20/2019	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Chief Information Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	Amerihealth Caritas	2 International Plaza, Suite 440	Philadelphia, PA	PA	19113	11/20/2019	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	CMS Casework Communication Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	06/23/2023	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Complaints Tracking Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	06/23/2023	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Contact for Fraud Investigations	Director, SIU	Mr.	McCall	Trevor		4844971241					tmccall2@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr	Philadelphia	PA	19113	08/04/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Coordination of Benefits Contact	Manager, Provider Network Oversight	Ms.	Williams	Kathy		8437467499					kwilliams@firstchoicevipcareplus.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/09/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Corporate Mailing						2159378000					macompliance-general@keystonefirstpa.com	Amerihealth Caritas VIP Plans	200 Stevens Drive	Philadelphia	PA	19113	06/20/2019	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager	Ms.	Maheepathi	Geetha		4435279822					gmaheepathi@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	3875 West Chester Pike	Newtown Square	PA	19073	03/15/2023	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Customer Service Operations Contact	Director, Medicare Customer Service	Ms.	Veras	Helen		2672981794					hveras@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/29/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	DIR Contact	Director, Medicare Risk Adjustment and Performance	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/09/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	DIR Contact (Secondary)	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Electronic Health Record Contact	Manager, Information Services		Drumming	Ms. Terri		2159378578					tdrumming@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	11/19/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Emergency Part D Contact	Director of Pharmacy	Ms.	Shepard	Jennifer		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	04/07/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Emergency Part D Contact (Secondary)	Director, Corporate Pharmacy		Cherian	Sheena		2158635768					scherian@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	12/28/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Encounter Data & Risk Adjustment Operations Contact	Director, Medicare ACA and Risk Adjustment	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Enrollment Contact	Manager, Enrollment Operations	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/21/2019	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	EOB Transfer Contact	Director, Medicare Claims	Mr.	Boyer	Joseph		2158636668				2159375321	jboyer@Amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/27/2019	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Financial Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Financial Reporting Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Formulary Contact	Director of Clinical Services, Formulary/DUR	Ms.	Megargell	Lauren		2159374135					Lauren.megargell@performrx.com	PerformRx	200 Stevens Dr. 4th Floor	Philadelphia	PA	19113	05/08/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Formulary Contact (Secondary)	Director of Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	07/29/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	General Contact	VP, Medicare Integrated Health Plans & Revenue Mgt	Mr.	McDade	Chris		4844971892					cmcdade@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	09/08/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Government Relations Contact	Director, Public Policy		Cozzo	Mr.Steven		2159378236					scozzo@Amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	11/19/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	HIPAA Privacy Officer	Director of Privacy	Ms.	Gustafson	Rebecca		2158636634					rgustafson@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr	Philadelphia	PA	19113	08/04/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	HIPAA Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Drive	Philadelphia	PA	19113	04/24/2015	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Hospice Contact	Directory of Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadephia	PA	19113	07/29/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Interoperability Contact	Director, Medicare Performance Management		Kindred	Amanda		2484045991					akindred@amerihealthcaritas.com	4000 Town Center	Suite 1300	Southfield	MI	48075	03/10/2023	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	MA Appeals/Grievances Contact	Director, Corporate Appeals	Ms.	Garber	Brenda		2158635585					bgarber@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200  Stevens Drive	Philadelphia	PA	19113	12/03/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	MA Claims Processing Contact for Public Website			Services	Provider		8886670318					VIPProviderComm@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	01/17/2017	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Marketing Contact	Medicare Compliance  Sr Operations Analyst	Ms.	Morris	Gail	P	2158178922					gpmorris@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	300 Stevens Drive, Suite 201	Philadelphia	PA	19119	11/19/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Medical Director	Medicare Medical Director	Dr.	Busch	Gregory		8562174603					gbusch@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	09/02/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Medicare Compliance Officer	Medicare Compliance Officer	Ms	Dupre	Colleen		2035068413					cdupre@selecthealthofsc.com	AmeriHealth Caritas Family of Companies	200  Stevens Drive	Philadelphia	PA	19113	01/27/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Medicare Coordinator	VP, Medicare Integrated Health Plans & Revenue Mgt	Mr.	McDade	Chris		4844971892					cmcdade@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	09/08/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	01/05/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Medication Therapy Management Contact	Director,Clinical Outcomes &Therap Optimization	Ms.	Patel	Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	10/05/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	MMP Reporting Requirements Contact	Manager, Medicare Performance Management	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	MMP Point of Contact	VP, Medicare Integrated Health Plans & Revenue Mgt	Mr.	McDade	Chris		4844971892					cmcdade@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	09/08/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	OffShore Subcontractor Contact	Performance Program Oversight Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	3785 Chester Pike	Newtown Square	PA	19073	01/05/2023	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Online Enrollment Center Contact (Back-up)	Sr Medicare Enrollment Processor	Ms.	Price	Jamilla		2158636355					jprice@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	04/09/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part C Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part C Reporting Contact	Manager, Medicare Performance Management	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Appeals	Interim Manager, Appeals	Ms.	Clark	Jannie							jclark2@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	11/23/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	4844985214				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Appeals Contact (Secondary)	Director, Corporate Appeals	Ms	Garber	Brenda							bgarber@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	04/07/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2159378685				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Benefits Contact	Pharmacist II	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	09/02/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Claims Submission Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	12/29/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Exceptions Contact	Dir., Pharmacy Uitlization Management	Mr.	Bonko	Gerald						2158635100	gbonko@performrx.com	PerformRx	200 Stevens Dr.	Philadelphia	PA	19113	12/22/2016	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636483				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Prior Authorization	Mr.	McHale	Shawn						2158635100	smchale@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	12/22/2016	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636370				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Price File Contact (Back-up)	Claims Processor Associate		Reed	Lindsay		8473466370					lindsay.reed@abarcahealth.com	Abarca Health	14650 Ave Munoz Rivera, Suite 701	San Juan	PR	00918	02/10/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Price File Contact (Optional)	Claims Processor Associate		Canales	Ms Desiree		7875231212	1107				desiree.canales@abarcahealth.com	Abarca Health	650 Ave Munoz Rivera	San Juan	PR	00918	04/07/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Price File Contact (Primary)	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	12/30/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Quality Assurance Contact	Pharmacist II	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	09/02/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Part D Reporting Contact	Quality Assurance Contract Account Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@keystonefirstpa.com	AmeriHealth Caritas Family of Companies	300 Stevens Dr. Suite 201	Philadelphia	PA	19113	03/10/2023	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Patient Safety Contact	Director,Clin Outcomes &Therapy Optimization		Patel	Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	02/10/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Payment Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Pharmacy Director	Director of Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	11/19/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Pharmacy Network Management Contact	Director	Ms.	Leal	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Dr. 4th Floor	Philadelphia	PA	19113	12/30/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Pharmacy Network Management Contact (Secondary)			Kramerov	Allen		2159374120					akramerov@performrx.com	PerformRx	200 Stevens Dr. 4th Floor	Philadelphia	PA	19113	12/30/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Pharmacy Technical Help Desk Contact	Director, Service Operations	Ms.	Leal	Avelina								PerformRx	200 Stevens Drive	Philadelphia	PA	19113	11/05/2019	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8553280011				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Care Center	Ms.	Lee	Pamela								PerformRx	200 Stevens Drive	Philadelphia	PA	19113	08/28/2018	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8553280011				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Plan Directory Contact for Public Website			Services	Provider		8886670318					VIPProviderComm@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	01/17/2017	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Plan to Plan Reconciliation Contact	Director, Finance	Ms	Sow	Oumou		4102584587					osow@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	P.O. 7137	London	KY	40742	06/15/2023	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Processor Contact	Director of Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	06/04/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Quality Contact	Director Quality Management	Ms.	Trimble	Dorothea		6162507322					dtrimble@amerihealthcaritas.com	Amerihealth Michigan	4000 Town Center, Suite 1300	Southfield	MI	48075	02/11/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Reconciliation Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					ak16850@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/09/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Reconciliation Contact (Secondary)	Business Analyst	Ms.	Griggs	Sarah		6073426766					sg31189@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	08/09/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Recovery Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Surveillance Contact	Business Development Manager	Ms.	Kumagai	Naoko		2157563724					nkumagai@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/08/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	System Contact	Manager, Medicare IS		Drumming	Terri		2159378578					tdrumming@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	07/23/2020	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Third Party Administrator (TPA) Liaison	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	User Access Contact	Medicare Compliance Officer	Mr.	Lovin	Dan		2676085073					dlovin@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive, 2nd flr	Philadelphia	PA	19113	02/03/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Utilization Management Contact	VP, Utilization Management Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	09/02/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0192	Utilization Review Contact	VP, Utilization Management Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	09/02/2021	2023	AMERIHEALTH MICHIGAN, INC.	Demo	AmeriHealth Caritas VIP Care Plus	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0216	Automated TrOOP Balance Transfer Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Backup User Access Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Best Available Evidence Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Bid Primary Contact	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	03/22/2018	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	CAP Report Contact for Public Website	VP of PACE Operations	Mrs	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/06/2022	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	CEO - CMS Administrator Contact	CEO	Mr	Gurley	Eric		4028292950				4028292939	egurley@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	08/28/2017	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	CEO - Senior Official for Contracting	CEO	Mr	Gurley	Eric		4028292950				4028292939	egurley@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	03/14/2016	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Chief Financial Officer	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	03/22/2018	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Chief Operating Officer	Senior VP & COO	Mrs	Kaminski	Julie		4028292954				4028292939	Jkaminski@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	08/28/2017	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Chief Information Officer	CFO	Mr	Bear	Scott		4028292922					sbear@immanuel.com	1044 North 115th Street Suite 500		Omaha	NE	68154	02/16/2022	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Chief Information Security Officer	CFO	Mr.	Bear	Scott		4028292922					sbear@immanuel.com	1044 North 115th Street Suite 500		Omaha	NE	68154	01/06/2022	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	CMS Casework Communication Contact	VP of PACE Operations	Mrs	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/06/2022	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Complaints Tracking Contact	VP of PACE Operations	Mrs	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/06/2022	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Contact for Fraud Investigations	Corporate Compliance Officer	Mrs	Durbin	Tracy		4028292968				4028292939	TDurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	01/25/2021	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Coordination of Benefits Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Corporate Mailing						4028292999				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	01/16/2018	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Coverage Gap Discount Program (CGDP) Payment Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Customer Service Operations Contact	VP of PACE Operations	Mrs	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/06/2022	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	DIR Contact	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	03/22/2018	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	DIR Contact (Secondary)	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Emergency Part D Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Emergency Part D Contact (Secondary)	Health Plan Analyst	Mrs.	Battaglia	Trisha		4028296951					tbattaglia@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	09/21/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Encounter Data & Risk Adjustment Operations Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Enrollment Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	EOB Transfer Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Financial Audit Contact	Dir of Health Plan Management	Mrs	Boyle	Amanda		4028292933					aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	09/21/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Financial Reporting Contact	Dir of Health Plan Management	Mrs	Boyle	Amanda		4028292933					aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	09/21/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Formulary Contact	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	03/22/2018	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	General Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Government Relations Contact	Corporate Compliance Officer	Mr	Sigmond	John		4028292910					jsigmond@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	HIPAA Privacy Officer	Corporate Compliance Officer	Mrs	Durbin	Tracy		4028292968				4028292939	Tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/06/2022	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	HIPAA Security Officer	CFO	Mr	Bear	Scott		4028292922					sbear@immanuel.com	1044 North 115th Street Suite 500		Omaha	NE	68154	02/16/2022	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Interoperability Contact	CFO	Mr	Bear	Scott		4028292922					sbear@immanuel.com	1044 N 115th Street		Omaha	NE	68135	02/16/2022	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	MA Appeals/Grievances Contact	Director of PACE Clinical Operations	Mrs	Grasz	Liza		4028292967					LGrasz@immanuel.com	1044 N 115th Street	Suite 500	Omaha	NE	68154	02/20/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	MA Claims Processing Contact for Public Website	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292943				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Marketing Contact	VP of PACE Operations	Mrs.	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/06/2022	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Medical Director	VP of Clinical Operations	Mr	Fox	Devin		4028293278					DFox@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	02/20/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Medicare Compliance Officer	Corp Compliance Officer	Ms	Durbin	Tracy		4028292968					tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	09/21/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Medicare Coordinator	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Medicare Part D Opioid Overutilization Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 N 115th Street		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Medication Therapy Management Contact	Vice President of Clinic Operations	Mr	Fox	Devin		4028293278					DFox@immanuel.com	1044 North 115th Street		Omaha	NE	68154	02/20/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Part C Application Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Part D Appeals	Corporate Compliance Officer	Mrs	Durbin	Tracy						4028292939	tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	01/22/2021	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active	4028292968				PACE - Nat		C	Kansas City
H0216	Part D Appeals Contact (Secondary)	Dir. Health Plan Management	Mrs.	Boyle	Amanda						4028292939	aboyle@immanuel.com	1044 N 115th Street		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active	4028292993				PACE - Nat		C	Kansas City
H0216	Part D Application Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Part D Benefits Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Part D Claims Submission Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Part D Exceptions Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda						4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active	0000000000				PACE - Nat		C	Kansas City
H0216	Part D Exceptions Contact (Secondary)	Corporate Compliance Officer	Mrs	Durbin	Tracy						4028292939	tdurbin@immanuel.com	1044 N Street		Omaha	NE	68154	01/22/2021	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active	4028292968				PACE - Nat		C	Kansas City
H0216	Part D Price File Contact (Back-up)	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Part D Price File Contact (Primary)	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	03/22/2018	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Part D Quality Assurance Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 N 115th Street		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Part D Reporting Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Patient Safety Contact	Corporate Compliance Officer	Mrs	Durbin	Tracy		4028292968				4028292939	tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	01/25/2021	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Payment Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Personal Health Record Contact	VP of PACE Operations	Mrs	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/06/2022	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Pharmacy Director	VP of Clinical Operations	Mr	Fox	Devin		4028293278					DFox@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	02/20/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Pharmacy Network Management Contact	VP of Clincial Operations	Mr	Fox	Devin		4028293278					DFox@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	02/20/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Pharmacy Technical Help Desk Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda						4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active	0000000000				PACE - Nat		C	Kansas City
H0216	Plan Directory Contact for Public Website	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Plan to Plan Reconciliation Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Processor Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Quality Contact	Director of Clincial Operations	Mrs	Grasz	Liza		5155182403					LGrasz@immanuel.com	1044 N 115th Street		Omaha	NE	68154	02/20/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Reconciliation Contact	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	03/22/2018	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Recovery Audit Contact	Corporate Compliance Officer	Mrs	Durbin	Tracy		4028292968				4028292939	tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	01/05/2021	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Surveillance Contact	Corporate Compliance Officer	Ms	Durbin	Tracy		4028292968				4028292939	tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	08/13/2021	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	System Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Third Party Administrator (TPA) Liaison	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	User Access Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Utilization Management Contact	Director of Clinical Operations	Mrs	Grasz	Liza		4028292967					LGrasz@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	02/20/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0216	Utilization Review Contact	Director of Clinical Operations	Mrs	Grasz	Liza		4028292697					LGrasz@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	02/20/2023	2023	PACE IOWA	National PACE	Immanuel Pathways Iowa	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H0235	Automated TrOOP Balance Transfer Contact	Chief Financial Officer	Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Backup User Access Contact	PACE President		Vandagrifft	Jim		2607451200	316				pace.president@pacenein.org	2927 Lake Avenue		Ft. Wayne	IN	46805	07/21/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Best Available Evidence Contact		Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Bid Primary Contact	Chief Financial Officer	Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	CAP Report Contact for Public Website	VP of PACE Operations		Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active	2604694148				PACE - Nat		C	Chicago
H0235	CEO - CMS Administrator Contact		Ms.	Benton Wolfe	Connie		2607451200	222				cbwolfe@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	12/20/2018	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	CEO - Senior Official for Contracting		Ms.	Benton Wolfe	Connie		2607451200	222				cbwolfe@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	12/20/2018	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Chief Financial Officer		Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	12/20/2018	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Chief Operating Officer	Chief Operating Officer	Ms	Widner	Maureen		2607451200	285				mwidner@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	12/20/2018	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Chief Information Officer	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Chief Information Security Officer	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	CMS Casework Communication Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Complaints Tracking Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Contact for Fraud Investigations	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Coordination of Benefits Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Corporate Mailing						2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Coverage Gap Discount Program (CGDP) Payment Contact		Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Customer Service Operations Contact	Chief Operating Officer		Widner	Maureen		2607451200	285				mwidner@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	12/20/2018	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	DIR Contact		Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	DIR Contact (Secondary)	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Emergency Part D Contact		Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Emergency Part D Contact (Secondary)	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Encounter Data & Risk Adjustment Operations Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Enrollment Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	EOB Transfer Contact	Chief Financial Officer		Shapiro	Aaron		2607451200	261			2604224916	ashapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Financial Audit Contact	Chief Financial Officer	Mr	Shapiro	Aaron		2607451200	261				ashapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Financial Reporting Contact		Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Formulary Contact	Chief Financial Officer		Shapiro	Aaron		2607451200	261				ashapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Formulary Contact (Secondary)	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	General Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Government Relations Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	HIPAA Privacy Officer	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	HIPAA Security Officer	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Interoperability Contact			Houghman	Katie		2604694148					katie.hougham@pacenein.org	2927 Lake Ave		Fort Wayne	IN	46805	06/01/2022	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	MA Appeals/Grievances Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	MA Claims Processing Contact for Public Website	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Marketing Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Medical Director	Medical Director		Uncheselu	Dona		2604694148					dona.uncheselu@parkview.com	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Medicare Compliance Officer	VP of PACE Operations	Mr	Hougham	Katie		2604694148	316				katie.hougham@pacenein.org	2927 Lake Ave		Fort Wayne	IN	46805	09/28/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Medicare Coordinator	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Medicare Part D Opioid Overutilization Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	06/01/2022	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Medication Therapy Management Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Part C Application Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Part D Appeals	VP of PACE Operations		Hougham	Katie							katie.hougham@pacenein.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active	2604694148	643			PACE - Nat		C	Chicago
H0235	Part D Appeals Contact (Secondary)	VP of PACE Operations		Hougham	Katie							khougham@agingihs.org	2927 Lake Ave		Fort Wayne	IN	46805	01/25/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active	2607451200	334			PACE - Nat		C	Chicago
H0235	Part D Application Contact		Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Part D Benefits Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Part D Claims Submission Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Part D Exceptions Contact	VP of PACE Operations		Hougham	Katie							katie.hougham@pacenein.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active	2604694148	643			PACE - Nat		C	Chicago
H0235	Part D Price File Contact (Back-up)	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Part D Price File Contact (Primary)	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Part D Quality Assurance Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Part D Reporting Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Patient Safety Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Payment Contact		Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Pharmacy Director	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Pharmacy Network Management Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Pharmacy Technical Help Desk Contact	VP of PACE Operations		Hougham	Katie							katie.hougham@pacenein.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active	2604694148	643			PACE - Nat		C	Chicago
H0235	Plan Directory Contact for Public Website	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Plan to Plan Reconciliation Contact		Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Processor Contact		Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Quality Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Reconciliation Contact		Mr	Shapiro	Aaron		2607451200	261				AShapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Recovery Audit Contact	Chief Financial Officer	Mr	Shapiro	Aaron		2607451200	261				ashapiro@agingihs.org	2927 Lake Avenue		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Surveillance Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	System Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Third Party Administrator (TPA) Liaison	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	User Access Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Utilization Management Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0235	Utilization Review Contact	VP of PACE Operations	Ms	Hougham	Katie		2604694148	643				katie.hougham@pacenein.org	2927 Lake Ave		Ft. Wayne	IN	46805	05/27/2021	2023	PACE OF NORTHEAST INDIANA, LLC	National PACE	PACE of Northeast Indiana, LLC	National PACE		Aging & In-Home Services of Northeast Indiana, Inc	743	Yes	Active					PACE - Nat		C	Chicago
H0242	Automated TrOOP Balance Transfer Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Backup User Access Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Best Available Evidence Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Bid Primary Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	CAP Report Contact for Public Website	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	CEO - CMS Administrator Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	CEO - Senior Official for Contracting	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Chief Financial Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Chief Operating Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Chief Information Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Chief Information Security Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	CMS Casework Communication Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Complaints Tracking Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Contact for Fraud Investigations	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Coordination of Benefits Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Corporate Mailing						2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Customer Service Operations Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	DIR Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	DIR Contact (Secondary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Emergency Part D Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Emergency Part D Contact (Secondary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Encounter Data & Risk Adjustment Operations Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Enrollment Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	EOB Transfer Contact	CFO	Mrs	Prentis	Kristin		7328063224				7328063224	kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Financial Audit Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Financial Reporting Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Formulary Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Formulary Contact (Secondary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	General Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Government Relations Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	HIPAA Privacy Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	HIPAA Security Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Interoperability Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	MA Appeals/Grievances Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	MA Claims Processing Contact for Public Website	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Marketing Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Medical Director	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Medicare Compliance Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Medicare Coordinator	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Medicare Part D Opioid Overutilization Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Medication Therapy Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	OffShore Subcontractor Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Online Enrollment Center Contact (Back-up)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Online Enrollment Center Contact (Primary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Part C Application Contact	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenix	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Part D Appeals	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Atlanta
H0242	Part D Appeals Contact (Secondary)	Executive Director	Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H0242	Part D Application Contact	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenix	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Part D Benefits Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Part D Claims Submission Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Part D Exceptions Contact	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Atlanta
H0242	Part D Exceptions Contact (Secondary)		Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H0242	Part D Price File Contact (Back-up)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Part D Price File Contact (Primary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Part D Quality Assurance Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Part D Reporting Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Patient Safety Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Payment Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Personal Health Record Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Pharmacy Director	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Pharmacy Network Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Pharmacy Network Management Contact (Secondary)	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Pharmacy Technical Help Desk Contact	Executive Director	Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H0242	Pharmacy Technical Help Desk Contact (Secondary)	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Atlanta
H0242	PHR Beneficiary Contact																	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE	Beacon of Life SC			Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H0242	Plan Directory Contact for Public Website	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Plan to Plan Reconciliation Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Processor Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Quality Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Reconciliation Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Reconciliation Contact (Secondary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Recovery Audit Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Surveillance Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	System Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Third Party Administrator (TPA) Liaison	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	User Access Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Utilization Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0242	Utilization Review Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BEACON OF LIFE FLORIDA, LLC	National PACE	Beacon of LIfe Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H0247	Automated TrOOP Balance Transfer Contact	VP Pharmacy Benefit Management	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Backup User Access Contact	Lead Developer, IT		Eyman	John		5414714106					john.eyman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	02/13/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Best Available Evidence Contact	VP Pharmacy Benefit Management	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Bid Primary Contact	PACE Executive Director	Mrs.	Grajalez	Tillie		5414748000	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	CAP Report Contact for Public Website	PACE Executive Director		Grajalez	Tillie		5414748000	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	CEO - CMS Administrator Contact	PACE Executive Director	Mrs.	Grajalez	Tillie		5414748005	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine St		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	CEO - Senior Official for Contracting	CEO	Mr.	Flow	Douglas		5414714106				5414711524	doug.flow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	09/28/2018	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Chief Financial Officer	CFO	Mr.	Woodin	Matthew	P	5414714106				5414711524	matthew.woodin@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/07/2022	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Chief Operating Officer	PACE Executive Director	Mrs.	Grajalez	Tillie		5414748005	8457			5414711524	Tillie.Grajalez@allcarehealth.com	2166 NW Vine St		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Chief Information Officer	CIO	Mr.	Zesiger	Justin		5414714106					justin.zesiger@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	09/28/2018	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Chief Information Security Officer	CIO	Mr.	Zesiger	Justin		5414714106					justin.zesiger@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	09/28/2018	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	CMS Casework Communication Contact	VP Compliance		Matola	Laura		5414714106				5414711524	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	01/05/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Complaints Tracking Contact	VP Compliance		Matola	Laura		5414714106	3121			5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	01/05/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Contact for Fraud Investigations	Chief Compliance Officer		Ackerman	Cynthia		5414714106				5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	09/28/2018	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Coordination of Benefits Contact	VP Claims Administration & Business Services		Gillespie	Lori		5414714106	5111			5419561674	lori.gillespie@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	07/01/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Corporate Mailing						5414748000				5414743296	megan.resetar@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Coverage Gap Discount Program (CGDP) Payment Contact	VP Controller		Crow	Jennifer		5414714106				5414711524	jennifer.crow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Customer Service Operations Contact	Director of Operations		Grajalez	Tillie		5414748000	8314			5414743296	tillie.grajalez@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	DIR Contact	VP Controller		Crow	Jennifer		5414714106				5414711524	jennifer.crow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	DIR Contact (Secondary)	VP Pharmacy Benefit Management	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Emergency Part D Contact	VP Pharmacy Benefit Management	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Emergency Part D Contact (Secondary)	VP, Benefit Management & Pharmacy Services	Dr.	Burns	Amy		9712226045					amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	12/28/2021	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Encounter Data & Risk Adjustment Operations Contact	VP Claims Operations & Business Services		Gillespie	Lori		5414714106					lori.gillespie@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	07/01/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Enrollment Contact	Intake & Referral Coordinator		Grajalez	Tillie		5414748005	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine St		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	EOB Transfer Contact	PACE Clinical Pharmacist	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Financial Audit Contact	Controller	Ms.	Crow	Jennifer	E	5414714106				5414711524	jennifer.crow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Financial Reporting Contact	VP Controller		Crow	Jennifer		5414714106				5414711524	jennifer.crow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Formulary Contact	VP Pharmacy Benefit Management	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Formulary Contact (Secondary)	Manager, Formulary Administration & Maintenance		Nyawabila	Christina		8587906297					FAS@MedImpact.com	10680 Treena Street		San Diego	CA	92131	02/13/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	General Contact	PACE Executive Director		Grajalez	Tillie		5414748005	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine St		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Government Relations Contact	PACE Executive Director		Grajalez	Tillie		5414748005	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine St		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	HIPAA Privacy Officer	Chief Compliance Officer		Ackerman	Cynthia		5414714106				5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	02/13/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	HIPAA Security Officer	Chief Compliance Officer		Ackerman	Cynthia		5414714106				5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	02/13/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Interoperability Contact	CIO		Zesinger	Justin		5414714106					justin.zesiger@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/25/2022	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	MA Appeals/Grievances Contact	VP Compliance		Matola	Laura		5414714106	3121			5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	01/05/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	MA Claims Processing Contact for Public Website	VP, Benefit Management & Pharmacy Services		Gillespie	Lori		5414714106				5414711524	lori.gillespie@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	01/05/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Marketing Contact	Chief Marketing & Innovation Officer		Sennhauser	Freddy		5414714106				5414711524	freddy.sennhauser@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/15/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Medical Director	PACE Medical Director	Dr.	Williams	Richard		5414748000				5414743296	rick.williams@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Ackerman	Cynthia	A	5414714106	8115			5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	12/02/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Medicare Coordinator	Executive Director		Grajalez	Tillie		5414748005	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine St		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Medicare Part D Opioid Overutilization Contact	VP Pharmacy Benefit Management	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Medication Therapy Management Contact	VP Pharmacy Benefit Management	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Online Enrollment Center Contact (Primary)	Developer, IT		Ridenour	Joseph		5414714106					joe.ridenour@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	02/13/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Part C Application Contact	PACE Executive Director	Ms.	Grajalez	Tillie		5414748005	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine St		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Part D Appeals	VP Compliance		Matola	Laura						5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	01/05/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active	8884600185				PACE - Nat		C	Seattle
H0247	Part D Appeals Contact (Secondary)	PACE Clinical Pharmacist	Dr.	Burns	Amy						5414743296	amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active	8449507223	8157			PACE - Nat		C	Seattle
H0247	Part D Application Contact	PACE Executive Director	Ms.	Grajalez	Tillie		5414748005	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine St		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Part D Benefits Contact	VP Pharmacy Benefit Management	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Part D Claims Submission Contact	VP Pharmacy Benefit Management	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Part D Exceptions Contact	PACE Clinical Pharmacist	Dr.	Burns	Amy						5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active	8449507223				PACE - Nat		C	Seattle
H0247	Part D Exceptions Contact (Secondary)	VP of Benefit Management & Pharmacy Services	Dr.	Burns	Amy							amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	12/29/2021	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active	8884600185				PACE - Nat		C	Seattle
H0247	Part D Price File Contact (Back-up)	Lead Developer, IT	Mr	Eyman	John		5414714106	8202				john.eyman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	02/13/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Part D Price File Contact (Optional)	Medicare Part D Project Manager		Niemi	Kirstin		8587906455					PlanFinderCommunications@MedImpact.com	10680 Treena Street		San Diego	CA	92131	02/13/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Part D Price File Contact (Primary)	Developer, IT		Ridenour	Joseph		5414714106					joe.ridenour@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	02/13/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Part D Quality Assurance Contact	VP Compliance		Matola	Laura		5414714106				5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	01/05/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Part D Reporting Contact	VP Compliance		Matola	Laura		5414714106				5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	01/05/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Patient Safety Contact	PACE Executive Director	Ms.	Grajalez	Tillie		5414748005	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine St		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Payment Contact	Controller	Ms.	Crow	Jennifer	E	5414714106				5414711524	jennifer.crow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Pharmacy Director	VP Pharmacy Benefit Management	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Pharmacy Network Management Contact	VP Pharmacy Benefit Management	Dr.	Burns	Amy		5414748000				5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Pharmacy Network Management Contact (Secondary)	VP of Benefit Management & Pharmacy Services	Dr.	Burns	Amy		5414714106					amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	12/29/2021	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Pharmacy Technical Help Desk Contact	PACE Clinical Pharmacist	Dr.	Burns	Amy						5414743296	amy.burns@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active	5414748000				PACE - Nat		C	Seattle
H0247	Pharmacy Technical Help Desk Contact (Secondary)	VP of Benefit Management & Pharmacy Services	Dr.	Burns	Amy							amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	12/29/2021	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active	8884600185				PACE - Nat		C	Seattle
H0247	Plan Directory Contact for Public Website	Chief Marketing & Innovation Officer		Sennhauser	Freddy		5414714106				5414711524	freddy.sennhauser@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/15/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Plan to Plan Reconciliation Contact	Controller	Ms.	Crow	Jennifer	E	5414714106				5414711524	jennifer.crow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Processor Contact	Executive Director		Grajalez	Tillie		5414748005	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine St		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Quality Contact	Executive Director	Ms.	Grajalez	Tillie		5414748005	8457			5414743296	Tillie.Grajalez@allcarehealth.com	2166 NW Vine St		Grants Pass	OR	97526	09/28/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Reconciliation Contact	Executive Director		Resetar	Megan		5414748000				5414743296	megan.resetar@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Reconciliation Contact (Secondary)	Controller	Ms.	Crow	Jennifer	E	5414714106				5414711524	jennifer.crow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Recovery Audit Contact	Controller	Ms.	Crow	Jennifer		5414714106				5414711524	jennifer.crow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Surveillance Contact	Chief Compliance Officer		Ackerman	Cynthia		5414714106				5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	02/13/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	System Contact	Developer, IT		Ridenour	Joseph		5414714106					joe.ridenour@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	02/13/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Third Party Administrator (TPA) Liaison	Controller		Crow	Jennifer		5414714106				5414711524	jennifer.crow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	User Access Contact	Developer, IT		Ridenour	Joseph		5414714106					joe.ridenour@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	02/13/2020	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Utilization Management Contact	Director of Operations		Grajalez	Tillie		5414748000	8314			5414743296	tillie.grajalez@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0247	Utilization Review Contact	Director of Operations		Grajalez	Tillie		5414748000	8314			5414743296	tillie.grajalez@allcarehealth.com	2166 NW Vine Street		Grants Pass	OR	97526	05/10/2023	2023	ALLCARE PACE, LLC	National PACE	AllCare PACE, LLC	National PACE		AllCare Health, Inc.	660	Yes	Active					PACE - Nat		C	Seattle
H0251	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H0251	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H0251	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H0251	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H0251	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/06/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0251	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE PLAN OF THE RIVER VALLEY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0270	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H0270	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H0270	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H0270	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H0270	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H0270	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H0270	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H0270	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0270	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF AMERICA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0271	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	03/23/2018	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	03/14/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	11/03/2020	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/17/2021	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	03/23/2018	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	03/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	01/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	01/04/2021	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	01/20/2022	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	03/27/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	03/27/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	03/31/2021	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	01/29/2018	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	04/12/2021	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	03/23/2018	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	03/27/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/14/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	12/14/2020	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	03/14/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	03/27/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	08/26/2022	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	03/14/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	03/17/2022	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	01/06/2021	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	03/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/03/2022	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/03/2018	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	03/27/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	03/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	10/01/2018	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	11/25/2020	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	03/14/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H0271	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	03/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H0271	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	06/28/2022	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/14/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H0271	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	03/27/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	03/27/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	10/17/2019	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	03/23/2018	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	11/25/2020	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	11/24/2020	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	03/23/2018	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	03/23/2022	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H0271	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	10/14/2019	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/14/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	03/23/2018	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/23/2018	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	03/27/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	03/14/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0271	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	03/14/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0292	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H0292	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H0292	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0292	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF OHIO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0294	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H0294	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H0294	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H0294	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H0294	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0294	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0302	Agent/Broker Compensation Data Contact	Medicare Sales Compliance & Audit Oversight Specia	Ms.	Aguayo	Nancy		6029168515					nancy.aguayo@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/28/2020	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Automated TrOOP Balance Transfer Contact			Esp	Brian		8587906445					partdcat@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/12/2013	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Backup User Access Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Best Available Evidence Contact	Mgr- Medicare Enrollment		Ramirez	Michelle		6029168404					michelle.ramirez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Bid Audit Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		PHOENIX	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Bid Primary Contact	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	01/12/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	CAP Report Contact for Public Website			Services	Member		4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	CEO - CMS Administrator Contact	General Manager, Government Business Segment	Ms.	Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N. 23rd Ave.		Phoenix	AZ	85021	02/24/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	CEO - Senior Official for Contracting	General Manager, Government Business Segment	Ms.	Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N. 23rd Ave.		Phoenix	AZ	85021	02/24/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Chief Financial Officer	Chief Financial Officer	Mr.	El-Tawil	Mark		6028645700					mark.el-tawil@azblue.com	8220 N 23rd Ave	MS C410	Phoenix	AZ	85021	01/13/2020	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Chief Operating Officer	Chief Operating Officer	Mr.	Greenberg	Joe		6029166930					joe.greenberg@azblue.com	8220 N. 23rd Ave		Phoenix	AZ	85021	04/18/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Chief Information Officer	VP- CIO	Mr.	Pencek	Michael		6029166728					michael.pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Chief Information Security Officer	Director, Chief Information Security Officer	Mr.	Pencek	Michael		6029166728					Michael.Pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	CMS Casework Communication Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Complaints Tracking Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Contact for Fraud Investigations	Staff Vice President, Corp & Medicare Compliance	Ms.	Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Coordination of Benefits Contact	Mgr- Medicare Finance		Nguyen	Peter		6029168506					peter.nguyen@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Corporate Mailing						4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst/Accountant	Mr.	Westphal	Robert		6029168503					robert.westphal@azblue.com	8220 N 23rd Ave.		Phoenix	AZ	85021	08/07/2019	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Customer Service Operations Contact	Staff VP, MA Ops & FEP Progs		Langum	Becca	S	6029166742					rebecca.langum@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	DIR Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	10/22/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	DIR Contact (Secondary)	Mgr- Medicare Finance		Nguyen	Peter		6029168506					peter.nguyen@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	02/26/2021	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Emergency Part D Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Emergency Part D Contact (Secondary)	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N. 23rd Ave.		Phoenix	AZ	85021	12/28/2021	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Encounter Data & Risk Adjustment Operations Contact	Sr. Manager, Risk Adjustment Operations		Hubler	Jamee		6029168220					Jamee.Hubler@azblue.com	8220 N. 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Enrollment Contact	Mgr- Medicare Enrollment		Ramirez	Michelle		6029168404					michelle.ramirez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	EOB Transfer Contact	Director, PDP Operations		Weideman	Stacy		6028644391				8583572494	stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Financial Audit Contact	Chief Audit Executive	Mrs.	Lohse	Deepa		6028644452					deepa.lohse@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	09/20/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Financial Reporting Contact	Director, Financial Reporting	Ms.	Acquafredda	Brandy		6028644683					brandy.acquafredda@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	03/09/2020	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Formulary Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Formulary Contact (Secondary)	Director, Formulary Services		Zele	Carolyn		8587905737				8006833053	FMT@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	12/03/2013	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	General Contact	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	01/12/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Government Relations Contact	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	01/12/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	HIPAA Privacy Officer	Director of Legal and Privacy Officer		Schrock	Anne		6028644315					anne.schrock@azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	05/14/2019	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	HIPAA Security Officer	Director, Chief Information Security Officer	Mr.	Pencek	Michael		6029166728					Michael.Pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Hospice Contact	Sr Health Plan Rx Specialist		Norman	Laci		6029168577					laci.norman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Interoperability Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	MA Appeals/Grievances Contact			Services	Member		4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	MA Claims Processing Contact for Public Website	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	01/12/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Marketing Contact	Marketing Manager		Johnson	Nichelle		6028645215					MedSalesHPMSMaterial@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Medical Director	Medical Director	Dr	Raja	Rubina		6028642176					rubina.raja@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Medicare Compliance Officer	Staff Vice President, Corp & Medicare Compliance	Mrs.	Moore	Veronica		6023367600				6028643152	veronica.moore@azblue.com	8220 N 23rd Ave.		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Medicare Coordinator	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Medicare Part D Opioid Overutilization Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Medication Therapy Management Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Online Enrollment Center Contact (Primary)	Mgr- Medicare Enrollment		Ramirez	Michelle		6029168404					michelle.ramirez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Part C Application Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		PHOENIX	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Part C Reporting Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		PHOENIX	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Part D Appeals			Services	Member							contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active	8004468331				HMO - Health Maintenance Organization		C	San Francisco
H0302	Part D Appeals Contact (Secondary)	Manager Disputes and Appeals Department		Angel	Clarissa							GrievanceAppeals@Azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	01/08/2021	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active	6029168073				HMO - Health Maintenance Organization		C	San Francisco
H0302	Part D Application Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Part D Benefits Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Part D Claims Submission Contact			Scherlippens	Carine		8587907415					MedicarePartDProjectManagers@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	01/17/2013	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Part D Exceptions Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy							Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active	6028644391				HMO - Health Maintenance Organization		C	San Francisco
H0302	Part D Price File Contact (Back-up)	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Part D Price File Contact (Primary)			Jordan	Felicia		8587906416					planfindercommunications@medimpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	01/17/2013	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Part D Quality Assurance Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Part D Reporting Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Patient Safety Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Payment Contact	Finance Manager	Mr.	Nguyen	Peter		6029168506					peter.nguyen@azblue.com	8220 N 23rd Ave.		Phoenix	AZ	85021	01/13/2020	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Pharmacy Director	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Pharmacy Network Management Contact	Supervisor, Pharmacy Network Support		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	12/03/2013	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Pharmacy Network Management Contact (Secondary)	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services		Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct .		San Diego	CA	92131	11/16/2022	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active	8774036038				HMO - Health Maintenance Organization		C	San Francisco
H0302	Pharmacy Technical Help Desk Contact (Secondary)	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy							Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active	6028644391				HMO - Health Maintenance Organization		C	San Francisco
H0302	Plan Directory Contact for Public Website			Services	Member		4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Plan to Plan Reconciliation Contact	Director, Financial Reporting		Acquafredda	Brandy		6028644683				6028645308	brandy.acquafredda@azblue.com	PO Box 81049		Phoenix	AZ	85069	03/09/2020	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Processor Contact			Scherlippens	Carine		8587907415					MedicarePartDProjectManagers@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	12/03/2015	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Quality Contact	VP Medicare Performance		Cash	Gerri		6028644668					gerrilin.cash@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/21/2020	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Reconciliation Contact	Mgr- Medicare Finance		Nguyen	Peter		6024272128					peter.nguyen@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	02/18/2021	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Reconciliation Contact (Secondary)	Director, Financial Reporting		Acquafredda	Brandy		6028644683					brandy.acquafredda@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	02/26/2021	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Recovery Audit Contact	Staff Vice President, Corp & Medicare Compliance	Ms.	Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Surveillance Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	System Contact	Informatn Security Svcs- Lead	Ms.	O'Brien	Debi		6029167939					debi.o'brien@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Third Party Administrator (TPA) Liaison	Finacial Analyst/Accountant	Mr.	Westphal	Robert		6029168503					robert.westphal@azblue.com	8220 N 23rd Ave.		Phoenix	AZ	85021	08/07/2019	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	User Access Contact	Informatn Security Svcs- Lead	Ms.	O'Brien	Debi		6029167939					debi.o'brien@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Utilization Management Contact	Mgr- Utilization Management		Guddendorf	Kelly		6028644358					kelly.guddendorf@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/28/2020	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0302	Utilization Review Contact	Mgr- Utilization Management		Guddendorf	Kelly		6028644358					kelly.guddendorf@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/28/2020	2023	MEDISUN, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H0321	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H0321	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H0321	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H0321	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/15/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0321	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	ARIZONA PHYSICIANS IPA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Agent/Broker Compensation Data Contact	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Automated TrOOP Balance Transfer Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Backup User Access Contact	VP, Managed Care Analytics		Dixon	Sarah		7134420069				7134425105	sarah.dixon@kelsey-seybold.com	11511 Shadow Creek Parkway	2nd Floor	Pearland	TX	77584	06/06/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Best Available Evidence Contact	Director Service Operations		Garcia	Shelly		7134429502				7134425212	shelly.garcia@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77587	05/07/2019	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Bid Audit Contact	VP, Managed Care Analytics		Dixon	Sarah		7134420069				7134425105	sarah.dixon@kelsey-seybold.com	11511 Shadow Creek Parkway	2nd Floor	Pearland	TX	77584	06/06/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Bid Audit Site Contact	VP, Managed Care Analytics		Dixon	Sarah		7134420069				7134425105	sarah.dixon@kelsey-seybold.com	11511 Shadow Creek Parkway	2nd Floor	Pearland	TX	77584	06/06/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Bid Primary Contact	VP of Health Plan Services/COO	Ms	Jonathan	Denise	M	7134425592				7134425105	denise.jonathan@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	06/08/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	CAP Report Contact for Public Website	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				7134425212	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	CEO - CMS Administrator Contact	President	Mrs.	Matheny	Marnie	P	7139627242				7134420771	marnie.matheny@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	12/20/2019	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	CEO - Senior Official for Contracting	President	Mrs.	Matheny	Marnie		7134420775				7134420771	marnie.matheny@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	10/26/2017	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Chief Financial Officer	Chief Financial Officer	Mr.	Kumar	Saurabh		7134424873				7134420799	saurabh.kumar@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	07/15/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Chief Operating Officer	VP of Health Plan Services/COO	Ms	Jonathan	Denise	M	7134425592				7134425105	denise.jonathan@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	02/28/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Chief Information Officer	Chief Technology Officer	Mr.	Littmann	Martin	H	7134429977					martin.littman@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	03/06/2017	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Chief Information Security Officer	Chief Technology Officer	Mr.	Littmann	Martin	H	7134429977					martin.littman@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	04/15/2016	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	CMS Casework Communication Contact	Director, Service Operations		Garcia	Shelly		7134429502				7134425212	shelly.garcia@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	10/26/2017	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Complaints Tracking Contact	Director, Service Operations		Garcia	Shelly		7134429502				7134425212	shelly.garcia@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	10/26/2017	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Contact for Fraud Investigations	Sr. Fraud Investigator	Mr.	Kimble	John		7134429595				7124425212	MedicareFraudHotline@kelseycareadvantage.com	11511 Shadow Creek Parkway		Pearland	TX	77584	12/30/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Coordination of Benefits Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Corporate Mailing						7134420775				7134420771	marnie.matheny@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	10/26/2017	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Coverage Gap Discount Program (CGDP) Payment Contact	VP, Managed Care Analytics		Dixon	Sarah		7134420069				7134425105	sarah.dixon@kelsey-seybold.com	11511 Shadow Creek Parkway	2nd Floor	Pearland	TX	77584	06/06/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Customer Service Operations Contact	Director Member Services & Enrollment		Garcia	Shelly		7134429502				7134425212	shelly.garcia@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	05/07/2019	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	DIR Contact	VP, Managed Care Analytics		Dixon	Sarah		7134420069				7134425105	sarah.dixon@kelsey-seybold.com	11511 Shadow Creek Parkway	2nd Floor	Pearland	TX	77584	06/06/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	DIR Contact (Secondary)	Director of Pharmacy		Gandhi	Kirti		7134425519					kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	09/07/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Emergency Part D Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Emergency Part D Contact (Secondary)	Vice President Healthcare Finance	Mr.	Janis	Kenneth		7139622251				7134425105	kenneth.janis@kelsey-seybold.com	11511 Shadow Creek Parkway	2nd Floor	Pearland	TX	77584	12/21/2017	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Employer Waiver Contact	Director of Account Strategy		Hueske	Kristen		7134429081					kristen.hueske@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/13/2020	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Encounter Data & Risk Adjustment Operations Contact	VP, Managed Care Analytics		Dixon	Sarah		7134420069				7134425105	sarah.dixon@kelsey-seybold.com	11511 Shadow Creek Parkway	2nd Floor	Pearland	TX	77584	06/06/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Enrollment Contact	Director Member Services & Enrollment		Garcia	Shelly		7134429502				7134425212	shelly.garcia@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	02/19/2020	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	EOB Transfer Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Financial Audit Contact	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				7134425105	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Financial Reporting Contact	Manager, Finance - Medicare Advantage	Mrs.	Vincent	Haley	W	7134425639				7134420799	haley.vincent@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	07/15/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Formulary Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	General Contact	VP of Health Plan Services/COO		Jonathan	Denise		7134425592				7134425212	denise.jonathan@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	02/28/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Government Relations Contact	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	HIPAA Privacy Officer	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	HIPAA Security Officer	Chief Technology Officer	Ms.	Littmann	Martin	H	7134429977					martin.littman@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	12/20/2019	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Hospice Contact	VP of Health Plan Services/COO		Jonathan	Denise		7134425592					Denise.Jonathan@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	02/28/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Interoperability Contact	VP of Health Plan Services/COO	Ms	Jonathan	Denise	M	7134425592				7134425105	denise.jonathan@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	02/28/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	MA Appeals/Grievances Contact	Director Member Services & Enrollment		Garcia	Shelly		7134429502				7134425212	shelly.garcia@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	05/08/2019	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	MA Claims Processing Contact for Public Website	Director TPA Services		Cole	Laura		7134425266				7134425212	laura.cole@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/13/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Marketing Contact	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Medical Director	Medical Director	Dr.	O'Leary	Paul	A	7134422136				7134425212	paul.oleary@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	11/09/2020	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Medicare Compliance Officer	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Medicare Coordinator	VP of Health Plan Services/COO		Jonathan	Denise		7134425592				7134425212	Denise.Jonathan@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	02/28/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	12/21/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Medication Therapy Management Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	OffShore Subcontractor Contact	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Online Enrollment Center Contact (Back-up)	Reconciliation Business Analyst		Triplett	Toni		7134425283				7124425450	Toni.Triplett@Kelsey-Seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	05/07/2019	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Online Enrollment Center Contact (Primary)	Director Member Services & Enrollment		Garcia	Shelly		7134429502				7134425212	shelly.garcia@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	02/19/2020	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Part C Application Contact	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Part C Reporting Contact	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Appeals	Director Service Operations		Garcia	Shelly						7134425212	shelly.garcia@kelsey-seybold.com	11511 Shadow Creek Parkway		Houston	TX	77054	12/06/2019	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8665358343				HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Appeals Contact (Secondary)	Appeals and Grievances Manager	Mrs.	Garcia	Maggie						7134429536	maggie.garcia@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	06/06/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8665358343				HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Application Contact	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Benefits Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Claims Submission Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Exceptions Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti						7134424848	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8445418507				HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Exceptions Contact (Secondary)	VP of Health Plan Services/COO		Jonathan	Denise						7134424848	kcapa@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	02/28/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8445418507				HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Price File Contact (Back-up)	VP of Health Plan Services/COO	Ms	Jonathan	Denise	M	7134425592				7134425105	denise.jonathan@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	02/28/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Price File Contact (Optional)	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Price File Contact (Primary)	Sr Manager - Finance		Schilcher	Sydney		4806064615					Sydney.Schilcher@CVSHealth.com	8801 E. Raintree Drive		Scottsdale	AZ	85260	01/04/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Quality Assurance Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Part D Reporting Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Patient Safety Contact	VP of Health Plan Services/COO	Ms	Jonathan	Denise	M	7134425592				7134425105	denise.jonathan@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	02/28/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Payment Contact	VP, Managed Care Analytics		Dixon	Sarah		7134420069				7134425105	sarah.dixon@kelsey-seybold.com	11511 Shadow Creek Parkway	2nd Floor	Pearland	TX	77584	06/06/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Pharmacy Director	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Pharmacy Network Management Contact	Sr Manager - Networks		Johnson	Tanner		4802023593					tanner.johnson@cvshealth.com	9501 E. Shea Blvd MC 049		Scottsdale	AZ	85260	01/04/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Pharmacy Technical Help Desk Contact	Advisor - Client Operations		Browning	Jennifer							jennifer.browning@cvshealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	01/04/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889700914				HMO - Health Maintenance Organization		C	San Francisco
H0332	Pharmacy Technical Help Desk Contact (Secondary)	Advisor - Client Operations		Okrie	Courtney							courtney.okrie@cvshealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	01/04/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889700914				HMO - Health Maintenance Organization		C	San Francisco
H0332	Plan Directory Contact for Public Website	Member Services Representative		Services	Member		8665358343					memberservices@kelseycareadvantage.com	11511 Shadow Creek Parkway		Pearland	TX	77584	10/26/2017	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Plan to Plan Reconciliation Contact	Director of Pharmacy, Health Plan Services		Gandhi	Kirti		7134425519				7134425105	kirti.gandhi@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	01/25/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Processor Contact	Director of TPA Services		Cole	Laura		7134425266				7134425212	laura.cole@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	05/27/2021	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Quality Contact	VP of Health Plan Services/COO	Ms	Jonathan	Denise	M	7134425592				7134425105	denise.jonathan@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	02/28/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Reconciliation Contact	VP, Managed Care Analytics		Dixon	Sarah		7134420069				7134425105	sarah.dixon@kelsey-seybold.com	11511 Shadow Creek Parkway	2nd Floor	Pearland	TX	77584	06/06/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Reconciliation Contact (Secondary)	Vice President Healthcare Finance	Mr.	Janis	Kenneth		7134420764				7134425105	kenneth.janis@kelsey-seybold.com	11511 Shadow Creek Parkway	2nd Floor	Pearland	TX	77584	07/29/2013	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Recovery Audit Contact	VP, Managed Care Analytics	Ms.	Dixon	Sarah		7134420069				7134425105	sarah.dixon@kelsey-seybold.com	11511 Shadow Creek Parkway	2nd Floor	Pearland	TX	77584	06/06/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Surveillance Contact	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	System Contact	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Third Party Administrator (TPA) Liaison	VP, Managed Care Analytics	Ms	Dixon	Sarah	L	7134420069				7134425105	sarah.dixon@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	06/06/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	User Access Contact	Sr. Director, Medicare Compliance	Mr.	Wilson	Thomas		9046698710				9046698710	Thomas.Wilson@kelsey-seybold.com	11511 Shadow Creek Parkway		Pearland	TX	77584	08/25/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Utilization Management Contact	VP of Health Plan Services/COO		Jonathan	Denise	M	7134425592				7134425105	denise.jonathan@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	02/28/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0332	Utilization Review Contact	VP of Health Plan Services/COO		Jonathan	Denise	M	7134425592				7134425105	denise.jonathan@kelsey-seybold.com	11511 Shadow Creek Parkway	3rd Floor	Pearland	TX	77584	02/28/2022	2023	KS PLAN ADMINISTRATORS, LLC	Local CCP	KelseyCare Advantage	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0336	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	MMP Reporting Requirements Contact			Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	MMP Point of Contact			Steckbeck	Marie		5024763081					MSteckbeck@humana.com	500 W. Main Street		Louisville	KY	40202	11/24/2019	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0336	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Demo	Humana	Medicare-Medicaid Plan HMO/HMOPOS		Humana Inc.	128	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0342	Agent/Broker Compensation Data Contact	Vice President, Medicare Sales & Marketing	Ms.	McManus	Marie		6179729400	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Automated TrOOP Balance Transfer Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Backup User Access Contact	Medicare Compliance Program Manager		Tran	Brenda		7816121000	85880				brenda.tran@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Best Available Evidence Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Bid Audit Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Bid Audit Site Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Bid Primary Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852	84759				taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Chief Financial Officer	SVP Chief Financial Officer	Mr.	Walker	Scott		7816126840					r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Chief Operating Officer	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Chief Information Officer	SVP and Chief Information Officer	Ms.	Ferhatbegovic	Selma		7816121000	84633				Selma.Ferhatbegovic@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	CMS Casework Communication Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Complaints Tracking Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Contact for Fraud Investigations	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Coordination of Benefits Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Corporate Mailing						7816121000					Cain.Hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Customer Service Operations Contact	Manager, Member Services	Ms.	Villatoro	Yesly		7816121000	54152				yesly.villatoro@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	DIR Contact	Senior Manager, Pharmacy reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	DIR Contact (Secondary)	Pharmacy Analyst Senior	Ms.	Santino	Cristina		7816121000	82560				cristina.santino@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Emergency Part D Contact	Director, Pharmacy Operations		Bonica	Joseph		7816123342					joseph.bonica@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Emergency Part D Contact (Secondary)	Manager, Pharmacy Compliance		Lake	Matthew		7816123976					matthew.lake@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Employer Waiver Contact	Manager, Client Service	Ms.	Bartkiewicz	Mary		7816121000	83937				mary.bartkiewicz@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Data Analyst Lead	Ms.	Quinlan	Judith		7816121000	83377				judith.quinlan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Enrollment Contact	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	EOB Transfer Contact	Manager, Business Implementation		Nesmith	Tanisha		7816124861				6176730286	tanisha.nesmith@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Financial Audit Contact	Chief Financial Officer	Mr.	Walker	Scott		7816121000	86840				r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Financial Reporting Contact	SVP Finance & Chief Accounting Officer	Mr.	Porter	Mark		6179729400	85536				mark.porter@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Formulary Contact	Clinical Pharmacist Senior	Mr.	Kowalski	Alec		7816121000	82045				alec.kowalski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Formulary Contact (Secondary)	Clinical Pharmacist Senior		Shafir	Frances		7816122897					frances.shafir@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	General Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Government Relations Contact	Chief Government Affairs Officer	Ms.	Lewis	Kristin		7816121000	83621				kristin.lewis@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	HIPAA Privacy Officer	VP Privacy & Special Investigation	Mr.	Walsh	Chris		7816121000	82508				Christopher.walsh@point32health.org	1600 Crown Colony Drive		Quincy	MA	02169	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	HIPAA Security Officer	VP Chief  Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Hospice Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Interoperability Contact	Vice President & Chief Technology Officer		Querusio	David		7816122629					david.querusio@point32health.org	One Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	MA Claims Processing Contact for Public Website	Vice President, Claims	Mr.	Fernandez	David		6175844884					david.fernandez@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Marketing Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Medical Director	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Medicare Compliance Officer	Medicaid Compliance Officer	Mrs	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Medicare Coordinator	SVP, President Medicare	Ms.	Blake	Patty		7816124287					Patty.Blake@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Dohan	David		7816121000	82615				David.Dohan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Medication Therapy Management Contact	Sr Pharmacy Program Manager		Burns	Ashlyn		7816122239					ashlyn.burns@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	OffShore Subcontractor Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Online Enrollment Center Contact (Back-up)	Director, Enrollment & Payment - Senior Products	Ms.	Bullock	Jennifer		7816121000	83183				jennifer.bullock@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Online Enrollment Center Contact (Optional)	Supervisor, Enrollment	Ms.	Van De Mortel	Migdalia		7816121000	84104				Migdalia.Van.De.Mortel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Online Enrollment Center Contact (Primary)	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Part C Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Part C Reporting Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Part D Appeals	Director, Appeals & Grievances		Evans	Kathleen							Kathleen.Evans@point32health.org	1 Wellness Way		Canton	MA	02021	09/20/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active	6179729400	87204			PPO - BBA		C	Boston
H0342	Part D Appeals Contact (Secondary)	Program Manager Senior	Ms.	Mello	Sheri							sheri.mello@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active	7816121000	84862			PPO - BBA		C	Boston
H0342	Part D Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Part D Benefits Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Part D Claims Submission Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Chan	Bryan							bryan.chan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active	7816121000	82370			PPO - BBA		C	Boston
H0342	Part D Exceptions Contact (Secondary)	Supervisor, Pharmacy Utilization Management	Ms.	Griffith	Samantha							samantha.griffith@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active	7816121000	84551			PPO - BBA		C	Boston
H0342	Part D Price File Contact (Back-up)	Advisor, Medicare Operations		Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Part D Price File Contact (Optional)	Sr. Pharmacy Implementation Specialist		Sullivan	Tim		7816124922					tim.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Part D Price File Contact (Primary)	Sr Business Analyst		Moore-Elliott	Shalandria		7637974305					shalandria.moore-elliott@optum.com	1600 McConnor Pwy.		Schaumburg	IL	60173	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Part D Quality Assurance Contact	Vice President, Behavioral Health	Ms.	Borrelli	Jill		6179729400	85397				jill.borrelli@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Part D Reporting Contact	Director, Pharmacy Financial & Reporting	Mr.	Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Patient Safety Contact	Sr Pharmacy Implementation Specialist		von Fritzinger	Lisa		7816123778					lisa.vonfritzinger@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Payment Contact	Program Manager III	Ms.	Cook	Tiffany		7816121000	84908				Tiffany.Cook@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Pharmacy Director	Vice President, Pharmacy	Ms.	Sullivan	Miriam		7816121000	84116				miriam.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations		Ashby	JoLynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Pharmacy Technical Help Desk Contact	Sr. Manager		Villaneuva	Juan							Juan.Villanueva@optum.com	3515 S Harbor Blvd.		Costa Mesa	CA	92626	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active	7148253761				PPO - BBA		C	Boston
H0342	Pharmacy Technical Help Desk Contact (Secondary)	Associate Director, Pharmacy Help Desk		Betten	Brad							bradley.betten@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active	8555240380				PPO - BBA		C	Boston
H0342	Plan Directory Contact for Public Website	Supervisor, Marketing Materials Production	Mr.	Kayser	Kenneth		7816121000	83518				kenneth.kayser@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Plan to Plan Reconciliation Contact	Manager, Finance Operations	Ms.	Olson	Rachel		7816121000	84360				rachel.olson@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Processor Contact	Director, Claims	Ms.	Patel	Monal		7816121000	88187				monal.patel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Quality Contact	Senior Manager, Quality Informatics	Ms.	McCoy	Kelly		7816121000	83515				kelly.mccoy@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Reconciliation Contact	Senior Manager, Pharmacy Reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Reconciliation Contact (Secondary)	Director, Pharmacy Financial & Reporting		Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	09/11/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Recovery Audit Contact	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	SNP Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	SNP State Contact	Director Business Implementation		Chukwu	Matthew		7816123967					matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Surveillance Contact	Director, Sales Operations		McManus	Marie		6117972940	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	System Contact	Senior Manager, Business Account Management	Mr.	Allen	Jeffrey		7816121000	83167			6179729008	Jeffrey.Allen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Third Party Administrator (TPA) Liaison	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	User Access Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Utilization Management Contact	Director, Care Management	Ms.	Menery	Maureen		7816121000	83994				maureen.menery@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0342	Utilization Review Contact	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H0351	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/10/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H0351	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/10/2020	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/10/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/03/2018	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1850 W. Rio Salado Parkway		Tempe	AZ	85281	07/19/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/10/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/10/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/10/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/10/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Medical Director	Chief Medical Officer	Dr.	Chen	Alex		8186766564					alex.y.chen@healthnet.com	21281 Burbank Blvd		Woodland Hills	CA	91367	03/30/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/27/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/10/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1850 W. Rio Salado Parkway		Tempe	AZ	85281	07/19/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/10/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/10/2020	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0351	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0351	PHR Beneficiary Contact																	09/27/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8009777522				HMO - Health Maintenance Organization		C	Dallas
H0351	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Plan Directory Contact for Public Website			Services	Provider		8009777522					CorporateMedicareComplianceDept@CENTENE.COM	1850 W. Rio Salado Parkway		Tempe	AZ	85281	07/19/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/10/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0351	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF ARIZONA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0354	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	05/19/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06512	03/11/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Backup User Access Contact	Legal Compliance Sr. Analyst		Allen	Carolyn		8609024552					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Best Available Evidence Contact	Enrollment/Billing Sr Manager	Mrs	Rice	Sarah		4802159884					Sarah.Rice2@cigna.com	25501 N Norterra Pkwy		Phoenix	AZ	85085	02/09/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Bid Audit Site Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	500 Great Circle Road		Nashville	TN	37228	11/09/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	500 Great Circle Road		Nashville	TN	37228	11/09/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	11/24/2020	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	09/06/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Chief Information Security Officer	SVP Chief Information Security Officer	Mr	Beeson	James		8602261761					james.beeson@cigna.com	900 Cottage Grove Rd		Bloomfield	CT	06152	03/11/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	11/09/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	01/07/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	01/07/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	02/02/2019	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Coordination of Benefits Contact	Enrollment/Billing Sr Manager	Mrs	Rice	Sarah		4802159884					Sarah.Rice2@cigna.com	25501 N Norterra Pkwy		Phoenix	AZ	85085	02/09/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Customer Service Operations Contact	Customer Service Manager		Soltis	Mike		6238063361					Michael.Soltis@Cigna.com	25501 Norterra Pkwy		Phoenix	AZ	85085	03/11/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	06/09/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	01/03/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cigna.com	500 Great Circle Rd		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Encounter Data & Risk Adjustment Operations Contact	Business Lead Analyst		Singh	Sangita		4802903948					Sangita.Singh@Cigna.com	25502 N Norterra Pkwy		Phoenix	AZ	85085	03/15/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Enrollment Contact	Enrollment/Billing Sr Manager	Mrs	Rice	Sarah		4802159884					Sarah.Rice2@cigna.com	25501 N Norterra Pkwy		Phoenix	AZ	85085	02/09/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	EOB Transfer Contact	Program Management Senior Director		Bodyk	Sheila		5715396358				4802965600	sheila.bodyk@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/21/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		8607876801					jennifer.duncan@cigna.com	500 Great Circle Road		Nashville	TN	37228	01/03/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Hospice Contact	Enrollment/Billing Sr Manager	Mrs	Rice	Sarah		4802159884					Sarah.Rice2@cigna.com	25501 N Norterra Pkwy		Phoenix	AZ	85085	02/09/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	530 Great Circle Road		Nashville	TN	37228	01/07/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	MA Claims Processing Contact for Public Website	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	11/09/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	530 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	02/14/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	02/09/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Sr Manager	Mrs	Rice	Sarah		4802159884					Sarah.Rice2@cigna.com	25501 N Norterra Pkwy		Phoenix	AZ	85085	02/09/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Online Enrollment Center Contact (Optional)	Legal Compliance Manager	Mrs.	Panich	Danielle		8049046922					danielle.panich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Online Enrollment Center Contact (Primary)	Enrollment Sr. Supervisor	Mr.	Steinbrink	David		6232771216					DAVID.STEINBRINK@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	03/11/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H0354	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H0354	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H0354	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H0354	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/20/2020	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/20/2020	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	02/02/2019	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	02/02/2019	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	01/03/2022	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	01/01/2020	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H0354	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H0354	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Soltis	Mike		8006683813				8887666403	LetUsHelpYou@healthspring.com	25502 N Norterra Pkwy		Phoenix	AZ	85085	03/15/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	04/24/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	07/18/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0354	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF ARIZONA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Agent/Broker Compensation Data Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Automated TrOOP Balance Transfer Contact			Rush	Jamie		5616901134					ESITroopTransfer@express-scripts.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Backup User Access Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1, Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Best Available Evidence Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N 107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Bid Audit Contact			Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Bid Audit Site Contact			Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Bid Primary Contact		Mr.	Granow	Les		5614440709					Les.Granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	CAP Report Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	CEO - CMS Administrator Contact		Dr.	Lerer	Rene		5614440780					rene.lerer@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	CEO - Senior Official for Contracting		Ms.	Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Chief Financial Officer		Mr.	Granow	Les		5614440709					les.granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Chief Operating Officer		Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Chief Information Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Chief Information Security Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	CMS Casework Communication Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Complaints Tracking Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Contact for Fraud Investigations			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Coordination of Benefits Contact		Ms.	Burdelik	Dawn		5618153729					dawn.burdelik@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Corporate Mailing						5616901134					compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Coverage Gap Discount Program (CGDP) Payment Contact		Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	Longevity Health Plan	485 Madison Avenue Suite 202	New York	NY	10022	03/11/2021	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Customer Service Operations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	DIR Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	DIR Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Electronic Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Emergency Part D Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Emergency Part D Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Encounter Data & Risk Adjustment Operations Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Enrollment Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	EOB Transfer Contact		Ms.	Socoski	Beth		5616901134				5616901134	Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Financial Audit Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Financial Reporting Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Formulary Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Formulary Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	General Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Government Relations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	HIPAA Privacy Officer		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	HIPAA Security Officer		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Hospice Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Interoperability Contact	CIO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	MA Appeals/Grievances Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	MA Claims Processing Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Marketing Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Medical Director		Mr.	Orgain	Javette		3127206656					javette.orgain@longevityhealthplan.com	Longevity Health Plan	1611 Church Street	Evanston	IL	60201	02/15/2021	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Medicare Compliance Officer		Ms.	Lacey	Jennifer		8133677169					Jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Medicare Coordinator	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Medicare Part D Opioid Overutilization Contact	Director, Clinical & Trend Solutions	Ms.	Muralidharan	Adrienne		5616901134					amuralidharan@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Medication Therapy Management Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	OffShore Subcontractor Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Part C Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Part C Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Part D Appeals	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H0363	Part D Appeals Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H0363	Part D Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Part D Benefits Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		8002040016					Rosario_dovico@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H0363	Part D Exceptions Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H0363	Part D Price File Contact (Back-up)	Product Manager Advisor	Ms.	Williams	Stephanie		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Part D Price File Contact (Optional)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Part D Price File Contact (Primary)	sr mgr, Government Programs		Dolfi	Amanda		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Part D Quality Assurance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Part D Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Patient Safety Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Payment Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Personal Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Pharmacy Director	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra	Ms.	Kelly	Heather		8002040016					hakelly@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Pharmacy Network Management Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Pharmacy Technical Help Desk Contact	Director, Customer Service	Ms.	Moore	LaTasha						8882358551	LaTasha_Monroe@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H0363	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Account Manager	Ms.	Kolesar	Bhrena							Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H0363	Physician Incentive Contact		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Plan Directory Contact for Public Website	Medicare Compliance Director	Ms.	Socoski	Beth		8883133609					Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Plan to Plan Reconciliation Contact		Ms.	Zhai	Vicky		5616328915					Vicky.Zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Processor Contact		Ms.	Gibson	Sharon		6143766614					SGGibson@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Quality Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Reconciliation Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Reconciliation Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Recovery Audit Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	SNP Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	SNP State Contact		Ms.	Lacey	Jennifer		5614440706					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Surveillance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	System Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Third Party Administrator (TPA) Liaison	COO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	User Access Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Utilization Management Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0363	Utilization Review Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF COLORADO, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0390	Automated TrOOP Balance Transfer Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360					donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Backup User Access Contact	CEO	Mr.	Schlaman	James		2694084375				2694084340	jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	11/23/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Best Available Evidence Contact	CEO	Mr.	Schlaman	James		2694084375				2694084340	jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	11/23/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Bid Primary Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360					donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	CAP Report Contact for Public Website	CEO	Mr.	Schlaman	James		2694084375				2694084340	jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	11/23/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	CEO - CMS Administrator Contact	CEO	Mr.	Schlaman	James		2694084375				2694084340	jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	11/23/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	CEO - Senior Official for Contracting	CEO	Mr.	Schlaman	James		2694084375				2694084340	jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	11/23/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Chief Financial Officer	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Chief Operating Officer	CEO	Mr.	Schlaman	James		2694084375				2694084340	jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	01/07/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Chief Information Officer	CEO	Mr.	Schlaman	James		2694084375				2694084340	jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	01/07/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Chief Information Security Officer	Compliance Officer	Mr.	Erny	Corey		2694084359				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	CMS Casework Communication Contact	Compliance Officer	Mr.	Erny	Corey		2694084359				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Complaints Tracking Contact	Compliance Officer	Mr.	Erny	Corey		2694084395				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Contact for Fraud Investigations	Compliance Officer	Mr.	Erny	Corey		2694084395				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Coordination of Benefits Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Corporate Mailing						2694084375					jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	12/29/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Customer Service Operations Contact	Center Manager		Gibson	Rhonda		2694084302					rhondagibson@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	08/08/2018	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	DIR Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	DIR Contact (Secondary)	CEO	Mr.	Schlaman	James		2694084375				2694084340	jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	01/07/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Emergency Part D Contact	Compliance Officer	Mr.	Erny	Corey		2694084359				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Emergency Part D Contact (Secondary)	Medical Director	Ms.	White	Jennifer		2694084322				2694084340	jenniferwhite@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	01/07/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Encounter Data & Risk Adjustment Operations Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Enrollment Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	Donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	EOB Transfer Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Financial Audit Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Financial Reporting Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Formulary Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Formulary Contact (Secondary)			N/A	N/A		0000000000					N/A@na.org	N/A		N/A	MI	49085	03/12/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	General Contact	CEO	Mr.	Schlaman	James		2694084375				2694084340	jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	11/23/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Government Relations Contact	CEO	Mr.	Schlaman	James		2694084375				2694084340	jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	11/23/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	HIPAA Privacy Officer	Compliance Officer	Mr.	Erny	Corey		2694084359				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	HIPAA Security Officer	Compliance Officer	Mr.	Erny	Corey		2694084359				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Interoperability Contact			Weberg	DONNA		2694084360					donnaweberg@paceswmi.org	2920 LAKEVIEW AVE		ST JOSEPH	MI	49085	06/06/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	MA Appeals/Grievances Contact	Quality Manager	Ms.	Lewis	Sandi		2694084370				2694084340	sandilewis@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/12/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	MA Claims Processing Contact for Public Website	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Marketing Contact	Marketing and Enrollment Manager	Mrs.	Gibson	Rhonda		2694084322	4302			2694084340	rhondagibson@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Medical Director	Medical Director	Ms.	White	Jennifer		2694084322				2694084340	jenniferwhite@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	09/02/2021	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Medicare Compliance Officer	Compliance Officer	Mrs.	Woerdehoff	Victoria		2694084322				2694084340	victoriawoerdehoff@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	09/13/2023	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Medicare Coordinator	Finance Manager	Ms.	Rendell	Chris		2694084378					chrisrendell@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	09/25/2023	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Medicare Part D Opioid Overutilization Contact	Medical Director	Ms.	White	Jennifer		2694084322				2694084340	jenniferwhite@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Medication Therapy Management Contact	Compliance Officer	Mr.	Erny	Corey		2694084359				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	OffShore Subcontractor Contact			N/A	N/A		0000000000					N/A@na.org	N/A		N/A	MI	49085	04/09/2013	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Online Enrollment Center Contact (Back-up)			N/A	N/A		0000000000					N/A@na.org	N/A		N/A	MI	49085	01/29/2018	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Online Enrollment Center Contact (Optional)			N/A	N/A		0000000000					N/A@na.org	N/A		N/A	MI	49085	01/29/2018	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Online Enrollment Center Contact (Primary)	Chief Financial Officer		Weberg	Donna		2694084360					donnaweberg@paceswmi.org	2900 Lakeview		Saint Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Part C Application Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Part D Appeals	Quality Manager	Ms.	Lewis	Sandi						2694084340	sandilewis@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/12/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active	2694084370				PACE - Nat		C	Chicago
H0390	Part D Appeals Contact (Secondary)	Compliance Officer	Mr.	Erny	Corey						2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active	8552438876				PACE - Nat		C	Chicago
H0390	Part D Application Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Part D Benefits Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Part D Claims Submission Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Part D Exceptions Contact	Compliance Officer	Mr.	Erny	Corey						2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active	8552438876				PACE - Nat		C	Chicago
H0390	Part D Exceptions Contact (Secondary)	Chief Financial Officer	Ms.	Weberg	Donna						2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active	2694084360				PACE - Nat		C	Chicago
H0390	Part D Price File Contact (Back-up)	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Part D Price File Contact (Optional)			N/A	N/A		0000000000					N/A@na.org	N/A		N/A	MI	49085	03/12/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Part D Price File Contact (Primary)	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Part D Quality Assurance Contact	Quality Manager	Ms.	Lewis	Sandi		2694084370				2694084340	sandilewis@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	10/01/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Part D Reporting Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Patient Safety Contact	Quality Manager	Ms.	Lewis	Sandi		2694084370				2694084340	sandilewis@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	10/01/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Payment Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Personal Health Record Contact	Quality Manager	Ms.	Lewis	Sandi		2694084370				2694084340	sandilewis@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	10/01/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Pharmacy Director	Medical Director	Ms.	White	Jennifer		2694084322				2694084340	jenniferwhite@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	01/07/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Pharmacy Network Management Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Pharmacy Network Management Contact (Secondary)	Compliance Officer	Mr.	Erny	Corey		2694084359				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Pharmacy Technical Help Desk Contact	Compliance Officer	Mr.	Enry	Corey						2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active	8552438876				PACE - Nat		C	Chicago
H0390	Pharmacy Technical Help Desk Contact (Secondary)	Medical Director	Ms.	White	Jennifer						2694084340	jenniferwhite@paceswmi.org	2900 Lakeview Ave.		St. Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active	2694084353				PACE - Nat		C	Chicago
H0390	PHR Beneficiary Contact																	03/20/2012	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE	PACE of Southwest Michigan	PACE of Southwest Michigan, Inc.	507	Yes	Active	2699827767				PACE - Nat		C	Chicago
H0390	Plan Directory Contact for Public Website	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Plan to Plan Reconciliation Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview		Saint Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Processor Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview		Saint Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Quality Contact	Quality Manager	Ms.	Lewis	Sandi		2694084370				2694084340	sandilewis@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/12/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Reconciliation Contact	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview		Saint Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Reconciliation Contact (Secondary)			N/A	N/A		0000000000					N/A@na.org	N/A		N/A	MI	49085	03/12/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Recovery Audit Contact	Compliance Officer	Mr.	Erny	Corey		2694084314				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Surveillance Contact	Compliance Officer	Mr.	Erny	Corey		2694084314				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	System Contact	CEO	Mr.	Schlaman	James		2694084375				2694084340	jimschlaman@paceswmi.org	2900 Lakeview Avenue		Saint Joseph	MI	49085	11/23/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Ms.	Weberg	Donna		2694084360				2694084340	donnaweberg@paceswmi.org	2900 Lakeview		Saint Joseph	MI	49085	08/11/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	User Access Contact	Compliance Officer	Mr.	Erny	Corey		2694084395				2694084340	coreyerny@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/16/2022	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Utilization Management Contact	Quality Manager	Ms.	Lewis	Sandi		2694084370				2694084340	sandilewis@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/12/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0390	Utilization Review Contact	Quality Manager	Ms.	Lewis	Sandi		2694084370				2694084340	sandilewis@paceswmi.org	2900 Lakeview Avenue		St Joseph	MI	49085	03/12/2020	2023	PACE OF SOUTHWEST MICHIGAN, INC.	National PACE	PACE of Southwest Michigan	National PACE		PACE of Southwest Michigan, Inc.	507	Yes	Active					PACE - Nat		C	Chicago
H0422	Agent/Broker Compensation Data Contact	Associate Vice President Sales		Eck	Brian		6126763380					beck@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/08/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Automated TrOOP Balance Transfer Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					FIR_Transactions@ucare.org	500 Stinson Boulevard NE		Minnneapolis	MN	55413	08/16/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Backup User Access Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Best Available Evidence Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Bid Audit Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Bid Audit Site Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Bid Primary Contact	Corporate Actuary		Uding	Chris		6126763372					bids@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	CAP Report Contact for Public Website	Senior Regulatory  Auditor		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/14/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Chief Financial Officer	SVP and Chief Financial Officer	Ms.	Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Chief Operating Officer	SVP and Chief Administrative Officer	Ms.	Schmitt	Pat		6126763460					pschmitt@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/03/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Chief Information Officer	Executive VP, Chief Information Officer	Mr	McDonald	Darin		9493098524					dmcdonald@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Chief Information Security Officer	Chief Information Security Officer, Director	Mr	Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	CMS Casework Communication Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Complaints Tracking Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Contact for Fraud Investigations	Manager SIU		Weidemann	Angie		6128171655					aweidemann@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Coordination of Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Corporate Mailing						6126766500				6126766501	sschwartz@ucare.org	UCare	500 Stinson Boulevard NE	Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Senior		Ly	Tong		6126277157					tly@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/17/2021	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Customer Service Operations Contact	Customer Service Workforce Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/08/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	DIR Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	DIR Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Emergency Part D Contact	Customer Service Workforce Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Emergency Part D Contact (Secondary)	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	600 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Encounter Data & Risk Adjustment Operations Contact			Olberding	Milissia		6126763205					molberding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/29/2019	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Enrollment Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	EOB Transfer Contact	Customer Service Workforce Manager		Vang	Pakou		6126763585				6128842145	pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/08/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Financial Audit Contact	VP Controller	Mr.	Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Financial Reporting Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Formulary Contact	Pharmacy Supervisor		Merk	Zachariah		6126763483					zmerk@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	07/29/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Formulary Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	General Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Government Relations Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	HIPAA Privacy Officer	Associate General Counsel - Privacy Officer		Heacox	Katie		5073408378					kheacox@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	HIPAA Security Officer	IS Business Security Manager		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Hospice Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Interoperability Contact	VP, Deputy General Counsel		Owen	Elizabeth		6513992800					eowen@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	MA Appeals/Grievances Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	MA Claims Processing Contact for Public Website	CCO Audit & Compliance Manager		Tenhoff	Reed		6126763664					rtenhoff@ucare.og	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/11/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Marketing Contact	Government Relations Materials Coordinator		Morales	Ana Sophia		6122945641					amorales@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/22/2021	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Medical Director	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	McMahon	Jane		6124567817					federalgrleadershipteam@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/30/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Medicare Coordinator	Federal Government Relations Manager		Mitchell	Milonda		6122945143					mmitchell1@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/12/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030					anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Medication Therapy Management Contact	Pharmacy Quality Manager		Bower	Erika		6122945800				6128842321	ebower@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/10/2021	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	OffShore Subcontractor Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Online Enrollment Center Contact (Back-up)	MBE Operations Manager		Rooney	Courtney		6126763468					crooney@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	11/12/2020	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Part C Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Part C Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/13/2021	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Appeals	A&G Regulatory and Compliance Specialist		Wood	Nakia							cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945668				HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Appeals Contact (Secondary)	Manager Appeals & Grievances		Paciorek	Joshua							jpaciorek@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945225				HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Claims Submission Contact	Data Analyst Sr.		Krishnan	Kamali		6122945146					kkrishnan@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/30/2019	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Exceptions Contact	Vice President Pharmacy Management		Mitsch	Patrick						6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945051				HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Exceptions Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam						6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945030				HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Price File Contact (Back-up)	Pharmacy Operations Manager Sr.		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Price File Contact (Optional)	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Price File Contact (Primary)	Sr Manager, Government Programs		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	01/18/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Quality Assurance Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Part D Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/13/2019	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Patient Safety Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Payment Contact	Chief Financial Officer		Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Pharmacy Director	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	patmitsch@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Pharmacy Network Management Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Pharmacy Technical Help Desk Contact	Director, Customer Service		Moore	LaTasha							LaTasha_Monroe@expressscripts.com	13051 N Telecom Parkway	Suite 150	Temple Terrace	FL	33637	01/18/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H0422	PHR Beneficiary Contact																	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS	UCare	UCare Minnesota	238	Yes	Active	8775231515				HMO - Health Maintenance Organization		C	Chicago
H0422	Physician Incentive Contact	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/06/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Plan Directory Contact for Public Website	Customer Service Workforce Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/08/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Plan to Plan Reconciliation Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Processor Contact	Pharmacy Operations Manager Sr		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Quality Contact	Vice President Quality Management		Hanley	Greg		6122945296					ghanley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Reconciliation Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Reconciliation Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Recovery Audit Contact	Audit Director	Mr.	Schach	Steve		6126763562					sschach@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	554132615	04/17/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	SNP Application Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	SNP State Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Surveillance Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	System Contact	IS Business Security Manager		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Third Party Administrator (TPA) Liaison	Accountant		Zator	Chris		6126763563					czator@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/15/2021	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	User Access Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/19/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Utilization Management Contact	VP Clinical Services		Wickman	Amy		6126763418					awickman@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0422	Utilization Review Contact	Clinical Regulatory Specialist		Brown	Julie	B	6126763433					jbbrown@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0423	Agent/Broker Compensation Data Contact	Director of Regulatory Compliance	Mr.	Francois	Jackedja		2129083329					FRANCOJ@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/16/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Automated TrOOP Balance Transfer Contact	Medicare Part D Operations Manager	Mr.	Oh	Benjamin		2129083131				2129088603	ohben@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Backup User Access Contact	Medicare Regulatory Compliance Manager	Ms.	Rasch	Jennifer		2129085221					peguem@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	08/13/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Best Available Evidence Contact	Medicare Operations Regulatory Analyst		Vilchez	Erika		2129083150				2129088603	vilchee@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/16/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Bid Audit Contact	Chief Administrative Officer	Ms.	Leverich	Lauren		2129088592				2129088520	LEVERL@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Bid Audit Site Contact	Chief Financial Officer	Ms.	Leverich	Lauren		2129088592				2129088520	LEVERL@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	08/13/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Bid Primary Contact	Chief Administrative Officer	Ms.	Leverich	Lauren		2129088592				2129088520	LEVERL@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	CAP Report Contact for Public Website	Director Regulatory Compliance	Ms.	Francois	Jackedja	N	2129083329				2129088620	franco@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	12/13/2022	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active	2129083329				HMO - Health Maintenance Organization		C	New York
H0423	CEO - CMS Administrator Contact	President & Chief Executive Officer	Dr.	Schwartz	Talya		2129088569				2129088667	schwata@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	CEO - Senior Official for Contracting	President & Chief Executive Officer	Dr.	Schwartz	Talya		2129088569				2129088667	schwata@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Chief Financial Officer	Chief Administrative Officer	Ms.	Leverich	Lauren		2129088592					LEVERL@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Chief Operating Officer	Chief Operating Officer	Ms.	Benayoun	Lila		2129088627				2129084402	BENAYL@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	09/19/2022	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Chief Information Officer	Chief Information Officer	Mr.	Ramratan	Ganesh		2129088803					ramratg@metroplus.org	50 Water St	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Chief Information Security Officer	Chief Information Security Officer	Mr.	Micillo	Robert		2129088425					micillor@metroplus.org	50 Water St	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	CMS Casework Communication Contact	Senior Director of Call Center Operations	Ms.	Bartley	Kenesha		2129083643				2129088701	bartleyk@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	09/19/2022	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Complaints Tracking Contact	Senior Director of Call Center Operations	Ms.	Bartley	Kenesha		2129083643				2129088701	bartleyk@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	09/19/2022	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Contact for Fraud Investigations	Director of SIU	Mr.	Mullen	Shawn		2129083138				2129084402	mullensh@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Coordination of Benefits Contact		Mr.	Ansari	Zia	M	2129083124					ansarmo@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	09/19/2022	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Corporate Mailing						2129088600				2129088667	schwata@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Analyst	Ms.	Goyal	Anandita		2129088807				2129088520	goyalan@metroplus.org	50 Water St	7th Floor	New York	NY	10004	08/31/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Customer Service Operations Contact	Senior  Director of Call Center Operations	Ms.	Bartley	Kenesha		2129083643				2129088705	bartleyk@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	12/09/2022	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	DIR Contact	Risk Analytics Manager	Mr.	Harber	Steve		2129083712					harbers@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	DIR Contact (Secondary)	Chief Administrative Officer	Ms.	Leverich	Lauren		2129088592	9088592			2129088520	LEVERL@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Emergency Part D Contact	Director of Regulatory Compliance		Francois	Jackedja		2129083329					FRANCOJ@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/16/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Emergency Part D Contact (Secondary)	Deputy Director of Pharmacy	Ms.	Suchdeve	Swati		2129083765					suchds@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	07/12/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Encounter Data & Risk Adjustment Operations Contact	Healthcare Payment Innovation Lead	Mr.	Badillo	Frank		2129083715					badilf@metroplus.org	50 Water St	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Enrollment Contact	Medicare Operations Regulatory Analyst		Vilchez	Erika		2129083150				2129088603	vilchee@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/16/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	EOB Transfer Contact	Director of Claims		Hardy	Monique		2129088852				2129088666	hardymo@metroplus.org	50 Water Street	7th floor	New York	NY	10004	08/29/2022	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Financial Audit Contact	Chief Financial Officer	Ms.	Leverich	Lauren		2129088592					leverl@metroplus.org	50 Water Street	12th floor	New York	NY	10004	08/13/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Financial Reporting Contact	Risk Analytics Manager	Mr.	Harber	Steve		2129083712				2129088520	harbers@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Formulary Contact	Clinical Advisor		Houska	Heather		3149064727					heather.houska@cvshealth.com	One CVS Drive		Woonsocket	RI	02895	08/02/2022	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Formulary Contact (Secondary)	Deputy Director of Pharmacy	Ms.	Suchdeve	Swati		2129083765					suchds@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	07/12/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	General Contact	Medicare Operations Regulatory Analyst		Vilchez	Erika		2129083150				2129088603	vilchee@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/16/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Government Relations Contact	President & Chief Executive Officer	Dr.	Schwartz	Talya		2129088569				2129088667	schwata@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	HIPAA Privacy Officer	Chief Legal & Compliance Officer	Ms.	Solon	Raven	R	2129085205				2129088602	solonr@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	HIPAA Security Officer	Chief Information Security Officer	Mr.	Micillo	Robert		2129088425					micillor@metroplus.org	50 Water St	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Hospice Contact	Deputy Director Pharmacy Department		Suchdeve	Swati		2129083765					suchds@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	12/17/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Interoperability Contact	MIS Core Systems Analyst		Fox	Howard		2129088739					foxh@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	05/02/2022	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	MA Appeals/Grievances Contact	Director of Regulatory Compliance	Ms.	Francois	Jackedja		2129083329					FRANCOJ@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/19/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	MA Claims Processing Contact for Public Website			Services	Customer		8669860356				2129088620	pricek@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Marketing Contact	Medicare/MAP Regulatory Affairs Analyst	Mr.	Mishel	Joseph		2129083364					mishej@metroplus.org	50 Water Street	12th floor	New York	NY	10004	12/13/2022	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Medical Director	Chief Medical Officer	Dr.	Shah	Sanjiv		2129083640					shahs@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Medicare Compliance Officer	Director of Regulatory Compliance	Ms.	Francois	Jackedja		2129083329				2129083013	FRANCOJ@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/19/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Medicare Coordinator	Medicare Operations Regulatory Analyst		Vilchez	Erika		2129083150				2129088603	vilchee@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/16/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Medicare Part D Opioid Overutilization Contact	Medicare Part D Operations Manager	Mr.	Oh	Benjamin		2129083131					ohben@metroplus.org	50 Water Street	7th Floor	NY	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Medication Therapy Management Contact	Medicare Part D Operations Manager	Mr.	Oh	Benjamin		2129083131					ohben@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Online Enrollment Center Contact (Back-up)	DST Health Solutions	Ms.	Wimer	Lori		8164353266					lawimer@dsthealthsolutions.com	2400 Thea Dr		Harrisburg	PA	17110	02/08/2017	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Online Enrollment Center Contact (Primary)	Medicare Operations Regulatory Analyst		Vilchez	Erika		2129083150				2129088603	vilchee@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/16/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Part C Application Contact	Director of Regulatory Compliance	Ms.	Francois	Jackedja		2129083329					FRANCOJ@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/19/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Part C Reporting Contact	Medicare Operations Regulatory Analyst	Ms.	Vilchez	Erika		2129083150				2129088603	vilchee@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/19/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Part D Appeals	Deputy Director of Pharmacy	Ms.	Suchdeve	Swati							suchds@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	07/12/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active	2129083765				HMO - Health Maintenance Organization		C	New York
H0423	Part D Appeals Contact (Secondary)	Medicare Part D Operations Manager	Mr.	Oh	Benjamin							ohben@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active	2129083131				HMO - Health Maintenance Organization		C	New York
H0423	Part D Application Contact	Director of Regulatory Compliance		Francois	Jackedja		2129083329					FRANCOJ@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/16/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Part D Benefits Contact	Medicare Part D Operations Manager	Mr.	Oh	Benjamin		2129083131				2129088603	ohben@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	07/12/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Part D Claims Submission Contact	Medicare Part D Operations Manager	Mr.	Oh	Benjamin		2129083131				2129088603	ohben@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Part D Exceptions Contact	Deputy Director of Pharmacy	Ms.	Suchdeve	Swati							suchds@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	07/12/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active	2129083765				HMO - Health Maintenance Organization		C	New York
H0423	Part D Exceptions Contact (Secondary)	Medicare Part D Operations Manager	Mr.	Oh	Benjamin						2129088603	ohben@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	07/12/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active	2129083131				HMO - Health Maintenance Organization		C	New York
H0423	Part D Price File Contact (Back-up)	Manager		Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	9501 E Shea Blvd	MC121	Scottsdale	AZ	85260	07/14/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Part D Price File Contact (Primary)	Medicare Part D Operations Manager	Mr.	Oh	Benjamin		2129083131					ohben@metroplus.org	50 Water St	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Part D Quality Assurance Contact	Deputy Director of Pharmacy	Ms.	Suchdeve	Swati		2129083765					suchds@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	07/12/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Part D Reporting Contact	Medicare Operations Regulatory Analyst		Vilchez	Erika		2129083150				2129088603	vilchee@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/16/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Patient Safety Contact	Medicare Part D Operations Manager	Mr.	Oh	Benjamin		2129083131					ohben@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Payment Contact	Controller	Mr.	Santiago	Jose		2129088444					santiagjo@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Personal Health Record Contact	Director of Legal Research, Records & Infrastructu	Ms.	Binns	Pamela		2129085205				2129088602	binnspa@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Pharmacy Director	Deputy Director of Pharmacy	Ms.	Suchdeve	Swati		2129083765					suchds@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	07/12/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Pharmacy Network Management Contact	Director of Pharmacy		Patel	Suzana		2129083014				2129083014	patelsu@metroplus.org	50 Water St	7th Floor	New York	NY	10004	07/12/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Pharmacy Network Management Contact (Secondary)	Deputy Director of Pharmacy	Ms.	Suchdeve	Swati		2129083765					suchds@metroplus.org	50 Water St	7th Floor	New York	NY	10004	07/12/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Pharmacy Technical Help Desk Contact	Pharmacist	Mr.	Curtis	Kirk							kirk.curtis@cvshealth.com	42121 E. Cotton Center Blvd.		Phoenix	AZ	85040	12/05/2019	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H0423	Pharmacy Technical Help Desk Contact (Secondary)	Deputy Director of Pharmacy	Ms.	Suchdeve	Swati							suchds@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	07/12/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active	2129083765				HMO - Health Maintenance Organization		C	New York
H0423	Plan Directory Contact for Public Website	Director of Communications	Ms.	Soman	Kathryn		2129088588				2129088603	somank@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Plan to Plan Reconciliation Contact	Finance Analyst	Ms.	Goyal	Anandita		2129088807					goyalan@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	08/31/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Processor Contact	Director of MIS Core Systems	Mr.	Baig	Aleem		2129088869				2129088655	baiga@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Quality Contact	Sr. Director of Quality Management	Ms.	Sorrentino	Eleanor		2129088896					sorrene@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Reconciliation Contact	Risk Analytics Manager	Mr.	Harber	Steven		2129083712				2129088620	harbers@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Reconciliation Contact (Secondary)	Chief Administrative Officer	Ms.	Leverich	Lauren		2129088592					LEVERL@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Recovery Audit Contact	Risk Analytics Manager	Mr.	Harber	Steven		2129083721					harbers@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	SNP Application Contact	Director of Regulatory Compliance		Francois	Jackedja		2129083329					FRANCOJ@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/16/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	SNP State Contact	Director of Regulatory Compliance		Francois	Jackedja		2129083329					FRANCOJ@metroplus.org	50 Water Street	12th floor	New York	NY	10004	07/16/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Surveillance Contact	Chief Legal & Compliance Officer	Ms.	Solon	Raven	R	2129085205				2129084402	solonr@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	System Contact	Director of MIS Core Systems	Mr.	Baig	Aleem		2129088600	8869			2129088655	baiga@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Third Party Administrator (TPA) Liaison	Finance Analyst	Ms.	Goyal	Anandita		2129088807				2129088520	goyalan@metroplus.org	50 Water St	7th Floor	New York	NY	10004	08/31/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	User Access Contact	Chief Legal & Compliance Officer	Ms.	Solon	Raven	R	2129085205				2129085205	solonr@metroplus.org	50 Water Street	7th Floor	New York	NY	10004	04/28/2021	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Utilization Management Contact	Sr.Director of Clinical Services	Ms.	St. Hilaire	Lynn		2129085296					sthilail@metroplus.org	160 Water Street	3rd Floor	New York	NY	10038	12/11/2019	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0423	Utilization Review Contact	Sr.Director of Clinical Services	Ms.	St. Hilaire	Lynn		2129085296					sthilail@metroplus.org	160 Water Street	3rd Floor	New York	NY	10038	12/11/2019	2023	METROPLUS HEALTH PLAN, INC.	Local CCP	MetroPlus Health Plan	HMO/HMOPOS		New York City Health and Hospitals Corporation	430	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0424	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Backup User Access Contact	Chief Information Officer		Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Best Available Evidence Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Bid Primary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	CAP Report Contact for Public Website	VP of Clinical Compliance		Teter	Lezlie		7203929719				3039961600	lteter@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	CEO - CMS Administrator Contact	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	CEO - Senior Official for Contracting	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Chief Financial Officer	CFO	Mr	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Chief Operating Officer	Senior Advisor	Ms.	Lozzano	Maria		9098902854				3039961600	mlozzano@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Chief Information Officer	Chief Information Officer	Ms.	Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Chief Information Security Officer	SVP of Information Technology	Mr.	Naus	Cole		7209210443				3039961600	MNaus@innovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	CMS Casework Communication Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Complaints Tracking Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Contact for Fraud Investigations	Chief Legal Officer		D'Amato	Nicole		6154732250				3039961600	NDAmato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Coordination of Benefits Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Corporate Mailing						3038694664				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Customer Service Operations Contact	Senior Advisor		Lozanno	Maria		9098902854				3039961600	mlozanno@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	DIR Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	DIR Contact (Secondary)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Emergency Part D Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Emergency Part D Contact (Secondary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Encounter Data & Risk Adjustment Operations Contact	Director of PACE Finance		Hewitt	Jessica		7209746767					jhewitt@innovage.com	8950 E Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Enrollment Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	EOB Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Financial Audit Contact	Director of PACE Finance	Ms	Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Financial Reporting Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Formulary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Formulary Contact (Secondary)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	General Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Government Relations Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	HIPAA Privacy Officer	Corporate Counsel		Moxon	Jeff		3038694664				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	HIPAA Security Officer	SVP of Information Technology		Naus	Cole		7209210443				3039961600	MNaus@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Interoperability Contact	SVP of Applications		Zierolf	Kris		7209742380					kzierolf@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	MA Appeals/Grievances Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	MA Claims Processing Contact for Public Website	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Marketing Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Medical Director	Medical Director		Ferrance	Randy		2159514586				3039961600	rferrance@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Medicare Compliance Officer	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Medicare Coordinator	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Medicare Part D Opioid Overutilization Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 E. Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Medication Therapy Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Online Enrollment Center Contact (Back-up)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Online Enrollment Center Contact (Primary)	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Part C Application Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Part D Appeals	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending	7207444048				PACE - Nat		C	Atlanta
H0424	Part D Appeals Contact (Secondary)	Managing Legal  Counsel	Mr..	Robertson	Cody						3039961600	crobertson@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	06/07/2021	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending	7209742459				PACE - Nat		C	Atlanta
H0424	Part D Application Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Part D Benefits Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Part D Claims Submission Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Part D Exceptions Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending	7207444048				PACE - Nat		C	Atlanta
H0424	Part D Exceptions Contact (Secondary)	Finance and Compliance Analyst	Mr.	Kizewski	Alex						3039961600	akizewski@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	06/07/2021	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending	3038694664				PACE - Nat		C	Atlanta
H0424	Part D Price File Contact (Back-up)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Part D Price File Contact (Primary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Part D Quality Assurance Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Part D Reporting Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Patient Safety Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Personal Health Record Contact	VP Associate of General Counsel		Moxon	Jeff		3033006930				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Pharmacy Director	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Pharmacy Network Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Pharmacy Technical Help Desk Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending	7207444048				PACE - Nat		C	Atlanta
H0424	PHR Beneficiary Contact																	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE	Total Longterm Care Inc	Total Community Options, Inc	813	Yes	Pending	8772776163	732			PACE - Nat		C	Atlanta
H0424	Plan Directory Contact for Public Website	Director of Marketing		Stavros	Sarah		3033006904				3039961600	sstavros@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Plan to Plan Reconciliation Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				7209173390	akizewski@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Processor Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Quality Contact	VP of Quality		Curry	Jill		2153782123				3039961600	jcurry@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Reconciliation Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Reconciliation Contact (Secondary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7206663817					mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/15/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Recovery Audit Contact	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444404					mcinque@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Surveillance Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	System Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Third Party Administrator (TPA) Liaison	Medicare Compliance Manager		Brown	Lauren		7209746767				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	User Access Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Utilization Management Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0424	Utilization Review Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE FLORIDA PACE II, LLC	National PACE	InnovAge Florida PACE - Orlando	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H0432	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H0432	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H0432	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H0432	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H0432	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0432	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0439	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	05/19/2022	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	11/24/2020	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	09/06/2022	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	11/08/2022	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	01/07/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	01/07/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/02/2018	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	01/03/2022	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	09/05/2018	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/21/2022	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	12/15/2022	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	11/09/2022	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	02/14/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	02/09/2022	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/30/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H0439	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H0439	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H0439	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H0439	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	12/13/2019	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	02/02/2019	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	02/02/2019	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	01/03/2022	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	01/01/2020	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H0439	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H0439	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	03/15/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	04/24/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/18/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	07/17/2023	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0439	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTHCARE OF GEORGIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0440	Automated TrOOP Balance Transfer Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Backup User Access Contact	VP - IT	Mr.	Clark	Arthur		7275234050				7275234006	ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Best Available Evidence Contact			Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Bid Primary Contact	Executive Director		Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	CAP Report Contact for Public Website	Executive Director		Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	CEO - CMS Administrator Contact	CEO/President	Mr.	Fleece	Jonathan		9415527525					JFleece@EmpathHealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	02/27/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	CEO - Senior Official for Contracting	CEO/President	Mr.	Fleece	Jonathan		9415527525					JFleece@EmpathHealth.org	5771 Roosevelt		Clearwater	FL	33760	02/27/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Chief Financial Officer	CFO	Ms.	Bouhamid	Saida		7275864432					SaidaBouhamid@EmpathHealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	10/18/2022	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Chief Operating Officer	CEO/President	Mr.	Fleece	Jonathan		9415527525					jonathanfleece@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Chief Information Officer	VP IT	Ms.	Clark	Arthur		9413743213					ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	05/02/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Chief Information Security Officer	VP IT	Ms.	Clark	Arthur		9413743213					arthurclark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	05/02/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	CMS Casework Communication Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Complaints Tracking Contact	Quality Coordinator		McNeill	Lisa		7273241827					lisamcneill@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Contact for Fraud Investigations	Vice President - Compliance		Mosby	Laura		7275864432					LauraMosby@EmpathHealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Coordination of Benefits Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Corporate Mailing						9415527525				9415565800	jonathanfleece@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Coverage Gap Discount Program (CGDP) Payment Contact	Executive Director		Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Customer Service Operations Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	DIR Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	DIR Contact (Secondary)	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Emergency Part D Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Emergency Part D Contact (Secondary)	Executive Director		Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Clearwater	FL	33760	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Encounter Data & Risk Adjustment Operations Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Clearwater	FL	33760	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Enrollment Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	EOB Transfer Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204				7273241866	jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Financial Audit Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Financial Reporting Contact	CFO		Bouhamid	Saida		7275233339					SaidaBouhamid@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Formulary Contact	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Formulary Contact (Secondary)	Vice President	Mr.	Pettry	Jason		7273241843					JasonPettry@EmpathHealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	02/27/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	General Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Government Relations Contact	SVP	Mr.	Reiter	Thomas		7205304082					thomasreiter@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	HIPAA Privacy Officer	Vice President - Compliance		Mosby	Laura		7275864432					LauraMosby@EmpathHealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	HIPAA Security Officer	Vice President - Compliance		Mosby	Laura		7275864432					LauraMosby@EmpathHealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Interoperability Contact	SVP	Mr.	Reiter	Thomas		7205304082					thomasreiter@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	MA Appeals/Grievances Contact	Quality Coordinator		McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	MA Claims Processing Contact for Public Website	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Marketing Contact	VP of Marketing and Communications	Ms.	Allen	Kelly		7275233395					kellyallen@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Medical Director	Medical Director	Dr.	Burt	William		7272890062					WilliamBurt@EmpathHealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Medicare Compliance Officer	Vice President-Compliance	Ms.	Mosby	Laura		7275864432					LauraMosby@EmpathHealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Medicare Coordinator	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Medicare Part D Opioid Overutilization Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Medication Therapy Management Contact	Medical Director	Dr.	Burt	William		7272890062					WilliamBurt@EmpathHealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	OffShore Subcontractor Contact		Mr.	Pettry	Jason		7273241843					JasonPettry@EmpathHealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	02/27/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Online Enrollment Center Contact (Back-up)		Mr.	Pettry	Jason		7273241843					JasonPettry@EmpathHealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	02/27/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Online Enrollment Center Contact (Primary)	Enrollment Supervisor	Ms.	Gruden	Sheri		7272890062					SheriGruden@EmpathHealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Part C Application Contact	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Part D Appeals	Health Plan Operations Manager		Crevier	Jeanne						7273241866	jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active	7272599204				PACE - Nat		C	Atlanta
H0440	Part D Appeals Contact (Secondary)	Operations Manager	Mr	Messersmith	Christophe						7273241866	christophermessersmith@empathhhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	12/29/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active	7273241868	3241868			PACE - Nat		C	Atlanta
H0440	Part D Application Contact	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Part D Benefits Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Part D Claims Submission Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Part D Exceptions Contact	Executive Director	Mr.	Messersmith	Christophe						7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active	7273241858				PACE - Nat		C	Atlanta
H0440	Part D Exceptions Contact (Secondary)			Mamutaj	Miranda							MirandaMamutaj@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	03/31/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active	7275864432				PACE - Nat		C	Atlanta
H0440	Part D Price File Contact (Back-up)	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Part D Price File Contact (Primary)	Executive Director	Mr.	Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Part D Quality Assurance Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Part D Reporting Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Patient Safety Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Payment Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Personal Health Record Contact		Mr.	Pettry	Jason		7273241843					JasonPettry@EmpathHealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	02/27/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Pharmacy Director	Pharmacy Director		Rigali	Aaron		7275864432					AaronRigali@EmpathHealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Pharmacy Network Management Contact	Pharmacy Director		Rigali	Aaron		7275864432					AaronRigali@EmpathHealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Pharmacy Network Management Contact (Secondary)	Medical Director	Dr.	Burt	William		7272890062					WilliamBurt@EmpathHealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Pharmacy Technical Help Desk Contact			Rigali	Aaron							AaronRigali@EmpathHealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active	7275864432				PACE - Nat		C	Atlanta
H0440	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Manager		Harvey	Tracy							TracyHarvey@EmpathHealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active	7275864432				PACE - Nat		C	Atlanta
H0440	PHR Beneficiary Contact																	09/24/2020	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE	Empath LIFE	Empath Health, Inc.	635	Yes	Active	7272890062				PACE - Nat		C	Atlanta
H0440	Plan Directory Contact for Public Website	Executive Director	Mr.	Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Plan to Plan Reconciliation Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Processor Contact	Pharmacy Director	Mr.	Rigali	Aaron		7275232550					aaronrigali@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Quality Contact	Quality Coordinator		McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Reconciliation Contact	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Reconciliation Contact (Secondary)			Pettry	Jason		7273241843					JasonPettry@EmpathHealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	02/27/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Recovery Audit Contact	VP of Compliance	Ms.	Mosby	Laura		7275232106					LauraMosby@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Surveillance Contact	VP of Compliance		Mosby	Laura		7275232106					LauraMosby@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	System Contact	VP of IT	Mr.	Clark	Arthur		7275234050				7275234006	ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Third Party Administrator (TPA) Liaison	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	User Access Contact	VP of IT	Mr.	Clark	Arthur		7275234050				7275234006	ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Utilization Management Contact	Quality Coordinator		McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0440	Utilization Review Contact	Quality Coordinator	Mr.	McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	6774 102nd Ave North		Pinellas Park	FL	33782	09/06/2023	2023	EMPATH LIFE, LLC	National PACE	Empath LIFE	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H0473	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H0473	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025807929				PPO - BBA		C	Kansas City
H0473	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H0473	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5024682494				PPO - BBA		C	Kansas City
H0473	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	8008658715				PPO - BBA		C	Kansas City
H0473	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025800475				PPO - BBA		C	Kansas City
H0473	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0473	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF KENTUCKY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H0477	Automated TrOOP Balance Transfer Contact			Moroz	Margarita	N	4136279772					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Backup User Access Contact			Norton	Margarita		4136279772					rita.norton@ihserv.org	604 Cottage st		Springfield	MA	01104	04/22/2013	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Best Available Evidence Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Bid Primary Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	CAP Report Contact for Public Website			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	CEO - CMS Administrator Contact		Mrs.	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	CEO - Senior Official for Contracting	Administrator	Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Chief Financial Officer	Administrator	Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Chief Operating Officer		Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	604 Cottage st		Springfield	MA	01104	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Chief Information Officer		Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	604 Cottage st		Springfield	MA	01104	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Chief Information Security Officer		Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	604 Cottage st		Springfield	MA	01104	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	CMS Casework Communication Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Complaints Tracking Contact		Ms	Bessarabova	Daniella		4133742416					daniella.bessarabova@serenitypace.org	P.O.Box2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Contact for Fraud Investigations		Ms	Bassarabova	Daniella		4133742416					daniella.bessarabova@serenitypace.org	P.O.Box2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Coordination of Benefits Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Corporate Mailing						6176050727					rita.blanter@ihserv.org	P.O.Box2006		Andover	MA	01810	04/23/2013	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Coverage Gap Discount Program (CGDP) Payment Contact		Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	604 Cottage st		Springfield	MA	01104	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Customer Service Operations Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	DIR Contact			Tannery	Bob		8882787000					sales@pharmastarpbm.com	P.O.Box		Eau Claire	WI	54702	04/23/2013	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Emergency Part D Contact		Mr	Tannery	Bob		8882787000					sales@pharmastarpbm.com	P.O.Box		Eau Claire	WI	54702	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Encounter Data & Risk Adjustment Operations Contact			Blanter	Margarita		4132416231					rita.blanter@ihserv.org	604 Cottage Street		Springfield	MA	01104	05/28/2020	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Enrollment Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	EOB Transfer Contact		Mrs.	Blanter	Margarita		6176050727				6174875261	rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Financial Audit Contact	Administrator	Mrs.	Blanter	Margarita		6176050727				6174875261	rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Financial Reporting Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Formulary Contact		Mr	Tannery	Bob		8882787000					sales@pharmastarpbm.com	P.O.Box		Eau Claire	WI	54702	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	General Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Government Relations Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	HIPAA Privacy Officer		Ms	Bessarabova	Daniella		4133742416					daniella.bessarabova@serenitypace.org	P.O.Box2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	HIPAA Security Officer		Mrs	Bessarabova	Daniella		4133742416					daniella.bessarabova@serenitypace.org	P.O.Box2006		Andover	MA	01810	04/24/2021	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Interoperability Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	604 Cottage Street		Springfield	MA	01104	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	MA Appeals/Grievances Contact		Ms	Bessarabova	Daniella		4133742416					daniella.bessarabova@serenitypace.org	P.O.Box2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	MA Claims Processing Contact for Public Website			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Marketing Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Medical Director		Dr.	Alexeyenko	Alexandre		6176050727					rita.blanter@ihserv.org	P.O.Box2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Medicare Compliance Officer		Ms	Bessarabova	Daniella		4133742416					daniella.bessarabova@serenitypace.org	P.O.Box2006		Andover	MA	01810	04/24/2021	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Medicare Coordinator			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Medicare Part D Opioid Overutilization Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Medication Therapy Management Contact		Mr	Tannery	Bob		8882787000					sales@pharmastarpbm.com	P.O.Box		Eau Claire	WI	54702	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Part C Application Contact	Executive Director	Mrs	Blanter	Margarita		6176050727				9788870032	rita.blanter@ihserv.org	P.O. Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Part D Appeals		Ms	Bessarabova	Daniella							daniella.bessarabova@serenitypace.org	P.O.Box2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active	4137342416				PACE - Nat		C	Boston
H0477	Part D Appeals Contact (Secondary)	Part D Compliance Officer	Ms	Bessarabova	Daniella						4138316639	daniella.bessarabova@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active	6176050727				PACE - Nat		C	Boston
H0477	Part D Application Contact	Executive Director	Mrs	Blanter	Margarita		6176050727				9788870032	rita.blanter@ihserv.org	P.O. Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Part D Benefits Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Part D Claims Submission Contact		Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Part D Exceptions Contact		Mr	Tannery	Bob							sales@pharmastarpbm.com	P.O.Box		Eau Claire	WI	54702	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active	8882787770				PACE - Nat		C	Boston
H0477	Part D Price File Contact (Back-up)			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Part D Price File Contact (Primary)			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Part D Quality Assurance Contact		Ms	Bessarabova	Daniella		4137342416					daniella.bessarabova@serenitypace.org	P.O.Box2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Part D Reporting Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Patient Safety Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Payment Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Pharmacy Director		Mr	Tannery	Bob		8882787000					sales@pharmastarpbm.com	P.O.Box		Eau Claire	WI	54702	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Pharmacy Network Management Contact		Mr	Tannery	Bob		8882787000					sales@pharmastarpbm.com	P.O.Box		Eau Claire	WI	54702	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Pharmacy Technical Help Desk Contact		Mr	Tannery	Bob							sales@pharmastarpbm.com	P.O.Box		Eau Claire	WI	54702	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active	8882787770				PACE - Nat		C	Boston
H0477	Plan Directory Contact for Public Website		Mr	Tannery	Bob		8882787000					sales@pharmastarpbm.com	P.O.Box		Eau Claire	WI	54702	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Plan to Plan Reconciliation Contact		Mr	Tannery	Bob		8882787000					sales@pharmastarpbm.com	P.O.Box		Eau Claire	WI	54702	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Processor Contact		Mr	Tannery	Bob		8882787000					sales@pharmastarpbm.com	P.O.Box		Eau Claire	WI	54702	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Quality Contact		Ms	Bessarabova	Daniella		4137342416					daniella.bessarabova@serenitypace.org	P.O.Box2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Reconciliation Contact			Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Recovery Audit Contact	Administrator	Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Surveillance Contact	Administrator	Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	System Contact	Administrator	Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Third Party Administrator (TPA) Liaison		Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	604 Cottage st		Springfield	MA	01104	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	User Access Contact	Administrator	Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Utilization Management Contact	Administrator	Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0477	Utilization Review Contact	Administrator	Mrs	Blanter	Margarita		6176050727					rita.blanter@ihserv.org	P.O.Box 2006		Andover	MA	01810	05/24/2022	2023	SERENITY CARE, INC.	National PACE	Serenity Care PACE	National PACE		Serenity Care, Inc.	561	Yes	Active					PACE - Nat		C	Boston
H0480	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Chief Information Officer	SVP, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	01/24/2020	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	09/26/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Corporate Mailing						8132063477					crysten.troutman@wellcare.com	P. O. Box 31386		Tampa	FL	33631	04/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	09/26/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	DIR Contact (Secondary)	Senior Director, Predictive Analytics		Lamour	David		8132067536					david.lamour@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/26/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	02/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Encounter Data & Risk Adjustment Operations Contact	Sr Manager, Risk Adjustment		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	09/26/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Financial Reporting Contact	Regulatory Compliance Mgr		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/25/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/25/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Medical Director	Chief Medical Officer	Dr.	Miskimmin	Renee		3133243700					renee.miskimmin@mhplan.com	1 Campus Martius	Suite 700	Detroit	MI	48226	07/19/2017	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	MMP Reporting Requirements Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	MMP Point of Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	09/26/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/24/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	09/26/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	09/26/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	PHR Beneficiary Contact																	09/27/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8553234578				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Plan Directory Contact for Public Website			Services	Member		8553234578				8778582437	meridianmedicare@mhplan.com	1 Campus Martius	Suite 700	Detroit	MI	48226	02/27/2017	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/26/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	09/26/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0480	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Demo	MeridianComplete (Medicare-Medicaid Plan)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0482	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H0482	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	02/05/2020	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/05/2020	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/05/2020	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Medical Director	Chief Medical Director	Dr.	Lucas	Brad		8662464356					blucas@centene.com	3700 Embassy Parkway, Suite 200		Akron	OH	44333	03/30/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0482	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0482	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334311356				HMO - Health Maintenance Organization		C	Dallas
H0482	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	03/31/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0482	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0504	Agent/Broker Compensation Data Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8183316954					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	12/12/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Automated TrOOP Balance Transfer Contact	Senior Manager, Medicare Operations		Halley	Derek		8182286374					Derek.Halley@blueshieldca.com	6300 Canoga Ave,		Woodland Hills	CA	91367	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Backup User Access Contact			Mata	Marcos	R	8183316954					marcos.mata@blueshieldca.com	6300 Canoga Ave.		Woodland Hills	CA	91367	12/12/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Best Available Evidence Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Bid Audit Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Bid Audit Site Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Bid Primary Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	CAP Report Contact for Public Website	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	CEO - CMS Administrator Contact	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/26/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	CEO - Senior Official for Contracting	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Chief Financial Officer	Senior Director, Medicare Finance	Mr.	Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Chief Operating Officer	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Chief Information Officer	Chief Information Officer	Ms.	Davis	Lisa		5106073600					Lisa.Davis@blueshieldca.com	601 12th Street		Oakland	CA	94607	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Chief Information Security Officer	Chief Information Officer	Ms.	Davis	Lisa		5106073600					Lisa.Davis@blueshieldca.com	601 12th Street		Oakland	CA	94607	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	CMS Casework Communication Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Complaints Tracking Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Contact for Fraud Investigations	Senior Manager, Medicare Compliance		Mata	Marcos		8183316954					marcos.mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	12/12/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Coordination of Benefits Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					alfonso.loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	11/02/2017	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Corporate Mailing						5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Customer Service Operations Contact	Director		Mathews	Carolyn		5626135004					Carolyn.Mathews@blueshieldca.com	3021 Reynolds Ranch Pkwy		Lodi	CA	95240	09/07/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	DIR Contact	VP Pharmacy Services		Lum	Alison		5106073697					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	03/02/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	DIR Contact (Secondary)	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/02/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Emergency Part D Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Emergency Part D Contact (Secondary)	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Employer Waiver Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland HIlls	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Encounter Data & Risk Adjustment Operations Contact	Senior Director, Actuary		Rodgers	John		3107442643					John.Rodgers@blueshieldca.com	100 N. Sepulveda Boulevard		El Segundo	CA	90245	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Enrollment Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	EOB Transfer Contact	Medicare Project & Program Manager		Zuehlke	Erica		2093713036				8558953519	zuehlke@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/07/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Financial Audit Contact	Senior Manager, Medicare Compliance	Mr.	Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Ave		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Financial Reporting Contact	Senior Director, Medicare Finance		Ballou	Taylor		5625806311					Taylor.ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Formulary Contact	Director, Formulary Strategy and P&T		Nguyen	Nhi		9168410342					Nhi.Nguyen@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Formulary Contact (Secondary)	Principal Pharmacist, Formulary Management		Trinh	Andy		3238276322					Andy.Trinh@blueshieldca.com	601 Potrero Grande Drive		Monterey Park	CA	91755	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	General Contact			Mata	Marcos	R	8183316954					marcos.mata@blueshieldca.com	6300 Canoga Ave.		Woodland Hills	CA	91367	12/12/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Government Relations Contact			Mata	Marcos	R	8183316954					marcos.mata@blueshieldca.com	6300 Canoga Ave.		Woodland Hills	CA	91367	12/12/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	HIPAA Privacy Officer	Chief Privacy Officer		Keystone	David		5103013363					david.keystone@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/27/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	HIPAA Security Officer	Chief Privacy Officer		Keystone	David		5103013363					david.keystone@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/27/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Hospice Contact	Senior Program Manager		Fields	Torrie		4152295839					Torrie.Fields@blueshieldca.com	50 Beale St.		San Francisco	CA	94105	02/02/2018	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Interoperability Contact	VP Enterprise Digital Growth		Grimm	David		6196864233					david.grimm@blueshieldca.com	2275 Rio Bonito Way	Suite 250	San Diego	CA	92108	02/15/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	MA Appeals/Grievances Contact	Supervisor, Medicare Appeals and Grievances		Lopez	Celina		8182286183				9163506593	celina.lopez@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/02/2015	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	MA Claims Processing Contact for Public Website	Senior Manager, Medicare Operations		Halley	Derek		8182286374					Derek.Halley@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Marketing Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Medical Director	Medicare Medical Director	Dr.	Siddiq	Khaliq		5627137953					Khaliq.Siddiq@blueshieldca.com	555 Anton Boulevard	Suite 800	Costa Mesa	CA	92626	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Medicare Compliance Officer	Senior Director, Medicare Compliance	Mr.	Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Medicare Coordinator	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Medicare Part D Opioid Overutilization Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					OpioidDUR@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/13/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Medication Therapy Management Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					Dawn.Becker-Ellison@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	OffShore Subcontractor Contact	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Online Enrollment Center Contact (Back-up)			Mata	Marcos	R	8183316954					marcos.mata@blueshieldca.com	6300 Canoga Ave.		Woodland Hills	CA	91367	12/12/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Online Enrollment Center Contact (Optional)	WH Application Development and Support		Miller	Terri		8182282155					terri.miller@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	08/22/2013	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Online Enrollment Center Contact (Primary)	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Part C Application Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Part C Reporting Contact			Mata	Marcos	R	8183316954					marcos.mata@blueshieldca.com	6300 Canoga Ave.		Woodland Hills	CA	91367	12/12/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Part D Appeals	Supervisor, Medicare Appeals and Grievances		Lopez	Celina						9163506593	celina.lopez@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/02/2015	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active	8007764466				HMO - Health Maintenance Organization		C	San Francisco
H0504	Part D Appeals Contact (Secondary)	Senior Manager, Operations		Salam	Shahid							Shahid.Salam@blueshieldca.com	4203 Town Center Boulevard		El Dorado Hills	CA	95762	12/30/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active	8007764466				HMO - Health Maintenance Organization		C	San Francisco
H0504	Part D Application Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Part D Benefits Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Part D Claims Submission Contact	Lead Medicare Rx Benefits & Claims Specialist		Campbell	Leslie		5306263838					leslie.campbell@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/18/2016	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Part D Exceptions Contact	Director, Pharmacy Prior Authorization		March	Nancee							nancee.march@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active	8007764466				HMO - Health Maintenance Organization		C	San Francisco
H0504	Part D Exceptions Contact (Secondary)	Senior Manager, Medicare Compliance		Mata	Marcos							Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active	8007764466				HMO - Health Maintenance Organization		C	San Francisco
H0504	Part D Price File Contact (Back-up)	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106072901					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Part D Price File Contact (Primary)	Business Analyst, Rx Benefit/Claims Implementation		Ng	Alvin		5106072964					Alvin.Ng@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Part D Quality Assurance Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Part D Reporting Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8183316954					marcos.mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	12/12/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Patient Safety Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					dawn.becker-ellison@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/18/2016	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Payment Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Pharmacy Director	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Pharmacy Network Management Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106072901					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Pharmacy Technical Help Desk Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik							Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active	8889700933				HMO - Health Maintenance Organization		C	San Francisco
H0504	Physician Incentive Contact	Director, Provider Services - Network		Gonzalez	Maria		3238534445					Maria.Gonzalez2@blueshieldca.com	601 Potrero Grande Drive		Monterey Park	CA	91755	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Plan Directory Contact for Public Website			Services	Member		8007764466					membersvcs@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Plan to Plan Reconciliation Contact	Financial Analyst Consultant		Dahl	Chris		8182282575					BSCP2PRecon@blueshieldca.com	3021 Reynolds Ranch Parkway		Lodi	CA	95240	05/24/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Processor Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106073281					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Quality Contact	Director, Case Management		Taylor	Christy		6197194536					christy.taylor@blueshieldca.com	313 Camino Del Rio	North, Ste. 1300	San Diego	CA	92108	12/16/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Reconciliation Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Reconciliation Contact (Secondary)			Mata	Marcos	R	8183316954					marcos.mata@blueshieldca.com	6300 Canoga Ave.		Woodland Hills	CA	91367	12/12/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Recovery Audit Contact	Senior Manager, Medicare Compliance	Mr.	Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	SNP Application Contact			Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Surveillance Contact			Mata	Marcos	R	8183316954					marcos.mata@blueshieldca.com	6300 Canoga Ave.		Woodland Hills	CA	91367	12/12/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	System Contact	Sr. Director, IT Product Management		Chambers	Shelley		1916866073					Shelley.Chambers@blueshieldca.com	4203 Town Center Boulevard		El Dorado Hills	CA	95762	09/07/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Third Party Administrator (TPA) Liaison	Senior Manager, Finance Analytics		Chen	Jacob		3107442819					Jacob.Chen@blueshieldca.com	100 N. Sepulveda Boulevard		El Segundo	CA	90245	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	User Access Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/21/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Utilization Management Contact	Senior Director, Utilization & Medical Review		Albertsen	Mirela		9168410418					Mirela.Albertsen@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0504	Utilization Review Contact	Senior Director, Utilization & Medical Review		Albertsen	Mirela		9168410418					Mirela.Albertsen@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0523	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	12/29/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/20/2023	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/20/2023	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/14/2023	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/12/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	12/29/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	HIPAA Security Officer	Deputy chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/06/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/14/2023	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/29/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	12/29/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/12/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/05/2015	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/21/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/29/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H0523	PHR Beneficiary Contact																	11/27/2013	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				HMO - Health Maintenance Organization		C	Philadelphia
H0523	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/11/2015	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0523	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0524	Agent/Broker Compensation Data Contact	Manager, Medicare Compliance		Lawrence	Winston		5105070510					winston.d.lawrence@kp.org	1 Kaiser Plaza, 12th Floor		Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Automated TrOOP Balance Transfer Contact	Project Manager III, Pharmacy Benefit Mgmt		Perez	Elizabeth	R	5623670592					Elizabeth.R.Perez@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	08/02/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Backup User Access Contact	Manager, Medicare Compliance		Lawrence	Winston		5105070510					winston.d.lawrence@kp.org	1 Kaiser Plaza, 12th Floor		Oakland	CA	94612	09/05/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Best Available Evidence Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Bid Audit Contact	Executive Director Actuarial		Kenny	Kevin		5102677544					kevin.x.kenny@kp.org	300 Lakeside Drive, 28th Floor		Oakland	CA	94612	12/18/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Bid Audit Site Contact	Compliance Consultant		Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/01/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Bid Primary Contact	Actuarial Director		Chung	Soyoung		5102716816					soyoung.m.chung@kp.org	300 Lakeside Drive, 28th Floor		Oakland	CA	94612	09/04/2019	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	CAP Report Contact for Public Website	Medicare Compliance Lead		Piper	Kimberly		2064739504					Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	CEO - CMS Administrator Contact	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	CEO - Senior Official for Contracting	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Chief Financial Officer	SVP, CFO Business Units and Finance Operations	Mr.	Beltch	Robert	R	8184897560					rob.beltch@kp.org	1 Kaiser Plaza, Suite 806	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/15/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Chief Operating Officer	Executive Director, Medicare Market Strategy & Ops	Mr.	Miller	Paul		5033410073					paul.a.miller@kp.org	500 NE Multnomah St., Ste. 100		Portland	OR	97232	04/10/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Chief Information Officer	Chief Information Officer	Ms.	Comer	Diane		5102258777					Diane.B.Comer@kp.org	2600 Napa Valley Corporate Drive		Napa	CA	94558	09/17/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Chief Information Security Officer	VP, Chief Information Security Officer	Mr.	Goddard	Jim		9252065125					bill.d.vourthis@kp.org	6560 Greenwood Plaza Blvd.		Greenwood Village	CO	80111	08/25/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	CMMI Model Point of Contact	Executive Director, Medicare Compliance		Brandi	Jamie		5102091877					jamie.l.brandi@kp.org	1 Kaiser Plaza, 12th Fl.		Oakland	CA	94612	08/17/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	CMS Casework Communication Contact	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Complaints Tracking Contact	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Contact for Fraud Investigations	Director, Fraud Control and NSIU		Janiga	Marita	C	5102716937				5108917977	marita.c.janiga@kp.org	One Kaiser Plaza	Ordway Building, 12th Floor	Oakland	CA	94612	03/28/2013	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Coordination of Benefits Contact	Senior Director		Chung	Clarence		5623909293				5626583866	clarence.j.chung@kp.org	12254 Bellflower Blvd - Suite 106, 1st Floor		Downey	CA	90242	04/28/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Corporate Mailing						8004430815					mscc@kp.org	P.O. Box 12916		Oakland	CA	946042916	03/28/2013	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Coverage Gap Discount Program (CGDP) Payment Contact			Ballestros	Mayra		6262525164					mayra.x.lujano@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	02/15/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Customer Service Operations Contact			Services	Member		8004430815					mscc@kp.org	1800 Harrison St., 23rd Floor		Oakland	CA	94612	03/28/2013	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	DIR Contact	Senior Business Process Manager		Hsiue	Tony		5626583836					tony.x.hsiue@kp.org	12254 Bellflower Blvd.  Flr. 2		Downey	CA	90242	03/09/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	DIR Contact (Secondary)	Sr. Financial Analyst		San	Kei		5626583445					Kei.San@kp.org	12254 Bellflower Blvd. Fl. 2		Downey	CA	90242	07/17/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Electronic Health Record Contact	Sr Manager, Meaningful Use PMO		Poole	Dolly		5106255813					dolly.poole@kp.org	1800 Harrison St.		Oakland	CA	94612	07/02/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Emergency Part D Contact	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/04/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Emergency Part D Contact (Secondary)	Executive Director, Medicare Compliance		Brandi	Jamie		5102091877					jamie.l.brandi@kp.org	1 Kaiser Plaza, 12th Fl.		Oakland	CA	94612	08/17/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Employer Waiver Contact	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Encounter Data & Risk Adjustment Operations Contact	Director, Risk Adjustment Submission	Ms.	Gu	Jialin		3033383507					jialin.gu@kp.org	2500 South Havana		Aurora	CO	80014	10/21/2019	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Enrollment Contact	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	EOB Transfer Contact	Pharmacy Medicare Operations, Project Manager II		Bonoan	John		5624180564				5626583848	john.b.bonoan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	05/25/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Financial Audit Contact	Compliance Consultant	Ms.	Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/01/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Financial Reporting Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Formulary Contact	Pharmacy Project Manager		Kim	Jung		5624459129					jung.x3.kim@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/19/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Formulary Contact (Secondary)	PHARMACY PROJECT MGR I		Lin	Clement	J	5624459129					Clement.J.Lin@kp.org	12254 Bellflower Blvd		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	General Contact	Medicare Compliance Lead	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	04/06/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Government Relations Contact	Senior Vice President, Government Relations		Barrueta	Anthony	A	5102716835					Anthony.Barrueta@kp.org	One Kaiser Plaza		Oakland	CA	94612	03/28/2013	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	HIPAA Privacy Officer	Compliance Director		Anderson	Angela		5104353413					Angela.B.Anderson@kp.org	1800 Harrison Street	16th Floor	Oakland	CA	94612	11/06/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	HIPAA Security Officer	Senior Director	Mr.	Vourthis	Bill		9252065125					bill.d.vourthis@kp.org	5820 Owens Drive	Building E	Pleasanton	CA	94588	08/25/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Hospice Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Interoperability Contact	National EDI Business Operations		Plattner	Cathy		6268336526					Cathy.P.Plattner@kp.org	75 N Fair Oaks Ave.		Pasadena	CA	91103	11/03/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	MA Appeals/Grievances Contact	Executive Director, Member Relations	Ms	Osborne	Susan		5038133924					susan.a.osborne@kp.org	500 NE Multnomah Street	Suite 100	Portland	OR	97232	08/28/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	MA Claims Processing Contact for Public Website	Dir Customer Engagement Mgmt		Galloway	Lonnie		9094772466					Lonnie.L.Galloway@kp.org	10740 4th Street		Rancho Cucamonga	CA	91730	08/02/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Marketing Contact	Medicare Compliance Lead	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	04/06/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Medical Director	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	11/16/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Medicare Compliance Officer	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Medicare Coordinator	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Medicare Part D Opioid Overutilization Contact	Pharmacist Project Manager		Chong	Sue	H	5626583661					sue.h.chong@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	12/04/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Medication Therapy Management Contact	Medication Therapy Management		Deguzman	Lynn		5106253989					lynn.f.deguzman@kp.org	1800 Harrison St., 13th Floor		Oakland	CA	94612	08/10/2015	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	OffShore Subcontractor Contact	Compliance Consultant - Privacy and Security		Glenn	Jovan		9092512010					jovan.robinson@kp.org	10740 Fourth Street	2nd Floor, Cubicle 023W02	Rancho Cucamonga	CA	91730	08/26/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Online Enrollment Center Contact (Back-up)	Senior Team Manager, Medicare Membership Admin		Nugent	Kristin		8586376801					kristin.n.nugent@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Online Enrollment Center Contact (Optional)	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/05/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Online Enrollment Center Contact (Primary)	Team Manager, Medicare Membership Administration		Covarrubio	Danny		8586143433					danny.x.covarrubio@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Part C Application Contact	Project Manager Lead		Morgan	Emily	M	5104072515					emily.m.morgan@kp.org	1800 Harrison Street		Oakland	CA	94612	10/28/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Part C Reporting Contact	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Part D Appeals	Executive Director, Member Relations		Osborne	Susan							Susan.A.Osborne@kp.org	500 NE Multnomah St., Suite 100		Portland	OR	97232	08/28/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8774083496				HMO - Health Maintenance Organization		C	San Francisco
H0524	Part D Application Contact	Project Manager Lead		Morgan	Emily	M	5104072515					emily.m.morgan@kp.org	1800 Harrison Street		Oakland	CA	94612	10/28/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Part D Benefits Contact	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	04/16/2019	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Part D Claims Submission Contact	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	04/16/2019	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Part D Exceptions Contact	Executive Director, Medicare Compliance		Brandi	Jamie							jamie.l.brandi@kp.org	1 Kaiser Plaza, 12th Fl.		Oakland	CA	94612	08/17/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8004430815				HMO - Health Maintenance Organization		C	San Francisco
H0524	Part D Price File Contact (Back-up)	Financial Analyst		Kamikawa	Emely		5622998753				5626583712	emely.a.kamikawa@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	05/21/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Part D Price File Contact (Optional)	Associate Consultant		Quan	Mariclare		5623850395					mariclare.a.quan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Part D Price File Contact (Primary)	Pharmacy Pricing		Bullard	Myra		5623195747				5626583712	myra.c.bullard@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Part D Quality Assurance Contact	Vice President, Clinical Pharmacy Services		Le	Kim		5622997015					Kim.N1.Le@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Part D Reporting Contact	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Patient Safety Contact	Vice President, Clinical Pharmacy Services		Le	Kim		5622997015					Kim.N1.Le@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Payment Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza, Suite 2552		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Personal Health Record Contact	Executive Director, Medicare Compliance		Brandi	Jamie		5102091877					jamie.l.brandi@kp.org	1 Kaiser Plaza, 12th Fl.		Oakland	CA	94612	08/17/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Pharmacy Director	National Pharmacy Benefits, Vice President		Miller	Wayne		5626583674					wayne.i.miller@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	04/16/2019	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Pharmacy Network Management Contact	National Pharmacy Benefits, Project Manager II		Munoz	Vanessa		5624477739					Vanessa.L.Munoz@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	04/16/2019	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Pharmacy Network Management Contact (Secondary)	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	04/16/2019	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Pharmacy Technical Help Desk Contact	Customer Care Center		OptumRx	PBM								755 Research Parkway Suite 160		Oklahoma City	OK	73104	11/02/2016	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8776451282				HMO - Health Maintenance Organization		C	San Francisco
H0524	Physician Incentive Contact	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Plan Directory Contact for Public Website			Services	Member		8004430815					mscc@kp.org	10740 Fourth St., Second Floor		Rancho Cucamonga	CA	91730	10/10/2014	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Plan to Plan Reconciliation Contact	Interim Director, Medicare Accounting		Wright	Mark	A	9253239443					mark.a.wright@kp.org	1 Kaiser Plaza, 25th Floor		Oakland	CA	94612	01/19/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Processor Contact	Medicare Compliance Consultant	Mr.	Carver	Jon	R	4257578659					jonathan.r.carver@kp.org	1300 SW 27th St.		Renton	WA	98057	09/05/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Quality Contact	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	05/25/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Reconciliation Contact	Controller, National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Reconciliation Contact (Secondary)	Vice President & Chief Financial Officer	Ms.	Shepler	Courtney	R	5102714644					courtney.r.shepler@kp.org	National Medicare Finance, 1 Kaiser Plaza, 13th Floor	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Recovery Audit Contact	Manager, Revenue Mgmt Compliance	Ms	Gonzalez	Heidy	G	6263723181					heidy.gonzalez@kp.org	74 S Fair Oaks Avenue		Pasadena	CA	91103	08/03/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	SNP Application Contact	Project Manager Lead		Morgan	Emily	M	5104072515					emily.m.morgan@kp.org	1800 Harrison Street		Oakland	CA	94612	10/28/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	SNP State Contact	Executive Director, Medicare Compliance		Brandi	Jamie		5102091877					jamie.l.brandi@kp.org	1 Kaiser Plaza, 12th Fl.		Oakland	CA	94612	08/17/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Surveillance Contact	Medicare Contract Compliance Manager, WA Region	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	04/06/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	System Contact	Director, Membership Administration Systems & S.S.		Putman	Anthony		8586506364					anthony.m.putman@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Third Party Administrator (TPA) Liaison	Senior Accountant		Thornal	Sun		6264056311					sun.a.thornal@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	12/12/2016	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	User Access Contact	Medicare Contract Compliance Manager, WA Region	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	04/06/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Utilization Management Contact	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0524	Utilization Review Contact	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0542	Automated TrOOP Balance Transfer Contact	Director, Data Operations - PACE		Fajardo	Lucia		3233848394					lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/16/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Backup User Access Contact	Director, Data Operations - PACE		Fajardo	Lucia		3233848394					lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/16/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Best Available Evidence Contact	Senior VP and Chief Operating Officer - PACE	Mrs.	Garg	Joyita		3235587750					jogarg@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/29/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Bid Primary Contact	Director, Budgets & Planning	Mr.	Hamamoto	Jeffrey		3238897354				3238897398	jhamamoto@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/13/2019	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	CAP Report Contact for Public Website	Senior VP and Chief Operating Officer - PACE	Mrs.	Garg	Joyita		3235587750					jogarg@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/29/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	CEO - CMS Administrator Contact	President and CEO	Mr.	de la Rocha	Castulo		3238897310				3238897399	cdelarocha@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/02/2017	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	CEO - Senior Official for Contracting	President and CEO	Mr.	de la Rocha	Castulo		3238897310					cdelarocha@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/02/2017	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Chief Financial Officer	Vice President and Chief Financial Officer	Mr.	Esparza	Jose		3238897320					jesparza@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/02/2017	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Chief Operating Officer	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/17/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Lowe	Raymond		3237656178					raylowe@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/21/2018	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Chief Information Security Officer	Senior Vice President, Chief Information Officer	Mr.	Lowe	Raymond		3237656178					raylowe@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/21/2018	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	CMS Casework Communication Contact	Director, Data Operations - PACE		Fajardo	Lucia		3233848394					lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/16/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Complaints Tracking Contact	Director, Data Operations - PACE		Fajardo	Lucia		3233848394					lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/16/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Contact for Fraud Investigations	Vice President, Corporate Compliance	Mr.	Jackson	Jerry		3238897383				3238897803	jejackson@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/02/2017	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Coordination of Benefits Contact	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	8664669722					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Corporate Mailing						3238897300					info@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/02/2017	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Budgets & Planning	Mr.	Hamamoto	Jeffrey		3238897354				3238897398	jhamamoto@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/13/2019	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Customer Service Operations Contact	Senior VP and Chief Operating Officer - PACE	Mrs.	Garg	Joyita		3235587750					jogarg@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/29/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	DIR Contact	Manager, Clinical Pharmacy - PACE	Dr.	Bravo	Juan		3232047202					Jbravo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/21/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	DIR Contact (Secondary)	Director, Budgets & Planning	Mr.	Hamamoto	Jeffrey		3238897354				3238897398	jhamamoto@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/13/2019	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Emergency Part D Contact	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Emergency Part D Contact (Secondary)	Director, Data Operations - PACE		Fajardo	Lucia		3233848394					lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/16/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Encounter Data & Risk Adjustment Operations Contact	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Enrollment Contact	Director, Marketing - Senior Care Services		Galicia	Miriam		3233134367					mgalicia@altamed.org	2040 Camfield Ave.		Los Angeles	CA	90040	08/14/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	EOB Transfer Contact	Director, Data Operations - PACE		Fajardo	Lucia		3233848394				3232013224	lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Financial Audit Contact	Vice President of Finance	Mr.	Flores	Fernando		3236222443					feflores@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	07/10/2018	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Financial Reporting Contact	Director, Budgets & Planning	Mr.	Hamamoto	Jeffrey		3238897354				3238897398	jhamamoto@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/13/2019	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Formulary Contact	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660				3232013224	ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Formulary Contact (Secondary)	Manager, Clinical Pharmacy - PACE	Dr.	Bravo	Juan		3232047202				2132175397	Jbravo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/16/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	General Contact	Senior VP and Chief Operating Officer - PACE	Mrs.	Garg	Joyita		3235587750					jogarg@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/29/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Government Relations Contact	Senior VP and Chief Operating Officer - PACE	Mrs.	Garg	Joyita		3235587750					jogarg@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/29/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	HIPAA Privacy Officer	Director, Compliance & Ethics Privacy Officer		Barlev	Ofer		3232822303					obarlev@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	HIPAA Security Officer	Senior Vice President, Chief Information Officer	Mr.	Lowe	Raymond		3237656178					raylowe@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/21/2018	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Interoperability Contact	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/16/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	MA Appeals/Grievances Contact	Director, Quality Improvement		Donato-Hernandez	Victoria		3235587628					vdonato@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	MA Claims Processing Contact for Public Website	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3232019700					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Marketing Contact	Director, Marketing - Senior Care Services		Galicia	Miriam		3233134367					mgalicia@altamed.org	2040 Camfield Ave.		Los Angeles	CA	90040	08/14/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Medical Director	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Medicare Compliance Officer	Vice President, Corporate Compliance	Mr.	Jackson	Jerry		3238897383				3238897803	jejackson@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	10/13/2020	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Medicare Coordinator	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Medicare Part D Opioid Overutilization Contact	Manager, Clinical Pharmacy - PACE	Dr.	Bravo	Juan		3232047202					jbravo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/16/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Medication Therapy Management Contact	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Online Enrollment Center Contact (Back-up)	Specialist, Data - PACE		Robles	Maria	G	3238327548					Mrobles@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Online Enrollment Center Contact (Optional)	Data Operations Manager	Mrs.	Garcia	Patricia		3233464095					pagarcia@altamed.org	2040 Camfield Ave		Los Angeles	CA	90022	02/16/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Online Enrollment Center Contact (Primary)	Director, Data Operations - PACE		Fajardo	Lucia		3233848394					lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Part C Application Contact	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Part D Appeals	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G						ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active	3235587660				PACE - Nat		C	San Francisco
H0542	Part D Appeals Contact (Secondary)	Manager, Clinical Pharmacy - PACE	Dr.	Bravo	Juan							jbravo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/16/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active	3232047202				PACE - Nat		C	San Francisco
H0542	Part D Application Contact	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Part D Benefits Contact	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Part D Claims Submission Contact	Director, Data Operations - PACE		Fajardo	Lucia		3233848394					lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Part D Exceptions Contact	VP, Strategic Account Management		Harrison	Terry	J						tharrisson@citizensrx.com	1144 Lake Street		Oak Park	IL	60301	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active	3128096877				PACE - Nat		C	San Francisco
H0542	Part D Exceptions Contact (Secondary)	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G						ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/17/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active	3235587660				PACE - Nat		C	San Francisco
H0542	Part D Price File Contact (Back-up)	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/17/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Part D Price File Contact (Optional)	VP, Strategic Account Management		Harrison	Terry	J	3128096877					tharrison@citizensrx.com	1144 Lake Street		Oak Park	IL	60301	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Part D Price File Contact (Primary)	VP, Strategic Account Management		Harrison	Terry	J	3128096877					tharrison@citizensrx.com	1144 Lake Street		Oak Park	IL	60301	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Part D Quality Assurance Contact	Director, Quality Improvement		Donato-Hernandez	Victoria		3235587628					vdonato@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Part D Reporting Contact	Director, Data Operations - PACE		Fajardo	Lucia		3233848394					lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Patient Safety Contact	Director, Quality Improvement		Donato-Hernandez	Victoria		3235587628					vdonato@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Payment Contact	Director, Budgets & Planning	Mr.	Hamamoto	Jeffrey		3238897354				3238897398	jhamamoto@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/13/2019	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Personal Health Record Contact	Director, Health Recs Sys & PO		Jones	Shauntara		3236222444					shjones@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/02/2017	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Pharmacy Director	Manager, Clinical Pharmacy - PACE	Dr.	Bravo	Juan		3232047202					jbravo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/16/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Pharmacy Network Management Contact	AVP, Pharmacy		Lloyd	Genevieve		3235587666					glloyd@altamed.org	2040 Camfield Avenue		Los Angeles	CA	90040	08/13/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Pharmacy Technical Help Desk Contact	Manager, Clinical Pharmacy - PACE	Dr.	Bravo	Juan						2132175397	Jbravo@altamed.org	2040 Camfield Avenue		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active	3232047202				PACE - Nat		C	San Francisco
H0542	PHR Beneficiary Contact																	08/17/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE	AltaMed Health Services Corporation	Altamed Health Services Corporation	11	Yes	Active	8884999303				PACE - Nat		C	San Francisco
H0542	Plan Directory Contact for Public Website	Senior VP and Chief Operating Officer - PACE	Mrs.	Garg	Joyita		3235587750					jogarg@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/29/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Plan to Plan Reconciliation Contact	Director, Budgets & Planning	Mr.	Hamamoto	Jeffrey		3238897354				3238897398	jhamamoto@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/13/2019	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Processor Contact	Director, Data Operations - PACE		Fajardo	Lucia		3233848394				3232013224	lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Quality Contact	Director, Quality Improvement		Donato-Hernandez	Victoria		3235587628					vdonato@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Reconciliation Contact	Director, Budgets & Planning	Mr.	Hamamoto	Jeffrey		3238897354				3238897398	jhamamoto@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/13/2019	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Reconciliation Contact (Secondary)	Director, Data Operations - PACE		Fajardo	Lucia		3233848394					lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Recovery Audit Contact	VP - PACE Program	Mrs.	Garg	Joyita		3235587750					jogarg@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	10/27/2021	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Surveillance Contact	Senior VP and Chief Operating Officer - PACE	Mrs.	Garg	Joyita		3235587750					jogarg@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/29/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	System Contact	Senior Vice President, Chief Information Officer	Mr.	Lowe	Raymond		3237656178					raylowe@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	03/21/2018	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Third Party Administrator (TPA) Liaison	Director, Data Operations - PACE		Fajardo	Lucia		3233848394					lfajardo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	User Access Contact	Senior VP and Chief Operating Officer - PACE	Mrs.	Garg	Joyita		3235587750					jogarg@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	08/29/2023	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Utilization Management Contact	SVP, Chief Medical Officer PACE	Dr.	Casillas	Esiquio	G	3235587660					ECasillas@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0542	Utilization Review Contact	Manager, Clinical Pharmacy - PACE	Dr.	Bravo	Juan		3232047202				2132175397	Jbravo@altamed.org	2040 Camfield Ave		Los Angeles	CA	90040	02/22/2022	2023	ALTAMED HEALTH SERVICES CORPORATION	National PACE	AltaMed Health Services Corporation	National PACE		Altamed Health Services Corporation	11	Yes	Active					PACE - Nat		C	San Francisco
H0543	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H0543	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H0543	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H0543	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H0543	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0543	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0544	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	04/22/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	04/21/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	01/18/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	01/18/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	12/16/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	12/16/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/07/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	04/22/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/02/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/07/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/07/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	10/18/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/07/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	04/22/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	04/24/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H0544	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H0544	PHR Beneficiary Contact																	12/28/2017	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H0544	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	04/21/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/11/2023	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/06/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	04/22/2021	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0544	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	BLUE CROSS OF CALIFORNIA	Local CCP	Anthem Blue Cross	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0562	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H0562	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2020	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/03/2018	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Medical Director	Chief Medical Officer	Dr.	Chen	Alex		8186766564					alex.y.chen@healthnet.com	21281 Burbank Blvd		Woodland Hills	CA	91367	03/30/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2020	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0562	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0562	PHR Beneficiary Contact																	09/27/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8002754737				HMO - Health Maintenance Organization		C	Dallas
H0562	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Plan Directory Contact for Public Website			Services	Provider		8002754737					CorporateMedicareComplianceDept@CENTENE.COM	PO Box 10198		Van Nuys	CA	91410	03/31/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0562	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0571	Agent/Broker Compensation Data Contact	Chief Operations Officer	Ms	Bonde	Toni		6282283241					toni.bonde@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	07/14/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Manosca	Nova		8587905873					partdcat@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/11/2017	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Backup User Access Contact	Compliance Officer		Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Best Available Evidence Contact	Director of Compliance	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Ave. Suite 700		San Francisco	CA	94108	02/02/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Bid Audit Contact	Compliance Officer	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue, suite 700	Suite 700	San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Bid Audit Site Contact	CFO	Mr.	Choi	Ken		6282283251					ken.choi@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Bid Primary Contact	CFO	Mr.	Choi	Ken		6282283251					Ken.Choi@cchphealthplan.com	445 Grant Avenue, suite 700	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	CAP Report Contact for Public Website	Chief Executive Officer	Mr.	Loo	Larry		4159558832					larry.loo@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	01/04/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Loo	Larry		4159558832				4159558818	larry.loo@cchpheatlhplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	01/04/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Loo	Larry		4159558832				4159558818	larry.loo@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	01/04/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Chief Financial Officer	CFO	Mr.	Choi	Ken		6282283251					ken.choi@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Chief Operating Officer	Chief Operating Officer	Ms.	Bonde	Toni		6282283241				4159558818	toni.bonde@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	07/12/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Chief Information Officer	IT Director	Mr.	Aguirre	Christophe		6282283357	3347			4159558818	christopher.aguirre@cchphealthplan.com	445 Grant Ave Suite 700		San Francisco	CA	94108	08/08/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Chief Information Security Officer	Security Officer / IT Director CHA	Mr.	Lai	Abel		4156772393				4159558818	abell@chasf.org	445 Grant Ave Suite 700		San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	CMMI Model Point of Contact	Compliance Officer		Eisenbeg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue, suite 700		San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	CMS Casework Communication Contact	Compliance Officer	Ms.	Eisenberg	Janet		6282283393	3393				janet.eisenberg@cchphealthplan.com	445 Grant Avenue Suite 700		San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Complaints Tracking Contact	Director of PHM		Cortez	Rocio		6282283212				4159558818	rocio.cortez@cchphealthplan.com	445 Grant Avenue Suite 700		San Francisco	CA	94108	02/02/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Contact for Fraud Investigations	Compliance Officer	Mr.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue Suite 700		San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Coordination of Benefits Contact	Eligbility and Enrollment Supervisor		Leung	Kenneth		6282283268					kenneth.leung@cchphealthplan.com	445 Grant Ave Suite 700		San Francisco	CA	94102	01/27/2018	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Corporate Mailing						6282283393	3393			4159558818	janet.eisenberg@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	06/16/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Choi	Kenneth		6282283251					Ken.Choi@CCHPHEALTHPLAN.COM	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Customer Service Operations Contact	Member Services Manager	Ms.	Soder	Sonya		6282283306				4153972129	Sonya.Soder@CCHPHEALTHPLAN.COM	445 Grant Ave. Suite 700		San Francisco	CA	94108	03/18/2020	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	DIR Contact	CFO	Mr.	Choi	Kenneth		6282283251					Ken.Choi@CCHPHEALTHPLAN.COM	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	DIR Contact (Secondary)	Compliance Officer	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue, suite 700	Suite 700	San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Electronic Health Record Contact	Compliance Officer		Eisenberg	Janet		6282283393				4159558818	janet.eisenberg@cchphealthplan.com	445 Grant Avenue, suite 700		San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Emergency Part D Contact	Chief Executive Officer	Mr.	Loo	Larry		4159558832				4159558818	larry.loo@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	01/04/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Emergency Part D Contact (Secondary)	Chief Medical Officer	Mr.	Reich	Craig		6282283273					craig.reich@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Encounter Data & Risk Adjustment Operations Contact	Director, Quality Improvement	Ms.	Cortez	Rocio		6282283212					rocio.cortez@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	03/04/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Enrollment Contact	Supervisor of Eligibility and Enrollment	Mr.	Leung	Kenneth		4159558800	3268			4159558817	kenneth.leung@cchphealthplan.com	445 Grant Ave.	Ste. 700	San Francisco	CA	94108	07/25/2019	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	EOB Transfer Contact	CFO	Mr.	Choi	Kenneth		6282283251				4159558817	Ken.Choi@CCHPHEALTHPLAN.COM	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Financial Audit Contact	CFO	Mr.	Choi	Kenneth		6282283251					Ken.Choi@CCHPHEALTHPLAN.COM	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Financial Reporting Contact	CFO	Mr.	Choi	Ken		6282283251					ken.choi@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	01/18/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Formulary Contact	Chief Medical Officer	Mr.	Reich	Craig		6282283273				4159558836	craig.reich@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Formulary Contact (Secondary)	Sup Formulary Operations		Nyawabila	Christina		8587906297					FMT@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/11/2017	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	General Contact	Compliance Officer	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue Suite 700		San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Government Relations Contact	Compliance Officer		Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue Suite 700		San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	HIPAA Privacy Officer	Compliance Officer		Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Ave Suite 700		San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	HIPAA Security Officer	Security Officer		Lai	Abel		4152174142				4152174142	abell@chasf.org	445 Grant Ave Suite 700		San Francisco	CA	94108	07/07/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Hospice Contact	Chief Medical Officer		Reich	Craig		6282283273					craig.reich@cchphealthplan.com	445 Grant Ave Suite 700		San Francisco	CA	94102	01/18/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Interoperability Contact	Chief Operations Officer		Bondi	Toni		6282283241					toni.bonde@cchphealthplan.com	445 Grant Avenue, suite 700		San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	MA Appeals/Grievances Contact	Director of PHM		Cortez	Rocio		6282283212					rocio.cortez@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	02/02/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	MA Claims Processing Contact for Public Website	Director of Claims		Johnson	Dee		4159558800	3342				dee.johnson@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	06/09/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Marketing Contact	Director of Marketing	Mr.	Cho	YoungSoo		6282283375					youngsoo.cho@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	06/01/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Medical Director	Medical Director	Dr.	Reich	Craig		4159558800	3273				Craig.Reich@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/10/2018	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Medicare Compliance Officer	Compliance Officer	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Medicare Coordinator	Compliance Officer	Ms	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Medicare Part D Opioid Overutilization Contact	Chief Medical Officer	Dr.	Reich	Craig		6282283273				4159558836	craig.reich@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Medication Therapy Management Contact	Chief Medical Officer	Dr.	Reich	Craig		6282283273				4159558836	craig.reich@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	OffShore Subcontractor Contact	Compliance Officer		Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue, suite 700		San Francisco	CA	91408	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Online Enrollment Center Contact (Back-up)	Eligibility & Enrollment Processor		Wang	Lisa		6282283262					lisa.wang@cchphealthplan.com	445 Grant Ave.	Ste. 700	San Francisco	CA	94108	06/09/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Online Enrollment Center Contact (Optional)	Eligibility and Enrollment Supervisor		Leung	Kenneth		4159558800	3268				kenneth.leung@cchphealthplan.com	445 Grant Avenue		San Francisco	CA	94108	06/18/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Online Enrollment Center Contact (Primary)	Supervisor of Eligibility and Enrollment	Mr.	Leung	Kenneth		4159558800	3268			4159558817	kleung@cchphmo.com	445 Grant Ave.	Ste. 700	San Francisco	CA	94108	07/22/2019	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Part C Application Contact	Compliance Officer	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Ave Suite 700		San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Part C Reporting Contact	Compliance Officer	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Appeals	Director of PHM	Ms.	Cortez	Rocio						4159558836	rocio.cortez@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	02/02/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active	6282283212				HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Appeals Contact (Secondary)	Compliance Officer	Ms.	Eisenberg	Janet							janet.eisenberg@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	01/07/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active	6282283393				HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Application Contact	Compliance Officer	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Ave Suite 700		San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Benefits Contact	Chief Medical Officer	Dr.	Reich	Craig		6282283273				4159558836	craig.reich@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Claims Submission Contact	Medicare Part D PDE Analyst		Nishiyama	Christie		8582915305					PDE@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/27/2019	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Exceptions Contact	Dir PA Clinical Programs		McGurran	Shawn							shawn.mcgurran@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/11/2017	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active	8587906682				HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Exceptions Contact (Secondary)	Pharmacist	Ms.	Zhang	Mary						4159558836	mary.zhang@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/28/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active	6282283354				HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Price File Contact (Back-up)	Chief Medical Officer	Dr.	Reich	Craig		6282283273				4159558836	craig.reich@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	08/17/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Price File Contact (Optional)	Compliance Officer	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue, suite 700		San Francisco	CA	94108	12/28/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Price File Contact (Primary)	Medicare Part D Project Manager		Niemi	Kirstin		8587906455					PlanFinderCommunications@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/11/2017	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Quality Assurance Contact	Chief Medical Officer	Dr.	Reich	Craig		6282283273				4159558836	craig.reich@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Part D Reporting Contact	Compliance Officer	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Patient Safety Contact	Medical Director	Dr.	Reich	Craig		4159558800	3273				Craig.Reich@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/10/2018	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Payment Contact	CFO	Mr.	Choi	Ken		6282283251					Ken.Choi@cchphealthplan.com	445 Grant Avenue, suite 700	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Personal Health Record Contact	Compliance Officer		Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Avenue, suite 700		San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Pharmacy Director	Chief Medical Officer	Dr.	Reich	Craig		6282283273				4159558836	craig.reich@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	08/17/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Pharmacy Network Management Contact	Manager, PNS & Claims Operations		Burke	Sharon		8587907148					sharon.burke@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/11/2017	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Pharmacy Network Management Contact (Secondary)	Chief Medical Officer	Dr.	Reich	Craig		6282283273				4159558836	craig.reich@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/28/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services		Brewer	Kathy							customerservice@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	01/02/2020	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active	8448630357				HMO - Health Maintenance Organization		C	San Francisco
H0571	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacist	Ms.	Zhang	Mary						4159558836	mary.zhang@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/28/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active	6282283354				HMO - Health Maintenance Organization		C	San Francisco
H0571	Physician Incentive Contact	Chief Financial Officer	Mr.	Choi	Ken		6282283251				4159558818	ken.choi@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	06/01/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Plan Directory Contact for Public Website	Director of Marketing	Mr.	Cho	Youngsoo		6282283375				4159558818	youngsoo.cho@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	06/01/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Plan to Plan Reconciliation Contact	CFO	Mr.	Choi	Ken		6282283251					Ken.Choi@cchphealthplan.com	445 Grant Avenue, suite 700	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Processor Contact	Director, Medicare Program		Davis-Jones	De'Lona		8587906229					DeLona.Davis-Jones@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/11/2017	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Quality Contact	Director, Quality Improvement		Cortez	Rocio		6282283212				4159558818	rocio.cortez@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	08/03/2020	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Reconciliation Contact	CFO	Mr.	Choi	Ken		6282283251					Ken.Choi@cchphealthplan.com	445 Grant Avenue, suite 700	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Reconciliation Contact (Secondary)	CFO	Mr.	Choi	Kenneth		6282283251				4159558817	Ken.Choi@CCHPHEALTHPLAN.COM	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Recovery Audit Contact	CFO	Mr.	Choi	Ken		6282283251					Ken.Choi@cchphealthplan.com	445 Grant Avenue, suite 700	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	SNP Application Contact	Compliance Officer	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Ave Suite 700		San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	SNP State Contact	Director of Compliance	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Ave Suite 700		San Francisco	CA	94108	06/01/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Surveillance Contact	Director of Compliance	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Ave Suite 700		San Francisco	CA	94108	04/14/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	System Contact	IT Director	Mr.	Aguirre	Christophe		6282283357				4159558818	christopher.aguirre@cchphealthplan.com	445 Grant Ave Suite 700		San Francisco	CA	94108	08/08/2023	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Third Party Administrator (TPA) Liaison	CFO	Mr.	Choi	Kenneth		6282283251					Ken.Choi@CCHPHEALTHPLAN.COM	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/01/2021	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	User Access Contact	Compliance Officer	Ms.	Eisenberg	Janet		6282283393					janet.eisenberg@cchphealthplan.com	445 Grant Ave Suite 700		San Francisco	CA	94108	09/30/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Utilization Management Contact	Director of Utilization Management	Ms.	Chow	Kienn		4159558800	3252			4159553669	kienn.chow@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0571	Utilization Review Contact	Director of Utilization Management	Ms.	Chow	Kienn		4159558800	3252			4159553669	kienn.chow@cchphealthplan.com	445 Grant Avenue	Suite 700	San Francisco	CA	94108	12/05/2022	2023	CHINESE COMMUNITY HEALTH PLAN	Local CCP	CCHP (Chinese Community Health Plan)	HMO/HMOPOS		Chinese Hospital Association	56	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H0609	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H0609	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H0609	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H0609	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0609	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0613	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Backup User Access Contact	Chief Information Officer		Babachicos	Cara		7209746739					cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Best Available Evidence Contact	Finance and Compliance Analyst	Mr.	Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Bid Primary Contact	Finance and Compliance Analyst	Mr.	Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	CAP Report Contact for Public Website	VP Clinical Compliance Audit Management		Teter	Lezlie		7206829848				3039961600	Lteter@innovage.com	3870 Rosin Court		Sacremento	CA	95834	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	9096779517				PACE - Nat		C	Dallas
H0613	CEO - CMS Administrator Contact	President & CEO	Mr.	Blair	Patrick		7209746704				3039961600	PBlair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	CEO - Senior Official for Contracting	President & CEO	Mr.	Blair	Patrick		7209746704				3039961600	PBlair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Chief Financial Officer	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Chief Operating Officer	COO	Ms.	Bent	Christine		7209742356				3039961600	cbent@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Chief Information Officer	CIO	Ms	Babachicos	Cara		3037202994					cbabachicos@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Chief Information Security Officer	Chief Information Security Officer	Mr	Smith	Alvin		7207896084				3039961600	ASmith2@innovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	CMS Casework Communication Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Complaints Tracking Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Contact for Fraud Investigations	Chief Legal Officer		D'Amato	Nicole		3038694664				3039961600	ndamato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Coordination of Benefits Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Corporate Mailing						3038694664				3039961600	bgutierrez@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Customer Service Operations Contact	Regional VP Operations COO	Mr.	Lohr	Clint		7209829868				3039961600	clohr@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	DIR Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Emergency Part D Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Encounter Data & Risk Adjustment Operations Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Enrollment Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	EOB Transfer Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Financial Audit Contact	Director of Finance	Ms.	Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Financial Reporting Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Formulary Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	General Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Government Relations Contact	Executive VP Government Relations		Steckel	Carol		7207896157				3039961600	CSteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	HIPAA Privacy Officer	Associate General Counsel	Mr.	Moxon	Jeff		7206613727				3039961600	crobertson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	HIPAA Security Officer	Chief Information Security Officer		Smith	Alvin		7207896084					asmith2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Interoperability Contact	SVP, Application Systems		Zierolf	Kris		7209742380					kzierolf@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	MA Appeals/Grievances Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	MA Claims Processing Contact for Public Website	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Marketing Contact	SVP, Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Medical Director	Chief Medical Officer	Dr.	Feifer	Rich		7206827305				3039961600	RFeifer@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Medicare Compliance Officer	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Medicare Coordinator	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Medicare Part D Opioid Overutilization Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 E. Lowry Blvd		Denver	CO	80230	08/28/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Medication Therapy Management Contact	SVP of Clinical Strategic Partnerships	Mrs.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Part C Application Contact	Executive VP Government Relations	Ms.	Steckel	Carol		7207896157				3039961600	CSteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Part D Appeals	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	Dallas
H0613	Part D Application Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Part D Benefits Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Part D Claims Submission Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Part D Exceptions Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	Dallas
H0613	Part D Price File Contact (Back-up)	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Part D Price File Contact (Primary)	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Part D Quality Assurance Contact	SVP of Clinical Strategic Partnerships		Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Part D Reporting Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Patient Safety Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Payment Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Pharmacy Director	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Pharmacy Network Management Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Pharmacy Technical Help Desk Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	Dallas
H0613	PHR Beneficiary Contact																	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE	Total Longterm Care, Inc.	Total Community Options, Inc.	230	Yes	Active	8772776163	732			PACE - Nat		C	Dallas
H0613	Plan Directory Contact for Public Website	Director of Marketing		Stavros	Sarah		3033006904				3039961600	sstavros@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Plan to Plan Reconciliation Contact	Financial and Compliance Analyst		Kizewski	Alex		7207896171				7209173390	AKizewsk@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Processor Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Quality Contact	Vice President of Quality		Curry	Jill		2153782123					JCurry@innovage.com	2000 Market Street	Suite 780	Philadelphia	PA	19103	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Reconciliation Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Recovery Audit Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817					mcinque@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Surveillance Contact	SVP, Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	System Contact	Director, PACE Finance		Hewitt	Jessica		7209746767					jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Third Party Administrator (TPA) Liaison	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	User Access Contact	Corporate Director of Compliance		Dickerson	Anzio		7208687356					adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Utilization Management Contact	Chief Quality & Population Health Officer	Dr.	Wells	Ann		7206827305				3039961600	awells@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0613	Utilization Review Contact	Chief Quality & Population Health Officer	Dr.	Wells	Ann		7206827305				3039961600	awells@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge Colorado PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H0624	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H0624	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H0624	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H0624	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H0624	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/15/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0624	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0628	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/06/2018	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/06/2019	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Emergency Part D Contact (Secondary)	Exec. Dir., Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	12/30/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	HIPAA Security Officer	Deputy chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/30/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	12/30/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	12/06/2018	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/30/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H0628	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/06/2018	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0628	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF OHIO INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0630	Agent/Broker Compensation Data Contact	Manager, Medicare Compliance		Lawrence	Winston		5105070510					winston.d.lawrence@kp.org	1 Kaiser Plaza, 12th Floor		Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Automated TrOOP Balance Transfer Contact	Project Manager III, Pharmacy Benefit Mgmt		Perez	Elizabeth	R	5623670592					Elizabeth.R.Perez@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	08/02/2018	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Backup User Access Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					Lynn.M.Cooper@kp.org	10350 E Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Best Available Evidence Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Bid Audit Contact	Executive Director Actuarial		Kenny	Kevin		5102677544					kevin.x.kenny@kp.org	300 Lakeside Drive, 28th Floor		Oakland	CA	94612	12/18/2020	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Bid Audit Site Contact	Compliance Consultant		Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/01/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Bid Primary Contact	Actuary		Tseng	Hsiang-Yi		3033062661					hsiang-yi.x.tseng@kp.org	300 Lakeside Dr.		Oakland	CA	94612	01/20/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	CAP Report Contact for Public Website	Medicare Compliance Lead	Ms.	Cooper	Lynn		7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	CEO - CMS Administrator Contact	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	CEO - Senior Official for Contracting	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Chief Financial Officer	SVP, CFO Business Units and Finance Operations	Mr.	Beltch	Robert	R	8184897560					rob.beltch@kp.org	1 Kaiser Plaza, Suite 806	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/15/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Chief Operating Officer	Executive Director, Medicare Market Strategy & Ops	Mr.	Miller	Paul		5033410073					paul.a.miller@kp.org	500 NE Multnomah St., Ste. 100		Portland	OR	97232	04/10/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Chief Information Officer	Chief Information Officer	Ms.	Comer	Diane		5102258777					Diane.B.Comer@kp.org	2600 Napa Valley Corporate Drive		Napa	CA	94558	09/17/2020	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Chief Information Security Officer	VP, Chief Information Security Officer	Mr.	Goddard	Jim		3037133890					James.P.Goddard@kp.org	6560 Greenwood Plaza Blvd.		Greenwood Village	CO	80111	02/03/2016	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	CMS Casework Communication Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Complaints Tracking Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Contact for Fraud Investigations	Director ,Fraud Control and National Special Inves		Janiga	Marita	C	5102716937				5108917977	marita.c.janiga@kp.org	One Kaiser Plaza, Ordway Building, 12th Floor		Oakland	CA	94612	03/26/2013	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Coordination of Benefits Contact	Senior Director		Chung	Clarence		5623909293				5626583866	clarence.j.chung@kp.org	12254 Bellflower Blvd - Suite 106, 1st Floor		Downey	CA	90242	04/28/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Corporate Mailing						7205279215					lynn.m.cooper@kp.org	10350 East Dakota Avenue		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Coverage Gap Discount Program (CGDP) Payment Contact			Ballestros	Mayra		6262525164					mayra.x.lujano@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	02/15/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Customer Service Operations Contact	Ex Director, Member Services Contact Centers, Denv		Martin	Norman	K	3039124673					NK.Martin@kp.org	7901 East Lowry Blvd, Ste 150 and 400		Denver	CO	80230	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	DIR Contact	Manager Financial Reporting & Analysis		Hsiue	Tony		5626583836				5626583866	tony.x.hsiue@kp.org	12254 Bellflower Blvd.  Flr. 2		Downey	CA	90242	03/21/2018	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	DIR Contact (Secondary)	Sr. Financial Analyst		San	Kei		5626583445					Kei.San@kp.org	12254 Bellflower Blvd. Fl. 2		Downey	CA	90242	07/17/2018	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Electronic Health Record Contact	Sr Manager, Meaningful Use PMO		Poole	Dolly		5106255813					dolly.poole@kp.org	1800 Harrison St.		Oakland	CA	94612	07/02/2018	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Emergency Part D Contact	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/04/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Emergency Part D Contact (Secondary)	RegAdmin-Pharmacy Benefits, Compliance, Prof Aff		Clark	Denese	A	3033266717					denese.a.clark@kp.org	16601 E. Centretech Parkway		Aurora	CO	80011	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Employer Waiver Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Encounter Data & Risk Adjustment Operations Contact	Director, Risk Adjustment Submission	Ms.	Gu	Jialin		3033383507					jialin.gu@kp.org	2500 South Havana		Aurora	CO	80014	10/21/2019	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Enrollment Contact	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	EOB Transfer Contact	Pharmacy Medicare Operations, Project Manager II		Bonoan	John	B	5624180564				5626583848	john.b.bonoan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	03/29/2013	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Financial Audit Contact	Compliance Consultant	Ms.	Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/01/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Financial Reporting Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Formulary Contact	Pharmacy Project Manager		Kim	Jung		5624459129					jung.x3.kim@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/20/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Formulary Contact (Secondary)	PHARMACY PROJECT MGR I		Lin	Clement	J	5624459129					Clement.J.Lin@kp.org	12254 Bellflower Blvd		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	General Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Government Relations Contact	Senior Vice President, Government Relations		Barrueta	Anthony	A	5102716835					Anthony.Barrueta@kp.org	One Kaiser Plaza		Oakland	CA	94612	11/16/2017	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	HIPAA Privacy Officer	Compliance Director		Anderson	Angela		5104353413					Angela.B.Anderson@kp.org	1800 Harrison Street	16th Floor	Oakland	CA	94612	11/06/2020	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	HIPAA Security Officer	Senior Director		Vourthis	Bill		9252065125					bill.d.vourthis@kp.org	5820 Owens Drive	Building E	Pleasanton	CA	94588	08/25/2020	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Hospice Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Interoperability Contact	National EDI Business Operations		Plattner	Cathy		6268336526					Cathy.P.Plattner@kp.org	75 N Fair Oaks Ave.		Pasadena	CA	91103	11/03/2021	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	MA Appeals/Grievances Contact	Customer Experience Operations Manager		Bloom	Andrew	T	5038132265					andrew.t.bloom@kp.org	500 NE Multnomah St., Suite 100		Portland	OR	97232	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	MA Claims Processing Contact for Public Website	Dir Customer Engagement Mgmt		Galloway	Lonnie		9094772466					Lonnie.L.Galloway@kp.org	10740 4th Street		Rancho Cucamonga	CA	91730	08/02/2018	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Marketing Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					KP-MedicareFilings@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Medical Director	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	11/16/2020	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Medicare Compliance Officer	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Medicare Coordinator	Program Director, Medicare Market/Product Strategy	Ms.	Johnston	Stacy		7203902574					stacy.johnston@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Medicare Part D Opioid Overutilization Contact	Pharmacist Project Manager		Chong	Sue	H	5626583661					sue.h.chong@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	12/05/2018	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Medication Therapy Management Contact	Medication Therapy Management		Deguzman	Lynn		5106253989					lynn.f.deguzman@kp.org	1800 Harrison St., 13th Floor		Oakland	CA	94612	07/02/2018	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	OffShore Subcontractor Contact	Compliance Consultant - Privacy and Security		Glenn	Jovan		9092512010					Jovan.Robinson@kp.org	10740 Fourth Street	2nd Floor, Cubicle 023W02	Rancho Cucamonga	CA	91730	08/26/2020	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Online Enrollment Center Contact (Back-up)	Senior Team Manager, Medicare Membership Admin		Nugent	Kristin		8586376801					kristin.n.nugent@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Online Enrollment Center Contact (Optional)	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Online Enrollment Center Contact (Primary)	Team Manager, Medicare Membership Administration		Covarrubio	Danny		8586143433					danny.x.covarrubio@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Part C Application Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Part C Reporting Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Appeals	Customer Experience Operations Manager		Bloom	Andrew	T						andrew.t.bloom@kp.org	500 NE Multnomah St., Suite 100		Portland	OR	97232	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	5038132265				HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Appeals Contact (Secondary)	Sr. Grievance and Appeals Consultant		Elkhaddari	Claudia							claudia.elkhaddari@kp.org	2500 S. Havana Street		Aurora	CO	80014	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	3032832813				HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Application Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Benefits Contact	PO PS, National Rx Programs & Servics		Bonvie	Claudette		5623199392					Claudette.R.Bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90042	07/20/2018	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Claims Submission Contact	PO PS, National Rx Programs & Servics		Bonvie	Claudette		5623199392					Claudette.R.Bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90042	07/20/2018	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Exceptions Contact	Chief Pharmacist, Pharmacy Benefits and Compliance		Maloy	Leah							leah.maloy@kp.org	16601 E. Centretech Parkway		Aurora	CO	80011	01/20/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	3037393623				HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Exceptions Contact (Secondary)	Chief Pharmacist, Pharmacy Benefits and Compliance		Maloy	Leah							leah.maloy@kp.org	16601 East Centretech Parkway		Aurora	CO	80011	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	3037393623				HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Price File Contact (Back-up)	Financial Analyst		Kamikawa	Emely		5622998753				5626583712	emely.a.kamikawa@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	07/02/2018	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Price File Contact (Optional)	Associate Consultant		Quan	Mariclare		5623850395					mariclare.a.quan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Price File Contact (Primary)	Pharmacy Benefits Pricing		Bullard	Myra		5623195747				5626583712	myra.c.bullard@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Quality Assurance Contact	Vice President, Clinical Pharmacy Services		Le	Kim		5622997015					Kim.N1.Le@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Part D Reporting Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Patient Safety Contact	Medical Safety & Quality Coordinator		Rasmussen	Jon		3039903890					Jon.Rasmussen@kp.org	2500 S. Havana St.		Aurora	CO	80014	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Payment Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza, Suite 2552		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Pharmacy Director	Chief Pharmacist		Maloy	Leah	k	3037393623				3037393660	leah.maloy@kp.org	16601 E. Centretech Parkway		Aurora	CO	80011	02/14/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Pharmacy Network Management Contact	Chief Pharmacist, Pharmacy Benefits & Compliance		Maloy	Leah		3037393623					leah.maloy@kp.org	16601 E. Centretech Parkway		Aurora	CO	80011	01/20/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Pharmacy Network Management Contact (Secondary)	Chief Pharmacist, Pharmacy Benefits & Compliance		Maloy	Leah		3037393623				3037393660	leah.maloy@kp.org	16601 East Centretech Parkway		Aurora	CO	80111	11/11/2009	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Pharmacy Technical Help Desk Contact	Customer Care Center		OptumRx	PBM								755 Research Parkway Suite 160		Oklahoma City	OK	73104	11/02/2016	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8887917255				HMO - Health Maintenance Organization		C	San Francisco
H0630	Plan Directory Contact for Public Website			Services	Member		8004762167					colorado.cs@kp.org	2500 S. Havana St.		Aurora	CO	80014	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Plan to Plan Reconciliation Contact	Interim Director, Medicare Accounting		Wright	Mark	A	9253239443					mark.a.wright@kp.org	1 Kaiser Plaza, 25th Floor		Oakland	CA	94612	01/20/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Processor Contact	Medicare Compliance Consultant	Mr.	Carver	Jon	R	4257578659					jonathan.r.carver@kp.org	1300 SW 27th St.		Renton	WA	98057	09/05/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Quality Contact	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	05/25/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Reconciliation Contact	Controller, National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Reconciliation Contact (Secondary)	Vice President & Chief Financial Officer	Ms.	Shepler	Courtney	R	5102714644					courtney.r.shepler@kp.org	National Medicare Finance, 1 Kaiser Plaza, 13th Floor	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Recovery Audit Contact	Manager, Revenue Mgmt Compliance	Ms	Gonzalez	Heidy	G	6263723181					heidy.gonzalez@kp.org	74 S Fair Oaks Avenue		Pasadena	CA	91103	08/03/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	SNP Application Contact	Director Accreditation, Regulatory & Licensing		Beagle	Robin	E	2063272431					robin.e.beagle@kp.org	10350 East Dakota Ave		Denver	CO	80247	02/14/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	SNP State Contact	Director Accreditation, Regulatory & Licensing		Beagle	Robin		2063272431				8776328502	Robin.e.beagle@kp.org	10350 East. Dakota Ave		Denver	CO	80247	02/14/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Surveillance Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	02/16/2023	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	System Contact	Director, Membership Administration Systems & S.S.		Putman	Anthony		8586506364					anthony.m.putman@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Third Party Administrator (TPA) Liaison	Senior Accountant		Thornal	Sun		6264056311					sun.a.thornal@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	12/12/2016	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	User Access Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Utilization Management Contact	Director, Utilization Management		Huerta	Cindy	R	7206963091					cindy.r.huerta@kp.org	2530 S. Havana St.		Aurora	CO	80014	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0630	Utilization Review Contact	Director, Utilization Management		Huerta	Cindy	R	7206963091					cindy.r.huerta@kp.org	2530 S. Havana St.		Aurora	CO	80014	01/21/2022	2023	KAISER FOUNDATION HP OF CO	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0672	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Corporate Mailing						6155658100					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H0672	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H0672	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H0672	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H0672	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H0672	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H0672	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0672	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTHCARE OF COLORADO, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H0710	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H0710	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H0710	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H0710	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H0710	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0710	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0712	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Chief Operating Officer	Regional VP, Medicare Markets & Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/13/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/13/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/13/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/13/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H0712	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/13/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H0712	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449089				HMO - Health Maintenance Organization		C	Dallas
H0712	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/13/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0712	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF CONNECTICUT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H0724	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/03/2018	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/14/2017	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Medical Director	Chief Medical Director	Dr.	Lucas	Brad		8662464356					blucas@centene.com	3700 Embassy Parkway, Suite 200		Akron	OH	44333	03/30/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/14/2017	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0724	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0724	PHR Beneficiary Contact																	09/27/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8557661851				HMO - Health Maintenance Organization		C	Dallas
H0724	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Plan Directory Contact for Public Website			Services	Member		8663897690					CorporateMedicareComplianceDept@Centene.com	4349 Easton Parkway	Suite 200	Columbus	OH	43219	03/31/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0724	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0738	Agent/Broker Compensation Data Contact	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Automated TrOOP Balance Transfer Contact	Manager, Technical Delivery & Oversight	Mr.	Gajarajan	Nivi		2678258648					ngajarajan2@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Backup User Access Contact	Medicare Compliance Sr Operations Analyst		Morris	Ms. Gail		2158178922					gpmorris@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	300 Stevens Drive, Suite 201	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Best Available Evidence Contact	Medicare Enrollment Manager	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Bid Audit Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Bid Audit Site Contact	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Bid Primary Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Lovin	Dan		2672985617					dlovin@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive, 2nd flr.	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	CEO - CMS Administrator Contact	President - Medicare Pennsylvania	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	04/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	CEO - Senior Official for Contracting	President, Medicare Pennjsylvania	Ms	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	04/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Chief Financial Officer	Chief Financial Officer	Mr.	Burgoyne	Michael		2159378875					mburgoyne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Chief Operating Officer	VP Medicare Health Plans	Mr.	McDade	Chris		4844971892					cmdade@amerihealthcaritas.com	AmeriHealth Caritas Families of Companies	3875 West Chester Pike	Newton Square	PA	19073	08/28/2023	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Chief Information Officer	Chief Information Officer	Mr.	Dickson	Fred		2158636570					fdickson@amerihealthcaritas.com	Amerihealth Caritas, Inc.	1 International Plaza IP2-4009	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Chief Information Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive	Philadelphia, PA	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	CMMI Model Point of Contact	Director, Medical Management Medicare	Ms.	Becker	Nancy		4844971265					nbecker1@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	CMS Casework Communication Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Complaints Tracking Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Contact for Fraud Investigations	Director, SIU	Mr.	McCall	Trevor		4844971241					tmccall2@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr	Philadelphia	PA	19113	08/04/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Coordination of Benefits Contact	Manager, Provider Network Oversight	Ms.	Williams	Kathy		8437467499					kwilliams@firstchoicevipcareplus.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/09/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Corporate Mailing						8434143130					tmoody@amerihealthcaritas.com	Select Health of South Carolina	4390 Belle Oaks Drive	Charleston	SC	29405	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager	Ms.	Maheepathi	Geetha		4435279822					gmaheepathi@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	3875 West Chester Pike	Newtown Square	PA	19073	03/15/2023	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Customer Service Operations Contact	Director, Medicare Customer Service	Ms.	Veras	Helen		2672981794					hveras@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/29/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	DIR Contact	Director, Medicare Risk Adjustment and Performance	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/09/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	DIR Contact (Secondary)	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2824045991					AKindred@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Electronic Health Record Contact	Manager, Information Services		Drumming	Ms. Terri		2159378578					tdrumming@amerihealthcaritas.com	200 Stevens Drive Philadelphia		Philadephia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Emergency Part D Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Emergency Part D Contact (Secondary)	Director, Corporate Pharmacy		Cherian	Sheena		2158635768					scherian@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	12/28/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Encounter Data & Risk Adjustment Operations Contact	Director, Medicare ACA and Risk Adjustment	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Enrollment Contact	Manager Enrollment Operations,	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealtharitas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	EOB Transfer Contact	Director, Medicare Claims	Mr.	Boyer	Joseph		2158636668				2159375321	Jboyer@Amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Financial Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					ak16850@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/09/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Financial Reporting Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Formulary Contact	Director of Clinical Services, Formulary/DUR	Ms.	Megargell	Lauren		2159374135					Lauren.megargell@performrx.com	PerformRx	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Formulary Contact (Secondary)	DIrector of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family	200 Stevens Drive	Philadephia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	General Contact	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philidelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Government Relations Contact	VP, Government Relations		Cozzo	Mr.Steven		2159378236					scozzo@Amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	HIPAA Privacy Officer	Direcort of Privacy	Ms.	Gustafson	Rebecca		2158636634					rgustafson@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr.	Philadelphia	PA	19113	08/04/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	HIPAA Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Hospice Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadephia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Interoperability Contact	Director, Medicare Performance Management		Kindred	Amanda		2484045991					akindred@amerihealthcaritas.com	4000 Town Center	Suite 1300	Southfield	MI	48075	03/10/2023	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	MA Appeals/Grievances Contact	Director, Corporate Appeals	Ms.	Garber	Brenda		2158635585					bgarber@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	MA Claims Processing Contact for Public Website			Services	Provider		8889780862					VIPProviderComm@amerihealthcaritas.com	The AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Marketing Contact	Medicare Compliance Sr Operations Analyst	Ms.	Morris	Gail	P	2158635141					gpmorris@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	300 Stevens Dr, Suite 201	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Medical Director	Medicare Medical Director	Dr.	Busch	Gregory		8562174603					gbusch@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Medicare Compliance Officer	Medicare Compliance Officer	Ms	Solomon	Mary		2673004846					mlsolomon@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Drive, 2flr.	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Medicare Coordinator	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philidelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	02/16/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Medication Therapy Management Contact	Director, Clinical Outcomes		Patel	Ms. Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	OffShore Subcontractor Contact	Performance Program Oversight Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	3785 Chester Pike	Newtown Square	PA	19073	01/05/2023	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Online Enrollment Center Contact (Back-up)	MCR Enrollment Plan Lead	Ms.	Dyer	Yashica		2158636337					ydyer@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	07/03/2023	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Online Enrollment Center Contact (Primary)	Medicare Enrollment Specialist	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part C Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part C Reporting Contact	Manager, Medicare Performance Management	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Appeals	Supvr, Quality Auditing	Ms.	Clark	Janine							jclark2@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	4844985214				HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Appeals Contact (Secondary)	Appeals & Grievance Admin		Christian	Ms.Yolanda							ychristian@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8552210045				HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Benefits Contact	Pharmacist II	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Claims Submission Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Bonko	Gerald						2158635100	gbonko@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636483				HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Utilization Management	Mr.	McHale	Shawn						2158635100	smchale@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636370				HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Price File Contact (Back-up)	Claims Processor Associate		Reed	Ms.Lindsay		8473466370					lindsay.reed@abarcahealth.com	Abarca Health	650 Ave Munoz Rivera, Suite 701	San Juan	PR	00918	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Price File Contact (Optional)	Medicare Financial Operations Analyst III	Ms	Weihe	Heather		7875231212	1444				heather.weihe@abarcahealth.com	650 Ave Munoz Rivera	Suite 701	San Juan	PR	00918	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Price File Contact (Primary)	Manager, Pharmacy Network Operations	Mr.	King	James		8435694845					jking@performrx.com	PerformRx	200 Stevens Drive,	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Quality Assurance Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Part D Reporting Contact	Quality Assurance Contract Account Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@keystonefirstpa.com	AmeriHealth Caritas Family of Companies	300 Stevens Dr. Suite 201	Philadelphia	PA	19113	03/10/2023	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Patient Safety Contact	Director, Clinical Outcomes		Patel	Ms. Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Payment Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Personal Health Record Contact	Manager, Information Services		Drumming	Ms. Terri		2159378578					tdrumming@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Pharmacy Director	Director of Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Pharmacy Network Management Contact	Manager, Pharmacy Network Operations	Mr.	King	James		8435694845					jking@performrx.com	PerformRx	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Pharmacy Network Management Contact (Secondary)	Director, Service Operations		Leal	Ms.Avelina		2158636540					aleal@peformrx.com	PerformRx	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Pharmacy Technical Help Desk Contact	Director, Service Operations	Ms.	Leal	Avelina							aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8553270511				HMO - Health Maintenance Organization		C	Philadelphia
H0738	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Care Center	Ms.	Lee	Pamela								PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8553270511				HMO - Health Maintenance Organization		C	Philadelphia
H0738	Physician Incentive Contact	Manager, Provider Relations	Ms.	Williams	Kathy		8437467499					kwilliams@firstchoicevipcareplus.com	4390 Belle Oak Drive,	Suite 400	Charletston	SC	29405	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Plan Directory Contact for Public Website			Services	Provider		8889780862					VIPProviderComm@amerihealthcaritas.com	The AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Plan to Plan Reconciliation Contact	Director, Finance	Ms	Sow	Oumou		4102584587					osow@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	P.O. 7137	London	KY	40742	06/15/2023	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Processor Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Quality Contact	Director Quality Management	Ms.	Trimble	Dorothea		6162507322					dtrimble@amerihealthcaritas.com	Amerihealth Michigan	4000 Town Center, Suite 1300	Southfield	MI	48075	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Reconciliation Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Reconciliation Contact (Secondary)	Business Analyst	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	08/10/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Recovery Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	SNP Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	07/04/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	SNP State Contact	Plan Lead		Moody	Ms. Tonya		2158635700					tmoody@amerihealthcaritas.com	200 Stevens Dr.		Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Surveillance Contact	Business Development Manager	Ms.	Kumagai	Naoko		2157563724					nkumagai@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/08/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	System Contact	Business Systems Analyst Lead	Ms.	Drumming	Terri		2159378578					tdrumming@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Third Party Administrator (TPA) Liaison	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	User Access Contact	Medicare Compliance Officer	Ms	Solomon	Mary		2673004846					mlsolomon@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Drive, 2flr.	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Utilization Management Contact	VP, Utilization Management Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0738	Utilization Review Contact	VP, Utilization Management Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AmeriHealth Caritas VIP Next, Inc.	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H0755	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H0755	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H0755	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H0755	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H0755	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0755	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0764	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				PPO - BBA		C	San Francisco
H0764	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				PPO - BBA		C	San Francisco
H0764	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H0764	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				PPO - BBA		C	San Francisco
H0764	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/15/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0764	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H0783	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H0783	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H0783	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0783	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H0798	Agent/Broker Compensation Data Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Automated TrOOP Balance Transfer Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Backup User Access Contact			Berg	Lynnsey		6126326655					lynnsey.berg@optum.com	P.O. Box 9472		Minneapolis	MN	554409472	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Best Available Evidence Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Bid Audit Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Bid Audit Site Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Bid Primary Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	CAP Report Contact for Public Website			Jacobson	Marissa		9529922093					marissa.jacobson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	CEO - CMS Administrator Contact	Interm President & CFO	Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	CEO - Senior Official for Contracting		Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Chief Financial Officer		Ms	Quist	Mary		9529922058					mary.quist@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Chief Operating Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Chief Information Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Chief Information Security Officer		Mr	Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	CMMI Model Point of Contact			Schaefer	Jennifer		9529912803					jennifer.schaefer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	CMS Casework Communication Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Complaints Tracking Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Contact for Fraud Investigations			Monson	Peter		9529921149					peter.monson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Coordination of Benefits Contact			Vilendrer	Krista		9529923252					krista.vilendrer@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Corporate Mailing						9529922900					ann.kinsella@medica.com	401 Carlson Parkway	P.O. Box 9310 CP320	Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Coverage Gap Discount Program (CGDP) Payment Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Customer Service Operations Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	DIR Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	DIR Contact (Secondary)			Gansen	Nate		9529923512					nathaniel.gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Emergency Part D Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Emergency Part D Contact (Secondary)			Janes	Kathy		9529928989					kathy.janes@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Employer Waiver Contact			Alness	Stacy		9529923825					stacy.alness@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Encounter Data & Risk Adjustment Operations Contact			Leth	Maria		9529928366					maria.leth@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Enrollment Contact			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	EOB Transfer Contact			Bourdages	Kathy		9529923653				9529923636	kathy.bourdages@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Financial Audit Contact	Director Finance & Strategy	Mr	Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Financial Reporting Contact			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Formulary Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Formulary Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	General Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Government Relations Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	HIPAA Privacy Officer			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	HIPAA Security Officer		Mr	Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Hospice Contact			Bourdages	Kathy		9529923653					PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Interoperability Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	MA Appeals/Grievances Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	MA Claims Processing Contact for Public Website			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Marketing Contact			Teff	Melissa		9529923972					melissa.teff@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Medical Director	Chief Clinical & Provider Strategy Officer		Webster	David		9529922801					david.webster@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Medicare Compliance Officer		Mrs	Koranteng	Milly		9529922090					mildred.koranteng@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Medicare Coordinator			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Medicare Part D Opioid Overutilization Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Medication Therapy Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	OffShore Subcontractor Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Online Enrollment Center Contact (Primary)			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Part C Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Part C Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Appeals			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract	9529922353				HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Appeals Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract	9529923448				HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Benefits Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Claims Submission Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Exceptions Contact			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract	9529922353				HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Exceptions Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract	9529923448				HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Price File Contact (Back-up)			Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Farifield	OH	45014	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Price File Contact (Optional)			Bourdages	Kathy		9529923653					PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Price File Contact (Primary)			Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Quality Assurance Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Part D Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Patient Safety Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Payment Contact			Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Pharmacy Director			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Pharmacy Network Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Pharmacy Network Management Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	La Tasha							LaTasha_Monroe@expressscripts.com	13051 N. Telecom Pkwy		Temple Terrace	FL	33637	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract	8009221557				HMO - Health Maintenance Organization		C	Kansas City
H0798	Pharmacy Technical Help Desk Contact (Secondary)			Bourdages	Kathy							PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract	8009221557				HMO - Health Maintenance Organization		C	Kansas City
H0798	Plan Directory Contact for Public Website			Service	Customer		8002348755					AskGovtPrograms@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Plan to Plan Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Processor Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Quality Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Reconciliation Contact (Secondary)			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Recovery Audit Contact	Manager Claims Operations	Mr	Foley	Steve		9529924160					steven.foley@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	SNP Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	SNP State Contact			Zillhardt	John		9529922290					John.Zillhardt@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Surveillance Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	System Contact			Schwartz	Pamela		9529922584					pamela.schwartz@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Third Party Administrator (TPA) Liaison			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	User Access Contact			Sherman	Autumn		9529923483					autumn.sherman@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Utilization Management Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0798	Utilization Review Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/05/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H0809	Automated TrOOP Balance Transfer Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Backup User Access Contact	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Best Available Evidence Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Bid Primary Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	CAP Report Contact for Public Website	Interim Executive Director	MS	Russell	Mellisa		4137487223				4134932024	Mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	CEO - CMS Administrator Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	CEO - Senior Official for Contracting	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	07/25/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Chief Financial Officer	Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Chief Operating Officer	COO	Ms	Lewis	Anne		4066472980				4134932024	Anne.Lewis@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	09/22/2020	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Chief Information Officer	Director Enterprise IT Operations	Mr	Gillespie	Jeff		6142348636					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Chief Information Security Officer	VP Information Security	Mr	Jennings	Preston		6105503083					preston.jennings@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	CMS Casework Communication Contact	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Complaints Tracking Contact	Regional Director QI/Compliance	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Contact for Fraud Investigations	Regional Director QI/Compliance	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Coordination of Benefits Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Corporate Mailing						4137487223				4134932024	emmanuel.cheo@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	12/29/2020	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Customer Service Operations Contact	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	DIR Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	DIR Contact (Secondary)	Director, Finance	Ms	Szymczyk	Dawn		4137487223				4134932024	dawn.szymczyk@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/27/2020	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Emergency Part D Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Encounter Data & Risk Adjustment Operations Contact	Director of Coding and Documentation		Creaney	Emy		7343431939					creaneye@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Enrollment Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	EOB Transfer Contact	Regional Director Finance	Ms	Szymczyk	Dawn		4138274243				4134932024	Dawn.Szymczyk@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Financial Audit Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/17/2021	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Financial Reporting Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	10/03/2022	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Formulary Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362				4134932024	joseph.garbarino@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	General Contact	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	07/25/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Government Relations Contact	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	HIPAA Privacy Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	HIPAA Security Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Interoperability Contact	Director Enterprise IT Operations		Gillespie	Jeff		7343433079					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	MA Appeals/Grievances Contact	Regional Director QI/Compliance	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	MA Claims Processing Contact for Public Website	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Marketing Contact	Director Marketing & Communication	Ms	Lark	Azia		9735182754					azia.lark@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	02/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Medical Director	Medical Director		Pierangelo	David		4137487223				4134932024	david.pierangelo@TrinityHealthOfNE.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	12/29/2020	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Medicare Compliance Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Medicare Coordinator	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/04/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362				4134932024	joseph.garbarino@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362				4134932024	joseph.garbarino@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Part C Application Contact	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Part D Appeals	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad Street		Philadelphia	PA	19145	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Boston
H0809	Part D Application Contact	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Part D Benefits Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Part D Claims Submission Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Part D Exceptions Contact	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Boston
H0809	Part D Price File Contact (Back-up)	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Part D Price File Contact (Primary)	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Part D Quality Assurance Contact	Regional Director QI/Compliance	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Part D Reporting Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Patient Safety Contact	Regional Director QI/Compliance	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Payment Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Pharmacy Director	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362				4134932024	joseph.garbarino@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Pharmacy Network Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362				4134932024	joseph.garbarino@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Pharmacy Technical Help Desk Contact	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad Street		Philadelphia	PA	19145	09/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Boston
H0809	Pharmacy Technical Help Desk Contact (Secondary)	Executive Director	Mr	Cheo	Emmanuel						4134932024	Emmanuel.Cheo@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	03/30/2020	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	4138274243				PACE - Nat		C	Boston
H0809	Plan Directory Contact for Public Website	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Plan to Plan Reconciliation Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Processor Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Quality Contact	Regional Director QI/Compliance	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Reconciliation Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Reconciliation Contact (Secondary)	Director of Finance	Ms	Szymczyk	Dawn		4137487223				4134932024	dawn.szymczyk@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	02/19/2021	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Recovery Audit Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	05/16/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Surveillance Contact	Interim Executive Director	Ms	Russell	Mellisa		2159901699				4134932024	mellisa.russell@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	System Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Third Party Administrator (TPA) Liaison	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	User Access Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Utilization Management Contact	Medical Director		Pierangelo	David		4137487223				4134932024	david.pierangelo@TrinityHealthOfNE.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0809	Utilization Review Contact	Medical Director		Pierangelo	David		4137487223				4134932024	david.pierangelo@TrinityHealthOfNE.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	MERCY LIFE, INC.	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Boston
H0819	Automated TrOOP Balance Transfer Contact	None		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Backup User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Best Available Evidence Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Bid Primary Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	CAP Report Contact for Public Website	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Chief Financial Officer	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Chief Operating Officer	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Chief Information Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Chief Information Security Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	CMS Casework Communication Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Complaints Tracking Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Contact for Fraud Investigations	Executive Director	Ms	Moreth	Carla		8145356000	22139			8142487902	CMORETH@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Coordination of Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Corporate Mailing						8145356000	22101			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Coverage Gap Discount Program (CGDP) Payment Contact			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Customer Service Operations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	DIR Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Emergency Part D Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Encounter Data & Risk Adjustment Operations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	10/18/2019	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Enrollment Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	EOB Transfer Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Financial Audit Contact	CFO	Mr	Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Financial Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Formulary Contact			N/A	N/A		1234567890	123				N/A@n/a.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	General Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Government Relations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	HIPAA Privacy Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	HIPAA Security Officer	IT Director		Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Interoperability Contact	Chief Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	MIrwin@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	02/16/2022	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	MA Appeals/Grievances Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Marketing Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Medical Director	Medical Director		Emesue	Evangeline		7177575433					Eemesue@PhysicianSolutionsGRP.com	1500 Memory Lane Ext		York	PA	17402	04/18/2023	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Medicare Compliance Officer	Executive Director	Mr	Hantz	Jordan		7177575433					SLYDirectors@seniorlifeyork.com	1500 Memory Lane Extended		York	PA	17402	08/12/2019	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Medicare Coordinator	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Medicare Part D Opioid Overutilization Contact	Medical Director		Emesue	Evangeline		7177575433					Eemesue@PhysicianSolutionsGRP.com	1500 Memory Lane Ext		York	PA	17402	04/18/2023	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Medication Therapy Management Contact	Chief Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	03/13/2019	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Part C Application Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Part D Appeals	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H0819	Part D Appeals Contact (Secondary)	Chief Executive Officer	Mr.	Irwin	Mark						8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	12/29/2020	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active	8145356000	22101			PACE - Nat		C	Philadelphia
H0819	Part D Application Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Part D Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Part D Claims Submission Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Part D Exceptions Contact	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H0819	Part D Price File Contact (Back-up)			N/A	N/A		1234567890	123				N/A@N/A.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Part D Price File Contact (Primary)			N/A	N/A		1234567890	123				N/A@N/A.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Part D Quality Assurance Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Part D Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Patient Safety Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Payment Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Pharmacy Director			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Pharmacy Network Management Contact			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Pharmacy Technical Help Desk Contact			Rowland	Bob							Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active	7242751203	219			PACE - Nat		C	Philadelphia
H0819	Plan Directory Contact for Public Website	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Processor Contact	Claims Manager		Hoffman	Lindsey		8145356000	22654			8142487878	Lhoffman@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	04/18/2023	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Quality Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Reconciliation Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Recovery Audit Contact	CFO	Mr	Dodson	David	M	8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Surveillance Contact			Irwin	Mark		8145356000	22101				Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	System Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Third Party Administrator (TPA) Liaison			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Utilization Management Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0819	Utilization Review Contact	ChieExecutive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE YORK, INC.	National PACE	Senior LIFE York	National PACE		Senior LIFE York, Inc.	544	Yes	Active					PACE - Nat		C	Philadelphia
H0826	Agent/Broker Compensation Data Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Automated TrOOP Balance Transfer Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Backup User Access Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Best Available Evidence Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Bid Audit Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Bid Audit Site Contact	Compliance Officer	Mr.	Roth	Clifford		5594120284					croth@iihcplans.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	07/29/2021	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Bid Primary Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	CAP Report Contact for Public Website	Director of Compliance	Ms.	Elser	Eva		9595085840					eelser@innovativeih.com	1125 N Magnolia Ave.		Anaheim	CA	92801	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	CEO - CMS Administrator Contact		Mr.	Longoria	Daniel		5105072010					dlongoria@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	CEO - Senior Official for Contracting		Mr.	Longoria	Daniel		5105072010					dlongoria@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Chief Financial Officer		Mr.	Longoria	Daniel		5105072010					dlongoria@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Chief Operating Officer	Chief Operating Officer	Ms.	Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Chief Information Officer	Chief Operating Officer	Ms.	Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Chief Information Security Officer	Chief Operating Officer	Ms.	Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	CMS Casework Communication Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Complaints Tracking Contact	Director of Compliance	Ms.	Elser	Eva		9595085840					eelser@innovativeih.com	1125 N Magnolia Ave.		Anaheim	CA	92801	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Contact for Fraud Investigations	Director of Compliance	Ms.	Elser	Eva		9595085840					eelser@innovativeih.com	1125 N Magnolia Ave.		Anaheim	CA	92801	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Coordination of Benefits Contact			Lyfoung	Tsuleng		6128072260					tlyfoung@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Corporate Mailing						9492997766					info@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Coverage Gap Discount Program (CGDP) Payment Contact			Lyfoung	Tsuleng		6128072260					tlyfoung@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Customer Service Operations Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	DIR Contact			Lyfoung	Tsuleng		6128072260					tlyfoung@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	DIR Contact (Secondary)			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/09/2021	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Electronic Health Record Contact			Rigden	Denise		5593885221					drigden@iihcplans.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	12/29/2021	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Emergency Part D Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Emergency Part D Contact (Secondary)			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/09/2021	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Encounter Data & Risk Adjustment Operations Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Enrollment Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	EOB Transfer Contact			Meronk	Cheryl		9494396130				8556296635	cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Financial Audit Contact	Director of Compliance	Ms.	Elser	Eva		9595085840					eelser@innovativeih.com	1125 N Magnolia Ave.		Anaheim	CA	92801	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Financial Reporting Contact			Lyfoung	Tsuleng		6128072260					tlyfoung@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Formulary Contact	Clinical Pharmacy Manager		Hofer	Alissa		7158522096					ahofer@pharmastar.com	P.O. Box 1123		Eau Claire	WI	54720	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Formulary Contact (Secondary)			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	General Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Government Relations Contact	Director of Compliance	Ms.	Elser	Eva		9595085840					eelser@innovativeih.com	1125 N Magnolia Ave.		Anaheim	CA	92801	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	HIPAA Privacy Officer	Director of Compliance	Ms.	Elser	Eva		9595085840					eelser@innovativeih.com	1125 N Magnolia Ave.		Anaheim	CA	92801	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	HIPAA Security Officer	Director of Compliance	Ms.	Elser	Eva		9595085840					eelser@innovativeih.com	1125 N Magnolia Ave.		Anaheim	CA	92801	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Hospice Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Interoperability Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	MA Appeals/Grievances Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	MA Claims Processing Contact for Public Website			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Marketing Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Medical Director	Medical Director	Dr.	Masatsugu	Miles		9493759308					mmasatsugu@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Medicare Compliance Officer	Director of Compliance	Ms.	Elser	Eva		9595085840					eelser@innovativeih.com	1125 N Magnolia Ave.		Anaheim	CA	92801	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Medicare Coordinator			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Medicare Part D Opioid Overutilization Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Medication Therapy Management Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	OffShore Subcontractor Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	06/09/2021	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Online Enrollment Center Contact (Back-up)			Roth	Clifford		5597724072					croth@iihcplans.com	1200 Newport Center Dr. Suite 230		Newport Beach	CA	92660	10/01/2021	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Online Enrollment Center Contact (Optional)			Reddy	Niyati		9495298727					nreddy@iihcplans.com	1200 Newport Center Drive, Suite 230		Newport Beach	CA	92660	10/01/2021	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Online Enrollment Center Contact (Primary)			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Part C Application Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Part C Reporting Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Appeals			Meronk	Cheryl							cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated	5592422802				HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Appeals Contact (Secondary)			Roth	Clifford							croth@iihcplans.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	12/30/2021	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated	8889006807				HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Application Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Benefits Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Claims Submission Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Exceptions Contact			Meronk	Cheryl							cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated	5592422802				HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Exceptions Contact (Secondary)			Roth	Clifford							croth@iihcplans.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	12/30/2021	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated	8889006807				HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Price File Contact (Back-up)			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Price File Contact (Optional)	Compliance Officer	Mr.	Roth	Clifford		5594120284					croth@iihcplans.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	12/30/2021	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Price File Contact (Primary)	Clinical Pharmacy Manager		Hofer	Alissa		7158522096					ahofer@pharmastar.com	P.O. Box 1123		Eau Claire	WI	54720	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Quality Assurance Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Part D Reporting Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Patient Safety Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Payment Contact			Lyfoung	Tsuleng		6128072260					tlyfoung@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Pharmacy Director	Clinical Pharmacy Manager		Hofer	Alissa		7158522096					ahofer@pharmastar.com	P.O. Box 1123		Eau Claire	WI	54720	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Pharmacy Network Management Contact	Clinical Pharmacy Manager		Hofer	Alissa		7158522096					ahofer@pharmastar.com	P.O. Box 1123		Eau Claire	WI	54720	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Pharmacy Network Management Contact (Secondary)			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Pharmacy Technical Help Desk Contact	Clinical Pharmacy Manager		Hofer	Alissa							ahofer@pharmastar.com	P.O. Box 1123		Eau Claire	WI	54720	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated	8009422931				HMO - Health Maintenance Organization		C	San Francisco
H0826	Pharmacy Technical Help Desk Contact (Secondary)			Meronk	Cheryl							cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated	8889006807				HMO - Health Maintenance Organization		C	San Francisco
H0826	Plan Directory Contact for Public Website			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Plan to Plan Reconciliation Contact			Lyfoung	Tsuleng		6128072260					tlyfoung@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Processor Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Quality Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Reconciliation Contact			Lyfoung	Tsuleng		6128072260					tlyfoung@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Reconciliation Contact (Secondary)			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/09/2021	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Recovery Audit Contact	Director of Compliance	Ms.	Elser	Eva		9595085840					eelser@innovativeih.com	1125 N Magnolia Ave.		Anaheim	CA	92801	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Surveillance Contact	Director of Compliance	Ms.	Elser	Eva		9595085840					eelser@innovativeih.com	1125 N Magnolia Ave.		Anaheim	CA	92801	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	System Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Third Party Administrator (TPA) Liaison			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	User Access Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Utilization Management Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0826	Utilization Review Contact			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	1200 Newport Center Dr.	Suite 230	Newport Beach	CA	92660	02/07/2023	2023	INNOVATIVE INTEGRATED HEALTH COMMUNITY PLANS, INC.	Local CCP	Integrated HealthPlan	HMO/HMOPOS		Innovative Integrated Health, Inc.	710	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H0838	Agent/Broker Compensation Data Contact	AVP, Sales		Popkin	Shaina		6572488003					spopkin@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/05/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Backup User Access Contact	Senior Compliance Manager	Mr.	Yee	William	S	6263882390				6574001212	wyee@brighthealthcare.com	2400 E. Katella Ave.	11th floor	Anaheim	CA	92806	06/02/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Best Available Evidence Contact	Enrollment Director	Ms.	Lugo-Garcia	Alejandra		6572482674				6574001207	alex.garcia@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Bid Audit Contact	CFO	Mr.	Uma	Chet	S	6263882390	2895				cuma@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Bid Audit Site Contact	CFO		Uma	Chet		6263882390	2895				cuma@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Bid Primary Contact	CFO		Uma	Chet		6263882390	2895				cuma@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	CAP Report Contact for Public Website	Senior Compliance Director & California CO	Ms.	Shieh	Annie		6268258653					ashieh@brighthealthgroup.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	03/06/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8662554795				HMO - Health Maintenance Organization		C	Chicago
H0838	CEO - CMS Administrator Contact	CEO	Mr.	Dewers	Shawn		6265887100					sdewers@centralhealthplan.com	2400  E. Katella Ave	11th floor	Anaheim	CA	92806	03/06/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	CEO - Senior Official for Contracting	CEO	Mr.	Dewers	Shawn		6265887100					sdewers@centralhealthplan.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	03/09/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Chief Financial Officer	Chief Financial Officer	Mr.	Uma	Chet		6263736811					cuma@brighthealthgroup.com	2400 E. Katella Ave.	11th floor	Anaheim	CA	92806	04/11/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Chief Operating Officer	Chief Financial Officer	Mr.	Uma	Chet		6263736811					cuma@brighthealthgroup.com	2400 E. Katella Ave.	11th floor	Anaheim	CA	92806	09/22/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Chief Information Officer	SVP, Information Technology	Ms.	Stewart	Maureen		2813803194					mstuart@brighthealthgroup.com	515 Congress Avenue	20th Floor	Austin	TX	78701	06/02/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Chief Information Security Officer	AVP, Head of Information Security	Mr.	Simms	Curtis		6363007586					csimms@brighthealthgroup.com	8000 Norman Center Drive	Suite 401	Bloomington	MN	55437	05/08/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	CMMI Model Point of Contact	Senior Compliance Director & California CO	Ms.	Shieh	Annie		6268258653					ashieh@brighthealthgroup.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	03/10/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	CMS Casework Communication Contact	 Manager, Appeals & Grievances	Ms.	Bautista	Darline		8663142427				6263882361	appealsandgrievances@centralhealthplan.com	2400 E. Katella Ave, 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Complaints Tracking Contact	Manager, Appeals & Grievance	Ms.	Bautista	Darline		8662554795					darline.bautista@brighthealthcare.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	03/09/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Contact for Fraud Investigations	Special Investigations Unit		SIU	Bright		6514675357					siu@brighthealthcare.com	Bright Health Mailroom,Attn:Special Investigations Unit	777 NW Blue Parkway	Lees Summit	MO	64086	09/22/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Coordination of Benefits Contact	Director, Pharmacy Operations	Mr.	Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Corporate Mailing						6263882390				6263882367	compliance@centralhealthplan.com	2400 E. Katella Ave.	11th Floor	Anaheim	CA	92806	04/14/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Financial Analyst	Ms.	Hoang	khinh		6574001900	4406			6574001215	khoang@universalcare.com	2400 E. Katella Ave.	11th floor	Anaheim	CA	92806	04/11/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Customer Service Operations Contact	Director, Member Services	Ms.	Williamson	Maria		5627120150					mwilliamson@brighthealthcare.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	06/05/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	DIR Contact	Controller/Director, Accounting	Mr.	Condon	Daniel		8772806207					dcondon@brighthealthgroup.com	2400 E. Katella Ave.	11th floor	Anaheim	CA	92806	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	DIR Contact (Secondary)	Senior Accountant	Ms.	Choi	Anne		7339091198					achoi@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Electronic Health Record Contact	Director, Compliance	Ms.	Olney	Marcy		7208391910					molney@brighthealthplan.com	10333 Dry Creek Road	Suite 150	Englewood	CO	80112	06/04/2021	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8662554795				HMO - Health Maintenance Organization		C	Chicago
H0838	Emergency Part D Contact	Senior Clinical Pharmacist		Jones	Edwina		7704031003				8776783655	edwina.jones@brighthealthcare.com	8000 Norman Center Drive	Suite 401	Bloomington	MN	55437	08/23/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Emergency Part D Contact (Secondary)	Director, Pharmacy Operations	Mr.	Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Encounter Data & Risk Adjustment Operations Contact			Gomez	Candice		6263882390	2207				candicegomez@centralhealthplan.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	03/09/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Enrollment Contact	Enrollment Director		Lugo-Garcia	Alejandra		6572482674				6574001207	alex.garcia@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Financial Audit Contact	CFO	Mr.	Uma	Chet		6263882390	2895				chetuma@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Financial Reporting Contact			Vyvyan	Marie		6122472080					mvyvyan@brighthealthgroup.com	8000 Norman Center Drive		Bloomington	MN	55437	11/14/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Formulary Contact	Senior Clinical Pharmacist		Jones	Edwina		7704031003					edwina.jones@brighthealthcare.com	8000 Norman Center Drive	Suite 401	Bloomington	MN	55437	08/23/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Formulary Contact (Secondary)	Director, Pharmacy Operations		Begey	Eric		8606203553					ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	08/23/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	General Contact	Senior Compliance Director & California CO	Ms.	Shieh	Annie	H	6268258653	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Government Relations Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	S	6263882390	2885				ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	HIPAA Privacy Officer	Senior Compliance Director & California CO	Ms.	Shieh	Annie		6268258653	2885			6263882317	ashieh@brighthealthgroup.com	2400 E. Katella Ave.	11th floor	Anaheim	CA	92806	04/14/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	HIPAA Security Officer	Head of Information Security	Mr.	Simms	Curtis		6363007586				6263882317	csimms@brighthealthgroup.com	8000 Norman Center Drive	Suite 401	Bloomington	MN	55437	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Hospice Contact	Director, Pharmacy Operations		Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Interoperability Contact			Vetter	Kevin		7575727208					kvetter@brighthealthgroup.com	8000 Norman Center Drive		Bloomington	MN	55437	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	MA Appeals/Grievances Contact	Appeals & Grievances, Manager	Ms.	Bautista	Darline		8662554795					darline.bautista@brighthealthcare.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	03/10/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	MA Claims Processing Contact for Public Website	Director, Medicare Claims	Ms.	Wiesmuller	Susan		8662554795				6574001217	swiesmuller@universalcare.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	03/10/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Marketing Contact	AVP, Marketing	Ms.	Romero-San	Elena		6268258467					eromero-san@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Medical Director	Medical Director		Fields	George		6574001900	4004			6474001212	gfields@brighthealthcare.com	2400 E. Katella Ave.	11th floor	Anaheim	CA	92806	04/11/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Medicare Compliance Officer	Senior Compliance Director & California CO	Ms.	Shieh	Annie		6268258653				6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	08/22/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Medicare Coordinator	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ahsu@centralhealthplan.com	1540 Bridgegate Drive		Diamond Bar	CA	91765	11/14/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Jones	Edwina		7704031003					edwina.jones@brighthealthcare.com	8000 Norman Center Drive	Suite 401	Bloomington	MN	55437	08/23/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Medication Therapy Management Contact	Director, Pharmacy Operations		Mehta	Reena		8669058540				8776783655	rmehta@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	OffShore Subcontractor Contact	Senior Compliance Counsel		Shieh	Annie	S	6263882390	2885				ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Online Enrollment Center Contact (Back-up)	Enrollment Department Manager	Ms.	Esquivel	Ana		8662554795	5048			6574001207	aesquivel@universalcare.com	2400 E. Katella Ave.	11th floor	Anaheim	CA	92806	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Online Enrollment Center Contact (Optional)			Vetter	Kevin		7575727208					kvetter@brighthealthgroup.com	8000 Norman Center Drive		Bloomington	MN	55437	11/14/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Online Enrollment Center Contact (Primary)	Enrollment Director		Lugo-Garcia	Alejandra		6572482674				6574001207	alex.garcia@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Part C Application Contact			Wrangham	Steve		6122817882					swragham@brighthealthcare.com	8000 Norman Center Drive		Bloomington	MN	55437	11/14/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Part C Reporting Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	S	6263882390	2885				ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Appeals	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer PKWY		Dublin	OH	43017	12/15/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Appeals Contact (Secondary)	Director, Pharmacy Operations		Begey	Eric						8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8606203553				HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Application Contact			Wrangham	Steve		6122817882					swragham@brighthealthcare.com	8000 Norman Center Drive		Bloomington	MN	55437	11/14/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Benefits Contact	Director, Pharmacy Operations		Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Claims Submission Contact	Director - Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	12/15/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Exceptions Contact	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer PKWY		Dublin	OH	43017	12/15/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Exceptions Contact (Secondary)	Director, Pharmacy Operations		Begey	Eric						8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8606203553				HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Price File Contact (Back-up)	Product Manager Advisor	Ms.	Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	12/15/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Price File Contact (Optional)	Director, Pharmacy Operations		Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer PKWY		Dublin	OH	43017	12/15/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Quality Assurance Contact	Director, Pharmacy Operations		Mehta	Reena		8669058540				8776783655	rmehta@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Part D Reporting Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	S	6263882390					ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Patient Safety Contact	Director, Pharmacy Operations		Mehta	Reena		8669058540				8776783655	rmehta@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Payment Contact	CFO	Mr.	Uma	Chet		6263882390	2895				cuma@brighthealthgroup.com	2400 E. Katella Ave.	11th floor	Anaheim	CA	92806	04/14/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Pharmacy Director	Director, Pharmacy Operations		Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra		Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	08/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Operations		Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Pharmacy Technical Help Desk Contact	Director, Customer Service	Ms.	Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N Telecom PKWY	STE 150	Temple Terrace	FL	33637	01/05/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H0838	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy Operations		Begey	Eric						8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8606203553				HMO - Health Maintenance Organization		C	Chicago
H0838	PHR Beneficiary Contact																	08/20/2013	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS	Brand New Day	Bright Health Group, Inc.	663	Yes	Active	8662554795				HMO - Health Maintenance Organization		C	Chicago
H0838	Physician Incentive Contact	Medical Director		Fields	George		5625198897					gfields@brighthealthcare.com	2400 E. Katella Ave, 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Plan Directory Contact for Public Website			Health	Bright		8442024463					info@brighthealthplan.com	8000 Norman Center Drive		Bloomington	MN	55437	11/14/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Plan to Plan Reconciliation Contact	Senior Accountant, Medicare	Ms.	Choi	Anne		7739091198					achoi@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	07/11/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Processor Contact	Sr. Director, Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	12/15/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Quality Contact	Director, Quality Compliance	Ms.	Kemp	Sara		3016765004					skemp@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Reconciliation Contact	VP Finance - Medicare Advantage	Mr.	Uma	Chet		6263882390	2895				cuma@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	03/07/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Reconciliation Contact (Secondary)			Martlock	Aaron		9513161069					amartlock@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Recovery Audit Contact	Senior Compliance Director & California CO	Ms.	Shieh	Annie	S	6263882390	2885				ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	SNP Application Contact	Senior Compliance Director & California CO	Ms.	Shieh	Annie		6268258653					ashieh@brighthealthgroup.com	2400 E Katella Ave. Ste 1100	Compliance Department	Anaheim	CA	92806	08/22/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	SNP State Contact	Senior Compliance Director & California CO	Ms.	Shieh	Annie		6263882390	2885				ashieh@brighthealthgroup.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Surveillance Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	S	6263882390	2885				ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	System Contact			Vetter	Kevin		7575727208					kvetter@brighthealthgroup.com	8000 Norman Center Drive		Bloomington	MN	55437	11/14/2022	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Third Party Administrator (TPA) Liaison	Director, Controller MA		Martlock	Aaron		6512472080					amartlock@brighthealthgroup.com	8000 Norman Center Drive	Suite 401	Bloomington	MN	55437	01/17/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	User Access Contact	Senior Compliance Director & California CO	Ms.	Shieh	Annie		6263882390	2885				ashieh@brighthealthgroup.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Utilization Management Contact	Director, Utilization Management	Ms.	Raboin	Amanda		6263882390	1523			6263882378	araboin@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0838	Utilization Review Contact	Director, Utilization Management	Ms.	Raboin	Amanda		6263882390	1523			6263882378	araboin@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	07/03/2023	2023	UNIVERSAL CARE, INC.	Local CCP	Brand New Day	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0839	Automated TrOOP Balance Transfer Contact	Business Office Manager	Ms.	Cox	Terra		9705087737					tecox@voa.org	2377 Robins Way		Montrose	CO	81401	03/07/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Backup User Access Contact	Executive Director		Hivley	Antoinette		9194253000				9194253005	thivley@voa.org	5400 S. Miami Blvd. ,Ste 150		Durham	NC	27703	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Best Available Evidence Contact	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste. 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Bid Primary Contact	Business Office Manager	Ms	Cox	Terra		9705087737					tecox@voa.org	2377 Robins Way		Montrose	CO	81401	03/07/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	CAP Report Contact for Public Website	Executive Director	Ms	Hively	Antionette		9194252971					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	CEO - CMS Administrator Contact	Chief of Community Healthcare	Mr.	Soczynski	Paul		4144068843				9529417097	PSoczynski@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	CEO - Senior Official for Contracting	Chief of Community Healthcare	Mr.	Soczynski	Paul		4144068843				9529417097	PSoczynski@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Chief Financial Officer	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Chief Operating Officer	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Chief Information Officer	Chief Information Officer	Mr	Osborne	David		9529410305					dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/03/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Chief Information Security Officer	Chief Information Security Officer	Mr	Osborne	David		9529410305					dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/03/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	CMS Casework Communication Contact	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Complaints Tracking Contact	Quality Manager	Mrs	Bertolotti	Gayle		9194253020					gbertolotti@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Contact for Fraud Investigations	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn		9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Coordination of Benefits Contact	Business office manager	Ms.	Cox	Terra		9705087737					tecox@voa.org	2377 Robins Way		Montrose	CO	81401	03/07/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Corporate Mailing						9529410305				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Customer Service Operations Contact	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	DIR Contact	Business Office Manager		Cox	Terra		9705087737					tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/20/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	DIR Contact (Secondary)	Finance Manger	Mr	Raynor	Eddy		9194253053					eraynor@voa.org	5400 S. Miami Blvd.	Ste 150	Durham	NC	27703	02/20/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Emergency Part D Contact	Executive Director		Hively	Antoinette		9194253000				9194253005	thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Emergency Part D Contact (Secondary)	Director Program Integrity/Compliance	Ms	Linnell	Kathryn		9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Encounter Data & Risk Adjustment Operations Contact	Business Office Manager	Ms	Cox	Terra		9705087737					tecox@voa.org	2377 Robins Way		Montrose	CO	81401	03/07/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Enrollment Contact	Executive Director		Hively	Antoinette		9194253000				9194253005	thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	EOB Transfer Contact	Business Office Manager	Ms	Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	03/07/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Financial Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Financial Reporting Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Formulary Contact	Executive Director	Mr	Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Formulary Contact (Secondary)	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	General Contact	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Government Relations Contact	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	HIPAA Privacy Officer	VOA IT Director	Mr.	Osborne	David		6123083526					DOsborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/03/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	HIPAA Security Officer	VOA IT Director	Mr.	Osborne	David		6123083526					DOsborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/03/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Interoperability Contact	Director Program Integrity/Compliance		Linnell	Kathryn		9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	MA Appeals/Grievances Contact	Director of Quality	Ms	Peterson	Nora		9709643500				9702520166	npeterson@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	MA Claims Processing Contact for Public Website	Claims Administrator	Ms	Ford	Jill		9705087711				9707971984	jford@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Marketing Contact	Marketing&Communication Relations		Rincon	Michelle		5173190740				5173190650	mrincon@voa.org	1921 E Miller Road		Lansing	MI	48911	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Medical Director	Medical Director	Ms.	Bugaj	Gregory		9194253000					gbugaj@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Medicare Compliance Officer	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9709643500				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	02/24/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Medicare Coordinator	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Medicare Part D Opioid Overutilization Contact	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	02/24/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Medication Therapy Management Contact	Medical Director	Dr.	Singh	Amrit		9194253000					ASingh@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	OffShore Subcontractor Contact	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Online Enrollment Center Contact (Back-up)	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Online Enrollment Center Contact (Primary)	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Part C Application Contact	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste. 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Part D Appeals	Director Program Integrity/Compliance	MS	Linnell	Kathryn						8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active	9705087757				PACE - Nat		C	Atlanta
H0839	Part D Appeals Contact (Secondary)	Quality Manager	Mrs	Bertolotti	Gayle							gbertolotti@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active	9194253000				PACE - Nat		C	Atlanta
H0839	Part D Application Contact	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287822				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Part D Benefits Contact	Business Office Manager	Ms	Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	03/07/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Part D Claims Submission Contact	Business Office Manager	Ms	Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	03/07/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Part D Exceptions Contact	Finance Manager	Mr	Raynor	Eddy						9194253001	eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active	9194253000				PACE - Nat		C	Atlanta
H0839	Part D Exceptions Contact (Secondary)	Director Program Integrity/Compliance	Ms	Linnell	Kathryn						8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active	9705087757				PACE - Nat		C	Atlanta
H0839	Part D Price File Contact (Back-up)	Regional Executive Director	Mr	Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Part D Price File Contact (Primary)	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Part D Quality Assurance Contact	Director Program Integrity/Compliance	Ms	Linnell	Kathryn		9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Part D Reporting Contact	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Patient Safety Contact	Executive Director	Ms	Hively	Antionette		9194253053				9194253001	thively@voa.org	5400 S. Miami Blvd. Ste 150		Durham	NC	27703	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Payment Contact	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Personal Health Record Contact	Quality Manager	Mrs.	Bertolotti	Gayle		9194253020				9194253001	gbertolotti@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Pharmacy Director	Regional Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Pharmacy Network Management Contact	Regional Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Pharmacy Technical Help Desk Contact	Regional Executive Director		Howell	Keith						9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active	9709643500				PACE - Nat		C	Atlanta
H0839	Plan Directory Contact for Public Website	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Plan to Plan Reconciliation Contact	Business Office Manager	Ms	Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	03/07/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Processor Contact	Executive Director	Ms	Hively	Antionette		9194252971					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Quality Contact	Director of Quality		Peterson	Nora		9709643500				9702520166	npeterson@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Reconciliation Contact	Executive Director	Ms	Hively	Antionette		9194252971					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Reconciliation Contact (Secondary)	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Recovery Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/07/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Surveillance Contact	East Regional Executive Director		Hively	Antionette		9194253000				9194253005	thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	System Contact	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Third Party Administrator (TPA) Liaison	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858					enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	User Access Contact	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Utilization Management Contact	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0839	Utilization Review Contact	Executive Director	Ms	Hively	Antionette		9194253000					thively@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	01/31/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTH CAROLINA, INC	National PACE	Senior CommUnity Care of North Carolina	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H0870	Automated TrOOP Balance Transfer Contact	CFO		Ringer	Cheryl		5403139200					cringer@blueridgehospice.org	314 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Backup User Access Contact	CFO		Ringer	Cheryl		5403139200					cringer@blueridgehospice.org	314 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Best Available Evidence Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Bid Primary Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	CAP Report Contact for Public Website	Director of IT		Rende	John		5403139200					jrende@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	CEO - CMS Administrator Contact	CEO	Ms	Fried	Cheryl		5403139200					chamiltonfried@blueridgehopsice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	CEO - Senior Official for Contracting	CEO	Ms	Fried	Cheryl	H	5403139200					chamiltonfried@blueridgehopsice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Chief Financial Officer	CFO	Ms	Cheryl	Ringer		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Chief Operating Officer	CEO	Ms	Fried	Cheryl	h	5403139200					chamiltonfried@blueridgehopsice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Chief Information Officer	Director of IT	Mr	Rende	John		5403139200					jrende@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Chief Information Security Officer	Director of IT	Mr	Rende	John		5403139200					jrende@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	CMS Casework Communication Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Complaints Tracking Contact	Quality and Compliance Director		Dehaven	Angel		5403139200					adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Contact for Fraud Investigations	Quality and Compliance Director		Dehaven	Angel		5403139200					adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Coordination of Benefits Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Corporate Mailing						5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Ms	Cheryl	Ringer		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Customer Service Operations Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	DIR Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	DIR Contact (Secondary)	CEO	Ms	Fried	Cheryl	h	5403139200					chamiltonfried@blueridgehopsice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Emergency Part D Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Emergency Part D Contact (Secondary)	CFO	Ms	Cheryl	Ringer		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Encounter Data & Risk Adjustment Operations Contact	Director of IT	Mr	Rende	John		5403139200					jrende@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Enrollment Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	EOB Transfer Contact	CEO	Ms	Fried	Cheryl	H	5403139200				5406780584	chamiltonfried@blueridgehopsice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Financial Audit Contact	CFO	Ms	Ringer	Cheryl		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Financial Reporting Contact	CFO	Ms	Cheryl	Ringer		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Formulary Contact	Director of IT	Mr	Rende	John		5403139200					jrende@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Formulary Contact (Secondary)	CEO	Ms	Fried	Cheryl		5403139200					chamiltonfried@blueridgehopsice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	General Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Government Relations Contact	CFO		Ringer	Cheryl		5403139200					cringer@blueridgehospice.org	314 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	HIPAA Privacy Officer	Quality and Compliance Director		Dehaven	Angel		5403139200					adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	HIPAA Security Officer	Quality and Compliance Director		Dehaven	Angel		5403139200					adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Interoperability Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	MA Appeals/Grievances Contact	CEO	Ms	Fried	Cheryl	H	5403139200					chamiltonfried@blueridgehopsice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	MA Claims Processing Contact for Public Website	Director of IT	Mr	Rende	John		5403139200					jrende@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Marketing Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Medical Director	CMO	Dr	Flynn	Brendan		5403139200					bflynn@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Medicare Compliance Officer	CEO	Ms	Fried	Cheryl	H	5403139200					chamiltonfried@blueridgehopsice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Medicare Coordinator	CEO	Ms	Fried	Cheryl	H	5403139200					chamiltonfried@blueridgehopsice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Medicare Part D Opioid Overutilization Contact	CMO	Dr	Flynn	Brendan		5403139200					bflynn@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Medication Therapy Management Contact	CMO	Dr	Flynn	Brendan		5403139200					bflynn@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Online Enrollment Center Contact (Primary)	Director of IT	Mr	Rende	John		5403139200					jrende@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Part C Application Contact			Myers	Sue Ann		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Part D Appeals	Quality and Compliance Director		Dehaven	Angel						5406780584	adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending	8002385678				PACE - Nat		C	Philadelphia
H0870	Part D Appeals Contact (Secondary)	Quality and Compliance Director		Dehaven	Angel						5406780584	adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending	8002385678				PACE - Nat		C	Philadelphia
H0870	Part D Application Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Part D Benefits Contact	CFO	Ms	Cheryl	Ringer		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Part D Claims Submission Contact	CFO	Ms	Ringer	Cheryl		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Part D Exceptions Contact	Quality and Compliance Director		Dehaven	Angel						5406780584	adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending	8002385678				PACE - Nat		C	Philadelphia
H0870	Part D Exceptions Contact (Secondary)	Quality and Compliance Director		Dehaven	Angel						5406780584	adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending	8002385678				PACE - Nat		C	Philadelphia
H0870	Part D Price File Contact (Back-up)	CFO	Ms	Ringer	Cheryl		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Part D Price File Contact (Optional)	CFO	Ms	Ringer	Cheryl		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Part D Price File Contact (Primary)	CFO	Ms	Ringer	Cheryl		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Part D Quality Assurance Contact	CFO	Ms	Ringer	Cheryl		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Part D Reporting Contact	Quality and Compliance Director		Dehaven	Angel		5403139200					adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Patient Safety Contact	Quality and Compliance Director		Dehaven	Angel		5403139200					adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Payment Contact	CFO	Ms	Ringer	Cheryl		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Personal Health Record Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Pharmacy Director	Quality and Compliance Director		Dehaven	Angel		5403139200					adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Pharmacy Network Management Contact	Quality and Compliance Director		Dehaven	Angel		5403139200					adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Pharmacy Network Management Contact (Secondary)	Quality and Compliance Director		Dehaven	Angel		5403139200					adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Pharmacy Technical Help Desk Contact	Quality and Compliance Director		Dehaven	Angel						5406780584	adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending	8002385678				PACE - Nat		C	Philadelphia
H0870	Plan Directory Contact for Public Website	Director of IT	Mr	Rende	John		5403139200					jrende@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Plan to Plan Reconciliation Contact	CFO	Ms	Cheryl	Ringer		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Processor Contact	CEO	Ms	Fried	Cheryl	H	5403139200					chamiltonfried@blueridgehopsice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Quality Contact	Quality and Compliance Director		Dehaven	Angel		5403139200					adehaven@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Reconciliation Contact	CFO	Ms	Cheryl	Ringer		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Recovery Audit Contact	CFO	Ms	Ringer	Cheryl		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Surveillance Contact	Director of IT	Mr	Rende	John		5403139200					jrende@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	System Contact	Director of IT	Mr	Rende	John		5403139200					jrende@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Third Party Administrator (TPA) Liaison	CFO	Ms	Cheryl	Ringer		5403139200					cringer@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	User Access Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Utilization Management Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0870	Utilization Review Contact	Executive Director		Myers	SueAnn		5403139200					samyers@blueridgehospice.org	814 Hope Drive		Winchester	VA	22601	09/29/2022	2023	BLUE RIDGE INDEPENDENCE AT HOME, INC.	National PACE	Blue Ridge Independence at Home	National PACE				Yes	Pending					PACE - Nat		C	Philadelphia
H0876	Agent/Broker Compensation Data Contact	Manager, Sales Operations	Mr.	Demos	John		6174260600					jdemos@commonwealthcare.org	30 Winter Street		Boston	MA	02108	04/22/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment and Eligibility		Sherman	Mandy		9202214083				9202214583	Relay.Health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Backup User Access Contact	Director, Health Plan Compliance		Dwinnells	Mark		6174260600	1239				mdwinnells@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Best Available Evidence Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931				randrade@commonwealthcare.org	30 Winter St		Boston	MA	02108	02/05/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Bid Audit Contact	Sr. Director, Actuarial Services		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Bid Audit Site Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Bid Primary Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/26/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	CAP Report Contact for Public Website	General Manager, Market Lead - Rhode Island		McCarty	Corey		6174260600	52262				cmccarty@commonwealthcare.org	3 Davol Square, Suite C-300		Providence	RI	02903	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Palmieri	Chris	D	8572468897					cpalmieri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/05/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	CEO - Senior Official for Contracting	President of Markets	Ms	Murphy	Courtney		6174260600	53892				cmurphy@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/23/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Chief Financial Officer	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/12/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Chief Operating Officer	Chief Operating Officer	Mr.	Mudunuri	Sesha		6178757140					smudunuri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/05/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Chief Information Officer	SVP & Chief Information Officer	Ms.	O'Rorke	Beth		6174260600	2485				bororke@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/21/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Chief Information Security Officer	VP, IT Governance and Cyber Security	Mr.	Jacobs	Tim		6174260600	52258				tjacobs@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	CMMI Model Point of Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	CMS Casework Communication Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320					tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Complaints Tracking Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320				8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Contact for Fraud Investigations	Director, FWA Program and SIU		Vasconcelos	Nadia		6174260600	52733				nvasconcelos@commonwealthcare.org	2 Lafayette	5th Floor	Boston	MA	02111	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Coordination of Benefits Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931			6174263109	randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/05/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Corporate Mailing						6174260600	1991				elgray@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Customer Service Operations Contact	Director, Contact Center Strategy		Cuevas	Sabrina		6174260600	51004				scuevas@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/05/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	DIR Contact	Sr. Director, Actuarial Services		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	DIR Contact (Secondary)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Electronic Health Record Contact	Director, Enterprise Clinical Informatics		Phan	Phuong		6174260600	52274				pphan@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	11/04/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Emergency Part D Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Emergency Part D Contact (Secondary)	Manager, Pharmacy Operations		Lee	Annie		6174260600					alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Encounter Data & Risk Adjustment Operations Contact	Manager, Encounters and Risk		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter St		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Enrollment Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931			6174263109	randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/05/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	EOB Transfer Contact	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194			6174260600	elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Financial Audit Contact	Director, Regulatory Audit	Ms	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Financial Reporting Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Formulary Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Formulary Contact (Secondary)	Medicare Team Lead, Formulary Services		Paddock	Deanna		6087291628				6087292628	deanna.paddock@navitus.com	361 Integrity Drive		Madison	WI	53717	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	General Contact	General Manager, Market Lead - Rhode Island		McCarty	Corey		6174260600	52262				cmccarty@commonwealthcare.org	3 Davol Square, Suite C-300		Providence	RI	02903	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Government Relations Contact	VP, Government Relations		Preede	Ken		6174260600	51412				kpreede@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	HIPAA Privacy Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	HIPAA Security Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Hospice Contact	Palliative Care Medical Director		Ragland	Julia		7815254203					JRagland@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	10/04/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Interoperability Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	MA Appeals/Grievances Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320				8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	MA Claims Processing Contact for Public Website	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194				elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Marketing Contact	SVP, Marketing		Kubilus	Melissa		6174260600	52448			6174263019	mkubilus@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/03/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Medical Director	Medical Director		Chittendene	Eva		6174260600	56924				echittenden@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/03/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Medicare Compliance Officer	Director, Medicare Compliance Officer	Ms.	Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/01/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Medicare Coordinator	General Manager, Market Lead - Rhode Island		McCarty	Corey		6174260600	52262				cmccarty@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/04/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/28/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Medication Therapy Management Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	OffShore Subcontractor Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Online Enrollment Center Contact (Back-up)	Manager, Member Enrollment and Retention		Taylor	Lena		6174260600	51126				ltaylor@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Online Enrollment Center Contact (Optional)	Director, Enrollment	Mr.	Andrade	Remo		6174260600					randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Online Enrollment Center Contact (Primary)	Director, Enrollment, Recon. & Retention	Mr	Andrade	Remo		6174260600	57931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Part C Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/26/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Part C Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Part D Appeals	Director, Appeals & Grievances		Schenk	Tyrone						8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8573273320				HMO - Health Maintenance Organization		C	Boston
H0876	Part D Appeals Contact (Secondary)	Manager Clinical Appeals and Grievances		Mancuso	Jeremiah							jmancuso@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600	51222			HMO - Health Maintenance Organization		C	Boston
H0876	Part D Application Contact	Sr Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/26/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Part D Benefits Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Part D Claims Submission Contact	Manager, Technical Operations		Derks	Bob		9202214176				9202214676	DL-TO-PDE@navitus.com	1025 West Navitus Dr		Appleton	WI	54913	05/04/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Part D Exceptions Contact	Sr. Manager, Clinical Prior Auth		LeClair	Christophe						9202214676	Christopher.LeClair@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8662703877				HMO - Health Maintenance Organization		C	Boston
H0876	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Operations		Lee	Annie						6174263109	alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/09/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600				HMO - Health Maintenance Organization		C	Boston
H0876	Part D Price File Contact (Back-up)	Manager, Pharmacy Operations		Lee	Annie		6174260600					alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/09/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Part D Price File Contact (Optional)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Part D Price File Contact (Primary)	Navitus Plan Finder		Finder	Plan		6087291578					Plan.Finder@Navitus.com	2601 West Beltline Highway	Suite 600	Madison	WI	53713	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Part D Quality Assurance Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Part D Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Patient Safety Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Payment Contact	VP Revenue Cycle Management		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Personal Health Record Contact	Mgr, Health Information Management		Lopez	Robin		6174260600	5235				rlopez@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Pharmacy Director	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688				6087292688	Jan.Robinson@Navitus.com	361 Integrity Drive		Madison	WI	53713	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Pharmacy Technical Help Desk Contact	Sr. Mgr, Customer Care Accounts		Nett	Danielle						9202214724	Danielle.Nett@navitus.com	1025 West Navitus Drive		Appleton	WI	53713	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Boston
H0876	PHR Beneficiary Contact																	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS	Commonwealth Care Alliance	Commonwealth Care Alliance, Inc.	60	Yes	Active	8666102273				HMO - Health Maintenance Organization		C	Boston
H0876	Physician Incentive Contact	VP, Provider Network Strategy	Mr.	Tirimacco	Robert		6174260600	1013				rtirimacco@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Plan Directory Contact for Public Website			Services	Member		8664209332					memberservices@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/16/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Plan to Plan Reconciliation Contact	Manager, Accounts Payable		Reeves	Jennifer		6174260600	51632				jreeves@commonwealthcare.org	30 Winter St		Boston	MA	02108	05/08/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Processor Contact	VP, Claims and Provider Network Operations		Breen	Donna		6176804446					dbreen@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Quality Contact	VP, Quality		Feierstein	Anne		6174260600	56868				afeierstein@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/10/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Reconciliation Contact	Director, Actuarial Service		Jesik	David		6174260600	1808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/01/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Reconciliation Contact (Secondary)	VP Revenue Cycle		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Recovery Audit Contact	Director, Regulatory Audit	Ms.	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	SNP Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	SNP State Contact	General Manager, Market Lead - Rhode Island		McCarty	Corey		6174260600	52262				cmccarty@commonwealthcare.org	3 Davol Square, Suite C-300		Providence	RI	02903	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Surveillance Contact	VP, National Sales		Spartano	Michael		6174260600	52179				mspartano@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	System Contact	Manager, Encounters and Risk Adjustment		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Third Party Administrator (TPA) Liaison	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	User Access Contact	Director Medicare Compliance Officer		Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	190 White Ave		Warwick	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Utilization Management Contact	VP UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0876	Utilization Review Contact	VP, UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H0885	Agent/Broker Compensation Data Contact	Medicare Program Analyst		Wilbanks	Dasha		9734665601					dasha_wilbanks@horizonblue.com	3 Penn Plaza	16-C	Newark	NJ	07105	04/19/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Automated TrOOP Balance Transfer Contact	Manager, PBM Ops.	Ms.	Hanson	Michelle		6127776755					EOBP2P@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	10/06/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Backup User Access Contact	Medicare Program Analyst		Vargas	Mario		9734666379					mario_vargas@horizonblue.com	3 Penn Plaza East	16-C	Newark	NJ	07105	01/22/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Best Available Evidence Contact	Supervisor, Govt. Programs		Achoe	Kisha		9734667328					Kisha_Achoe@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	07/27/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Bid Audit Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319				7322565428	jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Bid Audit Site Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319				7322565428	jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Bid Primary Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319				7322565428	jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	CAP Report Contact for Public Website	VP, Regulatory Compliance	Mr	McGrady	Daniel		6095373066					scott_johnson@horizonblue.com	3 Penn Plaza	PP-16F	Newark	NJ	07105	04/18/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active	6095372317				PPO - BBA		C	New York
H0885	CEO - CMS Administrator Contact	CEO - Chief Executive Officer	Ms.	Charbonneau	Luisa		8627630015					Luisa.Charbonneau@bravenhealth.com	3 Penn Plaza	PP-14	Newark	NJ	07105	08/31/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	CEO - Senior Official for Contracting	CEO - Chief Executive Officer	Ms.	Charbonneau	Luisa		8627630015					Luisa.Charbonneau@bravenhealth.com	3 Penn Plaza	PP-14	Newark	NJ	07105	08/31/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Chief Financial Officer	CFO	Mr.	Meaney	Frank		2035256777					Frank.Meaney@BravenHealth.com	3 Penn Plaza East		Newark	NJ	07105	01/03/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Chief Operating Officer	Chief Operating Officer	Ms.	Mahoney	Audrey		7329957148					Audrey.Mahoney@Bravenhealth.com	3 Penn Plaza	PP-16	Newark	NJ	07105	08/09/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Chief Information Officer	Chief Information Officer	Ms.	Machemer	Michelle		9734664188					Michelle_Machemer@horizonblue.com	3 Penn Plaza East	PP-10	Newark	NJ	07105	04/22/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Chief Information Security Officer	Chief Information Security Officer	Mr.	Becknel	Damon		9734667753					Damon_Becknel@horizonblue.com	3 Penn Plaza East	PP-16	Newark	NJ	07105	01/22/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	CMS Casework Communication Contact	Director, GP Operations		Maramraju	Venkata		6095372113					venkata.maramraju@horizonblue.com	1700 American Boulevard		Pennington	NJ	08534	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Complaints Tracking Contact	Mgr, Exec DOBI Compl & Appls		Mestres	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	06/15/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Contact for Fraud Investigations	Director, Special Investigations		Dineen	Timothy		9734668723					timothy_dineen@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	01/22/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Coordination of Benefits Contact	Manager, PBM Ops	Ms.	Hanson	Michelle		6127776755				6127776705	COBMedD@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	10/06/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Corporate Mailing						6095373066					scott_johnson@horizonblue.com	1700 American Blvd. HL-03	Hopewell Campus	Pennington	NJ	08534	04/30/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Reporting		Griffin	Kevin		6095372464					kevin_griffin@horizonblue.com	1700 American Blvd	HL-03Q	Pennington	NJ	08534	01/22/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Customer Service Operations Contact	Director, Operations - GP		Yanek	John		5182208000					john_yanek@horizonblue.com	3 Penn Plaza	PP-12	Newark	NJ	07105	06/13/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	DIR Contact	Director, Clinical Pharm. Programs		Patrikios	Athena		9734666542					Athena_Patrikios@horizonblue.com	3 Penn Plaza	PP-12Q	Newark	NJ	07105	01/03/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	DIR Contact (Secondary)	Pharmacy Analyst II		Farber	Keri	A	9734668995					keri_farber@horizonblue.com	3 Penn Plaza East	PP-12	Newark	NJ	07105	06/11/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Emergency Part D Contact	Pharmacy Analyst II		Farber	Keri	A	9734668995					keri_farber@horizonblue.com	3 Penn Plaza	PP -12	Newark	NJ	07105	06/11/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Emergency Part D Contact (Secondary)	Manager, Clinical Pharmacy		Sun	Jane		9734665044					jane_sun@horizonblue.com	3 Penn Plaza	PP 12-Q	Newark	NJ	07105	12/13/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Encounter Data & Risk Adjustment Operations Contact	Mgr, Medicare & Medicaid Risk Assessment		Goryachkovsky	Jenny		9734665956					jenny_goryachkovsky@horizonblue.com	3 Penn Plaza	PP-12	Newark	NJ	07105	12/02/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Enrollment Contact	Director, G. P. Operations		Maramraju	Venkata		6095372113					venkata_maramraju@horizonblue.com	1700 American Blvd. HL-03		Pennington	NJ	08534	01/22/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	EOB Transfer Contact	Manager, PBM Ops.	Ms.	Hanson	Michelle		6127776755				6127776705	EOBP2P@primetherapeutics.com	2990 Ames Crossing Rd		Eagan	MN	55121	10/06/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Financial Audit Contact	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					Lisa.keehn@bravenhealth.com	3 Penn Plaza		Newark	NJ	07105	04/30/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Financial Reporting Contact	Corporate Controller		Concepcion	Ivan		9734664188					Ivan_Concepcion@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	05/01/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Formulary Contact	Director, Clinical Pharm Prg & Op - Medicare		Patrikios	Athena		9734666542					athena_patrikios@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	01/22/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Formulary Contact (Secondary)	Supervisor, Formulary Ops.	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	10/06/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	General Contact	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					lisa.keehn@bravenhealth.com	3 Penn Plaza		Newark	NJ	07105	04/30/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Government Relations Contact	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					lisa.keehn@bravenhealth.com	3 Penn Plaza		Newark	NJ	07105	04/30/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	HIPAA Privacy Officer	Director, Privacy Official		Dates	Chris		9734667669					Chris_Dates@horizonblue.com	3 Penn Plaza East	PP-16	Newark	NJ	07105	01/22/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	HIPAA Security Officer	Chief Information Security Officer		Becknel	Damon		9734667753					Damon_Becknel@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Hospice Contact	Manager, Clinical Pharmacy		Sun	Jane		9734665044					Jane_Sun@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Interoperability Contact	Manager, Mandate Implementation		Victory	Jacqueline		9734668759					Jacqueline_Victory@horizonblue.com	3 Penn Plaza	PP-09	Newark	NJ	07105	01/07/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	MA Appeals/Grievances Contact	Manager, MA DOBI Appeals & Grievances		Mestres	Suze		9734665503					Suze_Mestres@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	06/13/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	MA Claims Processing Contact for Public Website	Mgr, Exec DOBI Compl & Appls		Mestress	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	06/15/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Marketing Contact	Sales Manager II		Cennamo	Steven		9084160480					Steven_Cennamo@horizonblue.com	3 Penn Plaza	PP-12F	Newark	NJ	07105	02/24/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Medical Director	Medical Director III, Govt. Programs	Dr.	Johnson	Terry		6095372097					terry_johnson@horizonblue.com	1700 American Blvd	HL-02	Pennington	NJ	08534	01/03/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					lisa.keehn@bravenhealth.com	3 Penn Plaza		Newark	NJ	07105	04/14/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Medicare Coordinator	VP, Regulatory Compliance	Mr	McGrady	Daniel		6095372317					daniel_mcgrady@horizonblue.com	3 Penn Plaza	PP-16F	Newark	NJ	07105	04/18/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Medicare Part D Opioid Overutilization Contact	Supv Pharmacists		Schons	Allison		8554570763				8557297221	PartDoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	01/03/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Medication Therapy Management Contact	Supervisor, MTM and Case/Care Management		Heibling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55120	12/27/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	OffShore Subcontractor Contact	Manager, Medicaid Regulatory Reqs/MCO		McGrady	Daniel		7325393680					daniel_mcgrady@horizonblue.com	1700 American Blvd	HL-03P	Pennington	NJ	08534	02/25/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Online Enrollment Center Contact (Back-up)	Supervisor		Johnson	Cheryl		9734666931					cheryl_johnson@horizonblue.com	3 Penn Plaza East, PP-12L		Newark	NJ	07105	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Online Enrollment Center Contact (Optional)	Team Leader		Johnson	Cheryl		9734666931					Cheryl_Johnson@horizonblue.com	3 Penn Plaza - PP12L		Newark	NJ	07105	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Online Enrollment Center Contact (Primary)	Manager, Medicare Operations		Santiago-Mercado	Nitza		9734667346					Nitza_Santiago-mercado@horizonblue.com	3 Penn Plaza East, PP-12L		Newark	NJ	07105	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Part C Application Contact	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					Lisa.keehn@bravenhealth.com	3 Penn Plaza East	PP-14A	Newark	NJ	07105	02/25/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Part C Reporting Contact	Medicare Program Analyst		Wilbanks	Dasha	N	9734665601					dasha_wilbanks@horizonblue.com	3 Penn Plaza	16-C	Newark	NJ	07105	04/19/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd	PRIME Therapeutics	Eagan	MN	55121	04/15/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active	6127775393				PPO - BBA		C	New York
H0885	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Kimberly	Emerson						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd	Clinical Review	Eagan	MN	55121	07/21/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active	8006936651				PPO - BBA		C	New York
H0885	Part D Application Contact	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					Lisa.keehn@bravenhealth.com	3 Penn Plaza East	PP-14A	Newark	NJ	07105	02/25/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Part D Benefits Contact	Director, Benefits Ops.	Ms.	Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	10/06/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Part D Claims Submission Contact	Functional Business Consultant - Govt. Programs	Mr.	Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	PRIME Therapeutics, LLC	2655 Eagan Woods Drive	Eagan	MN	55122	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Part D Exceptions Contact	Director, Reg/Audit Response	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd		Eagan,	MN	55121	04/15/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active	8006936651				PPO - BBA		C	New York
H0885	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Kimberly	Emerson						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagen	MN	55120	07/21/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active	8006936651				PPO - BBA		C	New York
H0885	Part D Price File Contact (Back-up)	Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	01/03/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Part D Price File Contact (Optional)	QA Analyst		Tastad	Emily		6127772557					emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	06/30/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Part D Price File Contact (Primary)	Manager, Pharmacy Operations	Ms.	Farber	Keri	A	9734668995					Keri_Farber@horizonblue.com	3 Penn Plaza East	PP-12	Newark	NJ	07105	08/20/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Part D Quality Assurance Contact	Director, Pharmacy-Medicare		Patrikios	Athena		9734666542					Athena_Patrikios@horizonblue.com	3 Penn Plaza	PP-12Q	Newark	NJ	07105	01/03/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Part D Reporting Contact	Medicare Program Analyst		Wilbanks	Dasha	N	9734665601					dasha_wilbanks@horizonblue.com	3 Penn Plaza	16-C	Newark	NJ	07105	04/19/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Patient Safety Contact	Director, Pharmacy-Medicare		Patrikios	Athena		9734666542					Athena_Patrikios@horizonblue.com	3 Penn Plaza	PP-12Q	Newark	NJ	07105	01/03/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Payment Contact	Manager, Financial Reporting		Griffin	Kevin		6095372464					kevin_griffin@horizonblue.com	1700 American Blvd	HL-03Q	Pennington	NJ	08534	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Pharmacy Director	Director, Clinical Pharmacy Programs		Patrikios	Athena		9734664654					athena_patrikios@horizonblue.com	3 Penn Plaza	PP-12Q	Newark	NJ	07105	01/03/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Pharmacy Network Management Contact	AVP, Network Mgmt	Ms	Conlin	Marci		6127772842					Marci.Conlin@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	04/15/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Pharmacy Network Management Contact (Secondary)	Sr. Director Network Client Svcs.	Ms	Hanley	Megan		6127773969				8778236373	Megan.Hanley@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55122	01/05/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Pharmacy Technical Help Desk Contact	Director, Member Services		Shultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	12/30/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active	8003911926				PPO - BBA		C	New York
H0885	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Exp. & Member Ops		Bunch	Jonathan							jonathan.bunch@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	12/30/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active	8003911926				PPO - BBA		C	New York
H0885	Plan Directory Contact for Public Website	Mgr, Exec DOBI Compl & Appls		Mestres	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	06/15/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Plan to Plan Reconciliation Contact	Pharmacy Business Admin		Cunningham	Theresa		9734667886				9734664665	theresa_cunningham@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Processor Contact	Manager, PBM Ops	Ms.	Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Rd	PRIME Therapeutics	Eagan	MN	55121	04/15/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Quality Contact	Director, Quality Improvement Operations		Harris	Andrea		6095373027					andrea_harris@horizonblue.com	1700 American Blvd	HL-02	Pennington	NJ	08534	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Reconciliation Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319				7322565428	jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Reconciliation Contact (Secondary)	Manager, Actuarial		Muellers	Barbara		7322565313				7322565428	barbara_muellers@horizonblue.com	1427 Wyckoff Road	WL-03R	Wall	NJ	07727	03/03/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Recovery Audit Contact	Director, Special Investigations	Mr.	Dineen	Timothy		9734668723					timothy_dineen@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	SNP Application Contact			CONTACT	NO		9734664015					NOEMAIL@HORIZONBLUE.COM	3 Penn Plaza	12-H	Newark	NJ	07105	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	SNP State Contact			CONTACT	NO		9734664015					NOEMAIL@HORIZONBLUE.COM	3 Penn Plaza	12-H	Newark	NJ	07105	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Surveillance Contact	Manager, Medicare Requirements	Mr.	Johnson	Scott		6095373066					scott_johnson@horizonblue.com	1700 American Blvd. HL-03	Hopewell Campus	Pennington	NJ	08534	04/30/2021	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	System Contact	Manager, Information Security Risk Management		Andreano	Matthew		9734664124					matthew_andreano@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	06/13/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Third Party Administrator (TPA) Liaison	Director, Pharmacy (Medicare)		Patrikios	Athena		9734666542					athena_patrikios@horizonblue.com	3 Penn Plaza	PP-12Q	Newark	NJ	07105	01/03/2022	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	User Access Contact	Medicare Program Analyst		Wilbanks	Dasha	N	6095372613					Dasha_Wilbanks@horizonblue.com	1700 American Blvd. HL-01	Hopewell Campus	Pennington	NJ	08534	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Utilization Management Contact	Dir, Clin Ops & Delegate Vendor Oversight		Rush	Lisa		7322565016					Lisa_Rush@horizonblue.com	250 Century Parkway	3-D	Mount Laurel	NJ	08054	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0885	Utilization Review Contact	Dir, Clin Ops & Delegate Vendor Oversight		Rush	Lisa		7322565016					Lisa_Rush@horizonblue.com	250 Century Parkway	3-D	Mount Laurel	NJ	08054	01/23/2020	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	Local PPO		NJ Collaborative Care, LLC	755	Yes	Active					PPO - BBA		C	New York
H0907	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	01/29/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/06/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	01/29/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/29/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/29/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/29/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H0907	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H0907	PHR Beneficiary Contact																	01/29/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H0907	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/06/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/29/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0907	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/29/2020	2023	AMERIGROUP IOWA, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H0908	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H0908	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Government Relations Contact	Vice President, Complex Care Products	Ms.	Arden	Gale		3147254477	47759				garden@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Medical Director	Chief Medical Director	Dr.	Lucas	Brad		8662464356					blucas@centene.com	3700 Embassy Parkway, Suite 200		Akron	OH	44333	03/30/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0908	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H0908	PHR Beneficiary Contact																	09/27/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8663897690				HMO - Health Maintenance Organization		C	Dallas
H0908	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	03/31/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0908	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	BUCKEYE COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H0913	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H0913	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H0913	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0913	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H0927	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	5701 Balloon Fiesta Parkway		Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	11/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	12/04/2018	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	02/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/04/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	MMP Reporting Requirements Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	11/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	MMP Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	11/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	08/09/2019	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2023	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	11/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2023	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8888403068				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	0000000000				Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	07/26/2018	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	07/29/2020	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	11/29/2017	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0927	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	07/26/2018	2023	HEALTH CARE SERVICE CORPORATION	Demo	Blue Cross Community MMAI	Medicare-Medicaid Plan HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H0934	Automated TrOOP Balance Transfer Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Backup User Access Contact		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Best Available Evidence Contact			Cadena	Maria		6505022961					maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Bid Primary Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	CAP Report Contact for Public Website			Thiry	Matt		6504305157					matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	CEO - CMS Administrator Contact		Mr.	Thiry	Matt		8008510966					matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	CEO - Senior Official for Contracting		Mr.	Thiry	Matt		8008510966					matt.thiry@welbehealth.com	50 Alessandro Place, Suite A20		Pasadena	CA	91105	08/24/2021	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Chief Financial Officer		Mr.	Epstein	Ethan		2036951178					ethan.epstein@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Chief Operating Officer		Ms.	Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 North Barranca Ave #4051		Covina	CA	91723	09/29/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Chief Information Officer		Ms.	O'Leary	Kate		9733031835					kate.oleary@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Chief Information Security Officer		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	CMS Casework Communication Contact			Costigan	Bobbie		2192106392					Bobbie.Costigan@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Complaints Tracking Contact			Costigan	Bobbie		2192106392					Bobbie.Costigan@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Contact for Fraud Investigations			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Coordination of Benefits Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Corporate Mailing						6508626371					matt.patterson@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Coverage Gap Discount Program (CGDP) Payment Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Customer Service Operations Contact			Thiry	Matt		6504305157					matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	DIR Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Emergency Part D Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Emergency Part D Contact (Secondary)			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Encounter Data & Risk Adjustment Operations Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Enrollment Contact			Cadena	Maria		6505022961					maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	EOB Transfer Contact			Cadena	Maria		6505022961				6263600082	maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Financial Audit Contact	Senior Accounting Manager	Ms.	Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Financial Reporting Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Formulary Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	General Contact			Thiry	Matt		6504305157					matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Government Relations Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	HIPAA Privacy Officer			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	HIPAA Security Officer		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Interoperability Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	MA Appeals/Grievances Contact	Quality Improvement Director		Sternberg	Mollie		6263460502					mollie.sternberg@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	MA Claims Processing Contact for Public Website			Grant	Alexsa		6503360300					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Marketing Contact			Castro	Marta		6509186233					marta.castro@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Medical Director	Chief Medical Officer		Le	Mike		7146086457					mike.le@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Medicare Compliance Officer		Ms.	Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Medicare Coordinator			Thiry	Matt		6504305157					matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Medicare Part D Opioid Overutilization Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Medication Therapy Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Part C Application Contact			Harden	Gabriele		3037754823					gabriele.harden@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Part D Appeals	Quality Improvement Director		Sternberg	Mollie							mollie.sternberg@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	6263460502				PACE - Nat		C	San Francisco
H0934	Part D Appeals Contact (Secondary)			Thiry	Matt							matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8007348041				PACE - Nat		C	San Francisco
H0934	Part D Application Contact			Harden	Gabriele		3037754823					gabriele.harden@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Part D Benefits Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Part D Claims Submission Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Part D Exceptions Contact			Grant	Alexsa							alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8007348041				PACE - Nat		C	San Francisco
H0934	Part D Price File Contact (Back-up)			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Part D Price File Contact (Primary)			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Part D Quality Assurance Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Part D Reporting Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Patient Safety Contact	Quality Improvement Director		Sternberg	Mollie		6263460502					mollie.sternberg@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Payment Contact	Quality Improvement Director		Sternberg	Mollie		6263460502					mollie.sternberg@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Pharmacy Director			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Pharmacy Network Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Pharmacy Technical Help Desk Contact			Grant	Alexsa							alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8007348041				PACE - Nat		C	San Francisco
H0934	Plan Directory Contact for Public Website			Grant	Alexsa		6503360300					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Plan to Plan Reconciliation Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Processor Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Quality Contact	Quality Improvement Director		Sternberg	Mollie		6263460502					mollie.sternberg@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Reconciliation Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Recovery Audit Contact	VP Compliance	Ms.	Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Surveillance Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	System Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Third Party Administrator (TPA) Liaison			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	User Access Contact		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Utilization Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0934	Utilization Review Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	PACIFIC PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H0969	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H0969	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H0969	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H0969	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H0969	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H0969	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H0969	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H0969	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0969	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW HAMPSHIRE	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H0978	Agent/Broker Compensation Data Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/16/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Automated TrOOP Balance Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189			5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Backup User Access Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Best Available Evidence Contact	Director, Enrollment & Reconciliation	Mr.	Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Bid Audit Contact	CVP Strategic Iniatives & Product Development	Ms.	Selby	Jill		5629898382					jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Bid Audit Site Contact	CVP Strategic Initiatives & Product Development	Ms.	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Bid Primary Contact	CVP Strategic Initiatives & Product Development	Ms.	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	CAP Report Contact for Public Website	Compliance Officer	Ms.	Hawkins	Ginette		5623081195				5629895225	ghawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	CEO - CMS Administrator Contact	President, Medicare	Mrs.	Schulte	Karen		5626371205					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/03/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	CEO - Senior Official for Contracting	CEO	Dr.	Jain	Sachin		5629898314	8314				sjain@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Chief Financial Officer	CFO	Mr.	Plumb	Michael		5629971589	1589				mplumb@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Chief Operating Officer	President	Mrs.	Schulte	Karen		5626371205	1205				kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Chief Information Officer	President	Mrs.	Schulte	Karen		5626371205	1205				kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Chief Information Security Officer	President	Mrs.	Schulte	Karen		5626371205	1205				kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	CMS Casework Communication Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131				5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/16/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Complaints Tracking Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131				5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/16/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Contact for Fraud Investigations	Chief Risk Executive		Hawkins	Ginette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	03/07/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Coordination of Benefits Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189			5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Corporate Mailing						5629895100				5629895200	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	Isaac	Sharon		5629894423					sisaac@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Customer Service Operations Contact	Director, (Customer) Member Services	Ms.	McBeath	Kim		5629971805				5629895181	kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	DIR Contact	Financial Accounting Specialist	Ms.	McClour	Tina		5629894459				5629890101	tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	DIR Contact (Secondary)	Manager Revenue Accounting	Ms.	Moreno	Sonia		5623081122					smoreno@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Emergency Part D Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		3237027662				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/21/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Emergency Part D Contact (Secondary)	Director,  Technical Pharmacy Operations	Ms.	Vaca	Ivette		5622091104				5629973196	ivaca@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/22/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Employer Waiver Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131				5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/16/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Encounter Data & Risk Adjustment Operations Contact	Chief Data Officer		Leung	Moon		5629895269					mleung@scanhealthplan.com	3800 Kilroy Airport Way suite 100		Long Beach	CA	90806	03/10/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Enrollment Contact	Director, Enrollment & Reconciliation	Mr.	Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	EOB Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189				5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Financial Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	1331			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Financial Reporting Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Formulary Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Formulary Contact (Secondary)	Clinical Pharmacist	Ms.	Truong	Weilan		5629973187				5629973196	wtruong@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/03/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	General Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Government Relations Contact	VP of Government Relations		Hill	Ryann		2023499008				5629899439	rhill@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	03/23/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	HIPAA Privacy Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835					a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/04/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	HIPAA Security Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835				5629895225	a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/04/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Hospice Contact	Manager, Pharmacy Experience and Access	Mr.	Tran	Tri		5623082884				5629973196	TMTran@scanhealthplan.com	3800 Kilroy Airport Way		Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Interoperability Contact	VP, IT Software & Services	Mr.	Carren	Marc		5629971821					mcarren@scanhealthplan.com	3800 Kilroy Airport Way, Suite 100		Long Beach	CA	90806	02/10/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	MA Appeals/Grievances Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	MA Claims Processing Contact for Public Website	Vice President, Claims & Shared Services	Mr.	Wheeler	Nathan		5623084341					nwheeler@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Marketing Contact	Compliance Specialist	Mr.	Lin	Richard		5623081156					rlin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	10/02/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Medical Director	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	RBatraM.D@scanhelathplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Medicare Compliance Officer	Compliance Officer	Ms.	Hawkins	Ginette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Medicare Coordinator	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist Programs	Ms.	Kelley	Mackenzie		5629973165				5629973196	mkelley@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/26/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Medication Therapy Management Contact	Director Pharmacy Quality & 5 Star	Mr.	Dinh	Matthew		5629895261				5629973196	mdinh@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	OffShore Subcontractor Contact	Dir, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ecordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/10/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment and Reconciliation	Ms.	Gongora	Irene		5629895209				5629895243	IGongora@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Online Enrollment Center Contact (Primary)	Director, Enrollment & Reconciliation	Mr.	Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Part C Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Part C Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Part D Appeals	Director, Grievance & Appeals	Ms.	Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way MS 220		Long Beach	CA	90801	02/01/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	5629895100	1290			HMO - Health Maintenance Organization		C	San Francisco
H0978	Part D Appeals Contact (Secondary)	Director, Grievance & Appeals	Ms.	Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way MS 220		Long Beach	CA	90801	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	5629895100	1290			HMO - Health Maintenance Organization		C	San Francisco
H0978	Part D Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Part D Benefits Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	One Express Way		St Louis	MO	63121	10/13/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Part D Exceptions Contact	Senior Pharmacy Manager	Mr.	Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/01/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	San Francisco
H0978	Part D Price File Contact (Back-up)	Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfiled	OH	45014	12/01/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Part D Price File Contact (Optional)	Pharmacy Analyst		Ramirez	Anthony		5623084348	4348			5629973196	a.ramirez@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/01/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Part D Quality Assurance Contact	CVP/Chier Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Part D Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Patient Safety Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Payment Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Pharmacy Director	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Pharmacy Network Management Contact	Network Acct Director, Retail Strategy	Ms.	Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		St Louis	MO	63121	01/23/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkwy	STE 150	Temple Terrace	FL	33637	12/01/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	San Francisco
H0978	Physician Incentive Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Plan Directory Contact for Public Website	Director, (Customer) Member Services	Ms.	McBeath	Kim		8777787226					kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Plan to Plan Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	P2PAdmin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Processor Contact	Senior Director Government Programs, Medicare	Ms.	Gibson	Sharon		8052361175					sggibson@express-scripts.com	One Express Way		St. Louis	MO	63121	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Quality Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Reconciliation Contact (Secondary)	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Recovery Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	SNP Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	SNP State Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Surveillance Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	System Contact		Mr.	Goode	Josh		5623082789					jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Third Party Administrator (TPA) Liaison	Financial Accounting Specialist	Ms.	McClour	Tina		5629894459					tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	User Access Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/17/2022	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Utilization Management Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0978	Utilization Review Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN NEVADA, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H0982	Agent/Broker Compensation Data Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibity		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	01/31/2019	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Backup User Access Contact	VP of Compliance		Biehler	Marie		3054203036					mnodal@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	04/29/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Best Available Evidence Contact	Director of Operations		Megias	Lisette		3059130049					lmegias@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	04/29/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Bid Audit Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Bid Audit Site Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Bid Primary Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	CAP Report Contact for Public Website	VP of Compliance		Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	04/29/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Duarte	Efrain		3054203047					eduarte@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	09/15/2022	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Duarte	Efrain		3054203047					eduarte@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	09/15/2022	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Chief Financial Officer	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Chief Operating Officer	Chief Operating Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	09/15/2022	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Chief Information Officer	Chief Technology Officer	Ms.	Hernandez	Raquel		3057999347					rhernandez@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Chief Information Security Officer	Director Data Integration	Mr.	Hernandez	Raquel		3057999347				3056750139	rhernandez@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	CMS Casework Communication Contact	VP of Compliance		Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	04/29/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Complaints Tracking Contact	VP of Compliance		Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	04/29/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Contact for Fraud Investigations	VP of Compliance		Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	04/29/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Coordination of Benefits Contact	Director of Operations		Megias	Lisette		3055108344					lmegias@solishealthplans.com	9250 NW 36th Street	# 400	Miami	FL	33178	07/26/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Corporate Mailing						8444476547					info@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	08/20/2018	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Customer Service Operations Contact	Director of Member Services	Mr.	Martin	Marvin		3059130056					mmartin@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	06/23/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	DIR Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Electronic Health Record Contact	VP of Compliance	Mrs.	Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	11/03/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Emergency Part D Contact	VP of Pharmacy Operations		Romay	Alfred		7864274923					aromay@solishealthplans.com	13620 SW 20th Street	Suite 400	Doral	FL	33127	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Emergency Part D Contact (Secondary)	Part D Analyst		Nodal	Raul		3057338374					rnodal@solishealthplans.com	9250 NW 36th Suite 400		Miami	FL	33178	03/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Encounter Data & Risk Adjustment Operations Contact	Chief Technology Officer		Hernandez	Raquel		3057999347					rhernandez@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Enrollment Contact	Director of Operations		Megias	Lisette		3059130049					lmegias@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	04/29/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	EOB Transfer Contact	Director of Operations		Megias	Lisette		3055108344				8336159263	lmegias@solishealthplans.com	9250 NW 36th Street	# 400	Miami	FL	33178	07/26/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Financial Audit Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Financial Reporting Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Formulary Contact	VP of Pharmacy Operations		Romay	Alfred		7864274923					aromay@solishealthplans.com	13620 SW 20th Street	Suite 400	Miami	FL	33127	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Formulary Contact (Secondary)	Team Lead, Formulary Services		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	2601 West Beltline Highway	Suite 600	Madison	WI	53713	01/29/2019	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	General Contact	VP of Compliance	Mrs.	Biehler	Marie		3054203036					mnodal@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	11/03/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Government Relations Contact	VP of Compliance	Mrs.	Biehler	Marie		9547747088					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	11/03/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	HIPAA Privacy Officer	VP of Compliance	Mrs.	Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	11/03/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	HIPAA Security Officer	Chief Technology Officer	Mr.	Hernandez	Raquel		3057999347				3056750139	rhernandez@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Hospice Contact	Chief Medical Officer	Dr.	Hernandez	Francisco		7862863409					fhernandez@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Interoperability Contact	Chief Technology Officer		Hernandez	Raquel		3057999347					rhernandez@solishealthplans.com	9250 NW 36th Street Suite 400		Miami	FL	33178	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	MA Appeals/Grievances Contact	Director of Customer Service	Mr.	Martin	Marvin		3059130056					mmartin@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	06/23/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	MA Claims Processing Contact for Public Website	Director of Operations		Megias	Lisette		3055108344					lmegias@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	07/26/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Marketing Contact	VP of Compliance	Mrs.	Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	11/03/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Medical Director	Chief Medical Officer	Dr.	Hernandez	Francisco		7862863409					fhernandez@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Medicare Compliance Officer	VP of Compliance	Mrs.	Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	04/29/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Medicare Coordinator	Chief Executive Officer	Mr.	Duarte	Efrain		3054203047					eduarte@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	09/15/2022	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Medicare Part D Opioid Overutilization Contact	Chief Medical Officer		Hernandez	Francisco		7862863409					fhernandez@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	03/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Medication Therapy Management Contact	VP of Pharmacy Operations		Romay	Alfred		7864274923					aromay@solishealthplans.com	13620 SW 20th Street	Suite 400	Miami	FL	33127	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Online Enrollment Center Contact (Back-up)	Director of Operations		Megias	Lisette		3059130049					lmegias@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	11/03/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Online Enrollment Center Contact (Primary)	Director of Operations		Megias	Lisette		3055108344					lmegias@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	04/27/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Part C Application Contact	VP of Compliance		Biehler	Marie	M	9547747088					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Doral	FL	33178	09/15/2022	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Part C Reporting Contact	VP of Compliance	Mrs.	Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	11/03/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Appeals	Supervisor, Grievance and Appeals	Mr.	LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/19/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active	8442699790				HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Appeals Contact (Secondary)	Part D Analyst		Nodal	Raul	R						rnodal@solishealthplans.com	9250 NW 36th Suite 400	Suite 400	Miami	FL	33178	03/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active	3057338374	2055665			HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Application Contact	VP of Compliance		Biehler	Marie	M	9547747088					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Doral	FL	33178	09/15/2022	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Benefits Contact	VP of Pharmacy Operations		Romay	Alfred		7864274923					aromay@solishealthplans.com	13620 SW 20th Street	Suite 400	Miami	FL	33127	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Claims Submission Contact	Manager, Technical Operations	Mr	Derks	Bob		9202214404				9202214904	dl-to-pde@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	01/29/2019	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Exceptions Contact	Manager, Medicare Clinical Programs	Ms.	Murphy	Eileen						6087292525	Eileen.Murphy@Navitus.com	1025 West navitus Drive		Appleton	WI	54913	03/10/2020	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active	6087291525				HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Exceptions Contact (Secondary)	Part D Analyst		Nodal	Raul							rnodal@solishealthplans.com	9250 NW 36th Suite 400	Suite 400	Miami	FL	33178	03/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active	3057338374				HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Price File Contact (Back-up)	VP of Pharmacy Operations		Romay	Alfred		7864274923					aromay@solishealthplans.com	13620 SW 20th Street	Suite 400	Doral	FL	33127	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Price File Contact (Optional)	Part D Analyst		Nodal	Raul		3057338374					rnodal@solishealthplans.com	9250 NW 36th Suite 400		Miami	FL	33178	03/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@navitus.com	2601 West Beltline Highway, Suite 600		Madison	WI	53713	01/29/2019	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Quality Assurance Contact	VP of Pharmacy Operations		Romay	Alfred		7864274923					aromay@solishealthplans.com	13620 SW 20th Street	Suite 400	Miami	FL	33127	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Part D Reporting Contact	Part D Analyst		Nodal	Raul		3057338374					rnodal@solishealthplans.com	9250 NW 36th Suite 400	Suite 400	Miami	FL	33178	03/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Patient Safety Contact	VP of Pharmacy Operations		Romay	Alfred		7864274923					aromay@solishealthplans.com	13620 SW 20th Street	Suite 400	Miami	FL	33127	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Payment Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Personal Health Record Contact	VP of Compliance	Mrs.	Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	11/03/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Pharmacy Director	VP of Pharmacy Operations		Romay	Alfred	R	7864274923					aromay@solishealthplans.com	13620 SW 20th Street	Suite 400	Doral	FL	33127	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Pharmacy Network Management Contact	Associate Director, Provider Operations	Mrs.	Burdick	Tammy		9202214089				9202214589	tammy.burdick@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/23/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Pharmacy Network Management Contact (Secondary)	Part D Analyst		Nodal	Raul		3057338374					rnodal@solishealthplans.com	9250 NW 36th Suite 400	Suite 400	Miami	FL	33178	03/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Pharmacy Technical Help Desk Contact	Pharmacy Technical Help Desk Contact	Sr.	Nett	Danielle						9202214724	Danielle.nett@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/03/2020	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Atlanta
H0982	Physician Incentive Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Plan Directory Contact for Public Website	Provider Services Department		Services	Provider		8336159259					providerrelations@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	08/20/2019	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Processor Contact	Director of Operations		Megias	Lisette		3055108344					lmegias@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	07/26/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Quality Contact	Director of Quality Operations	Mrs.	Megias	Lisette		3055108344					lmegias@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Reconciliation Contact	Chief Financial Officer	Mr.	Lynch	Michael		9546474259					mlynch@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Reconciliation Contact (Secondary)	Controller	Ms.	Knez	Paula		3054203028					pknez@solishealthplans.com	9250 NW 36th Street	Suite 400	Doral	FL	33178	07/17/2018	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Recovery Audit Contact	VP of Compliance	Mrs.	Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	04/29/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	SNP Application Contact	VP of Compliance		Biehler	Marie	M	9547747088					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Doral	FL	33178	09/15/2022	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	SNP State Contact	Chief Executive Officer		Duarte	Efrain		3054203047					eduarte@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	09/15/2022	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Surveillance Contact	VP of Compliance	Mrs.	Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	11/03/2021	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	System Contact	Chief Technology Officer		Hernandez	Raquel		3057999347					rhernandez@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	07/28/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Third Party Administrator (TPA) Liaison	VP of Compliance		Biehler	Marie	M	9547747088					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Doral	FL	33027	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	User Access Contact	VP of Compliance	Mrs.	Biehler	Marie		3054203036					mbiehler@solishealthplans.com	9250 NW 36th Street	Suite 400	Doral	FL	33178	03/03/2022	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Utilization Management Contact	Chief Medical Officer	Dr.	Hernandez	Francisco		7862863409					fhernandez@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H0982	Utilization Review Contact	Chief Medical Officer	Dr.	Hernandez	Francisco		7862863409					fhernandez@solishealthplans.com	9250 NW 36th Street	Suite 400	Miami	FL	33178	02/22/2023	2023	SOLIS HEALTH PLANS, INC.	Local CCP	Solis Health Plans	HMO/HMOPOS		Athena Healthcare Holdings, LLC	662	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1016	Agent/Broker Compensation Data Contact	Director, Sales Operations		Bouchillon	Joanne		3056715437	20231				Joanne.Bouchillon@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/14/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Automated TrOOP Balance Transfer Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Backup User Access Contact	Lead Governance, Risk and Compliance Analyst		Reynaud	Barbara		3056715437	20118			3056710211	Barbara.Reynaud@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/14/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Best Available Evidence Contact	Supervisor, Medicare Enrollment		Villar	Adna		3056715437	26130			3056710087	Adna.Villar@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/14/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Bid Audit Contact	SVP - Chief Actuary & CIO		Johnson	Eric		3523728400	40631			3523378526	Eric.Johnson@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Bid Audit Site Contact	SVP - Chief Actuary & CIO		Johnson	Eric		3523728400	40631				Eric.Johnson@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	09/25/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Bid Primary Contact	SVP - Chief Actuary & CIO		Johnson	Eric		3523728400	40631				Eric.Johnson@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	09/25/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	CAP Report Contact for Public Website	Director, Corporate Compliance		Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	CEO - CMS Administrator Contact	President and COO	Mr.	Repp	James		3056715437				3056714782	COO.Medicare@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	01/03/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	CEO - Senior Official for Contracting	President and COO, AvMed	Mr.	Repp	James		3056715437	26122			3056714782	Executive.Medicare@avmed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/13/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Chief Financial Officer	Vice President, Finance	Mr.	Matsubara	Timothy		3523378871					Timothy.Matsubara@avmed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	01/18/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Chief Operating Officer	President and COO, AvMed	Mr.	Repp	James		3056715437	26122			3056714782	COO.Medicare@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/13/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Chief Information Officer	SVP - Chief Actuary & CIO	Mr.	Johnson	Eric		3523728400	40631			3523378526	Eric.Johnson@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Chief Information Security Officer	SVP - Chief Actuary & CIO	Mr.	Johnson	Eric		3523728400	40631			3523378526	Eric.Johnson@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	CMS Casework Communication Contact	Director, Corporate Compliance		Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Complaints Tracking Contact	Director, Corporate Compliance		Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Contact for Fraud Investigations	Director, Audit Services		Carrigan	Tonya		3523378782	40782				Tonya.Carrigan@AvMed.org	4300 NW 89th Blvd		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Coordination of Benefits Contact	Supervisor, Medicare Enrollment		Villar	Adna		3056715437	26130			3056710087	Adna.Villar@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/14/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Corporate Mailing						3523378740	40740				Catherine.Lojko@AvMed.org	AvMed, Inc.	4300 NW 89th Blvd.	Gainesville	FL	32606	09/21/2020	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Manager, Accounting		Etienne	Emmanuel		7542169625					Emmanuel.Etienne@avmed.org	3470 NW 82nd Avenue		Doral	FL	33122	09/20/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Customer Service Operations Contact	Director, Member Engagement		Hernandez	Juan		3056717354					Juan.Hernandez@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/13/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	DIR Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	DIR Contact (Secondary)	Clinical Pharmacist		Naiditch	Camila		3523378981				3523378737	Camila.Naiditch@avmed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	05/27/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Emergency Part D Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89th Blvd		Gainesville	FL	32606	01/03/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Emergency Part D Contact (Secondary)	Clinical Pharmacist		Naiditch	Camila		3523378981				3523378737	Camila.Naiditch@avmed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	01/03/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Employer Waiver Contact	Director, Public Policy and Benefit Contracts		Crews	Jacqueline	M	3523378832	40832				Jackie.Crews@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	02/22/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Encounter Data & Risk Adjustment Operations Contact	Sr. Manager Retrospective Review		Ramalingam	Sundar		3056715437	27353				Sundar.Ramalingam@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/13/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Enrollment Contact	Supervisor, Medicare Enrollment		Villar	Adna		3056715437	26130			3056710087	Adna.Villar@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/14/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	EOB Transfer Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Financial Audit Contact	Director, Corporate Compliance	Ms.	Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Financial Reporting Contact	Director, Financial Regulatory Reporting		Miller	Daniel		3523728400	42983			3523378897	Daniel.Miller@AvMed.org	4300 NW 89th Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Formulary Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Formulary Contact (Secondary)	Clinical Pharmacist		Naiditch	Camila		3523378981				3523378737	Camila.Naiditch@avmed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	05/27/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	General Contact	Director, Corporate Compliance		Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Government Relations Contact	Director, Public Policy and Benefit Contracts		Crews	Jacqueline	M	3523378832	40832				Jackie.Crews@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	03/02/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	HIPAA Privacy Officer	Vice President, Compliance & Chief Audit Executive		Rice	Tammy		3523378747				3523378551	Tammy.Rice@AvMed.org	4300 NW 89th Blvd		Gainesville	FL	32606	01/09/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	HIPAA Security Officer	SVP - Chief Actuary & CIO		Johnson	Eric		3523728400	40631			3523378526	Eric.Johnson@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	02/01/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Hospice Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Interoperability Contact	SVP-Chief Actuary & CIO		Johnson	Eric		3523728400	40631			3523378526	Eric.Johnson@avmed.org	4300 NW 89th Blvd		Gainesville	FL	32606	02/16/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	MA Appeals/Grievances Contact	Manager, Member Relations and Compliance		Kidd	Peggy		3523378616				3523378794	Peggy.Kidd@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	MA Claims Processing Contact for Public Website	Manager, Claims Operations		Knopf-Cruz	Migdalia		3523378838	40838				Migdalia.Knopf-Cruz@AvMed.org	4300 NW 89th Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Marketing Contact	CMS Medicare Client Service Specialist		Greenstein	Angela		3523728400	40638				Angela.Greenstein@AvMed.org	4300 NW 89th Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Medical Director	Medical Director	Dr.	Kolsun	Joby		3056716104					Joby.Kolsun@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/13/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Medicare Compliance Officer	Vice President, Compliance & Chief Audit Executive	Ms.	Rice	Tammy		3523378747				3523378551	Medicare.Compliance@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	01/09/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Medicare Coordinator	Director, Corporate Compliance		Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Medicare Part D Opioid Overutilization Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Medication Therapy Management Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	OffShore Subcontractor Contact	Director, Corporate Compliance		Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Online Enrollment Center Contact (Back-up)	EPS Vendor Governance Spec		Villar	Adna		3056716130				3056710087	Adna.Villar@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	09/21/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Online Enrollment Center Contact (Optional)	Manager EPS & Supt Srvcs		Ramos	Alina		3056714938					Alina.Ramos@AvMed.org	3470 NW 82nd Avenue, Suite 1100,		Doral	FL	33122	09/21/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Online Enrollment Center Contact (Primary)	Supervisor, Medicare Enrollment		Villar	Adna		3056715437	26130			3056710087	Adna.Villar@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/14/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part C Application Contact	Director, Public Policy and Benefit Contracts		Crews	Jacqueline	M	3523378832	40832				Jackie.Crews@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	02/22/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part C Reporting Contact	CMS Medicare Client Service Specialist		Greenstein	Angela		3523728400	40638				Angela.Greenstein@AvMed.org	4300 NW 89th Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Appeals	Manager, Member Relations and Compliance		Kidd	Peggy						3523378794	Peggy.Kidd@avmed.org	4300 NW 89th Blvd		Gainesville	FL	32606	06/08/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	8002371255	40616			HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Appeals Contact (Secondary)	Reg Compliance & Acc Spe		AgueroZardon	Liset						3523378794	Liset.AgueroZardon@AvMed.org	3470 NW 82nd Avenue, Suite 1100,	9th Floor	Doral	FL	33122	09/21/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	7864755458				HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Application Contact	Director, Public Policy and Benefit Contracts		Crews	Jacqueline	M	3523378832	40832				Jackie.Crews@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	02/22/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Benefits Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Claims Submission Contact	Advisor		Loveland	Chet		4806064865					Chet.Loveland@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	12/06/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Exceptions Contact	Director, Clinical Pharmacy Management		Lachuk	Lester						3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	8002371255				HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Exceptions Contact (Secondary)	Clinical Pharmacist		Naiditch	Camila						3523378737	Camila.Naiditch@avmed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	05/27/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	8002371255				HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Price File Contact (Back-up)	Clinical Pharmacist		Naiditch	Camila		3523378981					Camila.Naiditch@avmed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	05/27/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Price File Contact (Optional)	Advisor		Loveland	Chet		4806064865					Chet.Loveland@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	12/06/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Price File Contact (Primary)	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Quality Assurance Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Part D Reporting Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89th Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Patient Safety Contact	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Payment Contact	Supervisor, Medicare Enrollment		Villar	Adna		3056715437	26130			3056710087	Adna.Villar@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/14/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Personal Health Record Contact	Manager, Member Relations and Compliance		Kidd	Peggy		3523378616				3523378794	Peggy.Kidd@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	03/02/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Pharmacy Director	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Pharmacy Network Management Contact	Advisor		Loveland	Chet		4806064865					Chet.Loveland@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	12/06/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Pharmacy Network Management Contact (Secondary)	Director, Clinical Pharmacy Management		Lachuk	Lester		3056710066				3523378737	Lester.Lachuk@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	07/06/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Pharmacy Technical Help Desk Contact	Pharmacy Help Desk Queue		Pharmacy Help Desk	Caremark							Chet.Loveland@CVSHealth.com	CVS Caremark Part D Services LLC, Medicare Operations	9501 E. Shea Blvd., MC042	Scottsdale	AZ	85260	12/06/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Philadelphia
H1016	Pharmacy Technical Help Desk Contact (Secondary)	Medicare Member Services Queue		Engagement	Member						3523378737		4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	8007828633				HMO - Health Maintenance Organization		C	Philadelphia
H1016	PHR Beneficiary Contact																	12/19/2008	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS	AvMed Health Plans	Sentara Health Care (SHC)	345	Yes	Active	8007828633				HMO - Health Maintenance Organization		C	Philadelphia
H1016	Physician Incentive Contact	Director, Corporate Compliance		Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Plan Directory Contact for Public Website	Director, Corporate Compliance		Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Plan to Plan Reconciliation Contact	Senior Staff Accountant		Brown	Patricia		3523728400	40984			3523378897	Patricia.Brown@AvMed.org	4300 NW 89th Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Processor Contact	Pharmacy Help Desk Queue		Pharmacy Help Desk	Caremark		4806064865					Chet.Loveland@CVSHealth.com	CVS Caremark Part D Services LLC, Medicare Operations	9501 E. Shea Blvd., MC042	Scottsdale	AZ	85260	12/06/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Quality Contact	Director, Quality Accreditation and Wellness		Weiss	Cynthia		3056716778					Cynthia.Weiss@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/14/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Reconciliation Contact	Senior Staff Accountant		Brown	Patricia		3523728400	40984			3523378897	Patricia.Brown@AvMed.org	4300 NW 89th Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Reconciliation Contact (Secondary)	Senior Manager, Accounting		Etienne	Emmanuel		7542169625					Emmanuel.Etienne@avmed.org	3470 NW 82nd Avenue		Doral	FL	33122	09/20/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Recovery Audit Contact	Director, Corporate Compliance	Ms.	Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	SNP Application Contact	Director, Public Policy and Benefit Contracts		Crews	Jacqueline	M	3523378832	40832				Jackie.Crews@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	02/22/2022	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	SNP State Contact	Vice President, Compliance & Chief Audit Executive		Rice	Tammy		3523378747				3523378551	Tammy.Rice@AvMed.org	4300 NW 89th Blvd		Gainesville	FL	32606	01/09/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Surveillance Contact	Director, Corporate Compliance		Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	System Contact	Supervisor, Medicare Enrollment		Villar	Adna		3056715437	26130			3056710087	Adna.Villar@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/14/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Third Party Administrator (TPA) Liaison	Senior Staff Accountant		Brown	Patricia		3523728400	40984			3523378897	Patricia.Brown@AvMed.org	4300 NW 89th Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	User Access Contact	Director, Corporate Compliance		Lojko	Catherine		3523728400	40740				Catherine.Lojko@AvMed.org	4300 NW 89 Blvd.		Gainesville	FL	32606	11/22/2021	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Utilization Management Contact	Medical Director	Dr.	Kolsun	Joby		3056716104					Joby.Kolsun@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/14/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1016	Utilization Review Contact	Medical Director	Dr.	Kolsun	Joby		3056716104					Joby.Kolsun@AvMed.org	3470 NW 82nd Avenue		Doral	FL	33122	03/14/2023	2023	AVMED, INC.	Local CCP	AvMed Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1019	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Best Available Evidence Contact	Director	Mrs.	Gay	Tiffany		8134395006				8135601398	tgay@careplus-hp.com	4925 Independence Pkwy	Suite # 300	Tampa	FL	33634	03/09/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	CMS Casework Communication Contact	Grievance and Appeals Director	Mrs.	Machado	Elina		9543295278				8009564288	elina.machado@careplus-hp.com	6101 Blue Lagoon Drive	Suite #195	Miami	FL	33126	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Complaints Tracking Contact	Grievance and Appeals Director	Mrs.	Machado	Elina		9543295278				8009564288	elina.machado@careplus-hp.com	6101 Blue Lagoon Drive	Suite #195	Miami	FL	33126	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Customer Service Operations Contact	Director, CarePlus Member Services	Mrs.	Ford	Angela		5029942678				5025086297	aford@humana.com	500 West Main Street	Floor 22	Louisville	KY	40204	04/13/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Encounter Data & Risk Adjustment Operations Contact			Guerrero	Kenner		8134395005					kenner.guerrero@humana.com	4925 Independence Pkwy	Suite 300	Tampa	FL	33634	06/21/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Enrollment Contact	Director	Mrs.	Gay	Tiffany		8134395006				8135601398	tgay@careplus-hp.com	4925 Independence Pkwy	Suite # 300	Tampa	FL	33634	03/09/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	MA Appeals/Grievances Contact	Grievance and Appeals Director	Mrs.	Machado	Elina		7863481130				8009564288	elina.machado@careplus-hp.com	6101 Blue Lagoon Drive	Suite #195	Miami	FL	33126	07/13/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Medical Director	Regional VP	Dr.	Rodriguez-Alonso	Madeleine		7865263041				3053706799	madeleinrodriguez@careplus-hp.com	6101 Blue Lagoon Drive	Suite 195	Miami	FL	33126	03/09/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	02/16/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Online Enrollment Center Contact (Back-up)	Manager	Mrs.	Cordova	Janelys		8134395006				8135601398	janelys.jimenez@careplus-hp.com	4925 Independence Pkwy	Ste # 300	Tampa	FL	33634	06/21/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Online Enrollment Center Contact (Primary)	Director	Mrs.	Gay	Tiffany		8134395006				8135601398	tgay@careplus-hp.com	4925 Independence Pkwy	Suite # 300	Tampa	FL	33634	03/09/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Part D Appeals	Grievance and Appeals Director	Mrs.	Machado	Elina						8009564288	elina.machado@careplus-hp.com	6101 Blue Lagoon Drive	Suite #195	Miami	FL	33126	07/13/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active	7863481130				HMO - Health Maintenance Organization		C	Kansas City
H1019	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H1019	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H1019	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Part D Reporting Contact	Grievance and Appeals Director	Mrs.	Machado	Elina		9543295278				8009564288	elina.machado@careplus-hp.com	6101 Blue Lagoon Drive	Suite #195	Miami	FL	33126	03/09/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008654034				HMO - Health Maintenance Organization		C	Kansas City
H1019	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H1019	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Utilization Management Contact	Director, UM/Compliance (UM)		Nieto	Javier		3052022942					jnieto@careplus-hp.com	6101 Blue Lagoon Drive	Suite 195	Miami	FL	33126	03/09/2023	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1019	Utilization Review Contact	Medical Director	Dr.	Seleznick	Mitchel		8138298300	1021036				mseleznick@humana.com	4925 Independence Pkwy	Suite 300	Tampa	FL	33634	03/09/2022	2023	CAREPLUS HEALTH PLANS, INC.	Local CCP	CarePlus Health Plans, Inc.	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1032	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Corporate Mailing						8132063477					crysten.troutman@wellcare.com	P. O. Box 31386		Tampa	FL	33631	10/02/2020	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/13/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/13/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/13/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Part C Application Contact	Director, Medicare Strategy		Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Application Contact	Director, Medicare Strategy		Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/13/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H1032	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/13/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H1032	PHR Beneficiary Contact																	09/27/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H1032	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/13/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	SNP Application Contact	Director, Medicare Strategy		Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1032	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	Sunshine State Health Plan, Inc.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1035	Agent/Broker Compensation Data Contact	VP FBM Growth Strat & Enable		Davis	Andrea		8478265793					andrea.davis@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	11/29/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Automated TrOOP Balance Transfer Contact	Manager, PBM operations	Ms.	Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/27/2020	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Backup User Access Contact	Corporate Compliance Specialist		Figueroa	Carmen		9049056658					carmen.figueroa@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	05/10/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Best Available Evidence Contact	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	07/16/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Bid Audit Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Bid Audit Site Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Bid Primary Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	CAP Report Contact for Public Website	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	CEO - CMS Administrator Contact	EVP Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 400	Jacksonville	FL	32246	01/05/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	CEO - Senior Official for Contracting	EVP, Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 100, 8th Flr	Jacksonville	FL	32246	01/13/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Chief Financial Officer	SVP and CFO	Mr.	Justice	Thurman		9049055085					Thurman.Justice@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 8th Floor	Jacksonville	FL	32246	02/17/2020	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Chief Operating Officer	EVP and COO	Mr.	Divita	Chuck		9049051739					Chuck.Divita@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 8th Floor	Jacksonville	FL	32246	09/11/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Chief Information Officer	SVP Chief Information Officer	Mr.	Anderson	Gary		9049050180					gary.anderson@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 8th Floor	Jacksonville	FL	32246	01/02/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Chief Information Security Officer	VP Chief Information & Security Officer	Mr.	Raymond	Jason		9049050070					jason.raymond@floridablue.com	4800 Deewood Campus Parkway	DCC Building 600, 2nd Floor	Jacksonville	FL	32246	01/02/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	CMS Casework Communication Contact	Sr Manager Med Ops & Integrity		Irizarry	Haydee		3212330635					Haydee.Irizarry@bcbsfl.com	4800 Deerwood Campus Parkway	Bldg. 400 2nd Floor	Jacksonville	FL	32246	04/25/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Complaints Tracking Contact	Sr Manager Med Ops & Integrity		Irizarry	Haydee		3212330635					Haydee Irizarry@bcbsfl.com	4800 Deerwood Campus Parkway	Bldg. 400 2nd Floor	Jacksonville	FL	32246	04/25/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Contact for Fraud Investigations	Manager II Data Integrity & SIU		Ramos	Jose		9049055835					jose.romas@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 400, 6th Floor	Jacksonville	FL	32246	01/02/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Coordination of Benefits Contact	Manager PBM Operations		Hanson	Michelle		6127776755				3127776706	COBMedD@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	02/16/2021	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Corporate Mailing						9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	12/29/2021	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant III, Corporate Receivables		Avis	Tammi		9049054034					Tammi.Avis@bcbsfl.com	4800 Deerwood Campus Pkwy	Bldg 100, 5th Floor	Jacksonville	FL	32246	04/25/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Customer Service Operations Contact	Sr Director Member Contact		Gamble	LaTonya		9049052057					latonya.gamble@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	DIR Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	DIR Contact (Secondary)	VP Medicare Chief Actuary		Phelps	Joshua		8048557732					joshua.phelps@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 6th Floor	Jacksonville	FL	32246	02/21/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Emergency Part D Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9045259651					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	12/23/2020	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Emergency Part D Contact (Secondary)	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Employer Waiver Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4thFloor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Encounter Data & Risk Adjustment Operations Contact	FBM Sr. Dir. Risk Adjustment		York	Dawn		9044636818					dawn.york@bcbsfl.com	4800 Deerwood Parkway		Jacksonville	FL	32246	07/18/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Enrollment Contact	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	EOB Transfer Contact	Sr Director Member Contact		Gamble	LaTonya		9049052057				9043576121	latonya.gamble@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	01/08/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Financial Audit Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Financial Reporting Contact	VP Medicare CFO		Dorsett	Kareen		9049051754					Kareen.Dorsett@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400	Jacksonville	FL	32246	08/20/2021	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Formulary Contact	Medicare Clinical Pharmacist		Shore	Stephanie		9049050114					stephanie.shore@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	08/08/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Formulary Contact (Secondary)	Manager of Medicare Products and Reporting		Laks	Christine		3866154050					claks@fhcp.com	1340 Ridgewood Avenue		Holly Hill	FL	32117	11/01/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	General Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Government Relations Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	HIPAA Privacy Officer	Asst. General Counsel & Privacy Officer		Resnick	Steven		9049055025					steven.resnick@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	HIPAA Security Officer	VP Chief Information Security Officer		Raymond	Jason		9049050070					jason.raymond@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 600, 2nd Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Hospice Contact	Medical Clinical Pharmacist Pharmacy Govt Prog		Adams	Tangela		9049050002					tangela.adams@floridablue.com	4800 Deerwood Campus Pkwy	DCC 900, 4th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Interoperability Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th FL	Jacksonville	FL	32246	06/13/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	MA Appeals/Grievances Contact	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	MA Claims Processing Contact for Public Website	FBM Sr. Dir. Claims		Allen	Jessica		9049053152					Jessica.Allen2@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	11/17/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Marketing Contact	FBM Spec.IV Product Operations		Lilly	Wanda		9043573900					wanda.lilly@bcbsfl.com	4800 Deerwood Campus Parkway	Building 400, 3rd Floor	Jacksonville	FL	32246	04/27/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Medical Director	VP Medicare Solutions	Dr.	Malko	Elizabeth		9049050491					Elizabeth.Malko@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Medicare Compliance Officer	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Medicare Coordinator	EVP, Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 100, 8th Flr	Jacksonville	FL	32246	11/17/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Medicare Part D Opioid Overutilization Contact	Medical Clinical Pharmacist Pharmacy Govt Prog		Adams	Tangela		9049050002					tangela.adams@floridablue.com	4800 Deerwood Campus Pkwy	DCC 900,  4th Floor	Jacksonville	FL	32246	01/08/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Medication Therapy Management Contact	Director Government Pharmacy Programs		Bryant-Riggins	Victoria		9049050194					victoria.bryant-riggins@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/02/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	OffShore Subcontractor Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Online Enrollment Center Contact (Back-up)	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@floridablue.com	4800 Deerwood Campus Pkwy	DCC Building 300, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Online Enrollment Center Contact (Optional)	Sr. Manager		Hogan	Kate		9049055131					kate.hogan@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 300 4th Flr	Jacksonville	FL	32246	05/06/2021	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Online Enrollment Center Contact (Primary)			EMB Analysts	FBM Ops		9049051711					FB_Medicare_Ops_EMB_Analysts@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 2nd Floor	Jacksonville	FL	32246	05/06/2021	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Part C Application Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Part C Reporting Contact	Corporate Compliance Specialist		Figueroa	Carmen		9049056658					carmen.figueroa@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th floor	Jacksonville	FL	32246	05/10/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Appeals	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia							cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773736	56307			HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Appeals Contact (Secondary)	MPP-Spec IIIb		Barr	Shamika						9043011849	Shamika.Barr@bcbsfl.com	4800 Deerwood Campus Parkway DCC Bldg 900 4th Flr		Jacksonville	FL	32246	12/29/2020	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773636	54283			HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Application Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Benefits Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	07/16/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Claims Submission Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Exceptions Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia							cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773736	56307			HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Exceptions Contact (Secondary)	Administrator of Member & Clinical Services		Siciliano	Daria							dsiciliano@fhcp.com	1340 Ridgewood Avenue		Holly Hill	FL	32117	01/08/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8003529824	7200			HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Price File Contact (Back-up)	Delivery System Coordinator		Rodriguez	Janina		3059217232					Janina.Rodriguez@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	08/04/2020	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Price File Contact (Optional)	Director Government Pharmacy Programs		Bryant-Riggins	Victoria		9049050194					victoria.bryant-riggins@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Price File Contact (Primary)	MPP-Spec IIIb		Barr	Shamika		9049054283					Shamika.Barr@floridablue.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Quality Assurance Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 5th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Part D Reporting Contact	Corporate Compliance Specialist		Figueroa	Carmen		9049056658					carmen.figueroa@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th floor	Jacksonville	FL	32246	05/10/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Patient Safety Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 5th Floor	Jacksonville	FL	32246	01/08/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Payment Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Pharmacy Director	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Pharmacy Network Management Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Pharmacy Network Management Contact (Secondary)	Pharmacy Administrator		Spitz	Benjamin		8886767173					bspitz@fhcp.com	1340 Ridgewood Avenue		Holly Hill	FL	32117	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Pharmacy Technical Help Desk Contact			HelpDesk	Prime Part	D					8882452422	pharmacyops@primetherapeutics.com	Prime Therapeutics, LLC	1305 Corporate Center Drive	Eagan	MN	55121	12/18/2018	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8888776420				HMO - Health Maintenance Organization		C	Atlanta
H1035	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Administrator		Spitz	Benjamin						3866154045	bspitz@fhcp.com	1340 Ridgewood Avenue		Holly Hill	FL	32117	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	3866767105				HMO - Health Maintenance Organization		C	Atlanta
H1035	Physician Incentive Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Plan Directory Contact for Public Website			Mbr Svcs	Medicare		8009266565					Chrissy.This@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	12/10/2020	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Plan to Plan Reconciliation Contact	Accounting Specialist		Williams	Lynn		9049054568					lynn.williams@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 3rd Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Processor Contact	FBM Sr. Dir. Claims		Allen	Jessica		9049053152					Jessica.Allen2@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	11/17/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Quality Contact	Sr. Dir. Medicare Quality Improvement		Wright	Carole		3059217224					carole.wright@bcbsfl.com	8600 NW 36th St.		Doral	FL	33166	07/17/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Reconciliation Contact	VP Medicare Chief Actuary		Phelps	Joshua		8048557732					joshua.phelps@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	02/21/2023	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Reconciliation Contact (Secondary)	VP Medicare CFO		Dorsett	Kareen		9049051754					Kareen.Dorsett@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400	Jacksonville	FL	32246	09/10/2021	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Recovery Audit Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/24/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	SNP Application Contact	Sr. Director SNP		De Llano	Yisel		3059217225					yisel.dellano@floridablue.com	8400 NW 33rd Street Suite 100		Miami	FL	33122	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	SNP State Contact	Sr. Director Special Projects		Salo	Dan		2134488616					Dan.Salo@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	08/04/2022	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Surveillance Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	System Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Third Party Administrator (TPA) Liaison	Medical Clinical Pharmacist Pharmacy Govt Prog		Adams	Tangela		9049050002					tangela.adams@floridablue.com	4800 Deerwood Campus Pkwy	DCC 900,  4th Floor	Jacksonville	FL	32246	01/02/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	User Access Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Utilization Management Contact	GWCS Sr Dir Clinical Ops		Sparandeo	Dominick		9049055332					Dominick.Sparandeo@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	10/15/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1035	Utilization Review Contact	GWCS Sr Dir Clinical Ops		Sparandeo	Dominick		9049055332					Dominick.Sparandeo@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	10/15/2019	2023	FLORIDA BLUE MEDICARE, INC.	Local CCP	Florida Blue HMO	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1036	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	08/14/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H1036	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H1036	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1036	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1043	Automated TrOOP Balance Transfer Contact	Sr. Claims Adjudicator	Ms	Johnson	Julie		3057518626	68204			3057621431	JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Backup User Access Contact	QAPI Manager	Mr.	Orozco	Andrew		3057518626	66754				BOROZCO@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Best Available Evidence Contact	EVP-PACE & President, Florida PACE Centers	Mr.	Hess	Steve		3057518626	66799			3057621431	SHess@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	02/09/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Bid Primary Contact	EVP-PACE & President, Florida PACE Centers	Mr.	Hess	Steve		3057518626	66799			3057621488	SHess@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	02/09/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	CAP Report Contact for Public Website	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057621538	mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	CEO - CMS Administrator Contact	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057621538	MLane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	CEO - Senior Official for Contracting	EVP President PACE	Mr.	Hess	Steve		3057518626	66799			3057951855	shess@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Chief Financial Officer	Chief Financial Officer	Mr.	Durr	Michael		3057518626	63298				MDurr@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Chief Operating Officer	AVP of PACE	Ms.	Lane	Maria		3057518626	66703				Mlane@miamijewishhealth.org	5200 NE 2nd /avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Chief Information Officer	Chief Informaton Officer	Mr.	Steinberg	Israel		3057518626	66927				isteinberg@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Chief Information Security Officer	Chief Information Security Officer	Mr.	Steinberg	Israel		3057518626	66927				isteinberg@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	CMS Casework Communication Contact	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057951855	mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Complaints Tracking Contact	QAPI Manager	Mr.	Orozco	Andrew		3057518626	66754			3057951855	borozco@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Contact for Fraud Investigations	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057951855	MLane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Coordination of Benefits Contact	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057621538	mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Corporate Mailing						3057958410				3057623847	mlane@miamijewithhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	12/04/2018	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204			3056750494	JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Customer Service Operations Contact	EVP-PACE & President, Florida PACE Centers	Mr.	Hess	Steve		3057518626	66799			3057621538	SHess@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	02/09/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	DIR Contact	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204			3057621431	JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	DIR Contact (Secondary)	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057621538	Mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Emergency Part D Contact	Pharmacy Manager	Mr.	Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Emergency Part D Contact (Secondary)	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204				JJohnson@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Encounter Data & Risk Adjustment Operations Contact	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204				JJohnson@miamijewishhealth.org	5200 NE 2ND AVENUE		MIAMI	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Enrollment Contact	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057621538	Mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	EOB Transfer Contact	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204			3057621431	JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Financial Audit Contact	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204			3056750494	JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Financial Reporting Contact	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204				JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Formulary Contact	Manager of Pharmacy Services	Mr.	Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Formulary Contact (Secondary)	Associate Vice President PACE Medical Director	Dr.	Alzugaray	Edilia		3057518626	66199				EAlzugaray@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	12/22/2020	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	General Contact	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057951855	MLane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Government Relations Contact	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057621488	MLane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	HIPAA Privacy Officer	QAPI Manager	Mr.	Orozco	Andrew		3057518626	66754			3057951855	Borozco@miamjewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	HIPAA Security Officer	IT Director	Mr.	Steinberg	Israel		3057518626	66927			3056723802	isteinberg@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Interoperability Contact	QAPI Manager	Mr.	Orozco	Andrew		3057518626	66754				borozco@miamijewishhealth.org	5200 NE 2nd Ave.		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	MA Appeals/Grievances Contact	QAPI Manager	Mr.	Orozco	Andrew		3057518626	66754			3057951855	Borozco@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	MA Claims Processing Contact for Public Website	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204			3057621431	JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Marketing Contact	VP Marketing and Brand Strategy Marketing	Ms.	Broderick	Leah		3057518626	65999			3057621538	LBroderick@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Medical Director	Associate Vice President PACE Medical Director	Dr.	Alzugaray	Edilia		3057518626	66922				EAlzugaray@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	12/22/2020	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Medicare Compliance Officer	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057951855	Mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Medicare Coordinator	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057621538	Mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Medicare Part D Opioid Overutilization Contact	Manager of Pharmacy	Mr.	Martinez	Mario		7862522431					MMartinez1@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Medication Therapy Management Contact	Associate Vice President PACE Medical Directo	Dr.	Alzugaray	Edilia		3057518626	66199				EAlzugaray@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	12/22/2020	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Part C Application Contact	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057621538	Mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Part D Appeals	QAPI Manager	Mr.	Orozco	Andrew							Borozco@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active	3057518626	66754			PACE - Nat		C	Atlanta
H1043	Part D Application Contact	EVP-PACE & President, Florida PACE Centers	Mr.	Hess	Steve		3057518626	63297			3057621488	SHess@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	02/09/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Part D Benefits Contact		Mr.	Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Part D Claims Submission Contact	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057951855	Mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Part D Exceptions Contact	AVP of PACE	Ms.	Lane	Maria							Mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active	3057518626	66703			PACE - Nat		C	Atlanta
H1043	Part D Price File Contact (Back-up)	IT Director	Mr.	Steinberg	Israel		3057518626	66927			3056723802	isteinberg@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Part D Price File Contact (Primary)	EVP-PACE & President, Florida PACE Centers	Mr.	Hess	Steve		3057518626	66799			3057621431	Shess@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Part D Quality Assurance Contact	QAPI Manager	Mr.	Orozco	Andrew		3057518626	66754				Borozco@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Part D Reporting Contact	Manager of Pharmacy Services	Mr.	Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Patient Safety Contact	QAPI Manager	Mr.	Orozco	Andrew		3057518626	66754				borozco@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Payment Contact	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204			3057621431	JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Pharmacy Director	Pharmacy Director	Mr.	Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Pharmacy Network Management Contact	Associate Vice President PACE Medical Director	Dr.	Alzugaray	Edilia		3057518626	66922				EAlzugaray@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	12/22/2020	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Pharmacy Technical Help Desk Contact	Database Programer	Mr.	Steinberg	Israel							isteinberg@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active	3057518626	65405			PACE - Nat		C	Atlanta
H1043	Plan Directory Contact for Public Website	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204			3057951855	JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Plan to Plan Reconciliation Contact	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204			3057621431	JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Processor Contact	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204			3057621431	JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Quality Contact	QAPI Manager	Mr.	Orozco	Andrew		3057518626	66754				borozco@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	09/07/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Reconciliation Contact	Sr. Claims Adjudicator	Ms.	Johnson	Julie		3057518626	68204			3057621431	JJohnson@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Reconciliation Contact (Secondary)	EVP-PACE & President, Florida PACE Centers	Mr.	Hess	Steve		3057518626	66799				SHess@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	02/09/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Recovery Audit Contact	EVP-PACE & President, Florida PACE Centers	Mr.	Hess	Steve		3057518626	66799			3057621538	SHess@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	02/09/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Surveillance Contact	QAPI Manager	Mr.	Orozco	Andrew		3057518626	66754				Borozco@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	System Contact	IT Director	Mr.	Steinberg	Israel		3057518626	66736			3056723802	isteinberg@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Third Party Administrator (TPA) Liaison	Business Office Manager	Ms.	Johnson	Julie		3057518626	68299			3056750494	JJohnson@miamijewishhealth.org	5200 N E 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	User Access Contact	AVP of PACE#	Ms.	Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Utilization Management Contact	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057621538	Mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	11/11/2022	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1043	Utilization Review Contact	AVP of PACE	Ms.	Lane	Maria		3057518626	66703			3057621538	Mlane@miamijewishhealth.org	5200 NE 2nd Avenue		Miami	FL	33137	01/04/2023	2023	FLORIDA PACE CENTERS, INC.	National PACE	Florida Pace Centers, Inc.	National PACE		Miami Jewish Health Systems, Inc.	654	Yes	Active					PACE - Nat		C	Atlanta
H1045	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H1045	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H1045	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H1045	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H1045	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1045	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PREFERRED CARE PARTNERS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1099	Agent/Broker Compensation Data Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Automated TrOOP Balance Transfer Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Backup User Access Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Best Available Evidence Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Bid Audit Contact	Chief Financial Officer	Mr.	Pulver	Joshua	P	3214344269					Joshua.Pulver@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/30/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Bid Audit Site Contact	Chief Financial Officer	Mr.	Pulver	Joshua	P	3214344269					Joshua.Pulver@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/30/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Bid Primary Contact	Chief Financial Officer	Mr.	Pulver	Joshua	P	3214344269					Joshua.Pulver@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/30/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	CAP Report Contact for Public Website	Interim Chief Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	CEO - CMS Administrator Contact	President/CEO	Mr.	Gerrell	Matthew	F	3212585521					Matthew.Gerrell@HF.org	6450 US Highway 1		Rockledge	FL	329555747	01/10/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	CEO - Senior Official for Contracting	President/CEO	Mr.	Gerrell	Matthew	F	3212585521					Matthew.Gerrell@hf.org	6450 US Highway 1		Rockledge	FL	329555747	01/10/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Chief Financial Officer	Chief Financial Officer	Mr.	Pulver	Joshua		3152895913					Joshua.Pulver@HF.org	6450 US Highway 1		Rockledge	FL	329555747	12/28/2022	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Chief Operating Officer	Chief Operating Officer	Mrs.	Forrest	Jamie	R	3214325832					Jamie.Forrest@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/28/2022	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Chief Information Officer	System VP Chief Technology Officer	Mr.	Carr	Michael		3214345559					michael.carr@hf.org	6450 US Highway 1		Rockledge	FL	32955	06/16/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Chief Information Security Officer	System Director Enterprise Risk Mangement	Ms.	Magar	Kathryn	J	3214344383					Kathryn.Magar@HF.org	6450 US Highway 1		Rockledge	FL	32955	11/06/2019	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	CMS Casework Communication Contact	Director, Member/Provider Appeals & Grievances		Heinssen	Lori		3214346761					Lori.Heinssen@hf.org	6450 US Highway 1		Rockledge	FL	32955	07/15/2021	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Complaints Tracking Contact	Director, Member/Provider Appeals & Grievances		Heinssen	Lori		3214346761					Lori.Heinssen@hf.org	6450 US Highway 1		Rockledge	FL	32955	07/15/2021	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Contact for Fraud Investigations	Director of Payment Integrity		Davanzo	Nicole	E	3214344340					nicole.davanzo@hf.org	6450 US Highway 1		Rockledge	FL	32955	05/04/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Coordination of Benefits Contact			Team	Pharmacy		8007167737					hfhppharmacy@hf.org	6450 US Highway 1		Rockledge	FL	32955	04/13/2022	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Corporate Mailing						3214344443					jamie.forrest@hf.org	6450 US Highway 1		Rockledge	FL	32955	08/26/2019	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Coverage Gap Discount Program (CGDP) Payment Contact	Regulatory Operations Analyst		Fromer	Maritza		3214344797					maritza.fromer@hf.org	6450 US Highway 1		Rockledge	FL	32955	04/26/2019	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Customer Service Operations Contact	Interim Director of Customer Service		Gerace	Brian		3214344478					Brian.Gerace@hf.org	6450 US Highway 1		Rockledge	FL	32955	10/08/2021	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	DIR Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	DIR Contact (Secondary)	Director Pharmaceutical Services		Terkoski	Eugene		3214345688					eugene.terkoski@hf.org	6450 US Highway 1`		Rockledge	FL	32955	03/03/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Electronic Health Record Contact	Corporate Integrity Analyst		Gutierrez	Dalia		3214345632					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Emergency Part D Contact	Vice President, Clinical Operations		Sooknanan	Kamela		4045425842					Kamela.Sooknanan@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Emergency Part D Contact (Secondary)	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Employer Waiver Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Encounter Data & Risk Adjustment Operations Contact	Supervisor Performance Improvement Analytics		Peake	Michelle	L	3214344741					Michelle.Peake@HF.org	6450 US Hwy #1		Rockledge	FL	32955	05/04/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Enrollment Contact	Director, Enrollment & Billing		Wynn	Sherri		3214344325					Sherri.Wynn@hf.org	6450 US Highway 1		Rockledge	FL	32955	04/30/2021	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	EOB Transfer Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769				3214344798	dalia.gutierrez@hf.org	6450 US Hwy #1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Financial Audit Contact	Corporate Integrity Analyst	Ms.	Gutierrez	Dalia		3214345632					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	329555747	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Financial Reporting Contact	Corporate Integrity Analyst	Ms.	Gutierrez	Dalia		3214345632					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	329555747	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Formulary Contact	Vice President, Clinical Operations		Sooknanan	Kamela		4045425842					Kamela.Sooknanan@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Formulary Contact (Secondary)	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	General Contact	Interim Chief Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Government Relations Contact	Interim Chief Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	HIPAA Privacy Officer	Privacy Officer	Ms.	Bouanis	Ghizlane		3214341249					Ghizlane.Bouanis@hf.org	3300 S Fiske Blvd		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	HIPAA Security Officer	System Director Enterprise Risk Mangement	Ms.	Magar	Kathryn	J	3214344383					Kathryn.Magar@HF.org	6450 US Highway 1		Rockledge	FL	32955	11/06/2019	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Hospice Contact	Interim Chief Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Interoperability Contact	Manager, Medicare Corporate Integrity		Eickholt	Molly		3214345632					molly.eickholt@hf.org	6450 US Highway 1		Rockledge	FL	32955	04/01/2022	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	MA Appeals/Grievances Contact	Director, Member/Provider Appeals & Grievances		Heinssen	Lori		3214346761					Lori.Heinssen@hf.org	6450 US Highway 1		Rockledge	FL	32955	07/15/2021	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	MA Claims Processing Contact for Public Website	Vice President of Network Operations & Engagement		Fleming	Katie		8445225282					HFHPinfo@hf.org	6450 US Highway 1		Rockledge	FL	32955	10/21/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Marketing Contact	Director of Marketing and Public Relations		Kelley-Ashley	Dana		3214344380					Dana.KelleyAshley@hf.org	6450 US Highway 1		Rockledge	FL	32955	04/24/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Medical Director	Medical Director	Dr.	Koraibaa	Khadidja		4045425842					khadidja.koraibaa@hf.org	6450 US Highway 1		Rockledge	FL	329555747	09/09/2022	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Medicare Compliance Officer	Interim Medicare Compliance Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Medicare Coordinator	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Medicare Part D Opioid Overutilization Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/21/2021	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Medication Therapy Management Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	OffShore Subcontractor Contact	Interim Chief Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Online Enrollment Center Contact (Back-up)	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Online Enrollment Center Contact (Optional)	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Online Enrollment Center Contact (Primary)	Director, Enrollment & Billing		Wynn	Sherri		3214344325					Sherri.Wynn@hf.org	6450 US Highway 1		Rockledge	FL	32955	04/30/2021	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Part C Application Contact	Interim Chief Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Part C Reporting Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Part D Appeals	Director of Appeals and Grievances		Heinssen	Lori							Lori.Heinssen@hf.org	6450 US Highway 1		Rockledge	FL	32955	07/15/2021	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active	8007167737				HMO - Health Maintenance Organization		C	Atlanta
H1099	Part D Application Contact	Interim Chief Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Part D Benefits Contact	Interim Chief Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Part D Claims Submission Contact	Interim Chief Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Part D Exceptions Contact			Team	Pharmacy							hfhppharmacy@hf.org	6450 US Hwy #1		Rockledge	FL	32955	04/24/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active	8007167737				HMO - Health Maintenance Organization		C	Atlanta
H1099	Part D Exceptions Contact (Secondary)	Interim Chief Integrity Officer	Ms.	Schneider	Michelle							Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active	8007167737				HMO - Health Maintenance Organization		C	Atlanta
H1099	Part D Price File Contact (Back-up)	CVS/Caremark		Loveland	Chet		4806064873					Chet.Loveland@cvshealth.com	9501 E. Shea Boulevard		Scottsdale	AZ	85260	04/15/2022	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Part D Price File Contact (Primary)	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Part D Quality Assurance Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Part D Reporting Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Patient Safety Contact	System Director Enterprise Risk Mangement	Ms.	Magar	Kathryn	J	3214344383					Kathryn.Magar@HF.org	6450 US Highway 1		Rockledge	FL	32955	04/24/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Payment Contact	Chief Financial Officer	Mr.	Pulver	Joshua	P	3214344269					Joshua.Pulver@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/30/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Personal Health Record Contact	Interim Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Pharmacy Director	Director of Pharmaceutical Services		Terkoski	Eugene		3214345688					Eugene.Terkoski@HF.org	6450 US Highway 1		Rockledge	FL	32955	08/19/2021	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Pharmacy Network Management Contact	Director of Pharmaceutical Services		Terkoski	Eugene		3214345688					Eugene.Terkoski@HF.org	6450 US Highway 1		Rockledge	FL	32955	08/19/2021	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Pharmacy Network Management Contact (Secondary)	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Pharmacy Technical Help Desk Contact	Sr Managed Care Pharmacist		Terkoski	Eugene							molly.eickholt@hf.org	6450 US Highway 1		Rockledge	FL	32940	09/29/2022	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active	8007167737				HMO - Health Maintenance Organization		C	Atlanta
H1099	Pharmacy Technical Help Desk Contact (Secondary)	Medicare Integrity Analyst		Gutierrez	Dalia							dalia.gutierrez@hf.org	6450 US Hwy #1		Rockledge	FL	32955	05/18/2021	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active	8007167737				HMO - Health Maintenance Organization		C	Atlanta
H1099	PHR Beneficiary Contact																	09/13/2007	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS	Health First Health Plans	Health First Shared Services, Inc.	112	Yes	Active	8007167737				HMO - Health Maintenance Organization		C	Atlanta
H1099	Physician Incentive Contact	Vice President, Network Operations/Engagement		Fleming	Katie		3214345607					Katie.Fleming@hf.org	6450 US Highway 1		Rockledge	FL	32955	04/24/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Plan Directory Contact for Public Website	Vice President, Network Operations/Engagement		Fleming	Katie		8445225282					HFHPinfo@hf.org	6450 US Highway 1		Rockledge	FL	32955	05/07/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Plan to Plan Reconciliation Contact	Interim Chief Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Processor Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Quality Contact	Chief Operating Officer	Mrs.	Forrest	Jamie	R	3214344443					Jamie.Forrest@hf.org	6450 US Highway 1		Rockledge	FL	32955	04/24/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Reconciliation Contact	Chief Financial Officer	Mr.	Pulver	Joshua	P	3214344269					Joshua.Pulver@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/30/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Reconciliation Contact (Secondary)	Regulatory Operations Analyst		Fromer	Maritza		3214344797					maritza.fromer@hf.org	6450 US Highway 1		Rockledge	FL	32955	04/26/2019	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Recovery Audit Contact	Corporate Integrity Analyst	Ms.	Gutierrez	Dalia		3214345632					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	329555747	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	SNP Application Contact	Chief Financial Officer	Mr.	Pulver	Joshua	P	3214344269					Joshua.Pulver@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/30/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	SNP State Contact	Interim Chief Integrity Officer	Ms.	Schneider	Michelle		3214348530					Michelle.Schneider@HF.org	3300 Fiske Boulevard		Rockledge	FL	32955	08/25/2023	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Surveillance Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	12/22/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	System Contact	Chief Operating Officer	Mrs.	Forrest	Jamie	R	3214344443					Jamie.Forrest@hf.org	6450 US Highway 1		Rockledge	FL	32955	04/24/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Third Party Administrator (TPA) Liaison	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	User Access Contact	Medicare Integrity Analyst		Gutierrez	Dalia		3214197769					dalia.gutierrez@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Utilization Management Contact	Vice President, Clinical Operations		Sooknanan	Kamela		4045425842					Kamela.Sooknanan@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1099	Utilization Review Contact	Vice President, Clinical Operations		Sooknanan	Kamela		4045425842					Kamela.Sooknanan@hf.org	6450 US Highway 1		Rockledge	FL	32955	09/05/2020	2023	HEALTH FIRST HEALTH PLANS	Local CCP	Health First Health Plans, Inc.	HMO/HMOPOS		Health First Shared Services, Inc.	112	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1109	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Emergency Part D Contact (Secondary)	Exec. Dir., Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	12/30/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/30/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	12/30/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/06/2015	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/30/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H1109	PHR Beneficiary Contact																	11/15/2012	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				HMO - Health Maintenance Organization		C	Philadelphia
H1109	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/11/2015	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1109	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC.(GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1111	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H1111	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H1111	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H1111	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H1111	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1111	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H1112	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Part C Application Contact	Director, Medicare Strategy		Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Application Contact	Director, Medicare Strategy		Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H1112	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H1112	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8668928340				HMO - Health Maintenance Organization		C	Dallas
H1112	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	SNP Application Contact	Director, Medicare Strategy		Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1112	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF GEORGIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1119	Agent/Broker Compensation Data Contact	Chief Financial Officer	Mr.	Film	George		3304988203					george.film@altercareonline.net	7171 Keck Park Circle NW		North Canton	OH	44720	07/07/2021	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Riggle	Susan		7249872149					susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Backup User Access Contact	Client Executive Director		Campbell	Brad		5014004118				8667053692	bcampbell@access-healthservices.com	One Riverfront Place, Suite 525		North Little Rock	AR	72114	03/08/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Best Available Evidence Contact	Member Service Manager		Stacy	Brittany		5012550873				8667053652	bstacy@access-healthservices.com	One Riverfront Place, Suite 513A		North Little Rock	AR	72114	01/30/2018	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Bid Audit Contact	Principal and Consulting Actuary, Milliman		Johnson	Nick		2065945941				2066825946	nick.johnson@milliman.com	301 Fifth Avenue, Suite 3800		Seattle	WA	981012605	05/10/2019	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Bid Primary Contact	Chief Financial Officer	Mr.	Film	George		3304988203					george.film@altercareonline.net	7171 Keck Park Circle NW		North Canton	OH	44720	07/07/2021	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	CAP Report Contact for Public Website	Compliance Officer	Ms.	Ferrara	Donna		3304988220					donna.ferrara@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	04/02/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	CEO - CMS Administrator Contact	Vice President of Managed Care	Mr.	Haas	Scott		3304988178					scott.haas@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	CEO - Senior Official for Contracting	Vice President of Managed Care	Mr.	Haas	Scott		3304988178					scott.haas@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Chief Financial Officer	Chief Financial Officer	Mr.	Film	George		3304988203					george.film@altercareonline.net	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Chief Operating Officer	Vice President of Managed Care	Mr.	Haas	Scott		3304988178					scott.haas@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Chief Information Officer	Chief Information Officer	Mr.	Marcoguiseppe II	Martin		3304985114					Martin.Marcoguiseppe@tsgrinc.com	7171 Keck Park Circle NW		N. Canton	OH	44720	03/16/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Chief Information Security Officer	Chief Information Officer	Mr.	Marcoguiseppe II	Martin		3304985114					Martin.Marcoguiseppe@tsgrinc.com	7171 Keck Park Circle NW		N. Canton	OH	44720	03/16/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	CMS Casework Communication Contact	Compliance Officer	Ms.	Ferrara	Donna		3304988220					donna.ferrara@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	04/02/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Complaints Tracking Contact	Compliance Officer	Ms.	Ferrara	Donna		3304988220					donna.ferrara@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	04/02/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Contact for Fraud Investigations	Client Executive Director		Campbell	Brad		5014004118				8667053692	bcampbell@access-healthservices.com	One Riverfront Place, Suite 525		North Little Rock	AR	72114	03/08/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Coordination of Benefits Contact	Director of Part D Operations		Riggle	Susan		7249872149					susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Corporate Mailing						3304988101					scott.haas@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Coverage Gap Discount Program (CGDP) Payment Contact	Controller	Mr.	Logan	Justin		3304988171				3304988171	Justin.Logan@TSGrinc.com	7171 Keck Park Circle NW		North Canton	OH	44720	01/13/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Customer Service Operations Contact	Client Executive Director		Campbell	Brad		5014004118				8667053692	bcampbell@access-healthservices.com	One Riverfront Place, Suite 525		North Little Rock	AR	72114	01/13/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	DIR Contact	Sr Dir Government Programs		Farmer	Jim		3308886098					jfarmer@elixirsolutions.com	7835 Freedom Avenue NW		N Canton	OH	44720	12/14/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	DIR Contact (Secondary)	Analyst lll Government Programs		Houchens	Logan		3308886095					lhouchens@elixirsolutions.com	7835 Freedom Avenue NW		N Canton	OH	44720	12/14/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Emergency Part D Contact	Director of Part D Operations		Riggle	Susan		7249872149					susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Emergency Part D Contact (Secondary)	Pharmacy Operations		Husted	Beth		3304983721				3304988158	beth.husted@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/13/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Encounter Data & Risk Adjustment Operations Contact	Client Executive Director		Campbell	Brad		5014004118				8667053652	bcampbell@access-healthservices.com	One Riverfront Place, Suite 525		North Little Rock	AR	72114	03/08/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Enrollment Contact	Member Service Manager		Stacy	Brittany		5012550873				8667053652	bstacy@access-healthservices.com	One Riverfront Place, Suite 513A		North Little Rock	AR	72114	01/30/2018	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	EOB Transfer Contact	Claims Monitoring Manager		Boyd	Sarah		5012324522	522			8667053652	sboyd@access-healthservices.com	One Riverfront Place, Suite 513A		North Little Rock	AR	72114	01/06/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Financial Audit Contact	Chief Financial Officer	Mr.	Film	George		3304988203					george.film@altercareonline.net	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Financial Reporting Contact	Chief Financial Officer	Mr.	Film	George		3304988203					george.film@altercareonline.net	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Formulary Contact	Director Clinical Audits		Rossi	David		3304866311					drossi@elixirsolutions.com	7835 Freedom Avenue NW		N Canton	OH	44720	06/13/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Formulary Contact (Secondary)	Director Formulary Operations		Singh	Roop		3304866482					rsingh@elixirsolutions.com	7835 Freedom Avenue NW		N Canton	OH	44720	12/14/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	General Contact	Vice President of Managed Care	Mr.	Haas	Scott		3304988178					scott.haas@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Government Relations Contact	Compliance Officer	Ms.	Ferrara	Donna		3304988220					donna.ferrara@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	04/02/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	HIPAA Privacy Officer	Compliance Officer	Ms.	Ferrara	Donna		3304988220					donna.ferrara@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	04/02/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	HIPAA Security Officer	Compliance Officer	Ms.	Ferrara	Donna		3304988220					donna.ferrara@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/16/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Hospice Contact	Director of Part D Operations		Riggle	Susan		7249872149					susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Interoperability Contact	Chief Information Officer		Marcoguiseppe	Mr. Martin		3304985114					Martin.Marcoguiseppe@tsgrinc.com	7171 Keck Park Circle NW		North Canton	OH	44720	01/13/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	MA Appeals/Grievances Contact	Appeals and Grievances Manager		Boyd	Sarah		5012324522	522				sboyd@access-healthservices.com	One Riverfront Place, Suite 513A		North Little Rock	AR	72114	01/06/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	MA Claims Processing Contact for Public Website	Vice President of Managed Care	Mr.	Haas	Scott		3304988178					scott.haas@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Marketing Contact	Vice President of Managed Care	Mr.	Haas	Scott		3304988178					scott.haas@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Medical Director	Medical Director	Dr.	Smith	Mark		3308012208					smithhickoryrun@sbcglobal.net	7171 Keck Park Circle NW		North Canton	OH	44720	07/06/2021	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Medicare Compliance Officer	Compliance Officer	Ms.	Ferrara	Donna		2342151042					donna.ferrara@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	04/13/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Medicare Coordinator	Vice President of Managed Care	Mr.	Haas	Scott		3304988178					scott.haas@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Medicare Part D Opioid Overutilization Contact	Director of Part D Operations		Riggle	Susan		7249872149					susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Medication Therapy Management Contact	VP Pharmacy Solutions		Miller	Holly		3302931916					hmiller@healthdialog.com	7835 Freedom Avenue NW		N Canton	OH	44720	12/14/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Part C Application Contact	Vice President of Managed Care	Mr.	Haas	Scott		3304988178					scott.haas@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Part C Reporting Contact	Client Executive Director		Campbell	Brad		5014004118				8667053652	bcampbell@access-healthservices.com	One Riverfront Place, Suite 525		North Little Rock	AR	72114	03/08/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Appeals	Director of Clinical Operations		Smith	Melisa							melissa.smith@valorhealthplan.com	7171 Keck Park Circle NW		N Canton	OH	44720	05/26/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active	3304988236				HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Appeals Contact (Secondary)	Appeals Supervisor Clinical Operations		Binegar	Sam						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		N Canton	OH	44720	12/14/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Application Contact	Vice President of Managed Care	Mr.	Haas	Scott		3304988178					scott.haas@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Benefits Contact	Director of Part D Operations		Riggle	Susan		7249872149					susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Claims Submission Contact	Account Manager		Voss	Laurie		2342123780					lvoss@elixirsolutions.com	7835 Freedom Avenue NW		N Canton	OH	44720	12/14/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Exceptions Contact	Director of Part D Operations		Riggle	Susan							susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active	7249872149				HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Exceptions Contact (Secondary)	Appeals Supervisor Clinical Operations		Binegar	Sam						3304058081	Appeals@elixirsolutions.com	7835 NW Freedom Avenue		N Canton	OH	44720	01/13/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Price File Contact (Back-up)	Financial Analyst, Finance		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	8921 Canyon Falls Blvd, Suite 1007835 Freedom Avenue NW		N Canton	OH	44720	12/14/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Price File Contact (Optional)	Director of Part D Operations		Riggle	Susan		7249872149					susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Price File Contact (Primary)	Sr Financial Mgr Report Analytics		Cambell	Tim		3308886988					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		N Canton	OH	44720	12/14/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Quality Assurance Contact	Director of Part D Operations		Riggle	Susan		7249872149					susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Part D Reporting Contact	Director of Part D Operations		Riggle	Susan		7249872149					susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Patient Safety Contact	Director of Part D Operations		Riggle	Susan		7249872149					susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Payment Contact	Chief Financial Officer	Mr.	Film	George		3304988203					george.film@altercareonline.net	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Pharmacy Director	Director of Part D Operations		Riggle	Susan		7249872149					susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Pharmacy Network Management Contact	Director Pharmacy Network		Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	7835 Freedom Avenue NW		N Canton	OH	44720	12/14/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Pharmacy Technical Help Desk Contact	Vice President Operations		Conn	Todd							tconn@elixirsolutions.com	7835 Freedom Avenue NW		N Canton	OH	44720	12/14/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active	8334594423				HMO - Health Maintenance Organization		C	Chicago
H1119	Pharmacy Technical Help Desk Contact (Secondary)	Director of Part D Operations		Riggle	Susan							susan.riggle@abshealth.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/12/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active	7249872149				HMO - Health Maintenance Organization		C	Chicago
H1119	Plan Directory Contact for Public Website			Service	Customer		8004853793					providerservices@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/08/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Plan to Plan Reconciliation Contact	Controller	Mr.	Logan	Justin		3304988171				3304985295	Justin.Logan@TSGrinc.com	7171 Keck Park Circle NW		North Canton	OH	44720	12/14/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Processor Contact	Quality Initiatives Director		Smith	Melissa		3304988236					melissa.smith@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	09/16/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Quality Contact	Quality Initiatives Director		Smith	Melissa		3304988236					melissa.smith@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	09/16/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Reconciliation Contact	Chief Financial Officer	Mr.	Film	George		3304988203					george.film@altercareonline.net	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Recovery Audit Contact	Chief Financial Officer	Mr.	Film	George		3304988203					george.film@altercareonline.net	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	SNP Application Contact	Vice President of Managed Care	Mr.	Haas	Scott		3304988178					scott.haas@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/23/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Surveillance Contact	Compliance Services Director		Gable	JB		5018596108					jgable@access-healthservices.com	One Riverfront Place, Suite 513A		North Little Rock	AR	72114	01/06/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	System Contact	Information Services Director		Harrington	Paige		5012957666					pharrington@access-healthservices.com	One Riverfront Place, Suite 513A		North Little Rock	AR	72114	03/16/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Third Party Administrator (TPA) Liaison	Compliance Officer	Ms.	Ferrara	Donna		3304988220					donna.ferrara@valorhealthplan.com	7171 Keck Park Circle NW		N Canton	OH	44720	01/13/2023	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	User Access Contact	Compliance Officer	Ms.	Ferrara	Donna		3304988220					donna.ferrara@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	03/16/2022	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Utilization Management Contact	Quality Initiatives Director		Smith	Melissa		3304988236					melissa.smith@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	09/16/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1119	Utilization Review Contact	Quality Initiatives Director		Smith	Melissa		3304988236					melissa.smith@valorhealthplan.com	7171 Keck Park Circle NW		North Canton	OH	44720	09/16/2020	2023	TSG GUARD, INC.	Local CCP	Valor Health Plan	HMO/HMOPOS		The Schroer Group, Inc.	702	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1170	Agent/Broker Compensation Data Contact	Manager, Medicare Compliance		Lawrence	Winston		5105070510					winston.d.lawrence@kp.org	1 Kaiser Plaza, 12th Floor		Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Automated TrOOP Balance Transfer Contact	Project Manager III, Pharmacy Benefit Mgmt		Perez	Elizabeth	R	5623670592					Elizabeth.R.Perez@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	08/02/2018	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Backup User Access Contact	Regional Compliance Officer		Stewart	Sean	L	4043644707				4042794642	sean.l.stewart@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	30305	01/13/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Best Available Evidence Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Bid Audit Contact	Executive Director Actuarial		Kenny	Kevin		5102677544					kevin.x.kenny@kp.org	300 Lakeside Dr.	28th Floor	Oakland	CA	94612	12/18/2020	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Bid Audit Site Contact	Compliance Consultant		Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/01/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Bid Primary Contact	Managing Actuary		Hu	Shelley	J	4043647109					shelley.j.hu@kp.org	3495 Piedmont Rd. NE	Nine Piedmont Center	Atlanta	GA	30305	07/10/2014	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	CAP Report Contact for Public Website	Medicare Compliance Leads	Ms.	Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	303051736	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	CEO - CMS Administrator Contact	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	CEO - Senior Official for Contracting	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Chief Financial Officer	SVP, CFO Business Units and Finance Operations	Mr.	Beltch	Robert	R	8184897560					rob.beltch@kp.org	1 Kaiser Plaza, Suite 806	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/15/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Chief Operating Officer	Executive Director, Medicare Market Strategy & Ops	Mr.	Miller	Paul		5033410073					paul.a.miller@kp.org	500 NE Multnomah St., Ste. 100		Portland	OR	97232	04/10/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Chief Information Officer	Chief Information Officer	Ms.	Comer	Diane		5102258777					Diane.B.Comer@kp.org	2600 Napa Valley Corporate Drive		Napa	CA	94558	09/17/2020	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Chief Information Security Officer	VP, Chief Information Security Officer	Mr.	Goddard	Jim		3037133890					James.P.Goddard@kp.org	6560 Greenwood Plaza Blvd.		Greenwood Village	CO	80111	02/03/2016	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	CMS Casework Communication Contact	Mrg, Member Relations		Kirkwood-Murphy	Alison	X	5102195415					alison.x.kirkwood-murphy@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Complaints Tracking Contact	Medicare Contract Compliance Manager		Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road N.E.	Nine Piedmont Center	Atlanta	GA	30305	01/13/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Contact for Fraud Investigations	Director, Fraud Control and NSIU		Janiga	Marita		5102716937				5108917977	marita.c.janiga@kp.org	One Kaiser Plaza	Ordway Building, 12th Floor	Oakland	CA	94612	02/24/2011	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Coordination of Benefits Contact	Senior Director		Chung	Clarence		5623909293				5626583866	clarence.j.chung@kp.org	12254 Bellflower Blvd - Suite 106, 1st Floor		Downey	CA	90242	04/28/2022	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Corporate Mailing						4049850135				4042794642	chandra.walden@kp.org	3495 Piedmont Road	Nine Piedmont Center	Atlanta	GA	303051736	03/20/2015	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Coverage Gap Discount Program (CGDP) Payment Contact			Ballestros	Mayra		6262525164					mayra.x.lujano@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	02/15/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Customer Service Operations Contact	Sr Director Member Relations		Devers	Jason	C	3233027947				4049495001	jason.c.devers@kp.org	Nine Piedmont Center	3495 Piedmont Road, NE	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	DIR Contact	Senior Business Process Manager		Hsiue	Tony		5626583836					tony.x.hsiue@kp.org	12254 Bellflower Blvd.  Flr. 2		Downey	CA	90242	03/09/2020	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	DIR Contact (Secondary)	Sr. Financial Analyst		San	Kei		5626583445					Kei.San@kp.org	12254 Bellflower Blvd. Fl. 2		Downey	CA	90242	07/17/2018	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Electronic Health Record Contact	Sr Manager, Meaningful Use PMO		Poole	Dolly		5106255813					dolly.poole@kp.org	1800 Harrison St.		Oakland	CA	94612	07/02/2018	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Emergency Part D Contact	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/04/2022	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Emergency Part D Contact (Secondary)	Pharmacy Compliance Manager		Sanders	Diane		5102091877					Diane.Sanders@kp.org	3495 Piedmont Road, NE	Ten Piedmont Center	Atlanta	GA	30305	12/28/2018	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Encounter Data & Risk Adjustment Operations Contact	Director, Risk Adjustment Submission	Ms.	Gu	Jialin		3033383507					jialin.gu@kp.org	2500 South Havana		Aurora	CO	80014	10/21/2019	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Enrollment Contact	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	EOB Transfer Contact	Pharmacy Medicare Operations, Project Manager II		Bonoan	John	B	5624180564				5626583848	john.b.bonoan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/12/2012	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Financial Audit Contact	Compliance Consultant	Ms.	Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	07/06/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Financial Reporting Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Formulary Contact	Pharmacy Project Manager		Kim	Jung		5624459129					jung.x3.kim@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/20/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Formulary Contact (Secondary)	PHARMACY PROJECT MGR I		Lin	Clement	J	5624459129					Clement.J.Lin@kp.org	12254 Bellflower Blvd		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	General Contact	Medicare Contract Compliance Manager	Ms.	Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	303051736	01/13/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Government Relations Contact	Manager, Government Relations		Ross	Shea		7062248939				4043644136	shea.ross@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	30305	09/06/2017	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	HIPAA Privacy Officer	Compliance Director		Anderson	Angela		5104353413					Angela.B.Anderson@kp.org	1800 Harrison Street	16th Floor	Oakland	CA	94612	11/06/2020	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	HIPAA Security Officer	Senior Director		Vourthis	Bill		9252065125					bill.d.vourthis@kp.og	5820 Owens Drive	Building E	Pleasanton	CA	94588	08/25/2020	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Hospice Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Interoperability Contact	National EDI Business Operations		Plattner	Cathy		6268336526					Cathy.P.Plattner@kp.org	75 N Fair Oaks Ave.		Pasadena	CA	91103	11/03/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	MA Appeals/Grievances Contact	Executive Director, Member Relations		Osborne	Susan		5038133924					susan.a.osborne@kp.org	500 NE Multnomah Street	Suite 100	Portland	OR	97232	01/20/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	MA Claims Processing Contact for Public Website	Dir Customer Engagement Mgmt		Galloway	Lonnie		9094772466					Lonnie.L.Galloway@kp.org	10740 4th Street		Rancho Cucamonga	CA	91730	08/02/2018	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Marketing Contact	Medicare Compliance Lead		Walden	Chandra		4049850135					KP-MedicareFilings@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Medical Director	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	11/16/2020	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Medicare Compliance Officer	Medicare Contract Compliance Manager	Ms.	Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road	Nine Piedmont Center	Atlanta	GA	303051736	01/13/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Medicare Coordinator	Medicare Compliance Lead		Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Medicare Part D Opioid Overutilization Contact	Pharmacist Project Manager		Chong	Sue	H	5626583661					sue.h.chong@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	12/05/2018	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Medication Therapy Management Contact	Clinical Pharmacy Manager		Laurenti	Teri		7709316176					teri.laurenti@kp.org	3650 Steve Reynolds Blvd		Duluth	GA	30096	02/23/2016	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	OffShore Subcontractor Contact	Compliance Consultant - Privacy and Security		Glenn	Jovan		9092512010					Jovan.Robinson@kp.org	10740 Fourth Street		Rancho Cucamonga	CA	91730	08/26/2020	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Online Enrollment Center Contact (Back-up)	Senior Team Manager, Medicare Membership Admin		Nugent	Kristin		8586376801					kristin.n.nugent@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Online Enrollment Center Contact (Optional)	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Online Enrollment Center Contact (Primary)	Team Manager, Medicare Membership Administration		Covarrubio	Danny		8586143433					danny.x.covarrubio@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Part C Application Contact	Medicare Compliance Lead		Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Part C Reporting Contact	Medicare Compliance Lead		Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road N.E.	Nine Piedmont Center	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Appeals	Sr. Director Member Relations		Devers	Jason	C					4043644743	jason.c.devers@kp.org	3495 Piedmont Center	Ten Piedmont Center	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	3233027947				HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Appeals Contact (Secondary)	Executive Director, Member Relations		Osborne	Susan							susan.a.osborne@kp.org	500 NE Multnomah Street	Suite 100	Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	5038133924				HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Application Contact	Executive Director		Robinson	Tanya	M	3013950877					tanya.m.robinson@kp.org	111 S Calvert Street	Suite 1850	Baltimore	MD	21202	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Benefits Contact	Manager, Pharmacy Benefits and Training		Gosnell	Nicole		4043647120					nicole.gosnell@kp.org	3495 Piedmont Road NE	Ten Piedmont Center	Atlanta	GA	30305	06/03/2011	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Claims Submission Contact	Pharmacy Benefits Manager		Gosnell	Nicole		4043647120					nicole.gosnell@kp.org	3495 Piedmont Road NE	Ten Piedmont Center	Atlanta	GA	30305	11/21/2008	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Exceptions Contact	Manager, Pharmacy Benefits and Training		Gosnell	Nicole							nicole.gosnell@kp.org	3495 Piedmont Road NE	Ten Piedmont Center	Atlanta	GA	30305	10/20/2009	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8002324404				HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Exceptions Contact (Secondary)	Manager, Pharmcy Compliance		Sanders	Diane							diane.sanders@kp.org	3495 Piedmont Road NE	Ten Piedmont Center	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	7707125654				HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Price File Contact (Back-up)	Financial Analyst		Kamikawa	Emely		5622998753				5626583712	emely.a.kamikawa@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Price File Contact (Optional)	Associate Consultant		Quan	Mariclare		5623850395					mariclare.a.quan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Price File Contact (Primary)	Pharmacy Pricing		Bullard	Myra		5623195747				5626583712	myra.c.bullard@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Quality Assurance Contact	Vice President, Clinical Pharmacy Services		Le	Kim		5622997015					Kim.N1.Le@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Part D Reporting Contact	Medicare Compliance Lead		Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road N.E.	Nine Piedmont Center	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Patient Safety Contact	Vice President, Clinical Pharmacy Services		Le	Kim		5622997015					Kim.N1.Le@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Payment Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza, Suite 2552		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Pharmacy Director	Mrg, Pharmacy Compliance		Sanders	Diane		7707125654					diane.sanders@kp.org	3495 Piedmont Road NE	Ten Piedmont Center	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Pharmacy Network Management Contact	Pharmacy Benefits Manager		Gosnell	Nicole		4043647120					nicole.gosnell@kp.org	3495 Piedmont Road NE	Ten Piedmont Center	Atlanta	GA	30305	01/13/2012	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Pharmacy Technical Help Desk Contact	Customer Care Center		OptumRx	PBM								755 Research Parkway Suite 160		Okalahoma City	OK	73104	11/02/2016	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8882773914				HMO - Health Maintenance Organization		C	San Francisco
H1170	Physician Incentive Contact	Medicare Contract Compliance Manager		Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	30305	01/13/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Plan Directory Contact for Public Website			Services	Member		8002324440				4043644939	kpnet@kp.org	3495 Piedmont Road NE	Ten Piedmont Center	Atlanta	GA	30305	06/03/2011	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Plan to Plan Reconciliation Contact	Interim Director, Medicare Accounting		Wright	Mark	A	9253239443					mark.a.wright@kp.org	1 Kaiser Plaza, 25th Floor		Oakland	CA	94612	01/20/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Processor Contact	Medicare Compliance Consultant	Mr.	Carver	Jon	R	4257578659					jonathan.r.carver@kp.org	1300 SW 27th St.		Renton	WA	98057	09/05/2023	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Quality Contact	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	05/25/2022	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Reconciliation Contact	Controller, National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Reconciliation Contact (Secondary)	Vice President & Chief Financial Officer	Ms.	Shepler	Courtney	R	5102714644					courtney.r.shepler@kp.org	National Medicare Finance, 1 Kaiser Plaza, 13th Floor	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Recovery Audit Contact	Manager, Revenue Mgmt Compliance	Ms	Gonzalez	Heidy	G	6263723181					heidy.gonzalez@kp.org	74 S Fair Oaks Avenue		Pasadena	CA	91103	08/03/2022	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	SNP Application Contact	Medicare Contract Compliance Manager	Ms.	Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	303051736	01/13/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	SNP State Contact	Medicare Compliance Lead	Ms.	Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	303051736	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Surveillance Contact	Medicare Compliance Lead		Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	System Contact	Director, Membership Administration Systems & S.S.		Putman	Anthony		8586506364					anthony.m.putman@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Third Party Administrator (TPA) Liaison	Senior Accountant		Thornal	Sun		6264056311					sun.a.thornal@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	12/12/2016	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	User Access Contact	Medicare Compliance Lead		Walden	Chandra		4049850135					chandra.walden@kp.org	3495 Piedmont Road NE	Nine Piedmont Center	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Utilization Management Contact	Sr Program Mgr, UM Compliance		Fountain	Tracy	F	4703163624					tracy.f.fountain@kp.org	3495 Piedmont Road NE	Building 10, 5th Floor	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1170	Utilization Review Contact	Sr Program Mgr, UM Compliance		Fountain	Tracy	F	4703163624					tracy.f.fountain@kp.org	3495 Piedmont Road NE	Building 10, 5th Floor	Atlanta	GA	30305	10/28/2021	2023	KAISER FOUNDATION HP OF GA, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1181	Agent/Broker Compensation Data Contact	Manager, Individual Sales		Gehrke	Kimberly		9207201569					kgehrke@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Backup User Access Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	akeenan@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Bid Audit Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Bid Audit Site Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Bid Primary Contact	Senior Actuary		Lanier	Eric		9207201636				9207201912	elanier@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	CAP Report Contact for Public Website	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	CEO - CMS Administrator Contact	CEO	Mrs.	Dicus-Johnson	Coreen		9202851898					coreen.dicusjohnson@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	CEO - Senior Official for Contracting	CEO	Mrs.	Dicus-Johnson	Coreen		2627889303					Coreen.DicusJohnson@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Chief Financial Officer	Chief Financial Officere	Mr	Ollech	Brian		9207201886					bollech@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Chief Operating Officer	Vice President, Operations	Ms.	Vander Zanden	Jessica		9207201652					jvanderz@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Chief Information Officer	Chief Information Officer	Mr	Riley	Timothy		9207201895					triley@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Chief Information Security Officer	Chief Information Security Officer	Mr	Bloedorn	Dave		9207201410					dbloedor@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	CMS Casework Communication Contact	Director, Regulatory Affairs		Schuster	Shannon		9206287267					sschuste@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Complaints Tracking Contact	Director, Regulatory Affairs		Schuster	Shannon		9206287267				9207201912	sschuste@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Contact for Fraud Investigations	VP, Risk Adjustment & Payment Integrity		Weisbrod	Josh		9207201461					jweisbro@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Corporate Mailing						9207201200					compliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Customer Service Operations Contact	Manager, Customer Service		Schwandner	Stacy		9207201309				9207201908	sschwand@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Electronic Health Record Contact	VP, Care Services		Dencker	Sarah		9207201694					sdencker@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Employer Waiver Contact	VP, Medicare & Individual Programs		Whittemore	John		9853773986					jwhittem@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Encounter Data & Risk Adjustment Operations Contact	Vice President, Risk Adjustment		Weisbrod	Josh		9207201461					jweisbro@networkhealth.com	1570 Midway Place		Fond du Lac	WI	54935	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Enrollment Contact	Manager, Enrollment and BA Integration		Ziegert	Amy		9207201414					amzieger@networkhealth.com	1570 Midway Place		Menasha	WI	54952	07/24/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Financial Audit Contact	Compliance Officer	Mrs.	Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Financial Reporting Contact	VP, Finance		Leigh	Dennis		9207201837					FinanceReporting@networkhealth.com	1570 Midway  Place		Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	General Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Government Relations Contact	Compliance Officer		Keenan	Angela		9207201242					nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Interoperability Contact			Zirbel	Justin		9207201202					jzirbel@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	MA Appeals/Grievances Contact	Manager, Appeals and Grievances		Skinner	Jeanne		9207201382					jskinner@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/20/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	MA Claims Processing Contact for Public Website	Manager, Claims		Adamick	Crystal		9207201547					cadamick@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Marketing Contact	Vice President - Marketing and Communications		Draheim	Melanie		9207201279				9207201912	mdraheim@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Medical Director	Chief Medical Officer	Dr.	Hassan	Mushir		2628259727					mhassan@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Medicare Compliance Officer	Compliance Officer	Mrs.	Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Medicare Coordinator	VP of Operations		Vander Zanden	Jessica		9207201652				9207201912	jvanderz@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	OffShore Subcontractor Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Part C Application Contact	Compliance Officer		Keenan	Angela		9207201242					nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Part C Reporting Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Payment Contact	Vice President - Finance		Leigh	Dennis		9207201837					FinanceReporting@networkhealth.com	1570 Midway  Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Personal Health Record Contact	VP, Care Services		Dencker	Sarah		9207201694				9207201908	sdencker@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	PHR Beneficiary Contact																	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA	Network Health Insurance Corporation	Network Health, Inc.	670	No	Active	8003785234				MSA		C	Denver
H1181	Physician Incentive Contact	VP, Network Development		Wille	Scott		2627889533					swille@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Plan Directory Contact for Public Website			Service	Customer		8003785234				9207201908	sschwand@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Quality Contact	VP, Quality and Clinical Integration		Benz	Elizabeth		2628259782					ebenz@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Recovery Audit Contact	Compliance Officer	Mrs.	Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Surveillance Contact	Compliance Officer		Keenan	Angela		9207201624				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	System Contact	IT Infrastructure Manager	Mr	Petersen	Chris		9207201445					cpeterse@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	User Access Contact	Information Security Risk Analyst	Ms	Pfefferle	Trish		9207201225					tpfeffer@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Utilization Management Contact	Vice President - Care Services		Dencker	Sarah		9207201694					sdencker@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1181	Utilization Review Contact	Vice President - Care Services		Dencker	Sarah		9207201694					sdencker@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	MSA	Network Health Medicare Advantage Plans	MSA		Network Health, Inc.	670	No	Active					MSA		C	Denver
H1189	Agent/Broker Compensation Data Contact	VP Product Sales	Mr.	Hirasaki	Ron		4692820316					ron.hirasaki@christushealth.org	919 Hidden Ridge		Irving	TX	75038	05/24/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Automated TrOOP Balance Transfer Contact	Director of Finance		Orr	Raven		4692823217					raven.orr@christushealth.org	919 Hidden Ridge		Irving	TX	75038	03/26/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Backup User Access Contact	Project Mgr II	Mrs.	Cooper	Katheryn		4692823115					Katheryn.cooper@christushealth.org	909 Hidden Ridge		Irving	TX	75038	09/01/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Best Available Evidence Contact	Enrollment/COB Manager		Satchell	DeMaurea		4692823224					Demaurea.Satchell@christushealh.org	909 Hidden Ridge		Irving	TX	75038	09/29/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Bid Audit Contact	Regulatory Affairs		Charless	Michele		4692823297					michele.charless@christushealth.org	909 Hidden Ridge		Irving	TX	75038	07/21/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Bid Audit Site Contact	Manager, Product Managment		Alles	Carrie		3608623056					carrie.alles@christushealth.org	919 Hidden Ridge		Irving	TX	75038	07/21/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Bid Primary Contact	Manager, Product Management		Alles	Carrie		4692823056					carrie.alles@christushealth.org	919 Hidden  Ridge		Irving	TX	75038	12/13/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	CAP Report Contact for Public Website	Regulatory Affairs		Charless	Michele		4692923523					michele.charless@christushealth.org	909 Hidden Ridge		Irving	TX	75038	06/12/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	CEO - CMS Administrator Contact	CEO CHRISTUS Health Plan	Mr.	Stansbury	Shannon		4692823337					shannon.stansbury@christushealth.org	919 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	CEO - Senior Official for Contracting	CEO CHRISTUS Health Plan	Mr.	Stansbury	Shannon		4692823337					shannon.stansbury@christushealth.org	919 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Chief Financial Officer	VP, CFO CHRISTUS Health Plan	Mr.	Beiermann	Jim		8053680932					jim.beiermann@christushealth.org	919 Hidden Ridge		Irving	TX	75038	07/21/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Chief Operating Officer	Chief Operating Officer	Mr.	Kitzmiller	George		4692823337					george.kitzmiller@christushealth.org	919 Hidden Ridge		Irving	TX	75038	10/20/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Chief Information Officer	System Director IM Health Plans and Population Ser	Ms.	Rivas	Noel		4692822246					noel.rivas2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	12/20/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Chief Information Security Officer	VP, Information Security Officer	Mr.	Blanco-Dopazo	Fernando		4692822000					Fernando.blanco@christushealth.org	919 Hidden Ridge		Irving	TX	75038	04/27/2017	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	CMMI Model Point of Contact	CEO Christus Health Plan	Mr.	Stansbury	Shannon		4692823337					shannon.stansbury@christushealth.org	919 Hidden Ridge		Irving	TX	75038	10/14/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	CMS Casework Communication Contact	Director, Complaints & Appeals		Hendon	Amanda		4692823039				8664162840	amanda.hendon@christushealth.org	919 Hidden Ridge		Irving	TX	75038	08/14/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Complaints Tracking Contact	Director, Complaints & Appeals		Hendon	Amanda		4692823039				8664162840	amanda.hendon@christushealth.org	919 Hidden Ridge		Irving	TX	75038	08/14/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Contact for Fraud Investigations	Regulatory Affairs	Mrs.	Charless	Michele		4692823523					michele.charless@christushealth.org	919 Hidden Ridge		Irving	TX	75038	06/12/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Coordination of Benefits Contact	Manager Claims	Mrs.	Grado	Sandra		4692823200					sandra.grado@christushealth.org	919 Hidden Ridge		Irving	TX	75038	04/14/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Corporate Mailing						8442823026					shannon.stansbury@christushealth.org	919 Hidden Ridge		Irving	TX	75038	09/30/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Coverage Gap Discount Program (CGDP) Payment Contact	CEO Christus Health Plan	Mr.	Stansbury	Shannon		4692823337					shannon.stansbury@christushealth.org	919 Hidden Ridge		Irving	TX	75038	10/14/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Customer Service Operations Contact	Director Health Plans	Ms.	Horn	Jeniffer		4692823252					jen.horn@christushealth.org	919 Hidden Ridge		Irving	TX	75038	10/13/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	DIR Contact	Director of Finance		Orr	Raven		4692822000					Raven.Orr@christushealth.org	919 Hidden Ridge		Irving	TX	75038	03/07/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	DIR Contact (Secondary)	Project Manager Regulatory Affairs		Solache	Melissa		4692823205					Melissa.Solache@christushealth.org	919 Hidden Ridge		Irving	TX	75038	09/20/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Electronic Health Record Contact	Regulatory Affairs	Mrs.	Charless	Michele		4692823523					michele.charless@christushealth.org	919 Hiiden Ridge		Irving	TX	75038	06/12/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Emergency Part D Contact	Pharmacy Benefit Specialist		Nguyen	Tina		8177063827					tina.nguyen2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	05/24/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Emergency Part D Contact (Secondary)	Pharmacy Benefit Spc		Johnson	Brooke		4692823073					brooke.johnson2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	05/24/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Employer Waiver Contact	Manager of product Mgmt	Ms.	Alles	Carrie		4692823226					carrie.alles@christushealth.org	909 Hidden Ridge		Irving	TX	75038	12/20/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Encounter Data & Risk Adjustment Operations Contact	Director, Complaints & Appeals		Hendon	Amanda		4692823052					Amanda.hendon@christushealth.org	919 Hidden Ridge		Irving	TX	75038	02/06/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Enrollment Contact	Enrollment Manager	Mr	Satchell	DeMaurea		4692823224					demaurea.satchell@christushealth.org	919 Hidden Ridge		Irving	TX	75038	12/20/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	EOB Transfer Contact	Manager, Claims		Grado	Sandra		4692823200				4692823200	sandra.grado@christushealth.org	919 Hidden Ridge		Irving	TX	75038	03/13/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Financial Audit Contact	CEO Christus Health Plan	Mr.	Stansbury	Shannon		4692823337					shannon.stansbury@christushealth.org	919 Hidden Ridge		Irving	TX	75038	10/14/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Financial Reporting Contact	VP, CFO Christus Health Plan	Mr.	Beiermann	Jim		8053680932					jim.beiermann@christushealth.org	919 Hidden Ridge		Irving	TX	75038	07/21/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Formulary Contact	Manager Pharmacy Benefits and Services		Nguyen	Tina		8177063827					tina.nguyen2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	05/24/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Formulary Contact (Secondary)	Pharmacy Benefit Mgr		Johnson	Brooke		2142885660					brooke.johnson2@christushealth.org	909 Hidden Ridge		Irving	TX	75038	09/01/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	General Contact	Regulatory Affairs		Charless	Michele		4692823523					michele.charless@christushealth.org	919 Hidden Ridge		Irving	TX	75038	06/12/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Government Relations Contact	Chief Administrative Officer	Ms.	Hefton	Ronda		4692823330					ronda.hefton@christushealth.org	909 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	HIPAA Privacy Officer	Regulatory Affairs	Mrs.	Charless	Michele		4692823523					michele.charless@christushealth.org	919 Hidden Ridge		Irving	TX	75038	06/12/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	HIPAA Security Officer	CIO	Mr	Blanco	Fernando		4692822000					fernando.blanco@christushealth.org	919 Hidden Ridge		Irving	TX	75038	12/20/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Hospice Contact	Director of Medical Mgmt		Abuhasheesh	Keli		4692823111					keli.abuhasheesh2@christushealth.org	909 Hidden Ridge		Irving	TX	75038	08/11/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Interoperability Contact	Director of IM		Rivas	Noel		4692822000					noel.rivas2@christushealth.org	919 Hidden Ridge Dr.		Irving	TX	75038	12/20/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	MA Appeals/Grievances Contact	Director, Complaints & Appeals		Hendon	Amanda		4692823039				8664162840	amanda.hendon@christushealth.org	919 Hidden Ridge		Irving	TX	75038	08/14/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	MA Claims Processing Contact for Public Website	Claims Manager		Grado	Sandra		4692823200				4692823200	sandra.grado@christushealth.org	919 Hidden Ridge		Irving	TX	75038	03/13/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Marketing Contact	VP Product Mgmt	Mr.	Hirasaki	Ron		4692820316					ron.hirasaki@christushealth.org	919 Hidden Ridge		Irving	TX	75038	12/20/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Medical Director	Director of Medical Management		Abuhasheesh	Keli		4692823111					keli.abuhasheesh2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	09/08/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Medicare Compliance Officer	Regulatory Affairs	Mrs.	Charless	Michele		4692823523					michele.charless@christushealth.org	919 Hidden Ridge		Irving	TX	75038	06/12/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Medicare Coordinator	Regulatory Affairs	Mrs.	Charless	Michele		4692823523					michele.charless@christushealth.org	919 Hidden Ridge		Irving	TX	75038	06/12/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Medicare Part D Opioid Overutilization Contact	Director of Clinical Trend Solutions		Muralidharan	Adrienne		3146846625					amuralidharan@express-scripts.com	One Express Way		St. Louis	MO	63121	05/16/2019	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Medication Therapy Management Contact	Director, Clinical and Trend Solutions		Muralidharan	Adrienne		3146846625					amuralidharan@express-scripts.com	One Express Way		St. Louis	MO	63121	05/16/2019	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	OffShore Subcontractor Contact	Chief Administrative Officer	Ms.	Hefton	Ronda		4692823330					ronda.hefton@christushealth.org	909 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Online Enrollment Center Contact (Back-up)	Manager Enrollment and Eligibility	Mr	Satchell	DeMaurea		4692823224					demaurea.satchell@christushealth.org	919 Hidden Ridge		Irving	TX	75038	01/15/2020	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Online Enrollment Center Contact (Optional)	Mgr of MA Enrollment	Mr	Satchell	DeMaurea		4692823224					demaurea.satchell@christushealth.org	919 Hidden Ridge		Irving	TX	75038	10/22/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Online Enrollment Center Contact (Primary)	Director of Health Plan CMS Compliance	Mrs.	Chavez	Rocio		4692823523					rocio.chavez@christushealth.org	919 Hidden Ridge		Irving	TX	75038	10/13/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Part C Application Contact	Chief Administrative Officer	Ms.	Hefton	Ronda		4692823330					ronda.hefton@christushealth.org	909 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Part C Reporting Contact	Chief Administrative Officer	Ms.	Hefton	Ronda		4692823330					ronda.hefton@christushealth.org	909 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Appeals	Manager of Complaints, Appeals, and Grievances		Hendon	Amanda						8664162840	amanda.hendon@christushealth.org	919 Hidden Ridge		Irving	TX	75038	07/06/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active	4692823039				HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Appeals Contact (Secondary)	Director, Complaints & Appeals	Ms.	Hendon	Amanda						8664162840	amanda.hendon@christushealth.org	919 Hidden Ridge		Irving	TX	75038	08/14/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active	4692823039				HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Application Contact	Regulatory Affairs	Mrs.	Charless	Michele		4692823523					michele.charless@christushealth.org	919 Hidden Ridge		Irving	TX	75038	06/12/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Benefits Contact	Mgr Pharmacy Benefits and Services		Nguyen	Tina		8177063827					tina.nguyen2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	05/24/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lanes	NJ	07417	07/28/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Exceptions Contact	Senior Pharmacy Manager		Schumm	Brian							brian_schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	04/28/2016	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active	8003443405	3363326			HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Exceptions Contact (Secondary)	Mgr Pharmacy Benefits and Services		Nguyen	Tina							tina.nguyen2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	05/24/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active	8177063827				HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Price File Contact (Back-up)	Sr. Mgr, Regulated Markets		Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	04/11/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Price File Contact (Optional)	Mgr Pharmacy Benefits		Nguyen	Tina		8177063827					tina.nguyen2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	05/24/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Price File Contact (Primary)	Director, Government Programs		Westrum	Josh		4807363132	433132				JWestrum@express-scripts.com	7909 S. Hardy Drive, Suite 106		Tempe	AZ	85284	04/28/2016	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Quality Assurance Contact	Mgr Pharmacy Benefits		Nguyen	Tina		8177063827					Tina.nguyen2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	05/24/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Part D Reporting Contact	Mgr Pharmacy Benefits		Nguyen	Tina		8177063827					tina.nguyen2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	05/24/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Patient Safety Contact	Manager Health Plan Quality	LBSW	Baldridge	Amy		5058189301					amy.baldridge@christushealth.org	919 Hidden Ridge		Irving	TX	75038	09/29/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Payment Contact	CEO Christus Health Plan	Mr.	Stansbury	Shannon		4692823337					shannon.stansbury@christushealth.org	919 Hidden Ridge		Irving	TX	75038	10/14/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Personal Health Record Contact	Medical Director Health Plan Utilization Review	Dr.	Cannon	Dean		4692823073					dean.cannon@christushealth.org	919 Hidden Ridge		Irving	TX	75038	09/14/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Pharmacy Director	Medical Director Health Plan Utilization Review	Dr.	Cannon	Dean		4692823073					dean.cannon@christushealth.org	919 Hidden Ridge		Irving	TX	75038	09/14/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Pharmacy Network Management Contact	Director, Retail & Strategy Contracting		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	07/28/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Pharmacy Network Management Contact (Secondary)	Mgr Pharmacy Benefits		Nguyen	Tina		8177063827					tine.nguyen2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	05/24/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Pharmacy Technical Help Desk Contact	Director of Operations,		Liu	Ian							iliu@express-scripts.com	6625 West 78th		Minneapolis	MN	55439	02/18/2019	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Dallas
H1189	Pharmacy Technical Help Desk Contact (Secondary)	Mgr Pharmacy Benefits		Nguyen	Tina							tina.nguyen2@christushealth.org	919 Hidden Ridge		Irving	TX	75038	05/24/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active	8177063827				HMO - Health Maintenance Organization		C	Dallas
H1189	Physician Incentive Contact	Chief Administrative Officer	Ms.	Hefton	Ronda		4692823330					ronda.hefton@christushealth.org	909 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Plan Directory Contact for Public Website	Chief Administrative Officer	Ms.	Hefton	Ronda		8442823026					ronda.hefton@christushealth.org	909 Hidden Ridge		Irving	TX	75038	01/19/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Plan to Plan Reconciliation Contact	CEO Christus Health Plan	Mr.	Stansbury	Shannon		4692823337					shannon.stansbury@christushealth.org	919 Hidden Ridge		Irving	TX	75038	10/14/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Processor Contact	Senior Director-Government Programs Medicare		Gibson	Sharon		8052361175					sggibson@express-scripts.com	One Express Way		St. Louis	MO	63121	04/27/2018	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Quality Contact	Chief Admin Officer		Hefton	Ronda		4692823040					ronda.hefton@christushealth.org	919 Hidden Ridge		Irving	TX	75038	06/07/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Reconciliation Contact	CEO Christus Health Plan	Mr.	Stansbury	Shannon		4692823337					shannon.stansbury@christushealth.org	919 Hidden Ridge		Irving	TX	75038	10/14/2022	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Reconciliation Contact (Secondary)	Chief Administrative Officer	Ms.	Hefton	Ronda		4692823330					ronda.hefton@christushealth.org	909 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Recovery Audit Contact	Chief Administrative Officer	Ms.	Hefton	Ronda		4692823330					ronda.hefton@christushealth.org	909 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	SNP Application Contact	Chief Administrative Officer	Ms.	Hefton	Ronda		4692823330					ronda.hefton@christushealth.org	909 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	SNP State Contact	Chief Administrative Officer	Ms.	Hefton	Ronda		4692823330					ronda.hefton@christushealth.org	909 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Surveillance Contact	Director of Operations,		Hendon	Amanda		4692823039				8664162840	amanda.hendon@christushealth.org	919 Hidden Ridge		Irving	TX	75038	08/14/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	System Contact	CEO Christus Health Plan	Mr.	Stansbury	Shannon		4692823337					shannon.stansbury@christushealth.org	919 Hidden Ridge		Irving	TX	75038	12/08/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Third Party Administrator (TPA) Liaison	Director of Finance	Mrs.	Orr	Raven	Y	4692823217					raven.orr@christushealth.org	919 Hidden Ridge		Irving	TX	75038	03/26/2021	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	User Access Contact	Regulatory Affairs	Mrs.	Charless	Michele		4692823297					michele.charless@christushealth.org	919 Hidden Ridge		Irving	TX	75038	08/11/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Utilization Management Contact	Mgr, Regulated Markets Product		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	04/11/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1189	Utilization Review Contact	Mgr Contact Center		Davidson	Reginia		7728128436					reginiadavidson@expressscripts.com	one express way		St Louis	MO	63121	04/11/2023	2023	CHRISTUS HEALTH PLAN	Local CCP	CHRISTUS Health Advantage	HMO/HMOPOS		CHRISTUS Health	576	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H1215	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	02/03/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/03/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/03/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Medical Director	Medical Director	Mr	Haake	Karl		9132951245					karl.haake@sunflowerhealthplan.com	77 West Wacker Drive, 14th Floor		Chicago	IL	60601	03/30/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/06/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H1215	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H1215	PHR Beneficiary Contact																	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS	Health Net of Arizona Member Services	Centene Corporation	351	Yes	Active	8009777522				HMO - Health Maintenance Organization		C	Dallas
H1215	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Plan Directory Contact for Public Website			Net	Health		8008676564				8009778226	CorporateMedicareComplianceDept@Centene.com	PO Box 419069		Rancho Cordova	CA	95741	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/24/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1215	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1224	Agent/Broker Compensation Data Contact	Director, Sales and Marketing Operations	Ms.	Quintanilla	Leslie		2134359195					LQuintanilla@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility	Ms.	Sherman	Mandy		9202214083				9202214583	Relay.Health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Backup User Access Contact	Chief Compliance Officer	Mr.	Mapp	Thomas		2023403132					LACareComplianceOfficer@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Best Available Evidence Contact	Chief Compliance Officer	Mr.	Mapp	Thomas		2023403132					LACareComplianceOfficer@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Bid Audit Contact	Product Solutions Manager II	Ms.	Park	Sueli		2134146344					spark1@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	08/24/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Bid Audit Site Contact	Product Solutions Manager II	Ms.	Park	Sueli		2134146344					spark1@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	08/24/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Bid Primary Contact	Product Solutions Manager II	Ms.	Park	Sueli		2134146344					spark1@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	08/24/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	CAP Report Contact for Public Website	Director, Communications	Ms.	De Lamare	Misty		2136043457					mdelamare@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Baackes	John		2136941250	4151				JBaackes@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Baackes	John		2136941250	4151				JBaackes@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Chief Financial Officer	Chief Financial Officer	Mr.	Shah	Syed Afzal		2136941250	4526				AShah@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	06/05/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Chief Operating Officer	Chief Operating Officer	Ms.	Reed	Acacia		2136941250	4230				areed@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	04/20/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Chief Information Officer	Chief Information Security Officer	Mr.	Magerr	Gene		3109099617					GMagerr@lacare.org	1055 W. 7th Street	10th Floor	Los Angeles	CA	90017	07/19/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Chief Information Security Officer	Chief Information and Technology Officer	Mr.	MacDougall	Tom		6177788939					TMacDougall@lacare.org	1055 W. 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	CMMI Model Point of Contact	Executive Director, Medicare Operations	Mr.	Hurtado	Victor		2134143680					vhurtado@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	CMS Casework Communication Contact	Director Customer Solution Center Appeals	Ms.	Crandall	Demetra		2136941250	4616				A&G_Intake@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Complaints Tracking Contact	Director Customer Solutions Center Appeals	Ms.	Crandall	Demetra		2136941250	4616				A&G_Intake@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	04/20/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Contact for Fraud Investigations	Director Investigations Unit (SIU)	Mr.	Devine	Michael		2136941250	4415				MDevine@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Coordination of Benefits Contact	Lead Product Solutions Manager, Medicare Product	Ms.	Tisdale	Mona		2133926050					mtisdale@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Corporate Mailing						2136941250	5948				LACareComplianceOfficer@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Revenue Premium and Recovery Billing	Mr.	Bautista	Sergio		2136941250	4358				SBautista1@lacare.org	1055 W. 7TH St.	10th Floor	Los Angeles	CA	90013	07/19/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Customer Service Operations Contact	Senior Director, Customer Solution Center	Mr.	Martinez	Robert		2135743220					RMartinez3@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	07/19/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	DIR Contact	Director Pharmacy Compliance	Ms.	Lee	Diane		2133326167					DLee@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	DIR Contact (Secondary)	Director, Clinical Pharmacy, Pharmacy & Formulary	Ms.	Phan	Ann		7147265358					APhan@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	07/19/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Electronic Health Record Contact	Manager Health Information Technology	Ms.	Vodela	Saikiran		2134076716					svodela@lacare.org	1055 W. 7th Street	10th Floor	Los Angeles	CA	90017	07/19/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Emergency Part D Contact	Director Pharmacy Compliance	Ms.	Lee	Diane		2133326167					DLee@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Emergency Part D Contact (Secondary)	Chief Compliance Officer	Mr.	Mapp	Thomas		2023403132					LACareComplianceOfficer@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Employer Waiver Contact	Lead Product Solution Manager	Mrs	Tisdale	Mona		2133926050					MTisdale@lacare.org	1055 W. 7th street 10th floor		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Encounter Data & Risk Adjustment Operations Contact	Director, Enterprise Risk Adjustment	Mr.	Ishimatsu	Mark		5627156158					MIshimatsu@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Enrollment Contact	Senior Manager Medicare Enrollment	Mr.	Broussard	Dwayne		2134351249					dbroussard@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	EOB Transfer Contact	Chief Pharmacy Officer	Mr.	Kang	Alex		3232525840				2136941250	akang@lacare.org	1055 W. 7th Street	10th Floor	Los Angeles	CA	90017	07/19/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Financial Audit Contact	Manager, Regulatory Affairs	Mr.	Murakami	Justin		2135182009					JMurakami@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	07/19/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Financial Reporting Contact	Controller, Accounting Services	Ms.	Bergman	Angela		2135058325					abergman@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Formulary Contact	Director, Clinical Pharmacy, Pharmacy & Formulary	Ms.	Phan	Ann		7147265358					aphan@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	07/19/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	2601 W. Beltline Highway, Suite 600		Madison	WI	53717	07/19/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	General Contact	Chief Compliance Officer	Mr.	Mapp	Thomas		2023403132					tmapp@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	02/24/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Government Relations Contact	Manager, Regulatory Affairs	Ms.	Madjdi	Mitra		2135446218					lacarecomplianceofficer@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	07/19/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	HIPAA Privacy Officer	Senior Manager, Privacy	Mr.	Herrera	Serge		2134078995					seherrera@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	HIPAA Security Officer	Information Security Officer	Mr.	Magerr	Gene		3109099617					GMagerr@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	08/08/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Hospice Contact	Manager Technical Operations		Moussa	Nicole		2132488246					nmoussa@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Interoperability Contact	Senior Executive Advisor Digital, IT	Mr.	Schwaninger	Tom		3102957208					TSchwaninger@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	04/20/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	MA Appeals/Grievances Contact	Director Customer Solution Center Appeals	Ms.	Crandall	Demetra		2133341730					A&G_Intake@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	08/08/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	MA Claims Processing Contact for Public Website	Senior Director Claims Integrity	Mr.	Chase	Erik		2136941250	4391				EChase@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Marketing Contact	Senior Manager Material Review Unit	Ms.	Flores	Gabriela		2136041701					gflores@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Medical Director	Chief Medical Officer	Dr.	Amin	Sameer		2137601158					SAmin@lacare.org	1055 West 7th Street	10th fl	Los Angeles	CA	90017	08/08/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Medicare Compliance Officer	Chief Compliance Officer	Mr.	Mapp	Thomas		2023403132					tmapp@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	02/24/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Medicare Coordinator	Executive Director, Medicare Operations	Mr.	Hurtado	Victor		2134143680					vhurtado@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Medicare Part D Opioid Overutilization Contact	Director, Clinical Pharmacy, Pharmacy & Formulary	Dr.	Kang	Alex	C	3232525840					akang@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	04/26/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Medication Therapy Management Contact	Director, Clinical Pharmacy, Pharmacy & Formulary	Dr.	Kang	Alex	C	3232525840					akang@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	OffShore Subcontractor Contact	Chief Compliance Officer	Mr.	Mapp	Thomas		2023403132					LACareComplianceOfficer@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Online Enrollment Center Contact (Back-up)	Medicare Enrollment Analyst	Mr.	Lanier	Mark		3233639113	4598			2134385736	mlanier@lacare.org	1055 West 7th Street	4th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Online Enrollment Center Contact (Primary)	Senior Manager Medicare Enrollment	Mr.	Broussard	Dwayne		2136941250	4584			2134385736	dbroussard@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Part C Application Contact	Product Solutions Manager II	Ms.	Park	Sueli		2134146344					spark1@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	08/24/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Part C Reporting Contact	Compliance Advisor III	Ms.	Alsawaf	Surah		2135031454					lacarecomplianceofficer@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Appeals	Director, Clinical Pharmacy, Pharmacy & Formulary	Dr.	Kang	Alex	C						akang@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active	3232525840				HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Appeals Contact (Secondary)	Director, Customer Solutions Center Appeals and Gr	Ms.	Crandall	Demetra							rpaul@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active	2136941250	4605			HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Application Contact	Product Solutions Manager II	Ms.	Park	Sueli		2134146344					spark1@lacare.org	1055 W. 7th Street	10th Floor	Los Angeles	CA	90017	08/24/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Benefits Contact	Chief Pharmacy Officer	Ms.	Paulson	Yana		2135050821					ypaulson@lacare.org	1055 W. 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Claims Submission Contact	Manager, Technical Operations	Mr.	Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Exceptions Contact	Senior Manager, Clinical Prior Authorization	Mr.	LeClair	Chris						9202214622	christopher.leclair@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active	9202214122				HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Exceptions Contact (Secondary)	Director Pharmacy Compliance	Ms.	Lee	Diane							DLee@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active	2133326167				HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Price File Contact (Back-up)	Director Pharmacy Compliance	Ms.	Lee	Diane		2133326167					DLee@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Price File Contact (Optional)	Chief Compliance Officer	Mr.	Mapp	Thomas		2023403132					LACareComplianceOfficer@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578					Plan.Finder@Navitus.com	2601 West Beltline Highway	STE 600	Madison	WI	53713	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Quality Assurance Contact	Director, Clinical Pharmacy, Pharmacy & Formulary	Dr.	Kang	Alex	C	3232525840					akang@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Part D Reporting Contact	Compliance Advisor III	Ms.	Alsawaf	Surah		2135031454					lacarecomplianceofficer@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Patient Safety Contact	Director, Clinical Pharmacy, Pharmacy & Formulary	Dr.	Kang	Alex	C	3232525840					akang@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Payment Contact	Senior Director Medical Payment Systems	Ms.	Liu	Feven		2136941250	4313				fliu@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	02/28/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Personal Health Record Contact	Manager Privacy, Compliance	Ms.	Goodman	Cindy		2134350471	6745				lacarecomplianceofficer@lacare.org	1055 West 7th Street, 10th Floor		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Pharmacy Director	Chief Pharmacy Officer	Ms.	Paulson	Yana		2135050821					ypaulson@lacare.org	1055 West 7th Street	4th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688				6087292688	jan.robinson@navitus.com	361 Integrity Drive		Madison	WI	53717	04/15/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Pharmacy Network Management Contact (Secondary)	Director, Clinical Pharmacy, Pharmacy & Formulary	Dr.	Kang	Alex	C	3232525840					akang@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Pharmacy Technical Help Desk Contact	Dedicated Help Desk		Help Line	Navitus						8558789207	danielle.nett@navitus.com	P.O Box 1039		Appleton	WI	54912	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active	8442689785				HMO - Health Maintenance Organization		C	San Francisco
H1224	Pharmacy Technical Help Desk Contact (Secondary)	Director, Clinical Pharmacy, Pharmacy & Formulary	Dr.	Kang	Alex	C						akang@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active	3232525840				HMO - Health Maintenance Organization		C	San Francisco
H1224	PHR Beneficiary Contact																	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS	LA Care Health Plan	Local Initiative Health Authority for LA County	334	Yes	Active	8885221298				HMO - Health Maintenance Organization		C	San Francisco
H1224	Physician Incentive Contact	Manager, Incentives	Mr.	Solomon	Henock		5627146730					HSolomon@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Plan Directory Contact for Public Website	Customer Solution Center		Service Unit	Provider		8665222736					mtisdale@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Plan to Plan Reconciliation Contact	Senior Director Medical Payment Systems	Ms.	Liu	Feven		2136941250	4313				fliu@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	02/28/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Processor Contact	Senior Director, Claims Operations	Mr.	Chase	Erik		2136941250	4391				EChase@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Quality Contact	Medical Director, QI	Dr.	Kyle	James		7604753927					JKyle@lacare.org	1055 West 9th Street		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Reconciliation Contact	Senior Director Medical Payment Systems	Ms.	Liu	Feven		2136941250	4313				fliu@lacare.org	1055 West 7th Street	10th Floor	Los Angeles	CA	90017	02/28/2023	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Reconciliation Contact (Secondary)	Director Managed Care Revenue	Mr.	Liu	Feven		2132002181					fliu@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Recovery Audit Contact	Chief Compliance Officer	Mr.	Mapp	Thomas		2023403132					LACareComplianceOfficer@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	SNP Application Contact	Product Solutions Manager II	Ms.	Park	Sueli		2134146344					spark1@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	08/24/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	SNP State Contact	Executive Director, Medicare Operations	Mr.	Hurtado	Victor		2134143680					vhurtado@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Surveillance Contact	Chief Compliance Officer	Mr.	Mapp	Thomas		2023403132					LACareComplianceOfficer@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	System Contact	Director, IT Solutions Delivery	Mr.	Roman	Hector		6263796181					hroman@lacare.org	1055 West 7th Street	7th Floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Third Party Administrator (TPA) Liaison	Director Pharmacy Compliance	Ms.	Lee	Diane		2133326167					DLee@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	User Access Contact	Chief Compliance Officer	Mr.	Mapp	Thomas		2023403132					LACareComplianceOfficer@lacare.org	1055 West 7th Street	10th floor	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Utilization Management Contact	Clinical Director, Health Services	Ms.	Ramussen	Jennifer		2136941250	5849				Jramussen@lacare.org	1055 West 7th Street		Los Angeles	CA	90017	04/20/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1224	Utilization Review Contact	Senior Medical Director, Health Services	Dr.	Kagan	David		2136941250	5849				DKagan@lacare.org	1055 West 7th Street	10th fl	Los Angeles	CA	90017	01/05/2022	2023	LOCAL INITIATIVE HEALTH AUTHORITY FOR LA COUNTY	Local CCP	L.A. Care Health Plan	HMO/HMOPOS		Local Initiative Health Authority for LA County	334	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1225	Agent/Broker Compensation Data Contact	Sales Manager	Mr.	Markuson	Richard		4102410788					RMarkuson@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Automated TrOOP Balance Transfer Contact	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Backup User Access Contact	Sr. Director IT	Mr.	Reppas	Soterios		4104244620					sreppas@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Best Available Evidence Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Bid Audit Contact	Chief Actuary	Ms.	McAleer	Bethany		2026588702					BMcAleer@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Bid Primary Contact	Director Medicare Business Product Development	Mr.	Alsahlani	Hazem		4129521008					HAlsahlani@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/04/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	CEO - CMS Administrator Contact	President Medicare Advantage	Ms.	Wilson	Marja		3603061205					MWilson@jhhp.org	7231 Parkway Drive,	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	CEO - Senior Official for Contracting	President Medicare Advantage	Ms.	Wilson	Marja		3603061205					MWilson@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Chief Financial Officer	Chief Financial Officer	Mr.	Chojnowski	Daniel		2078072496					DChojnowski@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Chief Operating Officer	Chief Operating Officer	Mr.	O'Donnell	Ryan		7038876201					RODonnell@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Chief Information Officer	Sr. Director Information Systems	Mr.	Minale	Nick		3153825005					NMinale@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Chief Information Security Officer	Information Security Manager, IT/IS	Mr.	Ross	Willie		4104244642					wross@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	CMS Casework Communication Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4436180786					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Complaints Tracking Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Contact for Fraud Investigations	Director of Special Investigations	Mr.	Waugh	John		4106891079					JWaugh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Coordination of Benefits Contact	Sr. Director Medicare Plan Administration	Ms.	Riaz	Salma		8636341202					Sriaz@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Corporate Mailing						4104244955					PGillan@jhhp.org	Johns Hopkins Health Plans	Attn:Paul Gillan, Esq., 7231 Parkway Drive, Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Coverage Gap Discount Program (CGDP) Payment Contact	Assistant Vice President	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Customer Service Operations Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	DIR Contact	AVP Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	DIR Contact (Secondary)	AVP  Pharmacy	Mr.	Fatodu	Hugh		4104244671					FatoduH@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Emergency Part D Contact	Director, Pharmacy	Ms.	Gazy	Nahid		3017423395				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Emergency Part D Contact (Secondary)	AVP Pharmacy	Mr.	Fatodu	Hugh		4109256831				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Employer Waiver Contact	Sr. Director Medicare Business Product Development	Mr.	Alsahlani	Hazem		4129521008					HAlsahlani@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Encounter Data & Risk Adjustment Operations Contact	AVP of Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Enrollment Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	EOB Transfer Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679				4104242805	AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Financial Audit Contact	AVP of Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Financial Reporting Contact	AVP of Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Formulary Contact	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Formulary Contact (Secondary)	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	General Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					mdonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Government Relations Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Richardson	Carol	M	4106149900					crichar6@jhmi.edu	733 N. Broadway,	MRB Suite 102B	Baltimore	MD	21205	08/04/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	HIPAA Security Officer	Chief Information Security Officer	Mr.	Lacey	Darren		4107354477					dll@jhu.edu	5801 Smith Avenue	Davis Building, 3110B	Baltimore	MD	21209	02/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Hospice Contact	Medicare Part D Pharmacy Manager	Ms.	Wexler	Mary Beth		4107625938					MBWexler@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Interoperability Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					Mdonnelly@jhhp.org	Johns Hopkins HealthCare LLC	7231 Parkway Drive, Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	MA Appeals/Grievances Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679				4104242805	AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	MA Claims Processing Contact for Public Website	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Marketing Contact	Director of Communications and External Affairs	Ms.	Dixon	Karen		4106891970					KDixon@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Medical Director	Associate Chief Medical Officer	Dr.	Gerry	Danielle		4437642190					DGerry@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Donnelly	Mary		4436180786					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Medicare Coordinator	Sr. Director Medicare Plan Administration	Ms.	Riaz	Salma		8636341202					SRiaz@jhhp.org	7231 Parkway Drive,	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Medication Therapy Management Contact	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Online Enrollment Center Contact (Back-up)	Chief Operating Officer	Mr.	O'Donnell	Ryan		7038876201					RODonnell@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Online Enrollment Center Contact (Primary)	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part C Application Contact	Director Medicare Business Product Development	Mr.	Alsahlani	Hazem		4129521008					HAlsahlani@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/04/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part C Reporting Contact	Sr. Director Medicare Plan Administration	Ms.	Riaz	Salma		8636341202					Sriaz@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Appeals	Director, Pharmacy	Ms.	Gazy	Nahid						4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active	8002612396				HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Appeals Contact (Secondary)	AVP Pharmacy	Mr.	Fatodu	Hugh						4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active	8002612396				HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Application Contact	Director Medicare Business Product Development	Mr.	Alsahlani	Hazem		4129521008					HAlsahlani@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/04/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Benefits Contact	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Claims Submission Contact	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Exceptions Contact	Director, Pharmacy	Ms.	Gazy	Nahid						4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active	8002612396				HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Exceptions Contact (Secondary)	AVP Pharmacy	Mr.	Fatodu	Hugh						4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active	8002612396				HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Price File Contact (Back-up)	Senior Manager	Ms.	Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	9501 E. Shea Blvd.	MC121	Scottsdale	AZ	85260	02/02/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Price File Contact (Optional)	Senior Analyst	Mr.	Loeveland	Chet		4806064873					Chet.Loveland@cvshealth.com	9501 E. Shea Blvd.	MC121	Scottsdale	AZ	85260	04/03/2019	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Price File Contact (Primary)	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Quality Assurance Contact	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	FatoduH@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Part D Reporting Contact	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Patient Safety Contact	AVP Pharmacy Services	Mr.	Fatodu	Hugh		4104244671				4104244671	Fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Payment Contact	Associate Vice President Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Pharmacy Director	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Pharmacy Network Management Contact	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Pharmacy Technical Help Desk Contact	Director, Pharmacy	Ms.	Gazy	Nahid						4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Philadelphia
H1225	Pharmacy Technical Help Desk Contact (Secondary)	AVP Pharmacy	Mr.	Fatodu	Hugh						4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Philadelphia
H1225	Plan Directory Contact for Public Website	Sr. Director Medicare Plan Administration	Ms.	Riaz	Salma		4107625905					SRiaz@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/07/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Plan to Plan Reconciliation Contact	Associate Vice President Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Processor Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Quality Contact	Sr. Director of Quality Improvement	Ms.	Norrie	Joellyn		8134407027					JNorrie@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Reconciliation Contact	AVP of Finance	Mr.	Magee	Ryan		4104244948					RMagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Recovery Audit Contact	AVP of Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	SNP Application Contact	Director Medicare Business Product Development	Mr.	Alsahlani	Hazem		4129521008					HAlsahlani@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/04/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Surveillance Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	System Contact	Sr. Director Medicare Plan Administration	Ms.	Riaz	Salma		8636341202					SRiaz@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Third Party Administrator (TPA) Liaison	Associate Vice President Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	User Access Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Utilization Management Contact	AVP of Health Services	Ms.	Poth	Kristin		4105822700					KPoth@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1225	Utilization Review Contact	AVP of Health Services	Ms.	Poth	Kristin		4105822700					KPoth@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	HMO/HMOPOS		Johns Hopkins Healthcare LLC	616	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1228	Automated TrOOP Balance Transfer Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Backup User Access Contact	Executive Director		West	Jason		2097246000				2097246001	jwest@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Best Available Evidence Contact	Medical Director	Dr	Dunitz	Neal		2097246000				2097246001	ndunitz@gvhc.org	2401 East Orangeburg Ave.	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Bid Primary Contact	Executive Director		West	Jason		2097246000				2097246001	jwest@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	CAP Report Contact for Public Website	Quality and Safety Manager		Porras	Eva	M	2097246000				2097246001	eporras@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	09/02/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	CEO - CMS Administrator Contact	CEO	Mr	Weber	Tony		2096008168				2093830136	tweber@gvhc.org	2926 G St		Merced	CA	95340	12/10/2018	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	CEO - Senior Official for Contracting	CEO	Mr	Weber	Tony		2096008168				2093830136	tweber@gvhc.org	2926 G St		Merced	CA	95340	12/10/2018	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Chief Financial Officer	CFO	Ms	Sandhu	Gurjeet		2093846516				2093830136	gsandhu@gvhc.org	2926 G St		Merced	CA	95340	05/08/2020	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Chief Operating Officer	COO	Mrs.	Marshall	Melinda		2093854500				2093830136	mmarshall@gvhc.org	2926 G St		Merced	CA	95340	09/02/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Chief Information Officer	CIO	Mr	Mine	Wunna		2093855503				2093830136	wmine@gvhc.org	2926 G St		Merced	CA	95340	12/10/2018	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Chief Information Security Officer	CIO	Mr	Mine	Wunna		2093855503				2093830136	wmine@gvhc.org	2926 G St		Merced	CA	95340	12/10/2018	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	CMS Casework Communication Contact	Quality and Safety Manager		Porras	Eva	M	2097246000				2097246001	eporras@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	09/02/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Complaints Tracking Contact	Quality and Safety Manager		Porras	Eva	M	2097246000				2097246001	eporras@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	09/02/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Contact for Fraud Investigations	VP		Blair	Tracy		2096203172				2093830136	tblair@gvhc.org	2926 G St		Merced	CA	95340	12/15/2020	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Coordination of Benefits Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Corporate Mailing						2096286483				2093830136	jwest@gvhc.org	737 W Childs Ave		Merced	CA	95341	12/11/2018	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Ms	Sandhu	Gurjeet		2093846516				2093830136	gsandhu@gvhc.org	2926 G St		Merced	CA	95340	05/08/2020	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Customer Service Operations Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	DIR Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Emergency Part D Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Emergency Part D Contact (Secondary)	Executive Director		West	Jason		2097246000				2097246001	jwest@cvpace.org	2401 East Orangeburg Ave.	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Encounter Data & Risk Adjustment Operations Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Enrollment Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	EOB Transfer Contact	Health Plan Spacialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Financial Audit Contact	CFO	Ms	Sandhu	Gurjeet		2093846516				2093830136	gsandhu@gvhc.org	2926 G St		Merced	CA	95340	05/08/2020	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Financial Reporting Contact	CFO	Ms	Sandhu	Gurjeet		2093846516				2093830136	gsandhu@gvhc.org	2926 G St		Merced	CA	95340	05/08/2020	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Formulary Contact	Medical Director	Dr	Dunitz	Neal		2097246000				2097246001	ndunitz@gvhc.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	12/15/2020	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	General Contact	Executive Director		West	Jason		2097246000				2097246001	jwest@cvpace.org; tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	10/25/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Government Relations Contact	Executive Director		West	Jason		2097246000				2097246001	jwest@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	HIPAA Privacy Officer	CIO	Mr	Mine	Wunna		2093846632				2093830136	wmine@gvhc.org	847 W Childs Ave		Merced	CA	95341	11/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	HIPAA Security Officer	CIO	Mr	Mine	Wunna		2093855503				2093830136	wmine@gvhc.org	2926 G St	Suite 201	Merced	CA	95340	05/08/2020	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Interoperability Contact	Health Plan Manager	Mrs	Carr	Terrilyn		2097246000					tcarr@cvpace.org	2401 East Oragneburg Ave	Suite 330	Modesto	CA	95355	06/01/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	MA Appeals/Grievances Contact	Quality and Safety Manager		Porras	Eva	M	2097246000				2097246001	eporras@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	09/02/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	MA Claims Processing Contact for Public Website	Health Plan Specialist	Ms	Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Marketing Contact	Executive Director		West	Jason		2097246000				2097246001	jwest@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Medical Director	Medical Director	Dr	Dunitz	Neal		2097246000				2097246001	ndunitz@gvhc.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Medicare Compliance Officer	Executive Director	Mr	West	Jason		2093846529				2097246001	jwest@cvpace.org	2401 East Orangeburg	Suite 330	Modesto	CA	95355	01/23/2023	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Medicare Coordinator	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Medicare Part D Opioid Overutilization Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Medication Therapy Management Contact	Medical Director	Dr	Dunitz	Neal		2097246000				2097246001	ndunitz@gvhc.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Part C Application Contact	Executive Director		West	Jason		2097246000				2097246001	jwest@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Part D Appeals	Quality and Safety Manager		Porras	Eva	M					2097246001	eporras@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	09/02/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active	8554617223				PACE - Nat		C	San Francisco
H1228	Part D Appeals Contact (Secondary)	Health Plan Specialist		Carr	Terrylyn						2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave.	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active	8554617223	6001			PACE - Nat		C	San Francisco
H1228	Part D Application Contact	Executive Director		West	Jason		2097246000				2097246001	jwest@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Part D Benefits Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Part D Claims Submission Contact	Health Plan Specialist		Carr	Terryln		2097246000	6001			2093830136	tcarr@cvpace.org	2401 East Orangeburg Ave.	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Part D Exceptions Contact	Health Plan Specialist		Carr	Terrylyn						2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave.	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active	8554617223	6001			PACE - Nat		C	San Francisco
H1228	Part D Exceptions Contact (Secondary)	Executive Director		West	Jason						2097246001	jwest@gvhc.org	2401 East Orangeburg Ave	Suite 330	Modesto Ca	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active	8554617223				PACE - Nat		C	San Francisco
H1228	Part D Price File Contact (Back-up)	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Part D Price File Contact (Primary)	CFO	Ms	Sandhu	Gurjeet		2093846516				2093830136	gsandhu@gvhc.org	2926 G St		Merced	CA	95340	05/08/2020	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Part D Quality Assurance Contact	Quality and Safety Manager		Porras	Eva	M	2097246000				2097246001	eporras@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	09/02/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Part D Reporting Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Patient Safety Contact	Quality and Safety Manager		Porras	Eva	M	2097246000				2097246001	eporras@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	09/02/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Payment Contact	CFO	Ms	Sandhu	Gurjeet		2093846516				2093830136	gsandhu@gvhc.org	2926 G St		Merced	CA	95340	05/08/2020	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Personal Health Record Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East orangeburg Ave.	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Pharmacy Director	Medical Director	Dr	Dunitz	Neal		2097246000				2097246001	ndunitz@gvhc.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Pharmacy Network Management Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6000			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Pharmacy Technical Help Desk Contact	Health Plan Specialist		Carr	Terrylyn						2097246001	tcarr@gvhc.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active	8554617223	6001			PACE - Nat		C	San Francisco
H1228	Plan Directory Contact for Public Website	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Plan to Plan Reconciliation Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave.	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Processor Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Quality Contact	Quality and Safety Manager		Porras	Eva	M	2097246000				2097246001	eporras@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	09/02/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Reconciliation Contact	CFO	Ms	Sandhu	Gurjeet		2093846516				2093830136	gsandhu@gvhc.org	2926 G St		Merced	CA	95340	05/08/2020	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Recovery Audit Contact	CFO	Ms	Sandhu	Gurjeet		2093846516				2093830136	gsandhu@gvhc.org	2926 G St		Merced	CA	95340	05/08/2020	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Surveillance Contact	Quality and Safety Manager		Porras	Eva	M	2097246000				2097246001	eporras@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	09/02/2022	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	System Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Third Party Administrator (TPA) Liaison	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	User Access Contact	Executive Director		West	Jason		2097246000				2097246001	jwest@cvpace.org	2401 East Orangeburg Ave.	suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Utilization Management Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1228	Utilization Review Contact	Health Plan Specialist		Carr	Terrylyn		2097246000	6001			2097246001	tcarr@cvpace.org	2401 East Orangeburg Ave	Suite 330	Modesto	CA	95355	01/05/2021	2023	GOLDEN VALLEY HEALTH CENTERS	National PACE	Central Valley PACE	National PACE		Golden Valley Health Centers	742	Yes	Active					PACE - Nat		C	San Francisco
H1230	Agent/Broker Compensation Data Contact	Manager, Medicare Compliance		Lawrence	Winston		5105070510					winston.d.lawrence@kp.org	1 Kaiser Plaza, 12th Floor		Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Automated TrOOP Balance Transfer Contact	Project Manager III, Pharmacy Benefit Mgmt		Perez	Elizabeth	R	5623670592					Elizabeth.R.Perez@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	08/02/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Backup User Access Contact	Medicare Compliance Lead	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Mail Stop RCB-C3W-08	1300 SW 27th St, RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Best Available Evidence Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Bid Audit Contact	Executive Director Actuarial		Kenny	Kevin		5102677544					kevin.x.kenny@kp.org	300 Lakeside Drive, 28th Floor		Oakland	CA	94612	12/18/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Bid Audit Site Contact	Compliance Consultant		Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/01/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Bid Primary Contact	Attesting Actuary		Shigeta	Jaren		8087344706					jaren.shigeta@kp.org	711 Kapiolani		Honolulu	HI	96813	09/14/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	CAP Report Contact for Public Website	Medicare Compliance Lead	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	CEO - CMS Administrator Contact	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	CEO - Senior Official for Contracting	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Chief Financial Officer	SVP, CFO Business Units and Finance Operations	Mr.	Beltch	Robert	R	8184897560					rob.beltch@kp.org	1 Kaiser Plaza, Suite 806	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/15/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Chief Operating Officer	Executive Director, Medicare Market Strategy & Ops	Mr.	Miller	Paul		5033410073					paul.a.miller@kp.org	500 NE Multnomah St., Ste. 100		Portland	OR	97232	04/10/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Chief Information Officer	SVP, Business Information Officer	Ms.	Comer	Diane		5102258777					Diane.B.Comer@kp.org	2600 Napa Valley Corporate Drive		Napa	CA	94558	09/17/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Chief Information Security Officer	VP, Chief Information Security Officer	Mr.	Goddard	Jim		3037133890					James.P.Goddard@kp.org	6560 Greenwood Plaza Blvd.		Greenwood Village	CO	80111	02/03/2016	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	CMS Casework Communication Contact	Medicare Compliance Lead	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Complaints Tracking Contact	Medicare Compliance Lead	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Contact for Fraud Investigations	VP ,Fraud Control and National Special Inves		Janiga	Marita	C	5102716937				5108917977	marita.c.janiga@kp.org	One Kaiser Plaza, Ordway Building, 12th Floor		Oakland	CA	94612	11/17/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Coordination of Benefits Contact	Senior Director		Chung	Clarence		5623909293				5626583866	clarence.j.chung@kp.org	12254 Bellflower Blvd - Suite 106, 1st Floor		Downey	CA	90242	04/28/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Corporate Mailing						8083487832				8084325427	Kimberly.C.Piper@kp.org	711 Kapiolani Blvd.		Honolulu	HI	96813	10/06/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Coverage Gap Discount Program (CGDP) Payment Contact			Ballestros	Mayra		6262525164					mayra.x.lujano@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	02/15/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Customer Service Operations Contact	Director, Customer Service and Appeals		Devol	Michele		8084325215				8084325667	michelle.j.devol@kp.org	711 Kapiolani Blvd		Honolulu	HI	96813	11/05/2019	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	DIR Contact	Senior Business Process Manager		Hsiue	Tony		5626583836					tony.x.hsiue@kp.org	12254 Bellflower Blvd.  Flr. 2		Downey	CA	90242	03/09/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	DIR Contact (Secondary)	Sr. Financial Analyst		San	Kei		5626583445					Kei.San@kp.org	12254 Bellflower Blvd. Fl. 2		Downey	CA	90242	07/17/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Electronic Health Record Contact	Sr Manager, Meaningful Use PMO		Poole	Dolly		5106255813					dolly.poole@kp.org	1800 Harrison St.		Oakland	CA	94612	07/02/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Emergency Part D Contact	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/04/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Emergency Part D Contact (Secondary)	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Employer Waiver Contact	Senior Manager, Finance	Mr.	Radutiu	Adrian		5038132586					Adrian.X.Radutiu@kp.org	500 NE Multnomah St.		Portland	OR	97232	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Encounter Data & Risk Adjustment Operations Contact	Director, Risk Adjustment Submission	Ms.	Gu	Jialin		3033383507					jialin.gu@kp.org	2500 South Havana		Aurora	CO	80014	10/21/2019	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Enrollment Contact	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	EOB Transfer Contact	Pharmacy Medicare Operations, Project Manager II		Bonoan	John	B	5624180564				5626583848	john.b.bonoan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/12/2012	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Financial Audit Contact	Compliance Consultant	Ms.	Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/01/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Financial Reporting Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Formulary Contact	Pharmacy Project Manager		Kim	Jung		5624459129					jung.x3.kim@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/20/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Formulary Contact (Secondary)	PHARMACY PROJECT MGR I		Lin	Clement	J	5624459129					Clement.J.Lin@kp.org	12254 Bellflower Blvd		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	General Contact	Medicare Compliance Lead	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Government Relations Contact	Senior Vice President, Government Relations	Mr.	Barrueta	Anthony	A	5102716835					Anthony.Barrueta@kp.org	One Kaiser Plaza		Oakland	CA	94612	10/07/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	HIPAA Privacy Officer	Compliance Director		Anderson	Angela		5104353413					Angela.B.Anderson@kp.org	1800 Harrison Street	16th Floor	Oakland	CA	94612	11/06/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	HIPAA Security Officer	Senior Director		Vourthis	Bill		9252065125					bill.d.vourthis@kp.org	5820 Owens Drive	Building E	Pleasanton	CA	94588	08/25/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Hospice Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Interoperability Contact	National EDI Business Operations		Plattner	Cathy		6268336526					cathy.p.plattner@kp.org	75 N Fair Oaks Ave.		Pasadena	CA	91103	11/03/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	MA Appeals/Grievances Contact	Director, Member Services & Appeals		Devol	Michele		8084325215	1055			8084325906	michelle.j.devol@kp.org	711 Kapiolani Blvd.		Honolulu	HI	96813	11/05/2019	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	MA Claims Processing Contact for Public Website	Dir Customer Engagement Mgmt		Galloway	Lonnie		9094772466					Lonnie.L.Galloway@kp.org	10740 4th Street		Rancho Cucamonga	CA	91730	08/02/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Marketing Contact	Member and Marketing Communications		Moore	Cynthia	C	8083487832				8084325304	KP-MedicareFilings@kp.org	711 Kapiolani Blvd.		Honolulu	HI	96813	06/30/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Medical Director	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	11/16/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Medicare Compliance Officer	Medicare Compliance Lead	Ms	Piper	Kimberly	C	2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Medicare Coordinator	Medicare Business Line		Cunningham	Pamela		8082606560					Pamela.M.Cunningham@kp.org	711 Kapiolani Boulevard		Honolulu	HI	96813	03/09/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Medicare Part D Opioid Overutilization Contact	Pharmacist Project Manager		Chong	Sue	H	5626583661					sue.h.chong@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	12/05/2018	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Medication Therapy Management Contact	Ambulatory Care Clinical Pharmacist		Yamada	Joan		8084325787				8084325840	Joan.Yamada@kp.org	Kaiser Permanente Medication Therapy Management Program	2828 Pa'a Street	Honolulu	HI	96819	04/05/2010	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	OffShore Subcontractor Contact	Compliance Consultant - Privacy and Security		Glenn	Jovan		9092512010					Jovan.Robinson@kp.org	10740 Fourth Street		Rancho Cucamonga	CA	91730	08/26/2020	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Online Enrollment Center Contact (Back-up)	Senior Team Manager, Medicare Membership Admin		Nugent	Kristin		8586376801					kristin.n.nugent@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Online Enrollment Center Contact (Optional)	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Online Enrollment Center Contact (Primary)	Team Manager, Medicare Membership Administration		Covarrubio	Danny		8586143433					danny.x.covarrubio@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Part C Application Contact	Sr Dir Govt Programs		Mackertich	Sheila		8083487832					sheila.k.mackertich@kp.org	711 Kapiolani Blvd		Honolulu	HI	96813	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Part C Reporting Contact	Medicare Compliance Lead	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Appeals	Director, Member Services		Devol	Michele						8084325667	michelle.j.devol@kp.org	711 Kapiolani Blvd.		Honolulu	HI	96819	11/05/2019	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8009665955				HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Appeals Contact (Secondary)	Executive Director	Ms.	Benitz	Shirani	S						Shirani.S.Benitez@kp.org	10740 Fourth Street		Rancho Cucamonga	CA	91730	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	9096357320				HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Application Contact	Sr Dir Govt Programs		Mackertich	Sheila		8083487832					sheila.k.mackertich@kp.org	711 Kapiolani Blvd		Honolulu	HI	96813	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Benefits Contact	Pharmacy Benefits		Goo	Jeilyn		8084325534					jeilyn.s.goo@kp.org	Kaiser Permanente - Pharmacy Services	501 Alakawa Street	Honolulu	HI	96817	04/01/2013	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Claims Submission Contact	Pharmacy Medicare Business Line Manager	Ms	Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	10/06/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Exceptions Contact	Pharmacy Benefits		Goo	Jeilyn	S						jeilyn.s.goo@kp.org	Kaiser Permanente Pharmacy Services	501 Alakawa St., Suite 101	Honolulu	HI	96817	03/24/2011	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8008052739				HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Exceptions Contact (Secondary)	Pharmacy Benefits		Goo	Jeilyn	S						jeilyn.s.goo@kp.org	Kaiser Permanente Pharmacy Services	501 Alakawa St., Suite 101	Honolulu	HI	96817	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8008052739				HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Price File Contact (Back-up)	Financial Analyst		Kamikawa	Emely		5622998753				5626583712	emely.a.kamikawa@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Price File Contact (Optional)	Associate Consultant		Quan	Mariclare		5623850395					mariclare.a.quan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Price File Contact (Primary)	Pharmacy Pricing		Bullard	Myra		5623195747				5626583712	myra.c.bullard@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Quality Assurance Contact	Vice President, Clinical Pharmacy Services		Le	Kim		5622997015					Kim.N1.Le@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Part D Reporting Contact	Medicare Compliance Lead	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Patient Safety Contact	Vice President, Clinical Pharmacy Services		Le	Kim		5622997015					Kim.N1.Le@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Payment Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza, Suite 2552		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Pharmacy Director	Director, Pharmacy		Takara	Ross	T	8084325547					ross.t.takara@kp.org	501 Alakawa St, Suite 101		Honolulu	HI	96817	08/03/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Pharmacy Network Management Contact	Pharmacy Benefits		Goo	Jeilyn		8084325534					jeilyn.s.goo@kp.org	Kaiser Permanente - Pharmacy Services	501 Alakawa Street	Honolulu	HI	96817	04/01/2013	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Pharmacy Network Management Contact (Secondary)	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Pharmacy Technical Help Desk Contact	Customer Care Center		OptumRx	PBM								755 Research Parkway Suite 160		Oklahoma City	OK	73104	11/02/2016	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8882773917				HMO - Health Maintenance Organization		C	San Francisco
H1230	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Benefits		Goo	Jeilyn							jeilyn.s.goo@kp.org	501 Alakawa St., Suite 101		Honolulu	HI	96817	06/02/2011	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8882773917				HMO - Health Maintenance Organization		C	San Francisco
H1230	Plan Directory Contact for Public Website			Services	Member		8004430815					mscc@kp.org	10740 Fourth St., Second Floor		Rancho Cucamonga	CA	91730	11/12/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Plan to Plan Reconciliation Contact	Interim Director, Medicare Accounting		Wright	Mark	A	9253239443					mark.a.wright@kp.org	1 Kaiser Plaza, 25th Floor		Oakland	CA	94612	01/20/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Processor Contact	Medicare Compliance Consultant	Mr.	Carver	Jon	R	4257578659					jonathan.r.carver@kp.org	1300 SW 27th St.		Renton	WA	98057	09/05/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Quality Contact	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	05/25/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Reconciliation Contact	Controller, National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Reconciliation Contact (Secondary)	Vice President & Chief Financial Officer	Ms.	Shepler	Courtney	R	5102714644					courtney.r.shepler@kp.org	National Medicare Finance, 1 Kaiser Plaza, 13th Floor	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Recovery Audit Contact	Manager, Revenue Mgmt Compliance	Ms	Gonzalez	Heidy	G	6263723181					heidy.gonzalez@kp.org	74 S Fair Oaks Avenue		Pasadena	CA	91103	08/03/2022	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	SNP Application Contact	Sr Dir Govt Programs		Mackertich	Sheila		8083487832					sheila.k.mackertich@kp.org	711 Kapiolani Blvd		Honolulu	HI	96813	10/05/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	SNP State Contact	Sr Dir Govt Programs		Mackertich	Sheila		8083487832					sheila.k.mackertich@kp.org	711 Kapiolani Blvd		Honolulu	HI	96813	10/06/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Surveillance Contact	Medicare Compliance Lead	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	System Contact	Director, Membership Administration Systems & S.S.		Putman	Anthony		8586506364					anthony.m.putman@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Third Party Administrator (TPA) Liaison	Senior Accountant		Thornal	Sun		6264056311					sun.a.thornal@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	12/12/2016	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	User Access Contact	Medicare Compliance Lead	Ms.	Piper	Kimberly		2064739504				2068770645	Kimberly.C.Piper@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	08/29/2023	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Utilization Management Contact	Manger Utilization Management	Ms	Kon	Wendy		8082718148				8084325427	Wendy.Kon@kp.org	2828 Pa'a St.		Honolulu	HI	96819	10/06/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1230	Utilization Review Contact	Manger Utilization Management	Ms	Kon	Wendy		8082718148				8084325427	Wendy.Kon@kp.org	2828 Pa'a St.		Honolulu	HI	96819	10/06/2021	2023	KAISER FOUNDATION HP, INC.	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1234	Automated TrOOP Balance Transfer Contact	Accounting Manager	Mr.	Stern	Gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd.		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Backup User Access Contact	Executive Director	Ms.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Best Available Evidence Contact	Executive Director	Mrs	zavorski	lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Bid Primary Contact	Accounting Manager	Mr	stern	gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	CAP Report Contact for Public Website	Executive Director	Ms.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	CEO - CMS Administrator Contact	Chief Compliance Officer	Ms.	McGuire	Laura		6093946783					lmcguire@capitalhealth.org	750 Brunswick Ave.		Trenton	NJ	08638	09/01/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	CEO - Senior Official for Contracting	Executive Director	Mrs	zavorski	lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 Kevin Johnson Boulevard		Bordentown	NJ	08629	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Chief Financial Officer	Accounting Manager	Mr	Stern	Gregg		6095995474					gstern@capitalhealth.org	7500 Kevin Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Chief Operating Officer	Executive Director	Ms.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Chief Information Officer	Chief Information Officer	Mr	Koganti	Ravi		6093944272					rkoganti@capitalhealth.org	2 Capital Way		Pennington	NJ	08534	09/01/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Chief Information Security Officer	Chief Information Officer	Mr	Koganti	Ravi		6093944272					rkoganti@capitalhealth.org	2 Capital Way		Pennington	NJ	08534	09/01/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	CMS Casework Communication Contact	Executive Director	Mrs	zavorski	lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Complaints Tracking Contact	executive director	mrs	zavorski	lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Contact for Fraud Investigations	Executive Director	Ms	zavorski	lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Coordination of Benefits Contact	Accounting Manager	mr	stern	gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Corporate Mailing						6095995433				6095996203	anne.lewis@trinity-health.org	7500 K Johnson Blvd		Bordentown	NJ	08505	11/29/2016	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Coverage Gap Discount Program (CGDP) Payment Contact			None	None		6099999999					none@stfrancismedical.org	None, does not apply to PACE		none	NJ	08629	05/20/2016	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Customer Service Operations Contact	Executive Director	Ms.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	DIR Contact	Accounting Manager	mr	stern	gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Emergency Part D Contact	Executive Director	Ms.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Emergency Part D Contact (Secondary)	accounting manager	mr	stern	gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 Kevin Johnson Boulevard		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Encounter Data & Risk Adjustment Operations Contact			Creaney	Emy		7343431939					creaneye@trinity-health.org	7500 Kevin Johnson Blvd		Bordentown	NJ	08505	10/23/2019	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Enrollment Contact	Community Liaison	Mrs.	Eusebia	Brianna		6095712704				6095996203	beusebio@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	07/19/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	EOB Transfer Contact	Accountng Manager	mr	stern	gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Financial Audit Contact	accounting manager	mr	stern	gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Financial Reporting Contact	accounting manager	mr	stern	gregg		6095995478				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Formulary Contact	Medical Director	Dr.	Gertzman	Jerrold		6095289150				6095289151	jgertzman@capitalhealth.org	4056 Quakerbridge Rd.		Lawrenceville	NJ	08648	07/27/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	General Contact	Executive Director	Ms.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Government Relations Contact	Executive Director	Ms.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	HIPAA Privacy Officer	Chief Compliance Officer	ms	McGuire	Laura		6093946783					lmcguire@capitalhealth.org	750 Brunswick Ave.		Trenton	NJ	08638	09/01/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	HIPAA Security Officer	Chief Information Officer	mr	Koganti	Ravi		6093944272					rkoganti@capitalhealth.org	2 Capital Way		Pennington	NJ	08534	09/01/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Interoperability Contact	Chief Information Officer	Mr	Koganti	Ravi		6093944272					rkoganti@capitalhealth.org	2 Capital Way		Pennington	NJ	08534	09/01/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	MA Appeals/Grievances Contact	executive director	ms	zavorski	lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	MA Claims Processing Contact for Public Website	accounting manager	mr	stern	gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Marketing Contact	Regional Marketing Manager	Ms.	Lark	Azia		9735182754				6095996203	azia.lark@trinity-health.org	7500 K Johnson Blvd		Bordentown	NJ	08505	02/10/2020	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Medical Director	Medical Director	Dr.	Gertzman	Jerrold		6095289150				6095289151	jgertzman@capitalhealth.org	4056 Quakerbridge Rd.		Lawrenceville	NJ	08648	07/27/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Medicare Compliance Officer	Chief Compliance & Privacy Officer	Ms.	Capik McGuire	Laura		6093946783				6093946783	LMcGuire@capitalhealth.org	750 Brunswick Ave		Trenton	NJ	08638	03/01/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Medicare Coordinator	Executive Director	Mrs.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	07/27/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	07/27/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Part C Application Contact	Executive Director	Ms.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Part D Appeals	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@mercyhealth.org	1930 South Broad Street		Philadelphia	PA	19145	12/31/2020	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active	2153394362				PACE - Nat		C	New York
H1234	Part D Appeals Contact (Secondary)	Executive Director	Mrs.	Zavorski	Lisa						6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active	6095995478				PACE - Nat		C	New York
H1234	Part D Application Contact	Executive Director	Mrs.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Part D Benefits Contact	Executive Director	Mrs.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Part D Claims Submission Contact	Executive Director	Mrs.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Part D Exceptions Contact	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@mercyhealth.org	1930 South Broad Street		Philadelphia	PA	19145	12/31/2020	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active	2153394362				PACE - Nat		C	New York
H1234	Part D Exceptions Contact (Secondary)	Director Quality & Compliance	Ms.	Yocum	Jennifer							Jennifer.yocum@stfrancismedical.org	7500 K Johnson blvd		Bordentown	NJ	08505	03/08/2022	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active	6094006209				PACE - Nat		C	New York
H1234	Part D Price File Contact (Back-up)	Executive Director	Ms.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Part D Price File Contact (Primary)	Executive Director	Mrs.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Part D Quality Assurance Contact	Executive Director	Mrs.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Part D Reporting Contact	Executive Director	Mrs.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Patient Safety Contact	executive director	mrs	zavorski	lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Payment Contact	Accounting Manager	Mr.	Stern	Gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Pharmacy Director	executive director	mrs	zavorski	lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Pharmacy Network Management Contact	executive director	mrs	zavorski	lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Pharmacy Technical Help Desk Contact	executive director	mrs	zavorski	lisa						6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active	6095995478				PACE - Nat		C	New York
H1234	Plan Directory Contact for Public Website	Accounting Manager	Mr.	Stern	Gregg		6095995433				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Plan to Plan Reconciliation Contact	accounting manager	mr	stern	gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Processor Contact	accounting manager	mr	stern	gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Quality Contact	Executive Director	Mrs.	Zavorski	Lisa		6095995433				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	07/27/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Reconciliation Contact	accounting manager	mr	stern	gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Recovery Audit Contact	accounting manager	mr	stern	gregg		6095995474				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Surveillance Contact	Executive Director	Ms.	Zavorski	Lisa		6095995478				6095996203	gstern@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	System Contact	Executive Director	Ms.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Third Party Administrator (TPA) Liaison	Director of Claims	MS.	Woodruff	Tara		7343430784					tara.woodruff@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	03/15/2019	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	User Access Contact	Executive Director	Mrs.	Zavorski	Lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Utilization Management Contact	executive director	mrs	zavorski	lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1234	Utilization Review Contact	executive director	mrs	zavorski	lisa		6095995478				6095996203	lzavorski@capitalhealth.org	7500 K Johnson Blvd		Bordentown	NJ	08505	01/10/2023	2023	CAPITAL HEALTH LIFE	National PACE	Capital Health LIFE	National PACE		Capital Healthcare, INC.	809	Yes	Active					PACE - Nat		C	New York
H1239	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/14/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Backup User Access Contact	Chief Information Officer		Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Best Available Evidence Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Bid Primary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	CAP Report Contact for Public Website	VP of Clinical Compliance		Teter	Lezlie		7203929719				3039961600	lteter@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	CEO - CMS Administrator Contact	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	CEO - Senior Official for Contracting	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Chief Financial Officer	CFO	Mr	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Chief Operating Officer	Senior Advisor	Ms.	Lozzano	Maria		9098902854				3039961600	mlozzano@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Chief Information Officer	Chief Information Officer	Ms.	Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Chief Information Security Officer	SVP of Information Technology	Mr.	Naus	Cole		7209210443				3039961600	MNaus@innovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	CMS Casework Communication Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Complaints Tracking Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Contact for Fraud Investigations	Chief Legal Officer		D'Amato	Nicole		6154732250				3039961600	NDAmato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Coordination of Benefits Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/14/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Corporate Mailing						3038694664				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Customer Service Operations Contact	Senior Advisor		Lozanno	Maria		9098902854				3039961600	mlozanno@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	DIR Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	DIR Contact (Secondary)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Emergency Part D Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Emergency Part D Contact (Secondary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Encounter Data & Risk Adjustment Operations Contact	Director of PACE Finance		Hewitt	Jessica		7209746767					jhewitt@innovage.com	8950 E Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Enrollment Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/14/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	EOB Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	09/14/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Financial Audit Contact	Director of PACE Finance	Ms	Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Financial Reporting Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Formulary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Formulary Contact (Secondary)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	General Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Government Relations Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	HIPAA Privacy Officer	Corporate Counsel		Moxon	Jeff		3038694664				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	HIPAA Security Officer	SVP of Information Technology		Naus	Cole		7209210443				3039961600	MNaus@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Interoperability Contact	SVP of Applications		Zierolf	Kris		7209742380					kzierolf@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	MA Appeals/Grievances Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	MA Claims Processing Contact for Public Website	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/14/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Marketing Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Medical Director	Medical Director		Ferrance	Randy		2159514586				3039961600	rferrance@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Medicare Compliance Officer	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Medicare Coordinator	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Medicare Part D Opioid Overutilization Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 E. Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Medication Therapy Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Online Enrollment Center Contact (Back-up)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Online Enrollment Center Contact (Primary)	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/14/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Part C Application Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Part D Appeals	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H1239	Part D Appeals Contact (Secondary)	Chief Legal Officer		D'Amato	Nicole						3039961600	NDAmato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H1239	Part D Application Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Part D Benefits Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Part D Claims Submission Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Part D Exceptions Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H1239	Part D Exceptions Contact (Secondary)	Finance and Compliance Analyst	Mr.	Kizewski	Alex						3039961600	akizewski@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active	3038694664				PACE - Nat		C	Philadelphia
H1239	Part D Price File Contact (Back-up)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Part D Price File Contact (Primary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Part D Quality Assurance Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Part D Reporting Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Patient Safety Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Personal Health Record Contact	VP Associate of General Counsel		Moxon	Jeff		3033006930				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Pharmacy Director	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Pharmacy Network Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Pharmacy Technical Help Desk Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H1239	Plan Directory Contact for Public Website	Director of Marketing		Stavros	Sarah		3033006904				3039961600	sstavros@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Plan to Plan Reconciliation Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				7209173390	akizewski@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Processor Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Quality Contact	VP of Quality		Curry	Jill		2153782123				3039961600	jcurry@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Reconciliation Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Recovery Audit Contact	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444404					mcinque@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Surveillance Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	System Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Third Party Administrator (TPA) Liaison	Medicare Compliance Manager		Brown	Lauren		7209746767				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	User Access Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Utilization Management Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1239	Utilization Review Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-ROANOKE VALLEY, LLC	National PACE	InnovAge Virginia PACE- Roanoke Valley	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H1248	Agent/Broker Compensation Data Contact	Chief Financial Officer	Mr.	Short	Adam		2252952189					Adam.Short@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/07/2022	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Automated TrOOP Balance Transfer Contact	Controller	Ms.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 Desiard Street	#300	Monroe	LA	71201	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Backup User Access Contact	Manager, Medicare Compliance Programs	Mr.	Guillot	Mark	J	2252987040					Mark.Guillot@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Best Available Evidence Contact	Medicare Enrollment Supervisor	Ms.	Brasher	Michele		3189983083					mbrasher@vhpla.com	130 Desiard Street	#300	Monroe	LA	71201	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Bid Audit Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Bid Audit Site Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Bid Primary Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	CAP Report Contact for Public Website	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	05/06/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	CEO - CMS Administrator Contact	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	CEO - Senior Official for Contracting	President and CEO	Dr.	Udvarhelyi	Steven		2252952548					Steven.Udvarhelyi@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Chief Financial Officer	Chief Financial Officer	Mr.	Short	Adam		2252952189					adam.short@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/07/2022	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Chief Operating Officer	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Chief Information Officer	SVP, CIO & Security Officer	Ms.	Kozik	Sue		2252983307					Sue.Kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Chief Information Security Officer	SVP, CIO & Security Officer	Ms.	Kozik	Sue		2252953307					Sue.Kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	CMS Casework Communication Contact	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Complaints Tracking Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					wesley.miller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/08/2021	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Contact for Fraud Investigations	Manager, Federal Investigations	Mrs.	Cowart	Kandyce		2252952073					Kandyce.Cowart@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Coordination of Benefits Contact	Medicare Enrollment Supervisor	Ms.	Brasher	Michele		3189983083					mbrasher@vhpla.com	130 Desiard Street		Monroe	LA	71201	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Corporate Mailing						2252952589					Robbin.Calhoun@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant, Financial Reporting	Ms.	Brown	Leigh Ann		2259533055					Leigh-Ann.Brown@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/23/2021	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Customer Service Operations Contact	Director of Member Services	Ms.	Trichel	Amy		3189982870					atrichel@vhpla.com	130 Desiard Street		Monroe	LA	71201	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	DIR Contact	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	DIR Contact (Secondary)	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Emergency Part D Contact	Clinical Pharmacist I		Pennington	Hannah		2252987485					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	11/09/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Emergency Part D Contact (Secondary)	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					wesley.miller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Employer Waiver Contact	State Director, Individual and Senior Sales	Mr.	Wagner	Dan		5048325831					Dan.Wagner@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Encounter Data & Risk Adjustment Operations Contact	VP, Analytics and Quality Improvement		Vicidomina	Benjamin		2252952471					Benjamin.Vicidomina@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/23/2019	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Enrollment Contact	Medicare Enrollment Supervisor	Ms.	Brasher	Michele		3189983083					mbrasher@vhpla.com	130 Desiard Street		Monroe	LA	71201	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	EOB Transfer Contact	Controller	Ms.	Cupit	Chelle		3189983076				3188129987	ccupit@vhpla.com	130 Desiard Street		Monroe	LA	71201	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Financial Audit Contact	VP, Internal Audit, Compliance & Privacy	Ms.	Saporito	Mary		2252981742					Mary.Saporito@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Financial Reporting Contact	SVP Finance & Controller	Mr.	Short	Adam		2252952189					Adam.Short@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Formulary Contact	Clinical Pharmacist I		Pennington	Hannah		2252001752					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Formulary Contact (Secondary)	Clinical Pharmacist	Mr.	Seggerman	Wade		2252981972					wade.seggerman@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	General Contact	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Government Relations Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	05/06/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	HIPAA Privacy Officer	VP, Internal Audit, Compliance & Privacy	Ms.	Saporito	Mary		2252981742					Mary.Saporito@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	HIPAA Security Officer	Interim Head of Information Security	Mr.	Sotnikov	Slava		2252987036					Slava.Sotnikov@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Hospice Contact	Account Manager - Express Scripts	Ms.	Morgan	Stacy		4802818763					slmorgan@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Interoperability Contact	SVP, COO	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Re1tz Ave		Baton Route	LA	70809	04/11/2022	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	MA Appeals/Grievances Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					wesley.miller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	MA Claims Processing Contact for Public Website	Controller	Ms.	Cupit	Chelle		3189983076				8665087145	customerservice@blueadvantage.bcbsla.com	130 Desiard Street		Monroe	LA	71201	01/04/2021	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Marketing Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Medical Director	Lead Medical Director	Ms.	Barfield	Deirdre	Y	2252981978					deirdre.barfield@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/14/2019	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Medicare Compliance Officer	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					wesley.miller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	05/06/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Medicare Coordinator	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Medicare Part D Opioid Overutilization Contact	Director, Clinical Programs		Hunziker	Simone		3143976681					SHunziker@express-scripts.com	One Express Way		St. Louis	MO	63121	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Medication Therapy Management Contact	Director, Clinical Programs		Muralidharan	Adrienne		3146846625					AMuralidharan@express-scripts.com	One Express Way		St. Louis	MO	63121	05/03/2019	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	OffShore Subcontractor Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Online Enrollment Center Contact (Back-up)	Medicare Advantage Marketing Manager	Mrs.	Booth	Ann		2252982180					Ann.Booth@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor	Ms.	Brasher	Michele		3189983083					mbrasher@vhpla.com	130 Desiard Street		Monroe	LA	71201	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Part C Application Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	05/06/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Part C Reporting Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	05/06/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Part D Appeals	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@Express-Scripts.com	5151 Blazer Memorial Parkway		Dublin	OH	43017	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active	8003443405	733326			PPO - BBA		C	Denver
H1248	Part D Appeals Contact (Secondary)	Clinical Pharamcist I		Pennington	Hannah							Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active	2252001752				PPO - BBA		C	Denver
H1248	Part D Application Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	05/06/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Part D Benefits Contact	Clinical Pharamcist I		Pennington	Hannah		2252001752					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Part D Claims Submission Contact	Director Product Management	Mr.	Etherton	Jim		5133163889					jbetherton@express-scripts.com	8990 Duke Drive		Mason	OH	45040	10/12/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Part D Exceptions Contact	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@Express-Scripts.com	5151 Blazer Memorial Parkway		Dublin	OH	43017	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active	8003443405	733326			PPO - BBA		C	Denver
H1248	Part D Exceptions Contact (Secondary)	Clinical Pharamcist I		Pennington	Hannah							Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active	2252001752				PPO - BBA		C	Denver
H1248	Part D Price File Contact (Back-up)	Sr. Manager - Government Relations	Mrs.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Part D Price File Contact (Optional)	Clinical Pharamcist I		Pennington	Hannah		2252001752					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Part D Price File Contact (Primary)	Director-Government Programs	Mr.	Westrum	Josh		4807363132	433132				jwestrum@express-scripts.com	7909 S. Hardy Drive, Suite 106		Tempe	AZ	85284	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Part D Quality Assurance Contact	Clinical Pharmacist I	Ms.	Pennington	Hannah		2252001752					hannah.pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Part D Reporting Contact	Clinical Pharmacist I		Pennington	Hannah		2252987485					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	11/09/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Patient Safety Contact	Lead Medical Director	Dr.	Barfield	Deirdre	Y	2252981978					Deirdre.barfield@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/14/2019	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Payment Contact	SVP Finance & Controller	Mr.	Short	Adam		2252952189					Adam.Short@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Pharmacy Director	VP, Pharmacy Services	Mr.	Ford	Milam		2252981850					Milam.Ford@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Pharmacy Network Management Contact	Network Account Dir, Retail Strategy & Contracting	Ms.	Kelly	Heather		3146921866					Hakelly@express-scripts.com	One Express Way		St Louis	MO	63121	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist I		Pennington	Hannah		2252001752					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Pharmacy Technical Help Desk Contact	Sr. Manager - Memeber Services Contact Center		McVey	Darcheena							Darcheena_McVey@express-scripts.com	1640 Century Center Pkwy		Memphis	TN	38134	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active	8009221557				PPO - BBA		C	Denver
H1248	Pharmacy Technical Help Desk Contact (Secondary)	Clinical Pharmacist I		Pennington	Hannah							Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active	2252001752				PPO - BBA		C	Denver
H1248	Physician Incentive Contact	Controller	Ms.	Cupit	Chelle		8665087145					customerservice@blueadvantage.bcbsla.com	130 Desiard Street		Monroe	LA	71201	01/04/2021	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Plan Directory Contact for Public Website			Service	Customer		8665087145					customerservice@blueadvantage.bcbsla.com	130 Desiard Street		Monroe	LA	71201	01/04/2021	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Plan to Plan Reconciliation Contact	Senior Accountant, Financial Reporting	Ms.	Brown	Leigh Ann		2259533055					Leigh-Ann.Brown@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/23/2021	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Processor Contact	Senior Director, Government Programs, Medicare	Ms.	Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	10/12/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Quality Contact	Dir, Clinical Informatics & Gov Program Performanc	Mr.	Vicidomina	Benjamin	V	2252952471					Benjamin.Vicidomina@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Reconciliation Contact	SVP Finance & Controller	Mr.	Short	Adam		2252952189					Adam.Short@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Reconciliation Contact (Secondary)	Director, Financial Strategic Planning	Mr.	Prescott	Clinton		2252981931					Clinton.Prescott@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Recovery Audit Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	05/06/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Surveillance Contact	Medicare Advantage Sales Director	Mr.	Whittemore	John	E	2252004836					John.Whittemore@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/14/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	System Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Third Party Administrator (TPA) Liaison	Senior Accountant, Financial Reporting	Ms.	Brown	Leigh Ann		2259533055					Leigh-Ann.Brown@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/23/2021	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	User Access Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	708093809	05/06/2020	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Utilization Management Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1248	Utilization Review Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	LOUISIANA HEALTH SERVICE & INDEMNITY COMPANY	Local CCP	Blue Cross and Blue Shield of Louisiana	Local PPO		Louisiana Health Service & Indemnity Company	617	Yes	Active					PPO - BBA		C	Denver
H1277	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	12/31/2019	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Backup User Access Contact	Medicare Compliance Officer, Plan Partner Support	Ms.	Bouyer	Valorie		6159161254					valorie.bouyer@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/24/2019	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	CEO - CMS Administrator Contact	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	CEO - Senior Official for Contracting	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Chief Financial Officer	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Chief Operating Officer	Chief Operating Officer/General Manager	Mr.	Emami	John		7038837508					john.emami@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	06/21/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	06/21/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Contact for Fraud Investigations	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/24/2019	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Corporate Mailing						8558550489					customerservice@alignseniorcare.com	PO BOX 4440		Glen Allen	VA	23058	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Coverage Gap Discount Program (CGDP) Payment Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment	Mr.	Hassenstab	Mark		5072697711					Mark.Hassenstab@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/24/2019	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	EOB Transfer Contact			Lowry	Kristy		8558550489				8336102390	kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Financial Audit Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Financial Reporting Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	12/31/2019	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	General Contact	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	HIPAA Privacy Officer	Chief Compliance Officer and HIPAA Privacy Officer	Ms.	Crowe	Melanie		4049330409					melanie.crowe@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	HIPAA Security Officer	Sr. Director Cybersecurity	Mr	Brogdon	Clevelen		6158094476					Clevelen.Brogdon@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Interoperability Contact	Director of Data Operations and Architecture	Mr.	Karunakaran	Sukumaran		8043966384					sukumaran.karunakaran@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	01/25/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	06/21/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	MA Claims Processing Contact for Public Website	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Medical Director	VP Medical Affairs		Dahlgren	Andrew		8042968288					Andrew.Dahlgren@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	06/14/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Medicare Coordinator	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/14/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	03/09/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part C Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	01/06/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	12/31/2019	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Payment Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Philadelphia
H1277	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/05/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H1277	Physician Incentive Contact	Executive Director	Mr.	Dunn	Jamie		8048140844					jamie.dunn@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Plan Directory Contact for Public Website			Sindlinger	Rocio		8558550489					rocio.sindlinger@allyalign.com	PO BOX 4440		Glen Allen	VA	23058	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Plan to Plan Reconciliation Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/24/2019	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Quality Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	03/09/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Reconciliation Contact		Mr.	Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/08/2019	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Reconciliation Contact (Secondary)	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Recovery Audit Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Third Party Administrator (TPA) Liaison	Manager of Regulatory Accounting	Ms.	Weis	Katelyn		6073294042					kate.weis@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	User Access Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1277	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1278	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H1278	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H1278	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H1278	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H1278	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1278	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1280	Agent/Broker Compensation Data Contact	Senior Director, Marketing		Cardinal	Brittany		4136524780					brittany.cardinal@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Automated TrOOP Balance Transfer Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Backup User Access Contact	CCO		Ross	Cheyenne		6239103321					Cheyenne.Ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Best Available Evidence Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Bid Audit Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Bid Audit Site Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Bid Primary Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	CAP Report Contact for Public Website	Chief Compliance Officer		Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Ika	Pooja	V	5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Ika	Pooja	V	5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Chief Financial Officer	Chief Financial Officer	Mr.	Lawless	Tom		6085091628					tom.lawless@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Chief Operating Officer	Chief Operating Officer	Mr.	Price	John		2158806876					john.price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Chief Information Officer	IT Manager	Mr.	Harsha	Vijay		6176657331					vijay.harsha@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Chief Information Security Officer	IT Manager	Mr.	Harsha	Vijay		6176657331					vijay.harsha@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	CMS Casework Communication Contact	Medical Director	Dr.	Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Complaints Tracking Contact	Chief Compliance Officer		Ross	Cheyenne		6239103321					Cheyenne.Ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Contact for Fraud Investigations	Chief Compliance Officer		Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Coordination of Benefits Contact	VP of Finance		Texeria	Edward		6176657430					edward.texeria@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Corporate Mailing						5088046904					pooja.sammeta@rxadvance.com	136 Turnpike Road		Southborough	MA	01772	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Coverage Gap Discount Program (CGDP) Payment Contact	CFO		Lawless	Tom		6172450509					Tom.Lawless@eternalhealth.com	31 St James Ave	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Customer Service Operations Contact	Chief Operating Officer		Price	John		2158806876					john.price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	DIR Contact	CFO		Lawless	Tom		6085091628					Tom.Lawless@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	DIR Contact (Secondary)	Pharmacy Director		Wingerchuk	Caron		4804923852					Caron.Wingerchuk@eternal.com	31 St. James Ave	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Electronic Health Record Contact	Chief Medical Officer		Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Emergency Part D Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Emergency Part D Contact (Secondary)	Chief Medical Officer		Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Encounter Data & Risk Adjustment Operations Contact	CFO		Lawless	Tom		6085091628					Tom.Lawless@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Enrollment Contact	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	EOB Transfer Contact	Chief Operating Officer		Price	John		2158806876				8664371627	john.price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Financial Audit Contact	CFO	Mr.	Lawless	Tom		6085091628					Tom.Lawless@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Financial Reporting Contact	VP of Finance		Texeria	Edward		6176657430					edward.texeria@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Formulary Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Formulary Contact (Secondary)	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	32 St. James Ave	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	General Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Government Relations Contact	Chief Compliance Officer		Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	HIPAA Privacy Officer	Chief Compliance Officer		Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	HIPAA Security Officer	IT Manager	Mr.	Harsha	Vijay		6176657331					vijay.harsha@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Hospice Contact	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Interoperability Contact	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428					Chandra.Lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	MA Appeals/Grievances Contact	Operations Manager		Sosa-Alvarado	Steven		7875029188					steven.sosa-alvarado@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	MA Claims Processing Contact for Public Website	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Marketing Contact	Senior Director, Marketing		Cardinal	Brittany		4136524780					brittany.cardinal@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Medical Director	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Medicare Coordinator	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Medicare Part D Opioid Overutilization Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Medication Therapy Management Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	OffShore Subcontractor Contact	Chief Compliance Officer		Ross	Cheyenne		6239103321					Cheyenne.Ross@eternalhealth.com	31 St. James Ave		Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Online Enrollment Center Contact (Back-up)	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Online Enrollment Center Contact (Primary)			Rao	Chanukya		8565031661					chanukya.rao@rxadvance.com	136 Turnpike Rd.		Southborough	MA	01772	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Part C Application Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Part C Reporting Contact	Chief Compliance Officer		Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Part D Appeals	Manager		Bricker	Bryce							bryce.m.bricker@optum.com	2441 Warrenville Road		Lisle	IL	60532	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active	6126326838				HMO - Health Maintenance Organization		C	New York
H1280	Part D Appeals Contact (Secondary)	Appeals & Grievance Program Director		Sosa-Alvarado	Steven							steven.sosa-alvarado@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active	8006519613				HMO - Health Maintenance Organization		C	New York
H1280	Part D Application Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Part D Benefits Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Part D Claims Submission Contact	Director		Pereira	Michael		9494753456					pereira.mj@optum.com	2300 Main Street		Irvine	CA	92614	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Part D Exceptions Contact	Manager		Bricker	Bryce							bryce.m.bricker@optum.com	2441 Warrenville Road		Lisle	IL	60532	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active	6126326838				HMO - Health Maintenance Organization		C	New York
H1280	Part D Price File Contact (Back-up)			Moore-Elliot	Shalandria		6514955363					mailto:MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Pkwy		Schaumburg	IL	60173	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Part D Price File Contact (Optional)			Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Pkwy		Schaumburg	IL	60173	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Part D Price File Contact (Primary)			Rx	Optum		6514955363					medops_planfinder@optum.com	1600 McConnor Pkwy		Schaumburg	IL	60173	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Part D Quality Assurance Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Part D Reporting Contact	Chief Compliance Officer		Ross	Cheyenne		6239103321					Cheyenne.Ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Patient Safety Contact	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Payment Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Personal Health Record Contact	Chief Medical Officer		Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Pharmacy Director	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Pharmacy Network Management Contact	Director		Ashby	JoLynn		7637326364					JAshby@optum.com	1600 McConnor Pkwy		Schaumburg	IL	60173	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Pharmacy Technical Help Desk Contact			Villanueva	Juan								755 Research Parkway		Oklahoma City	OK	73104	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active	8007979791				HMO - Health Maintenance Organization		C	New York
H1280	Physician Incentive Contact	Director of Network		Abraham	Benita		6173158657					benita.abraham@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Plan Directory Contact for Public Website			Services	Provider		8006809255					providerrelations@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Plan to Plan Reconciliation Contact	VP of Finance		Texeria	Edward		6176657430					edward.texeria@eternalhealth.com	31 St. James Ave.	Suite 950,	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Processor Contact	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Quality Contact	Director of Medical Management		Baker	Christi		6176657430	339				Christi.Baker@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Reconciliation Contact	CFO		Lawless	Tom		6085091628					Tom.Lawless@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Recovery Audit Contact	Chief Financial Officer	Mr.	Lawless	Tom		6085091628					Tom.Lawless@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Surveillance Contact	Chief Compliance Officer		Ross	Cheyenne		6239103321					Cheyenne.Ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	System Contact	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Third Party Administrator (TPA) Liaison			Tati	Anand		5088046920					Anand.tati@rxadvance.com	136 Turnpike Road		Southborough	MA	01772	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	User Access Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Utilization Management Contact	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428	339				Chandra Lingisetty@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1280	Utilization Review Contact	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH,INC.	Local CCP	eternalHealth	HMO/HMOPOS		Eternal Health of Delaware, Inc.	769	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/09/2019	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/09/2018	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/23/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/14/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/02/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7812272122					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		7812272123					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7812272124					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		7812272127					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	12/14/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Chief Information Security Officer	Security Officer	Mr.	Careless	Jason		6025764139					Jason.careless@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	06/10/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Contact for Fraud Investigations	Head of SIU		Bowman	John		3144732898					john.bowman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	04/12/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/09/2018	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/26/2020	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	01/04/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/26/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/09/2018	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	12/14/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	04/26/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	05/08/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	06/09/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	06/10/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/02/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	06/14/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	General Contact	Compliance Manager	Ms.	Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		7812272122					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	HIPAA Privacy Officer	Privacy Officer		Reilly	Emily		4043049090					Emily.reilly@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	HIPAA Security Officer	Information Security Officer		Careless	Jason		6025764139					Jason.careless@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	04/11/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	12/07/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	04/11/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	02/03/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Marketing Contact	Marketing Manager		Lord	Austin		5085964196					Austin.lord@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	06/10/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Medicare Coordinator	Compliance Manager	Ms.	Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/02/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/17/2019	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	04/26/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	04/26/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	04/26/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/19/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	09/29/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H1290	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/23/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H1290	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/19/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	05/08/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/09/2018	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H1290	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/23/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H1290	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/09/2018	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	06/10/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/29/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	11/22/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Payment Contact	CFO	Mr.	Yale	Brad		7812272124					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/26/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/02/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/09/2018	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	01/09/2019	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H1290	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H1290	PHR Beneficiary Contact																	02/09/2018	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H1290	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2020	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	06/10/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Processor Contact	Chief Operating Officer		Henry	Larry		7812272127					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	06/10/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/19/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	06/09/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	01/04/2022	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Surveillance Contact	Chief Compliance Officer		OKane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/19/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/21/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	User Access Contact	Chief Compliance Officer	Ms.	OKane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/06/2023	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	03/23/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1290	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	02/19/2021	2023	DEVOTED HEALTH PLAN OF FLORIDA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1302	Agent/Broker Compensation Data Contact	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave		Meridian	ID	83642	08/19/2019	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Automated TrOOP Balance Transfer Contact	Quality Improvement Performance Specialist		Kober	Ashley		9862243495					ashley.kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Backup User Access Contact	Clinical Pharmacist		Hymel	Matthew		9862245786					Matthew.Hymel@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	10/03/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Best Available Evidence Contact	VP Compliance Medicare Compliance Officer		Thornock	Wade		9862246949					wade.thornock@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	11/28/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Bid Audit Contact	Medicare Compliance Officer		Thornock	Wade		9862246949					wade.thornock@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	11/28/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Bid Audit Site Contact	Medicare Compliance Officer		Thornock	Wade		9862246949					wade.thornock@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	11/28/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Bid Primary Contact	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	10/31/2018	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	CAP Report Contact for Public Website	Medicare Compliance Officer, VP Compliance		Thornock	Wade		9862246949					wade.thornock@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/09/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	CEO - CMS Administrator Contact	President and CEO	Ms.	Maher	Charlene		9862243440					charlene.maher@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	01/04/2019	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	CEO - Senior Official for Contracting	President and CEO	Ms.	Maher	Charlene		9862243440					charlene.maher@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	01/04/2019	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Chief Financial Officer	EVP Finance/CFO	Mr.	Ward	Dave		9862243438					dave.ward@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	10/12/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Chief Operating Officer	Executive VP and COO	Ms	Reardon	Valerie		9862243922					Valerie.Reardon@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	01/04/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Chief Information Officer	Senior VP IT and CIO	Mr	Sonalkar	Sameer		9862246363					sameer.sonalkar@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Chief Information Security Officer	Chief Information Officer	Mr.	Sonalkar	Sameer		9862246363					sameer.sonalkar@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	08/18/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	CMS Casework Communication Contact	Manager  Grievances & Appeals		Aharoni	Michelle		9862246604					michelle.aharoni@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	10/03/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Complaints Tracking Contact	Manager Grievances & Appeals		Aharoni	Michelle		9862246604					michelle.aharoni@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	10/03/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Contact for Fraud Investigations	Manager SIU		Wright	Karen		9862243929					karen.wright@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/14/2019	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Coordination of Benefits Contact			Service	Customer		2083958200					macs@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/14/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Corporate Mailing						9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/03/2018	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Supervisor		Hayes	Shannon		9862243529					Shannon.Hayes@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/14/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Customer Service Operations Contact	Customer Service Director		Davis	Natasha		9862246973					natasha.davis@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/14/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	DIR Contact	Supervisor, Government Funding Ops		Smith	Shawn		9862243720					Shawn.Smith@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	11/18/2015	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	DIR Contact (Secondary)	Manager, Government Funding Ops		Hannum	Leah		9862246826					leah.hannum@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/02/2015	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Emergency Part D Contact	Director Pharmacy Management		Olson	Steve		2085592275					steve.olson@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/29/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Emergency Part D Contact (Secondary)	Manager Clinical Pharmacist		Bohan	Jefferson		5705949198					Jefferson.Bohan@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/29/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Encounter Data & Risk Adjustment Operations Contact			Hannum	Leah		9862246826					leah.hannum@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	02/03/2020	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Enrollment Contact	Director, Enrollment and Billing Services		Jostsons	Eric		9862244453					eric.jostsons@bcidaho.com	3000 E Pine St		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	EOB Transfer Contact	Claims Manager		Curtis	Laura		9862243192				2083317451	laura.curtis@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	04/19/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Financial Audit Contact	Medicare Compliance Officer	Mr.	Thornock	Wade		9862246949					wade.thornock@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	11/28/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Financial Reporting Contact	Manager Financial Reporting		Gale	Alison		9862244004					alison.gale@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	01/03/2019	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Formulary Contact	Director Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	3080 Bristol Street		Costa Mesa	CA	92626	05/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Formulary Contact (Secondary)	QI Specialist, Pharmacy		Kober	Ashley		9862243495					Ashley.Kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/14/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	General Contact	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/03/2018	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Government Relations Contact	Medicare Compliance Officer		Thornock	Wade		9862246949					wade.thornock@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	11/28/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	HIPAA Privacy Officer	Privacy  and Security Officer		Maciejewski	Karen		9862243987					Karen.Maciejewski@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/14/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	HIPAA Security Officer	Privacy and Security Officer		Maciejewski	Karen		9862243987					Karen.Maciejewski@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/14/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Hospice Contact	Clinical Pharmacist		Hymel	Matthew		9862244539					Matthew.Hymel@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/14/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Interoperability Contact	VP Compliance		Thornock	Wade		9862246949					Wade.Thornock@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	12/14/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	MA Appeals/Grievances Contact	Manager Grievances & Appeals		Aharoni	Michelle		9862246604					michelle.aharoni@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	10/03/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	MA Claims Processing Contact for Public Website	Medicare Advantage Provider Support		Support	Provider		8664822250				2083876811	csproviderinquiries@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/04/2014	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Marketing Contact	Program Coordinator		Joyce	Ken		9862243507					ken.joyce@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	08/19/2019	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Medical Director	Chief Medical Officer		Kizilos	Melissa		9862244425					melissa.kizilos@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/27/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Medicare Compliance Officer	Compliance Director, Medicare Compliance Officer	Ms.	Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	02/06/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Medicare Coordinator	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	10/31/2018	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Medicare Part D Opioid Overutilization Contact	Manager Clinical Pharmacist		Bohan	Jefferson		9862243708					Jefferson.Bohan@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/14/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Medication Therapy Management Contact	MA Pharmacist		Hymel	Matthew		9862245786					Matthew.Hymel@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/13/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	OffShore Subcontractor Contact	VP Compliance Medicare Compliance Officer		Thornock	Wade		9862246949					wade.thornock@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	11/28/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Online Enrollment Center Contact (Back-up)	Director, Enrollment and Billing Services		Jostsons	Eric		9862244453					eric.jostsons@bcidaho.com	3000 E Pine St		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Online Enrollment Center Contact (Optional)	Enrollment Specialist		Davis	Brenda		9862245066					brenda.davis@bcidaho.com	3000 E Pine St		Meridian	ID	83642	12/22/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Online Enrollment Center Contact (Primary)	Supervisor MA EBS		Sherman	Missy		9862243236				2083876808	Missy.sherman@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/15/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Part C Application Contact	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	10/31/2018	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Part C Reporting Contact	Compliance Specialist Sr		Shade	Shannon		9862243727					shannon.shade@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Part D Appeals	Clinical Pharmacist Senior		Casals	Karla							IRxGrievanceandAppeals@ingenio-rx.com	9250 West Flagler Street	6th Floor	Miami	FL	33174	10/03/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active	3058127134				PPO - BBA		C	Seattle
H1302	Part D Appeals Contact (Secondary)	Quality Improvement Performance Specialist		Kober	Ashley							ashley.kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active	9862243495				PPO - BBA		C	Seattle
H1302	Part D Application Contact	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Part D Benefits Contact	Clinical Pharmacist		Bohan	Jefferson		9862243708					jefferson.bohan@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Part D Claims Submission Contact			Service	Customer		8884942583					macs@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Part D Exceptions Contact	VP Member and Provider Experience		Rothman	Alana							alana.rothman@ingenio-rx.com	6763 Strifler Place		Cincinnati	OH	45243	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active	5133363352				PPO - BBA		C	Seattle
H1302	Part D Price File Contact (Back-up)	Business Change Manager		Dunlap	Tiffany		6128167392					Tiffany.Dunlap@ingenio-rx.com	1285 Northland Drive		Mendota Heights	MN	55120	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Part D Price File Contact (Optional)	Business Change Advisor Sr		Torres	Krystal		5624188084					krystal.torres@Ingenio-rx.com	21555 W Oxnard St		Woodland Hills	CA	91367	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Part D Price File Contact (Primary)	Quality Improvement Performance Specialist		Kober	Ashley		9862243495					Ashley.Kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Part D Quality Assurance Contact	Quality Improvement Performance Specialist		Kober	Ashley		9862243495					ashley.kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Part D Reporting Contact	Compliance Specialist Sr		Shade	Shannon		9862243727					shannon.shade@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Patient Safety Contact	Pharmacy Clinical Reviewer Sr		Reynolds	Dina		9862245105					dina.reynolds@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Payment Contact	Manager Financial Reporting		Gale	Alison		9862244004					alison.gale@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	01/03/2019	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Pharmacy Director	VP, Pharmacy Management		Olson	Steve		9862243308					Steve.Olson@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Pharmacy Network Management Contact	Program Manager		De Leon	Rosanna		2012411560					Rosanna.DeLeon@Ingenio-Rx.com	2 Speedwell Avenue		Morristown	NJ	07960	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Pharmacy Network Management Contact (Secondary)	Pharmacy Management Director		Olson	Steve		9862243308					steve.olson@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Pharmacy Technical Help Desk Contact	Program Manager		De Leon	Rosanna							Rosanna.DeLeon@Ingenio-Rx.com	2 Speedwell Avenue		Morristown	NJ	07960	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active	8333774266				PPO - BBA		C	Seattle
H1302	Physician Incentive Contact	VP Provider Network Mgmt		Worley	John		9862245585					john.worley@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	01/04/2021	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Plan Directory Contact for Public Website			Service	Customer		2083958200					macs@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	01/25/2017	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Plan to Plan Reconciliation Contact	Quality Improvement Performance Specialist		Kober	Ashley		9862243495					ashley.kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Processor Contact	Compliance Officer		Thornock	Wade		2083876949					wade.thornock@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/23/2016	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Quality Contact	Manager, Quality Management		Gries	Katie		9862244756					katie.gries@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Reconciliation Contact	Supervisor, Government Funding Ops		Smith	Shawn		9862243720					Shawn.Smith@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	11/18/2015	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Reconciliation Contact (Secondary)	Manager, Government Funding Ops		Hannum	Leah		9862246826					leah.hannum@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	12/03/2015	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Recovery Audit Contact	Compliance Director, Medicare Compliance Officer	Ms.	Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/06/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	SNP Application Contact	Dual Eligible Program Director		Robertson	Jenny		9862245094					jenny.robertson@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Surveillance Contact	VP Compliance Medicare Compliance Officer		Thornock	Wade		9862246949					wade.thornock@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	11/28/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	System Contact	Sr IT Operations Analyst		Reichert	Dean		9862243084					dean.reichert@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/14/2019	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Third Party Administrator (TPA) Liaison	Supervisor Accounting Services		Hayes	Shannon		9862243529					shannon.hayes@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	02/16/2022	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	User Access Contact	Sr Compliance Specialist		Schwartz	Leanne		9862243984					leanne.schwartz@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Utilization Management Contact	VP, Healthcare Operations		Bloomer	Marissa		9862244445					marissa.bloomer@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/27/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1302	Utilization Review Contact	VP, Healthcare Operations		Bloomer	Marissa		9862244445					marissa.bloomer@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/27/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	Local PPO		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					PPO - BBA		C	Seattle
H1304	Agent/Broker Compensation Data Contact	VP Medicare Sales	Mr.	Hess	Brent		8013336143					Brent.Hess@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	07/06/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Automated TrOOP Balance Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Backup User Access Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St.	MS:E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Best Available Evidence Contact	Membership Ambassador	Ms.	Neufeld	Jeri		8006621470	2526			8883352988	ORMEMMEDAmbassador@regence.com	PO Box 1827		Medford	OR	97501	02/16/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Bid Audit Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Bid Audit Site Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Bid Primary Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	CAP Report Contact for Public Website	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	CEO - CMS Administrator Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/04/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	CEO - Senior Official for Contracting	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/09/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Chief Financial Officer	SVP & CFO	Mr.	Rains	Mike		2063326521					Mike.Rains@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Chief Operating Officer	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Chief Information Officer	SVP STRATEGIC TECH SOL & CIO	Mr	Rotival	Laurent		2063325034					Laurent.Rotival@cambiahealth.com	200 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Chief Information Security Officer	VP & CHIEF INFO SEC OFFICER	Mr	Anderson	Kirk		5037251608					Kirk.Anderson@cambiahealth.com	100 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	CMMI Model Point of Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	CMS Casework Communication Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Complaints Tracking Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Contact for Fraud Investigations	Senior Audit Investigator	Ms.	Grimes-Burke	Jennifer		5035873355					Jennifer.Grimes-Burke@regence.com	100 SW Market St	M/S E12B	Portland	OR	97201	06/16/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Coordination of Benefits Contact	Manager, Member Services	Ms	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	PO Box 1827	MS: B32M	Medford	OR	97501	07/09/2016	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Corporate Mailing						5032206237				5035884350	Jennifer.DelVillar@regence.com	100 SW Market Street		Portland	OR	97201	01/07/2013	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Sr I	Mr.	Gerken	Matthew		2063324809					Matthew.Gerken@cambiahealth.com	1800 9th Ave		Seattle	WA	98101	04/19/2016	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Customer Service Operations Contact	Manager Member Services	Ms	Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	DIR Contact	Manager Pharmacy Informatics		Kidd	Vicki		2083957739				2083337874	vicki.kidd@regence.com	1211 West Myrtle, Suite 110		Boise	ID	83702	01/08/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	DIR Contact (Secondary)	Dir. Gov. Pro Compliance / Medicare Compliance Off	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street E10C		Portland	OR	97201	07/21/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Emergency Part D Contact	VP Pharm Ops & Compliance	Mr.	Weiss	Justin		5032256677					Justin.Weiss@cambiahealth.com	200 SW Market St		Portland	OR	97201	12/20/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Emergency Part D Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Employer Waiver Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment, Manager	Mr.	Moore	Jason		2087982318					Jason.Moore@cambiahealth.com	1602 21st Ave		Lewiston	ID	83501	10/18/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Enrollment Contact	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	EOB Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Financial Audit Contact	Government Programs Audit Consultant	Mr.	Hutt	Brian		5032206160					Brian.Hutt@regence.com	200 SW Market Street	MS: E10C	Portland	OR	97201	05/09/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Financial Reporting Contact	Fin Acctg & Reporting, Assistant Director	Mr	Striplin	Daniel	W	5032256069					Dan.Striplin@regence.com	200 SW Market		Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Formulary Contact	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Ave		Portland	OR	97201	01/18/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	General Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Government Relations Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St.	MS:E10C	Portland	OR	97201	04/18/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	HIPAA Privacy Officer	VP Chief Compliance & Privacy Officer	Ms.	Erbes	Kristen		5035256533					kristen.erbes@regence.com	200 SW Market St	M/S: E14A	Portland	OR	97201	02/25/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	HIPAA Security Officer	Chief Information Security Officer	Mr.	Person	Steve		5037251654					Steve.Person@regence.com	1621 SW First Ave.		Portland	OR	97201	02/25/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Hospice Contact	Pharmacy Ops Oversight Specialist	Ms.	Pickens	Spring		5032255240					Spring.Pickens@regence.com	100 SW Market St	MS: WW5-56	Portland	OR	97201	02/05/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Interoperability Contact	VP Chief Tech Officer		Anderson	Kirk		5037251608					kirk.anderson@cambiahealth.com	Cambia Health Solutions	200 SW Market Street	Portland	OR	97201	02/09/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	MA Appeals/Grievances Contact	Director, Clinical Services Operations	Ms.	Sikora	Joelle		2063325320					Joelle.Sikora@regence.com	1800 Ninth Avenue		Seattle	WA	98101	05/09/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	MA Claims Processing Contact for Public Website	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Marketing Contact	Compliance Analyst		Meirose	Robyn		5033918668					robyn.meirose@regence.com	200 SW Market St  MS: E10C		Portland	OR	97201	09/14/2015	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Medical Director	SVP Chief Medical Officer	Ms.	Milavetz	Donna		8013336740					Donna.Milavetz@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	12/05/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Medicare Compliance Officer	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	07/14/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Medicare Coordinator	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827		Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Medicare Part D Opioid Overutilization Contact	Drug Management Program	Ms.	Anderson	Ally		8557297221					partdoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	12/05/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Medication Therapy Management Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/17/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Online Enrollment Center Contact (Back-up)	Dir Medicare Planning & Performance	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Online Enrollment Center Contact (Optional)	Manager Member Services	Ms.	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	2057 Commerce Dr		Medford	OR	97504	11/06/2017	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Online Enrollment Center Contact (Primary)	Spv Membership, GP OR Medicare Ops & Billing	Ms.	Cromwell	Krista		5416181286					Krista.Cromwell@regence.com	PO Box 1827	M/S: B32M	Medford	OR	97501	03/07/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Part C Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Part C Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				PPO - BBA		C	Seattle
H1304	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossig Rd	Eagan	MN	55120	03/21/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8006936651				PPO - BBA		C	Seattle
H1304	Part D Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Part D Benefits Contact	Product Manager III	Ms.	Holliston	Danica		5032254871					Danica.Holliston@regence.com	200 SW Market St  M/S: E10M		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Part D Claims Submission Contact	Functional Business Consultant - Government Prgrms	Mr.	Brook	Lance		4026862603					LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	08/05/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				PPO - BBA		C	Seattle
H1304	Part D Exceptions Contact (Secondary)	Asst Director Pharmacy Operations	Ms.	Yi	Edie							edie.yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	972071271	12/15/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	5032254801				PPO - BBA		C	Seattle
H1304	Part D Price File Contact (Back-up)	Database Reporting Analyst	Ms	Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Part D Price File Contact (Optional)	QA Analyst Sr	Ms.	Tastad	Emily		6127772557					emily.tastad@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/03/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Part D Price File Contact (Primary)	AD Pharmacy Informatics	Ms.	Kidd	Vicki		2083957739					Vicki.Kidd@regence.com	1211 West Myrtle		Boise	ID	83702	07/22/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Part D Quality Assurance Contact	Assistant Dir Pharmacy Operations	Ms.	Yi	Edie		5032254801				2083957744	Edie. Yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	97201	12/05/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Part D Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Patient Safety Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Payment Contact	Asst Director Fin Acctg & Reporting	Mr.	Striplin	Dan		5032256069					Dan.Striplin@cambiahealth.com	100 SW Market St	M/S: C2A	Portland	OR	97201	04/10/2014	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Pharmacy Director	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Avenue, M/S PDX - WW3-33		Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Pharmacy Network Management Contact	AVP, Network Mangement	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/18/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Cient Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55122	12/21/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Pharmacy Technical Help Desk Contact	Director, Member Services Government Programs	Mr.	Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				PPO - BBA		C	Seattle
H1304	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jon							jonathan.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				PPO - BBA		C	Seattle
H1304	Plan Directory Contact for Public Website	Manager Member Services		Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Plan to Plan Reconciliation Contact	Pharmacy Operations Oversight Specialist, Sr.	Ms.	Manzer	Amy		5032255368					Amy.Manzer@regence.com	200 SW Market St	M/S: PDX-ZOF WW3-33	Portland	OR	97201	08/26/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing	Egan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Quality Contact	Director, Quality Management	Mr.	Mcclure	Andy		5032206189					Andrew.Mcclure@regence.com	1621 SW First Ave	M/S WW5-52	Portland	OR	97201	04/12/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Reconciliation Contact	VP Finance Controller		Vannoy	Anjie		5032761865					Anjie.Vannoy@cambiahealth.com	100 SW Market St.	MS:PDX-WW2-21	Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Reconciliation Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS:E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Recovery Audit Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Surveillance Contact	Government Programs Compliance Officer		Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St  M/S: E10C		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	System Contact	Medicare Business Operations, Product Owner	Ms.	Fredinburg	Deana		5033754426					Deana.Fredinburg@regence.com	PO BOX 1827	M/S: B32AG	Medford	OR	97501	06/24/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Third Party Administrator (TPA) Liaison	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	User Access Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Utilization Management Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1304	Utilization Review Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield Of Idaho	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H1310	Automated TrOOP Balance Transfer Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	06/29/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Backup User Access Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Best Available Evidence Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Bid Primary Contact	Director of Finance CFO	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	09/19/2022	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	CAP Report Contact for Public Website	Chief Executive Officer	Ms.	Berglin	Sally		2694419300					s.berglin@seniorcarepartnersmi.org	200 W. Michigan Avenue, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Berglin	Sally		2692809446					s.berglin@seniorcarepartnersmi.org	200 W. Michigan Avenue, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Berglin	Sally		2692809446					s.berglin@seniorcarepartnersmi.org	200 W. Michigan Avenue, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Chief Financial Officer	Director of Finance	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/03/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Chief Operating Officer	COO	Ms.	Harrison	Qiana		2698886143					q.harrison@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	08/10/2022	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Chief Information Officer	Director of Finance	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Chief Information Security Officer	Director of Finance	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	CMS Casework Communication Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Complaints Tracking Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	06/29/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Contact for Fraud Investigations	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	06/29/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Coordination of Benefits Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	06/29/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Corporate Mailing						2694419300					s.berglin@seniorcarepartnersmi.org	200 W. Michigan Avenue, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Coverage Gap Discount Program (CGDP) Payment Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Customer Service Operations Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	06/29/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	DIR Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	08/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	DIR Contact (Secondary)			Cooper	Tim		2698886103					t.cooper@seniorcarepartnersmi.org	800 E Milham Ave		Portage	MI	49002	08/10/2022	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Emergency Part D Contact	Director of Risk Management	Mrs	Apodaca	Alex		2698886108					A.Lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	03/20/2023	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Emergency Part D Contact (Secondary)	Director of Finance	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	02/17/2022	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Encounter Data & Risk Adjustment Operations Contact	Director of Risk Management		Lueth	Alexandria	E	2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	06/29/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Enrollment Contact	COO	Mrs.	Harris	Qiana		2698886143					q.harris@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	03/20/2023	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	EOB Transfer Contact	Director of Finance	Mr.	Witt	Matt		2698886106				2694419329	m.witt@seniorcarepartnersmi.org	200 W. Michigan Avenue, Suite 103		Battle Creek	MI	49017	08/10/2022	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Financial Audit Contact	Director of Finance	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan Avenue, Suite 103		Battle Creek	MI	49017	11/03/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Financial Reporting Contact	Director of Finance	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/03/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Formulary Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2694419332					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	03/08/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Formulary Contact (Secondary)	Pharmacy Department Leader/Lead Clinical Pharmacis	Ms.	Balazs	Gianna		2698886137					g.balazs@seniorcarepartnersmi.org	200 Michigan Ave W Ste 103		Battle Creek	MI	49017	03/20/2023	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	General Contact	Chief Executive Officer	Ms.	Berglin	Sally		2692809446					s.berglin@seniorcarepartnersmi.org	200 W. Michigan Avenue, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Government Relations Contact	Chief Executive Officer	Ms.	Berglin	Sally		2692809446					s.berglin@seniorcarepartnersmi.org	200 W. Michigan Avenue, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	HIPAA Privacy Officer	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	06/29/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	HIPAA Security Officer	Director of Finance	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	08/10/2022	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Interoperability Contact			Cooper	Tim		2698886103					t.cooper@seniorcarepartnersmi.org	800 E Milham Ave		Portage	MI	49002	05/12/2022	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	MA Appeals/Grievances Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	MA Claims Processing Contact for Public Website	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	06/29/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Marketing Contact	COO	Ms.	Harrison	Qiana		2698886143					q.harrison@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	08/10/2022	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Medical Director	Medical Director	Dr.	Schreiner	Rebecca		2698886115				2694419329	r.schreiner@seniorcarepartnersmi.org	200 West Michigan, Suite 103		Battle Creek	MI	49017	08/10/2022	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Medicare Compliance Officer	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	06/29/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Medicare Coordinator	Director of Finance	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Medicare Part D Opioid Overutilization Contact	Lead Clinical Pharmacist	Ms.	Balazs	Gianna		2694885475					g.balazs@seniorcarepartnersmi.org	445 West Michigan Avenue		Kalamazoo	MI	49007	11/21/2019	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Medication Therapy Management Contact	Lead Clinical Pharmacist	Ms.	Balazs	Gianna		2694885475					g.balazs@seniorcarepartnersmi.org	445 West Michigan Avenue		Kalamazoo	MI	49007	11/21/2019	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Part C Application Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Part D Appeals	Director of IDT Operations	Ms.	Lueth	Alexandria							a.lueth@seniorcarepartnersmi.org	200 W. Michigan Avenue, Suite 103		Battle Creek	MI	49017	01/11/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active	8004885860				PACE - Nat		C	Chicago
H1310	Part D Application Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	08/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Part D Benefits Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	08/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Part D Claims Submission Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	08/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Part D Exceptions Contact	Director of Risk Management	Ms.	Lueth	Alexandria						2694419329	a.lueth@seniorcarepartnersmi.org	200 West Michigan Avenue	Suite 103	Battle Creek	MI	49017	03/08/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active	8772844071				PACE - Nat		C	Chicago
H1310	Part D Price File Contact (Back-up)	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Part D Price File Contact (Primary)	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	08/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Part D Quality Assurance Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Part D Reporting Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	06/29/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Patient Safety Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Payment Contact	Director of Finance	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Pharmacy Director	Lead Clinical Pharmacist	Ms.	Balazs	Gianna		2694885475					g.balazs@seniorcarepartnersmi.org	445 West Michigan Avenue		Kalamazoo	MI	49007	11/21/2019	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Pharmacy Network Management Contact	Lead Clinical Pharmacist	Ms.	Balazs	Gianna		2694885475					g.balazs@seniorcarepartnersmi.org	445 West Michigan Avenue		Kalamazoo	MI	49007	11/21/2019	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Pharmacy Technical Help Desk Contact	Lead Clinical Pharmacist	Ms.	Balazs	Gianna							g.balazs@seniorcarepartnersmi.org	445 West Michigan Avenue		Kalamazoo	MI	49007	11/21/2019	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active	8004885860				PACE - Nat		C	Chicago
H1310	Plan Directory Contact for Public Website	Chief Executive Officer	Ms.	Berglin	Sally		2692809446					s.berglin@seniorcarepartnersmi.org	200 W. Michigan Avenue, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Plan to Plan Reconciliation Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/03/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Processor Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Quality Contact	Quality Manager	Ms.	Montague	Melissa		2698886160				2698886160	m.montague@seniorcarepartnersmi.org	200 West Michigan Avenue	Suite 103	Battle Creek	MI	49017	02/10/2022	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Reconciliation Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Reconciliation Contact (Secondary)	Director of Finance	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	02/17/2022	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Recovery Audit Contact	Director of Finance	Mr.	Witt	Matt		2698886106					m.witt@seniorcarepartnersmi.org	200 W. Michigan Avenue, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Surveillance Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	System Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Third Party Administrator (TPA) Liaison	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	User Access Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Utilization Management Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1310	Utilization Review Contact	Director of IDT Operations	Ms.	Lueth	Alexandria		2698886108					a.lueth@seniorcarepartnersmi.org	200 W. Michigan, Suite 103		Battle Creek	MI	49017	11/24/2021	2023	COMPREHENSIVE SENIOR CARE CORPORATION	National PACE	Senior Care Partners P.A.C.E.	National PACE		Comprehensive Senior Care Corporation	396	Yes	Active					PACE - Nat		C	Chicago
H1312	Automated TrOOP Balance Transfer Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Backup User Access Contact	Executive Director	Mr.	Plaisance	Wayne		5045592350					wayne.plaisance@trinity-health.org	3403 Government Street		Alexandria	LA	71301	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Best Available Evidence Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Bid Primary Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	CAP Report Contact for Public Website	Executive Director	Mr.	Plaisance	Wayne		5045592350					wayne.plaisance@trinity-health.org	3403 Government Street		Alexandria	LA	71301	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	CEO - CMS Administrator Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	CEO - Senior Official for Contracting	Executive Director	Mr.	Plaisance	Wayne		5045592350					wayne.plaisance@trinity-health.org	3403 Government Street		Alexandria	LA	71301	04/11/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Chief Financial Officer	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Chief Operating Officer	Chief Operating Officer	Ms.	Lewis	Anne		4066472980					anne.lewis@trinity-health.org	6113 Norma Jean Lane		Billings	MT	59101	09/26/2022	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Chief Information Officer	Regional Director of IT Operations	Mr.	Latimer	Mike		6142348636					mike.latimer@trinity-health.org	20255 Victor Parkway		Livonia	MI	48152	09/26/2022	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Chief Information Security Officer	Regional Information Security Officer	Ms.	Matthews	Lynne		6105503083					lmatthews@trinity-health.org	20255 Victor Parkway		Livonia	MI	48152	09/26/2022	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	CMS Casework Communication Contact	Executive Director	Mr.	Plaisance	Wayne		5045592350					wayne.plaisance@trinity-health.org	3403 Government Street		Alexandria	LA	71301	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Complaints Tracking Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Contact for Fraud Investigations	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Coordination of Benefits Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Corporate Mailing						2489245892					murphysa@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	09/27/2022	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Coverage Gap Discount Program (CGDP) Payment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Customer Service Operations Contact	Executive Director	Mr.	Plaisance	Wayne		5045592350					wayne.plaisance@trinity-health.org	3403 Government Street		Alexandria	LA	71301	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	DIR Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Emergency Part D Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Encounter Data & Risk Adjustment Operations Contact	Director of Coding and Documentation		Creaney	Emy		7343431939					creaneye@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Enrollment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	EOB Transfer Contact	Regional director Finance	Ms.	Fuhrmeister	Nicole		2157788707				9104834930	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Financial Audit Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Financial Reporting Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Formulary Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	General Contact	Executive Director	Mr.	Plaisance	Wayne		5045592350					wayne.plaisance@trinity-health.org	3403 Government Street		Alexandria	LA	71301	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Government Relations Contact	Executive Director	Mr.	Plaisance	Wayne		5045592350					wayne.plaisance@trinity-health.org	3403 Government Street		Alexandria	LA	71301	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	HIPAA Privacy Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	HIPAA Security Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Interoperability Contact	Regional Director of IT Operations	Mr.	Latimer	Mike		6142348686					mike.latimer@trinity-health.org	20255 Victor Parkway		Livonia	MI	48125	09/26/2022	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	MA Appeals/Grievances Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	MA Claims Processing Contact for Public Website	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Marketing Contact	Director Marketing and Communication	Ms.	Lark	Azia		9735182754					azia.lark@trinity-health.org	20255 Victor Parkway		Livonia	MI	48152	02/03/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Medical Director	Chief Medical Officer	Dr	Nichols, MD	Karen		2154079507					karen.nichols001@trinity-health.org	20255 Victor Parkway		Livonia	MI	48152	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Medicare Compliance Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Medicare Coordinator	Executive Director	Mr.	Plaisance	Wayne		5045592350					wayne.plaisance@trinity-health.org	3403 Government Street		Alexandria	LA	71301	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Part C Application Contact	Chief Operating Officer	Ms.	Lewis	Anne		4066472980					anne.lewis@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	09/26/2022	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Part D Appeals	Manager Part D Compliance	Mr.	Garbarino	Joseph							joseph.garbarino@mercyhealth.org	1930 South Broad Street	Unit 3	Philadelphia	PA	19145	09/26/2022	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending	2153394362				PACE - Nat		C	Dallas
H1312	Part D Application Contact	Chief Operating Officer	Ms.	Lewis	Anne		4066472980					anne.lewis@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	09/26/2022	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Part D Benefits Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Part D Claims Submission Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Part D Exceptions Contact	Manager Part D Compliance	Mr.	Garbarino	Joseph							joseph.garbarino@mercyhealth.org	1930 South Broad Street	Unit 3	Philadelphia	PA	19145	09/26/2022	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending	2153394362				PACE - Nat		C	Dallas
H1312	Part D Price File Contact (Back-up)	Executive Director	Mr.	Plaisance	Wayne		5045592350					wayne.plaisance@trinity-health.org	3403 Government Street		Alexandria	LA	71301	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Part D Price File Contact (Primary)	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Part D Quality Assurance Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Part D Reporting Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Patient Safety Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Payment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Pharmacy Director	Manager Part D Compliance	Mr.	Garbarino	Joseph		2153394362					joseph.garbarino@mercyhealth.org	1930 South Broad Street	Unit 3	Philadelphia	PA	19145	09/26/2022	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Pharmacy Network Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	1001 Baltimore Pike		Springfield	PA	19064	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Pharmacy Technical Help Desk Contact	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@mercyhealth.org	1930 South Broad St	Unit 3	Philadelphia	PA	19145	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending	2153394362				PACE - Nat		C	Dallas
H1312	Plan Directory Contact for Public Website	Executive Director	Mr.	Plaisance	Wayne		5045592350					wayne.plaisance@trinity-health.org	3403 Government Street		Alexandria	LA	71301	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Plan to Plan Reconciliation Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Processor Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Quality Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Reconciliation Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Recovery Audit Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Surveillance Contact	Executive Director	Mr.	Plaisance	Wayne		5045592350					wayne.plaisance@trinity-health.org	3403 Government Street		Alexandria	LA	71301	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	System Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Third Party Administrator (TPA) Liaison	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	User Access Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Utilization Management Contact	Chief Medical Officer	Dr	Nichols, MD	Karen		2154079507					karen.nichols001@trinity-health.org	20255 Victor Parkway		Livonia	MI	48152	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1312	Utilization Review Contact	Chief Medical Officer	Dr	Nichols, MD	Karen		2154079507					karen.nichols001@trinity-health.org	20255 Victor Parkway		Livonia	MI	48152	08/04/2023	2023	TRINITY HEALTH PACE OF ALEXANDRIA	National PACE	Trinity Health PACE of Alexandria	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Dallas
H1347	Agent/Broker Compensation Data Contact	Department Mgr Comp & Benefits		Vollenweider	Laurie		2052207486					lvollenweider@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Automated TrOOP Balance Transfer Contact	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Backup User Access Contact	Compliance Analyst I		Goodlett	Dominique		2052206984					dgoodlett@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Best Available Evidence Contact	Sr. Business Analyst		Johnson	Geraldine		2052206077					gejohnson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Bid Audit Contact	Dept Manager Internal Audit		Echols	Molly		2052207036					mechols@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Bid Audit Site Contact	Dept Manager Internal Audit		Echols	Molly		2052207036					mechols@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Bid Primary Contact	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	CAP Report Contact for Public Website	Director Internal Audit/Corp Compliance		Miller	Keith		2052206123					kbmiller@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	CEO - CMS Administrator Contact	President and Chief Executive Officer	Mr	Vines	Tim		2052206363					TVines@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	CEO - Senior Official for Contracting	Executive Vice President	Mr.	Briggs III	Dick	D	2052206952					dbriggs@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/11/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Chief Financial Officer	SVP & Chief Financial Officer	Mr.	Carden	Noel		2052207741					ncarden@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/18/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Chief Operating Officer	SVP Business Operations	Mr.	Hill	James	S	2052202196					Jim.Hill@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Chief Information Officer	SVP and CIO	Mr.	McGlaun	Scott		2052207300					SMcGlaun@bcbsal.org	450 Riverchase Pkwy East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Chief Information Security Officer	Chief Info Security Officer	Mr.	Parton	Chris		2052207421					cparton@bcbsal.org	450 Riverchase Pkwy East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	CMMI Model Point of Contact	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	CMS Casework Communication Contact	Senior Compliance Analyst		Jones	Kimberly		2052207077					kwjones@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Complaints Tracking Contact	Senior Compliance Analyst		Jones	Kimberly		2052207077					kwjones@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Contact for Fraud Investigations	Network Integrity Operations Manager		Ellison	Amy		2052202573					aellison@bcbsal.org	450 Riverchase Parkway		Birmingham	AL	35244	11/10/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Coordination of Benefits Contact	Manager Claims Processing		Cole	Jason		2052202490					Jason.Cole@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	05/02/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Corporate Mailing						2052205915					O65ProdMgmt@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant		Lambert	Christophe		2052206593					CLambert@bcbsal.org	450 Riverchase Pkwy East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Customer Service Operations Contact	Dept Manager Customer Service		Pearson	Latreta		2052207905					llpearson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	DIR Contact	VP Controller		DeLawrence	Jennifer		2052207282				2052202795	JDeLawrence@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	DIR Contact (Secondary)	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Electronic Health Record Contact	Senior Compliance Analyst		Richardson	Misty		2052204366					misty.richardson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	01/10/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Emergency Part D Contact	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Emergency Part D Contact (Secondary)	Pharmacy Services Manager		Matthews	Ginny		2052206558					Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Employer Waiver Contact	Manager Enrollment Service		Sexton	Missy		2052206589					Melissa.Sexton@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/02/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Encounter Data & Risk Adjustment Operations Contact	MAQM Department Manager		Pruitt	Gwendolyn		2052202418					Gwendolyn.Pruitt@bcbsal.org	450 Riverchase Pkwy East		Hoover	AL	35244	04/18/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Enrollment Contact	Manager Enrollment Service		Sexton	Missy		2052206589					Melissa.Sexton@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/18/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	EOB Transfer Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558				2052200803	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Financial Audit Contact	Dept Manager Internal Audit	Ms.	Echols	Molly		2052207036					mechols@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Financial Reporting Contact	Dept Mgr Accounting/Reporting		O'Neal	Keith		2052206202					Keith.ONeal@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Formulary Contact	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	General Contact	Manager Corporate Compliance		Gregg	Roger		2052207480					RGregg@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Government Relations Contact	Manager Product Management	Mrs	Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	HIPAA Privacy Officer	Manager Corporate Compliance		Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	HIPAA Security Officer	Manager Corporate Compliance		Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Hospice Contact	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					WStevens@BCBSAL.ORG	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Interoperability Contact			Gregg	Roger		2052207480					rgregg@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	MA Appeals/Grievances Contact	Health Management Unit Mgr		Mattioli	Jared		2052205315					jmattioli@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	MA Claims Processing Contact for Public Website	Manager Claims Operations		Corley	Jeff		2052206367					jcorley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Marketing Contact	Department Manager Marketing		Glass	Carol		2052204124					Carol.Glass@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Medical Director	Associate Medical Director	Dr.	Darden	Barry		2052206605					James.Darden@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Medicare Compliance Officer	Manager Corporate Compliance	Mr.	Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Medicare Coordinator	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacist		Anderson	Ally		8554570763					partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/23/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Medication Therapy Management Contact	VP Pharmacy Services		Cale	Dorinda		2052202655					dcale@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	OffShore Subcontractor Contact	Senior Compliance Analyst		Richardson	Misty		2052204366					misty.richardson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35243	01/10/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Online Enrollment Center Contact (Back-up)	Sr. Business Analyst		Johnson	Geraldine		2052206077					gejohnson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Online Enrollment Center Contact (Optional)	Manager Enrollment Service		Sexton	Missy		2052207276					Melissa.Sexton@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/18/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Online Enrollment Center Contact (Primary)	Sr Business Analyst		Hurst	Terri		2052202695					Terri.Hurst@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Part C Application Contact	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Part C Reporting Contact	Senior Compliance Analyst		Parham	Andrea		2052207206					aparham@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	11/10/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Part D Appeals	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	8006936651				PPO - BBA		C	Atlanta
H1347	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936651	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	06/13/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	8006936703				PPO - BBA		C	Atlanta
H1347	Part D Application Contact	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Part D Benefits Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558					Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Part D Claims Submission Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558					Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Part D Exceptions Contact	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	8006936651				PPO - BBA		C	Atlanta
H1347	Part D Exceptions Contact (Secondary)	Pharmacy Services Manager		Matthews	Ginny							Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	2052206558				PPO - BBA		C	Atlanta
H1347	Part D Price File Contact (Back-up)	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593				2052202939	Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Part D Price File Contact (Optional)	Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Part D Price File Contact (Primary)	Pharmacy Services Mgr		Matthews	Ginny		2052206558				2057337486	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Part D Quality Assurance Contact	MAQM Clinical Analyst		Davis	Janice		2052204066					jddavis@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Part D Reporting Contact	Senior Compliance Analyst		Parham	Andrea		2052207206					aparham@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	11/10/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Patient Safety Contact	VP Pharmacy Services		Cale	Dorinda		2052202655				2052208739	dcale@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Payment Contact	VP Controller		DeLawrence	Jennifer		2052207282					JDeLawrence@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Pharmacy Director	VP Pharmacy Services		Cale	Dorinda		2052202655					dcale@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Pharmacy Network Management Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558				2054034052	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Pharmacy Network Management Contact (Secondary)	VP Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Pharmacy Technical Help Desk Contact	Pharmacy Services Mgr		Matthews	Ginny							Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	8778788668				PPO - BBA		C	Atlanta
H1347	Pharmacy Technical Help Desk Contact (Secondary)	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active	8778788668				PPO - BBA		C	Atlanta
H1347	Physician Incentive Contact	SVP Health Care Networks		Weaver	Darrel		2052207007					darrel.weaver@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/21/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Plan Directory Contact for Public Website	Manager Claims Operations		Corley	Jeff		8005176425					jcorley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Plan to Plan Reconciliation Contact	Sr. Analyst-Cash Management		Buford	Julie		2052207316					julie.buford@bcbsal.org	450 Riverchase Parkway		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Processor Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558				2052208739	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Quality Contact	Quality Improvement Manager		Chancy	Cortney		2052207251					Brooke.Kendrick@BCBSAL.ORG	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Reconciliation Contact	Manager Financial Accounting		Williamson	Amanda		2052207289					Amanda.Williamson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Reconciliation Contact (Secondary)	Sr. Accountant		Lambert	Christophe		2052206593				2052202795	CLambert@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Recovery Audit Contact	Manager Corporate Compliance	Mr.	Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Surveillance Contact	Consumer Sales Manager		Carter	Brent		2052207681					bcarter@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	System Contact	Manager Corporate Compliance		Gregg	Roger		2052207480					RGregg@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Third Party Administrator (TPA) Liaison	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	User Access Contact	Regulatory Compliance Manager		O'Dell	Laney		2052206655					laney.odell@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Utilization Management Contact	Health Management Unit Mgr		Wadsworth	Bonita		2052207437					bwadsworth@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1347	Utilization Review Contact	Health Management Unit Mgr		Wadsworth	Bonita		2052207437					bwadsworth@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/16/2022	2023	PATRIUS HEALTH INC	Local CCP	Patrius Health	Local PPO		BlueCross BlueShield of Alabama	32	Yes	Active					PPO - BBA		C	Atlanta
H1350	Agent/Broker Compensation Data Contact	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Automated TrOOP Balance Transfer Contact	Quality Improvement Performance Specialist		Kober	Ashley		9862243495					ashley.kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Backup User Access Contact	Clinical Pharmacist		Hymel	Matthew		9862245786					Matthew.Hymel@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Best Available Evidence Contact	MA EBS Supervisor Service Operations		Sherman	Missy		9862243236					Missy.Sherman@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Bid Audit Contact	Compliance Director, Medicare Compliance Officer		Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Bid Audit Site Contact	Compliance Director, Medicare Compliance Officer		Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Bid Primary Contact	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	CAP Report Contact for Public Website	Compliance Director, Medicare Compliance Officer		Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	CEO - CMS Administrator Contact	President and CEO	Ms.	Maher	Charlene		9862243440					charlene.maher@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	CEO - Senior Official for Contracting	President and CEO	Ms.	Maher	Charlene		9862243440					charlene.maher@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Chief Financial Officer	Vice President and CFO	Mr.	Ward	David		9862243438					dave.ward@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Chief Operating Officer	Chief Risk and Continuity Officer	Ms	Reardon	Valerie		9862243922					Valerie.Reardon@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Chief Information Officer	SR VP IT Services and CIO	Mr.	Sonalkar	Sameer		9862246363					sameer.sonalkar@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Chief Information Security Officer	SR VP IT Services and CIO	Mr.	Sonalkar	Sameer		9862246363					sameer.sonalkar@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	CMS Casework Communication Contact	Manager  Grievances & Appeals		Aharoni	Michelle		9862246604					michelle.aharoni@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Complaints Tracking Contact	Manager Grievances & Appeals		Aharoni	Michelle		9862246604					michelle.aharoni@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Contact for Fraud Investigations	Manager SIU		Wright	Karen		9862243929					karen.wright@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Coordination of Benefits Contact			Service	Customer		2083958200					macs@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Corporate Mailing						9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Services Supervisor		Hayes	Shannon		9862243529					shannon.hayes@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Customer Service Operations Contact	Director ASO Operations		Davis	Natasha		9862246973					natasha.davis@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	DIR Contact	Supervisor, Healthcare Analytics		Smith	Shawn		9862243720					Shawn.Smith@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	DIR Contact (Secondary)	Gov't Funding Operations Director		Hannum	Leah		9862246826					leah.hannum@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Emergency Part D Contact	VP, Pharmacy Management		Olson	Steve		9862243308					Steve.Olson@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Emergency Part D Contact (Secondary)	Clinical Pharmacist Manager		Bohan	Jefferson		5705949198					jefferson.bohan@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Encounter Data & Risk Adjustment Operations Contact			Hannum	Leah		9862246826					leah.hannum@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Enrollment Contact	Director, Enrollment and Billing Services		Jostsons	Eric		9862244453					eric.jostsons@bcidaho.com	3000 E Pine St		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	EOB Transfer Contact	Claims Manager		Curtis	Laura		9862243192				2083317451	laura.curtis@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Financial Audit Contact	Compliance Director, Medicare Compliance Officer	Ms.	Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Financial Reporting Contact	Manager Financial Reporting		Gale	Alison		9862244004					alison.gale@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Formulary Contact	Director Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	3080 Bristol Street		Costa Mesa	CA	92626	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Formulary Contact (Secondary)	Quality Improvement Performance Specialist		Kober	Ashley		9862243495					ashley.kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	General Contact	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Government Relations Contact	Compliance Director, Medicare Compliance Officer		Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	HIPAA Privacy Officer	Mgr Information Privacy		Maciejewski	Karen		9862243987					karen.maciejewski@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	HIPAA Security Officer	Mgr Information Privacy		Maciejewski	Karen		9862243987					karen.maciejewski@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Hospice Contact	Clinical Pharmacist Manager		Bohan	Jefferson		9862243708					jefferson.bohan@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Interoperability Contact	Compliance Director, Medicare Compliance Officer		Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	MA Appeals/Grievances Contact	Manager Grievances & Appeals		Aharoni	Michelle		9862246604					michelle.aharoni@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	MA Claims Processing Contact for Public Website	Medicare Advantage Provider Support		Support	Provider		8664822250				2083876811	csproviderinquiries@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Marketing Contact	Program Coordinator		Joyce	Ken		9862243507					ken.joyce@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Medical Director	Chief Medical Officer		Kizilos	Melissa		9862244425					melissa.kizilos@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/27/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Medicare Compliance Officer	Compliance Director, Medicare Compliance Officer	Ms.	Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Medicare Coordinator	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist Manager		Bohan	Jefferson		9862243708					jefferson.bohan@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Medication Therapy Management Contact	Clinical Pharmacist		Bohan	Jefferson		9862243708					jefferson.bohan@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	OffShore Subcontractor Contact	Compliance Director, Medicare Compliance Officer		Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Online Enrollment Center Contact (Back-up)	Director, Enrollment and Billing Services		Jostsons	Eric		9862244453					eric.jostsons@bcidaho.com	3000 E Pine St		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Online Enrollment Center Contact (Optional)	Enrollment Specialist		Davis	Brenda		9862245066					brenda.davis@bcidaho.com	3000 E Pine St		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Online Enrollment Center Contact (Primary)	MA EBS Supervisor Service Operations		Sherman	Missy		9862243236					Missy.Sherman@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Part C Application Contact	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Part C Reporting Contact	Compliance Specialist Sr		Shade	Shannon		9862243727					shannon.shade@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Appeals	Clinical Pharmacist Senior		Casals	Karla							RxGrievanceandAppeals@carelon.com	9250 West Flagler Street	6th Floor	Miami	FL	33174	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active	3058127134				HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Appeals Contact (Secondary)	Quality Improvement Performance Specialist		Kober	Ashley							ashley.kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active	9862243495				HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Application Contact	Director Medicare Markets		Scoresby	Royce		9862244650					royce.scoresby@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Benefits Contact	Clinical Pharmacist		Bohan	Jefferson		9862243708					jefferson.bohan@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Claims Submission Contact			Service	Customer		8884942583					macs@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Exceptions Contact	VP Member and Provider Experience		Rothman	Alana							alana.rothman@ingenio-rx.com	6763 Strifler Place		Cincinnati	OH	45243	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active	5133363352				HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Exceptions Contact (Secondary)	Pharmacy Management Director		Olson	Steve							Steve.Olson@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active	9862245088				HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Price File Contact (Back-up)	Business Change Manager		Nicholson-Sampson	Amanda		8503190159					amanda.nicholson-sampson@carelon.com	2716 Brewer St.		Lakewood	CA	90712	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Price File Contact (Optional)	Business Change Manager		Mendez	Daniela		3232193390					daniela.mendez@carelon.com	1723 Loma Rd		Montebello	CA	90640	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Price File Contact (Primary)	Quality Improvement Performance Specialist		Kober	Ashley		9862243495					Ashley.Kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Quality Assurance Contact	Quality Improvement Performance Specialist		Kober	Ashley		9862243495					ashley.kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Part D Reporting Contact	Compliance Specialist Sr		Shade	Shannon		9862243727					shannon.shade@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Patient Safety Contact	Pharmacy Clinical Reviewer Sr		Reynolds	Dina		9862245105					dina.reynolds@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Payment Contact	Manager Financial Reporting		Gale	Alison		9862244004					alison.gale@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Pharmacy Director	VP, Pharmacy Management		Olson	Steve		9862243308					Steve.Olson@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Pharmacy Network Management Contact	Director Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Pharmacy Network Management Contact (Secondary)	VP, Pharmacy Management		Olson	Steve		9862243308					steve.olson@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Pharmacy Technical Help Desk Contact	Director Pharmacy Oversight		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Seattle
H1350	Pharmacy Technical Help Desk Contact (Secondary)	Quality Improvement Performance Specialist		Kober	Ashley							ashley.kober@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active	9862243495				HMO - Health Maintenance Organization		C	Seattle
H1350	Physician Incentive Contact	VP Provider Network Management		Worley	John		9862245585					john.worley@bcidaho.com	3000 E Pine Ave		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Plan Directory Contact for Public Website			Service	Customer		2083958200					macs@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Plan to Plan Reconciliation Contact	Quality Improvement Performance Specialist		Kober	Ashley		9862243495					ashley.kober@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Processor Contact			Service	Customer		2083958200					macs@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Quality Contact	Manager, Quality Management		Gries	Katie		9862244756					katie.gries@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Reconciliation Contact	Supervisor Health Data Analysis		Smith	Shawn		9862243720					Shawn.Smith@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Reconciliation Contact (Secondary)	Gov't Funding Operations Director		Hannum	Leah		9862246826					leah.hannum@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Recovery Audit Contact	Compliance Director, Medicare Compliance Officer	Ms.	Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	SNP Application Contact	Dual Eligible Program Director		Robertson	Jenny		9862245094					jenny.robertson@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Surveillance Contact	Compliance Director, Medicare Compliance Officer		Martin	Julie		9862245030					julie.martin@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	System Contact	Sr IT Operations Analyst		Reichert	Dean		9862243084					dean.reichert@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Third Party Administrator (TPA) Liaison	Supervisor Accounting Services		Hayes	Shannon		9862243529					shannon.hayes@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	06/02/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	User Access Contact	Sr Compliance Specialist		Schwartz	Leanne		9862243984					leanne.schwartz@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/31/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Utilization Management Contact	VP, Healthcare Operations		Bloomer	Marissa		9862244445					marissa.bloomer@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/27/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1350	Utilization Review Contact	VP, Healthcare Operations		Bloomer	Marissa		9862244445					marissa.bloomer@bcidaho.com	3000 E. Pine Ave.		Meridian	ID	83642	07/27/2023	2023	BLUE CROSS OF IDAHO CARE PLUS, INC.	Local CCP	Blue Cross of Idaho	HMO/HMOPOS		Blue Cross of Idaho Health Service, Inc.	29	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1352	Agent/Broker Compensation Data Contact			Ray	Miles		8163952906					Miles.Ray@BlueKC.com	2301 Main St		Kansas City	MO	64108	05/10/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Automated TrOOP Balance Transfer Contact	Manager, Business Process		Diaz	Mario		7143172628					mario.diaz@optum.com	2300 Main St.		Irvine	CA	92614	04/03/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Backup User Access Contact			Muncy	Angela		8163953648					angela.muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	01/04/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Best Available Evidence Contact	Director of Operations		Power	Donna		8163953259					Donna.Power@bluekc.com	2301 Main St		Kansas City	MO	64108	10/01/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Bid Audit Contact			Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Bid Audit Site Contact			Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Bid Primary Contact			Muncy	Angela		8163953648					angela.muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	CAP Report Contact for Public Website			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	CEO - CMS Administrator Contact		Dr	Sweat	Greg		8163601040					greg.sweat@bluekc.com	2301 Main St		Kansas City	MO	64108	02/07/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	CEO - Senior Official for Contracting		Dr	Sweat	Greg		8163601040					greg.sweat@bluekc.com	2301 Main Street		Kansas City	MO	64108	02/07/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Chief Financial Officer		Mr.	Bowling	Philip		8163953885					Philip.Bowling@BlueKC.com	2301 Main Street		Kansas City	MO	64108	04/04/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Chief Operating Officer		Mrs.	Rund	Lori		8163952748					Lori.Rund@BlueKC.com	2301 Main Street		Kansas City	MO	64108	11/27/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Chief Information Officer		Mr.	Chowdhury	Bhaskar		8163953137					Bhaskar.Chowdhury@bluekc.com	2301 Main Street		Kansas City	MO	64108	08/11/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Chief Information Security Officer		Mr.	McAdams	Scott		8163953650					Scott.McAdams@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/15/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	CMS Casework Communication Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Complaints Tracking Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Contact for Fraud Investigations			Heath	Ashlee		8163953443					Ashlee.Heath@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Coordination of Benefits Contact			Phillips	Denise		8163952032					_MSP_COB@BlueKC.com	2301 Main Street		Kansas City	MO	64108	05/10/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Corporate Mailing						8889898842					customerservice@bluekcma.com	2301 Main Street		Kansas City	MO	64108	04/22/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant, Lead		Bresee	Mickey		8163953145					mickey.bresee@bluekc.com	2301 Main Street	ATTN: Finance	Kansas City	MO	64108	01/25/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Customer Service Operations Contact	Director of Operations		Power	Donna		8163953259					Donna.Power@bluekc.com	2301 Main St		Kansas City	MO	64108	10/01/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	DIR Contact			McMeen	Kera		8163952269					MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	08/02/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	DIR Contact (Secondary)			Muncy	Angela		8163953648					angela.muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Electronic Health Record Contact			Haynes	Elizabeth		8163952170					elizabeth.haynes@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Emergency Part D Contact		Mrs.	Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	08/11/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Emergency Part D Contact (Secondary)			McMenus	Cindy		8163952226					Cindy.McMenus@BlueKC.com	2301 Main Street		Kansas City	MO	64108	01/05/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Employer Waiver Contact			Muncy	Angela		8163953648					angela.muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Encounter Data & Risk Adjustment Operations Contact			Haynes	Elizabeth		8163952170					Elizabeth.Haynes@bluekc.com	2301 Main Street		Kansas City	MO	64108	08/29/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Enrollment Contact	Director of Operations		Power	Donna		8163953259					Donna.Power@bluekc.com	2301 Main St		Kansas City	MO	64108	10/01/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	EOB Transfer Contact	DVP, Operations		McComb	Michael		8163952751				8775491746	michael.mccomb@bluekc.com	2301 Main Street		Kansas City	MO	64108	12/31/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Financial Audit Contact	Medicare Advantage Compliance Officer	Mrs.	Muncy	Angela		8163953648					angela.muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	01/04/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Financial Reporting Contact			Smith	Jenny		8163952635					Jenny.Smith@bluekc.com	2301 Main Street		Kansas City	MO	64108	04/26/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Formulary Contact			Maloney	Julia		2242312718					Julia.Maloney@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/11/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Formulary Contact (Secondary)			McMenus	Cindy		8163952226					_MA_PartD@Bluekc.com	2301 Main Street		Kansas City	MO	64108	08/24/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	General Contact		Mrs.	Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/03/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Government Relations Contact			Hoey	Yen		8163953664					yen.hoey@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/03/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	HIPAA Privacy Officer		Mr.	McAdams	Scott		8163953650					Scott.McAdams@BlueKC.com	2301 Main Street		Kansas City	MO	64108	01/05/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	HIPAA Security Officer		Mr.	McAdams	Scott		8163953650					Scott.McAdams@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/15/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Hospice Contact			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Interoperability Contact	Director, Information Governance		Grace	Karen		8163952008					Karen.Grace@bluekc.com	2301 Main Street		Kansas City	MO	64108	11/03/2021	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	MA Appeals/Grievances Contact	Medicare Advantage Compliance Officer		Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	05/10/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	MA Claims Processing Contact for Public Website			McComb	Michael		8163952751					customerservice@bluekcma.com	2301 Main Street		Kansas City	MO	64108	12/31/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Marketing Contact	Manager, Government Programs Marketing	Mrs.	Sutton	Angie		8163952160					Angie.Sutton@bluekc.com	2301 Main Street		Kansas City	MO	64108	05/10/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Medical Director		Dr.	Barbour	Linda		8163952884					Linda.Barbour@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/27/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Medicare Compliance Officer		Mrs.	Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Medicare Coordinator		Mrs.	Rund	Lori		8163952748					Lori.Rund@BlueKC.com	2301 Main Street		Kansas City	MO	64108	01/06/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Medicare Part D Opioid Overutilization Contact			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Medication Therapy Management Contact			Liaqat	Tazeen		2242312290					tazeen.liaqat@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/03/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	OffShore Subcontractor Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Online Enrollment Center Contact (Back-up)			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Online Enrollment Center Contact (Optional)			Hoey	Yen		8163953664					yen.hoey@bluekc.com	2301 Main Street		Kansas City	MO	64108	10/01/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Online Enrollment Center Contact (Primary)	Director of Operations		Power	Donna		8163953259					Donna.Power@bluekc.com	2301 Main St		Kansas City	MO	64108	10/01/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Part C Application Contact			Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Part C Reporting Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Appeals	Manager, Prior Authorization		Bricker	Bryce							bryce.m.bricker@optum.com	9040 S. Rita Rd		Tucson	AZ	85747	01/08/2021	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active	8445694142				HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Appeals Contact (Secondary)			McMenus	Cindy							_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active	8665087140				HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Application Contact			Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Benefits Contact			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Claims Submission Contact			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Exceptions Contact			Bricker	Bryce							bryce.m.bricker@optum.com	9040 S. Rita Rd		Tucson	AZ	85747	04/03/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active	8445694142				HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Exceptions Contact (Secondary)			Campbell	Anna							Anna.Campbell@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/03/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active	4079276161				HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Price File Contact (Back-up)			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Price File Contact (Optional)			Rx	Optum		6514955363					medops_planfinder@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	10/03/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Price File Contact (Primary)			Kim	Kevin		7633617996					medops_planfinder@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/03/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Quality Assurance Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Part D Reporting Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Patient Safety Contact			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Payment Contact		Mrs.	Rund	Lori		8163952748					Lori.Rund@BlueKC.com	2301 Main Street		Kansas City	MO	64108	02/15/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Pharmacy Director			McMenus	Cindy		8163952226					Cindy.McMenus@BlueKC.com	2301 Main Street		Kansas City	MO	64108	06/17/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Pharmacy Network Management Contact			Hagan	Kyle		3039895828					kyle.hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	12/31/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Pharmacy Network Management Contact (Secondary)			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk		Summers	Todd							todd.summers@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	06/23/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active	8445694142				HMO - Health Maintenance Organization		C	Kansas City
H1352	Plan Directory Contact for Public Website			Service	Customer		8665087140					customerservice@bluekcma.com	2301 Main St		Kansas City	MO	64108	12/31/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Plan to Plan Reconciliation Contact	Accountant, Lead		Bresee	Mickey		8163953145					_P2P_Report@bluekc.com	2301 Main Street	ATTN: P2P Department	Kansas City	MO	64108	08/22/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Processor Contact			Cassata	Mercedes		6307809152					mercedes.cassata@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	12/31/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Quality Contact			Haynes	Elizabeth		8163952170					Elizabeth.Haynes@bluekc.com	2301 Main Street		Kansas City	MO	64108	08/11/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Reconciliation Contact		Mrs.	Rund	Lori		8163952748					Lori.Rund@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/31/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Reconciliation Contact (Secondary)			Galande	Anant		8163952507					Anant.Galande@bluekc.com	2301 Main Street		Kansas City	MO	64108	04/03/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Recovery Audit Contact	Medicare Advantage Compliance Officer	Mrs.	Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	01/04/2019	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Surveillance Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	System Contact		Mr.	Chowdhury	Bhaskar		8163953137					Bhaskar.Chowdhury@bluekc.com	2301 Main Street		Kansas City	MO	64108	08/11/2022	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Third Party Administrator (TPA) Liaison			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	User Access Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Utilization Management Contact		Dr.	Barbour	Linda		8163952884					Linda.Barbour@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/27/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1352	Utilization Review Contact		Dr.	Barbour	Linda		8163952884					Linda.Barbour@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/27/2020	2023	BLUE-ADVANTAGE PLUS OF KANSAS CITY, INC.	Local CCP	Blue Medicare Advantage	HMO/HMOPOS		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1353	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/15/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/15/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/15/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/15/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H1353	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/15/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H1353	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449089				HMO - Health Maintenance Organization		C	Dallas
H1353	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/15/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1353	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF WASHINGTON, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1357	Automated TrOOP Balance Transfer Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Backup User Access Contact	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Best Available Evidence Contact	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Bid Primary Contact	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	CAP Report Contact for Public Website	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active	8332234476				PACE - Nat		C	Atlanta
H1357	CEO - CMS Administrator Contact	Chief Operating Officer	Ms	Reimann	Aimee		3367463500				3367463565	areimann@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	CEO - Senior Official for Contracting	Chief Operating Officer	Ms	Reimann	Aimee		3367463500				3367463565	areimann@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Chief Financial Officer	Chief Financial Officer	Ms.	Jones	Tammy		8284658007				8284658015	tjones@EveryAge.org	100 Leonard Ave		Newton	NC	28658	02/01/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Chief Operating Officer	Senior Director Home and Community Services	Ms.	Chang	Thomas		3367463519				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/27/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Chief Information Officer	IT Director	Mr.	Larew	Brantley		8284658022				8284658537	blarew@EveryAge.org	100 Leonard Ave		Newton	NC	28658	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Chief Information Security Officer	IT Director	Mr.	Larew	Brantley		8284658022				8284658537	blarew@EveryAge.org	100 Leonard Ave		Newton	NC	28658	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	CMS Casework Communication Contact	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Complaints Tracking Contact	Quality Compliance Coordinator	Ms.	Pennington	Danielle		3367463513				3367463523	dpennington@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Contact for Fraud Investigations	Chief Compliance Officer	Ms.	Roseman	Michelle		8284658022				8284658537	mroseman@EveryAge.org	100 Leonard Ave		Newton	NC	28658	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Coordination of Benefits Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Corporate Mailing						8284658017				8284658015	tchang@EveryAge.org	100 Leonard Ave		Newton	NC	28658	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Coverage Gap Discount Program (CGDP) Payment Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Customer Service Operations Contact	Quality Compliance Coordinator	Ms.	Pennington	Danielle		3367463513				3367463523	dpennington@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	DIR Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	DIR Contact (Secondary)	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Emergency Part D Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Emergency Part D Contact (Secondary)	Executive Director	Mr.	Chang	Thomas		3367463519					tchang@everyage.org	802 E. Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Encounter Data & Risk Adjustment Operations Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Enrollment Contact	Marketing Coordinator	Ms.	Curry	Summer		3367463512				3367463565	sucurry@everyage.org	802 East Center Street		Lexington	NC	27292	04/18/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	EOB Transfer Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Financial Audit Contact	Chief Financial Officer	Mr.	Jones	Tammy		8284658007				8284658015	tjones@EveryAge.org	100 Leonard Ave		Newton	NC	28658	02/01/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Financial Reporting Contact	Chief Financial Officer	Mr.	Jones	Tammy		8284658007				8284658015	tjones@EveryAge.org	100 Leonard Ave		Newton	NC	28658	02/01/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Formulary Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Formulary Contact (Secondary)	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	General Contact	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Government Relations Contact	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	HIPAA Privacy Officer	Quality Compliance Coordinator	Ms.	Pennington	Danielle		3367463513				3367463523	dpennington@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	HIPAA Security Officer	Quality Compliance Coordinator	Ms.	Pennington	Danielle		3367463513				3367463523	dpennington@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Interoperability Contact	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	MA Appeals/Grievances Contact	Quality Compliance Coordinator	Ms.	Pennington	Danielle		3367463513				3367463523	dpennington@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	MA Claims Processing Contact for Public Website	Accounting Coordinator	Ms.	Henderson	Dee		3367463500				3367463565	dhenderson@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Marketing Contact	Marketing Coordinator	Ms.	Archible-Harris	Jasmin		3367463512				3367463523	jarchibleharris@uchas.org	802 East Center Street		Lexington	NC	27292	09/03/2019	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Medical Director	Medical Director	Dr.	Roddy	David		3367463500				3367463526	droddy@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Medicare Compliance Officer	Quality Compliance Coordinator	Ms.	Pennington	Danielle		3367463513				3367463523	dpennington@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Medicare Coordinator	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Roddy	David		3367463500				3367463526	droddy@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Medication Therapy Management Contact	Medical Director	Dr.	Roddy	David		3367463500				3367463526	droddy@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Online Enrollment Center Contact (Back-up)	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Online Enrollment Center Contact (Optional)		Ms.	Tahirkheli	Kimberly		3367463500					ktahirkheli@EveryAge.org	802 E. Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Online Enrollment Center Contact (Primary)	Marketing Coordinator	Ms.	Curry	Summer		3367463512				3367463565	sucurry@everyage.org	802 East Center Street		Lexington	NC	27292	04/18/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Part C Application Contact	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Part D Appeals	Quality Compliance Coordinator	Ms.	Pennington	Danielle						3367463523	dpennington@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active	8332234476				PACE - Nat		C	Atlanta
H1357	Part D Application Contact	Executive Director	Mr.	Chang	Thomas		3367463519				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Part D Benefits Contact	Business Analyst	Mr.	Holt	Nick		3367463500				3367463565	nickholt@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Part D Claims Submission Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Part D Exceptions Contact	Executive Director	Mr.	Chang	Thomas						3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active	8332234476				PACE - Nat		C	Atlanta
H1357	Part D Exceptions Contact (Secondary)	Business Office Team Lead	Ms.	Stormer	Kristen						3367463565	kstormer@EVERYAGE.org	802 East Center Street		Lexington	NC	27292	02/01/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active	8332234476				PACE - Nat		C	Atlanta
H1357	Part D Price File Contact (Back-up)	Business Analyst	Mr.	Holt	Nick		3363006661				3367463565	nickholt@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Part D Price File Contact (Optional)	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Part D Price File Contact (Primary)	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		802 E. Center Street	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Part D Quality Assurance Contact	Quality Compliance Coordinator	Ms.	Pennington	Danielle		3367463513				3367463523	dpennington@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Part D Reporting Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Patient Safety Contact	Quality Compliance Coordinator	Ms.	Pennington	Danielle		3367463513				3367463523	dpennington@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Payment Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Personal Health Record Contact	Quality Compliance Coordinator	Ms.	Pennington	Danielle		3367463513				3367463523	dpennington@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Pharmacy Director	Medical Director	Dr.	Roddy	David		3367463500				3367463526	droddy@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Pharmacy Network Management Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Pharmacy Network Management Contact (Secondary)	Business Analyst	Mr.	Holt	Nick		3367463500				3367463565	nickholt@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Pharmacy Technical Help Desk Contact	Executive Director	Mr.	Chang	Thomas						3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active	8332234476				PACE - Nat		C	Atlanta
H1357	Pharmacy Technical Help Desk Contact (Secondary)	Business Analyst	Mr.	Holt	Nick						3367463565	nickholt@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active	8332234476				PACE - Nat		C	Atlanta
H1357	PHR Beneficiary Contact																	01/04/2019	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE	Carolina SeniorCare	EveryAge	797	Yes	Active	8332234476				PACE - Nat		C	Atlanta
H1357	Plan Directory Contact for Public Website	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Plan to Plan Reconciliation Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Processor Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Quality Contact	Quality Compliance Coordinator	Ms.	Pennington	Danielle		3367463513				3367463523	dpennington@EveryAge.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Reconciliation Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Reconciliation Contact (Secondary)	Executive Director	Mr.	Chang	Thomas		3367463519				3367463565	tchang@everyage.org	802 East Center Street		Lexington	NC	27292	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Recovery Audit Contact	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Surveillance Contact	Executive Director	Mr.	Chang	Thomas		3367463500				3367463565	tchang@EveryAge.org	802 East Center Street		Lexington	NC	27292	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	System Contact	IT Director	Mr.	Larew	Brantley		8284658022				8284658537	blarew@EveryAge.org	100 Leonard Ave		Newton	NC	28658	08/26/2021	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Third Party Administrator (TPA) Liaison	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	User Access Contact	IT Director	Mr.	Larew	Brantley		8284658022				8284658537	blarew@EveryAge.org	100 Leonard Ave		Newton	NC	28658	04/05/2022	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Utilization Management Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1357	Utilization Review Contact	Business Office Team Lead	Mrs.	Kimbrell	Lindsay		3367463547				3367463565	lkimbrell@everyage.org	802 East Center Street		Lexington	NC	27292	06/15/2023	2023	CAROLINA SENIORCARE	National PACE	Carolina SeniorCare	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H1360	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H1360	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H1360	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H1360	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H1360	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1360	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1365	Agent/Broker Compensation Data Contact	Director, Medicare Sales		Cestaro	Connor		2077313136					connor.cestaro@martinspoin.org	P.O. Box 9746	891 Washington Ave.	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Backup User Access Contact	Interim CISO		Baker	Brandon		2077769821					brandon.baker@martinspoint.org	331 Veranda Street		Portland	ME	04014	08/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Best Available Evidence Contact	Manager, Member Operations		Whelan	James		2072742738					james.whelan@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	12/08/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Bid Audit Contact	VP, Health Plan Products		Orlando	Matt		2072536192					matthew.orlando@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	06/07/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Bid Audit Site Contact	VP, Health Plan Products		Orlando	Matt		2072536192					matthew.orlando@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	06/07/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Bid Primary Contact	VP, Health Plan Products		Orlando	Matt		2072536192					matthew.orlando@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	06/07/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	CAP Report Contact for Public Website	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04101	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	CEO - CMS Administrator Contact	President and Chief Executive Officer	Dr.	Kasuba	Paul		2077913710					paul.kasuba@martinspoint.org	331 Veranda Street	P. O.  Box 9746	Portland	ME	04104	01/03/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	CEO - Senior Official for Contracting	President and Chief Executive Officer	Dr.	Kasuba	Paul		2077913710					paul.kasuba@martinspoint.org	331 Veranda Street	P. O.  Box 9746	Portland	ME	04104	05/31/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Chief Financial Officer	Chief Financial Officer	Ms	Jackson	Amanda		2072536115					amanda.jackson@martinspoint.org	331 Veranda Street	P. O.  Box 9746	Portland	ME	04104	06/25/2020	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Chief Operating Officer	Chief Operating Officer	Ms	Di Re	Bernadette		2077913860					bernadette.dire@martinspoint.org	331 Veranda Street	P. O.  Box 9746	Portland	ME	04104	04/15/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Chief Information Officer	VP Information Technology	Ms	Downs	Amie		2072536184					amie.downs@martinspoint.org	331 Veranda Street		Portland	ME	04104	08/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Chief Information Security Officer	Interim CISO	Mr	Baker	Brandon		2077769821					brandon.baker@martinspoint.org	331 Veranda Street		Portland	ME	04014	08/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	CMS Casework Communication Contact	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Complaints Tracking Contact	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	PO Box 9746	331 Veranda Street	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Contact for Fraud Investigations	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	PO Box 9746	331 Veranda Street	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Coordination of Benefits Contact	Manager, Member Operations		Whelan	James		2072742738					james.whelan@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	04/07/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Corporate Mailing						2077913710					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04104	05/31/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant III		Allard	Kathleen		2078282490					kathleen.allard@martinspoint.org	P. O. Box 9746		Portland	ME	04104	08/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Customer Service Operations Contact	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04101	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	DIR Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/17/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	DIR Contact (Secondary)	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Emergency Part D Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	01/04/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Emergency Part D Contact (Secondary)	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	12/28/2020	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Encounter Data & Risk Adjustment Operations Contact			Hostetter	Andrew		2072536715					andrew.hostetter@martinspoint.org	PO Box 9746		Portland	ME	04104	08/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Enrollment Contact	Manager, Member Operations		Whelan	James		2072742738					james.whelan@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	12/08/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	EOB Transfer Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535				2072536202	elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Financial Audit Contact	MCO	Ms	Loomis	Elizabeth		5182290535				2078287845	elizabeth.loomis@martinspoint.org	P.O. Box 9746		Portland	ME	04104	09/28/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Financial Reporting Contact	Corporate Controller	Mr.	Evans	Warren		2072536204				2072536227	warren.evans@martinspoint.org	P.O. Box 9746		Portland	ME	04103	08/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Formulary Contact	Medicare Clinical Pharmacist		Brown	Nancy	J	4013333987	7941			8003730238	njbrown@pharmacare.com	695 George Washington Highway		Lincoln	RI	02865	02/11/2009	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Formulary Contact (Secondary)	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	General Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Government Relations Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	HIPAA Privacy Officer	Interim Privacy Officer		True	Erica		2077913848					erica.true@martinspoint.org	331 Veranda Street		Portland	ME	04104	08/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	HIPAA Security Officer	Interim CISO		Baker	Brandon		2077769821					brandon.baker@martinspoint.org	331 Veranda Street		Portland	ME	04104	08/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Hospice Contact	Senior Medicare Part D Specialist		Creighton-Galinas	Sheila		2078282471					sheila.creighton-galinas@martinspoint.org	891 Washington Ave	PO Box 9746	Portland	ME	041045040	02/05/2018	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Interoperability Contact			Reburn	Sarah		2072536966					sarah.reburn@martinspoint.org	PO Box 9746		Portland	ME	04104	04/18/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	MA Appeals/Grievances Contact	Member Operations Manager		Whelan	James		2072742738					james.whelan@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	09/29/2020	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	MA Claims Processing Contact for Public Website	Director, Provider Operations		Turkewitz	Todd		2072742718					todd.turkewitz@martinspoint.org	P.O. Box 9746	891 Washington Avenue	Portland	ME	04104	02/05/2018	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Marketing Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Medical Director	Physician & Health Plan Programs Medical Director	Dr.	Wesolowski	Martin		2076994759					martin.wesolowski@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04104	02/05/2018	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Medicare Compliance Officer	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Medicare Coordinator	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	02/15/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Medication Therapy Management Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Online Enrollment Center Contact (Back-up)	Supervisor Enrollment and Premium Biling		Whelan	James		2072742738					james.whelan@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	12/19/2019	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Online Enrollment Center Contact (Optional)	Director Member Engagement		Reburn	Sarah		2072536966					sarah.reburn@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	12/19/2019	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Online Enrollment Center Contact (Primary)	Systems Analyst, Enrollment		Tucker	Thad		2072536398					thad.tucker@martinspoint.org	P.O. Box 9746	891 Washington Ave.	Portland	ME	04104	05/23/2009	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Part C Application Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	12/23/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Part C Reporting Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Part D Appeals			Representative	Appeals							appealsmedicare@caremark.com	CVS Caremark	9501 E. Shea Blvd. MC 109	Scottsdale	AZ	85260	02/15/2011	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active	8668849479				PPO - BBA		C	New York
H1365	Part D Appeals Contact (Secondary)	Manager, Pharmacy Operations		Theriault	Anne							anne.theriault@martinspoint.org	PO Box 9746	891 Washington Ave.	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active	2077663144				PPO - BBA		C	New York
H1365	Part D Application Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	12/23/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Part D Benefits Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Part D Claims Submission Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Part D Exceptions Contact	Appeals Representative		Representative	Appeals							appealsmedicare@caremark.com	CVS Caremark	9501 E. Shea Blvd MC 109	Scottsdale	AZ	85260	02/15/2011	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active	8688849479				PPO - BBA		C	New York
H1365	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Operations		Theriault	Anne							anne.theriault@martinspoint.org	PO Box 9746	891 Washington Ave.	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active	2077663144				PPO - BBA		C	New York
H1365	Part D Price File Contact (Back-up)	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Part D Price File Contact (Primary)	Medicare Operations		Loveland	Chet		4806064873					Chet.Loveland@CVSHealth.com	CVS Caremark	9501 E. Shea Blvd.	Scottsdale	AZ	85260	11/27/2019	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Part D Quality Assurance Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Part D Reporting Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Patient Safety Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Payment Contact	Corporate Controller		Evans	Warren		2072536204					warren.evans@martinspoint.org	P. O. Box 9746		Portland	ME	04104	08/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Pharmacy Director	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Pharmacy Network Management Contact	Director, Network Operations		Smith	Shawn		4803914844				4803146964	Shawn.Smith@caremark.com	CVS Caremark	9501 E. Shea Blvd. MC143	Scottsdale	AZ	85260	01/26/2015	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Pharmacy Technical Help Desk Contact	Manager, Vendor Management		Palmieri	Mike							mike.palmieri@caremark.com	CVS Caremark	2401 Cherahala Blvd. MC650	Knoxville	TN	37932	11/21/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active	8666934620				PPO - BBA		C	New York
H1365	Plan Directory Contact for Public Website	Director Compliance & MCO	Ms	Loomis	Elizabeth		8887327364					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	01/12/2017	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Plan to Plan Reconciliation Contact	Accountant II		Ayub	Rehema		2072536991					rehema.ayub@martinspoint.org	P. O. Box 9746	891 Washington Ave	Portland	ME	04103	06/15/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Processor Contact	Director, Provider Operations		Turkewitz	Todd		2072742718					todd.turkewitz@martinspoint.org	P.O. Box 9746	891 Washington Avenue	Portland	ME	04104	02/05/2018	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Quality Contact	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	PO Box 9746	331 Veranda Street	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Reconciliation Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Reconciliation Contact (Secondary)	Corporate Controller		Evans	Warren		2072536118					warren.evans@martinspoint.org	P. O. Box 9746		Portland	ME	04104	08/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Recovery Audit Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		8887327364					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	02/05/2018	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Surveillance Contact	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	System Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535				2072536922	elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Third Party Administrator (TPA) Liaison	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	05/11/2021	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	User Access Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	03/22/2022	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Utilization Management Contact	Director, Health Management		Howard	Tracy		2072536912					tracy.howard@martinspoint.org	P.O. Box 9746	891 Washington Avenue	Portland	ME	04104	11/08/2019	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1365	Utilization Review Contact	Director, Health Management		Howard	Tracy		2072536912					tracy.howard@martinspoint.org	P.O. Box 9746	891 Washington Avenue	Portland	ME	04104	10/22/2018	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	Local PPO		Martin's Point Health Care, Inc.	287	Yes	Active					PPO - BBA		C	New York
H1372	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	12/31/2019	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Backup User Access Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	10/31/2018	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	CAP Report Contact for Public Website			Kleckner	Patty		5037010202					patty.kleckner@agerightadvantage.com	4560 SE International Way	#100	Milwaukie	OR	97222	04/25/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	CEO - CMS Administrator Contact	CEO	ms	Brown	Jonalyn		9712062069					jbrown@agerightcs.com	4560 SE International Way #100		Milwaukie	OR	97222	03/28/2023	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	CEO - Senior Official for Contracting	CEO	ms	Brown	Jonalyn		9712062069					jbrown@agerightcs.com	4560 SE International Way #100		Milwaukie	OR	97222	03/28/2023	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Chief Financial Officer	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Chief Operating Officer	Chief Operating Officer	Ms.	Schaub	Lindsey		9712065179					lindsey.schaub@agerightadvantage.com	4560 SE International Way	Suite 100	Milwaukie	OR	97222	03/03/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Contact for Fraud Investigations			Kleckner	Patty		5037010202					patty.kleckner@agerightadvantage.com	4560 SE International Way	#100	Milwaukie	OR	97222	04/25/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/01/2019	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Corporate Mailing						8448546885				8005036095	customerservice@agerightadvantage.com	P.O. Box 4440		Glen Allen	VA	230584440	01/29/2017	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Encounter Data & Risk Adjustment Operations Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	10/31/2018	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	EOB Transfer Contact			Lowry	Kristy		8448546883				8003756496	customerservice@agerightadvantage.com	P.O. Box 2190		Glen Allen	VA	230582190	12/08/2019	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Financial Audit Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Financial Reporting Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	12/31/2019	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	General Contact			Brown	Jonalyn		9712062069					jbrown@agerightcs.com	4560 SE International Way #100		Milwaukie	OR	97222	03/28/2023	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Government Relations Contact			Brown	Jonalyn		9712062069					jbrown@agerightcs.com	4560 SE International Way #100		Milwaukie	OR	97222	03/28/2023	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	HIPAA Privacy Officer			Kleckner	Patty		5037010202					pkleckner@marquiscompanies.com	4560 SE International Way #100		Milwaukie	OR	97222	03/28/2023	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	HIPAA Security Officer		Ms.	Kleckner	Patty		5037010202					patty.kleckner@agerightadvantage.com	4560 SE International Way	#100	Milwaukie	OR	97222	04/25/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Medical Director	Medical Director		Gaskill	William		9712802993					wmgaskill@agerightcs.com	4560 SE International Way	Suite 100	Milwaukie	OR	97222	03/17/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Medicare Compliance Officer		Ms.	Kleckner	Patty		5037010202					compliance@agerightadvantage.com	4560 SE International Way	#100	Milwaukie	OR	97222	04/25/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Medicare Coordinator	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/03/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Part C Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Part C Reporting Contact			Rennie	Lynda		8043966383					lynda@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/06/2018	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/14/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	12/31/2019	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Payment Contact	CFO	Mr.	Ragland	Robert		8042663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Seattle
H1372	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Seattle
H1372	Physician Incentive Contact			Howells	Heather		8049215196					heather.howells@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/14/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Plan Directory Contact for Public Website			Sindlinger	Rocio		8448546885					rocio.sindlinger@allyalign.com	P.O. Box 2190		Glen Allen	VA	230582190	12/14/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Plan to Plan Reconciliation Contact	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/06/2017	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Quality Contact			Ferguson	Laura		8043966412					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/05/2018	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Reconciliation Contact			Lowry	Kristy		8042107991					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/08/2019	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Reconciliation Contact (Secondary)	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Recovery Audit Contact	Chief Compliance Officer	Ms.	Kleckner	Patty		5037010202					patty.kleckner@agerightadvantage.com	4560 SE International Way	Suite 100	Milwaukie	OR	97222	04/25/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Third Party Administrator (TPA) Liaison	Manager of Regulatory Accounting	Ms.	Weis	Katelyn		6073294042					kate.weis@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	User Access Contact		Ms.	Kleckner	Patty		5037010202					patty.kleckner@agerightadvantage.com	4560 SE International Way	#100	Milwaukie	OR	97222	04/25/2022	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/14/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1372	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/14/2021	2023	MARQUIS ADVANTAGE, INC.	Local CCP	AgeRight Advantage	HMO/HMOPOS		Marquis Companies I, Inc.	636	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1375	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H1375	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H1375	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H1375	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H1375	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1375	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/26/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF CALIFORNIA, INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H1395	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H1395	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	02/05/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/05/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/05/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Medical Director	Medical Director	Mr	Haake	Karl		9132951245					karl.haake@sunflowerhealthplan.com	77 West Wacker Drive, 14th Floor		Chicago	IL	60601	03/30/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Part C Application Contact		Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H1395	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H1395	Part D Application Contact		Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H1395	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H1395	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H1395	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H1395	PHR Beneficiary Contact																	09/27/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8338530864				PPO - BBA		C	Dallas
H1395	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Plan Directory Contact for Public Website			Services	Provider		8667960530					CorporateMedicareComplianceDept@Centene.com	1301 International Parkway,	Suite 400	Sunrise	FL	33323	03/31/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	SNP Application Contact		Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1395	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	NEBRASKA TOTAL CARE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1415	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Corporate Mailing						6155658100					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation	4805480643				HMO - Health Maintenance Organization		C	New York
H1415	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation	8609024668				HMO - Health Maintenance Organization		C	New York
H1415	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation	4805480643				HMO - Health Maintenance Organization		C	New York
H1415	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation	8609024668				HMO - Health Maintenance Organization		C	New York
H1415	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation	8009221557				HMO - Health Maintenance Organization		C	New York
H1415	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation	8603389867				HMO - Health Maintenance Organization		C	New York
H1415	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1415	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Consolidation					HMO - Health Maintenance Organization		C	New York
H1416	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Corporate Mailing						8132063477					crysten.troutman@wellcare.com	P. O. Box 31386		Tampa	FL	33631	10/02/2020	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/13/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/13/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/13/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/13/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Pharmacy Director	Chief Pharmacy Officer & President		Hungiville	Laura		8132065577					laura.hungiville@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H1416	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/13/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H1416	PHR Beneficiary Contact																	09/27/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H1416	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/13/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1416	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	HARMONY HEALTH PLAN,  INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1423	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	01/30/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/06/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	11/18/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	11/18/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	01/30/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/30/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/30/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Formulary Contact (Secondary)	Manager, Clinical Pharmacy Operations		Redfern	Andrea	G	2166401028					andrea.redfern@ingenio-rx.com	4931 Payson Way SE		Atlanta	GA	30339	11/14/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/30/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H1423	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H1423	PHR Beneficiary Contact																	01/30/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H1423	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/06/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/30/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1423	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/30/2020	2023	AMERIGROUP OHIO, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1426	Agent/Broker Compensation Data Contact	Manager, Sales Operations	Mr.	Demos	John		6174260600					jdemos@commonwealthcare.org	30 Winter Street		Boston	MA	02108	04/22/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Automated TrOOP Balance Transfer Contact	Program Manager		Rivera-Aquino	Denisse		8582915269					Denisse.Rivera-Aquino@Medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Backup User Access Contact	Director, Regulatory Compliance		Dwinnells	Mark		6174260600	1239				mdwinnells@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/20/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Best Available Evidence Contact	Director, Enrollment, Recon. & Retention		Andrade	Remo		6174260600	7931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Bid Audit Contact	Sr. Director, Actuarial Services		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Bid Audit Site Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Bid Primary Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/26/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	CAP Report Contact for Public Website	General Manager, Market Lead CA		Yu	Wil		6174260600					wyu@commonwealthcare.org	18000 Studebaker	Suite 150	Cerritos	CA	90703	05/23/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Palmieri	Chris	D	8572468897					cpalmieri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/28/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	CEO - Senior Official for Contracting	President of Markets	Ms	Murphy	Courtney		6174260600	53892				cmurphy@commonwealthcare.org	18000 Studebaker	Suite 150	Cerritos	CA	90703	03/23/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Chief Financial Officer	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/12/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Chief Operating Officer	Chief Operating Officer	Mr.	Muduruni	Sesha		6179917865					smudunuri@commonwealthcare.org	30 Winter St		Boston	MA	02108	05/20/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Chief Information Officer	SVP & Chief Information Officer	Ms.	O'Rorke	Beth		6174260600	2485				bororke@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Chief Information Security Officer	VP, IT Governance and Cyber Security	Mr	Jacobs	Tim		6174260600	52258				tjacobs@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	CMMI Model Point of Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/14/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	CMS Casework Communication Contact	Director, Appeals & Grievances	Mr.	Schenk	Tyrone		8573273320					tschenk@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Complaints Tracking Contact	Director, Appeals & Grievances		Schenk	Tyrone		8573273320	1652			8574534517	tschenck@commonwealthcare.org	30 Winter St		Boston	MA	02108	09/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Contact for Fraud Investigations	Director, FWA Program and SIU	Ms.	Vasconcelos	Nadia		6174260600	52733				nvasconcelos@commonwealthcare.org	2 Avenue de Lafayette	5th Floor	Boston	MA	02111	05/18/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Coordination of Benefits Contact	Director, Enrollment, Recon. & Retention		Andrade	Remo		6174260600	57931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Corporate Mailing						8663333530					elgray@commonwealthcare.org	18000 Studebaker, Suite 150		Cerritos	CA	90703	10/06/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter St		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Customer Service Operations Contact	Director Contact Center Strategy		Cuevas	Sabrina		6174260600	51004				scuevas@commonwealthcare.org	2 Avenue de Lafayette		Boston	MA	02111	05/05/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	DIR Contact	Sr. Director, Actuarial Services		Jesik	David		6174160600	51808				DJesik@commonwealthcare.org	30 Winter St		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	DIR Contact (Secondary)	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Electronic Health Record Contact	Director, Enterprise Clinical Informatics		Phan	Phuong		6174260600	52274				pphan@commonwealthcare.org	Lafayette City Center  02111		Boston	MA	02111	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Emergency Part D Contact	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Emergency Part D Contact (Secondary)	Manager, Pharmacy Operations		Lee	Annie		6174261309					alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Employer Waiver Contact	General Manager, California	Mr.	Yu	Wil		6174260600					wyu@commonwealthcare.org	18000 Studebaker	Suite 150	Cerritos	CA	90703	08/24/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Encounter Data & Risk Adjustment Operations Contact	Manager, Encounters and Risk Adjustment		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Enrollment Contact	Director of Enrollment		Andrade	Remo		6174260600	7931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	EOB Transfer Contact	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194			6174260600	elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Financial Audit Contact	Director, Regulatory Audit	Ms.	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter St		Boston	MA	02108	12/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Financial Reporting Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Formulary Contact	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Formulary Contact (Secondary)	Manager, Formulary Admin & Maint		Nyawabila	Christina		8587906297					FAS@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/18/2019	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	General Contact	General Manager, California	Mr.	Yu	Wil		6174260600					wyu@commonwealthcare.org	18000 Studebaker	Suite 150	Cerritos	CA	90703	08/24/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Government Relations Contact	VP, Government Relations		Preede	Ken		6174260600	51412				kpreede@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	HIPAA Privacy Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	HIPAA Security Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Hospice Contact	Palliative Care Medical Director		Ragland	Julia		7815254203					jragland@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	10/04/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Interoperability Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	MA Appeals/Grievances Contact	Director, Appeals & Grievances		Schenk	Tyrone		8573273320					tschenk@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	MA Claims Processing Contact for Public Website	VP, Claims and Provider Network Operations		Breen	Donna		6176804446					dbreen@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Marketing Contact	SVP Marketing		Kubilus	Melissa		6174260600	52448				mkubilus@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/03/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Medical Director	Medical Director	Dr.	Clapper	Laura		6198231658					Lclapper@commonwealthcare.org	18000 Studebaker	Suite 150	Cerritos	CA	90703	11/16/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Medicare Compliance Officer	Director, Medicare Compliance Officer	Ms.	Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/01/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Medicare Coordinator	General Manager, California	Mr.	Yu	Wil		6174260600					wyu@commonwealthcare.org	18000 Studebaker	Suite 150	Cerritos	CA	90703	08/24/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/15/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Medication Therapy Management Contact	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	OffShore Subcontractor Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Online Enrollment Center Contact (Back-up)	Manager, Member Enrollment and Retention		Taylor	Lena		6174260600	51126				ltaylor@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Online Enrollment Center Contact (Optional)	Senior Director, Information Technology	Mr	Rivera	Francisco		7148333870					frivera@commonwealthcare.org	18000 Studebaker, Suite 150		Cerritos	CA	90703	10/04/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Online Enrollment Center Contact (Primary)	Director, Enrollment, Recon. & Retention		Andrade	Remo		6174260600	57931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Part C Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/26/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Part C Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047	56999				mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Part D Appeals	Director, Appeals & Grievances		Schenk	Tyrone							tschenk@commonwealthcare.org	30 Winter St		Boston	MA	02108	12/12/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8573273320				HMO - Health Maintenance Organization		C	Boston
H1426	Part D Appeals Contact (Secondary)	Manager Clinical Appeals and Grievances		Mancuso	Jeremiah							jmancuso@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600	51222			HMO - Health Maintenance Organization		C	Boston
H1426	Part D Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Part D Benefits Contact	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Part D Claims Submission Contact	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Part D Exceptions Contact	Director, Pharmacy	Ms	Berman	Tova							TBerman@commonwealthcare.org	30 Winter St		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600	51289			HMO - Health Maintenance Organization		C	Boston
H1426	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Operations		Lee	Annie							alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174263109				HMO - Health Maintenance Organization		C	Boston
H1426	Part D Price File Contact (Back-up)	Manager, Pharmacy Operations		Lee	Annie		6174263109					ALee@commonwealthcare.org	30 Winter St		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Part D Price File Contact (Optional)	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Part D Price File Contact (Primary)	Program Manager		Keller	Shannon		8587907404					Shannon.Keller@MedImpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Part D Quality Assurance Contact	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Part D Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwaealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Patient Safety Contact	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Payment Contact	VP Revenue Cycle Management		New	Maraland		6174600600	3976				mnew@commonwealthcare.org	30 Winter St		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Personal Health Record Contact	Manager, Health Information Management		Lopez	Robin		6174260600	5235				rlopez@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Pharmacy Director	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Pharmacy Network Management Contact	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Pharmacy Technical Help Desk Contact	Director Customer Contact Services		Brewer	Kathy							Kathy.Brewer@MedImpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/12/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8882549907				HMO - Health Maintenance Organization		C	Boston
H1426	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy	Ms	Berman	Tova							TBerman@commonwealthcare.org	30 Winter St		Boston	MA	02108	10/25/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600	51289			HMO - Health Maintenance Organization		C	Boston
H1426	PHR Beneficiary Contact																	08/24/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS	CCA Health Plan of California	Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600				HMO - Health Maintenance Organization		C	Boston
H1426	Physician Incentive Contact	Sr Director, Provider Network Operations		Aguilera	Elicia		6174260600					eaguilera@commonwealthcare.org	18000 Studebaker		Cerritos	CA	90703	08/24/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Plan Directory Contact for Public Website			Services	Member		8663333530					memberservices@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/16/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Plan to Plan Reconciliation Contact	Manager, Accounts Payable		Reeves	Jennifer		6174260600	51632				jreeves@commonwealthcare.org	30 Winter St		Boston	MA	02108	05/08/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Processor Contact	VP, Claims and Provider Network Operations		Breen	Donna		6176804446					dbreen@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Quality Contact	VP, Quality		Feierstein	Anne		6174260600	56868				afeierstein@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/10/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Reconciliation Contact	Director and Assistant Controller	Mr	Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter St		Boston	MA	02108	09/28/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Reconciliation Contact (Secondary)	VP Revenue Cycle		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/18/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Recovery Audit Contact	Director, Regulatory Audit	Ms.	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter St		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	SNP Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	SNP State Contact	General Manager, California	Mr.	Yu	Wil		6174260600					wyu@commonwealthcare.org	18000 Studebaker	Suite 150	Cerritos	CA	90703	08/24/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Surveillance Contact	VP, National Sales		Spartano	Michael		6174260600	52179				mspartano@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	System Contact	Manager, Encounters and Risk Adjustment		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Third Party Administrator (TPA) Liaison	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	User Access Contact	Director, Medicare Compliance Officer		Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/09/2022	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Utilization Management Contact	VP UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	Lafayette City Center		Boston	MA	02108	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1426	Utilization Review Contact	VP UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	09/11/2023	2023	CCA HEALTH PLANS OF CALIFORNIA, INC.	Local CCP	CCA Health California	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H1463	Agent/Broker Compensation Data Contact	Director of Consumer Sales and Retention		Jones	Jeremy		2179028167					Jeremy.Jones@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Automated TrOOP Balance Transfer Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Backup User Access Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Best Available Evidence Contact	Medicare Enrollment Manager		Kirby	Rae		2179029108					rae.kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Bid Audit Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Bid Audit Site Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Bid Primary Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	CAP Report Contact for Public Website	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8009654022				HMO - Health Maintenance Organization		C	Chicago
H1463	CEO - CMS Administrator Contact	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	CEO - Senior Official for Contracting	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Chief Financial Officer	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/18/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Chief Operating Officer	Chief Operating Officer	Mr.	McPhearson	Les		2179029740				2179029740	Les.McPhearson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Chief Information Officer		Ms.	Griffith	Kim		2179029004				2179029740	kim.griffith@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/02/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Chief Information Security Officer	Director of Information Security	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	CMS Casework Communication Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Complaints Tracking Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Contact for Fraud Investigations	Corporate Compliance and ERM Mgr		Adamson	Susan		2179029137					Susan.Adamson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Coordination of Benefits Contact	Director of Claims & Recovery		Parker	Lisa		2179028353				2179029786	lisa.parker@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Corporate Mailing						2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/02/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Coverage Gap Discount Program (CGDP) Payment Contact			Boyce	Heather		2179029467					heather.boyce@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Customer Service Operations Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	DIR Contact	Director of Accounting		Deane	Laura		2179028322				2179029740	laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/02/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	DIR Contact (Secondary)			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Emergency Part D Contact	VP, Chief Compliance Officer		Wilson	Hollie		2176214156				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Emergency Part D Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368					Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Employer Waiver Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224					Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Encounter Data & Risk Adjustment Operations Contact	Director, System Config and Technical Services		Walsh	Pam		2179029449				2173657111	Pam.Walsh@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Enrollment Contact	Medicare Enrollment Manager		Kirby	Rae		2179029108					rae.kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	EOB Transfer Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Financial Audit Contact	Executive Director of Finance	Mr.	Maxwell	Jamey		2179028321				2179029740	jamey.maxwell@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Financial Reporting Contact	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/18/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Formulary Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Formulary Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368				2179029798	Jena.Deschler@healthalliance.org	3310 Fields South		Champagin	IL	61822	11/19/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	General Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Government Relations Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	HIPAA Privacy Officer	Director, Corporate Compliance and Privacy Officer		Jensen	Traci		2179029152				2179029794	traci.jensen@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	HIPAA Security Officer	Director of Information Security	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Hospice Contact	Director of Pharmacy		Buhr	Aimee		2179029366					Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Interoperability Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	MA Appeals/Grievances Contact	Member / Provider Relations Manager		Regal	Wendi		2179028017				2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	MA Claims Processing Contact for Public Website		Ms.	Griffith	Kim		2179029004				2179029740	kim.griffith@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/02/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Marketing Contact	VP, Products and Marketing		Perry	Jana	L	2179028101				2179029740	jana.perry@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Medical Director	Associate Chief Medical Officer	Dr.	Revai	Krystal		2179028301				2179029740	Krystal.Revai@healthalliance.org	3310 Fields South Drive		Champaign	IL	61821	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Medicare Compliance Officer	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Medicare Coordinator	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Medicare Part D Opioid Overutilization Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Medication Therapy Management Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	OffShore Subcontractor Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Online Enrollment Center Contact (Back-up)	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Online Enrollment Center Contact (Optional)	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Online Enrollment Center Contact (Primary)	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Part C Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Part C Reporting Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Appeals	Member / Provider Relations Manager		Regal	Wendi						2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	2179028017				HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Appeals Contact (Secondary)	CEO		Madigan	Sinead						2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8008513379				HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Benefits Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029740	Hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Claims Submission Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Exceptions Contact	VP, Chief Compliance Officer		Wilson	Hollie						2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	2179028224				HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Exceptions Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena						2179029798	Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	2179029368				HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Price File Contact (Back-up)	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Price File Contact (Optional)	PBM Contact		Lyman	Dorothy		6126326265					DL-MedOpsPlanFinder@catamaranrx.com	1600 McConnor Parkway		Schaumburg	IL	60173	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Price File Contact (Primary)	Lead IT Operations		Walker	Kathy		2179025198				2173657111	kathy.walker@healthalliance.org	3310 Fields South		Champaign	IL	61822	01/02/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Quality Assurance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Part D Reporting Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Patient Safety Contact	Medicare Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Payment Contact	Director of BECS		Kleinert	Traci		2179029508				2179029797	Traci.Kleinert@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Pharmacy Director	Director of Pharmacy		Buhr	Aimee		2179029366				2179029798	Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Pharmacy Network Management Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Pharmacy Network Management Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368				2179029798	Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/22/2021	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Pharmacy Technical Help Desk Contact	VP, Chief Compliance Officer		Wilson	Hollie						2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8442651876				HMO - Health Maintenance Organization		C	Chicago
H1463	Physician Incentive Contact	VP, Provider Network Management		Walker	Randy		2179029106				2179029701	Randy.Walker@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Plan Directory Contact for Public Website	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Plan to Plan Reconciliation Contact			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Dr		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Processor Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029497	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Quality Contact	Quality Management Director		Migut	Tamara		2179028012				2179029789	tamara.migut@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/01/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Reconciliation Contact	Director of Accounting		Deane	Laura		2179078322				2179029740	laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Reconciliation Contact (Secondary)			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Recovery Audit Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	SNP Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Surveillance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	System Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Third Party Administrator (TPA) Liaison			Johnson	Danica		2179028322				2173657494	danica.johnson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/02/2019	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	User Access Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Utilization Management Contact	Director, Utilization management and Systems		Fossier	Lori		2179029025				2179029703	lori.fossier@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1463	Utilization Review Contact	Directo, Utilization Management and Systems		Fossier	Lori		2179029025				2179029703	lori.fossier@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE CONNECT, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1468	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H1468	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H1468	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1468	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1500	Automated TrOOP Balance Transfer Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Backup User Access Contact	Executive Director	Mrs	Alexander-Hines	Joyce		9104297202					joyce.alexander-hines@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Best Available Evidence Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Bid Primary Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	CAP Report Contact for Public Website	Executive Director	Ms.	Alexander-Hines	JOyce		9104297202				9104834930	joyce.alexander-hines@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	04/28/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	CEO - CMS Administrator Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	CEO - Senior Official for Contracting	Executive Director	Mrs	Alexander-Hines	Joyce		9104297202					joyce.alexander-hines@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	05/06/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Chief Financial Officer	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Chief Operating Officer	COO	Mrs	Lewis	Anne		4066472980					anne.lewis@trinity-health.org	120555 Victor Parkway		Livonia	MI	48152	09/22/2020	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Chief Information Officer	Director Enterprise IT Operations	Mr	Gillespie	Jeff		6142348636					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Chief Information Security Officer	VP Information Security	Mr	Jennings	Preston		6105503083					Preston.Jennings@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	CMS Casework Communication Contact	Executive Director	Ms.	Alexander-Hines	Joyce		9104297202				9104834930	joyce.alexander-hines@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	04/28/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Complaints Tracking Contact	Director QI/Compliance	Ms.	Singh	Rashmi		9104297210				9104834930	rashmi.singh@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Contact for Fraud Investigations	Director QI/Compliance	Ms.	Singh	Rashmi		9104297210				9104834930	rashmi.singh@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Coordination of Benefits Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Corporate Mailing						9104297255				9104834930	joyce-alexander-hines@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	09/15/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Coverage Gap Discount Program (CGDP) Payment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Customer Service Operations Contact	Executive Director	Ms.	Alexander-Hines	Joyce		9104297202				9104834930	joyce.alexander-hines@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	04/28/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	DIR Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	DIR Contact (Secondary)	Business Office Manager	Mrs	Reed	Melissa		9104297204				9104834930	Melissa.Reed001@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	09/13/2019	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Emergency Part D Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Emergency Part D Contact (Secondary)	Business Manager		Reed	Melissa		9104297204				9104834930	Melissa.Reed001@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	03/10/2020	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Encounter Data & Risk Adjustment Operations Contact	Director of Coding and Documentation		Creaney	Emy		7343431939					creaneye@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	10/25/2019	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Enrollment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	EOB Transfer Contact	Executive Director	Ms.	Alexander-Hines	Joyce		9104297202				9104834930	joyce.alexander-hines@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	04/28/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Financial Audit Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				9104834930	nicole.fuhrmeister@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Financial Reporting Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Formulary Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Formulary Contact (Secondary)	Business Manager	.	Reed	Melissa		9104297204				9104834930	Melissa.Reed001@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	03/10/2020	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	General Contact	Executive Director	Ms.	Alexander-Hines	Joyce		9104297202				9104834930	joyce.alexander-hines@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	04/28/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Government Relations Contact	Executive Director	Ms.	Alexander-Hines	Joyce		9104297202				9104834930	Joyce.alexander-hines@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	04/28/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	HIPAA Privacy Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	HIPAA Security Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Interoperability Contact	Director Enterprise IT Operations		Gillespies	Jeff		7343433079					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	MA Appeals/Grievances Contact	Director QI/Compliance	Ms.	Singh	Rashmi		9104297210				9104834930	rashmi.singh@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	MA Claims Processing Contact for Public Website	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Marketing Contact	Director Marketing & Communications	Ms	Lark	Azia		9735182754					azia.lark@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	02/03/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Medical Director	CMO	Dr.	Nichols	Karen		9104297226				9104834930	karen.nichols001@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	04/28/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Medicare Compliance Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Medicare Coordinator	Executive Director	Mrs	Alexander-Hines	Joyce		9104297202					joyce.alexander-hines@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	07/27/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	07/27/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Part C Application Contact	Executive Director	Ms.	Alexander-Hines	Joyce		9104297202				9104834930	joyce.alexander-hines@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	04/28/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Part D Appeals	Manager Part D Compliance		Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad Street		Philadelphia	PA	19145	09/15/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Atlanta
H1500	Part D Appeals Contact (Secondary)	Director Quality & Compliance		Simonsen	Erica							esimonsen@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	12/31/2020	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active	9104297458				PACE - Nat		C	Atlanta
H1500	Part D Application Contact	Executive Director	Mrs	Alexander-Hines	Joyce		9104297202					joyce.alexander-hines@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Part D Benefits Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Part D Claims Submission Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Part D Exceptions Contact	Manager Part D Compliance		Garbarino	Joseph							Joseph.Garbarino@mercyhealth.org	1930 Broad Street		Philadelphia	PA	19145	12/31/2020	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Atlanta
H1500	Part D Exceptions Contact (Secondary)	Director Quality & Compliance		Simonsen	Erica							esimonsen@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	12/31/2020	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active	9104297458				PACE - Nat		C	Atlanta
H1500	Part D Price File Contact (Back-up)	Executive Director	Mrs	Alexander-Hines	Joyce		9104297202					joyce.alexander-hines@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Part D Price File Contact (Primary)	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Part D Quality Assurance Contact	Director QI/Compliance	Ms.	Singh	Rashmi		9104297210				9104834930	rashmi.singh@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	10/03/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Part D Reporting Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Patient Safety Contact	Director QI/Compliance	Ms.	Singh	Rashmi		9104297210				9104834930	rashmi.singh@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	10/03/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Payment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Pharmacy Director	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Pharmacy Network Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	1001 Baltimore Pike		Springfield	PA	19064	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Pharmacy Technical Help Desk Contact	Manager Part D Compliance		Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Atlanta
H1500	Plan Directory Contact for Public Website	Executive Director	Mrs	Alexander-Hines	Joyce		9104297202					joyce.alexander-hines@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Plan to Plan Reconciliation Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Processor Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Quality Contact	Director QI/Compliance	Ms.	Singh	Rashmi		9104297210				9104834930	rashmi.singh@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	10/03/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Reconciliation Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				9104834930	nicole.fuhrmeister@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Reconciliation Contact (Secondary)			Reed	Melissa		9104297490					Melissa.Reed001@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	02/16/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Recovery Audit Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				9104834930	nicole.fuhrmeister@trinity-health.org	4900 Raeford Rd		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Surveillance Contact	Executive Director	Ms.	Alexander-Hines	Joyce		9104297202				9104834930	joyce.alexander-hines@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	04/28/2022	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	System Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Third Party Administrator (TPA) Liaison	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	User Access Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Utilization Management Contact	CMO	Dr.	Nichols	Karen		9104297226				9104834930	karen.nichols001@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1500	Utilization Review Contact	CMO	Dr.	Nichols	Karen		9104297226				9104834930	karen.nichols001@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	08/04/2023	2023	LIFE ST. JOSEPH OF THE PINES, INC.	National PACE	LIFE St. Joseph of the Pines	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H1518	Automated TrOOP Balance Transfer Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Backup User Access Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Best Available Evidence Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Bid Primary Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	CAP Report Contact for Public Website	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	CEO - CMS Administrator Contact	President & CEO PACE	Mr.	Beyer	John		7168195101				7168195099	jbeyer@chsbuffalo.org	55 Melroy Ave.	Ground Floor	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	CEO - Senior Official for Contracting	President & CEO PACE	Mr.	Beyer	John		7168195101				7168195099	jbeyer@chsbuffalo.org	55 Melroy Ave.	Ground Floor	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Chief Financial Officer	Vice President of Finance/Controller	Mr.	Edwards	Russell		7169232968					redwards@chsbuffalo.org	144 Genesee St.	4th Floor - Finance	Buffalo	NY	14203	08/09/2022	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Chief Operating Officer	President & CEO PACE	Mr.	Beyer	John		7168195101				7168195099	jbeyer@chsbuffalo.org	55 Melroy Ave.	Ground Floor	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Chief Information Officer	Chief Information Officer	Dr.	Galang	Michael		7168621779					mgalang@chsbuffalo.org	144 Genesee St.		Buffalo	NY	14203	03/23/2016	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Chief Information Security Officer	Director, IT Clinical Systems	Mr.	Nobumoto	Tak		7169237023					nobumoto@chsbuffalo.org	144 Genesee St.		Buffalo	NY	14203	03/09/2018	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	CMS Casework Communication Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Complaints Tracking Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Contact for Fraud Investigations	Compliance & Privacy Officer	Mrs	Whistler	Kimberly	E	7168214471					kwhistler@chsbuffalo.org	144 Genesee St	6th Floor	Buffalo	NY	14203	05/19/2022	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Coordination of Benefits Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Corporate Mailing						7168195101					arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Coverage Gap Discount Program (CGDP) Payment Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Customer Service Operations Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	DIR Contact	President & CEO	Mr.	Beyer	John		7168195101				7168195099	jbeyer@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/25/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	DIR Contact (Secondary)	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Ave	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Emergency Part D Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Emergency Part D Contact (Secondary)	President & CEO	Mr.	Beyer	John		7168195101				7168195099	jbeyer@chsbuffalo.org	55 Melroy Ave.	Ground Floor	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Encounter Data & Risk Adjustment Operations Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Ave.	Ground Floor	Lackawanna	NY	14218	01/11/2022	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Enrollment Contact	Community Liaison	Mrs.	Shalke	Karen		7168195100					kshalke@chsbuffalo.org	55 Melroy Av		Lackawanna	NY	14218	01/11/2022	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	EOB Transfer Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Financial Audit Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Ave.	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Financial Reporting Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Formulary Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	General Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Government Relations Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	HIPAA Privacy Officer	Compliance & Privacy Officer	Mrs.	Whistler	Kimberly	E	7168214471					kwhistler@chsbuffalo.org	144 Genesee St	6th Floor	Buffalo	NY	14203	05/19/2022	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	HIPAA Security Officer	Compliance & Privacy Officer	Mrs.	Whistler	Kimberly		7168214471					kwhistler@chsbuffalo.org	144 Genesee St	6th Floor	Buffalo	NY	14203	05/19/2022	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Interoperability Contact	Executive Director		Rudick	Ashley		7168195081				7168195099	alw3617@gmail.com	55 Melroy Ave		Lackawanna	NY	14218	05/16/2022	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	MA Appeals/Grievances Contact	President & CEO	Mr.	Beyer	John		7168195101				7168195099	jbeyer@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	MA Claims Processing Contact for Public Website	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Marketing Contact	Community Liaison	Mrs.	Shalke	Karen		7168195100					kshalke@chsbuffalo.org	55 Melroy Av		Lackawanna	NY	14218	01/11/2022	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Medical Director	Medical Director	Dr.	Naughton	Bruce		7168195025					bnaughto@buffalo.edu	55 Melroy Ave.		Lackawanna	NY	14218	03/05/2015	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Medicare Compliance Officer	Compliance & Privacy Officer	Mrs.	Whistler	Kimberly	E	7168214471					kwhistler@chsbuffalo.org	144 Genesee St	6th Floor	Buffalo	NY	14203	05/19/2022	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Medicare Coordinator	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Naughton	Bruce		7168195025					bnaughton@chsbuffalo.org	55 Melroy Av.		Lackawanna	NY	14218	12/14/2018	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Medication Therapy Management Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Part C Application Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Part D Appeals	Executive Director	Ms.	Rudick	Ashley						7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active	8556713341				PACE - Nat		C	New York
H1518	Part D Appeals Contact (Secondary)	President & CEO		Beyer	John						7168195099	jbeyer@chsbuffalo.org	55 Melroy Ave.	Ground Floor	Buffalo	NY	14218	01/05/2021	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active	7168195101				PACE - Nat		C	New York
H1518	Part D Application Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Part D Benefits Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Part D Claims Submission Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Part D Exceptions Contact	Executive Director	Ms.	Rudick	Ashley						7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active	8556713341				PACE - Nat		C	New York
H1518	Part D Price File Contact (Back-up)	President & CEO	Mr.	Beyer	John		7168195101				7168195099	jbeyer@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Part D Price File Contact (Primary)	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Part D Quality Assurance Contact	Executive Director	Mr.	Beyer	John		7168195101					jbeyer@chsbuffalo.org	55 Melroy Avenue		Lackawanna	NY	14218	03/05/2015	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Part D Reporting Contact	Executive Director	Mr.	Beyer	John		7168195101					jbeyer@chsbuffalo.org	55 Melroy Avenue		Lackawanna	NY	14218	03/05/2015	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Patient Safety Contact	QI Manager	Mrs.	Azzopardi	Susan		7168195319				7168195099	sazzopar@chsbuffalo.org	55 Melroy Ave	Ground Floor LIFE	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Payment Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Pharmacy Director	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Pharmacy Network Management Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Pharmacy Technical Help Desk Contact	Executive Director	Ms.	Rudick	Ashley						7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active	8556713341				PACE - Nat		C	New York
H1518	Plan Directory Contact for Public Website	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Plan to Plan Reconciliation Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Processor Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Quality Contact	QI Manager	Mrs.	Azzopardi	Susan		7168195319				7168195099	sazzopar@chsbuffalo.org	55 Melroy Ave	Ground Floor LIFE	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Reconciliation Contact	President & CEO	Mr.	Beyer	John		7168195101				7168195099	jbeyer@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/25/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Reconciliation Contact (Secondary)	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Ave.	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Recovery Audit Contact	Compliance & Privacy Officer	Mrs	Whistler	Kimberly	E	7168214471					kwhistler@chsbuffalo.org	144 Genesee St	6th Floor	Buffalo	NY	14203	05/19/2022	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Surveillance Contact	Compliance & Privacy Officer	Mrs	Whistler	Kimberly	E	7168214471					kwhistler@chsbuffalo.org	144 Genesee St	6th Floor	Buffalo	NY	14203	05/19/2022	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	System Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Third Party Administrator (TPA) Liaison	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	User Access Contact	President & CEO	Mr.	Beyer	John		7168195101				7168195099	jbeyer@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	09/24/2019	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Utilization Management Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1518	Utilization Review Contact	Executive Director	Ms.	Rudick	Ashley		7168195081				7168195099	arudick@chsbuffalo.org	55 Melroy Avenue	Ground Floor	Lackawanna	NY	14218	03/11/2020	2023	CATHOLIC HEALTH SYSTEM BUFFALO PACE	National PACE	Catholic Health LIFE	National PACE		Catholic Health System, Inc.	403	Yes	Active					PACE - Nat		C	New York
H1533	Automated TrOOP Balance Transfer Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Backup User Access Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Best Available Evidence Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Bid Primary Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	CAP Report Contact for Public Website	Marketing Director	Mr	Edwards	Cody		3366284200				3366284235	jordan.edwards@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	03/15/2022	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	CEO - CMS Administrator Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	CEO - Senior Official for Contracting	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Chief Financial Officer	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Chief Operating Officer	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Chief Information Officer	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Chief Information Security Officer	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	CMS Casework Communication Contact	Quality Assessment Performance Improvement Coor.	Mrs	Conrad	Janine		3366284215				3366284235	janine.conrad@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Complaints Tracking Contact	Quality Assurance and Performance Improvement Coor	Mrs	Conrad	Janine		3366284215				3366284235	janine.conrad@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Contact for Fraud Investigations	Quality Assessment Performance Improvement Coor.	Mrs	Conrad	Janine		3366284215				3366284235	janine.conrad@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Coordination of Benefits Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Corporate Mailing						3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Coverage Gap Discount Program (CGDP) Payment Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Customer Service Operations Contact	Quality Assessment Performance Improvement Coor.	Mrs	Conrad	Janine		3366284200				3366284235	janine.conrad@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	DIR Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Emergency Part D Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Encounter Data & Risk Adjustment Operations Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Enrollment Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	EOB Transfer Contact	Executive Director	Ms.	Martin	Karen		3366284210				3366284235	Karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	02/22/2021	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Financial Audit Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Financial Reporting Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Formulary Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	General Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Government Relations Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	HIPAA Privacy Officer	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	HIPAA Security Officer	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Interoperability Contact			Martin	Karen		3366284200					karen.martin@randolphhealth.org	809 Curry Drive		ASHEBORO	NC	27205	03/15/2022	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	MA Appeals/Grievances Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	MA Claims Processing Contact for Public Website	Executive Director	Ms.	Martin	Karen		3366284210				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	02/22/2021	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Marketing Contact	Marketing Coordinator	Mr	Edwards	Cody		3366284200				3366284235	jordan.edwards@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	03/15/2022	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Medical Director		MD	Thomas	Brad		3366284200					brad.thomas@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Medicare Compliance Officer	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Medicare Coordinator	ED	Ms.	Martin	Karen		3366284210				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	02/22/2021	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Medicare Part D Opioid Overutilization Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Medication Therapy Management Contact		MD	Thomas	Brad		3366284200					brad.thomas@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Part C Application Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Part D Appeals	Executive Director	Mrs	Martin	Karen						3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active	3366284200				PACE - Nat		C	Atlanta
H1533	Part D Application Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Part D Benefits Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Part D Claims Submission Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Part D Exceptions Contact	Executive Director	Mrs	Martin	Karen						3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active	8008005555				PACE - Nat		C	Atlanta
H1533	Part D Price File Contact (Back-up)	ED	Ms.	Martin	Karen		3366284210				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	02/22/2021	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Part D Price File Contact (Optional)	Executive Director	Mrs.	Martin	Karen		3366284200				3366284235	kmartin@staywellseniorcare.org	809 Curry Dr.		Asheboro	NC	27205	03/24/2016	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Part D Price File Contact (Primary)	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Part D Quality Assurance Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Part D Reporting Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Patient Safety Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Payment Contact	ED	Ms.	Martin	Karen		3366284210				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	02/22/2021	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Pharmacy Director	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Pharmacy Network Management Contact			Tanner	Robert		8778423210					rtanner@pharmastar.com	PO Box 3217		Eau Claire	WI	54702	11/21/2013	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Pharmacy Technical Help Desk Contact			Tanner	Robert							rtanner@pharmastar.com	PO Box 3217		Eau Claire	WI	54702	11/21/2013	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active	8778423210				PACE - Nat		C	Atlanta
H1533	Plan Directory Contact for Public Website	ED	Ms.	Martin	Karen		3366284210				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	02/22/2021	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Plan to Plan Reconciliation Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Processor Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Quality Contact	QAPI Coordinator	Ms	Conrad	Janine		3366284200				3366284235	janine.conrad@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Reconciliation Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Recovery Audit Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Surveillance Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	System Contact	Executive Director	Mrs	Martin	Karen		3366284200				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Third Party Administrator (TPA) Liaison	ED	Ms.	Martin	Karen		3366284210				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	02/22/2021	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	User Access Contact	ED	Ms.	Martin	Karen		3366284210				3366284235	karen.martin@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	02/22/2021	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Utilization Management Contact	QAPI Coordinator	Mrs	Conrad	Janine		3366284200				3366284235	janine.conrad@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1533	Utilization Review Contact	QAPI Coordinator	Mrs	Conrad	Janine		3366284200				3366284235	janine.conrad@randolphhealth.org	809 Curry Dr.		Asheboro	NC	27205	10/21/2019	2023	STAYWELL SENIOR CARE, INC.	National PACE	StayWell Senior Care	National PACE		American Healthcare Systems, LLC	605	Yes	Active					PACE - Nat		C	Atlanta
H1537	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H1537	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H1537	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H1537	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H1537	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1537	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1544	Automated TrOOP Balance Transfer Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Backup User Access Contact		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Best Available Evidence Contact			Cadena	Maria		6505022961					maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Bid Primary Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	CAP Report Contact for Public Website			Thiry	Matt		6504305157					matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	CEO - CMS Administrator Contact		Mr.	Thiry	Matt		6504305157					matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	CEO - Senior Official for Contracting		Mr.	Thiry	Matt		8007348041					matt.thiry@welbehealth.com	1220 E 4th Street		Long Beach	CA	90802	04/21/2022	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Chief Financial Officer		Mr.	Epstein	Ethan		2036951178					ethan.epstein@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Chief Operating Officer		Ms.	Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 North Barranca Ave #4051		Covina	CA	91723	09/29/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Chief Information Officer		Ms.	O'Leary	Kate		9733031835					kate.oleary@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Chief Information Security Officer		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	CMS Casework Communication Contact	Compliance Director		Costigan	Bobbie		2192106392					Bobbie.Costigan@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Complaints Tracking Contact	Compliance Director		Costigan	Bobbie		2192106392					Bobbie.Costigan@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Contact for Fraud Investigations			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Coordination of Benefits Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Corporate Mailing						6508626371					matt.patterson@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Coverage Gap Discount Program (CGDP) Payment Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Customer Service Operations Contact			Thiry	Matt		6504305157					matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	DIR Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Emergency Part D Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Emergency Part D Contact (Secondary)			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Encounter Data & Risk Adjustment Operations Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Enrollment Contact			Cadena	Maria		6505022961					maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	EOB Transfer Contact			Cadena	Maria		6505022961				6263600082	maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Financial Audit Contact	Senior Accounting Manager	Ms.	Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Financial Reporting Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Formulary Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	General Contact			Thiry	Matt		6504305157					matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Government Relations Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	HIPAA Privacy Officer			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	HIPAA Security Officer		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Interoperability Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	MA Appeals/Grievances Contact			Goel	Jyotika		6197462459					jyotika.goel@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	MA Claims Processing Contact for Public Website			Grant	Alexsa		6503360300					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Marketing Contact			Castro	Marta		6509186233					marta.castro@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Medical Director	Chief Medical Officer		Le	Mike		7146086457					mike.le@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Medicare Compliance Officer		Ms.	Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Medicare Coordinator			Thiry	Matt		6504305157					matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Medicare Part D Opioid Overutilization Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Medication Therapy Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Part C Application Contact			Harden	Gabriele		3037754823					gabriele.harden@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Part D Appeals			Goel	Jyotika							jyotika.goel@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	6197462459				PACE - Nat		C	San Francisco
H1544	Part D Appeals Contact (Secondary)			Thiry	Matt							matt.thiry@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8007348041				PACE - Nat		C	San Francisco
H1544	Part D Application Contact			Harden	Gabriele		3037754823					gabriele.harden@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Part D Benefits Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Part D Claims Submission Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Part D Exceptions Contact			Grant	Alexsa							alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8007348041				PACE - Nat		C	San Francisco
H1544	Part D Price File Contact (Back-up)			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Part D Price File Contact (Primary)			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Part D Quality Assurance Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Part D Reporting Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Patient Safety Contact			Goel	Jyotika		6197462459					jyotika.goel@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Payment Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Pharmacy Director			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Pharmacy Network Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Pharmacy Technical Help Desk Contact			Grant	Alexsa							alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8007348041				PACE - Nat		C	San Francisco
H1544	Plan Directory Contact for Public Website			Grant	Alexsa		6503360300					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Plan to Plan Reconciliation Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Processor Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Quality Contact			Goel	Jyotika		6197462459					jyotika.goel@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Reconciliation Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Recovery Audit Contact	VP Compliance	Ms.	Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Surveillance Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	System Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Third Party Administrator (TPA) Liaison			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	User Access Contact		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Utilization Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1544	Utilization Review Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/20/2023	2023	LA COAST PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H1587	Agent/Broker Compensation Data Contact	CFO/Director of Finance		Gable	Alan		5016974560				5013721932	agable@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Automated TrOOP Balance Transfer Contact	VP of TPA Operations		Allen	Kim		5016902985					pharmacysupport@accesshealthservices.com	1 Riverfront Place	Suite 760	N Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Backup User Access Contact	VP of Technical Operations		Harrington	Paige		5016974557				5013721932	pharrington@accesshealthservices.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Best Available Evidence Contact	Member Service Manager		Campbell	Brittany		5012550873				8667053652	brittanyc@accesshealthservices.com	1 Riverfront Place	Suite 513A	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Bid Audit Contact	CFO/Director of Finance		Gable	Alan		5016974560				5013721932	agable@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Bid Audit Site Contact	CFO/Director of Finance		Gable	Alan		5016974560				5013721932	agable@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Bid Primary Contact	CFO/Director of Finance		Gable	Alan		5016974560				5013721932	agable@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	CAP Report Contact for Public Website	Medicare Compliance Officer		Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	CEO - CMS Administrator Contact	Executive Director	Mr.	Lee	Jason	W	5013721922				5013721932	jlee@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	CEO - Senior Official for Contracting	Executive Director	Mr.	Lee	Jason	W	5013721922				5013721932	jlee@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	12/23/2020	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Chief Financial Officer	CFO/Director of Finance	Mr.	Gable	Alan		5016974560				5013721932	agable@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	12/23/2020	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Chief Operating Officer	CFO/Director of Finance	Mr.	Gable	Alan		5016974560				5013721932	agable@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	12/23/2020	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Chief Information Officer	VP of Technical Operations	Mrs.	Harrington	Paige		5016974557				5013721932	pharrington@accesshealthservices.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Chief Information Security Officer	VP of Technical Operations	Mrs.	Harrington	Paige		5013721922				5013721932	pharrington@accesshealthservices.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	CMS Casework Communication Contact	Medicare Compliance Officer		Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Complaints Tracking Contact	Medicare Compliance Officer		Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Contact for Fraud Investigations	Medicare Compliance Officer		Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Coordination of Benefits Contact	VP of TPA Operations		Allen	Kim		5016902985					pharmacysupport@accesshealthservices.com	1 Riverfront Place	Suite 760	N Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Corporate Mailing						5013721922					info@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	05/27/2022	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager		Smith	Leslie		5018596625				5013721932	lsmith@superiorselectinc.com	1 Riverfront Place	Suite 513A	North Little Rock	AR	72114	03/04/2019	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Customer Service Operations Contact	Member Service Manager		Campbell	Brittany		5012550873				8667053652	brittanyc@accesshealthservices.com	1 Riverfront Place	Suite 513A	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	DIR Contact	Financial Analyst, Finance		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Avenue NW North		Canton	OH	44720	02/06/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	DIR Contact (Secondary)	Sr Financial Manager Reporting and Analytics		Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW North		Canton	OH	44720	02/06/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Electronic Health Record Contact	Clinical Director		Stell	Kaitlyn		5016900463					kstell@superiorselectinc.com	1 Riverfront Place	Suite 760	North Little Rock	AR	72114	02/15/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Emergency Part D Contact	Clinical Pharmacist		Stephenson	Sarah		5016211503					sstephenson@accesshealthservices.com	1 Riverfront Place	Suite 600	N Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Emergency Part D Contact (Secondary)	Pharmacy Operations Manager		Maxenberger	Melida		5018596316					mvasquez@accesshealthservices.com	1 Riverfront Place, Suite 525		North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Encounter Data & Risk Adjustment Operations Contact	AHS Quality and Risk Manager		Shock	Lauri		5014047811					lshock@accesshealthservices.com	1 Riverfront Place, Suite 555		North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Enrollment Contact	Member Service Manager		Campbell	Brittany		5012550873				8667053652	brittanyc@accesshealthservices.com	1 Riverfront Place	Suite 513A	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	EOB Transfer Contact	Medicare Compliance Officer		Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Financial Audit Contact	CFO/Director of Finance	Mr.	Gable	Alan		5016974560				5013721932	agable@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	08/18/2021	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Financial Reporting Contact	CFO/Director of Finance		Gable	Alan		5016974560				5013721932	agable@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Formulary Contact	Formulary Operations Clinical Pharmacist		Ewigman	Andrea		4026720031					aewigman@elixirsolutions.com	7835 Freedom Avenue NW North		Canton	OH	44720	07/20/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Formulary Contact (Secondary)	Director Clinical Audits		Rossi	David		3304866311					drossi@elixirsolutions.com	7835 Freedom Avenue NW North		Canton	OH	44720	02/06/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	General Contact	Medicare Compliance Officer		Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Government Relations Contact	Medicare Compliance Officer		Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	HIPAA Privacy Officer	Medicare Compliance Officer		Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	HIPAA Security Officer	Information Security Officer		Moran	Tracy		5012953444				5013721932	tmoran@accesshealthservices.com	1 Riverfront Place	Suite 513A	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Hospice Contact	Clinical Director		Stell	Kaitlyn		5016900463					kstell@superiorselectinc.com	1 Riverfront Place	Suite 760	North Little Rock	AR	72114	02/15/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Interoperability Contact	VP of Technical Operations		Harrington	Paige		5013721922					pharrington@accesshealthservices.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	MA Appeals/Grievances Contact	Medicare Compliance Officer		Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	MA Claims Processing Contact for Public Website			Service	Customer		5013721922					info@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	05/27/2022	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Marketing Contact	Director of Sales and Business Development		Pollock	James		5014104450				5013721932	jpollock@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	02/01/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Medical Director	Medical Director	Dr.	Garner	Kimberly		5013721922				5013721932	kgarner@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	05/03/2022	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	01/14/2022	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Medicare Coordinator	Executive Director		Lee	Jason	W	5013721922				5013721932	jlee@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Stephenson	Sarah		5016211503					sstephenson@accesshealthservices.com	1 Riverfront Place	Suite 600	N Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Medication Therapy Management Contact	Director of Clinical Programs		Poore	Richard		6036285133					rpoore@elixirsolutions.com	7835 Freedom Avenue NW North	Suite 201	Canton	OH	44720	02/06/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Part C Application Contact	Executive Director		Lee	Jason	W	5013721922				5013721932	jlee@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Part C Reporting Contact	Data Integrity and Reporting Director		Pearce	Leah		5013478773					lpearce@accesshealthservices.com	1 Riverfront Place	Suite 513A	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Appeals	Clinical Pharmacist		Stephenson	Sarah							sstephenson@accesshealthservices.com	1 Riverfront Place	Suite 600	N Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active	5016211503				HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Appeals Contact (Secondary)	Pharmacy Operations Manager		Maxenberger	Melida							mvasquez@accesshealthservices.com	1 Riverfront Place	Suite 525	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active	8773721033				HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Application Contact	Executive Director		Lee	Jason	W	5013721922				5013721932	jlee@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Benefits Contact	VP of TPA Operations		Allen	Kim		5016902985					pharmacysupport@accesshealthservices.com	1 Riverfront Place	Suite 760	N Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Claims Submission Contact			Voss	Laurie		2342123780					lvoss@elixirsolutions.com	7835 Freedom Avenue NW North		Canton	OH	44720	02/06/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Exceptions Contact	Clinical Pharmacist		Stephenson	Sarah							sstephenson@accesshealthservices.com	1 Riverfront Place	Suite 600	N Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active	5016211503				HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Exceptions Contact (Secondary)	Pharmacy Operations Manager		Maxenberger	Melida							mvasquez@accesshealthservices.com	1 Riverfront Place	Suite 525	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active	5018596316				HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Price File Contact (Back-up)	Government Program Finance Analyst		Wentz	Christophe		0000000000					cwentz@elixirsolutions.com	7835 Freedom Avenue NW North		Canton	OH	44720	02/06/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Price File Contact (Optional)	VP of TPA Operations		Allen	Kim		5016902985					pharmacysupport@accesshealthservices.com	1 Riverfront Place	Suite 760	N Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Price File Contact (Primary)	Sr Financial Manager Reporting and Analytics		Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW North		Canton	OH	44720	02/06/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Quality Assurance Contact	Pharmacy Operations Manager		Maxenberger	Melida		5018596316					mvasquez@accesshealthservices.com	1 Riverfront Place	Suite 525	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Part D Reporting Contact	VP of TPA Operations		Allen	Kim		5016902985					pharmacysupport@accesshealthservices.com	1 Riverfront Place	Suite 760	N Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Patient Safety Contact	Clinical Pharmacist		Stephenson	Sarah		5016211503					sstephenson@accesshealthservices.com	1 Riverfront Place	Suite 600	N Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Payment Contact	Executive Director		Lee	Jason	W	5013721922				5013721932	jlee@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Personal Health Record Contact	Clinical Director		Stell	Kaitlyn		5016900463					kstell@superiorselectinc.com	1 Riverfront Place	Suite 760	North Little Rock	AR	72114	02/15/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Pharmacy Director	Clinical Pharmacist		Stephenson	Sarah		5016211503					sstephenson@accesshealthservices.com	1 Riverfront Place	Suite 600	N Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Pharmacy Network Management Contact	Director of Pharmacy Network Development and Ops		Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	7835 Freedom Avenue NW North	Suite 201	Canton	OH	44720	02/06/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Pharmacy Network Management Contact (Secondary)	Pharmacy Operations Manager		Maxenberger	Melida		5018596316					mvasquez@accesshealthservices.com	1 Riverfront Place	Suite 525	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Pharmacy Technical Help Desk Contact	Vice President Operations		Conn	Todd							tconn@elixirsolutions.com	7835 Freedom Avenue NW North	Suite 201	Canton	OH	44720	02/06/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active	8335026756				HMO - Health Maintenance Organization		C	Dallas
H1587	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Operations Manager		Maxenberger	Melida							mvasquez@accesshealthservices.com	1 Riverfront Place	Suite 525	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active	8773721033				HMO - Health Maintenance Organization		C	Dallas
H1587	Plan Directory Contact for Public Website			Service	Customer		5013721922					info@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	05/27/2022	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Plan to Plan Reconciliation Contact	CFO/Director of Finance		Gable	Alan		5016974560				5013721932	agable@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Processor Contact	Vice President of TPA Operations		Allen	Kim		5012619573				5013721932	kallen@accesshealthservices.com	1 Riverfront Place	Suite 760	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Quality Contact	Director of Quality and Utilization		Stone	Shana		5016902906					sstone@accesshealthservices.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Reconciliation Contact	CFO/Director of Finance		Gable	Alan		5016974560				5013721932	agable@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Recovery Audit Contact	CFO/Director of Finance	Mr.	Gable	Alan		5016974560				5013721932	agable@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	12/23/2020	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	SNP Application Contact	Executive Director		Lee	Jason	W	5013721922				5013721932	jlee@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	SNP State Contact	Executive Director		Lee	Jason	W	5013721922				5013721932	jlee@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Surveillance Contact	Medicare Compliance Officer		Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	System Contact	VP of Technical Operations		Harrington	Paige		5019122085					pharrington@accesshealthservices.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Third Party Administrator (TPA) Liaison	Senior Account Executive		Campbell	Brad		5019935269					bcampbell@accesshealth.services	1 Riverfront Place	Suite 513A	N Little Rock	AR	72114	01/20/2022	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	User Access Contact	Medicare Compliance Officer		Morgan	Tara		5019442642				5013721932	tmorgan@superiorselectinc.com	1 Riverfront Place	Suite 600	North Little Rock	AR	72114	07/28/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Utilization Management Contact	Clinical Director		Stell	Kaitlyn		5016900463					kstell@superiorselectinc.com	1 Riverfront Place	Suite 760	North Little Rock	AR	72114	02/15/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1587	Utilization Review Contact	Clinical Director		Stell	Kaitlyn		5016900463					kstell@superiorselectinc.com	1 Riverfront Place	Suite 760	North Little Rock	AR	72114	02/15/2023	2023	ARKANSAS SUPERIOR SELECT, INC.	Local CCP	Tribute Health Plans	HMO/HMOPOS		Select Founders, LLC	541	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1607	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H1607	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				PPO - BBA		C	Chicago
H1607	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H1607	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				PPO - BBA		C	Chicago
H1607	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				PPO - BBA		C	Chicago
H1607	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				PPO - BBA		C	Chicago
H1607	PHR Beneficiary Contact																	11/05/2015	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				PPO - BBA		C	Chicago
H1607	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1607	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H1608	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	12/30/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/30/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	12/30/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8042966237				PPO - BBA		C	Philadelphia
H1608	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	7132085765				PPO - BBA		C	Philadelphia
H1608	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/05/2017	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	12/19/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6026183945				PPO - BBA		C	Philadelphia
H1608	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6122633491				PPO - BBA		C	Philadelphia
H1608	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/30/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8002386279				PPO - BBA		C	Philadelphia
H1608	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Plan Directory Contact for Public Website			Customer Service	Aetna		8669014692					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	11/26/2014	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	6720-B Rockledge Drive	Suite 800	Bethesda	MD	20817	01/04/2023	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1608	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H1609	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	12/30/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/30/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	12/30/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/05/2017	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/30/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H1609	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Plan Directory Contact for Public Website			Customer Service	Aetna		8669014692					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	11/26/2014	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1609	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (FL)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/22/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	07/10/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	12/19/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	12/19/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Bid Primary Contact	Director, Product Management		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	06/12/2018	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	05/04/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	CMS Casework Communication Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Complaints Tracking Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Coordination of Benefits Contact	Director of Pharmacy		Stekol	Ilona		3478806082					StekolI@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/29/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Corporate Mailing						4107525721				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/01/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Customer Service Operations Contact	Director, Service Operations		Phillips	Tish		8666002139					PhillipsL1@aetna.com	7400 Camous Road		New Albany	OH	43054	01/21/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	11/30/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Emergency Part D Contact (Secondary)	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/12/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Encounter Data & Risk Adjustment Operations Contact	Director, Informatics		Sevchik	Melissa		6026591404					sevchikm@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	12/17/2019	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Enrollment Contact	Director Service Operations		Truitt	Michelle		7176716847					MLTruitt@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	07/19/2019	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	12/30/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	12/05/2019	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/05/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	General Contact	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/12/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Government Relations Contact	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/12/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/22/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Hospice Contact	Director, Service Operations		Truitt	Michelle		7176716847					MLTruitt@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	07/01/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	MA Appeals/Grievances Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	09/06/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	09/06/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Medical Director	Sr.  Medical Director		Hudson, MD	Karla		7739324873					hudsonk2@aetna.com	3200 Highland Ave.	MC F661	Downers Grove	IL	60515	09/06/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Medicare Coordinator	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/12/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/22/2021	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/30/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	12/30/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part D Appeals	Supervisor, Clinical Pharmacy	Ms.	Spencer	Tiffane						8772700148	MedicareCoverageDeterminationMMP-SNP@AETNA.com	4500 E Cotton Center, Blvd	F829	Phoenix	AZ	85040	01/11/2021	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8609004579				HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part D Appeals Contact (Secondary)	Director, Pharmacy	Ms.	Stekol	Ilona							StekolI@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	3478806082				HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part D Benefits Contact	Exec. Dir. ,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/12/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/18/2019	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part D Exceptions Contact	Director, Pharmacy		Stekol	Ilona							StekolI@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/05/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	3478806082				HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part D Exceptions Contact (Secondary)	Pharmacy Director		Vergil	Gina							Vergilg@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/12/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	4026997768				HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part D Quality Assurance Contact	Director, Pharmacy		Stekol	Ilona		3478806082					StekolI@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/29/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	02/18/2019	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/17/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	02/18/2019	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/30/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Pharmacy Technical Help Desk Contact	Director, Pharmacy		Stekol	Ilona							StekolI@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/29/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H1610	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Plan Directory Contact for Public Website	Senior Manager, Duals	Ms.	Brown	Anne Marie		7272720427					browna36@aetna.com	3482 Maclaren Dr.		Palm Harbor	FL	34684	09/08/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Processor Contact	Vice President, Duals Markets	Mr.	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/12/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Quality Contact	Director, Quality Management		Grifasi	Kimberly	H	8047639286					GrifasiK@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/06/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	SNP State Contact	Sr. Compliance Lead		Williams	Brooke		8137751411					williamsb6@cvshealth.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	06/16/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	System Contact	Director Business Information Magement	Ms.	Tanzillo	Hollie	M	7407398501					tanzilloh@aetna.com	7400 Campus Road		New Albany	OH	43054	07/07/2021	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Utilization Management Contact	Sr. Director Straregic Programs, AMA COE Clinical		Hawkins	Erin		8175288743					hawkinse@aetna.com	4300 Centreway Place		Arlington	TX	76018	07/07/2021	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1610	Utilization Review Contact	Duals Utilization Mgmt Principal Clinical Leader		Jones	Leslye		8606870283					JonesL12@cvshealth.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/19/2022	2023	COVENTRY HEALTH CARE OF VIRGINIA, INC.	Local CCP	Aetna Better Health of Virginia	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1622	Automated TrOOP Balance Transfer Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Backup User Access Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Best Available Evidence Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Bid Primary Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	CAP Report Contact for Public Website	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	CEO - CMS Administrator Contact	President and CEO	Mr.	Chan	Eddie		6505503923					Eddie.Chan@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	09/25/2020	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	CEO - Senior Official for Contracting	President and CEO	Mr.	Chan	Eddie		6505503923					Eddie.Chan@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	09/25/2020	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Chief Financial Officer	Chief Financial Officer	Mr.	Wong	Johnson		6505503923					Johnson.Wong@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	09/25/2020	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Chief Operating Officer	Chief Operating Officer	Ms.	Koh	Rachel		4153919686	5926				rachel.koh@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	08/06/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Chief Information Officer	Chief Information Officer	Mr.	Athuluri	Murali		6505503923					Murali.Athuluri@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	02/25/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Chief Information Security Officer	Chief Information Officer	Mr.	Athuluri	Murali		6505503923					Murali.Athuluri@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	02/25/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	CMS Casework Communication Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Complaints Tracking Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Contact for Fraud Investigations	Privacy and Compliance Officer		Lim	Rebecca		4153525105					Rebecca.Lim@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	11/30/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Coordination of Benefits Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Corporate Mailing						4153919686					Diana.Kawasaki-Yee@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	09/25/2020	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Manager II		Le	Peter		4153919686	7771				Peter.Le@nems.org	2171 Junipero Serra Blvd	Suite 260	Daly City	CA	94133	02/24/2023	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Customer Service Operations Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	DIR Contact	Accounting Manager II		Le	Peter		4153919686	7771				Peter.Le@nems.org	2171 Junipero Serra	Suite 260	Daly City	CA	94014	02/24/2023	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	DIR Contact (Secondary)	Accounting Supervisor II		Yu	Lucy		4153919686	7772				Lucy.Yu@nems.org	2171 Junipero Serra Blvd	Suite 260	Daly City	CA	94014	02/24/2023	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Emergency Part D Contact	Pharmacist		Kwok	Calvin		4153525120					calvin.kwok@nems.org	1520 Stockton Street, #604		San Francisco	CA	94133	01/09/2023	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Encounter Data & Risk Adjustment Operations Contact	CMCO		Tang	Linda		4153525048					Linda.Tang@nems.org	2171 Junipero Serra		Daly City	CA	94014	11/30/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Enrollment Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	EOB Transfer Contact	PACE Program Director		Bernet	Janet		4153919686	5934			4152404352	janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Financial Audit Contact	Chief Financial Officer	Mr.	Wong	Johnson		6505503923					Johnson.Wong@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	09/25/2020	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Financial Reporting Contact	Chief Financial Officer	Mr.	Wong	Johnson		6505503923					Johnson.Wong@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	09/25/2020	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Formulary Contact	Director of Pharmacy		Chan	Beverley		4153525031					Beverley.Chan@nems.org	2171 Junipero Serra		Daly City	CA	94014	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	General Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Government Relations Contact	Privacy and Compliance Officer		Lim	Rebecca		4153525105					Rebecca.Lim@nems.org	2171 Junipero Serra	Suite 300	Daly City	CA	94014	02/25/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	HIPAA Privacy Officer	Privacy and Compliance Officer		Lim	Rebecca		4153525105					Rebecca.Lim@nems.org	2171 Junipero Serra	Suite 300	Daly City	CA	94014	02/18/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	HIPAA Security Officer	Privacy and Compliance Officer		Lim	Rebecca		4153525105					Rebecca.Lim@nems.org	2171 Junipero Serra	Suite 300	Daly City	CA	94014	02/18/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Interoperability Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	MA Appeals/Grievances Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	MA Claims Processing Contact for Public Website	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Marketing Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Medical Director	PACE Medical Director	Dr.	Li	David		4153919686	5890				David.Li@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	09/29/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Medicare Compliance Officer	Privacy and Compliance Officer	Ms.	Lim	Rebecca		4153525105					Rebecca.Lim@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	02/18/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Medicare Coordinator	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Chan	Beverley		4153525031					Beverley.Chan@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Medication Therapy Management Contact	Director of Pharmacy		Chan	Beverley		4153525031					Beverley.Chan@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Part C Application Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Part D Appeals	Pharmacist		Kwok	Calvin							calvin.kwok@nems.org	1520 Stockton Street #604		San Francisco	CA	94133	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active	4153525120				PACE - Nat		C	San Francisco
H1622	Part D Appeals Contact (Secondary)	PACE Program Director		Bernet	Janet							janet.bernet@nems.org	728 Pacific Ave	2nd Floor	San Francisco	CA	94133	11/08/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active	4153919686	5934			PACE - Nat		C	San Francisco
H1622	Part D Application Contact	Pharmacist		Kwok	Calvin		4153525120					calvin.kwok@nems.org	1520 Stockton Street, #604		San Francisco	CA	94133	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Part D Benefits Contact	Pharmacist		Kwok	Calvin		4153525120					calvin.kwok@nems.org	1520 Stockton Street, #604		San Francisco	CA	94133	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Part D Claims Submission Contact	Pharmacist		Kwok	Calvin		4153525120					calvin.kwok@nems.org	1520 Stockton Street, #604		San Francisco	CA	94133	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Part D Exceptions Contact	Pharmacist		Kwok	Calvin							calvin.kwok@nems.org	1520 Stockton Street, #604		San Francisco	CA	94133	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active	4153525120				PACE - Nat		C	San Francisco
H1622	Part D Exceptions Contact (Secondary)	Director of Pharmacy		Chan	Beverley							beverley.chan@nems.org	2171 Junipero Serra		Daly City	CA	94014	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active	4153525031				PACE - Nat		C	San Francisco
H1622	Part D Price File Contact (Back-up)	Director of Pharmacy		Chan	Beverley		4153525031					beverley.chan@nems.org	2171 Junipero Serra		Daly City	CA	94014	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Part D Price File Contact (Primary)	Pharmacist		Kwok	Calvin		4153525120					calvin.kwok@nems.org	1520 Stockton Street, #604		San Francisco	CA	94133	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Part D Quality Assurance Contact	Pharmacist		Kwok	Calvin		4153525120					calvin.kwok@nems.org	1520 Stockton Street, #604		San Francisco	CA	94133	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Part D Reporting Contact	Pharmacist		Kwok	Calvin		4153525120					calvin.kwok@nems.org	1520 Stockton Street, #604		San Francisco	CA	94133	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Patient Safety Contact	Pharmacist		Kwok	Calvin		4153525120					calvin.kwok@nems.org	1520 Stockton Street, #604		San Francisco	CA	94133	02/25/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Payment Contact	Accounting Manager		Le	Peter		4153919686	7771				Peter.Le@nems.org	2171 Junipero Serra	Suite 260	Daly City	CA	94014	02/24/2023	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Pharmacy Director	Director of Pharmacy		Chan	Beverley		4153525031					Beverley.Chan@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Pharmacy Network Management Contact	Director of Pharmacy		Chan	Beverley		4153525031					beverley.chan@nems.org	2171 Junipero Serra		Daly City	CA	94014	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Pharmacy Network Management Contact (Secondary)	Pharmacist		Kwok	Calvin		4153525120					calvin.kwok@nems.org	1520 Stockton Street, #604		San Francisco	CA	94133	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Pharmacy Technical Help Desk Contact	Director of Pharmacy		Chan	Beverley							Beverley.Chan@nems.org	728 Pacific Avenue		San Francisco	CA	94133	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active	4153525031				PACE - Nat		C	San Francisco
H1622	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacist		Kwok	Calvin							calvin.kwok@nems.org	1520 Stockton Street, #604		San Francisco	CA	94133	02/24/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active	4153525120				PACE - Nat		C	San Francisco
H1622	Plan Directory Contact for Public Website	CMCO		Tang	Linda		4153525048					Linda.Tang@nems.org	2171 Junipero Serra		Daly City	CA	94014	11/30/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Plan to Plan Reconciliation Contact	Accounting Manager II		Le	Peter		4153919686	7771				Peter.Le@nems.org	2171 Junipero Serra Blvd	Suite 260	Daly City	CA	94014	02/24/2023	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Processor Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Quality Contact	QI Coordinator		Pan	Janet		4153919686					Janet.Pan@nems.org	728 Pacific Ave	2nd Floor	San Francisco	CA	94133	09/19/2023	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Reconciliation Contact	Accounting Manager II		le	Peter		4153919686	7771				Peter.Le@nems.org	2171 Junipero Serra Blvd	Suite 260	Daly City	CA	94014	02/24/2023	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Reconciliation Contact (Secondary)	Accounting Supervisor II		Yu	Lucy		4153919686	7772				Lucy.Yu@nems.org	2171 Junipero Serra Blvd	Suite 260	Daly City	CA	94014	02/24/2023	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Recovery Audit Contact	Chief Financial Officer	Mr.	Wong	Johnson		6505503923					Johnson.Wong@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	02/25/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Surveillance Contact	Chief Financial Officer	Mr.	Wong	Johnson		6505503923					Johnson.Wong@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	02/25/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	System Contact	Chief Financial Officer	Mr.	Wong	Johnson		6505503923					Johnson.Wong@nems.org	2171 Junipero Serra	Suite 700	Daly City	CA	94014	02/25/2021	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Third Party Administrator (TPA) Liaison	CMCO		Tang	Linda		6505503923					Linda.Tang@nems.org	2171 Junipero Serra	Suite 600	Daly City	CA	94014	11/30/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	User Access Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Utilization Management Contact	CMCO		Tang	Linda		4153525048					Linda.Tang@nems.org	2171 Junipero Serra		Daly City	CA	94014	11/30/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1622	Utilization Review Contact	PACE Program Director		Bernet	Janet		4153919686	5934				janet.bernet@nems.org	728 Pacific Avenue	2nd Floor	San Francisco	CA	94133	02/03/2022	2023	NORTH EAST MEDICAL SERVICES	National PACE	North East Medical Services - Program of All-Inclusive Care for the Elderly (PACE)	National PACE		North East Medical Services	767	Yes	Active					PACE - Nat		C	San Francisco
H1644	Agent/Broker Compensation Data Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Automated TrOOP Balance Transfer Contact			Rush	Jamie		5616901134					ESITroopTransfer@express-scripts.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Backup User Access Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1, Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Best Available Evidence Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N 107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Bid Audit Contact			Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Bid Audit Site Contact			Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Bid Primary Contact		Mr.	Granow	Les		5614440709					Les.Granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	CAP Report Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	CEO - CMS Administrator Contact		Dr.	Lerer	Rene		5614440780					rene.lerer@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	CEO - Senior Official for Contracting		Ms.	Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Chief Financial Officer		Mr.	Granow	Les		5614440709					les.granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Chief Operating Officer		Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Chief Information Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Chief Information Security Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	CMS Casework Communication Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Complaints Tracking Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Contact for Fraud Investigations			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Coordination of Benefits Contact		Ms.	Burdelik	Dawn		5618153729					dawn.burdelik@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Corporate Mailing						5616901134					compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Coverage Gap Discount Program (CGDP) Payment Contact		Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	Longevity Health Plan	485 Madison Avenue Suite 202	New York	NY	10022	03/09/2021	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Customer Service Operations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	DIR Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	DIR Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Electronic Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Emergency Part D Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Emergency Part D Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Encounter Data & Risk Adjustment Operations Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Enrollment Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	EOB Transfer Contact		Ms.	Socoski	Beth		5616901134				5616901134	Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Financial Audit Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Financial Reporting Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Formulary Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Formulary Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	General Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Government Relations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	HIPAA Privacy Officer		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	HIPAA Security Officer		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Hospice Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Interoperability Contact	CIO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	MA Appeals/Grievances Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	MA Claims Processing Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Marketing Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Medical Director		Mr.	Orgain	Javette		3127206656					javette.orgain@longevityhealthplan.com	Longevity Health Plan	1611 Church Street	Evanston	IL	60201	02/15/2021	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Medicare Compliance Officer		Ms.	Lacey	Jennifer		8133677169					Jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Medicare Coordinator	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Medicare Part D Opioid Overutilization Contact	Director, Clinical & Trend Solutions	Ms.	Muralidharan	Adrienne		5616901134					amuralidharan@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	12/13/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Medication Therapy Management Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	OffShore Subcontractor Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Part C Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Part C Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Part D Appeals	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H1644	Part D Appeals Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H1644	Part D Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Part D Benefits Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		8002040016					Rosario_dovico@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H1644	Part D Exceptions Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H1644	Part D Price File Contact (Back-up)	Product Manager Advisor	Ms.	Williams	Stephanie		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Part D Price File Contact (Optional)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Part D Price File Contact (Primary)	sr mgr, Government Programs		Dolfi	Amanda		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Part D Quality Assurance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Part D Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Patient Safety Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Payment Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Personal Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Pharmacy Director	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra	Ms.	Kelly	Heather		8002040016					hakelly@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Pharmacy Network Management Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Pharmacy Technical Help Desk Contact	Director, Customer Service	Ms.	Moore	LaTasha						8882358551	LaTasha_Monroe@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H1644	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Account Manager	Ms.	Kolesar	Bhrena							Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H1644	Physician Incentive Contact		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Plan Directory Contact for Public Website	Medicare Compliance Director	Ms.	Socoski	Beth		8883133609					Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Plan to Plan Reconciliation Contact		Ms.	Zhai	Vicky		5616328915					Vicky.Zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Processor Contact		Ms.	Gibson	Sharon		6143766614					SGGibson@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Quality Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Reconciliation Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Reconciliation Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Recovery Audit Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	SNP Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	SNP State Contact		Ms.	Lacey	Jennifer		5614440706					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Surveillance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	System Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Third Party Administrator (TPA) Liaison	COO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	User Access Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Utilization Management Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1644	Utilization Review Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF FLORIDA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1651	Agent/Broker Compensation Data Contact	Director of Finance		Mitchell	Jill		5635568070	4831			5635565134	jmitchell@mahealthcare.com	1605 Associates Dr., Suite 101		Dubuque	IA	52002	01/03/2023	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Backup User Access Contact	Comp Admin Assistant		Hoefler	Becca		5635568070				5635565134	bhoefler@mahealthcare.com	1605 Associates Dr., Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Bid Primary Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	CAP Report Contact for Public Website	Director of Operations		Hoffmann	Karen		5635568070	4817			5635565134	khoffman@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	CEO - CMS Administrator Contact	CEO	Mr.	Keeling	Zachary		5635568070					zkeeling@mahealthcare.com	1605 Associates Dr., Suite 101		Dubuque	IA	52002	01/03/2023	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Keeling	Zachary		5635568070				5635565134	zkeeling@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Chief Financial Officer	Director of Finance	Ms.	Mitchell	Jill		5635568070	4831			5635565134	jmitchell@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	01/03/2023	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Chief Operating Officer	Chief Operating Officer	Ms.	Mitchell	Jill		5635568070	4831			5635565134	jmitchell@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	07/28/2023	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Chief Information Officer	Director of Information Technology	Mr.	Wulfekuhle	Jeremy		5635844000					jwulfekuhle@mahealthcare.com	1500 Associates Drive		Dubuque	IA	52002	05/09/2016	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Chief Information Security Officer	Director of Information Technology	Mr.	Wulfekuhle	Jeremy		5635844000					jwulfekuhle@mahealthcare.com	1500 Associates Drive		Dubuque	IA	52002	05/09/2016	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	CMS Casework Communication Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Complaints Tracking Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Contact for Fraud Investigations	Director of Operations	Ms.	Hoffmann	Karen		5635568070	4817			5635565134	khoffman@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Corporate Mailing						5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	12/16/2020	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Cost Report Contact	Director of Finance		Mitchell	Jill		5635568070	4831				jmitchell@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Customer Service Operations Contact	Member Services Supervisor		Boge	Laura		5695568070	4857			5695565134	lboge@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Encounter Data & Risk Adjustment Operations Contact	Configuration Manager		Heston	Joan		5635568070					jheston@maheatlcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Enrollment Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	EOB Transfer Contact	Claims Manager		Simmons	Sherie		5635568070	4825			5635565134	ssimmons@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Financial Reporting Contact	Director of Finance		Mitchell	Jill		5635568070	4831			5635565134	jmitchell@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	General Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635568070	4836			5635565134	jdigmann@mahealthcare.com	1605 Associates Dr., Suite 101		Dubuque	IA	52002	01/03/2023	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Government Relations Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Interoperability Contact	Medicare Compliance Analyst		Digmann	Jodi		5635568070					jdigmann@mahealthcare.com	1605 Associates Dr., Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	MA Appeals/Grievances Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	MA Claims Processing Contact for Public Website	Claims Manager		Simmons	Sherie		5635568070	4825			5635565134	ssimmons@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Marketing Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Medical Director	Chief Medical Officer	Dr.	Schultz	Hendrik		5635568070	4862			5635565134	hschultz@mahealthcare.com	1500 Associates Drive		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Medicare Compliance Officer	Director of Operations	Ms.	Hoffmann	Karen		5635568070	4817			5635565134	khoffman@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Medicare Coordinator	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Part C Application Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Part C Reporting Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Payment Contact	Director of Finance		Mitchell	Jill		5635568070	4831			5635565134	jmitchell@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Plan Directory Contact for Public Website	Marketing Specialist		Hoffmann	Julie		5635568070	4818			5635565134	jhoffmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Quality Contact	Chief Medical Officer	Dr.	Schultz	Hendrik		5635568070	4862			5635565134	hschultz@mahealthcare.com	1500 Associates Drive		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Surveillance Contact	Director of Operations		Hoffmann	Karen		5635568070	4817			5635565134	khoffman@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	System Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	User Access Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Utilization Management Contact	Health Care Services Manager		Hollenback	Tammi		5635568070	4848			5635565134	thollenback@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1651	Utilization Review Contact	Health Care Services Manager		Hollenback	Tammi		5635568070	4848			5635565134	thollenback@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES HEALTH PLAN, INC.	1876 Cost	Medical Associates Health Plan, Inc.	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H1659	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H1659	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H1659	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H1659	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H1659	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1659	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1664	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H1664	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/14/2017	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Medical Director	Chief Medical Director	Dr.	Wessels	Jennifer		6362837536					Jennifer.wessels@homestatehealh.com	7711 Carondelet Ave.		St. Louis	MO	63105	08/11/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H1664	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H1664	PHR Beneficiary Contact																	09/27/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8557661452				HMO - Health Maintenance Organization		C	Dallas
H1664	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Plan Directory Contact for Public Website			Net	Health		8008676564				8009778226	CorporateMedicareComplianceDept@Centene.com	PO Box 419069		Rancho Cordova	CA	95741	08/15/2017	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1664	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HOME STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1666	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	01/30/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	5701 Balloon Fiesta Parkway		Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	11/27/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	12/04/2018	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	02/27/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/04/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H1666	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H1666	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	08/09/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H1666	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H1666	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	11/27/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/22/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	8772777898				PPO - BBA		C	Denver
H1666	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	0000000000				PPO - BBA		C	Denver
H1666	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	09/21/2018	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	07/29/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	04/26/2016	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1666	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	04/26/2016	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of NM, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H1692	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Financial Audit Contact	Financial Director	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	12/04/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/30/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	12/30/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/05/2017	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/30/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H1692	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Plan Directory Contact for Public Website			Customer Service	Aetna		8883656052					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	11/26/2014	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1692	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF WEST VIRGINIA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H1693	Automated TrOOP Balance Transfer Contact	Financial Analyst		Macaranas	Drew		6198764416					andrewma@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Backup User Access Contact	Director PACE & Older Adult Services		Green	Kristofer		6195152678					kristoferg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	06/12/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Best Available Evidence Contact	PACE Benefit Plans Specialist		Rodriguez	Sachary		6195152300	7009				sacharyr@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	02/16/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Bid Primary Contact	Financial Analyst		Macaranas	Drew		6198764416					andrewma@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	CAP Report Contact for Public Website	CFO		Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	06/07/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	CEO - CMS Administrator Contact	Chief Executive Officer	Ms,	Butler-Cohen	Fran		6195152301					fran@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	CEO - Senior Official for Contracting	Chief Executive Officer	Ms,	Butler-Cohen	Fran		6195152301					fran@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Chief Financial Officer	Chief Financial Officer	Mr.	Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Chief Operating Officer	Senior Vice President	Mr.	Gering	Jeffrey		6195152536	2536				jeffreyg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	02/25/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Chief Information Officer	CIO	Mr.	Kharodh	Harry		6195152378					harryk@fhcsd.org	5160 Federal Blvd		San Diego	CA	92105	06/12/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Chief Information Security Officer	CIO	Mr.	Kharodh	Harry		6195152378					harryk@fhcsd.org	5160 Federal Blvd		San Diego	CA	92105	06/12/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	CMS Casework Communication Contact	Senior Vice President		Gering	Jeffrey		6195152536					jeffreyg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	08/30/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Complaints Tracking Contact	CFO		Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	09/16/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Contact for Fraud Investigations	Chief Financial Officer		Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Coordination of Benefits Contact	PACE Benefit Plans Specialist		Rodriguez	Sasha		6195152445	7525				sacharyr@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Corporate Mailing						6195152300					PACE@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer		Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Customer Service Operations Contact	Director PACE & Older Adult Services		Green	Kristofer		6195152300	4321				kristoferg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	07/14/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	DIR Contact	Financial Analyst		Macaranas	Drew		6198764416					andrewma@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	DIR Contact (Secondary)	Controller		Schlagenhaft	George		6195152300	2465				georges@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Emergency Part D Contact	Financial Analyst II		Macaranas	Drew		6198764416					andrewma@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	02/16/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Encounter Data & Risk Adjustment Operations Contact	Director of Billing & Compliance		Ontiveros	Martha		6195152561					marthao@fhcsd.org	823 Gateway Ct Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Enrollment Contact	Director PACE & Older Adult Services		Green	Kristofer		6195152678					kristoferg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	06/12/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	EOB Transfer Contact	Healthcare Claims Specialist		Rodriguez	Ashley		6195152300	5508			6192690687	ashleyro@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Financial Audit Contact	Chief Financial Officer	Mr.	Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Financial Reporting Contact	Financial Analyst		Macaranas	Drew		6198764416					andrewma@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Formulary Contact	Clinical Pharmacist Specialist		Allahwerdy	Fady		6195158675	7016				fadya@fhcsd.org	3420 College Ave		San Diego	CA	92115	06/12/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Formulary Contact (Secondary)	Assistant Medical Director PACE	Dr.	Tabarsi	Hooman		6195152445					hoomant@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	06/12/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	General Contact	Director PACE & Older Adult Services		Green	Kristofer		6195152678					kristoferg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	08/30/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Government Relations Contact	Sr. VP of Support Services		Gering	Jeffrey		6193631694					jeffreyg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	HIPAA Privacy Officer	Senior VP and General Counsel		Baker	Donna		6165152457					donnab@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	HIPAA Security Officer	Director of Clinical Compliance		Duncan	Lisa		6195152416					lisad@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Interoperability Contact	Senior Vice President		Gering	Jeffrey		6195152536					jeffreyg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	MA Appeals/Grievances Contact	CFO		Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	09/16/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	MA Claims Processing Contact for Public Website	Director of Billing & Compliance		Ontiveros	Martha		6195152561					marthao@fhcsd.org	823 Gateway Ct Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Marketing Contact	Director PACE & Older Adult Services		Green	Kristifer		6195152678					kristoferg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	08/30/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Medical Director	Medical Director	Dr.	Tabarsi	Hooman		6195152445					hoomant@fhcsd.org	3420 College Ave		San Diego	CA	92115	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Medicare Compliance Officer	Senior Vice President	Mr.	Gering	Jeffrey	T	6195152536					jeffreyg@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	07/18/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Medicare Coordinator	Senior Vice President		Gering	Jefferey		6192152536					jeffreyg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	06/12/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Medicare Part D Opioid Overutilization Contact	Senior Vice President		Gering	Jeffrey		6195152636					jeffreyg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Medication Therapy Management Contact	Asst. Medical Director	Dr.	Tabarsi	Hooman		6195152445	7016				hoomant@fhcsd.org	3420 College Ave		San Diego	CA	92115	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Online Enrollment Center Contact (Primary)	Business Development Representative		Riesgo-Corrales	Luciana		6197980144					lucianar@fhcsd.org	3420 College Ave		San Diego	CA	92115	06/12/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Part C Application Contact	PACE Benefit Plans Specialist		Rodriguez	Sasha		6195982957					sacharya@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Part D Appeals	Financial Analyst		Macaranas	Drew							andrewma@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active	0000000000				PACE - Nat		C	San Francisco
H1693	Part D Application Contact	PACE Claims Coordinator		Rodriguez	Ashley		6195152300	5058				ashleyro@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	07/14/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Part D Benefits Contact	PACE Benefit Plans Specialist		Rodriguez	Sasha		6195982957					sacharyr@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Part D Claims Submission Contact	Director of Billing & Compliance		Ontiveros	Martha		6195152561					marthao@fhcsd.org	823 Gateway Ct Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Part D Exceptions Contact	Senior Vice President		Gering	Jeffrey							jeffreyg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	02/25/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active	6195152536				PACE - Nat		C	San Francisco
H1693	Part D Price File Contact (Back-up)	Director of Billing and Compliance		Ontiveros	Martha		6195152561					marthao@fhcsd.org	823 Gateway Ct Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Part D Price File Contact (Primary)	Chief Financial Officer		Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Part D Quality Assurance Contact	Senior VP of Support Services		Gering	Jeffrey		6195152536					jeffreyg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	08/30/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Part D Reporting Contact	PACE Financial Analyst II		Macaranas	Drew		6195152300	4416				andrewma@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	07/14/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Patient Safety Contact	Director of Clinical Compliance		Duncan	Lisa		6195152416					lisad@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Payment Contact	Financial Analyst		Macaranas	Drew		6198764416					andrewma@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Personal Health Record Contact	Manager HIM		Garcia	Ana		6195153662					anag@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Pharmacy Director	Clinical Pharmacist Specialist		Allahwerdy	Fady		6195158675					fadya@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	08/30/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Pharmacy Network Management Contact	Chief Financial Officer		Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Pharmacy Technical Help Desk Contact	PACE Financial Analyst II		Macaranas	Drew							andrewma@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	07/14/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active	6195152300	4416			PACE - Nat		C	San Francisco
H1693	Plan Directory Contact for Public Website	PACE Marketing Coordinator		Boyd	Jennifer		6195152300					jenniferbo@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	07/14/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Plan to Plan Reconciliation Contact	PACE Benefit Plans Specialist		Rodriguez	Sachary		6195982957					sacharyr@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Processor Contact	Healthcare Claims Specialist		Rodriguez	Ashley		6195152300	5058				ashleyro@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	12/29/2021	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Quality Contact	Senior VP of Support Services		Gering	Jeffrey		6195152536					jeffreyg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	08/30/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Reconciliation Contact	Financial Analyst		Macaranas	Drew		6198764416					andrewma@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Reconciliation Contact (Secondary)	Controller		Schlagenhaft	George		6195152300	2465				georges@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Recovery Audit Contact	Chief Financial Officer	Mr.	Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Surveillance Contact	Senior Vice President		Gering	Jeff		6195152300					jeffereyg@fhcsd.org	823 Gateway Center Way		San Diego	CA	92102	06/12/2023	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	System Contact	Chief Financial Officer		Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Third Party Administrator (TPA) Liaison	Chief Financial Officer		Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	02/06/2018	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	User Access Contact	Chief Financial Officer	Mr.	Roman	Ricardo		6199064603					ricardor@fhcsd.org	823 Gateway Ctr Way		San Diego	CA	92102	03/23/2020	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Utilization Management Contact	Manager Utilization Management & In-Home Care		Huggins	Tia		6195152300	7054				lindah@fhcsd.onmicrosoft.com	823 Gateway Center Way		San Diego	CA	92102	02/16/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1693	Utilization Review Contact	Manager Utilization Management & In-Home Care		Huggins	Tia		6195152300	7054				lindah@fhcsd.onmicrosoft.com	823 Gateway Center Way		San Diego	CA	92102	02/16/2022	2023	FAMILY HEALTH CENTERS OF SAN DIEGO, INC	National PACE	Family Health-Center for Older Adults	National PACE		Family Health Centers of San Diego	717	Yes	Active					PACE - Nat		C	San Francisco
H1714	Automated TrOOP Balance Transfer Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Backup User Access Contact	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Best Available Evidence Contact	Medical Director	Dr.	Mahdi	Khalida		3168581111	45128				khalida.mahdi@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Bid Primary Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	CAP Report Contact for Public Website	Director of Quality Improvement	Ms.	Eagles	Amber		3169465136				3169465105	amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	CEO - CMS Administrator Contact	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	CEO - Senior Official for Contracting	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Chief Financial Officer	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Chief Operating Officer	Vice President PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Chief Information Officer	Director of PACE Informatics	Mr.	Rice	Brandon		6202222766					brandon.rice@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Chief Information Security Officer	Director of PACE Informatics	Mr.	Rice	Brandon		6202222766					brandon.rice@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	CMS Casework Communication Contact	Director of Quality Improvement	Ms.	Eagles	Amber		3169465136				3169465105	amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Complaints Tracking Contact	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238					amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Contact for Fraud Investigations	Compliance Director	Mr.	Johnson	Jeff		3147293562					jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Coordination of Benefits Contact	Accounting	Ms.	Kennedy	Susan		3169465270					Susan.Kennedy@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Corporate Mailing						3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Coverage Gap Discount Program (CGDP) Payment Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Customer Service Operations Contact	Executive Director	Ms	Johnson	Melissa		3169465341				3166946510	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	DIR Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	DIR Contact (Secondary)	Accounting	Ms.	Kennedy	Susan		3169465270					Susan.Kennedy@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Emergency Part D Contact	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Emergency Part D Contact (Secondary)	Senior Director of Clinical Services-PACE	Ms.	Goetzinger	Jill		7725215733					jill.goetzinger@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Encounter Data & Risk Adjustment Operations Contact	Claims Manager		Stengele	Brett		8155291077				4236226048	Brett.Stengele@ascension.org	250 East 10st Street		Chattanoooga	TN	37402	04/14/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Enrollment Contact	Accounting	Ms.	Kennedy	Susan		3169465270					Susan.Kennedy@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	EOB Transfer Contact	Accounting	Ms.	Kennedy	Susan		3169465270				3169465105	Susan.Kennedy@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Financial Audit Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Financial Reporting Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/14/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Formulary Contact	Medical Director	Dr.	Mahdi	Khalida		3168581111	45128				khalida.mahdi@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	General Contact	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Government Relations Contact	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	HIPAA Privacy Officer	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238					amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	HIPAA Security Officer	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238					amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Interoperability Contact	Executive Director		Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	MA Appeals/Grievances Contact	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238	45136				amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	MA Claims Processing Contact for Public Website	Claims Manager		Stengele	Brett		8155291077				4236226048	Brett.Stengele@ascension.org	250 East 10st Street		Chattanoooga	TN	37402	04/14/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Marketing Contact	Marketing Director	Ms.	Campbell	Jennifer		3169465107				3169465106	jennifer.campbell@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Medical Director	Medical Director	Dr.	Mahdi	Khalida		3168581111	45128				khalida.mahdi@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Medicare Compliance Officer	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238					amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Medicare Coordinator	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Medicare Part D Opioid Overutilization Contact	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238					amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Medication Therapy Management Contact	Director of Quality Improvement	Ms.	Eagles	Amber		3169465136				3169465105	amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Part C Application Contact	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Part D Appeals	Director of Quality Improvement	Ms.	Eagles	Amber							amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active	3162072238				PACE - Nat		C	Kansas City
H1714	Part D Appeals Contact (Secondary)	Compliance Director	Mr.	Johnson	Jeff							jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active	8008814443				PACE - Nat		C	Kansas City
H1714	Part D Application Contact	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Part D Benefits Contact	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238					amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Part D Claims Submission Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Part D Exceptions Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty						4236226048	ty.webster@ascension.org	250 East 10th Street		Chattanooga	TN	37402	09/22/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active	8004418883				PACE - Nat		C	Kansas City
H1714	Part D Exceptions Contact (Secondary)	Compliance Director	Mr.	Johnson	Jeff							jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active	8008814443				PACE - Nat		C	Kansas City
H1714	Part D Price File Contact (Back-up)	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238					amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Part D Price File Contact (Primary)	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Part D Quality Assurance Contact	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238					amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Part D Reporting Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Patient Safety Contact	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238					amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Payment Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/14/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Pharmacy Director	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Pharmacy Network Management Contact	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Pharmacy Network Management Contact (Secondary)	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Pharmacy Technical Help Desk Contact	Executive Director	Ms	Johnson	Melissa						3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active	3169465136				PACE - Nat		C	Kansas City
H1714	Plan Directory Contact for Public Website	Executive Director	Ms	Johnson	Melissa		3169465341				3169465106	melissa.johnson9@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Plan to Plan Reconciliation Contact	Claims Manager		Stengele	Brett		8155291077				4236226048	Brett.Stengele@ascension.org	250 East 10st Street		Chattanoooga	TN	37402	03/14/2022	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Processor Contact	Claims Manager		Stengele	Brett		8155291077				4236226048	Brett.Stengele@ascension.org	250 East 10st Street		Chattanoooga	TN	37402	04/14/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Quality Contact	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238					amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Reconciliation Contact	Claims Manager		Stengele	Brett		8155291077				4236226048	Brett.Stengele@ascension.org	250 East 10st Street		Chattanoooga	TN	37402	04/14/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Reconciliation Contact (Secondary)	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Recovery Audit Contact	Vice President PACE Operations	Mr.	Cooper	Brian	D	3143849724					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/14/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Surveillance Contact	Compliance Director	Mr.	Johnson	Jeff		3147293562					jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	System Contact	Vice President PACE Operations	Mr.	Cooper	Brian	D	3147293592					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Third Party Administrator (TPA) Liaison	Claims Manager		Stengele	Brett		8155291077				4236226048	Brett.Stengele@ascension.org	250 East 10st Street		Chattanoooga	TN	37402	04/14/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	User Access Contact	Director of Quality Improvement	Ms.	Eagles	Amber		3162072238					amber.eagles@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Utilization Management Contact	Medical Director	Dr.	Mahdi	Khalida		3168581111	45128				khalida.mahdi@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1714	Utilization Review Contact	Medical Director	Dr.	Mahdi	Khalida		3168581111	45128				khalida.mahdi@ascension.org	755 N. Edwards		Wichita	KS	67203	04/28/2023	2023	VIA CHRISTI HEALTHCARE OUTREACH FOR ELDERS, INC.	National PACE	Ascension Living HOPE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Kansas City
H1722	Agent/Broker Compensation Data Contact	VP, Associate General Counsel	Ms.	Jan	Munizeh		6467675166					mjan@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Automated TrOOP Balance Transfer Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Backup User Access Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Best Available Evidence Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Bid Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Bid Audit Site Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Bid Primary Contact	Manager, Product Implementation	Mr.	Buntin	Bryant		2125192962					bbuntin@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	CAP Report Contact for Public Website	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	CEO - CMS Administrator Contact	President & CEO	Ms.	Wang	Pat		2128011500					pwang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	01/04/2023	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	CEO - Senior Official for Contracting	President & CEO	Ms.	Wang	Pat		2128011500					pwang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Chief Financial Officer	Chief Financial Officer	Mr.	Bermel	John		2124792777					jbermel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Chief Operating Officer	SVP, Operations	Ms.	Weinseiss	Karen		6466773595					kweinseiss@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Chief Information Officer	SVP, CIO	Mr.	Sweeney	GT		6467675199					gtsweeney@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Chief Information Security Officer	VP, Chief Security Information Officer	Mr.	Miller	Brian		6467675750					bmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	CMS Casework Communication Contact	Complaints Manager	Ms.	Gabriel	Charisse		6467675697					cgabriel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Complaints Tracking Contact	Complaints Manager	Ms.	Gabriel	Charisse		6467675697					cgabriel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Contact for Fraud Investigations	VP, Associate General Counsel	Mr.	Kianovsky	Nahum		2128013240					nkianovsky@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Coordination of Benefits Contact	Director, Payment Integrity Team	Ms.	Hutchinson	Chris		9176982415					chutchinson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Corporate Mailing						6463138967					clogreira@healthfirst.org	Healthfirst Medicare Plan	100 Church Street, 18th Floor	New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Manager, Accounting	Ms.	Tyme	Denise		6462732814					dtyme@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Customer Service Operations Contact	VP,  Member Services	Ms.	O'Connor	Kimberly		2128011639					koconnor@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	DIR Contact	Sr. Manager, Pharmacy Finance	Mr.	Denman	Hunter		2128013297					hdenman@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	DIR Contact (Secondary)	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					Tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Emergency Part D Contact	VP, Pharmacy	Mr.	Modi	Bhavesh		9734494186					bmodi@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/28/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Emergency Part D Contact (Secondary)	Director, Pharmacy Regulatory & Compliance	Ms.	Andreu	Kim		3475743277					kandreu@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/28/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters	Mr.	Miller	Robert		2125193011					rmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Enrollment Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	EOB Transfer Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753				6463134645	jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Financial Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Financial Reporting Contact	Chief Financial Officer	Mr.	Bermel	John		2124792777					jbermel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Formulary Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Formulary Contact (Secondary)	Medicare Clinical Pharmacist	Ms.	Baja	Melodie		6468565983					mbaja@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	General Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Government Relations Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	HIPAA Privacy Officer	AVP, Chief Privacy Officer	Ms.	Radler	Laurie		9172863902					lradler@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	HIPAA Security Officer	VP, Chief Security Information Officer	Mr.	Miller	Brian		6467675750					bmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Hospice Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Interoperability Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	MA Appeals/Grievances Contact	VP, Appeals & Grievances	Ms.	Johnston	Meredith		6467674748					mjohnston@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	MA Claims Processing Contact for Public Website	VP, Claims	Mr.	Johnson	Eric		2127292245					ejohnson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Marketing Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Medical Director	Chief Clinical Officer	Dr.	Schechtman	Jay		2128016170					jschechtman@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Medicare Compliance Officer	Chief Compliance Officer & Head of Internal Audit	Mr.	Hackendorn	John		2124534495					jhackendorn@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Medicare Coordinator	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/05/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Medication Therapy Management Contact	Sr. Pharmacy Manager	Mr.	Wiggall	Alex		2125198212					awiggall@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Online Enrollment Center Contact (Primary)	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Part C Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Part C Reporting Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Part D Appeals	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah							hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H1722	Part D Appeals Contact (Secondary)	Sr. Manager, Pharmacy Regulatory & Compliance	Ms.	Alenkina	Karolina							kalenkina@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H1722	Part D Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Part D Benefits Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Part D Claims Submission Contact	Manager, Pharmacy Benefits	Ms.	Grodzitsky	Janet		6467675231					jparedes@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Part D Exceptions Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah							hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H1722	Part D Exceptions Contact (Secondary)	Medicare Clinical Pharmacist	Ms.	Baja	Melodie							mbaja@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H1722	Part D Price File Contact (Back-up)	Senior Manager, PBM Financial Operations	Ms.	Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	CVS Health	9501 E. Shea Blvd	Scottsdale	AZ	85260	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Part D Price File Contact (Optional)	Advisor, Med D Finance	Mr.	Pertgen	Richard		8045258502					richard.pertgen@cvshealth.com	CVS Health	9501 E Shea Blvd, MC121	Scottsdale	AZ	85260	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Part D Price File Contact (Primary)	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Part D Quality Assurance Contact	AVP, Pharmacy	Ms.	Kourlas	Helen		2122096456					hkourlas@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Part D Reporting Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Patient Safety Contact	Manager, Pharmacy	Ms.	Gandara Rodriguez	Alexandra		2124792775					agandararodriguez@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Payment Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Pharmacy Director	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Pharmacy Network Management Contact	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist	Ms.	An	Diana		3476911405					dan@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Pharmacy Technical Help Desk Contact	Director, Client Operations	Ms.	Dayoub	Joselyn							dayoubj@cvshealth.com	CVS Health	800 NW Chipman Rd, Ste 5830	Lees Summit	MO	64063	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H1722	Physician Incentive Contact	VP, Deputy General Counsel	Mr.	Schiller	Robert		2124974347					rschiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Plan Directory Contact for Public Website			Services	Provider		8888011660					hfprovsrvs@healthfirst.org	P.O. Box 5168		New York	NY	102745168	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Plan to Plan Reconciliation Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor	Attn:  Treasury Department	New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Processor Contact	Director of Client Services Adjudication Solutions	Mr.	Mangin	Marty		3124981167					martin.mangin@cvshealth.com	CVS Health	2211 Sanders Road, 2215-5	Northbrook	IL	60062	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Quality Contact	VP, Clinical Quality	Ms.	Washington	Laisha		2128016186					lawashington@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Reconciliation Contact	VP, Actuarial Services	Ms.	Liang	Angela		2124535538					aliang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Recovery Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	SNP Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	SNP State Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Surveillance Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	System Contact	SVP, CIO	Mr.	Sweeney	GT		6467675199					gtsweeney@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Third Party Administrator (TPA) Liaison	Sr. Manager, Accounting	Ms.	Tyme	Denise		6462732814					dtyme@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	User Access Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Utilization Management Contact	VP, Utilization Management	Ms.	Gunderson	Christine		2123242688					cgunderson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1722	Utilization Review Contact	VP, Utilization Management	Ms.	Gunderson	Christine		2123242688					cgunderson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1723	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/07/2018	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Medical Director	Chief Medical Director	Dr.	Thompson	Robert		8038754346					robthompson@centene.com	1441 Main Street	Suite 900	Columbia	SC	29201	03/30/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	MMP Reporting Requirements Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/30/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	MMP Point of Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/30/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	PHR Beneficiary Contact																	09/27/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8557354398				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Plan Directory Contact for Public Website			Services	Provider		8664336041					CorporateMedicareComplianceDept@Centene.com	1441 Main Street		Columbia	SC	29201	03/31/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/24/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1723	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	ABSOLUTE TOTAL CARE, INC.	Demo	Wellcare Prime by Absolute Total Care	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H1732	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	01/30/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/06/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/06/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/16/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/16/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	01/30/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/30/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/30/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/30/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/06/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H1732	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H1732	PHR Beneficiary Contact																	01/30/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H1732	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/06/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/06/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/30/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1732	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/30/2020	2023	HEALTHPLUS HP, LLC	Local CCP	ANTHEM BLUE CROSS AND BLUE SHIELD	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Agent/Broker Compensation Data Contact	Director of Consumer Sales and Retention		Jones	Jeremy		2179028167					Jeremy.Jones@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/23/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Automated TrOOP Balance Transfer Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Backup User Access Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Best Available Evidence Contact	Medicare Enrollment Manager		Kirby	Rae		2179029108					rae.kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/23/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Bid Audit Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Bid Audit Site Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Bid Primary Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	CAP Report Contact for Public Website	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8009654022				HMO - Health Maintenance Organization		C	Chicago
H1737	CEO - CMS Administrator Contact	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	CEO - Senior Official for Contracting	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Chief Financial Officer	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/18/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Chief Operating Officer	Chief Operating Officer	Mr.	McPhearson	Les		2179029740				2179029740	Les.McPhearson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Chief Information Officer		Ms.	Griffith	Kim		2179029004				2179029740	kim.griffith@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/02/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Chief Information Security Officer	Director of Information Security	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	CMS Casework Communication Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Complaints Tracking Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Contact for Fraud Investigations	Corporate Compliance and ERM Mgr		Adamson	Susan		2179029137					Susan.Adamson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/24/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Coordination of Benefits Contact	Director of Claims & Recovery		Parker	Lisa		2179028353				2179029786	lisa.parker@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Corporate Mailing						2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/02/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Coverage Gap Discount Program (CGDP) Payment Contact			Boyce	Heather		2179029467					heather.boyce@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Customer Service Operations Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	DIR Contact	Director of Accounting		Deane	Laura		2179028322				2179029740	laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/02/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	DIR Contact (Secondary)			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Emergency Part D Contact	VP, Chief Compliance Officer		Wilson	Hollie		2176214156				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Emergency Part D Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368					Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/24/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Employer Waiver Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224					Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Encounter Data & Risk Adjustment Operations Contact	Director, System Config and Technical Services		Walsh	Pam		2179029449				2173657111	Pam.Walsh@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Enrollment Contact	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/24/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	EOB Transfer Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Financial Audit Contact	Executive Director of Finance	Mr.	Maxwell	Jamey		2179028321				2179029740	jamey.maxwell@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Financial Reporting Contact	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/18/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Formulary Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Formulary Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368				2179029798	Jena.Deschler@healthalliance.org	3310 Fields South		Champaign	IL	61822	11/19/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	General Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Government Relations Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	HIPAA Privacy Officer	Director, Corporate Compliance and Privacy Officer		Jensen	Traci		2179029152				2179029794	traci.jensen@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	HIPAA Security Officer	Director of Information Security	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/24/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Hospice Contact	Director of Pharmacy		Buhr	Aimee		2179029366					Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/24/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Interoperability Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	MA Appeals/Grievances Contact	Member / Provider Relations Manager		Regal	Wendi		2179028017				2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/24/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	MA Claims Processing Contact for Public Website		Ms.	Griffith	Kim		2179029004				2179029740	kim.griffith@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/02/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Marketing Contact	VP, Products and Marketing		Perry	Jana	L	2179028101				2179029740	jana.perry@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Medical Director	Associate Chief Medical Officer	Dr.	Revai	Krystal		2179028301				2179029740	Krystal.Revai@healthalliance.org	3310 Fields South Drive		Champaign	IL	61821	11/24/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Medicare Compliance Officer	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Medicare Coordinator	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Medicare Part D Opioid Overutilization Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Medication Therapy Management Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	OffShore Subcontractor Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Online Enrollment Center Contact (Back-up)	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/24/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Online Enrollment Center Contact (Optional)	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Online Enrollment Center Contact (Primary)	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Part C Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Part C Reporting Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Appeals	Member / Provider Relations Manager		Regal	Wendi						2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	2179028017				HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Appeals Contact (Secondary)	CEO		Madigan	Sinead						2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8008513379				HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Benefits Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029740	Hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Claims Submission Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Exceptions Contact	Medicare Compliance Officer		Wilson	Hollie						2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	2179028224				HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Exceptions Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena						2179029798	Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	2179029368				HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Price File Contact (Back-up)	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Price File Contact (Optional)	PBM Contact		Lyman	Dorothy		6126326265					DL-MedOpsPlanFinder@catamaranrx.com	1600 McConnor Parkway		Schaumburg	IL	60173	11/29/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Price File Contact (Primary)	Lead IT Operations		Walker	Kathy		2179025198				2173657111	kathy.walker@healthalliance.org	3310 Fields South		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Quality Assurance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Part D Reporting Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Patient Safety Contact	Medicare Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Payment Contact	Director of BECS		Kleinert	Traci		2179029508				2179029797	Traci.Kleinert@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Pharmacy Director	Director of Pharmacy		Buhr	Aimee		2179029366				2179029798	Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Pharmacy Network Management Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Pharmacy Network Management Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368				2179029798	Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Pharmacy Technical Help Desk Contact	VP, Chief Compliance Officer		Wilson	Hollie						2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8442651876				HMO - Health Maintenance Organization		C	Chicago
H1737	Physician Incentive Contact	VP, Provider Network Management		Walker	Randy		2179029106				2179029701	Randy.Walker@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Plan Directory Contact for Public Website	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Plan to Plan Reconciliation Contact			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Dr		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Processor Contact	Medicare Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Quality Contact	Quality Management Director		Migut	Tamra		2179028012				2179029789	tamara.migut@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/01/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Reconciliation Contact	Director of Accounting		Deane	Laura		2179078322				2179029740	laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Reconciliation Contact (Secondary)			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Recovery Audit Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	SNP Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Surveillance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	System Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Third Party Administrator (TPA) Liaison			Johnson	Danica		2179028322				2173657494	danica.johnson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/02/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	User Access Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Utilization Management Contact	Director, Utilization management and Systems		Fossier	Lori		2179029025				2179029703	lori.fossier@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1737	Utilization Review Contact	Directo, Utilization Management and Systems		Fossier	Lori		2179029025				2179029703	lori.fossier@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1742	Automated TrOOP Balance Transfer Contact	VP PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson		St. Louis	MO	63134	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Backup User Access Contact	Executive Director	Mr	Welch	Jeremy		4632713725				3175561765	jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Best Available Evidence Contact	Medical Director	Dr.	Harrison	Stephen		4632713726					stephen.harrison@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Bid Primary Contact	VP PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	CAP Report Contact for Public Website	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	CEO - CMS Administrator Contact	Executive Director	Mr.	Welch	Jeremy		4632713725					jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	CEO - Senior Official for Contracting	Executive Director	Mr.	Welch	Jeremy		4632713725					jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Chief Financial Officer	VP PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson		St. Louis	MO	63134	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Chief Operating Officer	Vice President PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/29/2022	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Chief Information Officer	Director of PACE Informatics	Mr.	Rice	Brandon		6202222766					brandon.rice@ascension.org	2622 W. Central #100		Wichita	KS	67203	04/29/2022	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Chief Information Security Officer	Director of PACE Informatics	Mr.	Rice	Brandon		6202222766					brandon.rice@ascension.org	2622 W. Central #100		Wichita	KS	67203	04/29/2022	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	CMS Casework Communication Contact	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Complaints Tracking Contact	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Contact for Fraud Investigations	Compliance Director	Mr.	Johnson	Jeff		3147293562					jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/03/2022	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Coordination of Benefits Contact	Accounting	Ms.	Kennedy	Susan		3169465270				3169465105	Susan.Kennedy@ascension.org	755 N. Edwards		Wichita	KS	67203	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Corporate Mailing						3177544565					jeremy.welch@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/03/2022	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Coverage Gap Discount Program (CGDP) Payment Contact	VP PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson St.		St. Louis	MO	63134	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Customer Service Operations Contact	Executive Director	Mr	Welch	Jeremy		4632713725				3175561765	jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	DIR Contact	VP PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson		St. Louis	MO	63134	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	DIR Contact (Secondary)	Accounting	Ms.	Kennedy	Susan		3169465270				3169465105	Susan.Kennedy@ascension.org	755 N. Edwards		Wichita	KS	67203	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Emergency Part D Contact	Executive Director	Mr	Welch	Jeremy		4632713725				3175561765	jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Emergency Part D Contact (Secondary)	Senior Director of Clinical Services-PACE	Ms.	Goetzinger	Jill		7725215733					jill.goetzinger@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/29/2022	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Encounter Data & Risk Adjustment Operations Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Enrollment Contact	Accounting	Ms.	Kennedy	Susan		3169465270				3169465105	Susan.Kennedy@ascension.org	755 N. Edwards		Wichita	KS	67203	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	EOB Transfer Contact	Accounting	Ms.	Kennedy	Susan		3169465270				3169465105	Susan.Kennedy@ascension.org	755 N. Edwards		Wichita	KS	67203	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Financial Audit Contact	VP PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Financial Reporting Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Rd.		St. Louis	MO	63134	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Formulary Contact	Medical Director	Dr.	Harrison	Stephen		4632713726					stephen.harrison@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	General Contact	Executive Director	Mr	Welch	Jeremy		4632713725				3175561765	jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Government Relations Contact	Executive Director	Mr	Welch	Jeremy		4632713725				3175561765	jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	HIPAA Privacy Officer	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	HIPAA Security Officer	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Interoperability Contact	Executive Director	Mr	Welch	Jeremy		4632713725				3175561765	jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	MA Appeals/Grievances Contact	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	MA Claims Processing Contact for Public Website	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Marketing Contact	Director	Ms.	Edwards	Beth		3178503753					beth.edwards2@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Medical Director	Medical Director	Dr.	Harrison	Stephen		4632713726					stephen.harrison@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Medicare Compliance Officer	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Medicare Coordinator	Executive Director	Mr	Welch	Jeremy		4632713725				3175561765	jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Medicare Part D Opioid Overutilization Contact	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Medication Therapy Management Contact	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Part C Application Contact	Executive Director	Mr	Welch	Jeremy		4632713725				3175561765	jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Part D Appeals	Director of Quality Management	Ms.	Wiles	Erin							erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active	8339493777				PACE - Nat		C	Chicago
H1742	Part D Appeals Contact (Secondary)	Compliance Director	Mr.	Johnson	Jeff							jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/03/2022	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active	8008814443				PACE - Nat		C	Chicago
H1742	Part D Application Contact	Executive Director	Mr	Welch	Jeremy		4632713725				3175561765	jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Part D Benefits Contact	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Part D Claims Submission Contact	VP PACE Operations	Mr.	Cooper	Brian		3143849724				4236226048	brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Part D Exceptions Contact	Vice President PACE Operations	Mr.	Cooper	Brian						4236226048	brian.cooper@ascension.org	250 East 10th Street		Chattanooga	TN	37402	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active	8004418883				PACE - Nat		C	Chicago
H1742	Part D Exceptions Contact (Secondary)	Compliance Director	Mr.	Johnson	Jeff							jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/03/2022	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active	8008814443				PACE - Nat		C	Chicago
H1742	Part D Price File Contact (Back-up)	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Part D Price File Contact (Primary)	Executive Director	Mr	Welch	Jeremy		4632713725				3175561765	jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Part D Quality Assurance Contact	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Part D Reporting Contact	VP PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson		St. Louis	MO	63134	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Patient Safety Contact	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Payment Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Pharmacy Director	Executive Director	Mr	Welch	Jeremy		4632713725				3175561765	jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Pharmacy Network Management Contact	Executive Director	Mr.	Welch	Jeremy		4632713725					jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Pharmacy Technical Help Desk Contact	Executive Director	Mr.	Welch	Jeremy							jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active	8339493777				PACE - Nat		C	Chicago
H1742	Plan Directory Contact for Public Website	Executive Director	Mr.	Welch	Jeremy		4632713725					jeremy.welch@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Plan to Plan Reconciliation Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Processor Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Quality Contact	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Reconciliation Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Reconciliation Contact (Secondary)	Vice President PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/03/2022	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Recovery Audit Contact	VP PACE Operations	Mr.	Cooper	Brian		3147293592					brian.cooper@ascension.org	4600 Edmundson		St. Louis	MO	63134	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Surveillance Contact	Compliance Director	Mr.	Johnson	Jeff		3147293562					jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/03/2022	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	System Contact	Vice President PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/03/2022	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Third Party Administrator (TPA) Liaison	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	06/08/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	User Access Contact	Director of Quality Management	Ms.	Wiles	Erin		4632713727					erin.wiles1@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	07/11/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Utilization Management Contact	Medical Director	Dr.	Harrison	Stephen		4632713726					stephen.harrison@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1742	Utilization Review Contact	Medical Director	Dr.	Harrison	Stephen		4632713726					stephen.harrison@ascension.org	5435 W Pike Plaza Rd		Indianapolis	IN	46254	06/13/2023	2023	ASCENSION LIVING ST. VINCENT PACE, INC.	National PACE	Ascension Living St. Vincent PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H1748	Agent/Broker Compensation Data Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/05/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Automated TrOOP Balance Transfer Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Backup User Access Contact	Chief Operating Officer	Mr	Merritt	Charles		4049655731					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	10/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Best Available Evidence Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Bid Audit Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/30/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Bid Audit Site Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/30/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Bid Primary Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/30/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	CAP Report Contact for Public Website	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	CEO - CMS Administrator Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	CEO - Senior Official for Contracting	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Chief Financial Officer	CEO/Chief Financial Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Chief Operating Officer	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Chief Information Officer	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Chief Information Security Officer	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	CMMI Model Point of Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	CMS Casework Communication Contact	Compliance Analyst	Ms	Fraser	Tonya		7708830401					tfraser@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Complaints Tracking Contact	Compliance Analyst	Ms	Fraser	Tonya		7708830401					tfraser@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Contact for Fraud Investigations	Compliance Analyst	Ms	Fraser	Tonya		7708830401					tfraser@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Coordination of Benefits Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Corporate Mailing						6782932034					kpinnock@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/30/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Customer Service Operations Contact	Chief Operating Officer	Mr	Merritt	Charles		4049655731					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	10/12/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	DIR Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/05/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	DIR Contact (Secondary)	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Electronic Health Record Contact	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Emergency Part D Contact	Pharmacy Director	Dr	Dunham	Scott		7248316035					Sdunham@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Emergency Part D Contact (Secondary)	Chief Medical Officer	Dr	Caraballo	Darwin		6785039219					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Employer Waiver Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4707652163					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Encounter Data & Risk Adjustment Operations Contact	Chief Operating Officer	Mr	Merritt	Charles		4049655731					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	10/12/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Enrollment Contact	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	EOB Transfer Contact	Chief Operating Officer	Mr	Merritt	Charles		4707652163				4043937617	cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/05/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Financial Audit Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Financial Reporting Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Formulary Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Formulary Contact (Secondary)	Pharmacy Director	Mr	Dunham	Scott		7248316035					sdunham@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	General Contact	Chief Compliance Officer	Mrs	Dreyer	Amber		9197933069					adreyer@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	06/22/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Government Relations Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	HIPAA Privacy Officer	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/21/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	HIPAA Security Officer	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Hospice Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Interoperability Contact	IT Director	Mr	DeNise	Christophe		9418702533					cdenise@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/16/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	MA Appeals/Grievances Contact	Chief Medical Officer	Dr	Caraballo	Darwin		6785039219					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Marketing Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/05/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Medical Director	Chief Medical Officer	Dr	Caraballo	Darwin		6785039219					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Medicare Compliance Officer	Chief Compliance Officer	Mrs	Dreyer	Amber		9197933069					adreyer@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	06/22/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Medicare Coordinator	Compliance Analyst	Ms	Fraser	Tonya		7708830401					tfraser@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Medicare Part D Opioid Overutilization Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Medication Therapy Management Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	OffShore Subcontractor Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Online Enrollment Center Contact (Back-up)	Compliance Analyst	Ms	Fraser	Tonya		7708830401					tfraser@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Online Enrollment Center Contact (Optional)	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Online Enrollment Center Contact (Primary)	Director, Enrollment Services	Ms	Kendrick	Daniell	M	7708830430					dkendrick@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Part C Application Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/30/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Part C Reporting Contact	Compliance Analyst	Ms	Fraser	Tonya		7708830401					tfraser@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Appeals	Chief Medical Officer	Dr	Caraballo	Darwin							dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active	4049655731				HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Appeals Contact (Secondary)	Chief Operating Officer	Mr	Merritt	Charles							cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active	4707652163				HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Application Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/30/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Benefits Contact	Pharmacy Director	Dr	Dunham	Scott		7248316035					Sdunham@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Claims Submission Contact	Pharmacy Director	Dr	Dunham	Scott		7248316035					sdunham@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Exceptions Contact	Pharmacy Director	Dr	Dunham	Scott							sdunham@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active	7248316035				HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Exceptions Contact (Secondary)	Chief Operating Officer	Mr	Merritt	Charles							cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/17/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active	4707652163				HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Price File Contact (Back-up)	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Price File Contact (Optional)	Pharmacy Director	Dr	Dunham	Scott		7248316035					sdunham@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Price File Contact (Primary)	CEO	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/30/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Quality Assurance Contact	Pharmacy Director	Dr	Dunham	Scott		7248316035					sdunham@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Part D Reporting Contact	Pharmacy Director	Dr	Dunham	Scott		7248316035					sdunham@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/28/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Patient Safety Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Payment Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/30/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Personal Health Record Contact	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Pharmacy Director	Pharmacy Director	Dr	Dunham	Scott		7248316035					sdunham@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Pharmacy Network Management Contact	Pharmacy Director	Dr	Dunham	Scott		7248316035					sdunham@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Pharmacy Network Management Contact (Secondary)	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Pharmacy Technical Help Desk Contact	Pharmacy Director	Dr	Dunham	Scott							sdunham@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/14/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active	8336847263				HMO - Health Maintenance Organization		C	Atlanta
H1748	Pharmacy Technical Help Desk Contact (Secondary)	Chief Operating Officer	Mr	Merritt	Charles							cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active	4707652163				HMO - Health Maintenance Organization		C	Atlanta
H1748	PHR Beneficiary Contact																	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS	Sonder Health Plans	Avian Health Holdings, LLC	728	Yes	Active	8884284440				HMO - Health Maintenance Organization		C	Atlanta
H1748	Physician Incentive Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Plan Directory Contact for Public Website	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/05/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Plan to Plan Reconciliation Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Processor Contact	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/05/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Quality Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Reconciliation Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/13/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Reconciliation Contact (Secondary)	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Recovery Audit Contact	CEO	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/30/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	SNP Application Contact	CEO	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Rd	Suite320	Atlanta	GA	30339	01/30/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	SNP State Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					Sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	01/30/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Surveillance Contact	Chief Executive Officer	Ms	Roberts	Suzanna		4703039206					sroberts@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	System Contact	IT Director	Mr	Denise	Christophe		4049655731					cdenise@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	03/12/2021	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Third Party Administrator (TPA) Liaison	Finance Manager	Ms	Newman	Yvonne		4702987673					ynewman@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	10/07/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	User Access Contact	Chief Operating Officer	Mr	Merritt	Charles		4707652163					cmerritt@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	04/18/2023	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Utilization Management Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1748	Utilization Review Contact	Chief Medical Officer	Dr	Caraballo	Darwin		4049655731					dcaraballo@sonderhealthplans.com	6190 Powers Ferry Road	Suite 320	Atlanta	GA	30339	12/13/2022	2023	SONDER HEALTH PLANS, INC.	Local CCP	Sonder Health Plans, Inc.	HMO/HMOPOS		Avian Health Holdings, LLC	728	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H1774	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H1774	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Medical Director	Chief Medical Director	Dr.	Lucas	Brad		8662464356					blucas@centene.com	3700 Embassy Parkway, Suite 200		Akron	OH	44333	03/30/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H1774	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H1774	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H1774	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H1774	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H1774	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H1774	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8335250824				PPO - BBA		C	Dallas
H1774	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	03/31/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1774	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1777	Agent/Broker Compensation Data Contact	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue	8th Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Services		Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Backup User Access Contact	Director of Non-Clinical Applications		Brown	Antonette		6462535650					atbrown@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	09/21/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Best Available Evidence Contact	VP, MCO		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Bid Audit Contact	Sr. Vice President, C.F.O	Ms	Covone	Annmarie		6466334702				6466334701	acovone@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Bid Audit Site Contact	Sr. Vice President, C.F.O	Ms	Covone	Annmarie		6466334702				6466334701	acovone@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Bid Primary Contact	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	CAP Report Contact for Public Website	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	CEO - CMS Administrator Contact	President and Chief Executive Officer	Mr.	La Rue	Scott		6462856858					slarue@archcare.org	205 Lexington Avenue	3rd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	CEO - Senior Official for Contracting	CEO	Mr.	La Rue	Scott		6464754868				6463955902	slarue@archcare.org	205 Lexington Avenue	3rd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Chief Financial Officer	Sr. Vice President, C.F.O	Ms	Covone	Annmarie		6466334702				6466334701	acovone@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Chief Operating Officer	Sr. Vice President, C.F.O	Ms	Covone	Annmarie		6466334702				6466334701	acovone@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Chief Information Officer	VP Information Technology	Ms.	Amoroso	Mitze		6465053860				6463695679	mamoroso@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Chief Information Security Officer	VP Information Technology	Ms.	Amoroso	Mitze		6465053860				6463695679	mamoroso@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	CMS Casework Communication Contact	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Complaints Tracking Contact	Director of Quality Improvement	Ms.	Holguin	Sylvia		9178901621				6462335745	sholguin2@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Contact for Fraud Investigations	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Coordination of Benefits Contact	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Corporate Mailing						6463955984				6462335745	vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Director, Finance		Traina	Marc		6466334732					mtraina@archcare.org	205 Lexington Avenue	2nd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Customer Service Operations Contact	Director, Customer Care		Swanger	Rachel		4405424056					Rachel.swanger@cvshealth.com	29100 Aurora Road		Solon	OH	44139	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	DIR Contact	Executive Vice President/Chief Financial Officer		Covone	Annmarie		6466334702					acovone@archcare.org	205 Lexington Avenue, 2nd Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	DIR Contact (Secondary)	Financial Analyst	Ms	Chan	Carol		6466334761					cchan@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Electronic Health Record Contact	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Emergency Part D Contact	Director, Pharmacy Services	Mr.	Krupar	Roman		9175244812					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Emergency Part D Contact (Secondary)	Sr. Vice President, C.F.O	Ms	Covone	Annmarie		6466334702				6466334701	acovone@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Encounter Data & Risk Adjustment Operations Contact	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Enrollment Contact	VP, Managed Care Organization		Fama	Victor		6465847984					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	EOB Transfer Contact	VP, Managed Care Organization		Fama	Victor		9174845055				9173981730	vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Financial Audit Contact	Sr. Vice President, C.F.O	Ms	Covone	Annmarie		6466334702				6466334701	acovone@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Financial Reporting Contact	Sr. Vice President, C.F.O	Ms	Covone	Annmarie		6466334702				6466334701	acovone@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Formulary Contact	Director, Pharmacy Services	Mr.	Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	General Contact	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Government Relations Contact	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	HIPAA Privacy Officer	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	HIPAA Security Officer	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Hospice Contact	Director, Pharmacy Services	Mr.	Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Interoperability Contact	Director of Non-Clinical Applications		Brown	Antonette		6462535650					atbrown@archcare.org	205 Lexington Avenue, 8th Floor	8th Floor	New York	NY	10016	09/21/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	MA Appeals/Grievances Contact	Director of Quality Improvement	Ms.	Holguin	Sylvia		9178901621				6462335745	sholguin2@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	MA Claims Processing Contact for Public Website	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Marketing Contact	Director of Marketing & Communications		Matta	Christine		6466334744					cmatta@archcare.org	205 Lexington Avenue	8th Floor	New York	NY	10016	09/21/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Medical Director	Medical Director	Dr.	Lechich	Anthony		6464709944					alechich@archcare.org	205 Lexington Avenue, 2nd Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Medicare Compliance Officer	Manager, Compliance	Ms.	McCosker	Elizabeth		9174849735					emccosker@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Medicare Coordinator	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Medicare Part D Opioid Overutilization Contact	AVP Clinical Services		Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Medication Therapy Management Contact	Director, Pharmacy Services	Mr.	Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Online Enrollment Center Contact (Back-up)	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Online Enrollment Center Contact (Optional)	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Online Enrollment Center Contact (Primary)	VP, Managed Care Organization		Fama	Victor		6465847984					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Part C Application Contact	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Part C Reporting Contact	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Part D Appeals	Director, Pharmacy Services		Krupar	Roman							rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract	8003733177				HMO - Health Maintenance Organization		C	New York
H1777	Part D Appeals Contact (Secondary)	VP, Managed Care Ops	Mr.	Fama	Victor							vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract	9174845055				HMO - Health Maintenance Organization		C	New York
H1777	Part D Application Contact	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Part D Benefits Contact	Director, Pharmacy Services	Mr.	Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Part D Claims Submission Contact	Director, Pharmacy Services	Mr.	Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Part D Exceptions Contact	Director, Medicare Clinical Operations		Patel	Nimesh							NimeshC.Patel@CVSCaremark.com	CVS Caremark Part D Services, LCC.	29100 Aurora Road	Solon	OH	44139	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract	4405425770				HMO - Health Maintenance Organization		C	New York
H1777	Part D Exceptions Contact (Secondary)	Director, Pharmacy Services	Mr.	Krupar	Roman							rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract	8003733177				HMO - Health Maintenance Organization		C	New York
H1777	Part D Price File Contact (Back-up)	Senior Analyst, Medicare Operations		Nichols	Kristy		4806147768					kristy.nichols@caremark.com	CVS Caremark Part D Services, LCC.	9501 E. Shea Blvd.	Scottsdale	AZ	85260	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Part D Price File Contact (Optional)	Analyst, Medicare Operations		McAuliffe	Kimberly		4806147876					kimberly.mcauliffe@caremark.com	CVS Caremark Part D Services, LCC.	9501 E. Shea Blvd.	Scottsdale	AZ	85260	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Part D Price File Contact (Primary)	Advisor, Medicare Operations		McDougall	Gary		4806314842				4803914373	gary.mcdougall@caremark.com	CVS Caremark Part D Services, LCC.	9501 East Shea Blvd.	Scottsdale	AZ	85260	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Part D Quality Assurance Contact	Director of Quality Improvement	Ms.	Holguin	Sylvia		9178901621				6462335745	sholguin2@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Part D Reporting Contact	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Patient Safety Contact	Director of Quality Improvement	Ms.	Holguin	Sylvia		9178901621				6462335745	sholguin2@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Payment Contact	Financial Analyst		Chan	Carol		6466334761				6462335745	cchan@archcare.org	205 Lexington Avenue, 2nd Floor	ArchCare Advantage - Finance	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Personal Health Record Contact	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Pharmacy Director	Director, Pharmacy Services	Mr.	Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Pharmacy Network Management Contact	Director, Network Systems & Standards		Tressler	Damon		4803914702				4803146023	damon.tressler@caremark.com	CVS Caremark Part D Services, LCC.	9501 E Shea Blvd., MC080	Scottsdale	AZ	85260	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Services	Mr.	Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Pharmacy Technical Help Desk Contact	Manager, Vendor Management		Palmieri	Mike						8666934620	Mike.Palmieri@caremark.com	CVS Caremark Part D Services, LCC.	2401 Cherahala Blvd., MC650	Knoxville	TN	37932	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract	8666934620				HMO - Health Maintenance Organization		C	New York
H1777	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy Services	Mr.	Krupar	Roman							rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract	8003733177				HMO - Health Maintenance Organization		C	New York
H1777	PHR Beneficiary Contact																	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS	ArchCare Advantage	Catholic Health Care System	317	Yes	Withdrawn Contract	8003733177				HMO - Health Maintenance Organization		C	New York
H1777	Physician Incentive Contact	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Plan Directory Contact for Public Website	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Plan to Plan Reconciliation Contact	Financial Analyst		Chan	Carol		6466334761				6462335745	cchan@archcare.org	205 Lexington Avenue, 2nd Floor	ArchCare Advantage - Finance	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Processor Contact	Vice President, Medicare Program Services		Merlino	Melanie		4802152151				4803146881	Melanie.Merlino@caremark.com	CVS Caremark Part D Services, LCC.	9501 E Shea Blvd.	Scottsdale	AZ	85260	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Quality Contact	Director of Quality Improvement	Ms.	Holguin	Sylvia		9178901621				6462335745	sholguin2@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Reconciliation Contact	Sr. Vice President, C.F.O	Ms	Covone	Annmarie		6466334702				6466334701	acovone@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Reconciliation Contact (Secondary)	Senior Director, Finance		Traina	Marc		6466334732					mtraina@archcare.org	205 Lexington Avenue, 2nd Floor	ArchCare Advantage - Finance	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Recovery Audit Contact	Financial Analyst	Ms.	Chan	Carol		6466334761				6462335745	cchan@archcare.org	205 Lexington Avenue, 2nd Floor	ArchCare Advantage - Finance	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	SNP Application Contact	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	SNP State Contact	Sr. Vice President, C.F.O	Ms	Covone	Annmarie		6466334702				6466334701	acovone@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Surveillance Contact	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	System Contact	Director of Non-Clinical Applications		Brown	Antonette		6462535650					atbrown@archcare.org	205 Lexington Avenue, 8th Floor	8th Floor	New York	NY	10016	09/21/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Third Party Administrator (TPA) Liaison	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	User Access Contact	VP, Managed Care Organization	Mr.	Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Utilization Management Contact	Assistant Vice President		Neiman	Leah		6463568424					lneiman@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1777	Utilization Review Contact	Assistant Vice President		Neiman	Leah		6463568424					lneiman@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	06/05/2023	2023	CATHOLIC SPECIAL NEEDS PLAN, LLC	Local CCP	ArchCare Advantage	HMO/HMOPOS		Catholic Health Care System	317	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H1787	Agent/Broker Compensation Data Contact	Director of Product Development	Ms.	Meyer	Courtney		6053122613					Courtney.Meyer@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Automated TrOOP Balance Transfer Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Backup User Access Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Best Available Evidence Contact	Director of Billing & Enrollment	Mr.	Reichelt	Daniel		6053122624					daniel.reichelt@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Bid Audit Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Bid Audit Site Contact	Director of Acturial Services	Mr.	Pence	Gregory		4156018550					gregory.pence@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Bid Primary Contact	Director of Actuarial Services	Mr.	Pence	Gregory		4156018550					gregory.pence@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	CAP Report Contact for Public Website	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	6053286806				HMO - Health Maintenance Organization		C	Dallas
H1787	CEO - CMS Administrator Contact	President	Mr.	Snyder	John		6053122750					john.snyder@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	CEO - Senior Official for Contracting	President	Mr.	Snyder	John		6053122750					john.snyder@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Chief Financial Officer	Vice President of Finance	Mr.	Maude	Brian		6053286801					Brian.Maude@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Chief Operating Officer	Chief Operating Officer	Ms.	Griese	Emily		6053287020					Emily.Griese@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Chief Information Officer	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Chief Information Security Officer	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	CMMI Model Point of Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	CMS Casework Communication Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 Cherapa place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Complaints Tracking Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Contact for Fraud Investigations	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Coordination of Benefits Contact	Director of Payment Integrity	Ms.	Lieser	Mesa		6053287024					mesa.lieser@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Corporate Mailing						8005354831					sanfordhealthplan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Customer Service Operations Contact	Director of Customer Service	Mr.	Ling	Ryan		6053127459					ryan.ling@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	DIR Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	DIR Contact (Secondary)	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Electronic Health Record Contact	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Emergency Part D Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Emergency Part D Contact (Secondary)	Senior Director of Goverment Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Employer Waiver Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Encounter Data & Risk Adjustment Operations Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Enrollment Contact	Director of Product Development	Ms.	Meyer	Courtney		6053122613					courtney.meyer@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	EOB Transfer Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182				6053286811	aleesa.jansick@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Financial Audit Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Financial Reporting Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Formulary Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Formulary Contact (Secondary)	Principal Pharmacy Benefits Specialist		Chen	Honghua		2242312740					Christine.Chen2@optum.com	1600  McConnor Parkway	Suite 201	Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	General Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Government Relations Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	HIPAA Privacy Officer	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	HIPAA Security Officer	Systems Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Hospice Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Interoperability Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	MA Appeals/Grievances Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	MA Claims Processing Contact for Public Website	Executive Director Operations	Ms.	Guggisberg	Stacey		6053286802					stacey.guggisberg@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Marketing Contact	Director of Marketing	Ms.	McCloskey	Diana		6053122762					diana.mccloskey@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Medical Director	Vice President, Medical Officer	Dr.	Faber	Kevin		6053287192					kevin.faber@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Medicare Compliance Officer	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Medicare Coordinator	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Medication Therapy Management Contact	Clinical Program Manager	Ms.	Liaqat	Tazeen		6305440541					Tazeen.liaqat@optum.com	1240 South Pine Island Rd.		Plantation	FL	33324	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	OffShore Subcontractor Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Online Enrollment Center Contact (Back-up)	Director of Medicare Programs	Mr.	Ovenden	Nathan		6053122606					nathan.ovenden@sanfordhealth.org	300 Cherapa Place, Suite 201		Sioux Falss	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Online Enrollment Center Contact (Optional)	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Online Enrollment Center Contact (Primary)	Senior Director of Development and Distribution	Ms.	Meyer	Courtney		6053122613					courtney.meyer@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Part C Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Part C Reporting Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Appeals	Manager, Prior Authorization Appeals	Ms.	Le	Christina						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Appeals Contact (Secondary)	Pharmacy Technician, PA Appeals		Chavez	Kelly						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Benefits Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Claims Submission Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Exceptions Contact	Manager, Prior Authorization	Ms.	Le	Christina						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Exceptions Contact (Secondary)	Pharmacy Technician, PA		Chavez	Kelly						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Price File Contact (Back-up)	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615				6053286811	timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Price File Contact (Optional)	Senior Director of Government Program	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Price File Contact (Primary)	Senior Business Analyst	Ms.	Lyman	Dorothy		6514955369					Dorothy.Lyman@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Quality Assurance Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007				6053286811	rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Part D Reporting Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Patient Safety Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Payment Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Personal Health Record Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Pharmacy Director	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615				6053286811	timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations	Ms.	Ashby	Jolynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk	Mr.	Summers	Todd							Todd.Summers@optum.com	1600 McConnor Parkway	Suite 200	Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8446429090				HMO - Health Maintenance Organization		C	Dallas
H1787	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Service	Mr.	Juarez	Ethan							ethan.juarez@optum.com	3515 Harbor Blvd		Costa Mesaa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	7148256891				HMO - Health Maintenance Organization		C	Dallas
H1787	PHR Beneficiary Contact																	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS	Sanford Health Plan	Sanford Health	740	Yes	Active	8885354831				HMO - Health Maintenance Organization		C	Dallas
H1787	Physician Incentive Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Plan Directory Contact for Public Website	Senior Director of Risk & Regulation	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Plan to Plan Reconciliation Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Processor Contact	Senior Manager, Benefit Administration	Ms.	Lievanos	Cassandra		7637974205					cassandra.lievanos@optum.com	5701 Katella Ave		Cypress	CA	90630	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Quality Contact	Senior Director of Risk & Regulation	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Reconciliation Contact	Director of Billing & Enrollment	Mr.	Reichelt	Daniel		6053122624					daniel.reichelt@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Reconciliation Contact (Secondary)	Executive Director of Opertions	Ms.	Guggisberg	Stacey		6053286802					stacey.guggisberg@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Recovery Audit Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	SNP Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	SNP State Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Surveillance Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	System Contact	Systems Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Third Party Administrator (TPA) Liaison	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	User Access Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Utilization Management Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1787	Utilization Review Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1799	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/19/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Best Available Evidence Contact	Director, Medicare Programs		Wolf	Mackenzie		5022138986					Mackenzie.Wolf@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	01/14/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	CAP Report Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	01/28/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/28/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Enrollment Contact	Director, Medicare Programs		Wolf	Mackenzie		5022138986					Mackenzie.Wolf@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	01/14/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	01/28/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	MA Claims Processing Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	01/28/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Online Enrollment Center Contact (Primary)	Director, Medicare Programs		Wolf	Mackenzie		5022138986					Mackenzie.Wolf@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	01/14/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H1799	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H1799	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H1799	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H1799	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	01/28/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/28/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/28/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H1799	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H1799	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Plan Directory Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/02/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	01/28/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1799	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF KENTUCKY, INC.	Local CCP	Passport Advantage	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H1821	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	6126562187				PPO - BBA		C	San Francisco
H1821	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	7632832653				PPO - BBA		C	San Francisco
H1821	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	8005959532				PPO - BBA		C	San Francisco
H1821	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	8007887871				PPO - BBA		C	San Francisco
H1821	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1821	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H1822	Agent/Broker Compensation Data Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131				5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Automated TrOOP Balance Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189			5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Backup User Access Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Best Available Evidence Contact	Director, Enrollment & Reconciliation	Mr.	Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Bid Audit Contact	CVP Strategic Iniatives & Product Development	Ms.	Selby	Jill		5629898382					jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Bid Audit Site Contact	CVP Strategic Initiatives & Product Development	Ms.	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Bid Primary Contact	CVP Strategic Initiatives & Product Development	Ms.	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	CAP Report Contact for Public Website	Compliance Officer	Ms.	Hawkins	Ginette		5623081195				5629895225	ghawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	CEO - CMS Administrator Contact	President, Medicare	Mrs	Schulte	Karen		5626371205					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/03/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	CEO - Senior Official for Contracting	CEO	Dr.	Jain	Sachin		5629898314	8314				sjain@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Chief Financial Officer	CFO	Mr.	Plumb	Michael		5629971589	1589				mplumb@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Chief Operating Officer	President	Mrs.	Schulte	Karen		5626371205	1205				kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Chief Information Officer	President	Mrs.	Schulte	Karen		5626371205	1205				kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Chief Information Security Officer	President	Mrs.	Schulte	Karen		5626371205	1205				kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	CMS Casework Communication Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131				5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Complaints Tracking Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131				5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Contact for Fraud Investigations	Chief Risk Executive		Hawkins	Ginette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	03/07/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Coordination of Benefits Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189			5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Corporate Mailing						5629895100				5629895200	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	Isaac	Sharon		5629894423					sisaac@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Customer Service Operations Contact	Director, (Customer) Member Services	Ms.	McBeath	Kim		5629971805				5629895181	kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	DIR Contact	Financial Accounting Specialist	Ms.	McClour	Tina		5629894459				5629890101	tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	DIR Contact (Secondary)	Manager Revenue Accounting	Ms.	Moreno	Sonia		5623081122					smoreno@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Emergency Part D Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		3237027662				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/21/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Emergency Part D Contact (Secondary)	Director,  Technical Pharmacy Operations	Ms.	Vaca	Ivette		5622091104				5629973196	ivaca@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/22/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Employer Waiver Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Encounter Data & Risk Adjustment Operations Contact	Chief Data Officer		Leung	Moon		5629895269					mleung@scanhealthplan.com	3800 Kilroy Airport Way suite 100		Long Beach	CA	90806	04/10/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Enrollment Contact	Director, Enrollment & Reconciliation	Mr.	Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	EOB Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189				5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Financial Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Financial Reporting Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Formulary Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Formulary Contact (Secondary)	Clinical Pharmacist	Ms.	Truong	Weilan		5629973187				5629973196	wtruong@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/03/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	General Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Government Relations Contact	VP of Government Relations		Hill	Ryann		2023499008				5629899439	rhill@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/10/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	HIPAA Privacy Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835	5835				a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/10/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	HIPAA Security Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835	5835				a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/10/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Hospice Contact	Manager, Pharmacy Experience and Access	Mr.	Tran	Tri		5623082884				5629973196	TMTran@scanhealthplan.com	3800 Kilroy Airport Way		Long Beach	CA	90806	02/09/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Interoperability Contact	VP, IT Software & Services	Mr.	Carren	Marc		5629971821					mcarren@scanhealthplan.com	3800 Kilroy Airport Way, Suite 100		Long Beach	CA	90806	02/10/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	MA Appeals/Grievances Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	MA Claims Processing Contact for Public Website	Vice President, Claims & Shared Services	Ms.	Wheeler	Nathan		5623084341					nwheeler@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Marketing Contact	Compliance Specialist	Mr.	Lin	Richard		5623081156					rlin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	10/02/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Medical Director	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431				5629899439	RBatraM.D@scanhelathplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Medicare Compliance Officer	Compliance Officer	Ms.	Hawkins	Ginette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Medicare Coordinator	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist Programs	Ms.	Kelley	Mackenzie		5629973165				5629973196	mkelley@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/26/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Medication Therapy Management Contact	Director Pharmacy Quality & 5 Star	Mr.	Dinh	Matthew		5629895261				5629973196	mdinh@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	OffShore Subcontractor Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ecordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/10/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment and Reconciliation	Ms.	Gongora	Irene		5629895209				5629895243	IGongora@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Online Enrollment Center Contact (Primary)	Director, Enrollment & Reconciliation	Mr.	Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Part C Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Part C Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Part D Appeals	Director, Grievance & Appeals	Ms.	Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way MS 220		Long Beach	CA	90801	02/01/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	5629895100	1290			HMO - Health Maintenance Organization		C	San Francisco
H1822	Part D Appeals Contact (Secondary)	Director, Grievance & Appeals	Ms.	Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way MS 220		Long Beach	CA	90801	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	5629895100	1290			HMO - Health Maintenance Organization		C	San Francisco
H1822	Part D Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Part D Benefits Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	04/29/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Part D Exceptions Contact	Senior Pharmacy Manager	Mr.	Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/01/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	San Francisco
H1822	Part D Price File Contact (Back-up)	Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfiled	OH	45014	12/01/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Part D Price File Contact (Optional)	Pharmacy Analyst		Ramirez	Anthony		5623084348	4348			5629973196	a.ramirez@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/01/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Part D Quality Assurance Contact	CVP/Chier Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Part D Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Patient Safety Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Payment Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Pharmacy Director	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Pharmacy Network Management Contact	Network Acct Director, Retail Strategy	Ms.	Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		St Louis	MO	63121	01/23/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkwy	STE 150	Temple Terrace''	FL	33637	12/01/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	San Francisco
H1822	Physician Incentive Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Plan Directory Contact for Public Website	Director, (Customer) Member Services	Ms.	McBeath	Kim		8777787226					kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Plan to Plan Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	P2PAdmin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Processor Contact	Senior Director Government Programs, Medicare	Ms.	Gibson	Sharon		8052361175					sggibson@express-scripts.com	One Express Way		St. Louis	MO	63121	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Quality Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Reconciliation Contact (Secondary)	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Recovery Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	SNP Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	SNP State Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Surveillance Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	System Contact		Mr.	Goode	Josh		5623082789					jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Third Party Administrator (TPA) Liaison	Financial Accounting Specialist	Ms.	McClour	Tina		5629894459					tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/19/2021	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	User Access Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Utilization Management Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1822	Utilization Review Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN DESERT HEALTH PLAN, INC.	Local CCP	SCAN Desert Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1846	Agent/Broker Compensation Data Contact	Director of Sales		Dues	Travis		6145463157				6145463131	Travis.Dues@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Automated TrOOP Balance Transfer Contact	Part D Analyst		Houk	Kim		6145463183				6145463131	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Backup User Access Contact	Sr. Application Specialist		Crawford	Carl		6145463215				6145463144	ccrawford@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Best Available Evidence Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Bid Audit Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463211	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Bid Audit Site Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Bid Primary Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	CAP Report Contact for Public Website	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	CEO - CMS Administrator Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	Jack.Randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	CEO - Senior Official for Contracting	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Chief Financial Officer	Chief Financial Officer	Mr	Vis	David		6145463211				6145463131	david.vis@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Chief Operating Officer	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Chief Information Officer	VP Service Optimization	Mr.	Trimmer	Matt		3017547190					matt.trimmer@trinity-health.org	3100 Easton Square Place		Columbus	OH	43219	07/17/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Chief Information Security Officer	Sr Security Manager, Enterprise Information Securi	Mr.	Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	CMS Casework Communication Contact	Compliance Specialist	Mr.	Jordan	David	A	6147068474				6142348372	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Complaints Tracking Contact	Compliance Specialist	Mr	Jordan	David	A	6147068474					djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Contact for Fraud Investigations	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Coordination of Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Corporate Mailing						4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Customer Service Operations Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	DIR Contact	CEO		Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square  Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	DIR Contact (Secondary)	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Electronic Health Record Contact	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Emergency Part D Contact	Chief Compliance Officer		Suffern	Patricia		4124780244				6145463132	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	12/23/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Emergency Part D Contact (Secondary)	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Employer Waiver Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Reconciliation Analyst		Sloan	Mike		6145463134					mike.sloan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Enrollment Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	EOB Transfer Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Financial Audit Contact	Chief Administration Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Financial Reporting Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Formulary Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Formulary Contact (Secondary)	Director, Pharmacy		Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	General Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Government Relations Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	HIPAA Privacy Officer	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	HIPAA Security Officer	Sr Security Manager, Enterprise Information Securi		Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Hospice Contact	Senior Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Interoperability Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	MA Appeals/Grievances Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	MA Claims Processing Contact for Public Website	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Marketing Contact	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Medical Director	MD	Dr.	Wise	Greg		6145463151				6145463131	gwise@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Medicare Compliance Officer	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Medicare Coordinator	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Medicare Part D Opioid Overutilization Contact	Pharmacy Data Analyst	Ms.	Houk	Kimberly		6145463183					kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Medication Therapy Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	OffShore Subcontractor Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment	Ms	Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Online Enrollment Center Contact (Optional)	Director, Enrollment and Premium Billing		Caudle	Jeff		6145463224				6145463148	jcaudle@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Online Enrollment Center Contact (Primary)	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Part C Application Contact	Director, Product Management and Business Devlpt		Mauck	Brandon		6145955681					brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Part C Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Part D Appeals	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H1846	Part D Appeals Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H1846	Part D Application Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Part D Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Part D Claims Submission Contact	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Part D Exceptions Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H1846	Part D Exceptions Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H1846	Part D Price File Contact (Back-up)	Formulary Consultant		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea		Scottsdale	AZ	85260	07/17/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Part D Price File Contact (Primary)	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Part D Quality Assurance Contact	Director of Pharmacy, Health Plans		Turoff	Chris		6144030394				6142346481	chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Part D Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Patient Safety Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Payment Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Pharmacy Director	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Pharmacy Network Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Pharmacy Network Management Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Pharmacy Technical Help Desk Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active	8666934620				PPO - BBA		C	Chicago
H1846	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Data Analyst	Mrs	Miller	Kim							kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active	8666934620				PPO - BBA		C	Chicago
H1846	PHR Beneficiary Contact																	12/05/2016	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO	MediGold	Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H1846	Physician Incentive Contact	Interim VP, Health Services	Ms	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Plan Directory Contact for Public Website	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Plan to Plan Reconciliation Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Processor Contact	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Quality Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Reconciliation Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Reconciliation Contact (Secondary)	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Recovery Audit Contact	Chief Administrative Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Surveillance Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	System Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Third Party Administrator (TPA) Liaison	Sr Finance Analyst		Fountain	Lisa		6145463220					lfountain@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	User Access Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Utilization Management Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1846	Utilization Review Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH INSURANCE COMPANY	Local CCP	MediGold	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H1848	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H1848	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H1848	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H1848	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H1848	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H1848	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H1848	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H1848	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1848	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1862	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H1862	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H1862	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H1862	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1862	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1889	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				PPO - BBA		C	San Francisco
H1889	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				PPO - BBA		C	San Francisco
H1889	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H1889	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				PPO - BBA		C	San Francisco
H1889	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1889	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H1894	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/06/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Bid Primary Contact	Product Management Director		Gray	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	02/11/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/11/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H1894	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H1894	PHR Beneficiary Contact																	02/07/2019	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H1894	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1894	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	AMERIGROUP WASHINGTON, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1904	Automated TrOOP Balance Transfer Contact	Director of Finance		McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Backup User Access Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Best Available Evidence Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Bid Primary Contact	Director of Finance		McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	CAP Report Contact for Public Website	Executive Director		Wootan	Kurt	D	5042273411					Kwootan@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active	5042273411				PACE - Nat		C	Denver
H1904	CEO - CMS Administrator Contact	Executive Director	Mr.	Wootan	Kurt	D	5042273411					Kwootan@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	CEO - Senior Official for Contracting	Executive Director	Mr.	Wootan	Kurt	D	5042273411					kwootan@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Chief Financial Officer	Director of Finance	Mr	McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Chief Operating Officer	Director of Operations	Mrs	Ventura	Trisha	D	5049416053					Tventura@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Chief Information Officer	CIO	Mr	Zlatnicky	Terry		5043108742					tzlatnick@ccano.org	1000 Howard Ave		New Orleans	LA	70113	06/01/2016	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Chief Information Security Officer	CIO	Mr	Zlatnicky	Terry		5043108742					tzlatnick@ccano.org	1000 Howard Ave		New Orleans	LA	70113	06/01/2016	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	CMS Casework Communication Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Complaints Tracking Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Contact for Fraud Investigations	Director of Operations		Ventura	Trisha		5049416053					Tventura@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Coordination of Benefits Contact	Director of Finance	Mr.	McCauley	Bryan		5049416075					bmccauley@ccano.org	4201 N Rampart St		New Orleans	LA	70117	05/22/2023	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Corporate Mailing						5049416057					pace@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	10/02/2018	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Coverage Gap Discount Program (CGDP) Payment Contact	Executive Director	Mr.	Wootan	Kurt	D	5042273411					kwootan@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Customer Service Operations Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	DIR Contact	Director of Finance		McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Emergency Part D Contact	Director of Finance		McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Encounter Data & Risk Adjustment Operations Contact	Director of Finance		McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Enrollment Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	EOB Transfer Contact	Executive Director	Mr	Wootan	Kurt	D	5042273411				5049416082	kwootan@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Financial Audit Contact	Director of Finance	Mr	McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Financial Reporting Contact	Director of Finance		McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Formulary Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	General Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Government Relations Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	HIPAA Privacy Officer	Director of Operations	Mrs	Ventura	Trisha	D	5049416053					Tventura@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	HIPAA Security Officer	Director of Operations	Mrs	Ventura	Trisha	D	5049416053					Tventura@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Interoperability Contact			Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N Rampart Street		New Orleans	LA	70117	06/03/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	MA Appeals/Grievances Contact	Director of Operations	Mrs	Ventura	Trisha	D	5049416053					Tventura@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	MA Claims Processing Contact for Public Website	Interim Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	11/02/2021	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Marketing Contact	Interim Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	11/02/2021	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Medical Director	Medical Director	Dr.	Cruz	Brian		5049416084					bcruz@ccano.org	4201 North Rampart Street		New Orleans	LA	70117	11/02/2021	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Medicare Compliance Officer	Director of Operations	Mrs	Ventura	Trisha	D	5049416053					Tventura@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Medicare Coordinator	Interim Executive Director	Mr.	Wootan	Kurt		5042273411					kwootan@ccano.org	4201 N Rampart St		New Orleans	LA	70117	11/02/2021	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Medicare Part D Opioid Overutilization Contact	Executive Director		Wootan	Kurt	D	5042273411					Kwootan@ccano.org	4201 North Rampart Street		New Orleans	LA	70117	09/22/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Medication Therapy Management Contact	Medical Director	Dr.	Cruz	Brian		5049416084					bcruz@ccano.org	4201 North Rampart Street		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Part C Application Contact	Interim Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	11/02/2021	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Part D Appeals	Director of Finance	Mr	McCauley	Bryan	D					5049416082	Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active	8667438778				PACE - Nat		C	Denver
H1904	Part D Application Contact	Director of Finance	Mr	McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Part D Benefits Contact	Director of Finance	Mr	McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Part D Claims Submission Contact	Director of Finance	Mr	McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Part D Exceptions Contact	Director of Finance	Mr	McCauley	Bryan	D					5049416082	McCauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active	8667438778				PACE - Nat		C	Denver
H1904	Part D Price File Contact (Back-up)	Director of Finance	Mr	McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Part D Price File Contact (Primary)	Director of Finance	Mr	McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Part D Quality Assurance Contact	Director of Finance	Mr	McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Part D Reporting Contact	Director of Finance	Mr	McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Patient Safety Contact	Interim Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	11/02/2021	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Payment Contact	Interim Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	11/02/2021	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Pharmacy Director	Interim Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	11/02/2021	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Pharmacy Network Management Contact	Interim Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	11/02/2021	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Pharmacy Technical Help Desk Contact	Interim Executive Director	Mr	Wootan	Kurt	D					5049416082	Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	11/02/2021	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active	8667438778				PACE - Nat		C	Denver
H1904	Plan Directory Contact for Public Website	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Plan to Plan Reconciliation Contact	Director of Finance	Mr	McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Processor Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Quality Contact	Director of Operations	Mrs	Ventura	Trisha	D	5049416053					Tventura@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Reconciliation Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Recovery Audit Contact	Executive Director	Mr	Wootan	Kurt		5042273411					kwootan@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Surveillance Contact	Executive Director		Wootan	Kurt		5042273411					Kwootan@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	System Contact	Executive Director	Mr.	Wootan	Kurt	D	5042273411					Kwootan@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Third Party Administrator (TPA) Liaison	Director of Finance	Mr	McCauley	Bryan		5049416075					Bmccauley@ccano.org	4201 N RAMPART ST		NEW ORLEANS	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	User Access Contact	Executive Director	Mr.	Wootan	Kurt	D	5042273411					Kwootan@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Utilization Management Contact	Executive Director	Mr.	Wootan	Kurt	D	5042273411					Kwootan@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1904	Utilization Review Contact	Executive Director	Mr.	Wootan	Kurt	D	5042273411					Kwootan@ccano.org	4201 N Rampart St		New Orleans	LA	70117	07/19/2022	2023	PACE GREATER NEW ORLEANS	National PACE	Pace Greater New Orleans	National PACE		Catholic Charities Archdiocese of New Orleans	471	Yes	Active					PACE - Nat		C	Denver
H1914	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H1914	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H1914	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H1914	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H1914	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H1914	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H1914	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H1914	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1914	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF CONNECTICUT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H1924	Agent/Broker Compensation Data Contact	VP Sales/Marketing	Ms.	Young	Saadia		3125353328					saadia.young@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Backup User Access Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Bid Audit Contact	Chief Operating Officer	Mr.	Collins	Garfield		3123195468					Garfield.Collins@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Bid Primary Contact	V.P. Product Development	Ms.	Pamanian	Lily		3127763356	325				lily.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	CAP Report Contact for Public Website			Healthcare	Lasso		8005790254					info@lassohealthcare.com	P.O. Box 261709		Plano	TX	75026	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	CEO - CMS Administrator Contact	CEO	Mr.	Clifton	Andrew		3128588400					andrew.clifton@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	CEO - Senior Official for Contracting	CEO	Mr.	Clifton	Andrew		3128588400					andrew.clifton@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Chief Financial Officer	Chief Financial Officer	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Chief Operating Officer	Chief Operating Officer	Mr.	Collins	Garfield		6029205331					garfield.collins@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Chief Information Officer	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Chief Information Security Officer	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	CMS Casework Communication Contact	Director, Compliance Audit & Monitoring	Ms.	Gordon	Reneatha		3128097947					reneatha.gordon@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Complaints Tracking Contact	Director, Compliance Audit & Monitoring	Ms.	Gordon	Reneatha		3128097947					reneatha.gordon@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Contact for Fraud Investigations	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Corporate Mailing						8009184024					info@lassohealthcare.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Customer Service Operations Contact	COO	Mr.	Collins	Garfield		3123195468	101				garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Encounter Data & Risk Adjustment Operations Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Enrollment Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Financial Audit Contact	Chief Financial Officer	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Financial Reporting Contact	Chief Financial Officer	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	General Contact	Chief Operating Officer	Mr.	Collins	Garfield		6029205331					garfield.collins@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Government Relations Contact	Communication	Mr.	Martin	Stephen		3122057948	138				stephen.martin@myzing.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Interoperability Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	MA Appeals/Grievances Contact	V.P. Health Plan Operations	Mr.	Smith	Mark		3125858846	165				mark.smith@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	MA Claims Processing Contact for Public Website			Healthcare	Lasso		8005790254					info@lassohealthcare.com	P.O. Box 261709		Plano	TX	75026	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Marketing Contact	VP Sales/Marketing	Ms.	Young	Saadia		3125353328					saadia.young@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Medical Director	Interim CMO	Dr	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Medicare Compliance Officer	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Medicare Coordinator	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	OffShore Subcontractor Contact	Director, Compliance Audit & Monitoring	Ms.	Gordon	Reneatha		3128097947					reneatha.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Part C Application Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Part C Reporting Contact	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Payment Contact	Chief Financial Officer	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Plan Directory Contact for Public Website			Services	Provider		8005790254					info@lassohealthcare.com	P.O. Box 261709		Plano	TX	75026	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Quality Contact	V.P. Enterprise Quality	Ms.	DeMers	Becky		3127762142					becky.demers@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Recovery Audit Contact	Director, Compliance Audit & Monitoring	Ms.	Gordon	Reneatha		3128097947					reneatha.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Surveillance Contact	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	System Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	User Access Contact	Director, Compliance Audit & Monitoring	Ms.	Gordon	Reneatha		3128097947					reneatha.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Utilization Management Contact	V.P. Clinical Operations		Wohkittel	Karen		3128585770					karen.wohkittel@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1924	Utilization Review Contact	V.P. Clinical Operations		Wohkittel	Karen		3128585770					karen.wohkittel@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/10/2023	2023	LASSO HEALTHCARE INSURANCE COMPANY	MSA	Lasso Healthcare	MSA		Zing Health Consolidator, Inc	730	No	Terminated					MSA		C	Denver
H1944	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H1944	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H1944	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H1944	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H1944	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1944	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1947	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	02/04/2019	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/06/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/06/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Bid Primary Contact	Product Management Director		Gray	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	02/14/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/14/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/04/2019	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H1947	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H1947	PHR Beneficiary Contact																	02/04/2019	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H1947	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/06/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1947	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	COMMUNITY CARE HEALTH PLAN OF LOUISIANA, INC.	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H1951	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H1951	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H1951	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1951	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH BENEFIT PLAN OF LOUISIANA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H1961	Agent/Broker Compensation Data Contact			Robert	Michael		5048494500	8550				michael.robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Backup User Access Contact			Hulin	Colin		5048494500	8900				colin.hulin@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Best Available Evidence Contact			Shirer	Rachael		5046818545					rachael.shirer@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Bid Audit Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	CEO - CMS Administrator Contact		Mrs.	O'Brien	Suzanne	S	5048494510	8510				Suzi.Swoop@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	01/04/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	CEO - Senior Official for Contracting		Mrs.	O'Brien	Suzanne	S	5048494500	8510				Suzi.Swoop@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	12/15/2022	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	01/21/2022	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Chief Operating Officer		Mrs.	Swoop O'Brien	Suzanne		5046818543	8510				suzi.swoop@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Chief Information Officer		Mr.	Hulin	Colin		5048494500	8900				colin.hulin@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	CMS Casework Communication Contact			Culotta	Dianne		5048494500	8672				dianne.culotta@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Complaints Tracking Contact			Culotta	Dianne		5048494500	8672				dianne.culotta@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Contact for Fraud Investigations			Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	09/02/2021	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Corporate Mailing						5046818550					michael.robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Blvd, Suite 2200	Metairie	LA	70002	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	04/12/2021	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Customer Service Operations Contact	Director of Customer Service		Miller	Cheryl		5048494500	8175				cheryl.miller@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/22/2022	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	12/17/2019	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	DIR Contact (Secondary)			Robert	Michael	J	5046818550					phn-pbmteam@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/13/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Enrollment Contact			Shirer	Rachael		5046818545					rachael.shirer@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Financial Audit Contact	Senior Vice President Audit and Compliance	Mr.	Robert	Michael		5048494500	8550				michael.robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Financial Reporting Contact			Geary	Emmet		5048494500	8604				emmet.geary@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	08/26/2022	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Formulary Contact (Secondary)			Smith	Shannon		5046818887					shannon.smith@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	12/17/2019	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	General Contact			Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	09/02/2021	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	MA Appeals/Grievances Contact			Culotta	Dianne		5048494500	8672				dianne.culotta@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	MA Claims Processing Contact for Public Website			Shirer	Rachael		5046818545					rachael.shirer@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Marketing Contact			Yarbrough	Natalie		5048494500	1263				Natalie.Yarbrough@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2500	Metairie	LA	70002	09/27/2021	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Medical Director			Wallis, MD	Brent		5048494500	1155				brent.wallis@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Medicare Coordinator			Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	09/02/2021	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/03/2022	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Medication Therapy Management Contact			Smith	Shannon		5048494500	8887				phn-pbmteam@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	OffShore Subcontractor Contact			Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	09/02/2021	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Online Enrollment Center Contact (Back-up)			Korndorffer	Gretchen		5048494500	8963				gretchen.korndorffer@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Online Enrollment Center Contact (Primary)	Vice President of Operations		Shirer	Rachael		5046818545					rachael.shirer@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2500	Metairie	LA	70002	08/26/2022	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Part C Application Contact			Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	12/02/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Appeals			Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Appeals Contact (Secondary)			Culotta	Dianne							dianne.culotta@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	5048494500	8672			HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Application Contact			Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	12/17/2019	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	06/28/2022	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Claims Submission Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Exceptions Contact (Secondary)			Robert	Michael	J						phn-pbmteam@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard Suite 2200	Metairie	LA	70002	04/13/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8006318443	8550			HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	12/17/2019	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	12/02/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	11/24/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Payment Contact			Geary	Emmet		5048494500	8604				emmet.geary@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	03/23/2022	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Pharmacy Network Management Contact			Fernandez	Marilyn		7633615037					marilyn_fernandez1@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Pharmacy Network Management Contact (Secondary)			Robert	Michael	j	5048494500	8550				phn-pbmteam@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/13/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H1961	Pharmacy Technical Help Desk Contact (Secondary)			Robert	Michael	j						phn-pbmteam@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/13/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8883465701				HMO - Health Maintenance Organization		C	San Francisco
H1961	Plan Directory Contact for Public Website			Courtney	Meghan		5048494500	8812				meghan.courtney@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	12/17/2019	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Processor Contact			Duss	Denise		7158582203					denise_duss@uhc.com	PO Box 9472		Minneapolis	MN	554409472	04/01/2021	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Quality Contact	Director of Quality Improvement HEDIS/Stars		Lester	Elizabeth		5048491339					elizabeth.lester@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2500	Metairie	LA	70002	08/26/2022	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Recovery Audit Contact	Sr. VP Audit and Compliance	Mr.	Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	09/02/2021	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	SNP Application Contact	Compliance Officer		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	03/25/2020	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	System Contact			Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	09/02/2021	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	02/12/2021	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	User Access Contact		Mr.	Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Utilization Management Contact			Ross	Kelli	A	5046818156					kelli.ross@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2500	Metairie	LA	70002	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1961	Utilization Review Contact			Ross	Kelli	A	5046818156					kelli.ross@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2500	Metairie	LA	70002	03/14/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1969	Agent/Broker Compensation Data Contact	VP Medicare Sales	Mr.	Hess	Brent		8013336143					Brent.Hess@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	07/06/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Automated TrOOP Balance Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Backup User Access Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St.	MS:E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Best Available Evidence Contact	Membership Ambassador	Ms.	Neufeld	Jeri		8006621470	2526			8883352988	ORMEMMEDAmbassador@regence.com	PO Box 1827		Medford	OR	97501	02/16/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Bid Audit Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Bid Audit Site Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Bid Primary Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	CAP Report Contact for Public Website	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	CEO - CMS Administrator Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/04/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	CEO - Senior Official for Contracting	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/09/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Chief Financial Officer	SVP & CFO	Mr.	Rains	Mike		2063326521					Mike.Rains@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Chief Operating Officer	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Chief Information Officer	SVP STRATEGIC TECH SOL & CIO	Mr	Rotival	Laurent		2063325034					Laurent.Rotival@cambiahealth.com	200 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Chief Information Security Officer	VP & CHIEF INFO SEC OFFICER	Mr	Anderson	Kirk		5037251608					Kirk.Anderson@cambiahealth.com	100 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	CMMI Model Point of Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	CMS Casework Communication Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Complaints Tracking Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Contact for Fraud Investigations	Senior Audit Investigator	Ms.	Grimes-Burke	Jennifer		5035873355					Jennifer.Grimes-Burke@regence.com	100 SW Market St	M/S E12B	Portland	OR	97201	06/16/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Coordination of Benefits Contact	Manager, Member Services	Ms	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	PO Box 1827	MS: B32M	Medford	OR	97501	07/09/2016	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Corporate Mailing						5032206237				5035884350	Jennifer.DelVillar@regence.com	100 SW Market Street		Portland	OR	97201	01/27/2014	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Sr I	Mr.	Gerken	Matthew		2063324809					Matthew.Gerken@cambiahealth.com	1800 9th Ave		Seattle	WA	98101	04/19/2016	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Customer Service Operations Contact	Manager Member Services	Ms	Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	DIR Contact	Manager Pharmacy Informatics		Kidd	Vicki		2083957739				2083337874	vicki.kidd@regence.com	1211 West Myrtle, Suite 110		Boise	ID	83702	01/08/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	DIR Contact (Secondary)	Dir. Gov. Pro Compliance / Medicare Compliance Off	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street E10C		Portland	OR	97201	07/22/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Emergency Part D Contact	VP Pharm Ops & Compliance	Mr.	Weiss	Justin		5032256677					Justin.Weiss@cambiahealth.com	200 SW Market St		Portland	OR	97201	12/20/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Emergency Part D Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Employer Waiver Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment, Manager	Mr.	Moore	Jason		2087982318					Jason.Moore@cambiahealth.com	1602 21st Ave		Lewiston	ID	83501	10/18/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Enrollment Contact	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	EOB Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Financial Audit Contact	Government Programs Audit Consultant	Mr.	Hutt	Brian		5032206160					Brian.Hutt@regence.com	200 SW Market Street	MS: E10C	Portland	OR	97201	05/09/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Financial Reporting Contact	Fin Acctg & Reporting, Assistant Director	Mr	Striplin	Daniel	W	5032256069					Dan.Striplin@regence.com	200 SW Market		Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Formulary Contact	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Ave		Portland	OR	97201	01/18/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	General Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Government Relations Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St.	MS:E10C	Portland	OR	97201	04/18/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	HIPAA Privacy Officer	VP Chief Compliance & Privacy Officer	Ms.	Erbes	Kristen		5035256533					kristen.erbes@regence.com	200 SW Market St	M/S: E14A	Portland	OR	97201	02/25/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	HIPAA Security Officer	Chief Information Security Officer	Mr.	Person	Steve		5037251654					Steve.Person@regence.com	1621 SW First Ave.		Portland	OR	97201	02/25/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Hospice Contact	Pharmacy Ops Oversight Specialist	Ms.	Pickens	Spring		5032255240					Spring.Pickens@regence.com	100 SW Market St	MS: WW5-56	Portland	OR	97201	02/05/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Interoperability Contact	VP Chief Tech Officer		Anderson	Kirk		5037251608					kirk.anderson@cambiahealth.com	Cambia Health Solutions	200 SW Market Street	Portland	OR	97201	02/09/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	MA Appeals/Grievances Contact	Director, Clinical Services Operations	Ms.	Sikora	Joelle		2063325320					Joelle.Sikora@regence.com	1800 Ninth Avenue		Seattle	WA	98101	05/09/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	MA Claims Processing Contact for Public Website	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Marketing Contact	Compliance Analyst		Meirose	Robyn		5033918668					robyn.meirose@regence.com	200 SW Market St  MS: E10C		Portland	OR	97201	09/15/2015	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Medical Director	SVP Chief Medical Officer	Ms.	Milavetz	Donna		8013336740					Donna.Milavetz@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	12/05/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Medicare Compliance Officer	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	07/14/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Medicare Coordinator	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827		Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Medicare Part D Opioid Overutilization Contact	Drug Management Program	Ms.	Anderson	Ally		8557297221					partdoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Medication Therapy Management Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Online Enrollment Center Contact (Back-up)	Dir Medicare Planning & Performance	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Online Enrollment Center Contact (Optional)	Manager Member Services	Ms.	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	2057 Commerce Dr		Medford	OR	97504	11/06/2017	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Online Enrollment Center Contact (Primary)	Spv Membership, GP OR Medicare Ops & Billing	Ms.	Cromwell	Krista		5416181286					Krista.Cromwell@regence.com	PO Box 1827	M/S: B32M	Medford	OR	97501	03/07/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Part C Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Part C Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossig Rd	Eagan	MN	55120	03/21/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Benefits Contact	Product Manager III	Ms.	Holliston	Danica		5032254871					Danica.Holliston@regence.com	200 SW Market St  M/S: E10M		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Claims Submission Contact	Functional Business Consultant - Government Prgrms	Mr.	Brook	Lance		4026862603					LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	08/05/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Exceptions Contact (Secondary)	Asst Director Pharmacy Operations	Ms.	Yi	Edie							edie.yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	972071271	12/15/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	5032254801				HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Price File Contact (Back-up)	Database Reporting Analyst	Ms	Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Price File Contact (Optional)	QA Analyst Sr	Ms.	Tastad	Emily		6127772557					emily.tastad@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/03/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Price File Contact (Primary)	AD Pharmacy Informatics	Ms.	Kidd	Vicki		2083957739					Vicki.Kidd@regence.com	1211 West Myrtle		Boise	ID	83702	07/22/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Quality Assurance Contact	Assistant Dir Pharmacy Operations	Ms.	Yi	Edie		5032254801				2083957744	Edie. Yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	97201	12/27/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Part D Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Patient Safety Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Payment Contact	Asst Director Fin Acctg & Reporting	Mr.	Striplin	Dan		5032256069					Dan.Striplin@cambiahealth.com	100 SW Market St	M/S: C2A	Portland	OR	97201	01/27/2014	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Pharmacy Director	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Avenue, M/S PDX - WW3-33		Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Pharmacy Network Management Contact	AVP, Network Mangement	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/18/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Management Relations		Lenhart	Alicia		6127773969				8778236373	Alicia.Lenhart@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	09/11/2020	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Pharmacy Technical Help Desk Contact	Director, Member Services Government Programs	Mr.	Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				HMO - Health Maintenance Organization		C	Seattle
H1969	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jon							jonathan.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				HMO - Health Maintenance Organization		C	Seattle
H1969	Plan Directory Contact for Public Website	Manager Member Services		Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Plan to Plan Reconciliation Contact	Pharmacy Operations Oversight Specialist, Sr.	Ms.	Manzer	Amy		5032255368					Amy.Manzer@regence.com	200 SW Market St	M/S: PDX-ZOF WW3-33	Portland	OR	97201	08/26/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing	Egan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Quality Contact	Director, Quality Management	Mr.	Mcclure	Andy		5032206189					Andrew.Mcclure@regence.com	1621 SW First Ave	M/S WW5-52	Portland	OR	97201	04/12/2019	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Reconciliation Contact	VP Finance Controller		Vannoy	Anjie		5032761865					Anjie.Vannoy@cambiahealth.com	100 SW Market St.	MS:PDX-WW2-21	Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Reconciliation Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS:E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Recovery Audit Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Surveillance Contact	Government Programs Compliance Officer		Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St  M/S: E10C		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	System Contact	Medicare Business Operations, Product Owner	Ms.	Fredinburg	Deana		5033754426					Deana.Fredinburg@regence.com	PO BOX 1827	M/S: B32AG	Medford	OR	97501	06/24/2022	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Third Party Administrator (TPA) Liaison	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	User Access Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Utilization Management Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1969	Utilization Review Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUESHIELD OF IDAHO, INC.	Local CCP	Regence BlueShield of Idaho	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1977	Agent/Broker Compensation Data Contact	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/07/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Automated TrOOP Balance Transfer Contact	Medicare Account Manager		Peczynski	Jody	S	2483418158	68158				jspeczynski@magellanhealth.com	Magellan Rx	2520 Industria Row Drive	Troy	MI	48084	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Backup User Access Contact	Director of Information Systems	Ms.	Chipelewski	Jill		9062253915					jchipelewski@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Best Available Evidence Contact	Government Programs Manager	Ms.	Stewart	Nicole		9062321601				9062321604	nstewart@uphp.com	853 W. Washington Street		Marquette	MI	49855	09/15/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Bid Audit Contact	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/07/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Bid Primary Contact	Chief Operating Officer	Ms.	Bicigo	Melanie		9062257749					mlbicigo@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	CAP Report Contact for Public Website	Compliance & Risk Management Officer	Ms.	Sandstrom	Nicole		9062257784				9062258684	nsandstrom@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/22/2022	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	CEO - CMS Administrator Contact	President & CEO	Ms.	Holmquist	Melissa		9063620303					mholmquist@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	CEO - Senior Official for Contracting	President & CEO	Ms.	Holmquist	Melissa		9062257157					mholmquist@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Chief Financial Officer	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/07/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Chief Operating Officer	Chief Operating Officer	Ms.	BIcigo	Melanie		9062257749					mlbicigo@uphp.com	853 W. Washington Street		Marquette	MI	49855	08/21/2018	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Chief Information Officer	Director of Information Systems	Ms.	Chipelewski	Jill		9062253915					jchipelewski@uphp.om	853 W. Washington Street		Marquette	MI	49855	12/07/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Chief Information Security Officer	Director of Information Systems	Ms,	Chipelewski	Jill		9062253915					jchipelewski@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	CMS Casework Communication Contact	Government Programs Manager	Ms.	Stewart	Nicole		9062321601				9062321604	nstewart@uphp.com	853 W. Washington Street		Marquette	MI	49855	09/15/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Complaints Tracking Contact	Government Programs Manager	Ms.	Stewart	Nicole		9062321601				9062321604	nstewart@uphp.com	853 W. Washington Street		Marquette	MI	49855	09/15/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Contact for Fraud Investigations	Compliance & Risk Management Officer	Ms.	Sandstrom	Nicole		9062257784				9062258684	nsandstrom@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/22/2022	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Coordination of Benefits Contact	Director of Claims Administration	Ms.	LaCosse	Leslie		9062257503					llacosse@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Corporate Mailing						9062257500				9062257690	mholmquist@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/07/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Customer Service Operations Contact	Chief Operating Officer	Ms.	Bicigo	Melanie		9062257749					mlbicigo@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	DIR Contact	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/07/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	DIR Contact (Secondary)	Pharmacy Director		Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Emergency Part D Contact	Pharmacy Director	Ms	Prusi	Rachael	Y	9063614868				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Emergency Part D Contact (Secondary)	Chief Operating Officer		Bicigo	Melanie		9063609451					mlbicigo@uphp.com	853 W. Washington St		Marquette	MI	49855	10/10/2018	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Encounter Data & Risk Adjustment Operations Contact	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington St		Marquette	MI	49855	12/07/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Enrollment Contact	Government Programs Manager	Ms.	Stewart	Nicole		9062321601				9062321604	nstewart@uphp.com	853 W. Washington Street		Marquette	MI	49855	09/15/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	EOB Transfer Contact	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Financial Audit Contact	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/08/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Financial Reporting Contact	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/08/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Formulary Contact	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Formulary Contact (Secondary)	Director, Account Management		Peczynski	Jody		2483418158	68158				jspeczynski@magellanhealth.com	Magellan Rx		Scottsdale	AZ	85251	07/01/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	General Contact	Government Programs Manager	Ms.	Stewart	Nicole		9062321601				9062321604	nstewart@uphp.com	853 W. Washington Street		Marquette	MI	49855	09/15/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Government Relations Contact	Chief Operating Officer	Ms.	Bicigo	Melanie		9062257749					mlbicigo@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	HIPAA Privacy Officer	Compliance & Risk Management Officer	Ms.	Sandstrom	Nicole		9062257784				9062258684	nsandstrom@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/22/2022	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	HIPAA Security Officer	Director of Information Systems	Ms,	Chipelewski	Jill		9062253915					jchipelewski@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Hospice Contact	Clinical Services Manager		Tyrrell	Maureen		9062275685				9062321624	mtyrrell@uphp.com	853 W. Washington Street		Marquette	MI	49855	01/13/2023	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Interoperability Contact	Director of Information Systems	Ms.	Chipelewski	Jill		9062253915					jchipelewski@uphp.om	853 W. Washington Street		Marquette	MI	49855	06/03/2022	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	MA Appeals/Grievances Contact	Clinical Services Manager	Ms.	Tyrrell	Maureen		9062275685				9062321624	mtyrrell@uphp.com	853 W. Washington Street		Marquette	MI	49855	01/13/2023	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	MA Claims Processing Contact for Public Website	Director of Claims Adminstration	Ms.	LaCosse	Leslie		9062257503				9062258751	llacosse@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Marketing Contact	Government Programs Manager	Ms.	Stewart	Nicole		9062321601				9062321604	nstewart@uphp.com	853 W. Washington Street		Marquette	MI	49855	09/15/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Medical Director	Medical Director	Dr.	Mlsna	Michael	M	9062257773					mmlsna@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Medicare Compliance Officer	Compliance & Risk Management Officer	Ms.	Sandstrom	Nicole		9062257784				9062258684	nsandstrom@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/22/2022	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Medicare Coordinator	Chief Operating Officer	Ms.	Bicigo	Melanie		9062257749					mlbicigo@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Medication Therapy Management Contact	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	MMP Reporting Requirements Contact	Director of Information Systems		Chipelewski	Jill		9062253915					jchipelewski@uphp.com	853 W. Washington St.		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	MMP Point of Contact	Chief Operating Officer		Bicigo	Melanie		9062257749					mlbicigo@uphp.com	853 W. Washington St.		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Online Enrollment Center Contact (Back-up)	Chief Operating Officer		Bicigo	Melanie		9062257749					mlbicigo@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Online Enrollment Center Contact (Primary)	Government Programs Manager	Ms.	Stewart	Nicole		9062321601				9062321604	nstewart@uphp.com	853 W. Washington Street		Marquette	MI	49855	09/15/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part C Application Contact	Chief Operating Officer	Ms.	Bicigo	Melanie		9062257749					mlbicigo@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part C Reporting Contact	Government Programs Manager	Ms.	Stewart	Nicole		9062321601				9062321604	nstewart@uphp.com	853 W. Washington Street		Marquette	MI	49855	09/15/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Appeals	Director of Pharmacy	Ms.	Prusi	Rachael	Y					9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	06/16/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active	9062254787				Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Appeals Contact (Secondary)	Pharmacist	Mr.	Moisio	Donald						9062254516	dmoisio@uphp.com	853 W Washington Ave		Marquette	MI	49855	06/16/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active	9062255488				Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Application Contact	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Benefits Contact	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Claims Submission Contact	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Exceptions Contact	Director of Pharmacy	Ms.	Prusi	Rachael	Y					9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active	8773499324				Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Exceptions Contact (Secondary)	Medicare Account Manager		Peczynski	Jody	S						jspeczynski@magellanhealth.com	Magellan Rx	2520 Industrial Row Drive	Troy	MI	48084	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active	2483418158				Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Price File Contact (Back-up)			Simons	Brenda		8164352295					pricecompare@argushealth.com	Argus Health	1300 Washington Street	Kansas City	MO	64105	10/22/2014	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Price File Contact (Optional)	Medicare Account Manager		Peczynski	Jody	S	2483418158	68158				jspeczynski@magellanhealth.com	Magellan Rx	2520 Industrial Row Drive	Troy	MI	48084	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Price File Contact (Primary)	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	10/19/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Quality Assurance Contact	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Part D Reporting Contact	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Patient Safety Contact	Director of Pharmacy	Ms	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Payment Contact	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/08/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Pharmacy Director	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Pharmacy Network Management Contact	Director of Pharmacy	Ms.	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W. Washington Street		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Pharmacy Network Management Contact (Secondary)	VP, Legal and Contracting		Borsand	Jonathan		2485408066	147				jdborsand@magellanhealth.com	4D	2520 Industrial Row Drive	Troy	MI	48084	09/25/2015	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Pharmacy Technical Help Desk Contact	Sr Manager, CDAG, Medicare Part D		DiBiase	Joe							jdibiase@magellanhealth.com	Magellan Rx	PO Box 2187	Maryland Heights	MO	63043	12/16/2022	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active	8553800275				Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Pharmacy Technical Help Desk Contact (Secondary)	Account Manager Health Plans		Millage	Laura	C						lcmillage@magellanhealth.com	Magellan Rx	PO Box 2187	Maryland Heights	MO	63043	12/16/2022	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active	8553800275				Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Plan Directory Contact for Public Website	Government Programs Manager	Ms.	Stewart	Nicole		9062321601				9062321604	nstewart@uphp.com	853 W. Washington Street		Marquette	MI	49855	09/15/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Plan to Plan Reconciliation Contact	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/08/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Processor Contact	Director of Claims Administration		LaCosse	Leslie		9062257503					llacosse@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Quality Contact	Director of Population Health	Ms.	Joffee	Janey		9062264286					jjoffee@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Reconciliation Contact	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/08/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Reconciliation Contact (Secondary)	Director of Pharmacy	Ms	Prusi	Rachael	Y	9062257876				9062254516	rprusi@uphp.com	853 W Washington Ave		Marquette	MI	49855	03/22/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Recovery Audit Contact	Compliance & Risk Management Officer	Ms.	Sandstrom	Nicole		9062257784				9062258684	nsandstrom@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/22/2022	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	SNP Application Contact	Chief Operating Officer	Ms.	Bicigo	Melanie		9062257749					mlbicigo@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	SNP State Contact	Chief Operating Officer	Ms.	Bicigo	Melanie		9062257749					mlbicigo@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Surveillance Contact	Chief Operating Officer	Ms.	BIcigo	Melanie		9062257749					mlbicigo@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/08/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	System Contact	Director of Information Systems		Chipelewski	Jill		9062253915					jchipelewski@uphp.com	853 W. Washington Street		Marquette	MI	49855	07/20/2020	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Ms.	Houghton	Jaime		9062257491				9062258687	jhoughton@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/08/2021	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	User Access Contact	Compliance & Risk Management Officer	Ms.	Sandstrom	Nicole		9062257784				9062258684	nsandstrom@uphp.com	853 W. Washington Street		Marquette	MI	49855	12/22/2022	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Utilization Management Contact	Director of Population Health	Ms.	Joffee	Janey		9062264286				9062258782	jjoffee@uphp.com	853 W. Washington Street		Marquette	MI	49855	09/28/2023	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1977	Utilization Review Contact	Clinical Services Manager	Ms.	Tyrrell	Maureen		9062275685				9062321624	mtyrrell@uphp.com	853 W. Washington Street		Marquette	MI	49855	01/13/2023	2023	UPPER PENINSULA HEALTH PLAN, LLC	Demo	Upper Peninsula Health Plan (UPHP) MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		DLP Marquette General Hospital, LLC	416	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H1980	Automated TrOOP Balance Transfer Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Backup User Access Contact			West	Turner		8592765344					twest@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/22/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Best Available Evidence Contact			West	Turner		8592765344					twest@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/22/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Bid Primary Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	CAP Report Contact for Public Website			Klumb	Laura		8592765344					lklumb@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/21/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	CEO - CMS Administrator Contact		Ms.	Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	CEO - Senior Official for Contracting		Ms.	Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Chief Financial Officer	CFO	Mrs.	Hodge	Holly		8592765344					hhodge@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/21/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Chief Operating Officer		Mrs.	Greene	Stephanie		8592765344					sgreene@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	08/30/2022	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Chief Information Officer		Mr.	Chambers	Croswell		8592765344					cchambers@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/22/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Chief Information Security Officer		Mr.	Chambers	Croswell		8592765344					cchambers@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/22/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	CMS Casework Communication Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Complaints Tracking Contact			Smither	Eugenia		8592765344					esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/22/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Contact for Fraud Investigations			Smither	Eugenia		8592765344					esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/22/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Coordination of Benefits Contact	CFO	Mrs.	Hodge	Holly		8592765344					hhodge@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/21/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Corporate Mailing						8592765344					twest@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/22/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mrs.	Hodge	Holly		8592765344					hhodge@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/21/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Customer Service Operations Contact		Mrs.	Greene	Stephanie		8592765344					sgreene@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	08/30/2022	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	DIR Contact		Mr.	Chambers	Croswell		8592765344					cchambers@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/22/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Emergency Part D Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Encounter Data & Risk Adjustment Operations Contact		Mr.	Chambers	Croswell		8592765344					cchambers@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/22/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Enrollment Contact		Mrs.	Greene	Stephanie		8592765344					sgreene@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	08/30/2022	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	EOB Transfer Contact			Chambers	Croswell		8592765344				8592230490	cchambers@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Financial Audit Contact	CFO	Mrs.	Hodge	Holly		8592765344					hhodge@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/06/2022	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Financial Reporting Contact	CFO	Mrs.	Hodge	Holly		8592765344					hhodge@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/21/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Formulary Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	General Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Government Relations Contact			West	Turner		8592765344					twest@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	HIPAA Privacy Officer			Cummings	Cindy		8592765344					ccummings@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	HIPAA Security Officer			Cummings	Cindy		8592765344					ccummings@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Interoperability Contact			Chambers	Croswell		8592765344					cchambers@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	MA Appeals/Grievances Contact			Smither	Eugenia		8592765344					esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	MA Claims Processing Contact for Public Website			Klumb	Laura		8592765344					lklumb@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Marketing Contact			Klumb	Laura		8592765344					lklumb@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Medical Director			Cote	Todd		8592765344					tcote@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Medicare Compliance Officer		Ms.	Smither	Eugenia		8592765344					esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Medicare Coordinator			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Medicare Part D Opioid Overutilization Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/25/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Medication Therapy Management Contact			Short	Wendell		8592765344					wshort2@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	OffShore Subcontractor Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Online Enrollment Center Contact (Primary)		Mrs.	Greene	Stephanie		8592765344					sgreene@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	08/30/2022	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Part C Application Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Part D Appeals			Smither	Eugenia							esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active	8592765344				PACE - Nat		C	Atlanta
H1980	Part D Application Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Part D Benefits Contact		Mrs.	Hodge	Holly		8592966826					hhodge@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Part D Claims Submission Contact		Mrs.	Hodge	Holly		8592966826					hhodge@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Part D Exceptions Contact			Smither	Eugenia							esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active	8592765344				PACE - Nat		C	Atlanta
H1980	Part D Price File Contact (Back-up)		Mrs.	Hodge	Holly		8592966826					hhodge@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Part D Price File Contact (Primary)			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Part D Quality Assurance Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Part D Reporting Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Patient Safety Contact		Ms.	Smither	Eugenia		8592765344					esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Payment Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Personal Health Record Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Pharmacy Director			Short	Wendell		8592765344					wshort2@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Pharmacy Network Management Contact			Short	Wendell		8592765344					wshort2@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Pharmacy Technical Help Desk Contact			Smither	Eugenia							esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active	8592765344				PACE - Nat		C	Atlanta
H1980	PHR Beneficiary Contact																	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE	Bluegrass Care Navigators	Hospice of the Bluegrass, Inc.	794	Yes	Active	8592765344				PACE - Nat		C	Atlanta
H1980	Plan Directory Contact for Public Website			Klumb	Laura		8592765344					lklumb@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	04/18/2023	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Plan to Plan Reconciliation Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Processor Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Quality Contact			Smither	Eugenia		8592765344					esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Reconciliation Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Recovery Audit Contact	Quality/Compliance	Ms.	Smither	Eugenia		8592765344					esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Surveillance Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	System Contact		Mr.	Chambers	Croswell		8592765344					cchambers@bgcarenav.org	1733 Harrodsburg Rd.		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Third Party Administrator (TPA) Liaison			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	User Access Contact			Fowler	Elizabeth	D	8592966810					lfowler@bgcarenav.org	1733 Harrodsburg Road		Lexington	KY	40504	09/24/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Utilization Management Contact			Smither	Eugenia		8592765344					esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1980	Utilization Review Contact			Smither	Eugenia		8592765344					esmither@bgcarenav.org	1733 Harrodsburg Rd		Lexington	KY	40504	09/23/2020	2023	HOSPICE OF THE BLUEGRASS, INC	National PACE	Bluegrass PACE Care	National PACE		Hospice of the Bluegrass, Inc.	794	Yes	Active					PACE - Nat		C	Atlanta
H1993	Agent/Broker Compensation Data Contact	VP, Marketing & Provider Relations	Mr.	Diep	Tyler		7146007836					cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Automated TrOOP Balance Transfer Contact	Controller	Mr.	Tran	Son		7147669099				9493938879	cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Backup User Access Contact	Chairman of the Board/CEO	Dr.	Nguyen	Tri		8584493755				9493938879	cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Best Available Evidence Contact			Department	Enrollment		8666889021					enrollment@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/14/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Bid Audit Contact	Chairman of the Board/CEO	Dr.	Nguyen	Tri	T	8584493755				9493938879	cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Bid Primary Contact	Chairman of the Board/CEO	Dr.	Nguyen	Tri	T	8584493755				9493938879	cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	CAP Report Contact for Public Website	Controller		Tran, CPA	Son		7147669099					cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	CEO - CMS Administrator Contact	Chairman of the Board/CEO	Dr.	Nguyen	Tri	T	8584493755				9493938879	tri.nguyen@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/15/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	CEO - Senior Official for Contracting	Chairman of the Board/CEO	Dr.	Nguyen	Tri	T	8584493755				9493938879	tri.nguyen@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/15/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Chief Financial Officer	Chief Financial Officer	Ms.	Luong	Chi		8582293755				9493938879	chi.luong@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/15/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Chief Operating Officer	Chief Information Officer/Chief Operations Officer	Mr.	Tran	Viet		8587075111				9493938879	viet.tran@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Chief Information Officer	Chief Information Officer/Chief Operations Officer	Mr.	Tran	Viet		8587075111				9493938879	viet.tran@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Chief Information Security Officer	Chief Information Officer/Chief Operations Officer	Mr.	Tran	Viet		8587075111				9493938879	viet.tran@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/14/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	CMS Casework Communication Contact	Compliance Officer	Ms.	Blacklock	Gail		9096302031				9493938879	gail.blacklock@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/14/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Complaints Tracking Contact	Compliance Officer	Mr.	Blacklock	Gail		9096302031					Gail.Blacklock@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/14/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Contact for Fraud Investigations	General Counsel/Compliance Officer	Mr.	Song	Paul	J	6262607366					cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Coordination of Benefits Contact	General Counsel/Compliance Officer	Mr.	Song	Paul	J	6262607366				9493938879	cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Corporate Mailing						8584493755					cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Coverage Gap Discount Program (CGDP) Payment Contact	Controller	Mr.	Tran	Son		7147669099				9493938879	son.tran@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Customer Service Operations Contact	Sr. Manager, Enrollment & Member Services	Ms.	Dao	Kery		9495229170				9493938879	kery.dao@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	DIR Contact	SVP of Operations		Johnson	Monique		9493507818					monique.johnson@astivahealth.com	3200 Bristol Steet, Suite 640	Address line 2	Costa Mesa	CA	92626	07/26/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	DIR Contact (Secondary)			Bonus	Jason	M	3304864841					jbonus@elixirsolutions.com	2181 East Aurora Road, Suite 201	Address line 2	Twinsburg	OH	44087	07/26/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Emergency Part D Contact	Chairman of the Board/CEO	Dr.	Nguyen	Tri	T	8584493755				9493938879	tri.nguyen@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/15/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Emergency Part D Contact (Secondary)	Director of Pharmacy		Johnson, PharmD, APh	Monique		9493507818					monique.johnson@astivahealth.com	3200 BRISTOL ST.	SUITE 640	COSTA MESA	CA	92626	02/15/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Encounter Data & Risk Adjustment Operations Contact	VP Quality, Risk Adjustment, Oversight	Ms.	Reed	Mechelle		5624549103				7149088122	mechelle.reed@astivahealth.com	3200 Bristol St. Suite 640		Costa Mesa	CA	92626	07/26/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Enrollment Contact	Sr. Manager, Enrollment & Member Services	Ms.	Dao	Kery		9495229170					kery.dao@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	EOB Transfer Contact	VP of Claims	Ms.	Chafar	Giomara		7143945113				7149087667	giomara.chafar@astivahealth.com	3200 Bristol Steet,	Suite 640	Costa Mesa	CA	92626	07/26/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Financial Audit Contact	Controller	Mr.	Tran	Son		7147669099					son.tran@astivahealth.com	3200 Bristol St.		Costa Mesa	CA	92626	03/14/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Financial Reporting Contact	Controller	Mr.	Tran	Son		7147669099				9493938879	son.tran@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Formulary Contact	Pharmacy Manager - Formulary		Rossi	David		3304866311					drossi@envisionrx.com	2181 East Aurora Road, Suite 201		Twinsburg	OH	44087	02/11/2020	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Formulary Contact (Secondary)	SVP of Operations	Dr.	Johnson, PharmD, APh	Monique		9493507818					monique.johnson@astivahealth.com	3200 BRISTOL ST.	STE. 640	COSTA MESA	CA	92626	07/20/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	General Contact	SVP Operations	Mrs.	johnson	Monique		9493507818					cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Government Relations Contact	General Counsel	Mr.	Song	Paul	J	6262607366					cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	HIPAA Privacy Officer	General Counsel	Mr.	Song	Paul	J	6262607366					cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	HIPAA Security Officer	General Counsel	Mr.	Song	Paul	J	6262607366					cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Hospice Contact	Chief Medical Officer	Dr.	Trinh	Dung		7143348739				9493938879	dung.trinh@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Interoperability Contact	VP, Quality		Reed	Mechelle		5624549103					mechelle.reed@astivahealth.com	3200 BRISTOL ST.	SUITE 640	COSTA MESA	CA	92626	03/14/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	MA Appeals/Grievances Contact	Sr. Manager, Enrollment & Member Services	Ms.	Dao	Kery		9495229170				9493938879	kery.dao@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	MA Claims Processing Contact for Public Website	VP of Claims	Ms.	Chafar	Giomara		8666889021					claims@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	04/03/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Marketing Contact		Mr.	Diep	Tyler		7146007836					cmscasework@astivahealth.com	3200 Bristol St. Suite 640		Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Medical Director	Chief Medical Officer	Dr.	Trinh	Dung		7143348739					dung.trinh@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/15/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Medicare Compliance Officer	Compliance Officer	Ms.	Blacklock	Gail		9096302031					gail.blacklock@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/14/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Medicare Coordinator	VP, Provider Network Mgt.	Ms.	Pham, MHA	Ann		7144678733				9493938879	ann.pham@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Dr.	Johnson, PharmD, APh	Monique		9493507818				7149088111	monique.johnson@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	04/05/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Medication Therapy Management Contact	Director of Clinical Product Development and Strat		Miller	Holly		3304866457					hrmiller@elixirsolutions.com	2181 East Aurora Road, Suite 201		Twinsburg	OH	44087	11/18/2020	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	OffShore Subcontractor Contact	Compliance Officer	Ms	Blacklock	Gail	M	9096302031					cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	04/05/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Online Enrollment Center Contact (Back-up)	Business Systems Manager	Mr.	Bishop	Nolan		5202414270					nolan.bishop@astivahealth.com	3200 BRISTOL ST.	STE 640	COSTA MESA	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Online Enrollment Center Contact (Primary)	Sr. Manager, Enrollment & Member Services	Ms.	Dao	Kery		9495229170					kery.dao@astivahealth.com	3200 Bristol Street	Suite 640	Costa Mesa	CA	92626	12/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Part C Application Contact	Chairman of the Board/CEO	Dr.	Nguyen	Tri	T	8584493755				9493938879	tri.nguyen@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Part C Reporting Contact	SVP Operations		Johnson	Monique		8666100655					cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Appeals	Director of Clinical Product Development and Strat		Miller	Holly							hrmiller@elixirsolutions.com	2181 East Aurora Road, Suite 201		Twinsburg	OH	44087	11/18/2020	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active	3304866457				HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Appeals Contact (Secondary)		Ms.	Dozier	Rhea						3304058081	Appeals@elixirsolutions.com	2181 East Aurora Road, Suite 201		Twinsburg	OH	44087	01/22/2021	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active	3304864913				HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Application Contact	Chairman of the Board/CEO	Dr.	Nguyen	Tri	T	8584493755				9493938879	tri.nguyen@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Benefits Contact	SVP of Operations		Johnson	Monique		9493507818					monique.johnson@astivahealth.com	3200 Bristol Steet, Suite 640	Address line 2	Costa Mesa	CA	92626	07/26/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Claims Submission Contact	Account Manager		Keams	Diane		4802923170					dkeams@elixirsolutions.com	2181 East Aurora Road, Suite 201		Twinsburg	OH	44087	09/08/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Exceptions Contact	Associate Vice President of Clinical Operations		Lavignette	Amanda							alavignette@elixirsolutions.com	2181 East Aurora Road, Suite 201		Twinsburg	OH	44087	11/18/2020	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Exceptions Contact (Secondary)	Director of Pharmacy	Dr.	Johnson, PharmD, APh	Monique							monique.johnson@astivahealth.com	3200 BRISTOL ST.	STE. 640	COSTA MESA	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active	9493507818				HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Price File Contact (Back-up)	Director Reporting & Analytics		Campbell	Tim		3304866375					tcampbell@envisionrx.com	8957 Canyon Falls Blvd		Twinsburg	OH	44087	06/14/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Price File Contact (Optional)	Financial Analyst III		Wentx	Christophe		5304171432					cwentz@elixirsolutions.com	8957 Canyon Falls Blvd		Twinsburg	OH	44087	06/14/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Price File Contact (Primary)	SVP of Operations	Dr.	Johnson	Monique	M	9493507818					monique.johnson@astivahealth.com	3200 Bristol Steet, Suite 640	Address line 2	Costa Mesa	CA	92626	07/20/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Quality Assurance Contact	Director Pharmacy Network Contracting		Dyer	Tim		3308884812					Tdyer@envisionrx.com	2181 East Aurora Road, Suite 201		Twinsburg	OH	44087	02/11/2020	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Part D Reporting Contact	SVP of Operations		Johnson	Monique		9493507818					monique.johnson@astivahealth.com	3200 Bristol Steet, Suite 640	Address line 2	Costa Mesa	CA	92626	07/26/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Patient Safety Contact	Compliance Officer	Ms.	Blacklock	Gail		6262607366				9493938879	gail.blacklock@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/14/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Payment Contact	Controller	Mr.	Tran	Son		7147669099				9493938879	son.tran@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Pharmacy Director	Director of Pharmacy	Dr.	Johnson, PharmD, APh	Monique		9493507818				9493938879	monique.johnson@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Pharmacy Network Management Contact	Director Pharmacy Network Contracting		Dyer	Tim		3308884812					Tdyer@envisionrx.com	2181 East Aurora Road, Suite 201		Twinsburg	OH	44087	02/11/2020	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy	Dr.	Johnson, PharmD, APh	Monique		9493507818					monique.johnson@astivahealth.com	3200 BRISTOL ST.	STE. 640	COSTA MESA	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Pharmacy Technical Help Desk Contact	Vice President Operations		Conn	Todd							wtafoya@envisionrx.com	2181 East Aurora Road, Suite 201		Twinsburg	OH	44087	01/26/2021	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active	8336976561				HMO - Health Maintenance Organization		C	San Francisco
H1993	Plan Directory Contact for Public Website			Services Department	Member		8666889021					memberservices@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/02/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Plan to Plan Reconciliation Contact	Controller	Mr.	Tran	Son		7147669099				7149088111	son.tran@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	04/05/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Processor Contact	Controller	Mr.	Tran	Son		7147669099				9493938879	son.tran@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Quality Contact	VP, Quality	Ms.	Reed	Mechelle		8584493755				9493938879	mechelle.reed@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/14/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Reconciliation Contact	Controller	Mr.	Tran	Son		7147669099				9493938879	son.tran@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Recovery Audit Contact	General Counsel/Compliance Officer	Mr.	Song	Paul	J	6262607366					paul.song@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	09/21/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	SNP Application Contact	Chairman of the Board/CEO	Dr.	Nguyen	Tri	T	8584493755					tri.nguyen@astivahealth.com	3200 Bristol Street	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Surveillance Contact	General Counsel/Compliance Officer	Mr.	Song	Paul	J	6262607366					cmscasework@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	03/31/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	System Contact	Chief Information Officer/Chief Operations Officer		Tran	Viet		8587075111				9493938879	viet.tran@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	02/16/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Third Party Administrator (TPA) Liaison	General Counsel/Compliance Officer	Mr.	Song	Paul	J	6262607366					paul.song@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	09/21/2022	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	User Access Contact	General Counsel	Mr.	Song	Paul	J	6262607366					paul.song@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	04/03/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Utilization Management Contact	VP Quality, Risk Adjustment, Oversight		Reed	Mechelle		5624549103				7149088122	dung.trinh@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	04/24/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1993	Utilization Review Contact	VP Quality, Risk Adjustment, Oversight		Reed	Mechelle		5624549103				7149088122	dung.trinh@astivahealth.com	3200 Bristol St.	Suite 640	Costa Mesa	CA	92626	04/24/2023	2023	ASTIVA HEALTH, INC.	Local CCP	Astiva Health	HMO/HMOPOS		Astiva Group, LLC	748	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H1994	Agent/Broker Compensation Data Contact	Broker Relations Development Manager	Ms.	DeSpain	Amy		8014427702					amy.despain@selecthealth.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Automated TrOOP Balance Transfer Contact		Mr.	Williams	Steven		8014427801					steven.l.williams@selecthealth.org	5381 S Green St		Murray	UT	84123	09/11/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Backup User Access Contact	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	01/21/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Best Available Evidence Contact	Medicare Enrollment Supervisor	Ms.	Baer	Mallory		8014429842					mallory.baer@selecthealth.org	5381 S Green St		Murray	UT	84123	09/20/2021	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Bid Audit Contact	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/06/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Bid Primary Contact	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/06/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	CAP Report Contact for Public Website	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/09/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	CEO - CMS Administrator Contact	President and CEO	Mr.	Hitchcock	Rob		8014427889					rob.hitchcock@selecthealth.org	5381 S. Green Street		Murray	UT	84123	03/20/2023	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	CEO - Senior Official for Contracting	President and CEO	Mr.	Hitchcock	Rob		8014427889					rob.hitchcock@selecthealth.org	5381 S. Green Street		Murray	UT	84123	03/20/2023	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Chief Financial Officer	Chief Financial Officer	Mr.	Trettin	Todd		8014427760					todd.trettin@selecthealth.org	5381 S. Green Street		Murray	UT	84123	01/25/2021	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Chief Operating Officer	Vice President of Operations	Mr.	Griffith	Jon		8014427566					jon.griffith@selecthealth.org	5381 S. Green Street		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Chief Information Officer	Vice President of Operations	Mr.	Griffith	Jon		8014427566					jon.griffith@selecthealth.org	5381 S. Green Street		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Chief Information Security Officer	Chief Information Security Officer	Mr.	West	Karl		8014425662					karl.west@imail.org	4646 W Lake Park Blvd		West Valley City	UT	84130	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	CMMI Model Point of Contact			Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	11/30/2021	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	CMS Casework Communication Contact	Appeals and Grievances Director	Ms.	Johnson	Emily		8014427650					emily.johnson@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Complaints Tracking Contact	Appeals and Grievances Director	Ms.	Johnson	Emily		8014427650					emily.johnson@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Contact for Fraud Investigations	VP and Chief Administrative Officer		McCullagh	Kristin		8014423436					kristin.mccullagh@selecthealth.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Coordination of Benefits Contact	ORBT Supervisor	Ms.	Aagard	Amanda		8014427006					Rxcob@imail.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Corporate Mailing						8014425000					marketing@selecthealth.org	5381 S Green St		Murray	UT	84123	01/16/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Supervisor	Mr.	Applegarth	John		8014427980					john.applegarth@selecthealth.org	5381 S Green St		Murray	UT	84123	04/22/2016	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Customer Service Operations Contact	Operations Manager	Mr.	Richins	JJ		8014428173					jj.richins@selecthealth.org	5381 S Green St		Murray	UT	84123	05/10/2016	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	DIR Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	DIR Contact (Secondary)	Actuary Chief	Mr.	Heitman	Bob		8014429928					bob.heitman@selecthealth.org	5381 S Green St		Murray	UT	84123	04/09/2014	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Emergency Part D Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Emergency Part D Contact (Secondary)		Mr.	Williams	Steven		8014427801					steven.l.williams@selecthealth.org	5381 S Green St		Murray	UT	84123	09/11/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Employer Waiver Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					Kaleb.Holt@selecthealth.org	5381 Green Street		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment and Coding AVP	Ms.	Welling	Rebecca		8014427760					rebecca.welling@selecthealth.org	5381 S. Green Street		Murray	UT	84123	11/16/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Enrollment Contact	Medicare Enrollment Supervisor	Ms.	Baer	Mallory		8014429842					mallory.baer@selecthealth.org	5381 S Green St		Murray	UT	84123	09/20/2021	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	EOB Transfer Contact		Mr.	Williams	Steven		8014427801				8014426870	steven.l.williams@selecthealth.org	5381 S Green St		Murray	UT	84123	09/11/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Financial Audit Contact	Controller	Ms.	Peterson	Nicole		8014427989					nicole.peterson@selecthealth.org	5381 S Green St		Murray	UT	84123	12/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Financial Reporting Contact	Controller	Ms.	Peterson	Nicole		8014427989					nicole.peterson@selecthealth.org	5381 S Green St		Murray	UT	84123	12/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Formulary Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Formulary Contact (Secondary)	Government Programs Clinical Coordinator	Mrs.	Eshelman	Samantha		8014427816					Samantha.Eshelman@selecthealth.org	5381 S Green St		Murray	UT	84123	07/01/2021	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	General Contact	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	01/16/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Government Relations Contact	VP and Chief Administrative Officer	Ms.	McCullagh	Kristin		8014423436					kristin.mccullagh@selecthealth.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	HIPAA Privacy Officer	Business Ethics and Compliance Vice President	Ms.	Draper	Suzie		8014421502					suzie.draper@imail.org	36 South State Street, 10th Floor		Salt Lake City	UT	84111	11/24/2014	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	HIPAA Security Officer	Chief Information Security Officer	Mr.	West	Karl		8014425662					karl.west@imail.org	4646 Lake Park Boulevard		Salt Lake City	UT	84120	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Hospice Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Interoperability Contact	Medicare Compliance Officer		Schmidt	Clifton		8014427249					Clifton.Schmidt@selecthealth.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	MA Appeals/Grievances Contact	Appeals and Grievances Director	Ms.	Johnson	Emily		8014427650					emily.johnson@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	MA Claims Processing Contact for Public Website	Claims Director	Ms.	White	Marianne		8014428206					marianne.white@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Marketing Contact	Compliance Partner	Ms.	Hagman	Dee		8014429331					dee.hagman@selecthealth.org	5381 S. Green Street		Murray	UT	84123	09/20/2021	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Medical Director	Chief Medical Officer	Dr.	O'Toole	Heather		8014427775					heather.otoole@selecthealth.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Schmidt	Cliff		8014427249					clifton.schmidt@selecthealth.org	5381 S Green St		Murray	UT	84123	10/27/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Medicare Coordinator	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	01/16/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Medicare Part D Opioid Overutilization Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Medication Therapy Management Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	OffShore Subcontractor Contact	Medicare Compliance Consultant	Ms.	Aumua	Portia		8014428186					portia.aumua@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor	Ms.	Baer	Mallory		8014429842					mallory.baer@selecthealth.org	5381 S Green St		Murray	UT	84123	09/20/2021	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Part C Application Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					Kaleb.Holt@selecthealth.org	5381 Green Street		Murray	UT	84123	01/16/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Part C Reporting Contact	Medicare Advantage Program Manager	Ms.	Christensen	Star		8014427156					star.christensen@selecthealth.org	5381 Green Street		Murray	UT	84123	01/04/2021	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Appeals	Appeal and Grievances Director	Ms.	Johnson	Emily							emily.johnson@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active	8442089012				HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Appeals Contact (Secondary)	Appeals Specialist	Ms.	Olano	Marina							marina.olano@selecthealth.org	5381 S Green St		Murray	UT	84123	01/13/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active	8014427498				HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Application Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					Kaleb.Holt@selecthealth.org	5381 Green Street		Murray	UT	84123	11/24/2015	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Benefits Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	01/21/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Claims Submission Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Exceptions Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike							mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active	8554429900				HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Exceptions Contact (Secondary)	Operations Supervisor	Ms.	Morgan	Laura							laura.morgan@selecthealth.org	5381 S Green St		Murray	UT	84123	09/05/2018	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active	8554429900				HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Price File Contact (Back-up)	Business Analyst	Ms.	Robinson	Elisabeth		8014428091					Elisabeth.Robinson@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Price File Contact (Optional)	Medicare Program/Business Analyst Team Lead	Ms.	Nkansah	Cheryl		8014427818					Cheryl.Nkansah@selecthealth.org	5381 Green Street		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Price File Contact (Primary)	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Quality Assurance Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	09/20/2021	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Part D Reporting Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Patient Safety Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Payment Contact	Accounts Receivable Manager	Ms.	Worsley	Tracy		8014427624					tracy.worsley@selecthealth.org	5381 S Green St		Murray	UT	84123	01/21/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Pharmacy Director	Pharmacy Benefit Services AVP	Mr.	Cannon	Eric		8014427816					eric.cannon@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Pharmacy Network Management Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Pharmacy Network Management Contact (Secondary)	Pharmacy Benefit Services AVP	Mr.	Cannon	Eric		8014427816					eric.cannon@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Pharmacy Technical Help Desk Contact	Pharmacy Operations Supervisor	Mr.	Smith	Shawn							Eric.Myers@selecthealth.org	5381 S Green St		Murray	UT	84123	09/26/2023	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active	8554429900				HMO - Health Maintenance Organization		C	Dallas
H1994	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Government Specialist-Team Lead	Ms.	Mortensen	Shellie							Eric.Myers@selecthealth.org	5381 S Green St		Murray	UT	84123	09/26/2023	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active	8554429900				HMO - Health Maintenance Organization		C	Dallas
H1994	Plan Directory Contact for Public Website	Director of Medicare Programs and Products	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/28/2013	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Plan to Plan Reconciliation Contact	Accounting Supervisor	Mr.	Applegarth	John		8014427980					john.applegarth@selecthealth.org	5381 S Green St		Murray	UT	84123	11/20/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Processor Contact		Mr.	Williams	Steven		8014427801					steven.l.williams@selecthealth.org	5381 S Green St		Murray	UT	84123	09/11/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Quality Contact	Clinical and Outcomes Management Director	Ms.	Barrus	Kim		8014427399					kim.barrus@selecthealth.org	5381 S Green St		Murray	UT	84123	09/20/2021	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Reconciliation Contact	Controller	Ms.	Peterson	Nicole		8014427989					nicole.peterson@selecthealth.org	5381 S Green St		Murray	UT	84123	12/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Reconciliation Contact (Secondary)	Actuary Chief	Mr.	Heitman	Bob		8014429928					bob.heitman@selecthealth.org	5381 S Green St		Murray	UT	84123	08/27/2014	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Recovery Audit Contact	Controller	Ms.	Peterson	Nicole		8014427989					nicole.peterson@selecthealth.org	5381 S Green St		Murray	UT	84123	12/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	SNP Application Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	03/14/2018	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Surveillance Contact	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/09/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	System Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	01/21/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Third Party Administrator (TPA) Liaison	Accounting Supervisor	Mr.	Applegarth	John		8014427980					john.applegarth@selecthealth.org	5381 S Green St		Murray	UT	84123	04/22/2016	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	User Access Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	01/17/2012	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Utilization Management Contact	Health Services Manager	Ms.	Owens	Mary Ann		8014428171					maryann.owens@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1994	Utilization Review Contact	Health Services Manager	Ms.	Owens	Mary Ann		8014428171					maryann.owens@selecthealth.org	5381 S Green St		Murray	UT	84123	01/23/2020	2023	SELECTHEALTH, INC.	Local CCP	Select Health	HMO/HMOPOS		Intermountain Health Care, Inc.	480	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H1997	Agent/Broker Compensation Data Contact	VP Medicare Sales	Mr.	Hess	Brent		8013336143					Brent.Hess@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	07/06/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Automated TrOOP Balance Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Backup User Access Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St.	MS:E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Best Available Evidence Contact	Membership Ambassador	Ms.	Neufeld	Jeri		8006621470	2526			8883352988	ORMEMMEDAmbassador@regence.com	PO Box 1827		Medford	OR	97501	02/16/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Bid Audit Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Bid Audit Site Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Bid Primary Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	CAP Report Contact for Public Website	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	CEO - CMS Administrator Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/04/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	CEO - Senior Official for Contracting	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/09/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Chief Financial Officer	SVP & CFO	Mr.	Rains	Mike		2063326521					Mike.Rains@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Chief Operating Officer	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Chief Information Officer	SVP STRATEGIC TECH SOL & CIO	Mr	Rotival	Laurent		2063325034					Laurent.Rotival@cambiahealth.com	200 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Chief Information Security Officer	VP & CHIEF INFO SEC OFFICER	Mr	Anderson	Kirk		5037251608					Kirk.Anderson@cambiahealth.com	100 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	CMMI Model Point of Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	CMS Casework Communication Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Complaints Tracking Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Contact for Fraud Investigations	Senior Audit Investigator	Ms.	Grimes-Burke	Jennifer		5035873355					Jennifer.Grimes-Burke@regence.com	100 SW Market St	M/S E12B	Portland	OR	97201	06/16/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Coordination of Benefits Contact	Manager, Member Services	Ms	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	PO Box 1827	MS: B32M	Medford	OR	97501	07/09/2016	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Corporate Mailing						5032206237				5035884350	Jennifer.DelVillar@regence.com	100 SW Market Street		Portland	OR	97201	01/07/2013	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Sr I	Mr.	Gerken	Matthew		2063324809					Matthew.Gerken@cambiahealth.com	1800 9th Ave		Seattle	WA	98101	04/19/2016	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Customer Service Operations Contact	Manager Member Services	Ms	Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	DIR Contact	Manager Pharmacy Informatics		Kidd	Vicki		2083957739				2083337874	vicki.kidd@regence.com	1211 West Myrtle, Suite 110		Boise	ID	83702	01/08/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	DIR Contact (Secondary)	Dir. Gov. Pro Compliance / Medicare Compliance Off	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street E10C		Portland	OR	97201	07/22/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Emergency Part D Contact	VP Pharm Ops & Compliance	Mr.	Weiss	Justin		5032256677					Justin.Weiss@cambiahealth.com	200 SW Market St		Portland	OR	97201	12/20/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Emergency Part D Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Employer Waiver Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment, Manager	Mr.	Moore	Jason		2087982318					Jason.Moore@cambiahealth.com	1602 21st Ave		Lewiston	ID	83501	10/18/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Enrollment Contact	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	EOB Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Financial Audit Contact	Government Programs Audit Consultant	Mr.	Hutt	Brian		5032206160					Brian.Hutt@regence.com	200 SW Market Street	MS: E10C	Portland	OR	97201	05/09/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Financial Reporting Contact	Fin Acctg & Reporting, Assistant Director	Mr	Striplin	Daniel	W	5032256069					Dan.Striplin@regence.com	200 SW Market		Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Formulary Contact	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Ave		Portland	OR	97201	01/18/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	General Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Government Relations Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St.	MS:E10C	Portland	OR	97201	04/18/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	HIPAA Privacy Officer	VP Chief Compliance & Privacy Officer	Ms.	Erbes	Kristen		5035256533					kristen.erbes@regence.com	200 SW Market St	M/S: E14A	Portland	OR	97201	02/25/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	HIPAA Security Officer	Chief Information Security Officer	Mr.	Person	Steve		5037251654					Steve.Person@regence.com	1621 SW First Ave.		Portland	OR	97201	02/25/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Hospice Contact	Pharmacy Ops Oversight Specialist	Ms.	Pickens	Spring		5032255240					Spring.Pickens@regence.com	100 SW Market St	MS: WW5-56	Portland	OR	97201	02/05/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Interoperability Contact	VP Chief Tech Officer		Anderson	Kirk		5037251608					kirk.anderson@cambiahealth.com	Cambia Health Solutions	200 SW Market Street	Portland	OR	97201	02/09/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	MA Appeals/Grievances Contact	Director, Clinical Services Operations	Ms.	Sikora	Joelle		2063325320					Joelle.Sikora@regence.com	1800 Ninth Avenue		Seattle	WA	98101	05/09/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	MA Claims Processing Contact for Public Website	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Marketing Contact	Compliance Analyst		Meirose	Robyn		5033918668					robyn.meirose@regence.com	200 SW Market St  MS: E10C		Portland	OR	97201	09/15/2015	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Medical Director	SVP Chief Medical Officer	Ms.	Milavetz	Donna		8013336740					Donna.Milavetz@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	12/05/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Medicare Compliance Officer	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	07/14/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Medicare Coordinator	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827		Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Medicare Part D Opioid Overutilization Contact	Drug Management Program	Ms.	Anderson	Ally		8557297221					partdoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/14/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Medication Therapy Management Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Online Enrollment Center Contact (Back-up)	Dir Medicare Planning & Performance	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Online Enrollment Center Contact (Optional)	Manager Member Services	Ms.	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	2057 Commerce Dr		Medford	OR	97504	11/06/2017	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Online Enrollment Center Contact (Primary)	Spv Membership, GP OR Medicare Ops & Billing	Ms.	Cromwell	Krista		5416181286					Krista.Cromwell@regence.com	PO Box 1827	M/S: B32M	Medford	OR	97501	03/07/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Part C Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Part C Reporting Contact	Director Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	12/23/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossig Rd	Eagan	MN	55120	03/21/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Benefits Contact	Product Manager III	Ms.	Holliston	Danica		5032254871					Danica.Holliston@regence.com	200 SW Market St  M/S: E10M		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Claims Submission Contact	Functional Business Consultant - Government Prgrms	Mr.	Brook	Lance		4026862603					LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	08/05/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Exceptions Contact (Secondary)	Asst Director Pharmacy Operations	Ms.	Yi	Edie							edie.yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	972071271	12/15/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	5032254801				HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Price File Contact (Back-up)	Database Reporting Analyst	Ms	Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Price File Contact (Optional)	QA Analyst Sr	Ms.	Tastad	Emily		6127772557					emily.tastad@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/03/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Price File Contact (Primary)	AD Pharmacy Informatics	Ms.	Kidd	Vicki		2083957739					Vicki.Kidd@regence.com	1211 West Myrtle		Boise	ID	83702	07/22/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Quality Assurance Contact	Assistant Dir Pharmacy Operations	Ms.	Yi	Edie		5032254801				2083957744	Edie. Yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	97201	12/27/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Part D Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Patient Safety Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Payment Contact	Asst Director Fin Acctg & Reporting	Mr.	Striplin	Dan		5032256069					Dan.Striplin@cambiahealth.com	100 SW Market St	M/S: C2A	Portland	OR	97201	01/14/2014	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Pharmacy Director	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Avenue, M/S PDX - WW3-33		Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Pharmacy Network Management Contact	AVP, Network Mangement	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/18/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Management Relations		Lenhart	Alicia		6127773969				8778236373	Alicia.Lenhart@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	09/11/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Pharmacy Technical Help Desk Contact	Director, Member Services Government Programs	Mr.	Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				HMO - Health Maintenance Organization		C	Seattle
H1997	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jon							jonathan.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				HMO - Health Maintenance Organization		C	Seattle
H1997	Plan Directory Contact for Public Website	Manager Member Services		Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Plan to Plan Reconciliation Contact	Pharmacy Operations Oversight Specialist, Sr.	Ms.	Manzer	Amy		5032255368					Amy.Manzer@regence.com	200 SW Market St	M/S: PDX-ZOF WW3-33	Portland	OR	97201	08/26/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing	Egan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Quality Contact	Director, Quality Management	Mr.	Mcclure	Andy		5032206189					Andrew.Mcclure@regence.com	1621 SW First Ave	M/S WW5-52	Portland	OR	97201	04/12/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Reconciliation Contact	VP Finance Controller		Vannoy	Anjie		5032761865					Anjie.Vannoy@cambiahealth.com	100 SW Market St.	MS:PDX-WW2-21	Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Reconciliation Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS:E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Recovery Audit Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Surveillance Contact	Government Programs Compliance Officer		Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St  M/S: E10C		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	System Contact	Medicare Business Operations, Product Owner	Ms.	Fredinburg	Deana		5033754426					Deana.Fredinburg@regence.com	PO BOX 1827	M/S: B32AG	Medford	OR	97501	06/24/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Third Party Administrator (TPA) Liaison	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	User Access Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Utilization Management Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H1997	Utilization Review Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2001	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Formulary Contact (Secondary)	Sr. Clinical Program Consultant		Murtaugh	Tracy		9529315138					tracy_murtaugh@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	10/24/2017	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H2001	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H2001	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H2001	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H2001	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2001	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2029	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	MA Appeals/Grievances Contact	Senior Compliance Professional		Rodriguez Casillas	Lymari		7873061621					crodriguez2@humana.com	101 East Main Street		Louisville	KY	40202	02/11/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	02/16/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Part D Appeals			Cardona	Solcire							G_APuertoRicoTeam@humana.com	PO Box 195560		San Jaun	PR	00919	01/11/2021	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	8005950462				PPO - BBA		C	Kansas City
H2029	Part D Appeals Contact (Secondary)			Torres	Frank							FTorres6@humana.com	11430 N W 20th Street	Suite 200	Miami	FL	33172	12/01/2020	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5024763947				PPO - BBA		C	Kansas City
H2029	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H2029	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5024682494				PPO - BBA		C	Kansas City
H2029	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	8008658715				PPO - BBA		C	Kansas City
H2029	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025800475				PPO - BBA		C	Kansas City
H2029	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2029	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H2032	Agent/Broker Compensation Data Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Automated TrOOP Balance Transfer Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Backup User Access Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Best Available Evidence Contact	Director HP Enrollment		Wilson	Deanna		2542983340					Deanna.Wilson@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Bid Audit Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Bid Audit Site Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Bid Primary Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	CAP Report Contact for Public Website	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	CEO - CMS Administrator Contact	CEO and President	Mr.	Ingrum	Jeff		2542986090					Jeffrey.Ingrum@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/23/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	CEO - Senior Official for Contracting	CEO and President	Mr.	Ingrum	Jeff		2542986088					Jeffrey.Ingrum@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/20/2017	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Chief Financial Officer	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/20/2017	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Chief Operating Officer	Chief Operating Officer	Mr.	Richey	Victor		2148204200					Vic.Richey@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Chief Information Officer	Director of Information Systems	Mr.	Fort	Rob		2542983233					Rob.Fort@bswhealth.org	1206 West Campus Drive		Temple	TX	76502	07/12/2019	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Chief Information Security Officer	Director of Information Systems	Mr.	Fort	Rob		2542983233					Rob.Fort@bswhealth.org	1206 West Campus Drive		Temple	TX	76502	07/12/2019	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	CMMI Model Point of Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	CMS Casework Communication Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Complaints Tracking Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Contact for Fraud Investigations	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Coordination of Benefits Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Corporate Mailing						2542986088					Jeffrey.Ingrum@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Coverage Gap Discount Program (CGDP) Payment Contact	VP Finance		Cutroni	Michael		2542983085				2542983005	michael.cutroni@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	09/19/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Customer Service Operations Contact	Manager, Customer Advocacy		Perkins	Michelle		2542983393					Michelle.Perkins@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	DIR Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	DIR Contact (Secondary)	VP Finance		Cutroni	Michael		2542983085					michael.cutroni@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	09/19/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Electronic Health Record Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Emergency Part D Contact	Director Pharmacy Operations		Luebbert	Charlotte		2546243358					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/23/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Emergency Part D Contact (Secondary)	Manager Pharmacy Operations	Ms.	Symm	Sheila		2542929095					Sheila.Symm@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/23/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Employer Waiver Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Encounter Data & Risk Adjustment Operations Contact	Director Risk Adjustment		Coakley	Deborah		5059342320					Deborah.Coakley@BSWHealth.org	1206 West Campus Dr.		Temple	TX	76502	10/22/2019	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Enrollment Contact	Director HP Enrollment		Wilson	Deanna		2542983340					Deanna.Wilson@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	EOB Transfer Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Financial Audit Contact	VP Finance	Mr.	Cutroni	Michael		2542983000					michael.cutroni@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	10/13/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Financial Reporting Contact	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/20/2017	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Formulary Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Formulary Contact (Secondary)	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	General Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Government Relations Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	HIPAA Privacy Officer	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	HIPAA Security Officer	Director IS	Mr.	Fort	Rob		2542983233					Rob.Fort@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/12/2019	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Hospice Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Interoperability Contact	Director of Information Systems	Mr.	Fort	Rob		2542983233					Rob.Fort@bswhealth.org	1206 West Campus Drive		Temple	TX	76502	01/10/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	MA Appeals/Grievances Contact	Director, Appeals and Grievance		Saravia	Sharon		2542986156					Sharon.Saravia@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	MA Claims Processing Contact for Public Website	Claims Manager		Fabianke	Elizabeth		2542983385					Elizabeth.Fabianke@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/20/2017	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Marketing Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Medical Director	Chief Medical Officer	Dr.	Ramalingam	S		2542983487					S.Ramalingam@BSWHealth.org	1206 West Campus Dr		Temple	TX	76502	07/07/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Medicare Compliance Officer	Compliance Officer	Mrs	Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Medicare Coordinator	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Medicare Part D Opioid Overutilization Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Medication Therapy Management Contact	Clinical Pharmacist		Thomas	Megan		2542986154					Megan.Cunningham@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/21/2017	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	OffShore Subcontractor Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Online Enrollment Center Contact (Back-up)	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Online Enrollment Center Contact (Primary)	Director HP Enrollment		Wilson	Deanna		2542983340					Deanna.Wilson@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Part C Application Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Part C Reporting Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Part D Appeals	Director, Appeals and Grievance		Saravia	Sharon							Sharon.Saravia@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active	2542986156				PPO - BBA		C	Denver
H2032	Part D Appeals Contact (Secondary)	Director, Appeals and Grievance		Saravia	Sharon						2542983086	sharon.saravia@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active	2542986156				PPO - BBA		C	Denver
H2032	Part D Application Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Part D Benefits Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Part D Claims Submission Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Part D Exceptions Contact	Manager Pharmacy Admin.		Thomas	Megan							Megan.Cunningham@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/15/2019	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active	2542986108				PPO - BBA		C	Denver
H2032	Part D Exceptions Contact (Secondary)	Director Pharmacy Operations		Luebbert	Charlotte							Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/15/2019	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active	2542986151				PPO - BBA		C	Denver
H2032	Part D Price File Contact (Back-up)	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/15/2019	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Part D Price File Contact (Optional)	Manager Rx Operations		Symm	Sheila		2542986173					Sheila.Symm@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/12/2019	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Part D Price File Contact (Primary)			Rx	Optum		6514955363					medops_planfinder@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/02/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Part D Quality Assurance Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Part D Reporting Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Patient Safety Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Payment Contact	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/20/2017	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Pharmacy Director	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Pharmacy Network Management Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Pharmacy Network Management Contact (Secondary)	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Pharmacy Technical Help Desk Contact	OptumRx		Rx	Optum								1600 McConnor Parkway		Schaumburg	IL	601736801	03/14/2019	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active	8442309357				PPO - BBA		C	Denver
H2032	Pharmacy Technical Help Desk Contact (Secondary)	SWHP Pharmacy Customer Service		Customer Service	Pharmacy								1206 W Campus Drive		Temple	TX	76502	03/23/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active	8007287947				PPO - BBA		C	Denver
H2032	Physician Incentive Contact	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/26/2017	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Plan Directory Contact for Public Website	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Plan to Plan Reconciliation Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Processor Contact	Chief Financial Officer		Bush	Stephen		2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Quality Contact	Director of Quality		Martin	Kathleen		5033274425				2542983005	Kathleen.Martin@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	08/17/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Reconciliation Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Reconciliation Contact (Secondary)	Financial Advisor II		Albright	Irina		5122576254					Irina.Albright@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Recovery Audit Contact	Chief Financial Officer	Mr.	Bush	Stephen		2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	SNP Application Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	SNP State Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Surveillance Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	System Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Third Party Administrator (TPA) Liaison	VP Finance		Cutroni	Michael		2542983085				2542983005	michael.cutroni@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	09/19/2022	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	User Access Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/06/2020	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Utilization Management Contact	Director of Health Services		Starks	Chmyra		2542983386				2542983005	Chmyra.Starks@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	08/24/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2032	Utilization Review Contact	Director of Health Services		Starks	Chmyra		2542983386				2542983005	Chmyra.Starks@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	08/24/2021	2023	Baylor Scott & White Insurance Company	Local CCP	Baylor Scott & White Health Plan	Local PPO		Baylor Scott & White Holdings	588	Yes	Active					PPO - BBA		C	Denver
H2034	Agent/Broker Compensation Data Contact	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Automated TrOOP Balance Transfer Contact	Director of Operations	Mrs.	Slowiak	Andrea		7158522983					aslowiak@pharmastar.com	2427 Hillcrest Parkway		Altoona	WI	54720	02/19/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Backup User Access Contact	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Best Available Evidence Contact	Accounting Specialist - Medicare	Ms.	Instefjord	Lori		2622079374					lori.instefjord@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	10/25/2016	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Bid Audit Contact	Financial Planning Manager	Mr	Siddiqui	Imran		2622079353					imran.siddiqui@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	06/22/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Bid Audit Site Contact	Financial Planning Manager	Mr.	Siddiqui	Imran		2622079353					imran.siddiqui@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	06/22/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Bid Primary Contact	Financial Planning Manager	Mr.	Siddiqui	Imran		2622079353					imran.siddiqui@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	11/18/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	CAP Report Contact for Public Website	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Munson	Kenneth		4142314000					kenneth.munson@communitycareinc.org	205 Bishops Way		Brookfiedl	WI	53005	08/14/2013	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	CEO - Senior Official for Contracting	CEO	Mr	Munson	Kenneth		4142314000					kenneth.munson@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Chief Financial Officer	Chief Financial Officer	Ms.	Smith	Christy		4142314000					christy.smith@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/25/2017	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Chief Operating Officer	Chief Program Officer	Mr.	Kohl	Edward		4142314000					edward.kohl@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	12/21/2016	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Chief Information Officer	Chief Information Officer	Ms.	Kramer	Virginia		4142314292					virginia.kramer@communitycareinc.org	3220 W. Vliet St.		Milwaukee	WI	53208	02/26/2016	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Chief Information Security Officer	Chief Information Officer	Ms.	Kramer	Virginia		4142314292					virginia.kramer@communitycareinc.org	3220 W. Vliet St.		Milwaukee	WI	53208	02/26/2016	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	CMS Casework Communication Contact	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Complaints Tracking Contact	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Contact for Fraud Investigations	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Coordination of Benefits Contact	Claims Manager	Ms	Halloran	Colleen		2629538627					colleen.halloran@communitycareinc.org	1801 Dolphin Drive		Waukesha	WI	53186	04/12/2016	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Corporate Mailing						4142314000					kenneth.munson@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2013	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Customer Service Operations Contact	CCHP Program Officer	Ms.	Carter	Kelly		2622079323					kelly.carter@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	11/13/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	DIR Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/21/2023	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	DIR Contact (Secondary)	Chief Financial Officer	Ms.	Smith	Christy		2622079370					christy.smith@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	07/19/2016	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Electronic Health Record Contact	Director, Clinical Informatics		Cowie	Cindy		4142314250					cindy.cowie@communitycareinc.org	3220 W. Vliet St.		Milwaukee	WI	53208	04/12/2016	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Emergency Part D Contact	Clinical  and Plan Services Pharmacy Manager	Mr	Mayer	Dmitri		4142314107					dmitri.mayer@communitycareinc.org	3220 W. Vliet		Milwaukee	WI	53208	06/22/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Emergency Part D Contact (Secondary)	Clinical Pharmacy Specialist	Ms.	Farley Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S. Layton blvd.		Milwaukee	WI	53215	06/30/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Encounter Data & Risk Adjustment Operations Contact			Schlei	Matthew		4142314258					Matthew.Schlei@communitycareinc.org	205 Bishop's Way		Brookfield	WI	53005	03/10/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Enrollment Contact	Claims Manager	Ms.	Halloran	Colleen		2629538627					colleen.halloran@communitycareinc.org	1801 Dolphin Drive		Waukesha	WI	53186	05/14/2014	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	EOB Transfer Contact	Operations Support Supervisor	Ms.	Biren	Alicia		8882987770				7158367683	abiren@pharmastarpbm.com	P.O. Box 3217		Eau Claire	WI	54702	11/24/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Financial Audit Contact	Chief Financial Officer	Ms.	Smith	Christy		2622079370					christy.smith@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/25/2017	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Financial Reporting Contact	Chief Financial Officer		Smith	Christy		2622079352					christy.smith@communitycareinc.org	205 Bishops Way.		Brookfield	WI	53005	07/19/2016	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Formulary Contact	Clinical  and Plan Services Pharmacy Manager	Mr.	Mayer	Dmitri		4142314107					dmitri.mayer@communitycareinc.org	3220 W. Vliet		Milwaukee	WI	53208	06/22/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Formulary Contact (Secondary)	Clincal Pharmacy Specialist	Ms.	Farley Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S. Layton Blvd.		Milwaukee	WI	53215	06/30/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	General Contact	Regulatory Affairs Specialist		Melnick	Nancy		2622079362					nancy.melnick@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	05/08/2013	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Government Relations Contact	Chief Executive Officer	Mr	Munson	Kenneth		2622079339					kenneth.munson@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	03/23/2015	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	HIPAA Privacy Officer	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	HIPAA Security Officer	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Hospice Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Interoperability Contact	Chief Information Officer	MS.	Kramer	Virginia		4142314292					virginia.kramer@communitycareinc.org	3220 W. Vliet Street		Milwaukee	WI	53208	02/16/2022	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	MA Appeals/Grievances Contact	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	MA Claims Processing Contact for Public Website	Claims Manager	Ms	Halloran	Colleen		2629538627					colleen.halloran@communitycareinc.org	1801 Dolphin Drive		Waukesha	WI	53186	12/19/2011	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Marketing Contact	Chief Adminitrative Officer	Ms.	Gilcreast	Sherrice		4142314139					sherrice.gilcreast@communitycareinc.org	3220 W. Vliet Street		Milwaukee	WI	53208	02/26/2016	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Medical Director	Medical Director	Dr.	Almas	Rakhshinda		2622079338					rakhshinda.almas@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	01/24/2014	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Medicare Compliance Officer	Chief Compliance and Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	03/10/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Medicare Coordinator	Chief Compliance & Quality Officer	Mr	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Medication Therapy Management Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Part C Application Contact	Regulatory Affairs Specialist	Ms.	Melnick	Nancy		2622079362					nancy.melnick@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	05/08/2013	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Part C Reporting Contact	Regulatory Affairs Specialist	Ms.	Melnick	Nancy		2622079362					Nancy.Melnick@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	06/22/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Part D Appeals	Chief Compliance & Quality Officer	Mr.	Garlie	Michael							michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active	2622079307				HMO - Health Maintenance Organization		C	Chicago
H2034	Part D Appeals Contact (Secondary)	Member Rights Specialist	Mr.	Olson	Christophe						2628274044	christopher.olson@communitycareinc.org	205 Bishops Way		Brookfiedl	WI	53005	10/13/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active	8669926600	79305			HMO - Health Maintenance Organization		C	Chicago
H2034	Part D Application Contact	Regulatory Affairs Specialist	Ms.	Melnick	Nancy		2622079362					nancy.melnick@communitycareinc.org	205 Bishops Way		Brokfield	WI	53005	05/08/2013	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Part D Benefits Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/29/2023	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Part D Claims Submission Contact	Client Support Supervisor	Ms	Vang	Jane		8882987770					jvang@pharmastar.com	2503 N. Hillcrest Parkway		Altoona	WI	54720	03/02/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Part D Exceptions Contact	Clinical  and Plan Services Pharmacy Manager	Mrs.	Farley-Snieg	Megan							megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/29/2023	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active	8669926600	22527			HMO - Health Maintenance Organization		C	Chicago
H2034	Part D Price File Contact (Back-up)	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Part D Price File Contact (Optional)	Client Support Manager	Ms	Slowiak	Andrea		7158522983					aslowiak@pharmastar.com	Pharmastar	P.O. Box 3217	Eau Claire	WI	54702	03/02/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Part D Price File Contact (Primary)	Formulary & Plan Benefit Coordinator	Ms	Biren	Alicia		7158522061					abiren@pharmastar.com	Pharmastar	P.O. Box 3217	Eau Claire	WI	54702	03/02/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Part D Quality Assurance Contact	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Part D Reporting Contact	Regulatory Affairs Specialist	Ms.	Melnick	Nancy		2622079362					Nancy.Melnick@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	06/22/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Patient Safety Contact	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Payment Contact	Financial Planning Manager	Mr.	Siddiqui	Imran		2622079353					imran.siddiqui@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	06/22/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Pharmacy Director	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/29/2023	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Pharmacy Network Management Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Pharmacy Technical Help Desk Contact			Service	Customer								2503 N. Hillcrest Pkwy		Altoona	WI	54720	03/16/2007	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active	8882987770				HMO - Health Maintenance Organization		C	Chicago
H2034	Physician Incentive Contact	Medical Director	Dr.	Almas	Rakhshinda		2622079338					rakhshinda.almas@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	11/13/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Plan Directory Contact for Public Website			Hotline	Provider		8669372783					claimsinquiries@communitycareinc.org	1801 Dolphin Drive		Waukesha	WI	53186	02/17/2010	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Plan to Plan Reconciliation Contact	Accounting Specialist - Medicare	Ms	Instefjord	Lori		2622079374					lori.instefjord@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	10/25/2016	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Processor Contact	Client Support Supervisor	Ms.	Vang	Jane		7158522064					jvang@pharmastar.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	03/02/2021	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Quality Contact	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Reconciliation Contact	Accounting Specialist - Medicare	Ms.	Instefjord	Lori		2622079374					lori.instefjord@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	10/25/2016	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Reconciliation Contact (Secondary)	Member Accounting Specialist	Ms.	Locke	Kelly		2622079373					kelly.locke@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	03/10/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Recovery Audit Contact	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycarinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	SNP Application Contact	Regulatory Affairs Specialist	Ms.	Melnick	Nancy		2622079362					nancy.melnick@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	05/29/2019	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	SNP State Contact	Regulatory Affairs Specialist	Ms.	Melnick	Nancy		2622079362					nancy.melnick@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	05/08/2013	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Surveillance Contact	Chief Compliance and Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	11/13/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	System Contact	Chief Information Officer		Kramer	Virginia		4142314292					virginia.kramer@communitycareinc.org	3220 W. Vliet Street		Milwaukee	WI	53208	05/25/2011	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Third Party Administrator (TPA) Liaison	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	User Access Contact	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Utilization Management Contact	Medical Director	Dr.	Almas	Rakhshinda		2622079338					rakhshinda.almas@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2020	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2034	Utilization Review Contact	Medical Director	Dr.	Almas	Rakhshinda		2622079338					rakhshinda.almas@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	01/24/2014	2023	COMMUNITY CARE HEALTH PLAN, INC.	Local CCP	Community Care	HMO/HMOPOS		Community Care, Inc.	62	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2056	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/06/2018	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/17/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	12/30/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/30/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	12/30/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	12/06/2018	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/30/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H2056	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/06/2018	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	12/06/2018	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2056	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2064	Automated TrOOP Balance Transfer Contact	DIrector, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Backup User Access Contact	Coordinator Quality & Reporting -LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Best Available Evidence Contact	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Bid Primary Contact	Director, Financial Reporting	Ms.	Pusti	Jessica		5705825447					jmpusti1@geisinger.edu	100 North Academy Avenue	MC 30-69	Danville	PA	178223069	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	CAP Report Contact for Public Website	Quality & Special Projects Coordinator	Ms.	Coolbaugh	Brenna		5708462911				5708088949	bcoolbaugh1@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	CEO - CMS Administrator Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	CEO - Senior Official for Contracting	Chief Administrative Officer	Ms.	Wolfe	Tracey		5702716712					twwolfe@geisinger.edu	44 Woodbine Lane	MC 01-41	Danville	PA	178220141	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Chief Financial Officer	Director, Financial Reporting	Ms.	Pusti	Jessica		5705825447					jmpusti1@geisinger.edu	100 North Academy Avenue	MC 30-69	Danville	PA	178223069	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Chief Operating Officer	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Chief Information Officer	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Chief Information Security Officer	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	CMS Casework Communication Contact	Quality & Special Projects Coordinator	Ms.	Coolbaugh	Brenna		5708462911				5708088949	bcoolbaugh1@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Complaints Tracking Contact	Quality & Special Projects Coordinator	Ms.	Coolbaugh	Brenna		5708462911				5708088949	bcoolbaugh1@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Contact for Fraud Investigations	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Coordination of Benefits Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena	A	5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Corporate Mailing						5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Ave	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Coverage Gap Discount Program (CGDP) Payment Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Customer Service Operations Contact	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	DIR Contact	Director, Financial Reporting	Ms.	Pusti	Jessica		5705825447					jmpusti1@geisinger.edu	100 North Academy Avenue	MC 30-69	Danville	PA	178223069	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	DIR Contact (Secondary)	Accountant Intermediate	Ms.	Manning	Emily		5702715555					ekmanning@geisinger.edu	100 North Academy Avenue		Danville	PA	17822	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Emergency Part D Contact	Director, LIFE Geisinger.edu	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Emergency Part D Contact (Secondary)	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Encounter Data & Risk Adjustment Operations Contact	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149790	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Enrollment Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	EOB Transfer Contact		Ms.	Bertollo	Krista		5702145059				5702146768	EOBP2P@thehealthplan.com	100 North Academy Avenue	MC3245	Danville	PA	17822	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Financial Audit Contact	Director, Financial Reporting	Ms.	Pusti	Jessica		5705825447					jmpusti1@geisinger.edu	100 N Academy Avenue	MC 30-69	Danville	PA	178223069	08/13/2021	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Financial Reporting Contact	Accountant Intermediate	Ms.	Manning	Emily		5702715555					ekmanning@geisinger.edu	10 N Academy Avenue		Danville	PA	17822	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Formulary Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	General Contact	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Government Relations Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	HIPAA Privacy Officer	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	HIPAA Security Officer	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Interoperability Contact		Ms.	Kubasti	Teena		5702149790					tmkubasti@geisinger.edu	100 North Academy Ave		Danville	PA	178227801	05/25/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	MA Appeals/Grievances Contact	Quality % Special Projects Coordinator	Ms.	Coolbaugh	Brenna		5708462911				5708088949	bcoolbaugh1@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	MA Claims Processing Contact for Public Website	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Marketing Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 7801	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Medical Director	Medical Director, LIFE Geisinger	Dr.	Pacheco	Cybele		5702149790				5702149791	cpacheco@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Medicare Compliance Officer	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Medicare Coordinator	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Medicare Part D Opioid Overutilization Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Medication Therapy Management Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Online Enrollment Center Contact (Back-up)	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Online Enrollment Center Contact (Optional)	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Online Enrollment Center Contact (Primary)	DIrector, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Part C Application Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Part D Appeals	Director, LIFE Geisinger	Ms.	Kubasti	Teena						5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active	8003958759				PACE - Nat		C	Philadelphia
H2064	Part D Appeals Contact (Secondary)	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A					5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active	8003958759				PACE - Nat		C	Philadelphia
H2064	Part D Application Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Part D Benefits Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Part D Claims Submission Contact	AVP Financial Operations	Mr.	Gallagher	Scott		5705922355					segallagher@geisinger.edu	100 North Academy Avenue	MC 49-52	Danville	PA	178224952	08/13/2021	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Part D Exceptions Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena						5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active	8003958759				PACE - Nat		C	Philadelphia
H2064	Part D Exceptions Contact (Secondary)	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A					5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active	8003958759				PACE - Nat		C	Philadelphia
H2064	Part D Price File Contact (Back-up)	AVP Financial Operations	Mr.	Gallagher	Scott		5705922355					segallagher@geisinger.edu	100 North Academy Avenue	MC 49-52	Danville	PA	178224952	08/13/2021	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Part D Price File Contact (Optional)	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Part D Price File Contact (Primary)	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Part D Quality Assurance Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Part D Reporting Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Patient Safety Contact	Quality Management & Special Project Coordinator	Ms.	Coolbaugh	Brenna		5708462911				5708088949	bcoolbaugh1@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Payment Contact	Director, Financial Reporting	Ms.	Pusti	Jessica		5705825447					jmpusti1@geisinger.edu	100 North Academy Avenue	MC 30-69	Danville	PA	178223069	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Personal Health Record Contact	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Pharmacy Director	Medical Director, LIFE Geisinger	Dr	Pacheco	Cybele		5702149790				5702149791	cpacheco@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Pharmacy Network Management Contact	Director. LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Pharmacy Network Management Contact (Secondary)	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Pharmacy Technical Help Desk Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena						5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active	8003958759				PACE - Nat		C	Philadelphia
H2064	Pharmacy Technical Help Desk Contact (Secondary)	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A					5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active	8003958759				PACE - Nat		C	Philadelphia
H2064	Plan Directory Contact for Public Website	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Plan to Plan Reconciliation Contact	Accountant Intermediate	Ms.	Manning	Emily		5702715555					ekmanning@geisinger.edu	100 North Academy Avenue		Danville	PA	17822	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Processor Contact	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Quality Contact	Quality Management & Special Project Coordinator	Ms.	Coolbaugh	Brenna		5708462911				5708088949	bcoolbaugh1@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Reconciliation Contact	Director, Financial Reporting	Ms.	Pusti	Jessica		5705825447					jmpusti1@geisinger.edu	100 North Academy Avenue	MC 30-69	Danville	PA	178223069	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Reconciliation Contact (Secondary)	AVP Financial Operations	Mr.	Gallagher	Scott		5705822355					segallagher@geisinger.edu	100 North Academy Avenue	MC 49-52	Danville	PA	178224952	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Recovery Audit Contact	Coordinator Quality & Reporting - LIFE Geisinger	Ms.	Palmer	Deborah	A	5702149806				5702149791	dapalmer@geisinger.edu	100 North Academy Avenue	MC 60-65	Danville	PA	178226065	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Surveillance Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	System Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Third Party Administrator (TPA) Liaison	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	User Access Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Utilization Management Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2064	Utilization Review Contact	Director, LIFE Geisinger	Ms.	Kubasti	Teena		5702149790				5702149791	tmkubasti@geisinger.edu	100 North Academy Avenue	MC 78-01	Danville	PA	178227801	03/11/2022	2023	GEISINGER COMMUNITY HEALTH SERVICES	National PACE	LIFE Geisinger	National PACE		Geisinger Health	96	Yes	Active					PACE - Nat		C	Philadelphia
H2085	Automated TrOOP Balance Transfer Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Backup User Access Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Best Available Evidence Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Bid Primary Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	CAP Report Contact for Public Website	Health Plan Operations Manager		Wachsmuth	Rosalie		5032156556				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	CEO - CMS Administrator Contact	Executive Director	Ms.	Tuller	Susan		2063205325				2067606339	susan.tuller@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	06/17/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	CEO - Senior Official for Contracting	Executive Director	Ms.	Tuller	Susan		2063205325				2067606339	susan.tuller@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	06/17/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Chief Financial Officer		Ms	Barr	Natalie		5032153859					natalie.barr@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Chief Operating Officer		Ms.	Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	02/23/2023	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Chief Information Officer		Ms.	Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Chief Information Security Officer		Ms.	Noordijk	Cindy		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	CMS Casework Communication Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Complaints Tracking Contact	Quality, Compliance Manager		Vemuri	Susan		2063205325				2067606339	susan.vemuri@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Contact for Fraud Investigations	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Coordination of Benefits Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Corporate Mailing						7072544169					cregalia@collabriacare.org	414 South Jefferson Street		Napa	CA	94559	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Coverage Gap Discount Program (CGDP) Payment Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Customer Service Operations Contact			Chinn	Velaa		2063205325					Velaa.Chinn@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	DIR Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	DIR Contact (Secondary)			Chambers	Perry		5032153672					Perry.Chambers@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Emergency Part D Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Emergency Part D Contact (Secondary)			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Encounter Data & Risk Adjustment Operations Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Enrollment Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	EOB Transfer Contact	PACEHealth Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Financial Audit Contact	Health Plan Operations Manager	Ms.	Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Financial Reporting Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Formulary Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Formulary Contact (Secondary)			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	General Contact			Regalia	Celine		7072544169					cregalia@collabriacare.org	414 South Jefferson Street		Napa	CA	94559	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Government Relations Contact		Ms.	Noordijk	Cindy		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	HIPAA Privacy Officer			Noordijk	Cindy		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	HIPAA Security Officer		Ms.	Noordijk	Cindy		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Interoperability Contact			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	MA Appeals/Grievances Contact			Chinn	Velaa		2063205325					Velaa.Chinn@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	MA Claims Processing Contact for Public Website	Mgr Admin and Support Svcs		Chinn	Velaa		2063205325				2067606339	velaa.chinn@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Marketing Contact			Kentta	Jenny		2063205325					Jennifer.Kentta@providence.org	2811 South 102nd St, Suite 220		Tukwila	WA	98168	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Medical Director	Medical Director		Kazemi	Assad		2063205325				2067606339	Assad.Kazemi@providence.org	4515 Martin Luther King Jr. Way S		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Medicare Compliance Officer		Ms.	Noordijk	Cindy		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/21/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Medicare Coordinator			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	01/12/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Medicare Part D Opioid Overutilization Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Medication Therapy Management Contact	Medical Director		Kazemi	Assad		2063205325				2067606339	assadullah.kazemi@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Part C Application Contact			Regalia	Celine		7072544169					cregalia@collabriacare.org	414 S. Jefferson Street		Napa	CA	94559	10/24/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Part D Appeals	Health Plan Operations Manager		Wachsmuth	Rosalie						5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active	5032153681				PACE - Nat		C	San Francisco
H2085	Part D Appeals Contact (Secondary)			Chinn	Velaa							Velaa.Chinn@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	01/21/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active	2063205325				PACE - Nat		C	San Francisco
H2085	Part D Application Contact			Regalia	Celine		7072544169					cregalia@collabriacare.org	414 S. Jefferson Street		Napa	CA	94559	10/24/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Part D Benefits Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Part D Claims Submission Contact			Chambers	Perry		5032153672					Perry.Chambers@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/21/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Part D Exceptions Contact			Chambers	Perry							Perry.Chambers@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/21/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active	5032153672				PACE - Nat		C	San Francisco
H2085	Part D Exceptions Contact (Secondary)	Health Plan Operations Manager		Wachsmuth	Rosalie						5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	01/21/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active	5032153681				PACE - Nat		C	San Francisco
H2085	Part D Price File Contact (Back-up)			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/21/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Part D Price File Contact (Optional)			Chinn	Velaa		2063205325					Velaa.Chinn@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	01/21/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Part D Price File Contact (Primary)			Chambers	Perry		5032153672					Perry.Chambers@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/21/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Part D Quality Assurance Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	01/21/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Part D Reporting Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Patient Safety Contact	Quality, Risk, and Informatics Manager		Reed	Rebecca		5032153465					rebecca.reed@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Payment Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Personal Health Record Contact	Mgr Admin and Support Svcs		Chinn	Velaa		2063205325				2067606339	velaa.chinn@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Pharmacy Director			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Pharmacy Network Management Contact			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Pharmacy Network Management Contact (Secondary)			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Pharmacy Technical Help Desk Contact			Schultz	Elizabeth							Elizabeth.Schultz@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active	4255256908				PACE - Nat		C	San Francisco
H2085	Pharmacy Technical Help Desk Contact (Secondary)			Wachsmuth	Rosalie							rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active	5032153681				PACE - Nat		C	San Francisco
H2085	Plan Directory Contact for Public Website			Bering	Rika		5032153857				2067606339	rika.bering@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Plan to Plan Reconciliation Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Processor Contact	Mgr Admin and Support Svcs		Chinn	Velaa		2063205325				2067606339	velaa.chinn@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Quality Contact			Noordijk	Cindy		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Reconciliation Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Reconciliation Contact (Secondary)			Chambers	Perry		5032153672					Perry.Chambers@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Recovery Audit Contact	Health Plan Operations Manager	Ms.	Wachsmuth	Rosalie		5032154124					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Surveillance Contact	Mgr Admin and Support Svcs		Chinn	Velaa		2063205325				2067606339	velaa.chinn@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	System Contact			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	02/24/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Third Party Administrator (TPA) Liaison			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	12/20/2021	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	User Access Contact			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	4515 Martin Luther King Jr. Way S. Ste. 100		Seattle	WA	98108	02/24/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Utilization Management Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2085	Utilization Review Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	COLLABRIA CARE	National PACE	Providence PACE	National PACE		St. Joseph Home Care Network	800	Yes	Active					PACE - Nat		C	San Francisco
H2108	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Corporate Mailing						6155658100					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H2108	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H2108	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H2108	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H2108	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H2108	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H2108	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2108	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	BRAVO HEALTH MID-ATLANTIC, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2109	Automated TrOOP Balance Transfer Contact	Director	Ms.	Hampton	Tonoah		4105507044				4105507045	thampto4@jh.edu	4940 Eastern Avenue,	Mason F Lord Bldg., East Tower, First Floor	Baltimore	MD	21224	03/03/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Backup User Access Contact	Operations Director	Mr.	Rund	Jack		4105507044				4105507045	jrund1@jhmi.edu	4940 Eastern Avenue, Mason Lord Bldg., East Tower, First Floor		Baltimore	MD	21224	09/20/2018	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Best Available Evidence Contact	Director	Ms.	Hampton	Tonoah		4105507044				4105507045	thampto4@jh.edu	4940 Eastern Avenue,	Mason F Lord Bldg., East Tower, First Floor	Baltimore	MD	21224	03/03/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Bid Primary Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	CAP Report Contact for Public Website	Director	Ms.	Hampton	Tonoah		4105507044				4105507045	thampto4@jh.edu	4940 Eastern Avenue,	Mason F Lord Bldg., East Tower, First Floor	Baltimore	MD	21224	03/03/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	CEO - CMS Administrator Contact	President	Mr.	Sowers	Kevin	W	4109559540					ksowers4@jhmi.edu	600 N. Wolfe Street, Administration 400		Baltimore	MD	212871900	04/12/2018	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	CEO - Senior Official for Contracting	President	Mr.	Sowers	Kevin	W	4109559540					ksowers4@jhmi.edu	600 N. Wolfe Street, Administration 400		Baltimore	MD	212871900	04/12/2018	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Chief Financial Officer	Chief Financial Officer	Mr.	Larson	Mike		4439975710				4439975711	mlarson@jhmi.edu	3910 Keswick Rd Ste S4300A Rm S4200		Baltimore	MD	21211	03/13/2019	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Chief Operating Officer	Chief Operating Officer	Dr.	Ishii	Lisa		4109554985					learnes2@jhmi.edu	733 N Broadway		Baltimore	MD	21205	08/09/2022	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Chief Information Officer	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Chief Information Security Officer	Director	Ms.	Hampton	Tonoah		4105507044				4105507045	thampto4@jh.edu	4940 Eastern Avenue,	Mason F Lord Bldg., East Tower, First Floor	Baltimore	MD	21224	03/03/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	CMS Casework Communication Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Complaints Tracking Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Contact for Fraud Investigations	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Coordination of Benefits Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Corporate Mailing						4109555000					ksowers4@jhmi.edu	600 N. Wolfe Street, Administration 400		Baltimore	MD	212871900	08/09/2022	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Coverage Gap Discount Program (CGDP) Payment Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Customer Service Operations Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	DIR Contact	Director	Ms.	Hampton	Tonoah		4105507044				4105507045	thampto4@jh.edu	4940 Eastern Avenue,	Mason F Lord Bldg., East Tower, First Floor	Baltimore	MD	21224	03/03/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	DIR Contact (Secondary)	Operations Director	Mr.	Rund	Jack		4105507044				4105507045	jrund1@jhmi.edu	4940 Eastern Avenue, Mason Lord Bldg., East Tower, First Floor		Baltimore	MD	21224	09/20/2018	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Emergency Part D Contact	Manager On-Call		on-call	Manager		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Emergency Part D Contact (Secondary)	Director of Operations		Rund	Jack		4436178247					jrund1@jhmi.edu	4940 Eastern Avenue	Mason Lord Bldg., East Tower, First Floor	Baltimore	MD	21224	12/14/2022	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Encounter Data & Risk Adjustment Operations Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Enrollment Contact	Outreach Coordinator	Ms.	Williams	Tiffani		4105507044				4105507045	twilli19@jhmi.edu	4940 Eastern Avenue, Mason F Lord Building 1st Floor		Baltimore	MD	21224	08/09/2022	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	EOB Transfer Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Financial Audit Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Financial Reporting Contact	Director	Ms.	Hampton	Tonoah		4105507044				4105507045	thampto4@jh.edu	4940 Eastern Avenue,	Mason F Lord Bldg., East Tower, First Floor	Baltimore	MD	21224	03/03/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Formulary Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	General Contact	Director	Ms.	Hampton	Tonoah		4105507044				4105507045	thampto4@jh.edu	4940 Eastern Avenue,	Mason F Lord Bldg., East Tower, First Floor	Baltimore	MD	21224	03/03/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Government Relations Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	HIPAA Privacy Officer	Senior Counsel	Mr.	Bradfield	Donald	L	4105507044				4105507045	dbradfi4@jhmi.edu	5801 Smith Avenue, McAuley Hall, Suite 310		Baltimore	MD	21209	01/13/2012	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	HIPAA Security Officer	Senior Counsel	Mr.	Bradfield	Donald	L	4105507044				4105507045	dbradfi4@jhmi.edu	5801 Smith Avenue, McAuley Hall, Suite 310		Baltimore	MD	21209	01/13/2012	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Interoperability Contact	Director	Mrs.	Hampton	Tonoah		4105507124					thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	MA Appeals/Grievances Contact	Director	Mr.	Hampton	Tonoah		4105507044				4105507045	thampto4@jh.edu	4940 Eastern Avenue,	Mason F Lord Bldg., East Tower, First Floor	Baltimore	MD	21224	03/03/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	MA Claims Processing Contact for Public Website	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Marketing Contact	Outreach Coordinator	Ms.	Williams	Tiffani		4105507044				4105507045	twilli19@jhmi.edu	4940 Eastern Avenue, Mason F Lord Building 1st Floor		Baltimore	MD	21224	08/09/2022	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Medical Director	Medical Director	Dr.	McNabney	Matthew	K	4105507044				4105507045	mmcnabn1@jhmi.edu	4940 Eastern Avenue, Mason Lord Bldg., East Tower, First Floor		Baltimore	MD	21224	01/13/2012	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Medicare Compliance Officer	Director, Hopkins ElderPlus	Mrs.	Hampton	Tonoah	H	4105507044				4105507045	thampto4@jh.edu	4940 Eastern Avenue,	Mason F Lord Bldg., East Tower, First Floor	Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Medicare Coordinator	Director	Ms.	Hampton	Tonoah		4105507044				4105507045	thampto4@jh.edu	4940 Eastern Avenue,	Mason F Lord Bldg., East Tower, First Floor	Baltimore	MD	21224	03/03/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Medicare Part D Opioid Overutilization Contact	Pharmacy Coordinator	Mr.	Green	Robert		4102886000				4105507045	rgreen59@jhmi.edu	5901 Holabird Ave Ste A-2		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Medication Therapy Management Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Online Enrollment Center Contact (Primary)	Director	Mr.	Aistrop	Jonathan		4105507044				4105507045	jaistro1@jhmi.edu	4940 Eastern Avenue, Mason Lord Bldg., East Tower, First Floor		Baltimore	MD	21224	01/31/2013	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Part C Application Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Part D Appeals	Director	Mrs.	Hampton	Tonoah						4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active	4105507124				PACE - Nat		C	Philadelphia
H2109	Part D Appeals Contact (Secondary)	Director of Operations	Mr.	Rund	Jack						4105507045	jrund@jhmi.edu	494 Eastern Avenue	Mason F. Lord Building - East First Floor	Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active	4105501006				PACE - Nat		C	Philadelphia
H2109	Part D Application Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Part D Benefits Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Part D Claims Submission Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Part D Exceptions Contact	Director	Mrs.	Hampton	Tonoah						4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active	4105507124				PACE - Nat		C	Philadelphia
H2109	Part D Price File Contact (Back-up)	Pharmacy Coordinator	Mr.	Green	Robert		4102886000				4105507045	rgreen59@jhmi.edu	5901 Holabird Ave Ste A-2		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Part D Price File Contact (Primary)	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Part D Quality Assurance Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Part D Reporting Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Patient Safety Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Payment Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Pharmacy Director	Pharmacy Coordinator	Mr.	Green	Robert		4102886000				4105507045	rgreen59@jhmi.edu	5901 Holabird Ave Ste A-2		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Pharmacy Network Management Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Pharmacy Technical Help Desk Contact	Director	Mrs.	Hampton	Tonoah						4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active	4105507124				PACE - Nat		C	Philadelphia
H2109	Plan Directory Contact for Public Website	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Plan to Plan Reconciliation Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Processor Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Quality Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Reconciliation Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Reconciliation Contact (Secondary)	Operations Director	Mr.	Rund	Jack		4105507044				4105507045	jrund1@jhmi.edu	4940 Eastern Avenue, Mason Lord Bldg., East Tower, First Floor		Baltimore	MD	21224	09/20/2018	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Recovery Audit Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Surveillance Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	System Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Third Party Administrator (TPA) Liaison	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	User Access Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Utilization Management Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2109	Utilization Review Contact	Director	Mrs.	Hampton	Tonoah		4105507124				4105507045	thampto4@jh.edu	4940 Eastern Ave		Baltimore	MD	21224	08/11/2023	2023	THE JOHNS HOPKINS HEALTH SYSTEM CORPORATION	National PACE	Hopkins ElderPlus	National PACE		The Johns Hopkins Health System Corporation	137	Yes	Active					PACE - Nat		C	Philadelphia
H2117	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Corporate Mailing						8132063477					crysten.troutman@wellcare.com	P. O. Box 31386		Tampa	FL	33631	01/20/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Part C Application Contact	Manager, Product Development		Macklin	Tia		8132841525					Tia.D.Macklin@CENTENE.COM	5130 Sun Forest Drive	Suite 175	Tampa	FL	33634	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H2117	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H2117	Part D Application Contact	Manager, Product Development		Macklin	Tia		8132841525					Tia.D.Macklin@CENTENE.COM	5130 Sun Forest Drive	Suite 175	Tampa	FL	33634	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H2117	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H2117	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H2117	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H2117	PHR Beneficiary Contact																	09/27/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8668928340				PPO - BBA		C	Dallas
H2117	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	SNP Application Contact	Manager, Product Development		Macklin	Tia		8132841525					Tia.D.Macklin@CENTENE.COM	5130 Sun Forest Drive	Suite 175	Tampa	FL	33634	01/20/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2117	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H2128	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/05/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/05/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Medical Director	Sr. VP, Medical Affairs	Dr.	Nelson	Vincent		3145056872					vincent.nelson@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/17/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	09/21/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H2128	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H2128	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H2128	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H2128	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H2128	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H2128	PHR Beneficiary Contact																	09/27/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8557661456				PPO - BBA		C	Dallas
H2128	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Plan Directory Contact for Public Website			Services	Member		8557661452					CorporateMedicareComplianceDept@Centene.com	300 Corporate Center Drive		Camp Hill	PA	17011	03/31/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2128	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	CELTIC INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2134	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H2134	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/30/2018	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/30/2018	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/30/2018	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Medical Director	Chief Medical Director	Dr.	Shankar	Latha		5058866243					Latha.RajaShankar@WesternSkyCommunitycare.com	5300 Homestead road NE		Alburqerque	NM	87110	03/30/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	04/07/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/30/2018	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H2134	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H2134	PHR Beneficiary Contact																	09/27/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8448107965				HMO - Health Maintenance Organization		C	Dallas
H2134	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	03/31/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2134	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	09/21/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H2162	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H2162	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H2162	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2162	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF NEW HAMPSHIRE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2168	Agent/Broker Compensation Data Contact	AVP of Medicare, Medicaid & Regulatory Affairs	Miss	Platt	Keneisha		2123375641					KeneishaP@villagecare.org	112 Charles Street		New York	NY	10014	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Automated TrOOP Balance Transfer Contact		Mr.	Esp	Bryan		8587906445					PartDCAT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/03/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Backup User Access Contact	Chief Security Officer		Grijalva	Alexander		2124509779					Alexander@villagecare.org	154 Christopher Street		New York	NY	10014	11/15/2017	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Best Available Evidence Contact	VP, Member Experience and Support Services		Fernandez	Vanessa		2123375678					VanessaF@villagecare.org	120 Broadway		New York	NY	10271	02/01/2018	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Bid Audit Contact	Director of Medicare Products	Miss	Rodriguez	Alexandra		9295855582					alexandra.rodriguez@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	07/03/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Bid Audit Site Contact	Director of Medicare Products	Miss	Rodriguez	Alexandra		9295855582					alexandra.rodriguez@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	07/03/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Bid Primary Contact	Director of Medicare Products	Miss	Rodriguez	Alexandra		9295855582					alexandra.rodriguez@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	07/03/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	CAP Report Contact for Public Website	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375641					SabrinaW2@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active	2123375884				HMO - Health Maintenance Organization		C	New York
H2168	CEO - CMS Administrator Contact	President & Chief Executive Officer	Mrs	DeVito	Emma		8004696292					EmmaD@villagecare.org	120 Broadway	Suite 2840	New York	NY	10271	03/09/2020	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	CEO - Senior Official for Contracting	President and Chief Executive Officer	Ms.	DeVito	Emma		2123375801					EmmaD@villagecare.org	120 Broadway	Suite 2840	New York	NY	10271	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Chief Financial Officer	Chief Financial Officer	Ms.	Tirado	Debra		2123375710					DebraT@villagecare.org	120 Broadway	Suite 2840	New York	NY	10271	12/28/2022	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Chief Operating Officer	Chief Operating Officer	Mrs	Garay	Lisa		2123375862					lisag@villagecare.org	120 Broadway	Suite 2740	New York	NY	10271	03/02/2022	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Chief Information Officer	Chief Information Officer	Mr	Myer	Stuart		2123379251					stuartm@villagecare.org	154 Christopher Street  3rd Floor		New York	NY	10014	02/16/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Chief Information Security Officer	Chief Security Officer	Mr	Grijalva	Alexander		2124509779					Alexander@villagecare.org	154 Christopher Street		New York	NY	10014	11/15/2017	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	CMS Casework Communication Contact	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Complaints Tracking Contact	Assistant Director of Grievance & Appeals	Ms.	Hernandez	Liukysha		7185172739					LiukyshaH@villagecare.org	112 Charles Street		New York	NY	10014	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Contact for Fraud Investigations	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway		New York	NY	10271	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Coordination of Benefits Contact	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Corporate Mailing						2123375600	5750				info@villagecare.org	112 Charles Street		New York	NY	10014	02/03/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Coverage Gap Discount Program (CGDP) Payment Contact	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Customer Service Operations Contact	VP of Member Experience	Ms.	Fernandez	Vanessa		2123375678					vanessaf@villagecare.org	112 Charles Street		New York	NY	10014	11/15/2017	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	DIR Contact	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway		New York	NY	10271	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	DIR Contact (Secondary)	Pharmacy Specialist		Eng-Liu	Eileen		2123375600	5964				EileenE@villagecare.org	120 Broadway		New York	NY	10271	03/09/2020	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Emergency Part D Contact	VP, Clinical Operations		Garay	Lisa		8004696292					LisaG@villagecare.org	120 Broadway	Suite 2840	New York	NY	10271	12/23/2020	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Emergency Part D Contact (Secondary)	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway		New York	NY	10271	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Encounter Data & Risk Adjustment Operations Contact	VP of Business Intelligence		Kessler	Bruce		2123375780					brucek@villagecare.org	120 Broadway	Suite 2840	New York	NY	10271	09/23/2022	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Enrollment Contact	VP, Member Experience and Support Services		Fernandez	Vanessa		2123375678					VanessaF@villagecare.org	120 Broadway		New York	NY	10271	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	EOB Transfer Contact	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884				2123375711	SabrinaW2@villagecare.org	120 Broadway		New York	NY	10271	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Financial Audit Contact	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway		New York	NY	10271	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Financial Reporting Contact	Chief Financial Officer	Ms.	Tirado	Debra		2123375710					DebraT@villagecare.org	120 Broadway	Suite 2840	New York	NY	10271	12/28/2022	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Formulary Contact	AVP, Government Affairs	Ms.	Momita	Paul		8587906350					FMT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/03/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Formulary Contact (Secondary)	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway		New York	NY	10271	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	General Contact	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway		New York	NY	10271	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Government Relations Contact	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway		New York	NY	10271	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	HIPAA Privacy Officer	Chief Compliance Officer	Mrs,	Quinn-Bermack	Dara		2123375760					DaraQ@villagecare.org	120 Broadway	Suite 2840	New York	NY	10271	12/28/2022	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	HIPAA Security Officer	HIPAA Privacy Officer		Grijalva	Alexander		2124509779					alexanderg2@villagecare.org	154 Christopher Street		New York	NY	10014	02/03/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Hospice Contact	Pharmacy Specialist		Eng-Liu	Eileen		2123375600	5964				EileenE@villagecare.org	120 Broadway		New York	NY	10271	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Interoperability Contact	Chief Information Officer	Mr.	Myer	Stuart		2123379251					StuartM@villagecare.org	154 Christopher Street		New York	NY	10014	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	MA Appeals/Grievances Contact	Assistant Director of Grievance & Appeals	Ms.	Hernandez	Liukysha		7185172739					LiukyshaH@villagecare.org	112 Charles Street		New York	NY	10014	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	MA Claims Processing Contact for Public Website			Services	Provider		8557692500					villagecaremaxinfo@villagecare.org	PO Box 5536		Hauppauge	NY	11788	02/03/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Marketing Contact	SVP Business Development and Health Plan Ops	Ms.	Fernandez	Vanessa		2123375678					vanessaf@villagecare.org	112 Charles Street		New York	NY	10014	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Medical Director	Chief Medical Officer	Dr	Arnold	Steven		3475152240					SteveA@villagecare.org	120 Broadway	27th Floor	New York	NY	10271	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Medicare Compliance Officer	AVP of Medicare Regulatory Compliance	Miss	Wright	Sabrina		2123375884					sabrinaw2@villagecare.org	120 Broadway	Suite 2740	New York	NY	10271	10/21/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Medicare Coordinator	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Medicare Part D Opioid Overutilization Contact	Pharmacist Specialist		Eng Liu	Eileen		2123375600	5964				EileenE@villagecare.org	120 Broadway		New York	NY	10271	07/06/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Medication Therapy Management Contact			Mason	Betsy		8587905897					MTMP@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Online Enrollment Center Contact (Optional)	AVP of Medicare Regulatory Affairs		Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway		New York	NY	10271	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Online Enrollment Center Contact (Primary)	Sr. Director Eligibility and Retention	Miss	Wu-Malloy	Amie		2123375643					Mengying@villagecare.org	112 Charles Street		New York	NY	10014	10/26/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Part C Application Contact	Director of Medicare Products	Miss	Rodriguez	Alexandra		9295855582					alexandra.rodriguez@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Part C Reporting Contact	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Part D Appeals	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina							SabrinaW2@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active	2123375884				HMO - Health Maintenance Organization		C	New York
H2168	Part D Appeals Contact (Secondary)			Redd Guinto	Karen						8587906060	karen.reddguinto@medimpact.com	10181 Scripps Gateway Court	Appeals and Grievance	San Diego	CA	92131	01/08/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active	8587906584				HMO - Health Maintenance Organization		C	New York
H2168	Part D Application Contact	Director of Medicare Products	Miss	Rodriguez	Alexandra		9295855582					alexandra.rodriguez@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Part D Benefits Contact	Director of Medicare Products	Miss	Rodriguez	Alexandra		9295855582					alexandra.rodriguez@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Part D Claims Submission Contact	Pharmacy Specialist		Eng-Liu	Eileen		2123375600	5964				EileenE@villagecare.org	120 Broadway		New York	NY	10271	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Part D Exceptions Contact	AVP of Medicare Regulatory Affairs	Ms.	Wright	Sabrina							SabrinaW2@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active	2123375884				HMO - Health Maintenance Organization		C	New York
H2168	Part D Price File Contact (Back-up)	Medicare Part D Program Manager	Mr.	Larkin	Rory		8587905849					planfindercommunications@medImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	07/15/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Part D Price File Contact (Optional)	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Part D Price File Contact (Primary)	Pharmacy Specialist		Eng-Liu	Eileen		2123375600	5964				EileenE@villagecare.org	120 Broadway		New York	NY	10271	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Part D Quality Assurance Contact	Pharmacy Specialist		Eng-Liu	Eileen		2123375600	5964				EileenE@villagecare.org	120 Broadway		New York	NY	10271	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Part D Reporting Contact			MacLochlainn	Tine		8587907031					MedicarePartDProjectManagers@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/03/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Patient Safety Contact	Chief Operating Officer		Garay	Lisa		2123375862					LisaG@villagecare.org	120 Broadway	27th Floor	New York	NY	10271	09/23/2022	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Payment Contact	Chief Financial Officer	Ms.	Tirado	Debra		2123375710					DebraT@villagecare.org	120 Broadway	Suite 2840	New York	NY	10271	12/28/2022	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Pharmacy Director			Scharaga	Ellen		8004696292					EllenS@villagecare.org	120 Broadway		New York	NY	10271	02/01/2018	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Pharmacy Network Management Contact			Maldonado	Cheryl		8587906397					cheryl.maldonado@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/03/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Pharmacy Technical Help Desk Contact			Battle	Dorry							customerservice@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/03/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active	8888076806				HMO - Health Maintenance Organization		C	New York
H2168	Plan Directory Contact for Public Website			Services	Provider		8557692500					villagecaremaxinfo@villagecare.org	PO Box 5536		Hauppauge	NY	11788	02/03/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Plan to Plan Reconciliation Contact	Chief Financial Officer		Tirado	Debra		2123375710					DebraT@villagecare.org	120 Broadway	Suite 2840	New York	NY	10271	06/19/2019	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Processor Contact			Scherlippens	Carine		8587907415					MedicarePartDProjectManagers@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/03/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Quality Contact	AVP of Quality		Rooney	Cynthia		2123375706					CynthiaR3@villagecare.org	120 Broadway	27th Floor	New York	NY	10271	02/17/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Reconciliation Contact	AVP of Medicare, Medicaid & Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	02/21/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Reconciliation Contact (Secondary)	Pharmacy Specialist		Eng-Liu	Eileen		2123375600	5964				EileenE@villagecare.org	120 Broadway		New York	NY	10271	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Recovery Audit Contact	Chief Financial Officer	Ms.	Tirado	Debra		2123375710					DebraT@villagecare.org	120 Broadway	Suite 2840	New York	NY	10271	12/28/2022	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	SNP Application Contact	AVP of Medicare, Medicaid & Regulatory Affairs	Miss	Platt	Keneisha		2123375641					KeneishaP@villagecare.org	112 Charles Street		New York	NY	10014	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	SNP State Contact	AVP of Medicare, Medicaid & Regulatory Affairs	Miss	Platt	Keneisha		2123375641					KeneishaP@villagecare.org	112 Charles Street		New York	NY	10014	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Surveillance Contact	AVP of Medicare, Medicaid & Regulatory Affairs	Miss	Platt	Keneisha		2123375641					KeneishaP@villagecare.org	112 Charles Street		New York	NY	10014	01/13/2021	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	System Contact	CIO		Myer	Stuart		2123379251					stuartm@villagecare.org	154 Christopher Street		New York	NY	10014	02/03/2016	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Third Party Administrator (TPA) Liaison	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway, Suite 2740		New York	NY	10271	08/07/2023	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	User Access Contact	AVP of Medicare Regulatory Affairs	Miss	Wright	Sabrina		2123375884					SabrinaW2@villagecare.org	120 Broadway, Ste 2740		New York	NY	10271	08/09/2022	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Utilization Management Contact	Chief Operating Officer		Garay	Lisa		2123375862					LisaG@villagecare.org	120 Broadway	27th Floor	New York	NY	10271	09/23/2022	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2168	Utilization Review Contact	Chief Operating Officer		Garay	Lisa		2123375862					LisaG@villagecare.org	120 Broadway	27th Floor	New York	NY	10271	09/23/2022	2023	VILLAGE SENIOR SERVICES CORPORATION	Local CCP	VillageCareMAX	HMO/HMOPOS		Village Care of New York, Inc.	547	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2171	Agent/Broker Compensation Data Contact	Chief Sales Officer	Mr.	Ortiz	Jesus		2147076260				8178105214	jesus.ortiz@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Automated TrOOP Balance Transfer Contact	Account Manager	Mr.	Battaglia	James		3308886165				3308886015	jbattaglia@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Backup User Access Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Best Available Evidence Contact	Director, Pharmacy	Ms.	May	Amy		8176322128				8178105214	Amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Bid Audit Contact	Compliance Officer	Ms	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Bid Audit Site Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Bid Primary Contact	Compliance Officer	Ms	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	CAP Report Contact for Public Website	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY		Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	CEO - CMS Administrator Contact	Plan President and Chief Operating Officer	Mr.	Gadde	Kiran		8176323023					kiran.gadde@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	CEO - Senior Official for Contracting	Plan President and Chief Operating Officer	Mr.	Gadde	Kiran		8176323023					kiran.gadde@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Chief Financial Officer	Chief Financial Officer	Mr	Birch	Harvey		8176323023					harvey.birch@southwesternhealth.org	1601 LBJ FWY	Suite 200	Farmers Branch	TX	75234	01/03/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Chief Operating Officer	Chief Operating Officer	Mr.	Gadde	Kiran		8176321741					kiran.gadde@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	01/03/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Chief Information Officer	SVP, Chief Information Officer	Mr	Marlow	Mac		8176323023					mac.marlow@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Chief Information Security Officer	SVP, Chief Information Officer	Mr	Marlow	Mac		8176323023					mac.marlow@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	CMMI Model Point of Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	CMS Casework Communication Contact	Director, Compliance Officer	Ms.	Scott	Elizabeth		8176323023				8178105214	elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Complaints Tracking Contact	Director, Compliance Officer	Ms.	Scott	Elizabeth		8176323023				8178105214	elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Contact for Fraud Investigations	Compliance Officer	Ms	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Coordination of Benefits Contact	Sr Director, Strategic Operations	Mr.	Smith	Charles		8176323023				8178105214	charles.smith@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Corporate Mailing						8176323023				8178105214	elizabeth.scott@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant	Mr.	Liu	Robert		8176323023					robert.liu@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Customer Service Operations Contact	Sr Director, Operations	Mr.	Greene	Shane		8176874066				8176874103	Shane.greene@cnchealthplan.com	1603 Lyndon B. Johnson	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	DIR Contact	Senior Director, Government Programs	Mr.	Farmer	Jim		3308886098					jfarmer@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	DIR Contact (Secondary)	Analyst III, Government Programs	Mr.	Houchens	Logan		3308886095					lhouchens@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Emergency Part D Contact	Director, Pharmacy Services	Ms.	May	Amy		8176322128				8178105214	Amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Emergency Part D Contact (Secondary)	Director, Pharmacy Services	Mrs.	May	Amy		8176323023				8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Employer Waiver Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Encounter Data & Risk Adjustment Operations Contact	Finance	Ms.	Sheriff	Laura		8176323023					Laura.Sheriff@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Enrollment Contact	Sr Director, Strategic Operations	Mr	Smith	Charles		8176323023				8178105214	charles.smith@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	EOB Transfer Contact	Sr Director, Strategic Operations	Mr.	Smith	Charles		8176323023				8178105214	charles.smith@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Financial Audit Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Financial Reporting Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Formulary Contact	Clinical Formulary Pharmacist	Mr	Shick	Ryan		2342123614					rshick@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Formulary Contact (Secondary)	Director, Pharmacy	Ms.	May	Amy		8176322128				8178105214	Amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	General Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suit 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Government Relations Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	HIPAA Privacy Officer	Interim Privacy Officer and General Counsel	Mr.	Smith	Randall		4025993884					Randall.Smith@southwesternhealth.org	1601 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	07/05/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	HIPAA Security Officer	VP IT and Security	Mr.	Marlow	Mac		8176323023					mac.marlow@southwesternhealth.org	1601 Lyndon B. Johnson Freeway	Suite 200	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Hospice Contact	Clinical Pharmacy Services	Ms.	May  Pharm D	Amy		8176322128				8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Interoperability Contact	Sr Director, Operations	Mr.	Greene	Shane		8176321741					shane.greene@cnchealthplan.com	1603 LBJ FWY		Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	MA Appeals/Grievances Contact	Sr Director, Operations	Mr.	Greene	Shane		8176321741				8178105214	shane.greene@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	MA Claims Processing Contact for Public Website			Administration	Claims		8175298301					info@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Marketing Contact	Chief Sales Officer	Mr.	Ortiz	Jesus		2147076260					jesus.ortiz@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Medical Director	Chief Medical Officer, SWHR	Dr.	DeMartini	Robert		9726793982					robert.demartini@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Medicare Compliance Officer	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Medicare Coordinator	Manager Compliance Operations	Ms.	Geltman	Megan		8176323023				8178105214	megan.geltman@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy Services	Ms.	May	Amy		8176322128				8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	02/13/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Medication Therapy Management Contact	VP Pharmacy Solutions	Ms.	Miller	Holly		3302931916					hmiller@healthdialog.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	OffShore Subcontractor Contact	Manager Compliance Regulatory Oversight	Ms	Geltman	Megan		8176323023					megan.geltman@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	04/11/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Online Enrollment Center Contact (Back-up)	Sr Director, Operations	Mr.	Greene	Shane		8176321741				8176874103	shane.greene@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Online Enrollment Center Contact (Primary)	Sr Director, Strategic Operations	Mr.	Smith	Charles		8176323023				8178105214	charles.smith@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Part C Application Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Part C Reporting Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Appeals	Director, Pharmacy Services	Ms	May	Amy						8174388483	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active	8773747993				HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations		Binegar	Sam						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Application Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Benefits Contact	Account Manager	Mr.	Battaglia	James		3308886165				3308886015	jbattaglia@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Claims Submission Contact	Senior Account Manager	Mr.	Battaglia	James		3308886165				3308886015	jbattaglia@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Exceptions Contact	Director, Pharmacy Services	Ms.	May	Amy							amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active	8176322128				HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Exceptions Contact (Secondary)	Clinical Pharmacy Services	Ms.	May PharmD	Amy						8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active	8176322128				HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Price File Contact (Back-up)	Financial Analyst, Finance		Kessler	Cameron		2342123110				3304864801	ckessler@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Price File Contact (Optional)	Director, Pharmacy Services	Ms.	May	Amy		8176322128				8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Price File Contact (Primary)	Sr Financial Manager Reporting & Analytics	Mr.	Campbell	Tim		3308886988				3304864801	tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Quality Assurance Contact	Director, Pharmacy Services	Ms.	May	Amy		8176322128				8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Part D Reporting Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Patient Safety Contact	Director, Pharmacy Services	Ms.	May	Amy		8176322128					amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Payment Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Personal Health Record Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Pharmacy Director	Sr Director,  Pharmacy Services	Ms.	Flowers	Amy		8176323023				8178105214	amy.flowers@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Pharmacy Network Management Contact	Director Pharmacy Network Development	Ms.	Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active	8557915302				HMO - Health Maintenance Organization		C	Dallas
H2171	PHR Beneficiary Contact																	02/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS	Care N Care	Texas Health Resources	709	Yes	Active	8557915302				HMO - Health Maintenance Organization		C	Dallas
H2171	Physician Incentive Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Plan Directory Contact for Public Website			Concierge	Provider		8176874004					info@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	10/21/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Birch	Harvey		8176323023					harvey.birch@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/31/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Processor Contact	Sr Director, Strategic Operations	Mr.	Smith	Charles		8176323023				8178105214	charles.smith@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Quality Contact	Chief Medical Officer, SWHR	Dr.	DeMartini	Robert		9726793982					robert.demartini@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Reconciliation Contact	Chief Financial Officer	Mr.	Birch	Harvey		8176323023					harvey.birch@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/31/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Reconciliation Contact (Secondary)	Director Pharmacy Network Development	Ms.	May	Amy		8176323023				3304864801	amy.may@cnchealthplan.com	1603 LBJ FWY	Suite 201	Farmers Branch	TX	75234	11/30/2022	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Recovery Audit Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Surveillance Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	System Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Third Party Administrator (TPA) Liaison	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	User Access Contact	Compliance Officer	Ms	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	01/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Utilization Management Contact	Chief Medical Officer, SWHR	Dr.	DeMartini	Robert		9726793982					robert.demartini@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2171	Utilization Review Contact	Chief Medical Officer, SWHR	Dr.	DeMartini	Robert		9726793982					robert.demartini@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	HMO/HMOPOS		Texas Health Resources	709	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2172	Agent/Broker Compensation Data Contact	Manager, Medicare Compliance		Lawrence	Winston		5105070510					winston.d.lawrence@kp.org	1 Kaiser Plaza, 12th Flr		Oakland	CA	94612	10/25/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Automated TrOOP Balance Transfer Contact	Project Manager III, Pharmacy Benefit Mgmt		Perez	Elizabeth	R	5623670592					Elizabeth.R.Perez@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	08/02/2018	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Backup User Access Contact	Senior Medicare Products Consultant		Hershkovitz	Lena		4103618543					lena.b.hershkovitz@kp.org	111 S. Calvert St.		Baltimore	MD	21202	11/06/2019	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Best Available Evidence Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Bid Audit Contact	Executive Director Actuarial		Kenny	Kevin		5102677544					kevin.x.kenny@kp.org	300 Lakeside Drive, 28th Floor		Oakland	CA	94612	12/18/2020	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Bid Audit Site Contact	Compliance Consultant		Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/01/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Bid Primary Contact	Managing Actuary		Hu	Shelley	J	4043647109					shelley.j.hu@kp.org	3495 Piedmont Rd. NE	Nine Piedmont Center	Atlanta	GA	30305	01/20/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	CAP Report Contact for Public Website	Medicare Contract Compliance Manager		McLean	Pamela		3018165737				3018167275	pamela.l.mclean@kp.org	2101 East Jefferson Street		Rockville	MD	20852	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	CEO - CMS Administrator Contact	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	CEO - Senior Official for Contracting	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Chief Financial Officer	SVP, CFO Business Units and Finance Operations	Mr.	Beltch	Robert	R	8184897560					rob.beltch@kp.org	1 Kaiser Plaza, Suite 806	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/15/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Chief Operating Officer	Executive Director, Medicare Market Strategy & Ops	Mr.	Miller	Paul		5033410073					paul.a.miller@kp.org	500 NE Multnomah St., Ste. 100		Portland	OR	97232	04/10/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Chief Information Officer	Chief Information Officer	Ms.	Comer	Diane		5102258777					Diane.B.Comer@kp.org	2600 Napa Valley Corporate Drive		Napa	CA	94558	09/17/2020	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Chief Information Security Officer	VP, Chief Information Security Officer	Mr.	Goddard	Jim		3037133890					James.P.Goddard@kp.org	6560 Greenwood Plaza Blvd.		Greenwood Village	CO	80111	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	CMS Casework Communication Contact	Medicare Contract Compliance Manager		McLean	Pamela		3018165737				3018167275	pamela.l.mclean@kp.org	2101 East Jefferson Street		Rockville	MD	20852	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Complaints Tracking Contact	Medicare Contract Compliance Manager		McLean	Pamela		3018165737				3018167275	pamela.l.mclean@kp.org	2101 East Jefferson Street		Rockville	MD	20852	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Contact for Fraud Investigations	Director ,Fraud Control and National Special Inves		Janiga	Marita	C	5102716937				5108917977	marita.c.janiga@kp.org	One Kaiser Plaza, Ordway Building, 12th Floor		Oakland	CA	94612	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Coordination of Benefits Contact	Senior Director		Chung	Clarence		5623909293				5626583866	clarence.j.chung@kp.org	12254 Bellflower Blvd - Suite 106, 1st Floor		Downey	CA	90242	04/28/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Corporate Mailing						3018165737				3018167275	pamela.l.mclean@kp.org	2101 East Jefferson St		Rockville	MD	20852	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Coverage Gap Discount Program (CGDP) Payment Contact			Ballestros	Mayra		6262525164					mayra.x.lujano@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	02/15/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Customer Service Operations Contact	Sr Director Member Relations		Devers	Jason	C	3233027947				4049495001	jason.c.devers@kp.org	Nine Piedmont Center	3495 Piedmont Road, NE	Atlanta	GA	30305	01/10/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	DIR Contact	Senior Business Process Manager		Hsiue	Tony		5626583836					tony.x.hsiue@kp.org	12254 Bellflower Blvd.  Flr. 2		Downey	CA	90242	03/09/2020	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	DIR Contact (Secondary)	Sr. Financial Analyst		San	Kei		5626583445					Kei.San@kp.org	12254 Bellflower Blvd. Fl. 2		Downey	CA	90242	07/17/2018	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Electronic Health Record Contact	Sr Manager, Meaningful Use PMO		Poole	Dolly		5106255813					dolly.poole@kp.org	1800 Harrison St.		Oakland	CA	94612	07/02/2018	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Emergency Part D Contact	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/04/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Emergency Part D Contact (Secondary)	Pharmacy Benefits Specialist		Xhixho	Anila		3019156151				7034664802	anila.x.xhixho@kp.org	22370 Davis Drive	Suite 190	Sterling	VA	20164	07/31/2020	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Encounter Data & Risk Adjustment Operations Contact	Director, Risk Adjustment Submission	Ms.	Gu	Jialin		3033383507					jialin.gu@kp.org	2500 South Havana		Aurora	CO	80014	10/21/2019	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Enrollment Contact	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/20/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	EOB Transfer Contact	Pharmacy Medicare Operations, Project Manager II		Bonoan	John	B	5624180564				5626583848	john.b.bonoan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Financial Audit Contact	Compliance Consultant	Ms.	Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/01/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Financial Reporting Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Formulary Contact	Pharmacy Project Manager		Kim	Jung		5624459129					jung.x3.kim@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/20/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Formulary Contact (Secondary)	PHARMACY PROJECT MGR I		Lin	Clement	J	5624459129					Clement.J.Lin@kp.org	12254 Bellflower Blvd		Downey	CA	90242	06/01/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	General Contact	Medicare Contract Compliance Manager		McLean	Pamela		3018165737				3018167275	pamela.l.mclean@kp.org	2101 East Jefferson Street		Rockville	MD	20852	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Government Relations Contact	Senior Vice President, Government Relations		Barrueta	Anthony	A	5102716835					Anthony.Barrueta@kp.org	One Kaiser Plaza		Oakland	CA	94612	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	HIPAA Privacy Officer	Compliance Director		Anderson	Angela		5104353413					Angela.B.Anderson@kp.org	1800 Harrison Street	16th Floor	Oakland	CA	94612	11/06/2020	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	HIPAA Security Officer	Senior Director		Vourthis	Bill		9252065125					bill.d.vourthis@kp.org	5820 Owens Drive	Building E	Pleasanton	CA	94588	08/25/2020	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Hospice Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Interoperability Contact	National EDI Business Operations		Plattner	Cathy		6268336526					cathy.p.plattner@kp.org	75 N Fair Oaks Ave.		Pasadena	CA	91103	11/03/2021	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	MA Appeals/Grievances Contact	Executive Director, Member Relations	Ms	Osborne	Susan		5038133924					susan.a.osborne@kp.org	500 NE Multnomah Street	Suite 100	Portland	OR	97232	08/02/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	MA Claims Processing Contact for Public Website	Dir Customer Engagement Mgmt		Galloway	Lonnie		9094772466					Lonnie.L.Galloway@kp.org	10740 4th Street		Rancho Cucamonga	CA	91730	08/02/2018	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Marketing Contact	Medicare Sales Manager		Dibuccio	Anthony		3018165651					KP-MedicareFilings@kp.org	2101 East Jefferson St	5th Floor East	Rockville	MD	20852	06/30/2021	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Medical Director	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	11/16/2020	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Medicare Compliance Officer	Medicare Contract Compliance Manager	Ms	McLean	Pamela		2403308451				3018167275	pamela.l.mclean@kp.org	2101 East Jefferson Street		Rockville	MD	20852	09/19/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Medicare Coordinator	Executive Director, Medicare		Robinson	Tanya		3013950877					tanya.m.robinson@kp.org	2101 East Jefferson St		Rockville	MD	20852	01/26/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Medicare Part D Opioid Overutilization Contact	Pharmacist Project Manager		Chong	Sue	H	5626583661					sue.h.chong@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	12/05/2018	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Medication Therapy Management Contact	Medication Therapy Management		Deguzman	Lynn		5106253989					lynn.f.deguzman@kp.org	1800 Harrison St., 13th Floor		Oakland	CA	94612	11/08/2019	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	OffShore Subcontractor Contact	Compliance Consultant - Privacy and Security		Glenn	Jovan		9092512010					Jovan.Robinson@kp.org	10740 Fourth Street		Rancho Cucamonga	CA	91730	08/26/2020	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Online Enrollment Center Contact (Back-up)	Senior Team Manager, Medicare Membership Admin		Nugent	Kristin		8586376801					kristin.n.nugent@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/20/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Online Enrollment Center Contact (Optional)	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	10/25/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Online Enrollment Center Contact (Primary)	Team Manager, Medicare Membership Administration		Covarrubio	Danny		8586143433					danny.x.covarrubio@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/20/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Part C Application Contact	Senior Medicare Products Consultant		Hershkovitz	Lena		4103618543					lena.b.hershkovitz@kp.org	111 S. Calvert St.		Baltimore	MD	21202	03/01/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Part C Reporting Contact	Medicare Contract Compliance Manager		McLean	Pamela		3018165737				3018167275	pamela.l.mclean@kp.org	2101 East Jefferson Street		Rockville	MD	20852	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Part D Appeals	Sr. Director Member Relations		Devers	Jason	C					4043644743	jason.c.devers@kp.org	3495 Piedmont Center	Ten Piedmont Center	Atlanta	GA	30305	01/10/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	3233027947				HMO - Health Maintenance Organization		C	San Francisco
H2172	Part D Application Contact	Senior Medicare Products Consultant		Hershkovitz	Lena		4103618543					lena.b.hershkovitz@kp.org	111 S. Calvert St.		Baltimore	MD	21202	03/01/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Part D Benefits Contact	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	11/08/2019	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Part D Claims Submission Contact	PO PS, National Rx Programs & Servics		Bonvie	Claudette		5623199392					Claudette.R.Bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90042	11/08/2019	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Part D Exceptions Contact	Pharmacy Benefits Manager		Hoard	Shannon						7034664802	shannon.m.hoard@kp.org	22370 Davis Drive	Suite 190	Sterling	VA	20164	08/02/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8887775536				HMO - Health Maintenance Organization		C	San Francisco
H2172	Part D Price File Contact (Back-up)	Financial Analyst		Kamikawa	Emely		5622998753				5626583712	emely.a.kamikawa@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	11/08/2019	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Part D Price File Contact (Optional)	Associate Consultant		Quan	Mariclare		5623850395					mariclare.a.quan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/26/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Part D Price File Contact (Primary)	Pharmacy Pricing		Bullard	Myra		5623195747				5626583712	myra.c.bullard@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/26/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Part D Quality Assurance Contact	Vice President, Clinical Pharmacy Services		Le	Kim		5622997015					Kim.N1.Le@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	06/01/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Part D Reporting Contact	Medicare Contract Compliance Manager		McLean	Pamela		3018165737				3018167275	pamela.l.mclean@kp.org	2101 East Jefferson Street		Rockville	MD	20852	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Patient Safety Contact	Vice President, Clinical Pharmacy Services		Le	Kim		5622997015					Kim.N1.Le@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	06/01/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Payment Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza, Suite 2552		Oakland	CA	94612	03/28/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Pharmacy Director	Interim Executive Dir, Pharmacy		Kim	Kun		7035873657				7034664802	kun.kim@kp.org	22370 Davis Drive		Sterling	VA	20164	08/02/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Pharmacy Network Management Contact	Pharmacy Benefits Manager		Hoard	Shannon		7036738660				7034664802	shannon.m.hoard@kp.org	22370 Davis Drive	Suite 190	Sterling	VA	20164	08/02/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Pharmacy Network Management Contact (Secondary)	Pharmacy Benefits Coordinator		Summers	Zarinah		7034664999					zarinah.r.summers@kp.org	22370 Davis Drive	Suite 190	Sterling	VA	20164	05/23/2018	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Pharmacy Technical Help Desk Contact	Customer Care Center		OptumRx	PBM								755 Research Parkway Suite 160		Oklahoma City	OK	73104	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8887917229				HMO - Health Maintenance Organization		C	San Francisco
H2172	Plan Directory Contact for Public Website	Manager, Provider Experience		Anderson	Allison		3018166481				8666409826	allison.x.anderson@kp.org	2101 East Jefferson Street		Rockville	MD	20852	10/25/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Plan to Plan Reconciliation Contact	Interim Director, Medicare Accounting		Wright	Mark	A	9253239443					mark.a.wright@kp.org	1 Kaiser Plaza, 25th Floor		Oakland	CA	94612	01/20/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Processor Contact	Medicare Compliance Consultant	Mr.	Carver	Jon	R	4257578659					jonathan.r.carver@kp.org	1300 SW 27th St.		Renton	WA	98057	09/05/2023	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Quality Contact	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	05/25/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Reconciliation Contact	Controller, National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Reconciliation Contact (Secondary)	Vice President & Chief Financial Officer	Ms.	Shepler	Courtney	R	5102714644					courtney.r.shepler@kp.org	National Medicare Finance, 1 Kaiser Plaza, 13th Floor	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	10/25/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Recovery Audit Contact	Manager, Revenue Mgmt Compliance	Ms	Gonzalez	Heidy	G	6263723181					heidy.gonzalez@kp.org	74 S Fair Oaks Avenue		Pasadena	CA	91103	08/03/2022	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Surveillance Contact	Medicare Contract Compliance Manager		McLean	Pamela		3018165737				3018167275	pamela.l.mclean@kp.org	2101 East Jefferson Street		Rockville	MD	20852	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	System Contact	Director, Membership Administration Systems & S.S.		Putman	Anthony		8586506364					anthony.m.putman@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/20/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Third Party Administrator (TPA) Liaison	Senior Accountant		Thornal	Sun		6264056311					sun.a.thornal@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	User Access Contact	Medicare Contract Compliance Manager		McLean	Pamela		3018165737				3018167275	pamela.l.mclean@kp.org	2101 East Jefferson Street		Rockville	MD	20852	01/12/2017	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Utilization Management Contact	UM Compliance Manager		Ambridge-Kawczynski	Nancy		3018167109					nancy.a.ambridge-kawczynski@kp.org	2101 East Jefferson Street		Rockville	MD	20852	11/06/2019	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2172	Utilization Review Contact	UM Compliance Manager		Ambridge-Kawczynski	Nancy		3018167109					nancy.a.ambridge-kawczynski@kp.org	2101 East Jefferson Street		Rockville	MD	20852	11/06/2019	2023	KAISER FDTN HLTH PLAN OF THE MID-ATLANTIC STATES	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2174	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H2174	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2020	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2020	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	12/27/2016	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	12/27/2016	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Medical Director	Medical Director	Dr.	Connolly	Coleen		5414317974	1328			5413028052	cconnolly@trilliumchp.com	1800 Millrace Drive		Eugene	OR	97403	03/30/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	09/21/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Appeals Contact (Secondary)	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2020	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H2174	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H2174	PHR Beneficiary Contact																	09/27/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8448671156				HMO - Health Maintenance Organization		C	Dallas
H2174	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Plan Directory Contact for Public Website	UO Riverfront Research Park		Services	Provider		8448671156					CorporateMedicareComplianceDept@Centene.com	1800 Millrace Drive		Eugene	OR	97403	03/31/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2174	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	TRILLIUM COMMUNITY HEALTH PLAN, INC.	Local CCP	Wellcare by Trillium	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2185	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Backup User Access Contact	Medicare Compliance Officer, Plan Partner Support	Ms.	Bouyer	Valorie		6159161254					valorie.bouyer@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	08/12/2019	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	CEO - CMS Administrator Contact	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	CEO - Senior Official for Contracting	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Chief Financial Officer	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Chief Operating Officer	Chief Operating Officer/General Manager	Mr.	Emami	John		7038837508					john.emami@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Contact for Fraud Investigations	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	08/12/2019	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Corporate Mailing						8448546883				8003756496	customerservice@lifeworksadvantage.com	P.O. Box 2190		Glen Allen	VA	230582190	01/29/2017	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Coverage Gap Discount Program (CGDP) Payment Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment	Mr.	Hassenstab	Mark		5072697711					Mark.Hassenstab@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	08/12/2019	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	EOB Transfer Contact			Lowry	Kristy		8448546883				8003756496	chris.porter@allyalign.com	P.O. Box 2190		Glen Allen	VA	230582190	06/21/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Financial Audit Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Financial Reporting Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	2601 West Beltline Highway		Madison	WI	53713	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	General Contact	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	HIPAA Privacy Officer	Chief Compliance Officer and HIPAA Privacy Officer	Ms.	Crowe	Melanie		4049330409					melanie.crowe@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	HIPAA Security Officer	Sr. Director Cybersecurity	Mr	Brogdon	Clevelen		6158094476					Clevelen.Brogdon@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	MA Claims Processing Contact for Public Website	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Medical Director	VP Medical Affairs		Dahlgren	Andrew		8042968288					Andrew.Dahlgren@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	06/14/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Medicare Coordinator	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part C Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						9202214649	Justin.LaCrosse@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations		Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Benefits Contact	Sr. Director Part D Operations		Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Exceptions Contact	Sr. Manager, Clinical Prior Authorization		LeClair	Christophe						9202214676	Christopher.LeClair@Navitus.com	1025 West Navitus Drive		Madison	WI	54913	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr		Madison	WI	53717	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Payment Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Pharmacy Director	Sr. Director Part D Operations		Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations		Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Pharmacy Technical Help Desk Contact	Sr. Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Philadelphia
H2185	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations		Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	03/18/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H2185	Physician Incentive Contact	Executive Director	Mr.	Dunn	Jamie		8048140844					jamie.dunn@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	03/31/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Plan Directory Contact for Public Website			Sindlinger	Rocio		8448546883					rocio.sindlinger@allyalign.com	P.O. Box 2190		Glen Allen	VA	230582190	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Plan to Plan Reconciliation Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	06/21/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Quality Contact			Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	08/12/2019	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Reconciliation Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/08/2019	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Reconciliation Contact (Secondary)	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Recovery Audit Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Third Party Administrator (TPA) Liaison	Manager of Regulatory Accounting	Ms.	Weis	Katelyn		6073294042					kate.weis@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	User Access Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2185	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	LIFEWORKS ADVANTAGE, LLC	Local CCP	LifeWorks Advantage	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2196	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H2196	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H2196	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H2196	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H2196	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2196	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H2218	Automated TrOOP Balance Transfer Contact	Director of Finance	Ms	O'Sullivan	Maureen		6175332400	3428			6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Backup User Access Contact	Director of Quality & Compliance		Azar	Pamela		7744706740				6175332401	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Best Available Evidence Contact	Director of ESP Finance		O'Sullivan	Maureen		6175332426				6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Bid Primary Contact	Executive Director	Ms.	Reynard	Gretchen		6175332424	2424			6175332401	greynard@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/19/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	CAP Report Contact for Public Website	Executive Director	Ms.	Reynard	Gretchen		6175332424	2424			6175332401	greynard@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/19/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	CEO - CMS Administrator Contact	CEO	Mr	Jones	Charles	T	6175332355				6175332401	ctjones@hhsi.us	1135 Morton Street		Mattapan	MA	02126	08/25/2021	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	CEO - Senior Official for Contracting	CEO Harbor Health Services Inc	Mr	Jones	Charles	T	6175332355				6175332401	ctjones@hhsi.us	1135 Morton Street		Mattapan	MA	02126	08/25/2021	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Chief Financial Officer	CFO	Mr.	Murphy	Todd		6175332300	2333				tmurphy@hhsi.us	1135 Morton Street		Mattapan	MA	02126	12/05/2017	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Chief Operating Officer	Executive Director	Ms.	Reynard	Gretchen		6175332424	2424			6175332401	greynard@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/19/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Chief Information Officer	CIO	Mr	Cortez	Armando		6175332356					acortez@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Chief Information Security Officer	CIO	Mr.	Cortez	Armando		6175332356					acortez@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	CMS Casework Communication Contact	Executive Director	Ms.	Reynard	Gretchen		6175332424	2424			6175332401	greynard@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/19/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Complaints Tracking Contact	Director of Quality & Compliance		Azar	Pamela		7744706740				6175332436	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Contact for Fraud Investigations	Director of Quality & Compliance	Ms.	Azar	Pamela		7744706740	2424			6175332401	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Coordination of Benefits Contact	Director of Finance	Ms.	O'Sullivan	Maureen		6175332400	2426			6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Corporate Mailing						6175332424	2424			6175332401	greynard@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/19/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	O'Sullivan	Maureen		6175332400					mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Customer Service Operations Contact	Director of Quality & Compliance		Azar	Pamela		7744706740				6175332401	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	DIR Contact	CFO		Murphy	Todd		6175332400	2333			6175332436	tmurphy@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	DIR Contact (Secondary)	ESP Director of Finance		O'Sullivan	Maureen		6175332426					mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Emergency Part D Contact	ESP Director of Finance	Ms.	O'Sullivan	Maureen		6175332426	2424			6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Emergency Part D Contact (Secondary)	Director of Quality & Compliance		Azar	Pamela		7744706740					paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Encounter Data & Risk Adjustment Operations Contact	Director of Finance	Ms	O'Sullivan	Maureen		6172332400	328				mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Enrollment Contact	Director of Marketing and Enrollment	Ms.	Richer	Julie		6175332400				6175332401	jricher@hhsi.us	1135 Morton Street		Mattapan	MA	02126	08/29/2017	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	EOB Transfer Contact	Director of Finance	Ms.	O'Sullivan	Maureen		6175332400	3428			6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Financial Audit Contact	Director of Finance	Ms.	O'Sullivan	Maureen		6175332400				6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Financial Reporting Contact	Director of Finance	Ms.	O'Sullivan	Maureen		6175332400				6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Formulary Contact	Medical Director	Dr.	Kalish, MD	Richard		6175332400				6175332401	rkalish@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Formulary Contact (Secondary)	CMO	Dr	Wong	Monera		6175332357					mwong@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	General Contact	Director of Quality & Compliance	Ms.	Azar	Pamela		7744706740				6175332401	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Government Relations Contact	Executive Director	Ms.	Reynard	Gretchen		6175332424	2424			6175332401	greynard@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/19/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	HIPAA Privacy Officer	Vice President, Compliance & Risk Management		Shipley	Jesse		6175332354				6175332401	jshipley@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	HIPAA Security Officer	Vice President, Compliance & Risk Management		Shipley	Jesse		6175332354				6175332401	jshipley@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Interoperability Contact	CIO		Cortez	Armando		6175332356					acortez@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	MA Appeals/Grievances Contact	Director of Quality and Compliance		Azar	Pamela		7744706700	6740			6175332484	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	09/30/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	MA Claims Processing Contact for Public Website	Director of Finance	Ms.	O'Sullivan	Maureen		6175332400	3428			6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Marketing Contact	Director of Marketing and Enrollment	Ms.	Richer	Julie		6175332400				6175332401	jricher@hhsi.us	1135 Morton Street		Mattapan	MA	02126	08/29/2017	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Medical Director	Medical Director	Dr.	Kalish, MD	Richard		6175332400				6175332401	rkalish@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Medicare Compliance Officer	Director of Quality and Compliance	Ms.	Azar	Pamela		7744706700	6740			6175332484	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	09/30/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Medicare Coordinator	Senior Vice President, ESP	Ms.	Reynard	Gretchen		6175332424				6175332401	greynard@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Medicare Part D Opioid Overutilization Contact	Director of Quality & Compliance		Azar	Pamela		7744706740				6175332401	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Medication Therapy Management Contact	Medical Director	Dr.	Kalish, MD	Richard		6175332400				6175332401	rkalish@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Part C Application Contact	Executive Director	Ms.	Reynard	Gretchen		6175332424	2424			6175332401	greynard@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/19/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Part D Appeals	ESP Director of Finance	Ms.	O'Sullivan	Maureen						6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active	6175332426				PACE - Nat		C	Boston
H2218	Part D Appeals Contact (Secondary)	Director of Quality & Compliance	Ms.	Azar	Pamela	M					6175332401	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	01/07/2021	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active	7744706740				PACE - Nat		C	Boston
H2218	Part D Application Contact	Executive Director	Ms.	Reynard	Gretchen		6175332424	2424			6175332401	greynard@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/19/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Part D Benefits Contact	Director of Finance		O'Sullivan	Maureen		6175332400				6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Part D Claims Submission Contact	ESP Director of Finance	Ms.	O'Sullivan	Maureen		6175332426	2424			6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Part D Exceptions Contact	Director of ESP Finance		O'Sullivan	Maureen						6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active	6175332426				PACE - Nat		C	Boston
H2218	Part D Exceptions Contact (Secondary)			Bouwmeester	Carla							cbouwmeester@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active	6175333530				PACE - Nat		C	Boston
H2218	Part D Price File Contact (Back-up)	Senior Vice President, ESP		Reynard	Gretchen		6175332426				6175332401	greynard@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Part D Price File Contact (Primary)	ESP Director of Finance	Ms.	O'Sullivan	Maureen		6175332426	2424			6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Part D Quality Assurance Contact	Director of Quality & Compliance	Ms.	Azar	Pamela		7744706740				6175332401	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	11/04/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Part D Reporting Contact	ESP Director of Finance	Ms.	O'Sullivan	Maureen		6175332426	2424			6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Patient Safety Contact	Director of Quality & Compliance	Ms.	Azar	Pamela		7744706740	2424			6175332401	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Payment Contact	Director of Finance	Ms.	O'Sullivan	Maureen		6175332400	3428			6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Personal Health Record Contact	Medical Director	Dr.	Kalish, MD	Richard		6175332400					rkalish@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Pharmacy Director	Medical Director		Kalish, MD	Richard		6175332400				6175332401	rkalish@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Pharmacy Network Management Contact	Executive Director	Ms.	Azar	Pamela		7744706740	2424			6175332401	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Pharmacy Network Management Contact (Secondary)	Executive Director	Ms.	Reynard	Gretchen		6175332424	2424			6175332401	greynard@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/19/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Pharmacy Technical Help Desk Contact	Pharmacist		Bouwmeester	Carla						6175332401	cbouwmeester@hhsi.us	1135 Morton Street		Mattapan	MA	02126	04/23/2010	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active	8667141277				PACE - Nat		C	Boston
H2218	Pharmacy Technical Help Desk Contact (Secondary)	Medical Director	Dr.	Kalish, MD	Richard						6175332401	rkalish@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active	6175332400				PACE - Nat		C	Boston
H2218	Plan Directory Contact for Public Website	Director of Marketing and Enrollment	Ms.	Richer	Julie		6175332400	2437			6175332401	jricher@hhsi.us	1135 Morton Street		Mattapan	MA	02126	08/29/2017	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Plan to Plan Reconciliation Contact	Director of Finance		O'Sullivan	Maureen		6175332400				6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Processor Contact	ESP Director of Finance	Ms.	O'Sullivan	Maureen		6175332426	2424			6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Quality Contact	Director of Quality & Compliance	Ms.	Azar	Pamela		7744706740				6175332401	paazar@hhsi.us	1135 Morton Street		Mattapan	MA	02126	11/04/2020	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Reconciliation Contact	CFO		Murphy	Todd		6175332400	3426			6175332401	tmurphy@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Reconciliation Contact (Secondary)	ESP Director of Finance		O'Sullivan	Maureen		6175332426					mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Recovery Audit Contact	CFO	Mr	Murphy	Todd		6175332424	2424			6175332401	tmurphy@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Surveillance Contact	Director of Marketing & Enrollment	Ms.	Richer	Julie		6175332424	2424			6175332401	jricher@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	System Contact	Director of Finance	Ms.	O'Sullivan	Maureen		6175332400	3428			6175332401	mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Third Party Administrator (TPA) Liaison	Director of Finance	Ms.	O'Sullivan	Maureen		6175332400					mosullivan@hhsi.us	1135 Morton Street		Mattapan	MA	02126	02/22/2022	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	User Access Contact	Director of Information Technology		Fudge	Kenneth		6175332300					kfudge@hhsi.us	1135 Morton Street		Mattapan	MA	02126	04/23/2010	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Utilization Management Contact	Manager of Utilization and Care Coordination	Ms.	Mackenzie	Regina		6175332400				6175332401	rmackenzie@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2218	Utilization Review Contact	Manager of Utilization and Care Coordination	Ms.	Mackenzie	Regina		6175332400	2424			6175332401	rmackenzie@hhsi.us	1135 Morton Street		Mattapan	MA	02126	03/07/2023	2023	HARBOR HEALTH SERVICES, INC.	National PACE	Elder Service Plan of Harbor Health Services, Inc	National PACE		Harbor Health Services, Inc.	104	Yes	Active					PACE - Nat		C	Boston
H2219	Automated TrOOP Balance Transfer Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Backup User Access Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689722					Keith.Greiner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	11/06/2017	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Best Available Evidence Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Bid Primary Contact	Actuary	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/01/2021	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	CAP Report Contact for Public Website	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/20/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	CEO - CMS Administrator Contact	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/20/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	CEO - Senior Official for Contracting	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/20/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Chief Financial Officer	Chief Financial Officer	Mr.	Bailey	Todd		5083689097				5087914332	Todd.Bailey@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/27/2019	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Chief Operating Officer	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Chief Information Officer	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Chief Information Security Officer	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	CMS Casework Communication Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Heather.Ulfves@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Complaints Tracking Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Heather.Ulfves@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Contact for Fraud Investigations	Director Internal Audit	Ms.	Brown	Velinda		5083689016				5083689111	Velinda.Brown@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Coordination of Benefits Contact	Senior Director, Claims Administration	Ms	Straitiff	Kirsten		5083689047					kirsten.straitiff@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/20/2022	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Corporate Mailing						5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Manager Accounting	Mr.	McNamara	Shawn		5083689085					Shawn.McNamara@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/11/2016	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Customer Service Operations Contact	VP, Customer Service	Mr.	Perron	Donald		5083689701					Donald.Perron@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	DIR Contact	Actuarial Associate	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/05/2021	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	DIR Contact (Secondary)	Director and Senior Actuary, Government Programs	Mr.	Leung	Hang		5083689258					Hang.Leung@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/15/2022	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Emergency Part D Contact	Manager, Customer Service	Ms.	Fregeau	Andrew		9784347996					Andrew.Fregeau@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Emergency Part D Contact (Secondary)	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Encounter Data & Risk Adjustment Operations Contact	Manager, Business Service Delivery	Ms.	Ernst	Alicia		5083689369					Alicia.Ernst@fallonhealth.org	One Chestnut Place	10 Chestnut St	Worcester	MA	01608	07/13/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Enrollment Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	EOB Transfer Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089			5088311136	Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Financial Audit Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Financial Reporting Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Formulary Contact	Sr. Director, Pharmacy Therapeutics	Ms.	Kendall	Kate		5087992100	79169				Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Formulary Contact (Secondary)	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	General Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Government Relations Contact	Government Affairs and Public Policy Director	Ms.	Bik	Christie		5083689523					Christie.Bik@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	HIPAA Privacy Officer	Privacy Officer	Ms.	Sanford	Katrin		5083689838					Katrin.Sanford@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/14/2019	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	HIPAA Security Officer	VP IT Operations	Mr.	Petisce	Tony		5083689300					Tony.Petisce@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Interoperability Contact	VP, Enterprise Technology Officer		Budaj	John		5083689362					john.budaj@fallonhealth.org	10 Chestnut Street		Worcester	MA	01608	12/29/2021	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	MA Appeals/Grievances Contact	Director, Care Services Support	Ms.	Ryan	Patricia		5083689771					Patricia.Ryan@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/04/2019	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	MA Claims Processing Contact for Public Website			Service	Customer		5087992100	69988				CustomerService@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/27/2019	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Marketing Contact	Manager, Medicare Programs	Ms.	Kudron	Julie		5083689591					Julie.Kudron@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Medical Director	Psychiatric NP and Manager, Site Providers	Ms.	Meunier	Brandy		5087992100	31027				Brandy.Meunier@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/18/2023	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Medicare Compliance Officer	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Medicare Coordinator	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Medicare Part D Opioid Overutilization Contact	Supervisor, Formulary Coordinators & Technicians	Ms.	Kendall	Kate		8003332535	79169				Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/29/2021	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Medication Therapy Management Contact	Manager, Pharmacy Ops & Clinical Programs	Mr.	Sartini	David		5083689790					David.Sartini@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/26/2017	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	OffShore Subcontractor Contact	Medicare Compliance & Regulatory Affairs Associate	Ms.	DeMarco	Kristie		5083689514					Kristie.DeMarco@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/02/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Part C Application Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/04/2018	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Part D Appeals	Director, Care Services Support	Ms.	Ryan	Patricia							Patricia.Ryan@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/04/2019	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689771				PACE - Nat		C	Boston
H2219	Part D Appeals Contact (Secondary)	Manager, Member Appeals and Grievances	Ms.	Foulkes	Christina							Christina.Foulkes@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/08/2021	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689447				PACE - Nat		C	Boston
H2219	Part D Application Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/04/2018	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Part D Benefits Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Part D Claims Submission Contact	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					benjamin.barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Part D Exceptions Contact	Manager, Pharmacy Ops & Clinical Programs	Mr.	Sartini	David							David.Sartini@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/04/2018	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689790				PACE - Nat		C	Boston
H2219	Part D Exceptions Contact (Secondary)	Sr. Director, Pharmacy Therapeutics	Ms.	Kendall	Kate							Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	5087992100	79169			PACE - Nat		C	Boston
H2219	Part D Price File Contact (Back-up)	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Part D Price File Contact (Primary)	Govt Programs and Quality Clinical Pharmacist	Mr.	Huynh	Jayce		5087992100	69212				Jayce.Huynh@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	07/13/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Part D Quality Assurance Contact	Sr. Director, Pharmacy Therapeutics	Mr.	Huynh	Jayce		5083689212					Jayce.Huynh@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Part D Reporting Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689772					Keith.Greiner@fallonhealth.org	One Chestnut Place	10Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Patient Safety Contact	Psychiatric NP and Manager, Site Providers	Ms.	Meunier	Brandy		5087992100	31027				Brandy.Meunier@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/18/2023	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Payment Contact	Senior Manager Accounting	Mr.	McNamara	Shawn		5083689085					Shawn.McNamara@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Pharmacy Director	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Pharmacy Network Management Contact	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Ops and Clinical Programs	Mr.	Sartini	David		5083689790					David.Sartini@fallonhealth.org	One Chestnut Place,	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Pharmacy Technical Help Desk Contact			Help Desk	OptumRx								1600 McConnor Parkway		Schaumburg	IL	60173	12/29/2021	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	8443688734				PACE - Nat		C	Boston
H2219	Pharmacy Technical Help Desk Contact (Secondary)			Summers	Todd								OptumRx	755 Research Pkwy, Suite 300	Oklahoma City	OK	73104	12/29/2021	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	8664431095				PACE - Nat		C	Boston
H2219	Plan Directory Contact for Public Website	Vice President, Summit ElderCare	Ms.	Bostek	Kristine		5083689923					Kristine.Bostek@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Plan to Plan Reconciliation Contact	Director, Medical Accounting	Mr.	Beaulieu	Michael		5083689020					Michael.Beaulieu@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/07/2023	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Processor Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Heather.Ulfves@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Quality Contact	Director of Quality & Risk, SE & FHW	Ms.	Malkoski	Michelle		8003332535	49979				Michelle.Malkoski@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Reconciliation Contact	Actuarial Associate	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/05/2021	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Reconciliation Contact (Secondary)	Director and Senior Actuary, Government Programs	Mr.	Leung	Hang		5083689258					Hang.Leung@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/15/2022	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Recovery Audit Contact	Senior Director, Claims Administration	Ms	Straitiff	Kirsten		5083689047					kirsten.straitiff@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/08/2022	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Surveillance Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	System Contact	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Third Party Administrator (TPA) Liaison	Financial Accounting & Reporting Sr. Analyst	Ms.	Maesto	Alison		5083689486					Alison.Maesto@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/27/2019	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	User Access Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Utilization Management Contact	Psychiatric NP and Manager, Site Providers	Ms.	Meunier	Brandy		5087992100	31027				Brandy.Meunier@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/18/2023	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2219	Utilization Review Contact	Psychiatric NP and Manager, Site Providers	Ms.	Meunier	Brandy		5087992100	31027				Brandy.Meunier@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/18/2023	2023	FALLON COMMUNITY HEALTH PLAN	National PACE	Fallon Health	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	Boston
H2220	Automated TrOOP Balance Transfer Contact	Insurance Coordinator		Wong	Kwok		6172880970				6174740757	kwwong@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	05/30/2023	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Backup User Access Contact	Chief PACE Program Officer	Ms.	Roach	Nancy	J	6172880970				6172828625	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Best Available Evidence Contact	Chief PACE Program Officer		Roach	Nancy	J	6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Bid Primary Contact	CFO		Cherry	Kevin		6172878000	8711				Kecherry@uphams.org	500 Columbia Road		Dorchester	MA	02125	05/19/2021	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	CAP Report Contact for Public Website	Chief PACE Program Officer		Roach	Nancy	J	6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	CEO - CMS Administrator Contact	CEO	Mr.	Trivedi	Jagdeep		6177408131				6172828625	jtrivedi@uphams.org	415 Columbia Road		Dorchester	MA	02125	12/09/2015	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	CEO - Senior Official for Contracting	CEO	Mr.	Trivedi	Jagdeep		6177408131				6172828625	jtrivedi@uphams.org	415 Columbia Road		Dorchester	MA	02125	12/09/2015	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Chief Financial Officer	CFO	Mr.	Cherry	Kevin		6172878000	8711				Kecherry@uphams.org	500 Columbia Road		Dorchester	MA	02125	05/19/2021	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Chief Operating Officer	Chief PACE Program Officer	Ms.	Roach	Nancy	J	6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Chief Information Officer	IT Operations Director	Mr.	Hraybi	Samir		6172878000	8190				shraybi@uphams.org	415 Columbia Road		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Chief Information Security Officer	CEO	Mr.	Trivedi	Jagdeep		6177408131				6172828625	jtrivedi@uphams.org	415 Columbia Road		Dorchester	MA	02125	02/22/2016	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	CMS Casework Communication Contact	Chief PACE Program Officer		Roach	Nancy	J	6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Complaints Tracking Contact	Chief PACE Program Officer		Roach	Nancy	J	6172880970	8030			6172828625	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/24/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Contact for Fraud Investigations	Compliance Officer		Mitza	Kerry		6172878000	8030			6172828625	kmitza@uphams.org	415 Columbia Road		Dorchester	MA	02125	04/22/2016	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Coordination of Benefits Contact	Chief PACE Program Officer		Roach	Nancy	J	6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Corporate Mailing						6172880970	8803			6174740757	nroach@uphams.org	500 Columbia Rd.	Mail Stop 1140-08	Dorchester	MA	02125	04/22/2016	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Coverage Gap Discount Program (CGDP) Payment Contact	Chief PACE Program Officer		Roach	Nancy	J	6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/24/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Customer Service Operations Contact	Chief PACE Program Officer		Roach	Nancy	J	6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/24/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	DIR Contact	CFO		Cherry	Kevin		6172878000	8711				Kecherry@uphams.org	500 Columbia Road		Dorchester	MA	02125	05/19/2021	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	DIR Contact (Secondary)	Chief PACE Program Director		Roach	Nancy	J	6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Emergency Part D Contact	Chief PACE Program Director		Roach	Nancy	J	6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Emergency Part D Contact (Secondary)	CEO	Mr.	Trivedi	Jagdeep		6177408131				6172828625	jtrivedi@uphams.org	415 Columbia Road		Dorchester	MA	02125	04/22/2016	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Encounter Data & Risk Adjustment Operations Contact	Chief PACE Program Officer		Roach	Nancy	J	6172880970	8803				nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Enrollment Contact	Insurance Coordinator		Wong	Kowk		6172880970				6174740757	kwwong@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	EOB Transfer Contact	Chief PACE Program Officer		Roach	Nancy		6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Financial Audit Contact	Chief PACE Program Officer	Ms.	Roach	Nancy		6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Financial Reporting Contact	CFO	Mr.	Cherry	Kevin		6172878000				6172828625	Kcherry@uphams.org	500 Columbia Road, Dorchester, MA 02125		Dorchester	MA	02125	03/17/2023	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Formulary Contact	Medical Director		Burrows	Adam		6174401615	8901			6174422589	aburrows@uphams.org	1140 Dorchester Ave.		Dorchester	MA	02125	11/30/2013	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Formulary Contact (Secondary)	Chief PACE Program Officer		Roach	Nancy		6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	General Contact	Chief PACE Program Officer		Roach	Nancy		6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Government Relations Contact	CEO	Mr.	Trivedi	Jagdeep		6177408131				6172828625	jtrivedi@uphams.org	415 Columbia Road		Dorchester	MA	02125	12/09/2015	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	HIPAA Privacy Officer	CEO	Mr.	Trivedi	Jagdeep		6177408131				6172828625	jtrivedi@uphams.org	415 Columbia Road		Dorchester	MA	02125	04/22/2016	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	HIPAA Security Officer	Compliance Officer		Mitza	Kerry		6172878000	8030			6172828625	kmitza@uphams.org	415 Columbia Road		Dorchester	MA	02125	04/22/2016	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Interoperability Contact			Hraybi	Samir		6177408190					shraybi@uphams.org	1140 Dorchester Ave, Dorchester, MA 02125		Dorchester, MA 02125	MA	02125	06/01/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	MA Appeals/Grievances Contact	Chief PACE Program Officer	Ms.	Roach	Nancy		6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	MA Claims Processing Contact for Public Website	Chief PACE Program Officer		Roach	Nancy		6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Marketing Contact	Director of Growth	MS	Burris	Michelle		6172880970	8852			6172828625	MiBurris@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	03/17/2023	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Medical Director	Medical Director		Burrows	Adam		6174401615	8901			6174422589	aburrows@uphams.org	1140 Dorchester Ave.		Dorchester	MA	02125	11/30/2013	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Medicare Compliance Officer	Compliance Officer	Mrs.	Mitza	Kerry		6172878000	8030			6172828625	kmitza@uphams.org	415 Columbia Road		Dorchester	MA	02125	09/12/2016	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Medicare Coordinator	Compliance Officer	Mrs.	Mitza	Kerry		6172878000	8030			6172828625	kmitza@uphams.org	415 Columbia Road		Dorchester	MA	02125	04/22/2016	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Medicare Part D Opioid Overutilization Contact	Chief PACE Program Officer	Ms.	Roach	Nancy	J	6172880970	8803				nroach@uphams.org	1140 Dorchester Ave.		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Medication Therapy Management Contact	Medical Director		Burrows	Adam		6174401615	8901			6174422589	aburrows@uphams.org	1140 Dorchester Ave.		Dorchester	MA	02125	11/30/2013	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Online Enrollment Center Contact (Back-up)	Compliance Officer		Mitza	Kerry		6172878000	8030			6172828625	kmitza@uphams.org	415 Columbia Road		Dorchester	MA	02125	04/22/2016	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Online Enrollment Center Contact (Optional)	Insurance Coordinator	MR	Wong	Kwok		6172880970				6174740757	kwwong@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	03/17/2023	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Online Enrollment Center Contact (Primary)	Chief PACE Program Officer		Roach	Nancy		6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Part C Application Contact	Chief PACE Program Officer		Roach	Nancy	J	6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Part D Appeals	Chief PACE Program Officer		Roach	Nancy						6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	05/30/2023	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active	6172880970				PACE - Nat		C	Boston
H2220	Part D Appeals Contact (Secondary)	Medical Director	Ms.	Burrows	Adam						6174740757	aburrows@uphams.org	36 Dearborn Street		Roxbury	MA	02119	02/02/2021	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active	6172880970				PACE - Nat		C	Boston
H2220	Part D Application Contact	Chief PACE Program Officer		Roach	Nancy		6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Part D Benefits Contact	Chief PACE Program Officer		Roach	Nancy		6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Part D Claims Submission Contact	Chief PACE Program Officer		Roach	Nancy		6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Part D Exceptions Contact	Chief PACE Program Officer		Roach	Nancy						6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active	6172880970				PACE - Nat		C	Boston
H2220	Part D Exceptions Contact (Secondary)	Medical Director		Burrows	Adam						6174422589	aburrows@uphams.org	1140 Dorchester Ave.		Dorchester	MA	02125	07/17/2013	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active	6172880970				PACE - Nat		C	Boston
H2220	Part D Price File Contact (Back-up)	Chief PACE Program Officer	Ms.	Roach	Nancy		6172880970					nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Part D Price File Contact (Primary)	CEO	Mr.	Trivedi	Jagdeep		6177408127					jtrivedi@uphams.org	415 Columbia Road		Dorchester	MA	02125	02/02/2021	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Part D Quality Assurance Contact	Quality Assurance		Mitza	Kerry		6172878000	8030			6174740757	kmitza@uphams.org	415 Columbia Road		Dorchester	MA	02125	11/30/2013	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Part D Reporting Contact	Chief PACE Program Officer		Roach	Nancy		6172880970				6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Patient Safety Contact	Chief PACE Program Officer	Ms.	Roach	Nancy	J	6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Payment Contact	CFO		Cherry	Kevin		6172878000	8711				Kecherry@uphams.org	500 Columbia Road		Dorchester	MA	02125	05/19/2021	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Pharmacy Director	Medical Director		Burrows	Adam		6174401615	8901			6174422589	aburrows@uphams.org	1140 Dorchester Ave.		Dorchester	MA	02125	11/30/2013	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Pharmacy Network Management Contact	Medical Director		Burrows	Adam		6174401615	8901			6174422589	aburrows@uphams.org	1140 Dorchester Ave.		Dorchester	MA	02125	11/30/2013	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Pharmacy Technical Help Desk Contact	Chief PACE Program Officer		Roach	Nancy						6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/24/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active	6172880970				PACE - Nat		C	Boston
H2220	Plan Directory Contact for Public Website	Chief PACE Program Officer		Roach	Nancy		6172880970				6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Plan to Plan Reconciliation Contact	Insurance Coordinator		Wong	Kwok		6172880970				6174740757	kwwong@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	05/30/2023	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Processor Contact	Chief PACE Program Officer		Roach	Nancy		6172880970				6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Quality Contact	Quality Manager		Fresco	Sarah	J	6172880970	8837				sfresco@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/24/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Reconciliation Contact	Chief PACE Program Officer		Roach	Nancy	J	6172880970				6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Recovery Audit Contact	Chief PACE Program Officer	Ms.	Roach	Nancy		6172880970	8803			6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	08/09/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Surveillance Contact	Chief PACE Program Officer		Roach	Nancy	J	6172880970				6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	System Contact	Chief PACE Program Officer		Roach	Nancy	J	6172880970				6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Third Party Administrator (TPA) Liaison	Chief PACE Program Officer		Roach	Nancy	J	6172880970				6174740757	nroach@uphams.org	1140 Dorchester Ave		Dorchester	MA	02125	02/17/2022	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	User Access Contact	CEO	Mr.	Trivedi	Jagdeep		6177408131				6172828625	jtrivedi@uphams.org	415 Columbia Road		Dorchester	MA	02125	12/09/2015	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Utilization Management Contact	Medical Director		Burrows	Adam		6174401615	8901			6174422589	aburrows@uphams.org	1140 Dorchester Ave.		Dorchester	MA	02125	11/30/2013	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2220	Utilization Review Contact	Medical Director		Burrows	Adam		6174401615	8901			6174422589	aburrows@uphams.org	1140 Dorchester Ave.		Dorchester	MA	02125	11/30/2013	2023	UPHAMS CORNER HEALTH COMMITTEE, INC.	National PACE	Upham's PACE	National PACE		Uphams Corner Health Committee, Inc.	250	Yes	Active					PACE - Nat		C	Boston
H2221	Automated TrOOP Balance Transfer Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Backup User Access Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Best Available Evidence Contact	Quality and Compliance Manager	M	Tylander	Kathryn		6175755850					ktylander@challiance.org	163 Gore St		Cambridge	MA	02141	09/03/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Bid Primary Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	CAP Report Contact for Public Website	Quality and Compliance Manager		Tylander	Kathryn		6175755850					ktylander@challiance.org	163 Gore St		Cambridge	MA	02141	09/03/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	CEO - CMS Administrator Contact	Executive Director	Mr	Geyerhahn	Jed		6175755850				6176653110	jgeyerhahn@challiance.org	163 Gore Street		Cambridge	MA	02141	03/08/2016	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	CEO - Senior Official for Contracting	Executive Director	Mr	Geyerhahn	Jed		6175755850					jgeyerhahn@challiance.org	163 Gore Street		Cambridge	MA	02141	04/27/2017	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Chief Financial Officer	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Chief Operating Officer	Director of Operations	M	Donnelly	Susan		6175755850					sdonnelly@challiance.org	163 Gore St		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Chief Information Officer	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Chief Information Security Officer	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	CMS Casework Communication Contact	Operations Director	M	Donnelly	Sue		6175755850					sdonnelly@challiance.org	163 Gore St		Cambridge	MA	02141	08/25/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Complaints Tracking Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Contact for Fraud Investigations	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Coordination of Benefits Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Corporate Mailing						6175755850				6174998360	jgeyerhahn@challiance.org	163 Gore Street		Cambridge	MA	02141	06/09/2016	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Customer Service Operations Contact	Operations Director	M	Donnelly	Sue		6175755850					sdonnelly@challiance.org	163 Gore St		Cambridge	MA	02141	08/25/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	DIR Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	DIR Contact (Secondary)	Pharmacist	Ms.	Emma	D'Alleva		6175755850					edalleva@challiance.org	163 Gore St		Cambridge	MA	02141	11/06/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Emergency Part D Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Emergency Part D Contact (Secondary)	Pharmacist	Ms.	Emma	D'Alleva		6175755850					edalleva@challiance.org	163 Gore St		Cambridge	MA	02141	11/06/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Encounter Data & Risk Adjustment Operations Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Enrollment Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	EOB Transfer Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Financial Audit Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Financial Reporting Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Formulary Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Formulary Contact (Secondary)	Pharmacist	Ms.	Emma	D'Alleva		6175755850					edalleva@challiance.org	163 Gore St		Cambridge	MA	02141	11/06/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	General Contact			Geyerhahn	Jed		6174998333					lgiovino@challiance.org	163 Gore St		Cambridge	MA	02141	03/02/2022	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Government Relations Contact	Executive Director	Mr	Geyerhahn	Jed		6175755850					jgeyerhahn@challiance.org	163 Gore Street		Cambridge	MA	02141	04/27/2017	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	HIPAA Privacy Officer	Quality and Compliance Manager	M	Tylander	Kathryn		6175755850					ktylander@challiance.org	163 Gore St		Cambridge	MA	02141	09/03/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	HIPAA Security Officer	Quality and Compliance Manager	M	Tylander	Kathryn		6175755850					ktylander@challiance.org	163 Gore St		Cambridge	MA	02141	09/03/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Interoperability Contact	Quality and Compliance Manager		Tylander	Kathryn		6175755850					ktylander@challiance.org	163 Gore St		Cambridge	MA	02141	02/28/2022	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	MA Appeals/Grievances Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	MA Claims Processing Contact for Public Website	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Marketing Contact		Mr.	Geyerhahn	Jed		6175755850					jgeyerhahn@challiance.org	163 Gore St		Cambridge	MA	02141	09/12/2018	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Medical Director	Medical Director	Dr.	Burns	Jonathan		6175755850					jburns@challiance.org	163 Gore St		Cambridge	MA	02141	04/27/2017	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Medicare Compliance Officer	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Medicare Coordinator	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Medicare Part D Opioid Overutilization Contact	Pharmacist	Ms.	Emma	D'Alleva		6175755850					edalleva@challiance.org	163 Gore St		Cambridge	MA	02141	11/06/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Medication Therapy Management Contact	Pharmacist	Ms.	Emma	D'Alleva		6175755850					edalleva@challiance.org	163 Gore St		Cambridge	MA	02141	11/06/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Part C Application Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Part D Appeals	Director, Health Plan Operations	M	Essi	Sharon							sessi@challiance.org	163 Gore St		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active	6175755850				PACE - Nat		C	Boston
H2221	Part D Appeals Contact (Secondary)	Pharmacist	Ms.	Emma	D'Alleva							edalleva@challiance.org	163 Gore St		Cambridge	MA	02141	11/06/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active	6175755850				PACE - Nat		C	Boston
H2221	Part D Application Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Part D Benefits Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Part D Claims Submission Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Part D Exceptions Contact	Director, Health Plan Operations	M	Essi	Sharon							sessi@challiance.org	163 Gore St		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active	6175755850				PACE - Nat		C	Boston
H2221	Part D Exceptions Contact (Secondary)	Pharmacist	Ms.	Emma	D'Alleva							edalleva@challiance.org	163 Gore St		Cambridge	MA	02141	11/06/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active	6175755850				PACE - Nat		C	Boston
H2221	Part D Price File Contact (Back-up)	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Part D Price File Contact (Optional)	Pharmacist	Ms.	Emma	D'Alleva		6175755850					edalleva@challiance.org	163 Gore St		Cambridge	MA	02141	11/06/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Part D Price File Contact (Primary)	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Part D Quality Assurance Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Part D Reporting Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Patient Safety Contact	Quality and Compliance Manager		Tylander	Kathryn		6175755850					ktylander@challiance.org	163 Gore St		Cambridge	MA	02141	09/03/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Payment Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Pharmacy Director	Pharmacist	Ms.	Emma	D'Alleva		6175755850					edalleva@challiance.org	163 Gore St		Cambridge	MA	02141	11/06/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Pharmacy Network Management Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Pharmacy Technical Help Desk Contact	Pharmacist		Emma	D'Alleva							edalleva@challiance.org	163 Gore St		Cambridge	MA	02141	11/06/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active	6175755850				PACE - Nat		C	Boston
H2221	Plan Directory Contact for Public Website	Quality and Compliance Manager	Mr.	Geyerhahn	Jed		6175755850					jgeyerhahn@challiance.org	163 Gore St		Cambridge	MA	02141	05/04/2018	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Plan to Plan Reconciliation Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Processor Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Quality Contact	Quality and Compliance Manager		Tylander	Kathryn		6175755850					ktylander@challiance.org	163 Gore St		Cambridge	MA	02141	09/03/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Reconciliation Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Recovery Audit Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Surveillance Contact	Quality and Compliance Manager		Tylander	Kathryn		6175755850					ktylander@challiance.org	163 Gore St		Cambridge	MA	02141	09/03/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	System Contact	Operations Director		Donnelly	Sue		6175755850					sdonnelly@challiance.org	163 Gore St		Cambridge	MA	02141	08/25/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Third Party Administrator (TPA) Liaison	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	User Access Contact	Operations Director		Donnelly	Sue		6175755850					sdonnelly@challiance.org	163 Gore St		Cambridge	MA	02141	08/25/2020	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Utilization Management Contact	Director, Health Plan Operations	M	Essi	Sharon		6175755850				6174998360	sessi@challiance.org	163 Gore Street		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2221	Utilization Review Contact	Director, Health Plan Operations		Essi	Sharon		6175755850					sessi@challiance.org	163 Gore St		Cambridge	MA	02141	05/25/2023	2023	CAMBRIDGE PUBLIC HEALTH COMMISSION	National PACE	CHA PACE	National PACE		Cambridge Health Alliance	40	Yes	Active					PACE - Nat		C	Boston
H2222	Automated TrOOP Balance Transfer Contact	EDI Systems Analyst		Caruso-Mahoney	Dee		7817156640				7817156698	dcaruso@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Backup User Access Contact	EDI Systems Analyst		Caruso-Mahoney	Dee		7817156640				7817156698	dcaruso@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Best Available Evidence Contact	Director Claims Management		Pickens	Deb		7817156616				7817156698	dpickens@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Bid Primary Contact	CFO		Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	CAP Report Contact for Public Website	COO		Dugan	Mary Ellen		7817156617				7817156699	mdugan@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	CEO - CMS Administrator Contact	Executive Director	Mr	Wakefield	Robert		7817156610				7817156699	bwakefield@elementcare.org	37 Friend Street		Lynn	MA	01901	02/27/2018	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	CEO - Senior Official for Contracting	Executive Director	Mr	Wakefield	Robert		7817156610				7817156699	bwakefield@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Chief Financial Officer	CFO	MR	Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Chief Operating Officer	COO	Mrs	Dugan	Mary Ellen		7817156617				7817156699	mdugan@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Chief Information Officer	CIO	Mr	Coolong	John		7817156608	6689			7817156699	jcoolong@elementcare.org	37 Friend St		Lynn	MA	01901	01/21/2016	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Chief Information Security Officer	CIO	Mr	Coolong	John		7817156608	6689			7817156699	jcoolong@elementcare.org	37 Friend St		Lynn	MA	01901	01/21/2016	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	CMS Casework Communication Contact	CFO		Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Complaints Tracking Contact	Department Specialist	Mrs	Hills	Melissa		7817156697				7817156699	mhills@elementcare.org	37 Friend Street		Lynn	MA	01901	01/29/2018	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Contact for Fraud Investigations	Director Compliance	Ms	Schneid	Jennifer		6309953776				7817156699	jschneid@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Coordination of Benefits Contact	CFO		Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Corporate Mailing						7817156608				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Coverage Gap Discount Program (CGDP) Payment Contact	Director Claims Management		Pickens	Deb		7817156616				7817156698	dpickens@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Customer Service Operations Contact	Customer Service		Recinos	Carla		7817156612				7817156699	crecinos@elementcare.org	37 Friend Street		Lynn	MA	01901	01/29/2018	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	DIR Contact	EDI Systems Analyst		Caruso-Mahoney	Dee		7817156640				7817156698	dcaruso@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Emergency Part D Contact	CFO		Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Encounter Data & Risk Adjustment Operations Contact	EDI Systems Analyst		Caruso-Mahoney	Dee		7817156640				7817156698	dcaruso@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Enrollment Contact	Marketing and Enrollment		Brownell	Caitlin		7817156608				7817156699	cbrownell@elementcare.org	37 Friend Street		Lynn	MA	01902	10/03/2019	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	EOB Transfer Contact	EDI Systems Analyst		Caruso-Mahoney	Dee		7817156640				7817156698	dcaruso@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Financial Audit Contact	CFO	MR	Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Financial Reporting Contact	Controller		Decker	Angie		7817156664				7817156699	adecker@elementcare.org	37 Friend Street		Lynn	MA	01901	02/21/2023	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Formulary Contact			None	None		7817156620				7817156699	bdurante@elementcare.org	None		None	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	General Contact	CFO		Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Government Relations Contact	COO	Mrs	Dugan	Mary Ellen		7817156617				7817156699	mdugan@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	HIPAA Privacy Officer	CIO		Coolong	John		7817156608				7817156699	jcoolong@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	HIPAA Security Officer	CIO		Coolong	John		7817156608				7817156699	jcoolong@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Interoperability Contact	CIO		Coolong	John		7817156608					jcoolong@elementcare.org	37 Friend St		Lynn	MA	01901	12/29/2021	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	MA Appeals/Grievances Contact	COO	Mrs	Dugan	Mary Ellen		7817156617				7817156699	mdugan@elementcare.org	37 Friend Street		Lynn	MA	01901	06/02/2016	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	MA Claims Processing Contact for Public Website	EDI Systems Analyst		Caruso-Mahoney	Dee		7817156640				7817156699	dcaruso@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Marketing Contact	Manager Marketing		Martinson	Katie		7817156650				7817156699	kmartinson@elementcare.org	37 Friend Street		Lynn	MA	01901	10/06/2022	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Medical Director	Medical Director		Duby	Joanna		7817152404	2404			7817156699	jduby@elementcare.org	37 Friend Street		Lynn	MA	01901	05/23/2019	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Medicare Compliance Officer	Director Compliance	Ms	Schneid	Jennifer		6302009658				7817156699	jschneid@elementcare.org	37 Friend Street		Lynn	MA	01902	01/21/2016	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Medicare Coordinator	Director Claims Management		Pickens	Deb		7817156616				7817156698	dpickens@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Medicare Part D Opioid Overutilization Contact	Director, Quality Improvement/Risk Management		Turnquist	Karen		7817156661					kturnquist@elementcare.org	37 Friend Street		Lynn	MA	01902	05/23/2019	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Medication Therapy Management Contact	CFO		Durante	Robert		7817156608				7817156699	rdurante@elementcare.org	37 Friend St		Lynn	MA	01901	10/21/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Part C Application Contact	CFO		Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Part D Appeals	CFO		Durante	Robert	P					7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active	7817156608				PACE - Nat		C	Boston
H2222	Part D Application Contact	CFO		Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Part D Benefits Contact	CFO		Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Part D Claims Submission Contact	EDI Systems Analyst		Caruso-Mahoney	Dee		7817156640				7817156699	dcaruso@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Part D Exceptions Contact	CFO		Durante	Robert	P					7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active	7817156620				PACE - Nat		C	Boston
H2222	Part D Exceptions Contact (Secondary)	Consultant Pharmacy Network		Dennison	Martha							mdennison@elementcare.org	37 Friend Street		Lynn	MA	01902	10/03/2019	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active	7817156608				PACE - Nat		C	Boston
H2222	Part D Price File Contact (Back-up)			NA	NA		1234123412					bdurante@elementcare.org	NA		NA	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Part D Price File Contact (Primary)			NA	NA		1234123412					bdurante@elementcare.org	NA		NA	MA	01970	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Part D Quality Assurance Contact	CFO		Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Part D Reporting Contact	EDI Systems Analyst		Caruso-Mahoney	Dee		7817156640				7817156698	dcaruso@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Patient Safety Contact	Clinical Pharmacist		Durante	Mary		7817156608				7817156699	mdurante@elementcare.org	37 Friend Street		Lynn	MA	01902	06/02/2016	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Payment Contact	CFO		Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Pharmacy Director	CFO		Durante	Robert		7819342936					rdurante@elementcare.org	37 Friend Street		Lynn	MA	01902	10/21/2019	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Pharmacy Network Management Contact	Consultant Pharmacy Network		Dennison	Martha		7819342936					mdennison@elementcare.org	37 Friend Street		Lynn	MA	01902	10/03/2019	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist		Durante	Mary		7817156608				7817156699	mdurante@elementcare.org	37 Friend Street		Lynn	MA	01902	10/03/2019	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Pharmacy Technical Help Desk Contact	Consultant Pharmacy Network		Dennison	Martha							mdennison@elementcare.org	37 Friend Street		Lynn	MA	01902	10/03/2019	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active	7817156608				PACE - Nat		C	Boston
H2222	Plan Directory Contact for Public Website	Director Marketing		Gibeley	Jodi		7817152937				7817156699	jgibeley@elementcare.org	37 Friend Street		Lynn	MA	01901	02/21/2023	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Plan to Plan Reconciliation Contact	CFO		Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Processor Contact	IT		Lynch	John	H	5084298506				5084298237	lynch@eatonapothecary.com	13 Water Street		Holliston	MA	01746	01/05/2006	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Quality Contact	Director, Quality Improvement/Risk Management		Turnquist	Karen		7817156661				7817156699	kturnquist@elementcare.org	37 Friend Street		Lynn	MA	01902	05/23/2019	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Reconciliation Contact	Director Claims Management		Pickens	Deb		7817156616				7817156698	dpickens@elementcare.org	37 Friend Street		Lynn	MA	01901	11/03/2020	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Recovery Audit Contact	CFO	MR	Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Surveillance Contact	Director Compliance	Ms	Schneid	Jennifer		6309953776				7817156680	jschneid@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	System Contact	IT		Vidal	Pedro		7817156634				7817156698	support@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Third Party Administrator (TPA) Liaison	CFO	MR	Durante	Robert	P	7817156620				7817156699	bdurante@elementcare.org	37 Friend Street		Lynn	MA	01901	03/07/2016	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	User Access Contact	IT		Vidal	Pedro		7817156634				7817156698	support@elementcare.org	37 Friend Street		Lynn	MA	01901	06/30/2014	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Utilization Management Contact	Utilization Manager		Doherty	Daniel		7817156629				7817156699	ddoherty@elementcare.org	37 Friend Street		Lynn	MA	01902	05/23/2019	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2222	Utilization Review Contact	Utilization Manager		Doherty	Daniel		7817156629				7817156699	ddoherty@elementcare.org	37 Friend Street		Lynn	MA	01902	05/23/2019	2023	ELEMENT CARE, INC.	National PACE	Element Care, Inc	National PACE		Element Care, Inc.	83	Yes	Active					PACE - Nat		C	Boston
H2223	Automated TrOOP Balance Transfer Contact	Health Plan Analyst		Moustafa	Saphia		6175686127					Moustasa@ebnhc.org	10 Gove Street		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Backup User Access Contact	VP		Ip	Calay		6175684732					ipc@ebnhc.org	10 Gove Street		East Boston	MA	02128	11/28/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Best Available Evidence Contact	Medical Director	Dr.	Pedulla	James		6175696800				6175687259	pedullaj@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/20/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Bid Primary Contact	VP		Ip	Calay		6175684570					ipc@ebnhc.org	10 Gove Street	Attn: Office of the CEO	East Boston	MA	02128	11/28/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	CAP Report Contact for Public Website	Director, Health Plan Operations		Febles	Jacklyn		6175686419					feblesj@ebnhc.org	10 Gove St		East Boston	MA	02128	05/20/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	CEO - CMS Administrator Contact	CEO/President	Mr.	Wilmot	Gregory		6175684570					wilmotg@ebnhc.org	10 Gove St		East Boston	MA	02128	03/01/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	CEO - Senior Official for Contracting	CEO/President	Mr.	Wilmot	Gregory		6175684570					wilmotg@ebnhc.org	10 Gove St		East Boston	MA	02128	03/01/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Chief Financial Officer	CFO	Mr.	Hazard	James		6175695800					hazardj@ebnhc.org	10 Gove St		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Chief Operating Officer	COO	Mr.	Boxill	Ryan		6175684570					boxillr@ebnhc.org	10 Gove Street		East Boston	MA	02128	01/30/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Chief Information Officer	CIO	Ms	Rogers	Laura		6175684570					rogersl@ebnhc.org	EBNHC 10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Chief Information Security Officer	VP/CTO	Mr	Hill	Jim		6175684570					hillj@ebnhc.org	EBNHC 10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	CMS Casework Communication Contact	VP		Ip	Calay		6175684570					ipc@ebnhc.org	10 Gove St		East Boston	MA	02128	11/28/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Complaints Tracking Contact	PACE Regulatory Manager		Firth	Madelyn		6175686335					firthm@ebnhc.org	East Boston Neighborhood Health Center	10 Gove Street	East Boston	MA	02128	07/11/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Contact for Fraud Investigations	Deputy General Counsel, AVP		McGee	Amanda		6175695800					mcgeea@ebnhc.org	10 Gove Street		East Boston	MA	02128	01/30/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Coordination of Benefits Contact	Health Plan Analyst		Moustafa	Saphia		6175686127					Moustasa@ebnhc.org	10 Gove Street		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Corporate Mailing						6175684732					ipc@ebnhc.org	10 Gove St		East Boston	MA	02128	11/28/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Coverage Gap Discount Program (CGDP) Payment Contact	PACE Regulatory Manager		Firth	Madelyn		6175686335					firthm@ebnhc.org	10 Gove St.		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Customer Service Operations Contact	VP		Ip	Calay		6175684714					ipc@ebnhc.org	10 Gove St		East Boston	MA	02128	11/28/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	DIR Contact	PACE Regulatory Manager		Firth	Madelyn		6175686335					firthm@ebnhc.org	10 Gove St.		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	DIR Contact (Secondary)	Health Plan Operations Director		Febles	Jacklyn		6175684732					feblesj@ebnhc.org	10 Gove St		East Boston	MA	02128	11/28/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Emergency Part D Contact	Medical Director	Dr.	Pedulla	James		6175685800					pedullaj@EBNHC.ORG	10 Gove St		East Boston	MA	02128	05/20/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Emergency Part D Contact (Secondary)	Clinical Pharmacist		Souza	Ashley		6175695800					souzaa@ebnhc.org	10 Gove St		East Boston	MA	02128	11/28/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Encounter Data & Risk Adjustment Operations Contact	PACE Regulatory Manager		Firth	Madelyn		6175686335					firthm@ebnhc.org	10 Gove St.		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Enrollment Contact	Health Plan Analyst		Moustafa	Saphia		6175686127					Moustasa@ebnhc.org	10 Gove Street		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	EOB Transfer Contact	Health Plan Analyst		Moustafa	Saphia		6175686127				6175686419	Moustasa@ebnhc.org	10 Gove Street		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Financial Audit Contact	Chief Financial Officer	Mr.	Hazard	James		6175687244					hazardj@ebnhc.org	10 Gove Street		East Boston	MA	02128	03/24/2014	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Financial Reporting Contact	PACE Regulatory Manager		Firth	Madelyn		6175686335					firthm@ebnhc.org	10 Gove Street		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Formulary Contact	Medical Director	Dr.	Pedulla	James		6175684570					pedullaj@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Formulary Contact (Secondary)	Clinical Pharmacist		Souza	Ashley		6175695800					souzaa@ebnhc.org	10 Gove St.		East Boston	MA	02128	11/28/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	General Contact	VP		Ip	Calay		6175684714					ipc@ebnhc.org	10 Gove St		East Boston	MA	02128	11/22/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Government Relations Contact	VP		Ip	Calay		6175684714					ipc@ebnhc.org	10 Gove St		East Boston	MA	02128	11/22/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	HIPAA Privacy Officer	Privacy Officer		Desisto	Elizabeth		6175695800					desistoe@EBNHC.ORG	10 Gove St		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	HIPAA Security Officer	Privacy Officer		Desisto	Elizabeth		6175695800					desistoe@EBNHC.ORG	10 Gove St		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Interoperability Contact	VP		Ip	Calay		6176342064					ipc@ebnhc.org	10 Gove Street		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	MA Appeals/Grievances Contact	Director PACE Clinical		Smith	Tina		6175686460					smitht@ebnhc.org	10 Gove St		East Boston	MA	02128	11/28/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	MA Claims Processing Contact for Public Website	PACE Regulatory Manager		Firth	Madelyn		6175686335					firthm@ebnhc.org	10 Gove St		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Marketing Contact	Director of Communications		Martin	Emily		6175684741					martine@ebnhc.org	10 Gove St		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Medical Director	Medical Director	Dr.	Pedulla	James		6175684570					pedullaj@EBNHC.ORG	10 Gove St		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Medicare Compliance Officer	Deputy General Counsel, AVP	Mrs.	McGee	Amanda		6175685800					mcgeea@ebnhc.org	10 Gove St		East Boston	MA	02128	02/24/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Medicare Coordinator	Director Health Plan Operations		Febles	Jacklyn		7815706650					feblesj@ebnhc.org	10 Gove Street		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Medicare Part D Opioid Overutilization Contact	Pharmacy Manager		Souza	Ashley		6175684610					souzaa@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Medication Therapy Management Contact	Pharmacy Manager		Souza	Ashley		6175684610					souzaa@EBNHC.ORG	10 Gove St		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	OffShore Subcontractor Contact	VP		Ip	Calay		6176342064					ipc@ebnhc.org	10 Gove St.		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Online Enrollment Center Contact (Back-up)	AVP		Sanabria	Andreina		6175684714					sanabria@ebnhc.org	10 Gove St		East Boston	MA	02128	11/04/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Online Enrollment Center Contact (Optional)	AVP		Sanabria	Andreina		6175684732					sanabria@ebnhc.org	10 Gove St.		East Boston	MA	02128	11/04/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Online Enrollment Center Contact (Primary)	Health Plan Analyst		Moustafa	Saphia		6175686127					Moustasa@ebnhc.org	10 Gove Street		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Part C Application Contact	VP		Ip	Calay		6175684714					ipc@ebnhc.org	10 Gove St		East Boston	MA	02128	11/28/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Part D Appeals	Clinical Pharmacist		Souza	Ashley							souzaa@ebnhc.org	10 Gove St		East Boston	MA	02128	11/28/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active	6175695800				PACE - Nat		C	Boston
H2223	Part D Appeals Contact (Secondary)	PACE Regulatory Manager		Firth	Madelyn							firthm@ebnhc.org	10 Gove St		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active	6175686335				PACE - Nat		C	Boston
H2223	Part D Application Contact	Director Health Plan Operations		Febles	Jacklyn		7815706650					feblesj@ebnhc.org	10 Gove Street		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Part D Benefits Contact	Director, Health Plan Operations		Febles	Jacklyn		6175684732					feblesj@ebnhc.org	10 Gove St		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Part D Claims Submission Contact	Director, Health Plan Operations		Febles	Jacklyn		6175684732					feblesj@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Part D Exceptions Contact	Medical Director	Dr.	Pedulla	James							pedullaj@ebnhc.org	10 Gove St		East Boston	MA	02128	05/20/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active	6175684570				PACE - Nat		C	Boston
H2223	Part D Exceptions Contact (Secondary)	AVP		Sanabria	Andreina							sanabria@ebnhc.org	10 Gove St.		East Boston	MA	02128	11/04/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active	6175684732				PACE - Nat		C	Boston
H2223	Part D Price File Contact (Back-up)	PACE Regulatory Manager		Firth	Madelyn		6175686335					firthm@ebnhc.org	10 Gove St		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Part D Price File Contact (Optional)	Pharmacy Manager		Souza	Ashley		6175684610					souzaa@ebnhc.org	10 Gove St		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Part D Price File Contact (Primary)	Director, Health Plan Operations		Febles	Jacklyn		6175684732					feblesj@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Part D Quality Assurance Contact	Medical Director	Dr.	Pedulla	James		6175684570					pedullaj@EBNHC.ORG	10 Gove St		East Boston	MA	02128	05/20/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Part D Reporting Contact	Director, Health Plan Operations		Febles	Jacklyn		6175684732					feblesj@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Patient Safety Contact	Medical Director	Dr.	Pedulla	James		6175684570					pedullaj@EBNHC.ORG	10 Gove St		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Payment Contact	Director, Health Plan Operations		Febles	Jacklyn		6175686420					feblesj@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Personal Health Record Contact	AVP		Sanabria	Andreina		6175684732					sanabria@ebnhc.org	10 Gove St.		East Boston	MA	02128	11/04/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Pharmacy Director	Pharmacy Manager		Souza	Ashley		6175684610					souzaa@ebnhc.org	10 Gove St		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Pharmacy Network Management Contact	Director, Health Plan Operations		Febles	Jacklyn		6175684732					feblesj@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist		Souza	Ashley		6178747545					souzaa@ebnhc.org	10 Gove St.		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Pharmacy Technical Help Desk Contact	Pharmacy Manager		Souza	Ashley							souzaa@ebnhc.org	10 Gove St		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active	8004390183				PACE - Nat		C	Boston
H2223	Pharmacy Technical Help Desk Contact (Secondary)	AVP		Sanabria	Andreina							sanabria@ebnhc.org	10 Gove St.		East Boston	MA	02128	11/04/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active	6175684732				PACE - Nat		C	Boston
H2223	PHR Beneficiary Contact																	05/20/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE	East Boston Neighborhood Health Center Corporation - Neighborhood PACE	East Boston Neighborhood Center Corp.	84	Yes	Active	6175684732				PACE - Nat		C	Boston
H2223	Plan Directory Contact for Public Website	Director, Health Plan Operations		Febles	Jacklyn		6175684732					feblesj@ebnhc.org	10 Gove St		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Plan to Plan Reconciliation Contact	Director, Health Plan Operations		Febles	Jacklyn		6175684732					feblesj@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Processor Contact	Director, Health Plan Operations		Febles	Jacklyn		6175684732					feblesj@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Quality Contact	Director, Health Plan Operations		Febles	Jacklyn		6175684741					feblesj@ebnhc.org	10 Gove St		East Boston	MA	02128	05/20/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Reconciliation Contact	Director, Health Plan Operations		Febles	Jacklyn		6175684732					feblesj@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Reconciliation Contact (Secondary)	AVP		Sanabria	Andreina		6175684714					sanabria@ebnhc.org	10 Gove St		East Boston	MA	02128	11/04/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Recovery Audit Contact	AVP	Mrs.	Ip	Calay		6176342064					Ipc@ebnhc.org	10 Gove St		East Boston	MA	02128	07/11/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Surveillance Contact	VP		Ip	Calay		6176342064					ipc@ebnhc.org	10 Gove St		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	System Contact	PACE Regulatory Manager		Firth	Madelyn		6175686335					firthm@ebnhc.org	10 Gove St		East Boston	MA	02128	03/20/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Third Party Administrator (TPA) Liaison	Director, Health Plan Operations		Febles	Jacklyn		6175684732					feblesj@ebnhc.org	10 Gove Street		East Boston	MA	02128	05/23/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	User Access Contact	Director, Health Plan Operations		Febles	Jacklyn		6175684741					feblesj@ebnhc.org	10 Gove St		East Boston	MA	02128	05/20/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Utilization Management Contact	Medical Director	Dr.	Pedulla	James		6175684570					pedullaj@ebnhc.org	10 Gove St		East Boston	MA	02128	05/20/2022	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2223	Utilization Review Contact	Health Plan Analyst		Moustafa	Saphia		6175686127					Moustasa@ebnhc.org	10 Gove St		East Boston	MA	02128	07/11/2023	2023	East Boston Neighborhood Center Corp.	National PACE	Neighborhood PACE	National PACE		East Boston Neighborhood Center Corp.	84	Yes	Active					PACE - Nat		C	Boston
H2224	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	CAP Report Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	12/14/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	09/16/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	MA Claims Processing Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H2224	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H2224	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H2224	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H2224	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	09/16/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	09/16/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	09/16/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H2224	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H2224	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Plan Directory Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2224	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	SENIOR WHOLE HEALTH, LLC	Local CCP	Senior Whole Health	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2225	Agent/Broker Compensation Data Contact	Manager, Sales Operations	Mr.	Demos	John		6174260600					jdemos@commonwealthcare.org	30 Winter Street		Boston	MA	02108	04/22/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment and Eligibility		Sherman	Mandy		9202214083				9202214583	Relay.Health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Backup User Access Contact	Director, Health Plan Compliance		Dwinnells	Mark		6174260600	1239				mdwinnells@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Best Available Evidence Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931				randrade@commonwealthcare.org	30 Winter St		Boston	MA	02108	02/05/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Bid Audit Contact	Sr. Director, Actuarial Services		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Bid Audit Site Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Bid Primary Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/26/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	CAP Report Contact for Public Website	General Manager, Market Lead - Massachusetts		Waggoner	Mark		6174260600	51606				mwaggoner@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Palmieri	Chris	D	8572468897					cpalmieri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/05/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	CEO - Senior Official for Contracting	President of Markets	Ms	Murphy	Courtney		6174260600	53892				cmurphy@commonwealthcare.org	30 Winter Street,		Boston	MA	02108	03/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Chief Financial Officer	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/12/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Chief Operating Officer	Chief Operating Officer	Mr.	Mudunuri	Sesha		6178757140					smudunuri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/05/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Chief Information Officer	SVP & Chief Information Officer	Ms.	O'Rorke	Beth		6174260600	2485				bororke@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/21/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Chief Information Security Officer	VP, IT Governance and Cyber Security	Mr.	Jacobs	Tim		6174260600	52258				tjacobs@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	CMMI Model Point of Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	CMS Casework Communication Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320				8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Complaints Tracking Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320					tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Contact for Fraud Investigations	Director, FWA Program and SIU		Vasconcelos	Nadia		6174260600	52733				nvasconcelos@commonwealthcare.org	2 Lafayette	5th Floor	Boston	MA	02111	08/08/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Coordination of Benefits Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931			6174263109	randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/05/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Corporate Mailing						6174260600	1991				elgray@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/24/2016	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Customer Service Operations Contact	Director, Contract Center		Cuevas	Sabrina		6174260600	51004			6174263097	scuevas@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/08/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	DIR Contact	Sr. Director, Actuarial Services		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	DIR Contact (Secondary)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Electronic Health Record Contact	Director, Clinical Informatics		Phan	Phuong		6174260600	52247				pphan@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	11/04/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Emergency Part D Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Emergency Part D Contact (Secondary)	Manager, Pharmacy Operations		Lee	Annie		6174263109					alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Encounter Data & Risk Adjustment Operations Contact	Manager, Encounters and Risk		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter St		Boston	MA	02108	11/13/2019	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Enrollment Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931			6174263109	randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/05/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	EOB Transfer Contact	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194			6174260600	elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Financial Audit Contact	Director, Regulatory Audit	Ms	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Financial Reporting Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Formulary Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Formulary Contact (Secondary)	Medicare Team Lead, Formulary Services		Paddock	Deanna		6087291628				6087292628	deanna.paddock@navitus.com	361 Integrity Drive		Madison	WI	53717	11/13/2019	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	General Contact	General Manager, Market Lead - Massachusetts		Waggoner	Mark		6174260600	51606				mwaggoner@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Government Relations Contact	VP, Government Relations		Preede	Ken		6174260600	51412				kpreede@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	HIPAA Privacy Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	HIPAA Security Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Hospice Contact	Palliative Care Medical Director		Ragland	Julia		7815254203					jragland@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	10/04/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Interoperability Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	MA Appeals/Grievances Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320				8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	MA Claims Processing Contact for Public Website	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194				elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Marketing Contact	SVP, Marketing		Kubilus	Melissa		6174260600	52448			6174263019	mkubilus@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/03/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Medical Director	Medical Director		Johnson	Brenda		6174260600	51639				brjohnson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Medicare Compliance Officer	Director, Medicare Compliance Officer	Ms.	Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/01/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Medicare Coordinator	Contract Manager		Belec	Steven		6174260600	1870				sbelec@commonwealthcare.org	30 Winter Street		Boston	MA	02108	04/16/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/02/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Medication Therapy Management Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	OffShore Subcontractor Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Online Enrollment Center Contact (Back-up)	Manager, Member Enrollment and Retention		Taylor	Lena		6174260600	51126				ltaylor@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Online Enrollment Center Contact (Optional)	VP, National Sales	Mr.	Spartano	Michael		6179139034					mspartano@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Online Enrollment Center Contact (Primary)	Director, Enrollment, Recon. & Retention	Mr	Andrade	Remo		6174260600	57931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Part C Application Contact	Sr. Director, Product		Martel	Annemarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Part C Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Part D Appeals	Director, Appeals & Grievances		Schenk	Tyrone						8573273320	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8666102273				HMO - Health Maintenance Organization		C	Boston
H2225	Part D Appeals Contact (Secondary)	Manager, Clinical Appeals and Grievances		Mancuso	Jeremiah							jmancuso@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600	51222			HMO - Health Maintenance Organization		C	Boston
H2225	Part D Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Part D Benefits Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Part D Claims Submission Contact	Manager, Technical Operations		Derks	Bob		9202214176				9202214676	DL-TO-PDE@navitus.com	1025 West Navitus Dr		Appleton	WI	54913	05/04/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Part D Exceptions Contact	Sr. Manager, Clinical Prior Auth		LeClair	Christophe						9202214676	Christopher.LeClair@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8662703877				HMO - Health Maintenance Organization		C	Boston
H2225	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Operations		Lee	Annie						6174263109	alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/09/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600				HMO - Health Maintenance Organization		C	Boston
H2225	Part D Price File Contact (Back-up)	Manager, Pharmacy Operations		Lee	Annie		6174260600					alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/09/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Part D Price File Contact (Optional)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Part D Price File Contact (Primary)	Navitus Plan Finder		Finder	Plan		6087291578					Plan.Finder@Navitus.com	2601 West Beltline Highway	Suite 600	Madison	WI	53713	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Part D Quality Assurance Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Part D Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Patient Safety Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Payment Contact	VP Revenue Cycle Management		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/20/2020	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Personal Health Record Contact	Mgr, Health Information Management		Lopez	Robin		6174260600	5235				rlopez@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Pharmacy Director	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688				6087292688	Jan.Robinson@Navitus.com	361 Integrity Drive		Madison	WI	53713	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Pharmacy Technical Help Desk Contact	Sr. Mgr, Customer Care Accounts		Nett	Danielle						9202214724	Danielle.Nett@navitus.com	1025 West Navitus Drive		Appleton	WI	53713	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Boston
H2225	PHR Beneficiary Contact																	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS	Commonwealth Care Alliance	Commonwealth Care Alliance, Inc.	60	Yes	Active	8666102273				HMO - Health Maintenance Organization		C	Boston
H2225	Physician Incentive Contact	VP, Provider Network Strategy	Mr.	Tirimacco	Robert		6174260600	1013				rtirimacco@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/25/2021	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Plan Directory Contact for Public Website			Services	Member		8664209332					memberservices@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/16/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Plan to Plan Reconciliation Contact	Manager, Accounts Payable		Reeves	Jennifer		6174260600	51632				jreeves@commonwealthcare.org	30 Winter St		Boston	MA	02108	05/08/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Processor Contact	VP, Claims and Provider Network Operations		Breen	Donna		6176804446					dbreen@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Quality Contact	VP, Quality		Feierstein	Anne		6174260600	56868				afeierstein@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/10/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Reconciliation Contact	Director, Actuarial Service		Jesik	David		6174260600	1808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/01/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Reconciliation Contact (Secondary)	VP Revenue Cycle		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/20/2020	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Recovery Audit Contact	Director, Regulatory Audit	Ms.	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	SNP Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	SNP State Contact	Contract Manager		Belec	Steve		6174260600	1870				sbelec@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/23/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Surveillance Contact	VP, National Sales		Spartano	Michael		6174260600	52179				mspartano@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	System Contact	Manager, Encounters and Risk Adjustment		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter Street		Boston	MA	02108	11/13/2019	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Third Party Administrator (TPA) Liaison	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	User Access Contact	Director Medicare Compliance Officer		Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	190 White Ave		Warwick	MA	02108	08/25/2022	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Utilization Management Contact	VP UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2225	Utilization Review Contact	VP UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	COMMONWEALTH CARE ALLIANCE, INC.	Local CCP	Commonwealth Care Alliance Massachusetts	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	Boston
H2226	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	Boston
H2226	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	Boston
H2226	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	Boston
H2226	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2226	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2228	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	6126562187				PPO - BBA		C	San Francisco
H2228	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	7632832653				PPO - BBA		C	San Francisco
H2228	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	8005959532				PPO - BBA		C	San Francisco
H2228	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	8007887871				PPO - BBA		C	San Francisco
H2228	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2228	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H2230	Agent/Broker Compensation Data Contact	Director, Broker and Sales Commissions		Newcomb	Stephen		6172469980					Stephen.Newcomb@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/07/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Automated TrOOP Balance Transfer Contact	Reporting Sr. Analyst		Kovalski	Robin		6172468586				6172468506	Robin.Kovalski@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/04/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Backup User Access Contact	Manager		Donovan	Gerard		6172468466					Gerard.Donovan@bcbsma.com	25 Technology Place		Hingham	MA	020434359	08/05/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Best Available Evidence Contact	Supervisor		Brown	Janice		6172468513				6172468506	janice.brown@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	04/12/2012	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Bid Audit Contact	Actuarial Analyst		West	Gregory		6172465077					Gregory.West@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	02/17/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Bid Audit Site Contact	Actuarial Analyst		West	Gregory		6172465077					Gregory.West@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	02/17/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Bid Primary Contact	Actuarial Analyst		West	Gregory		6172465077					Gregory.West@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	02/17/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	CAP Report Contact for Public Website	Medicare Compliance Manager		Sullivan	Christina		7816038012					MAPDCompliance@bcbsma.com	25 Technology Place		Hingham	MA	020434359	04/28/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Iselin	Sarah		6172463805					sarah.iselin@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	021997611	12/21/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Iselin	Sarah		6172463805					sarah.iselin@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	021997611	12/21/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Chief Financial Officer	Interim Chief Financial Officer	Mr.	Centrella	Anthony		6172465067					Anthony.Centrella@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	04/19/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Chief Operating Officer	Executive Vice President, Chief Operating Officer	Mr	Lynch	Richard		6172465000					Richard.Lynch@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/16/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Chief Information Officer	Chief Information Officer	Ms	Hildebrand	Victoria		6172465000					victoria.hildebrand@bcbsma.com	101 Huntington Ave	Suite 1300	Boston	MA	021997611	02/01/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Chief Information Security Officer	Chief Information Security Officer	Mr.	Baggett	Sean		6172465824					sean.baggett@bcbsma.com	101 Huntington Avenue, Suite 1300		Boston	MA	021997611	10/24/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	CMS Casework Communication Contact	Appeals and Grievance Manager		Ronaghan	Danielle		6172464663				6172468506	MedicareAdvantageRXAppeals@bcbsma.com	25 Technology Place	Mailstop 03-04	Hingham	MA	020434359	12/15/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Complaints Tracking Contact	Appeals and Grievance Manager		Ronaghan	Danielle		6172464663				6172468506	MedicareAdvantageRXAppeals@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	12/15/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Contact for Fraud Investigations	Associate General Counsel		Stewart	Jennifer		6172463527					Jennifer.Stewart@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	06/25/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Coordination of Benefits Contact	Specialist II Business Ops		Seesholtz	Janet		6172469587					Janet.Seesholtz@bcbsma.com	One Enterprise Drive		Quincy	MA	02171	05/26/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Corporate Mailing						8002004255					placeholder@cms.hhs.gov	P. O. Box 55007		Boston	MA	022055007	06/10/2010	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Corporate Accounting and Reporting		Thurber	Steven		6172466523					Steven.Thurber@bcbsma.com	101 Huntington Ave	Suite 1300	Boston	MA	02199	12/04/2017	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Customer Service Operations Contact	Member Service Director		Hanstein	deMarigny		6172468941					deMarigny.Hanstein@bcbsma.com	P. O. Box 55007		Boston	MA	022055007	11/18/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	DIR Contact	Reporting Sr. Analyst		Kovalski	Robin		6172468586				6172468506	Robin.Kovalski@bcbsma.com	25 Technology Place		Hingham	MA	02043	08/04/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	DIR Contact (Secondary)	Director, Corporate Accounting and Reporting	Mr	Thurber	Steven		6172466523				6172467806	Steven.Thurber@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/04/2017	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Emergency Part D Contact	Director, Medicare Compliance		Sullivan	Christina		7816038012				6172468506	medicarecompliance@bcbsma.com	25 Technology Place	Mailstop 03-03	Hingham	MA	020434359	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Employer Waiver Contact	Director, Medicare Product		Neylon	Sean		6172468553					Sean.Neylon@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Program Manager	Mr.	Mullin	Thomas		6172468344					Thomas.Mullin@bcbsma.com	25 Technology Place		Hingham	MA	02043	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Enrollment Contact	Enrollment Sr. Manager		Bailey	Elizabeth		6172468678				6172468506	Elizabeth.Bailey@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/01/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	EOB Transfer Contact	Reporting Sr. Analyst		Kovalski	Robin		6172468586				6172468506	Robin.Kovalski@bcbsma.com	25 Technology Place	Mail Stop: 03-04	Hingham	MA	020434359	08/04/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Financial Audit Contact	Audit and Risk Management	Mr.	Bulman	Tim		6172468038					Timothy.Bulman@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	021997611	11/18/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Financial Reporting Contact	Financial Reporting Manager		Goveia	Ross		6172465000					Ross.Goveia@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/07/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Formulary Contact	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	General Contact	Director, Medicare Compliance		Sullivan	Christina		7816038012				6172468506	medicarecompliance@bcbsma.com	25 Technology Place		Hingham	MA	02043	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Government Relations Contact	Vice President, Government Legislative Affairs		Savage	Deirdre		6172463359					deirdre.savage@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	HIPAA Privacy Officer	Privacy Officer		Abdel-Samed	Jennifer		4042424614					Jennifer.Abdel-Samed@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	04/13/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	HIPAA Security Officer	Vice President and Chief Information Security Offi		Baggett	Sean		6172465824					Sean.Baggett@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	11/16/2020	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Hospice Contact	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Interoperability Contact	Senior Director, Emerging Technologies		Narasimhan	Sri Ram		6172468640					Sri.Narasimhan@bcbsma.com	One Enterprise Drive		Quincy	MA	02171	05/05/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	MA Appeals/Grievances Contact	Appeals and Grievance Manager		Ronaghan	Danielle		6172464663				6172468506	MedicareAdvantageRXAppeals@bcbsma.com	25 Technology Place	Mail Stop 03/04	Hingham	MA	02043	12/15/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	MA Claims Processing Contact for Public Website	Sr. Manager, Claims and Appeals & Grievances		Moore	Teresa	J	6172469478					Teresa.Moore@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/25/2020	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Marketing Contact	Director, Medicare Product		Neylon	Sean		6172468553					Sean.Neylon@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Medical Director	Medical Director		Walsh	William		6172464418					William.Walsh@bcbsma.com	One Enterprise Drive		N. Qunicy	MA	02171	12/07/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Medicare Compliance Officer	Director, Medicare Compliance	Ms.	Sullivan	Christina		7816038012					MAPDCompliance@bcbsma.com	25 Technology Place	Mail stop 03/03	Hingham	MA	020434359	04/28/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Medicare Coordinator	Director, Medicare Operations		Bentley	Melanie		6172468403					Melanie.Bentley@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/26/2020	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Medicare Part D Opioid Overutilization Contact	Clinical Manager, Pharmacy Operations		Wong	Timothy		6172466927					timothy.wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	04/10/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Medication Therapy Management Contact	Senior Clinical Advisor		Tabor	Pamela		7272071264					pamela.tabor@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Online Enrollment Center Contact (Back-up)	Senior Manager, Business Ops		Bailey	Elizabeth		6172468678					elizabeth.bailey@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	01/28/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Online Enrollment Center Contact (Optional)	Supervisor		Brown	Janice		6172468513					Janice.Brown@BCBSMA.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	11/18/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Online Enrollment Center Contact (Primary)	Enrollment Sr. Manager		Bailey	Elizabeth		6172468678				6172468506	Elizabeth.Bailey@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/01/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Part C Application Contact	Director, Medicare Product		Neylon	Sean		6172468553					Sean.Neylon@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Part C Reporting Contact	Program Manager		MacDougall	Erin		6172469714				6172468506	erin.macdougall@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	01/25/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Part D Appeals	Appeals and Grievance Manager		Ronaghan	Danielle						8664637700	MedicareAdvantageRXAppeals@bcbsma.com	25 Technology Place		Hingham	MA	020434359	12/15/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active	8005836289				PPO - BBA		C	Boston
H2230	Part D Appeals Contact (Secondary)	Appeals and Grievance Supervisor		Weed	Justine						6172468506	MedicareAdvantageRXAppeals@bcbsma.com	25 Technology Place		Hingham	MA	02043	12/28/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active	8005836289				PPO - BBA		C	Boston
H2230	Part D Application Contact	Director, Medicare Product		Neylon	Sean		6172468553					Sean.Neylon@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Part D Benefits Contact	Director, Medicare Product		Neylon	Sean		6172468553					Sean.Neylon@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Part D Claims Submission Contact	Senior Manager Financial Operations		Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Part D Exceptions Contact	Director, Pharmacy Operations		Nelhuebel	Melinda						8664637700	Melinda.Nelhuebel@bcbsma.com	25 Technology Place		Hingham	MA	02043	05/29/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active	8003667778				PPO - BBA		C	Boston
H2230	Part D Exceptions Contact (Secondary)	Clinical Manager, Pharmacy Operations		Wong	Timothy						8664637700	Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	04/10/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active	8003667778				PPO - BBA		C	Boston
H2230	Part D Price File Contact (Back-up)	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Part D Price File Contact (Optional)	Clinical Pharmacist		Thomas	Mark		6172466906					Mark.Thomas@BCBSMA.com	25 Technology Place		Hingham	MA	02043	04/03/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Part D Price File Contact (Primary)	Senior Manager Financial Operations		Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Part D Quality Assurance Contact	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Part D Reporting Contact	Program Manager		MacDougall	Erin		6172469714				6172468506	erin.macdougall@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	01/25/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Patient Safety Contact	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Payment Contact	Director, Corporate Accounting and Reporting		Thurber	Steven		6172466523					Steven.Thurber@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/04/2017	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Pharmacy Director	Director, Pharmacy Operations		Nelhuebel	Melinda		6172464407					Melinda.Nelhuebel@bcbsma.com	25 Technology Place		Hingham	MA	02043	05/29/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Pharmacy Network Management Contact	Lead Director, Network Management		Smith	Shawn		4803914844					Shawn.Smith@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Pharmacy Network Management Contact (Secondary)	Senior Director, Pharmacy Services		Erwin	Mary Beth		6172463276					MaryBeth.Erwin@bcbsma.com	One Enterprise Dr		N. Quincy	MA	02171	06/18/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Pharmacy Technical Help Desk Contact	Director, Client Operations		Dayoub	Joselyn							Dayoubj@CVSHealth.com	CVS Health 800 NW Chipman RD	Ste 5830	Lees Summit	MO	64063	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active	8666934620				PPO - BBA		C	Boston
H2230	Physician Incentive Contact	Vice President, Network Contracting		Katinas	Stephan		6172466518					Stephan.Katinas@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/13/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Plan Directory Contact for Public Website			Services	Member		8002004255					MMService@bcbsma.com	25 Technology Place	Mailstop 03-02	Hingham	MA	020434359	11/18/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Plan to Plan Reconciliation Contact	Director, Corporate Accounting and Reporting		Thurber	Steven		6172466523				6172467806	Steven.Thurber@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/04/2017	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Processor Contact	Lead Director, Networks		Graham	Heather		2145370421					Heather.Graham@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Quality Contact	Director of Clinical Quality		Jean	Kristin		6172464727					Kristin.Jean@bcbsma.com	1 Enterprise Dr		Quincy	MA	02171	05/10/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Reconciliation Contact	Director, Corporate Accounting and Reporting	Mr	Thurber	Steven		6172466523				6172467806	steven.thurber@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/04/2017	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Reconciliation Contact (Secondary)	Associate Director, Accounting		Setzer	Bryan		6172466261					Bryan.Setzer@bcbsma.com	101 Huntington Avenue Suite 1300		Boston	MA	021997611	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Recovery Audit Contact	Reporting Sr. Analyst	Ms.	Kovalski	Robin		6172468586				6172468506	Robin.Kovalski@BCBSMA.com	25 Technology Place		Hingham	MA	02043	08/04/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Surveillance Contact	Medicare Compliance Manager		Sullivan	Christina		7816038012				6172468506	medicarecompliance@bcbsma.com	25 Technology Place	Mailstop 03-03	Hingham	MA	020434359	04/14/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	System Contact	Reporting Sr. Analyst		Kovalski	Robin		6172468586				6172468506	robin.kovalski@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/25/2020	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Third Party Administrator (TPA) Liaison	Director, Corporate Accounting and Reporting		Thurber	Steven		6172466523					Steven.Thurber@bcbsma.com	101 Huntington Ave	Suite 1300	Boston	MA	02199	12/04/2017	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	User Access Contact	Manager		Sullivan	Christina		6172462507					Christina.Sullivan@bcbsma.com	25 Technology Place		Hingham	MA	020434359	08/05/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Utilization Management Contact	Vice President of Medical Operations		Yeats M.D.	Ashley		6172464846					ashley.yeats@bcbsma.com	1 Enterprise Drive	Mail Stop 02-06	North Quincy	MA	02171	12/13/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2230	Utilization Review Contact	Vice President of Medical Operations		Yeats, M.D.	Ashley		6172464846					ashley.yeats@bcbsma.com	1 Enterprise Drive	Mail Stop 02-06	North Quincy	MA	02171	12/13/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	Local PPO		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					PPO - BBA		C	Boston
H2235	Agent/Broker Compensation Data Contact	Financial Specialist		Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street		Clearwater	FL	33759	07/20/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Automated TrOOP Balance Transfer Contact	Director, Enrollment	Mr.	Wade	Greg		3142092810					Enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Backup User Access Contact	Compliance Analyst		Patel	Karishma		7274674873					karishma.patel@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Best Available Evidence Contact	Director, Enrollment	Mr.	Wade	Greg		3142092810					Enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Bid Audit Contact	Financial Specialist		Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street		Clearwater	FL	33759	07/20/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Bid Audit Site Contact	Financial Specialist		Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street		Clearwater	FL	33759	07/20/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Bid Primary Contact	Financial Specialist		Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street		Clearwater	FL	33759	07/24/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	CAP Report Contact for Public Website	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	CEO - CMS Administrator Contact	Interim President	Ms.	Armstrong	Shawn		3043892792					Melisa.armstrong@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	07/20/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	CEO - Senior Official for Contracting	Chief Financial Officer	Mrs.	Polo	Janice		7278208021					Janice,polo@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/15/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Chief Financial Officer	Chief Financial Officer	Ms.	Polo	Janice		7278208021					Janice,polo@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/15/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Chief Operating Officer	Chief Operating Officer	Ms.	Garey-Roy	Deeann		9414450519					deeann.gareyroy@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	07/20/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Chief Information Officer	Vice President, Information Technology	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	01/03/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Chief Information Security Officer	Vice President, Information Technology	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/19/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	CMS Casework Communication Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Complaints Tracking Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Contact for Fraud Investigations	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Coordination of Benefits Contact	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/21/2021	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Corporate Mailing						7275191766					customerservice@baycarehealthplans.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	05/21/2021	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Specialist		Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street		Clearwater	FL	33759	08/09/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Customer Service Operations Contact	Vice President, Customer Service	Ms.	Meyerhoeffer	Linda		6366869682					rmeyerhoeffer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/10/2019	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	DIR Contact	Financial Specialist		Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street		Clearwater	FL	33759	07/20/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	DIR Contact (Secondary)	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Emergency Part D Contact	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/12/2019	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Emergency Part D Contact (Secondary)	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Employer Waiver Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment Services		Eschbach	Jason		6144397608					jeschbach@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/21/2021	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Enrollment Contact			Meyerhoeffer	Linda		6366869682					rmeyerhoeffer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/11/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	EOB Transfer Contact	Director, Claims	Ms.	Walter	Dawn		3142092726				3147706096	dwalter@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/10/2019	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Financial Audit Contact	Financial Specialist	Ms.	Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street	Suite 170	Clearwater	FL	33759	08/09/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Financial Reporting Contact	Financial Specialist	Ms.	Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street	Suite 170	Clearwater	FL	33759	08/09/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Formulary Contact		Ms	Nyawabila	Christina		8587906297					FMT@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Formulary Contact (Secondary)	Chief Medical Officer	Dr.	Beckert	Boris		6513877784					Boris.Beckert@baycare.org	300 Park Place Blvd., Suite 170		Clearwater	FL	33759	07/20/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	General Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Government Relations Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	HIPAA Privacy Officer	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	HIPAA Security Officer	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Hospice Contact	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					pharmacy@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Interoperability Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	11/16/2021	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	MA Appeals/Grievances Contact	Director, Appeals and Grievances	Ms.	Meyer	Jenell		3147703733					jameyer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/10/2019	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	MA Claims Processing Contact for Public Website			Customer Service	Lumeris		8665095396					customerservice@baycarehealthplans.org	13900 Riverport Dr		Maryland Heights	MO	63043	12/10/2019	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Marketing Contact	Compliance Analyst	Ms.	Patel	Karishma		7274674873					karishma.patel@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	12/03/2019	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Medical Director	Chief Medical Officer	Dr.	Beckert	Boris		6513877784					Boris.Beckert@baycare.org	300 Park Place Blvd., Suite 170		Clearwater	FL	33759	07/20/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Medicare Coordinator	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist	Ms.	Pasagic	Melita		3147703775					mpasagic@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	11/13/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Medication Therapy Management Contact	Manager, Pharmacy	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/21/2021	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	OffShore Subcontractor Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Online Enrollment Center Contact (Back-up)	Manager, Compliance	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	11/11/2021	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Online Enrollment Center Contact (Optional)	Director, Member Experience & Aquisition	Ms.	Croom Tucker	Kristy		7275191909					kristy.croomtucker@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	11/11/2021	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Online Enrollment Center Contact (Primary)	Engagement Delivery Director	Ms.	Riswadkar	Nicola		3146001998					nriswadkar@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	11/11/2021	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Part C Application Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Part C Reporting Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Part D Appeals	Director, Appeals and Grievances	Ms.	Meyer	Jenell							jameyer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	01/03/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active	3147703733				HMO - Health Maintenance Organization		C	Atlanta
H2235	Part D Appeals Contact (Secondary)	Manager, Appeals	Mr.	Lara	Junior							jlara@lumeris.com	13900 Riverport Drive		St. Louis	MO	63043	05/21/2021	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active	3147705642				HMO - Health Maintenance Organization		C	Atlanta
H2235	Part D Application Contact	Director, CMS Applications and PBP	Mr.	Moser	Phil		3142092725					Joanna.Tofani@baycare.org	13900 Riverport Drive		Maryland Heights	MO	63043	05/21/2021	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Part D Benefits Contact	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	01/22/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Part D Claims Submission Contact	Sup Medicare PDE Operations	Mr.	Blansfield	John		8582915304					PDE@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Part D Exceptions Contact	Dir PA Clinical Programs	Mr.	McGurran	Shawn							Shawn.McGurran@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active	8587906682				HMO - Health Maintenance Organization		C	Atlanta
H2235	Part D Price File Contact (Back-up)	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Part D Price File Contact (Primary)	Medicare Part D Project Manager	Ms.	Niemi	Kirstin		8587906455					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Part D Quality Assurance Contact	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/10/2019	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Part D Reporting Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Patient Safety Contact	Manager, Pharmacy	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/21/2021	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Payment Contact	Financial Specialist		Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street		Clearwater	FL	33759	08/09/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Pharmacy Director	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	01/22/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Pharmacy Network Management Contact	Manager, PNS & Claims Operations	Ms.	Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services	Ms.	Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	11/20/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active	8887415002				HMO - Health Maintenance Organization		C	Atlanta
H2235	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy	Ms.	Burgess	Sandra							sburgess@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/10/2019	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active	3142092886				HMO - Health Maintenance Organization		C	Atlanta
H2235	Physician Incentive Contact	Financial Specialist		Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street		Clearwater	FL	33759	07/20/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Plan Directory Contact for Public Website			CustomerService	Lumeris		8665095396					customerservice@baycarehealthplans.org	13900 Riverport Dr		Maryland Heights	MO	63043	12/10/2019	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Plan to Plan Reconciliation Contact	Manager, Health Plan Finance		William	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	08/08/2019	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Processor Contact	Director, Medicare Programs	Ms	Davis-Jones	De'Lona		8587906229					Delona.Davis-Jones@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Quality Contact	Chief Medical Officer	Dr.	Beckert	Boris		6513877784					Boris.Beckert@baycare.org	300 Park Place Blvd., Suite 170		Clearwater	FL	33759	07/20/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Reconciliation Contact	Financial Specialist		Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street		Clearwater	FL	33759	07/20/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Reconciliation Contact (Secondary)	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Recovery Audit Contact	Financial Specialist	Ms.	Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street	Suite 170	Clearwater	FL	33759	08/09/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	SNP Application Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	SNP State Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Surveillance Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	System Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Third Party Administrator (TPA) Liaison	Financial Specialist		Blas	Melissa		8133852084					Melissa.Blas@baycare.org	2985 Drew Street		Clearwater	FL	33759	08/09/2023	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	User Access Contact	Chief Compliance Officer	Ms.	Tofani	Joanna		7275191974					Joanna.Tofani@baycare.org	300 Park Place Blvd.	Suite 170	Clearwater	FL	33759	02/25/2020	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Utilization Management Contact	Dir PA Clinical Programs	Mr.	McGurran	Shawn		8587906682					Shawn.McGurran@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/05/2018	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2235	Utilization Review Contact	Dir PA Clinical Programs	Mr.	McGurran	Shawn		8587906682					Shawn.McGurran@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	08/08/2019	2023	BAYCARE SELECT HEALTH PLANS, INC.	Local CCP	BayCare Health Plans	HMO/HMOPOS		BayCare Health System, Inc.	688	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2237	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Automated TrOOP Balance Transfer Contact	Sr Compliance Professional		Rafel	Mary		4144141944					mrafel@humana.com	1555 N Rivercenter Drive	Suite 206	Milwaukee	WI	53212	07/25/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Best Available Evidence Contact	Manager, Enrollment		Woods	Byron		5025806016					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Bid Audit Contact	Director Financial Data Analytics		Harcus	Amanda		4142254708				4142311092	aharcus@icarehealthplan.org	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	06/04/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Bid Audit Site Contact	Director Financial Data Analytics		Harcus	Amanda		4142254708				4142311092	aharcus@icarehealthplan.org	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	06/04/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Bid Primary Contact	Director, Financial Data Analytics		Harcus	Amanda		4142254708				4142311092	aharcus@icarehealthplan.org	1555 N. RiverCenter Dr.		Milwaukee	WI	53212	06/23/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Mollica	Tony		6128179193					amollica@icarehealthplan.org	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	06/04/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Mollica	Tony		6128179193					amollica@icarehealthplan.org	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	06/04/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Chief Financial Officer	Chief Financial Officer	Ms	Bailey	Natalie		9205447034					nbailey1@humana.com	1100 Employers Boulevard		Green Bay	WI	54344	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Chief Information Officer	Chief Information Officer	Mr.	Pandey	Vinay		4142725602				4142311052	vpandey@icarehealthplan.org	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	06/04/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Chief Information Security Officer	Chief Information Officer	Mr.	Pandey	Vinay		4142725602				4142311052	vpandey@icarehealthplan.org	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	06/08/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	CMS Casework Communication Contact	Compliance		Fisher	Jill		4142254764					Jfisher@icarehealthplan.org	1555 N. RiverCenter Dr.		Milwaukee	WI	53212	06/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Complaints Tracking Contact	Compliance		Rafel	Mary		4144141944					MRafel@humana.com	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	03/10/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Contact for Fraud Investigations	Compliance		Fisher	Jill		4142254764				4142311092	jfisher@icarehealthplan.org	1555 N RiverCenter Dr, Ste 206		Milwaukee	WI	53212	06/08/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Corporate Mailing						4142254764					wjensen@icarehealthplan.org	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	06/04/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	DIR Contact	Director of Financial Data Analytics		Harcus	Amanda		4142254708					aharcus@icarehealthplan.org	1555 N Rivercenter Dr.	Suite 206	Milwaukee	WI	53212	06/24/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	DIR Contact (Secondary)			Rafel	Mary		4144141944					mrafel@humana.com	1555 N RiverCenter Dr, Ste 206		Milwaukee	WI	53212	07/25/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Emergency Part D Contact	Chief Medical Officer		Benzik	Mary Ellen		4143075318					mbenzik@humana.com	1555 N Rivercenter Drive	Suite 206	Milwaukee	WI	53212	07/25/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Encounter Data & Risk Adjustment Operations Contact	Director Financial Data Analytics		Harcus	Amanda		4142254708				4142311092	aharcus@icarehealthplan.org	1555 N RiverCenter Dr, Ste 206		Milwaukee	WI	53212	06/04/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Enrollment Contact	Director, Enrollment		Burrows	Matthew		5025800594					mburrows@humana.com	101 East Main Street		Louisville	KY	40202	05/27/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	EOB Transfer Contact	Sr. Compliance Professional		Rafel	Mary		4144141944				4149187598	mrafel@humana.com	1555 N Rivercenter Drive	Suite 206	Milwaukee	WI	53212	07/25/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	11/17/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Formulary Contact	Manager Formulary Admin & Maintenance		Nyawabila	Christina		8587906297					Christina.Nyawabila@medimpact.com	10181 Scripps Gateway Ct	Floor 22	San Diego	CA	92131	06/08/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	05/27/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	05/27/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	05/27/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Interoperability Contact	SVP, HQRI		Clark	Jessica		5025802864					jclark3@humana.com	500 West Main Street		Louisville	KY	40204	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Medical Director	Medical Director	Dr.	Benzik	Mary Ellen		4149187537					mbenzik@icarehealthplan.org	1555 N RiverCenter Dr	Ste 206	Milwaukee	WI	53212	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Medicare Part D Opioid Overutilization Contact	Pharmacist		Brown	Eboney		4144143172				4149187598	ebrown53@humana.com	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	07/25/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Medication Therapy Management Contact	Director of Pharmacy Services		Dykstra	Sarah		4144040104				4149187598	sdykstra@icarehealthplan.org	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	03/20/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Part D Appeals	Sr. Compliance Professional		Rafel	Mary						4149187598	mrafel@humana.com	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	07/25/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active	4144141944				HMO - Health Maintenance Organization		C	Kansas City
H2237	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Part D Benefits Contact	Sr. Compliance Professional		Rafel	Mary		4144141944					mrafel@humana.com	1555 N Rivercenter Dr.	Suite 206	Milwaukee	WI	53212	07/25/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Part D Claims Submission Contact	Sr. Compliance Professional		Rafel	Mary		4144141944					mrafel@humana.com	1555 N Rivercenter Dr	Suite 206	Milwaukee	WI	53212	07/25/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Part D Exceptions Contact	Sr. Compliance Professional		Rafel	Mary							mrafel@humana.com	1555 N Rivercenter Drive	Suite 206	Milwaukee	WI	53072	07/25/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active	4144141944				HMO - Health Maintenance Organization		C	Kansas City
H2237	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Part D Price File Contact (Primary)	Program Manager		Keller	Shanon		8587907104					shanon.keller@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	06/08/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Patient Safety Contact	Sr. Compliance Professional		Rafel	Mary		4144141944				4149187598	mrafel@humana.com	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	07/25/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Pharmacy Director	Chief Medical Officer		Benzik	Mary Ellen		4143075318					mbenzik@humana.com	1555 N Rivercenter Dr	Suite 206	Milwaukee	WI	53212	07/25/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Pharmacy Network Management Contact	Program Managers		Keller	Shanon		8587907104					Shanon.keller@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	06/10/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Pharmacy Network Management Contact (Secondary)	Program Manager		Niemi	Kristin		8587906455					Kirstin.Niemi@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	06/10/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Pharmacy Technical Help Desk Contact	Director, Contact Center Services		Battle	Dorry							dorry.battle@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8007774376				HMO - Health Maintenance Organization		C	Kansas City
H2237	Pharmacy Technical Help Desk Contact (Secondary)	Director, Contact Center Services		Brewer	Kathy							customerservice@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/13/2023	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8007774376				HMO - Health Maintenance Organization		C	Kansas City
H2237	Physician Incentive Contact	Value Based Purchasing Program Administrator		Hayden	Leigh		4142995497				4142725618	lhayden@icarehealthplan.org	1555 N Rivercenter Drive	Suite 206	Milwaukee	WI	53212	03/01/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Processor Contact	VP Government Programs & Services		Davis Jones	Delona		8587906229					Delona.davis-jones@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	06/08/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Quality Contact	CQO		Pandey	Vinay		4142725602				4142311052	vpandey@icarehealthplan.org	1555 N. RiverCenter Dr., Ste 206		Milwaukee	WI	53212	06/23/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Reconciliation Contact	Director of Financial Data Analytics		Harcus	Amanda	M	4142254708					aharcus@icarehealthplan.org	1555 N RiverCenter Drive	Suite 206	Milwaukee	WI	53212	06/25/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Third Party Administrator (TPA) Liaison	Director of Financial Data Analytics		Harcus	Amanda	M	4142254708					aharcus@icarehealthplan.org	1555 N RiverCenter Drive	Suite 206	Milwaukee	WI	53212	06/25/2021	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2237	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	12/29/2022	2023	INDEPENDENT CARE HEALTH PLAN	Local CCP	iCare	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2246	Agent/Broker Compensation Data Contact	Broker Relations Development Manager	Ms.	DeSpain	Amy		8014427702					amy.despain@selecthealth.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Automated TrOOP Balance Transfer Contact		Mr.	Williams	Steven		8014427801					steven.l.williams@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Backup User Access Contact	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Best Available Evidence Contact	Medicare Enrollment Supervisor	Ms.	Baer	Mallory		8014429842					mallory.baer@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Bid Audit Contact	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Bid Primary Contact	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	CAP Report Contact for Public Website	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	CEO - CMS Administrator Contact	President and CEO	Mr.	Hitchcock	Rob		8014427889					rob.hitchcock@selecthealth.org	5381 S. Green Street		Murray	UT	84123	03/20/2023	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	CEO - Senior Official for Contracting	President and CEO	Mr.	Hitchcock	Rob		8014427889					rob.hitchcock@selecthealth.org	5381 S. Green Street		Murray	UT	84123	03/20/2023	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Chief Financial Officer	Chief Financial Officer	Mr.	Trettin	Todd		8014427760					todd.trettin@selecthealth.org	5381 S. Green Street		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Chief Operating Officer	Vice President of Operations	Mr.	Griffith	Jon		8014427566					jon.griffith@selecthealth.org	5381 S. Green Street		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Chief Information Officer	Vice President of Operations	Mr.	Griffith	Jon		8014427566					jon.griffith@selecthealth.org	5381 S. Green Street		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Chief Information Security Officer	Chief Information Security Officer	Mr.	West	Karl		8014425662					karl.west@imail.org	4646 W Lake Park Blvd		West Valley City	UT	84130	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	CMMI Model Point of Contact			Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	CMS Casework Communication Contact	Appeals and Grievances Director	Ms.	Johnson	Emily		8014427650					emily.johnson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Complaints Tracking Contact	Appeals and Grievances Director	Ms.	Johnson	Emily		8014427650					emily.johnson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Contact for Fraud Investigations	VP and Chief Administrative Officer		McCullagh	Kristin		8014423436					kristin.mccullagh@selecthealth.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Coordination of Benefits Contact	ORBT Supervisor	Ms.	Aagard	Amanda		8014427006					Rxcob@imail.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Corporate Mailing						8014425000					marketing@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Supervisor	Mr.	Applegarth	John		8014427980					john.applegarth@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Customer Service Operations Contact	Operations Manager	Mr.	Richins	JJ		8014428173					jj.richins@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	DIR Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	DIR Contact (Secondary)	Actuary Chief	Mr.	Heitman	Bob		8014429928					bob.heitman@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Emergency Part D Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Emergency Part D Contact (Secondary)		Mr.	Williams	Steven		8014427801					steven.l.williams@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Employer Waiver Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					Kaleb.Holt@selecthealth.org	5381 Green Street		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment and Coding AVP		Welling	Rebecca		8014427760					rebecca.welling@selecthealth.org	5381 S. Green Street		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Enrollment Contact	Medicare Enrollment Supervisor	Ms.	Baer	Mallory		8014429842					mallory.baer@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	EOB Transfer Contact		Mr.	Williams	Steven		8014427801				8014426870	steven.l.williams@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Financial Audit Contact	Controller	Ms.	Peterson	Nicole		8014427989					nicole.peterson@selecthealth.org	5381 S Green St		Murray	UT	84123	12/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Financial Reporting Contact	Controller	Ms.	Peterson	Nicole		8014427989					nicole.peterson@selecthealth.org	5381 S Green St		Murray	UT	84123	12/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Formulary Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Formulary Contact (Secondary)	Government Programs Clinical Coordinator	Mrs.	Eshelman	Samantha		8014427816					Samantha.Eshelman@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	General Contact	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Government Relations Contact	VP and Chief Administrative Officer	Ms.	McCullagh	Kristin		8014423436					kristin.mccullagh@selecthealth.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	HIPAA Privacy Officer	Business Ethics and Compliance Vice President	Ms.	Draper	Suzie		8014421502					suzie.draper@imail.org	36 South State Street, 10th Floor		Salt Lake City	UT	84111	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	HIPAA Security Officer	Chief Information Security Officer	Mr.	West	Karl		8014425662					karl.west@imail.org	4646 Lake Park Boulevard		Salt Lake City	UT	84120	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Hospice Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Interoperability Contact	Medicare Compliance Officer		Schmidt	Clifton		8014427249					Clifton.Schmidt@selecthealth.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	MA Appeals/Grievances Contact	Appeals and Grievances Director	Ms.	Johnson	Emily		8014427650					emily.johnson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	MA Claims Processing Contact for Public Website	Claims Director	Ms.	White	Marianne		8014428206					marianne.white@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Marketing Contact	Compliance Partner	Ms.	Hagman	Dee		8014429331					dee.hagman@selecthealth.org	5381 S. Green Street		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Medical Director	Chief Medical Officer	Dr.	O'Toole	Heather		8014427775					heather.otoole@selecthealth.org	5381 S Green St		Murray	UT	84123	04/29/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Schmidt	Cliff		8014427249					clifton.schmidt@selecthealth.org	5381 S Green St		Murray	UT	84123	10/27/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Medicare Coordinator	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Medicare Part D Opioid Overutilization Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	06/03/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Medication Therapy Management Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	OffShore Subcontractor Contact	Medicare Compliance Consultant	Ms.	Aumua	Portia		8014428186					portia.aumua@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor	Ms.	Baer	Mallory		8014429842					mallory.baer@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Part C Application Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					Kaleb.Holt@selecthealth.org	5381 Green Street		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Part C Reporting Contact	Medicare Advantage Program Manager	Ms.	Christensen	Star		8014427156					star.christensen@selecthealth.org	5381 Green Street		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Part D Appeals	Appeal and Grievances Director	Ms.	Johnson	Emily							emily.johnson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active	8442089012				PPO - BBA		C	Dallas
H2246	Part D Appeals Contact (Secondary)	Appeals Specialist	Ms.	Olano	Marina							marina.olano@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active	8014427498				PPO - BBA		C	Dallas
H2246	Part D Application Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					Kaleb.Holt@selecthealth.org	5381 Green Street		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Part D Benefits Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Part D Claims Submission Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Part D Exceptions Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike							mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active	8554429900				PPO - BBA		C	Dallas
H2246	Part D Exceptions Contact (Secondary)	Operations Supervisor	Ms.	Morgan	Laura							laura.morgan@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active	8554429900				PPO - BBA		C	Dallas
H2246	Part D Price File Contact (Back-up)	Business Analyst	Ms.	Robinson	Elisabeth		8014428091					Elisabeth.Robinson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Part D Price File Contact (Optional)	Medicare Program/Business Analyst Team Lead	Ms.	Nkansah	Cheryl		8014427818					Cheryl.Nkansah@selecthealth.org	5381 Green Street		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Part D Price File Contact (Primary)	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Part D Quality Assurance Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Part D Reporting Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Patient Safety Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Payment Contact	Accounts Receivable Manager	Ms.	Worsley	Tracy		8014427624					tracy.worsley@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Pharmacy Director	Pharmacy Benefit Services AVP	Mr.	Cannon	Eric		8014427816					eric.cannon@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Pharmacy Network Management Contact	Pharmacy Government Programs Director	Mr.	Eaton	Mike		8014427797					mike.eaton@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Pharmacy Network Management Contact (Secondary)	Pharmacy Benefit Services AVP	Mr.	Cannon	Eric		8014427816					eric.cannon@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Pharmacy Technical Help Desk Contact	Pharmacy Operations Supervisor	Mr.	Myers	Eric							Eric.Myers@selecthealth.org	5381 S Green St		Murray	UT	84123	06/05/2023	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active	8554429900				PPO - BBA		C	Dallas
H2246	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Operations Supervisor	Mr.	Myers	Eric							Eric.Myers@selecthealth.org	5381 S Green St		Murray	UT	84123	06/05/2023	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active	8014429644				PPO - BBA		C	Dallas
H2246	Plan Directory Contact for Public Website	Director of Medicare Programs and Products	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Plan to Plan Reconciliation Contact	Accounting Supervisor	Mr.	Applegarth	John		8014427980					john.applegarth@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Processor Contact		Mr.	Williams	Steven		8014427801					steven.l.williams@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Quality Contact	Clinical and Outcomes Management Director	Ms.	Barrus	Kim		8014427399					kim.barrus@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Reconciliation Contact	Controller	Ms.	Peterson	Nicole		8014427989					nicole.peterson@selecthealth.org	5381 S Green St		Murray	UT	84123	12/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Reconciliation Contact (Secondary)	Actuary Chief	Mr.	Heitman	Bob		8014429928					bob.heitman@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Recovery Audit Contact	Controller	Ms.	Peterson	Nicole		8014427989					nicole.peterson@selecthealth.org	5381 S Green St		Murray	UT	84123	12/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	SNP Application Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Surveillance Contact	Director of Medicare Programs	Mr.	Richardson	Mark		8014428210					mark.richardson@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	System Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Third Party Administrator (TPA) Liaison	Accounting Supervisor	Mr.	Applegarth	John		8014427980					john.applegarth@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	User Access Contact	Medicare Advantage Program Manager	Mr.	Holt	Kaleb		8014427954					kaleb.holt@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Utilization Management Contact	Health Services Manager	Ms.	Owens	Mary Ann		8014428171					maryann.owens@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2246	Utilization Review Contact	Health Services Manager	Ms.	Owens	Mary Ann		8014428171					maryann.owens@selecthealth.org	5381 S Green St		Murray	UT	84123	02/15/2022	2023	SELECTHEALTH, INC.	Local CCP	Select Health	Local PPO		Intermountain Health Care, Inc.	480	Yes	Active					PPO - BBA		C	Dallas
H2247	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H2247	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H2247	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H2247	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H2247	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2247	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2256	Agent/Broker Compensation Data Contact	Vice President, Medicare Sales & Marketing	Ms.	McManus	Marie		6179729400	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Automated TrOOP Balance Transfer Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Backup User Access Contact	Medicare Compliance Program Manager		Tran	Brenda		7816121000	85880				brenda.tran@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Best Available Evidence Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Bid Audit Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Bid Audit Site Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Bid Primary Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852	84759				taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Chief Financial Officer	SVP Chief Financial Officer	Mr.	Walker	Scott		7816126840					r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Chief Operating Officer	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Chief Information Officer	SVP and Chief Information Officer	Ms.	Ferhatbegovic	Selma		7816121000	84633				Selma.Ferhatbegovic@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	CMS Casework Communication Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Complaints Tracking Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Contact for Fraud Investigations	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Coordination of Benefits Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Corporate Mailing						7816121000					Cain.Hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Customer Service Operations Contact	Manager, Member Services	Ms.	Villatoro	Yesly		7816121000	54152				yesly.villatoro@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	DIR Contact	Senior Manager, Pharmacy reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	DIR Contact (Secondary)	Pharmacy Analyst Senior	Ms.	Santino	Cristina		7816121000	82560				cristina.santino@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Emergency Part D Contact	Director, Pharmacy Operations		Bonica	Joseph		7816123342					joseph.bonica@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Emergency Part D Contact (Secondary)	Manager, Pharmacy Compliance		Lake	Matthew		7816123976					matthew.lake@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Employer Waiver Contact	Manager, Client Service	Ms.	Bartkiewicz	Mary		7816121000	83937				mary.bartkiewicz@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Data Analyst Lead	Ms.	Quinlan	Judith		7816121000	83377				judith.quinlan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Enrollment Contact	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	EOB Transfer Contact	Manager, Business Implementation		Nesmith	Tanisha		7816124861				6176730286	tanisha.nesmith@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Financial Audit Contact	Chief Financial Officer	Mr.	Walker	Scott		7816121000	86840				r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Financial Reporting Contact	SVP Finance & Chief Accounting Officer	Mr.	Porter	Mark		6179729400	85536				mark.porter@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Formulary Contact	Clinical Pharmacist Senior	Mr.	Kowalski	Alec		7816121000	82045				alec.kowalski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Formulary Contact (Secondary)	Clinical Pharmacist Senior		Shafir	Frances		7816122897					frances.shafir@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	General Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Government Relations Contact	Chief Government Affairs Officer	Ms.	Lewis	Kristin		7816121000	83621				kristin.lewis@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	HIPAA Privacy Officer	VP Privacy & Special Investigation	Mr.	Walsh	Chris		7816121000	82508				Christopher.walsh@point32health.org	1600 Crown Colony Drive		Quincy	MA	02169	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	HIPAA Security Officer	VP Chief  Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Hospice Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Interoperability Contact	Vice President & Chief Technology Officer		Querusio	David		7816122629					david.querusio@point32health.org	One Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	MA Claims Processing Contact for Public Website	Vice President, Claims	Mr.	Fernandez	David		6175844884					david.fernandez@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Marketing Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Medical Director	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Medicare Compliance Officer	Medicaid Compliance Officer	Mrs	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Medicare Coordinator	SVP, President Medicare	Ms.	Blake	Patty		7816124287					Patty.Blake@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Dohan	David		7816121000	82615				David.Dohan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Medication Therapy Management Contact	Sr Pharmacy Program Manager		Burns	Ashlyn		7816122239					ashlyn.burns@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	OffShore Subcontractor Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Online Enrollment Center Contact (Back-up)	Director, Enrollment & Payment - Senior Products	Ms.	Bullock	Jennifer		7816121000	83183				jennifer.bullock@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Online Enrollment Center Contact (Optional)	Supervisor, Enrollment	Ms.	Van De Mortel	Migdalia		7816121000	84104				Migdalia.Van.De.Mortel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Online Enrollment Center Contact (Primary)	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Part C Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Part C Reporting Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Part D Appeals	Director, Appeals & Grievances	Ms.	Evans	Kathleen							Kathleen.Evans@point32health.org	1 Wellness Way		Canton	MA	02021	09/20/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	6179729400	87204			HMO - Health Maintenance Organization		C	Boston
H2256	Part D Appeals Contact (Secondary)	Program Manager Senior	Ms.	Mello	Sheri							sheri.mello@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	84862			HMO - Health Maintenance Organization		C	Boston
H2256	Part D Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Part D Benefits Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Part D Claims Submission Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Chan	Bryan							bryan.chan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	82370			HMO - Health Maintenance Organization		C	Boston
H2256	Part D Exceptions Contact (Secondary)	Supervisor, Pharmacy Utilization Management	Ms.	Griffith	Samantha							samantha.griffith@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	84551			HMO - Health Maintenance Organization		C	Boston
H2256	Part D Price File Contact (Back-up)	Advisor, Medicare Operations		Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Part D Price File Contact (Optional)	Sr. Pharmacy Implementation Specialist		Sullivan	Tim		7816124922					tim.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Part D Price File Contact (Primary)	Sr Business Analyst		Moore-Elliott	Shalandria		7637974305					shalandria.moore-elliott@optum.com	1600 McConnor Pwy.		Schaumburg	IL	60173	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Part D Quality Assurance Contact	Vice President, Behavioral Health	Ms.	Borrelli	Jill		6179729400	85397				jill.borrelli@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Part D Reporting Contact	Director, Pharmacy Financial & Reporting	Mr.	Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Patient Safety Contact	Sr Pharmacy Implementation Specialist		von Fritzinger	Lisa		7816123778					lisa.vonfritzinger@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Payment Contact	Program Manager III	Ms.	Cook	Tiffany		7816121000	84908				Tiffany.Cook@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Pharmacy Director	Vice President, Pharmacy	Ms.	Sullivan	Miriam		7816121000	84116				miriam.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations		Ashby	JoLynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Pharmacy Technical Help Desk Contact	Sr. Manager		Villaneuva	Juan							Juan.Villanueva@optum.com	3515 S Harbor Blvd.		Costa Mesa	CA	92626	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7148253761				HMO - Health Maintenance Organization		C	Boston
H2256	Pharmacy Technical Help Desk Contact (Secondary)	Associate Director, Pharmacy Help Desk		Betten	Brad							bradley.betten@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	8555240380				HMO - Health Maintenance Organization		C	Boston
H2256	Plan Directory Contact for Public Website	Supervisor, Marketing Materials Production	Mr.	Kayser	Kenneth		7816121000	83518				kenneth.kayser@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Plan to Plan Reconciliation Contact	Manager, Finance Operations	Ms.	Olson	Rachel		7816121000	84360				rachel.olson@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Processor Contact	Director, Claims	Ms.	Patel	Monal		7816121000	88187				monal.patel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Quality Contact	Senior Manager, Quality Informatics	Ms.	McCoy	Kelly		7816121000	83515				kelly.mccoy@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Reconciliation Contact	Senior Manager, Pharmacy Reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Reconciliation Contact (Secondary)	Director, Pharmacy Financial & Reporting		Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	09/11/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Recovery Audit Contact	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	SNP Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	SNP State Contact	Director Business Implementation		Chukwu	Matthew		7816123967					matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Surveillance Contact	Director, Sales Operations		McManus	Marie		6117972940	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	System Contact	Senior Manager, Business Account Management	Mr.	Allen	Jeffrey		7816121000	83167			6179729008	Jeffrey.Allen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Third Party Administrator (TPA) Liaison	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	User Access Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Utilization Management Contact	Director, Care Management	Ms.	Menery	Maureen		7816121000	83994				maureen.menery@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2256	Utilization Review Contact	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Agent/Broker Compensation Data Contact	Director, Broker and Sales Commissions		Newcomb	Stephen		6172469980					Stephen.Newcomb@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/07/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Automated TrOOP Balance Transfer Contact	Reporting Sr. Analyst		Kovalski	Robin		6172468586				6172468506	Robin.Kovalski@BCBSMA.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/04/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Backup User Access Contact	Manager		Donovan	Gerard		6172468466					Gerard.Donovan@bcbsma.com	25 Technology Place		Hingham	MA	020434359	08/05/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Best Available Evidence Contact	Supervisor		Brown	Janice		6172468513				6172468506	janice.brown@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	03/28/2012	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Bid Audit Contact	Actuarial Analyst		West	Gregory		6172465077					Gregory.West@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	02/17/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Bid Audit Site Contact	Actuarial Analyst		West	Gregory		6172465077					Gregory.West@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	02/17/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Bid Primary Contact	Actuarial Analyst		West	Gregory		6172465077				6172463968	Gregory.West@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	02/17/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	CAP Report Contact for Public Website	Medicare Compliance Manager		Sullivan	Christina		7816038012					Medicarecompliance@bcbsma.com	25 Technology Place		Hingham	MA	020434359	04/15/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Iselin	Sarah		6172463805					sarah.iselin@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	021997611	12/21/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Iselin	Sarah		6172463805					sarah.iselin@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	021997611	12/21/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Chief Financial Officer	Interim Chief Financial Officer	Mr.	Centrella	Anthony		6172465067					Anthony.Centrella@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	04/19/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Chief Operating Officer	Executive Vice President, Chief Operating Officer	Mr.	Lynch	Richard		6172465000					Richard.Lynch@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/16/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Chief Information Officer	Chief Information Officer	Ms.	Hildebrand	Victoria		6172465000					victoria.hildebrand@bcbsma.com	101 Huntington Ave	Suite 1300	Boston	MA	021997611	02/01/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Chief Information Security Officer	Chief Information Security Officer	Mr.	Baggett	Sean		6172465824					sean.baggett@bcbsma.com	101 Huntington Avenue, Suite 1300		Boston	MA	021997611	10/24/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	CMS Casework Communication Contact	Appeals and Grievance Manager		Ronaghan	Danielle		6172464663				6172468506	MedicareAdvantageRXAppeals@bcbsma.com	25 Technology Place	Mailstop 03-04	Hingham	MA	020434359	12/15/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Complaints Tracking Contact	Appeals and Grievance Manager		Ronaghan	Danielle		6172464663				6172468506	MedicareAdvantageRXAppeals@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	12/15/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Contact for Fraud Investigations	Associate General Counsel		Stewart	Jennifer		6172463527					Jennifer.Stewart@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	06/25/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Coordination of Benefits Contact	Specialist II Business Ops		Seesholtz	Janet		6172469587					Janet.Seesholtz@bcbsma.com	One Enterprise Drive		Quincy	MA	02171	05/26/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Corporate Mailing						8002004255					placeholder@cms.hhs.gov	P. O. Box 55007		Boston	MA	022055007	06/10/2010	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Corporate Accounting and Reporting		Thurber	Steven		6172466523					Steven.Thurber@bcbsma.com	101 Huntington Ave	Suite 1300	Boston	MA	02199	12/04/2017	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Customer Service Operations Contact	Member Service Director		Hanstein	deMarigny		6172468941					deMarigny.Hanstein@bcbsma.com	P. O. Box 55007		Boston	MA	022055007	11/18/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	DIR Contact	Reporting Sr. Analyst		Kovalski	Robin		6172468586				6172468506	Robin.Kovalski@BCBSMA.com	25 Technology Place		Hingham	MA	02043	08/04/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	DIR Contact (Secondary)	Director, Corporate Accounting and Reporting	Mr	Thurber	Steven		6172466523				6172467806	Steven.Thurber@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/04/2017	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Emergency Part D Contact	Director, Medicare Compliance		Sullivan	Christina		7816038012				6172468506	medicarecompliance@bcbsma.com	25 Technology Place	Mailstop 03-03	Hingham	MA	020434359	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Employer Waiver Contact	Director, Medicare Product		Neylon	Sean		6172468553					Sean.Neylon@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Program Manager		Mullin	Thomas		6172468344					Thomas.Mullin@bcbsma.com	25 Technology Place		Hingham	MA	02043	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Enrollment Contact	Enrollment Sr. Manager		Bailey	Elizabeth		6172468678				6172468506	Elizabeth.Bailey@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/01/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	EOB Transfer Contact	Reporting Sr. Analyst		Kovalski	Robin		6172468586				6172468506	Robin.Kovalski@BCBSMA.com	25 Technology Place	Mail Stop: 03-04	Hingham	MA	020434359	08/04/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Financial Audit Contact	Audit and Risk Management	Mr	Bulman	Tim		6172468038					Timothy.Bulman@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	021997611	09/20/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Financial Reporting Contact	Financial Reporting Manager		Goveia	Ross		6172465000					Ross.Goveia@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/07/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Formulary Contact	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	General Contact	Director, Medicare Compliance		Sullivan	Christina		7816038012				6172468506	medicarecompliance@bcbsma.com	25 Technology Place		Hingham	MA	02043	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Government Relations Contact	Vice President, Government Legislative Affairs		Savage	Deirdre		6172463359					deirdre.savage@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	HIPAA Privacy Officer	Privacy Officer		Abdel-Samed	Jennifer		4042424614					Jennifer.Abdel-Samed@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	04/13/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	HIPAA Security Officer	Vice President and Chief Information Security Offi		Baggett	Sean		6172465824					Sean.Baggett@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	11/16/2020	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Hospice Contact	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Interoperability Contact	Senior Director, Emerging Technologies		Narasimhan	Sri Ram		6172468640					Sri.Narasimhan@bcbsma.com	One Enterprise Drive		Quincy	MA	02171	05/05/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	MA Appeals/Grievances Contact	Appeals and Grievance Manager		Ronaghan	Danielle		6172464663				6172468506	MedicareAdvantageRXAppeals@bcbsma.com	25 Technology Place	Mail Stop 03/04	Hingham	MA	02043	12/15/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	MA Claims Processing Contact for Public Website	Sr. Manager, Medicare Advantage Claims and Appeals		Moore	Teresa	J	6172469478					Teresa.Moore@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/25/2020	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Marketing Contact	Director, Medicare Product		Neylon	Sean		6172468553					Sean.Neylon@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Medical Director	Medical Director		Walsh	William		6172464418					William.Walsh@bcbsma.com	One Enterprise Drive		N. Qunicy	MA	02171	12/07/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Medicare Compliance Officer	Director, Medicare Compliance	Ms.	Sullivan	Christina		7816038012					MAPDCompliance@bcbsma.com	25 Technology Place	Mail stop 03/04	Hingham	MA	020434359	04/28/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Medicare Coordinator	Director, Medicare Operations		Bentley	Melanie		6172468403					Melanie.Bentley@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/26/2020	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Medicare Part D Opioid Overutilization Contact	Clinical Manager, Pharmacy Operations		Wong	Timothy		6172466927					timothy.wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	04/10/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Medication Therapy Management Contact	Senior Clinical Advisor		Tabor	Pamela		7272071264					pamela.tabor@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Online Enrollment Center Contact (Back-up)	Senior Manager, Business Ops		Bailey	Elizabeth		6172468678					elizabeth.bailey@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	01/28/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Online Enrollment Center Contact (Optional)	Supervisor		Brown	Janice		6172468513					Janice.Brown@BCBSMA.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	11/18/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Online Enrollment Center Contact (Primary)	Enrollment Sr. Manager		Bailey	Elizabeth		6172468678				6172468506	Elizabeth.Bailey@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/01/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Part C Application Contact	Director, Medicare Product		Neylon	Sean		6172468553					Sean.Neylon@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Part C Reporting Contact	Program Manager		MacDougall	Erin		6172469714				6172468506	erin.macdougall@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	01/25/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Part D Appeals	Appeals and Grievance Manager		Ronaghan	Danielle						8664637700	MedicareAdvantageRXAppeals@bcbsma.com	25 Technology Place		Hingham	MA	020434359	12/15/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active	8005836289				HMO - Health Maintenance Organization		C	Boston
H2261	Part D Appeals Contact (Secondary)	Appeals and Grievance Supervisor		Weed	Justine						6172468506	MedicareAdvantageRXAppeals@bcbsma.com	25 Technology Place		Hingham	MA	02043	12/28/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active	8005836289				HMO - Health Maintenance Organization		C	Boston
H2261	Part D Application Contact	Director, Medicare Product		Neylon	Sean		6172468553					Sean.Neylon@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Part D Benefits Contact	Director, Medicare Product		Neylon	Sean		6172468553					Sean.Neylon@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Part D Claims Submission Contact	Senior Manager Financial Operations		Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Part D Exceptions Contact	Director, Pharmacy Operations		Nelhuebel	Melinda						8664637700	Melinda.Nelhuebel@bcbsma.com	25 Technology Place		Hingham	MA	02043	05/29/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active	8003667778				HMO - Health Maintenance Organization		C	Boston
H2261	Part D Exceptions Contact (Secondary)	Clinical Manager		Wong	Timothy						8664637700	Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	12/04/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active	8003667778				HMO - Health Maintenance Organization		C	Boston
H2261	Part D Price File Contact (Back-up)	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Part D Price File Contact (Optional)	Clinical Pharmacist		Thomas	Mark		6172466906					Mark.Thomas@BCBSMA.com	25 Technology Place		Hingham	MA	02043	04/03/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Part D Price File Contact (Primary)	Senior Manager Financial Operations		Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Part D Quality Assurance Contact	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Part D Reporting Contact	Program Manager		MacDougall	Erin		6172469714				6172468506	erin.macdougall@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	01/25/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Patient Safety Contact	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Payment Contact	Director, Corporate Accounting and Reporting		Thurber	Steven		6172466523					Steven.Thurber@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/04/2017	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Pharmacy Director	Director, Pharmacy Operations		Nelhuebel	Melinda		6172464407					Melinda.Nelhuebel@bcbsma.com	25 Technology Place		Hingham	MA	02043	05/29/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Pharmacy Network Management Contact	Lead Director, Network Management		Smith	Shawn		4803914844					Shawn.Smith@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Pharmacy Network Management Contact (Secondary)	Senior Director, Pharmacy Services		Erwin	Mary Beth		6172463276					MaryBeth.Erwin@bcbsma.com	One Enterprise Dr		N. Quincy	MA	02171	10/24/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Pharmacy Technical Help Desk Contact	Lead Director, Client Operations		Dayoub	Joselyn							Dayoubj@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Boston
H2261	Physician Incentive Contact	Vice President, Network Contracting		Katinas	Stephan		6172466518					Stephan.Katinas@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/13/2018	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Plan Directory Contact for Public Website			Services	Member		8002004255					MMService@bcbsma.com	25 Technology Place	Mailstop 03-02	Hingham	MA	020434359	11/18/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Plan to Plan Reconciliation Contact	Director, Corporate Accounting and Reporting		Thurber	Steven		6172466523				6172467806	Steven.Thurber@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	10/24/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Processor Contact	Lead Director, Networks		Graham	Heather		2145370421					Heather.Graham@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Quality Contact	Director of Clinical Quality		Jean	Kristin		6172464727					Kristin.Jean@bcbsma.com	1 Enterprise Dr		Quincy	MA	02171	05/10/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Reconciliation Contact	Director, Corporate Accounting and Reporting	Mr	Thurber	Steven		6172466523				6172467806	steven.thurber@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	10/24/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Reconciliation Contact (Secondary)	Associate Director, Accounting		Setzer	Bryan		6172466261					Bryan.Setzer@bcbsma.com	101 Huntington Avenue Suite 1300		Boston	MA	021997611	04/25/2023	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Recovery Audit Contact	Reporting Sr. Analyst	Ms.	Kovalski	Robin		6172468586				6172468506	Robin.Kovalski@BCBSMA.com	25 Technology Place		Hingham	MA	02043	08/04/2021	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Surveillance Contact	Director, Medicare Compliance		Sullivan	Christina		7816038012				6172468506	medicarecompliance@bcbsma.com	25 Technology Place	Mailstop 03-04	Hingham	MA	020434359	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	System Contact	Reporting Sr. Analyst		Kovalski	Robin		6172468586				6172468506	robin.kovalski@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	08/25/2020	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Third Party Administrator (TPA) Liaison	Director, Corporate Accounting and Reporting		Thurber	Steven		6172466523					Steven.Thurber@bcbsma.com	101 Huntington Ave	Suite 1300	Boston	MA	02199	12/04/2017	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	User Access Contact	Director, Medicare Compliance		Sullivan	Christina		6172462507					Christina.Sullivan@bcbsma.com	25 Technology Place		Hingham	MA	020434359	12/27/2022	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Utilization Management Contact	Vice President of Medical Operations		Yeats M.D.	Ashley		6172464846					ashley.yeats@bcbsma.com	1 Enterprise Drive	Mail Stop 02-06	North Quincy	MA	02171	12/13/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2261	Utilization Review Contact	Vice President of Medical Operations		Yeats, M.D.	Ashley		6172464846					ashley.yeats@bcbsma.com	1 Enterprise Drive	Mail Stop 02-06	North Quincy	MA	02171	12/13/2019	2023	BCBS  OF MASSACHUSETTS HMO BLUE, INC.	Local CCP	Blue Cross Blue Shield of Massachusetts	HMO/HMOPOS		Blue Cross and Blue Shield of Massachusetts, Inc.	27	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H2272	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H2272	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H2272	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H2272	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H2272	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/27/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2272	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF NEW ENGLAND, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2292	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H2292	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H2292	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H2292	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H2292	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2292	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2293	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Backup User Access Contact	Lead Director, Medicare Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Bid Audit Contact	Actuary I		Bagwell	Devon		6787426516					BagwellD@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Bid Audit Site Contact	Actuary I		Bagwell	Devon		6787426516					BagwellD@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Coordination of Benefits Contact	Consultant		Schultz	Valerie		9525946623					SchultzV@aetna.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Emergency Part D Contact (Secondary)	Director, Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4128653823				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	11/30/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	12/30/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Government Relations Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	HIPAA Privacy Officer	VP, Chief Privacy Officer		Shimanek	Anna		4013742466					Anna.Shimanek@CVSHealth.com	1 CVS Drive	Attn:  Law Department	Woodsocket	RI	02895	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4807075698				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/14/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	MA Claims Processing Contact for Public Website	Executive Director, Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/30/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	12/30/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	12/19/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Part D Appeals	Manager, Clinical Pharmacy		Beyda	Trista						7326914838	trista.beyda@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	4123960695				PPO - BBA		C	Philadelphia
H2293	Part D Appeals Contact (Secondary)	Supervisor,Clinical Svs Med D		Fisk	Samantha						7326914838	samantha.fisk@CVSHealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	9095593962				PPO - BBA		C	Philadelphia
H2293	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Part D Benefits Contact	Director, Part D Product Development		Bohrer	Christophe		8602738849				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Part D Exceptions Contact	Executive Director, Medicare Support		Jackson	Scott							Scott.Jackson@CVSHealth.com	1 CVS Drive		Woonsocket	RI	02895	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	7633814676				PPO - BBA		C	Philadelphia
H2293	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6122633491				PPO - BBA		C	Philadelphia
H2293	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	12/19/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	09/14/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/30/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8002386279				PPO - BBA		C	Philadelphia
H2293	PHR Beneficiary Contact																	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				PPO - BBA		C	Philadelphia
H2293	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2293	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H2318	Automated TrOOP Balance Transfer Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	amy.dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Backup User Access Contact	President & CEO	Ms.	Naber	Mary		8554454554				2485569150	mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Best Available Evidence Contact	President & CEO	Ms.	Naber	Mary		8554454554				2485569150	mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Bid Primary Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	CAP Report Contact for Public Website	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	CEO - CMS Administrator Contact	President & CEO	Ms.	Naber	Mary		8554454554				2485569150	mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/17/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	CEO - Senior Official for Contracting	President & CEO	Ms.	Naber	Mary		8554454554				2485569150	mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Chief Financial Officer	Chief Financial Officer	Mr.	Burmeister	Jeff		2485569132				2485569150	jeff.burmeister@pacesemi.org	21700 Northwester Highway		Southfield	MI	48075	05/09/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Chief Operating Officer	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Chief Information Officer	Chief Financial Officer	Mr.	Burmeister	Jeff		2485569132				2485569150	jeff.burmeister@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	05/09/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Chief Information Security Officer	Director of Quality and Compliance	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	CMS Casework Communication Contact	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Complaints Tracking Contact	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Contact for Fraud Investigations	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Coordination of Benefits Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Corporate Mailing						8554454554					mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/17/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Customer Service Operations Contact	Senior Director of Operations	Ms.	White	Sandra		8554454554				2485569150	Sandra.White@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	DIR Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	DIR Contact (Secondary)	Chief Financial Officer	Mr.	Burmeister	Jeff		2485569132				2485569150	jeff.burmeister@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	05/09/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Emergency Part D Contact	Director of Pharmacy	Mrs.	Rood	Janis		2482237320				2485569150	Janis.Rood@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Emergency Part D Contact (Secondary)	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Encounter Data & Risk Adjustment Operations Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168					Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Enrollment Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	EOB Transfer Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Financial Audit Contact	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Financial Reporting Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Formulary Contact	Director of Pharmacy	Ms.	Rood	Janis		8554454554					Janis.Rood@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	General Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Government Relations Contact	President & CEO	Ms.	Naber	Mary		8554454554				2485569150	mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	HIPAA Privacy Officer	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	HIPAA Security Officer	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Interoperability Contact	Senior Director		Anderson	Roger		2485569106					roger.anderson@pacesemi.org	21700 Northwestern Highway - Suite 900		Southfield	MI	48075	12/15/2021	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	MA Appeals/Grievances Contact	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	MA Claims Processing Contact for Public Website	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	amy.dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Marketing Contact	Director of Business Development and Enrollment	Mrs.	Katz	Amy		8554454554				2485569150	amy.katz@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Medical Director	Medical Director	Dr.	Graddy	Gwendolyn		8554454554					ggraddy1@yahoo.com	21700 Northwestern Highway		Southfield	MI	48075	03/10/2023	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Medicare Compliance Officer	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Medicare Coordinator	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	amy.dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Ms.	Rood	Janis		8554454554				2485569150	janis.rood@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Medication Therapy Management Contact	Director of Pharmacy	Mrs.	Rood	Janis		8554454554					Janis.rood@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Online Enrollment Center Contact (Back-up)	President & CEO	Ms.	Naber	Mary		8554454554				2485569150	mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Online Enrollment Center Contact (Primary)	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Part C Application Contact	President & CEO	Ms.	Naber	Mary		8554454554				2485439150	mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/17/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Part D Appeals	Pharmacy Director	Ms.	Rood	Janis						2485569150	Janis.Rood@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	01/04/2021	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active	8554454554				PACE - Nat		C	Chicago
H2318	Part D Appeals Contact (Secondary)	Quality Director	Ms.	Diroff	Tracey							Tracey.Diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	01/04/2021	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active	8554454554				PACE - Nat		C	Chicago
H2318	Part D Application Contact	President & CEO	Ms.	Naber	Mary		8554454554				2485439150	mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/17/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Part D Benefits Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	amy.dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Part D Claims Submission Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	amy.dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Part D Exceptions Contact	Director of Pharmacy	Mrs.	Rood	Janis							Janis.rood@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active	8554454554				PACE - Nat		C	Chicago
H2318	Part D Exceptions Contact (Secondary)	Quality Director	Ms.	Diroff	Tracey						2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active	8554454554				PACE - Nat		C	Chicago
H2318	Part D Price File Contact (Back-up)	President & CEO	Ms.	Naber	Mary		8554454554				2485569150	mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Part D Price File Contact (Optional)	President & CEO	Ms.	Naber	Mary		8554454554				2485569150	mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Part D Price File Contact (Primary)	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	amy.dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Part D Quality Assurance Contact	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Part D Reporting Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	amy.dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Patient Safety Contact	quality director	Mrs.	Diroff	Tracey		2485569150					tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Payment Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/18/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Personal Health Record Contact	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Pharmacy Director	Director of Pharmacy	Ms.	Rood	Janis		2482237320					Janis.Rood@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/19/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Pharmacy Network Management Contact	Director of Pharmacy	Ms.	Rood	Janis		2482237320					Janis.Rood@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/19/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Pharmacy Network Management Contact (Secondary)	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Pharmacy Technical Help Desk Contact	Director of Pharmacy	Ms.	Rood	Janis							Janis.Rood@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/19/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active	1855445455				PACE - Nat		C	Chicago
H2318	Pharmacy Technical Help Desk Contact (Secondary)	quality director	Ms.	Diroff	Tracey						2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/19/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active	8554454554				PACE - Nat		C	Chicago
H2318	PHR Beneficiary Contact																	03/03/2017	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE	PACE Southeast Michigan	Henry Ford Health System	122	Yes	Active	8554454554				PACE - Nat		C	Chicago
H2318	Plan Directory Contact for Public Website	VP of Public Affairs	Ms.	Arora	Laurie		8554454554				2485569150	laurie.arora@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/19/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Plan to Plan Reconciliation Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/19/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Processor Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/19/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Quality Contact	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Reconciliation Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/19/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Reconciliation Contact (Secondary)	Chief Financial Officer	Mr.	Burmeister	Jeff		2485569132				2485569150	jeff.burmeister@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	05/09/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Recovery Audit Contact	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Surveillance Contact	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	System Contact	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/19/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Third Party Administrator (TPA) Liaison	Director of Finance	Mrs.	Dresselhouse	Amy		2485569168				2485569150	Amy.Dresselhouse@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	02/19/2022	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	User Access Contact	President & CEO	Ms.	Naber	Mary		8554454554				2485569150	mary.naber@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Utilization Management Contact	Medical Director	Dr.	Graddy	Gwendolyn		2485569126					ggraddy1@yahoo.com	21700 Northwestern Highway		Southfield	MI	48075	03/10/2023	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2318	Utilization Review Contact	Quality Director	Ms.	Diroff	Tracey		8554454554				2485569150	tracey.diroff@pacesemi.org	21700 Northwestern Highway		Southfield	MI	48075	08/19/2020	2023	PACE SOUTHEAST MICHIGAN	National PACE	PACE Southeast Michigan	National PACE		Henry Ford Health System	122	Yes	Active					PACE - Nat		C	Chicago
H2320	Agent/Broker Compensation Data Contact	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Automated TrOOP Balance Transfer Contact	Enrollment Coordinator		Rice	Lori		6164648667					PH-MedicareTrOOPContact@PriorityHealth.com	1231 East Beltline Ave NE	MS 1175	Grand Rapids	MI	49525	03/21/2018	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Backup User Access Contact	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Best Available Evidence Contact	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	09/30/2020	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Bid Audit Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Bid Audit Site Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Bid Primary Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	CAP Report Contact for Public Website	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648824					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648424				HMO - Health Maintenance Organization		C	Chicago
H2320	CEO - CMS Administrator Contact	CEO	Mr	Thandani	Praveen		6164949365				6169421150	CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	01/13/2021	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	CEO - Senior Official for Contracting	Vice President Medicare	Mr	Norman	Scott		2488803191					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	07/29/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Chief Financial Officer	Chief Financial Officer	Mr	Gates	Nick	P	6164648144					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	08/12/2021	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Chief Operating Officer	CEO	Mr	Thandani	Praveen		6164649365					CEOMedicare@priorityhealth.com	1231 East Beltine NE		Grand Rapids	MI	49525	08/12/2021	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Chief Information Officer	Chief Information Officer	Mr	Crook	Chris		6164649939					CEOMedicare@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	03/20/2018	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Chief Information Security Officer	SVP, IS Technology Services	Mr	Dresen	Scott		6164864277					CEOMedicare@priorityhealth.com	100 Michigan Street NE	MC 843	Grand Rapids	MI	49503	03/20/2018	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	CMMI Model Point of Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	CMS Casework Communication Contact	Manager for Business Monitoring - G & A		LaBelle	Julie		9178417869					Radha.LaBelle@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	12/14/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Complaints Tracking Contact	Manager for Business Monitoring - G & A		LaBelle	Julie		9178417869					Radha.LaBelle@priorityhealth.com	1231 East Beltline Ave NE	MS 1115	Grand Rapids	MI	49525	12/14/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Contact for Fraud Investigations	Manager, Special Investigations Unit		Gross	Brenda		6164648152					Brenda.Gross@PriorityHealth.com	1231 E Beltline Ave NE		Grand Rapids	MI	49525	08/20/2015	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Coordination of Benefits Contact	Claims Manager		Ball	Jill		8883896648					CEOMedicare@priorityhealth.com	1239 East Beltline Ave NE	MS2205	Grand Rapids	MI	49525	04/14/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Corporate Mailing						6169420954				6164640145	PH-DistributionSE@PriorityHealth.com	1231 East Beltline Ave, NE		Grand Rapids	MI	49525	12/05/2005	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Coverage Gap Discount Program (CGDP) Payment Contact	Operations Supervisor		Johnston	Adam		6164648915					adam.johnston@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	03/06/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Customer Service Operations Contact	Customer Care Center Manager, Medicare		Storment	Joe		5033309550					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	12/07/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	DIR Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	12/06/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	DIR Contact (Secondary)	Senior Financial Analyst		McZee	Nikki		6164648205					nikki.mczee@corewellhealth.org	1231 East Beltline Ave NE		Grand Rapids	MI	49525	02/21/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Electronic Health Record Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648824					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648424				HMO - Health Maintenance Organization		C	Chicago
H2320	Emergency Part D Contact	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	12/06/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Emergency Part D Contact (Secondary)	Manager, Medicare Pharmacy Operations		VanLoenen	Amanda		6164648750					Amanda.VanLoenen@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	04/03/2017	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Employer Waiver Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Encounter Data & Risk Adjustment Operations Contact			Florn	Cathy		7348902858					cathy.florn@priorityhealth.com	1239 E Beltline Ave Ne		Grand Rapids	MI	49525	09/27/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Enrollment Contact	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	09/30/2020	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	EOB Transfer Contact	Claims Manager		Ball	Jill		6164648044				6169750247	CEOMedicare@priorityhealth.com	1239 East Beltline Ave NE	MS 2205	Grand Rapids	MI	49525	02/16/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Financial Audit Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Financial Reporting Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Formulary Contact	Medicare Part D Operations Manager		Van Loenen	Amanda		6164648750					PH-MedicareFormularyContact@PriorityHealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	12/24/2015	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	General Contact	Vice President Medicare	Mr	Norman	Scott		2488803191					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	07/29/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Government Relations Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	HIPAA Privacy Officer	VP, Compliance & Privacy Officer		Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS1155	Grand Rapids	MI	49525	08/24/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	HIPAA Security Officer			Dresen	Scott		6164864277					CEOMedicare@priorityhealth.com	100 Michigan Street NE		Grand Rapids	MI	49503	03/21/2018	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Hospice Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Interoperability Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	MA Appeals/Grievances Contact	Manager Grievance & Appeal		Macdonald	Amanda		6164648264					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1115	Grand Rapids	MI	49525	12/14/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	MA Claims Processing Contact for Public Website	Claims Manager		Ball	Jill		6164648044					CEOMedicare@priorityhealth.com	1239 East Beltline Ave NE	MS 2205	Grand Rapids	MI	49525	02/16/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Marketing Contact	Sr. Markets & Product Development Director		Brown	Samia		6164648002					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	01/25/2021	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Medical Director	Medicare Director		Forshee	James		6164644873					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/04/2019	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Medicare Compliance Officer	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					cindy.rollenhagen@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Medicare Coordinator	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Medicare Part D Opioid Overutilization Contact	Medicare Quality Manager		Gutierrez	Salvador		6165757622					salvador.gutierrez@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	02/07/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Medication Therapy Management Contact	Director of Pharmacy Operations		Chaffee	Jacob		6168261329					jacob.chaffee@priorityhealth.com	1231 East Beltline Dr Ne		Grand Rapids	MI	49525	05/18/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	OffShore Subcontractor Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Online Enrollment Center Contact (Optional)	Government Programs Enrollment Coordinator		Rice	Lori		6164648667					lori.rice@priorityhealth.com	1231 East Beltline Ave NE	MS 1180	Grand Rapids	MI	49525	01/07/2014	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Online Enrollment Center Contact (Primary)	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	09/30/2020	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Part C Application Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Part C Reporting Contact	Sr. Compliance Analyst		Eizinger	Eric		2178400871					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Appeals	Supervisor, Medicare Part D Appeals		Anderson	Melissa							PHMedicarePartDAPPLS@spectrumhealth.org	1231 East Beltline Ave NE		Grand Rapids	MI	49525	04/02/2020	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648547				HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Appeals Contact (Secondary)	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy							CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648424				HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Application Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Benefits Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Claims Submission Contact	Manager, Medicare Part D Operations		Van Loenen	Amanda		6164648750					part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	03/21/2018	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Exceptions Contact			Help Desk	Pharmacy							part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	02/04/2018	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	8004666642				HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Exceptions Contact (Secondary)	Mgr, Medicare Part D Operations	Ms.	Van Loenen	Amanda							amanda.vanloenen@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	11/18/2016	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648750				HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Price File Contact (Back-up)	Product Manager Advisor		Williams	Stephanie		5135091549					Medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	11/22/2021	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Price File Contact (Optional)	Manager, Medicare Part D Operations		Van Loenen	Amanda		6164648750					part.d.ops@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	02/05/2018	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/22/2021	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Quality Assurance Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Part D Reporting Contact	Sr. Compliance Analyst		Eizinger	Eric		2178400871					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Patient Safety Contact	Clinical Pharmacy Program Manager	Mr	Chaffee	Jacob		6165756149					CEOMedicare@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	10/09/2020	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Payment Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	12/06/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Personal Health Record Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Pharmacy Director	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	12/06/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Pharmacy Network Management Contact	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	12/06/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Pharmacy Network Management Contact (Secondary)	Manager, Medicare Pharmacy Operations		Van Loenen	Amanda		6164648750					amanda.vanloenen@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	04/03/2017	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Pharmacy Technical Help Desk Contact			Help Desk	Pharmacy							part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	02/04/2018	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	8004666642				HMO - Health Maintenance Organization		C	Chicago
H2320	Pharmacy Technical Help Desk Contact (Secondary)	Mgr, Medicare Part D Ops	Ms.	Van Loenen	Amanda							amanda.vanloenen@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	11/18/2016	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648750				HMO - Health Maintenance Organization		C	Chicago
H2320	Physician Incentive Contact	Director, Provider Strategy & Solutions		Ryan	Susan		3137010444					CEOMedicare@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	12/06/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Plan Directory Contact for Public Website			Service	Customer		8883896648					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	03/20/2018	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Plan to Plan Reconciliation Contact	Reconciliation & Billing Specialist		Bentley-Brown	Linda		6164648582				6169573420	linda.bentley-brown@priorityhealth.com	1231 East Beltline Ave NE	MS 1190	Grand Rapids	MI	49525	12/02/2014	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Processor Contact	ESI Sr Dir - Product Management Medicare		Mahon	Snezana		3146846361					SMahon@express-scripts.com	ESI	One Express Way	St. Louis	MO	63121	12/24/2015	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Quality Contact	Manager, Quality	Mr	Straayer	Ian		6165752782					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	10/09/2020	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Reconciliation Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	12/06/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Reconciliation Contact (Secondary)	Manager, Finance Reporting		Hendricks	Rachel		6164648205					rachel.hendricks@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	02/22/2021	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Recovery Audit Contact	Manager Cost Recovery	Ms	Gross	Brenda		6164648152					brenda.gross@priorityhealth.com	1231 East Beltline NE	Mail Stop 2305	Grand Rapids	MI	49525	05/15/2014	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	SNP Application Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					janine.bishop@priorityhealth.com	1231 E Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	SNP State Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					janine.bishop@priorityhealth.com	1231 E Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Surveillance Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	System Contact	Data Analytics Analyst-Senior, Sr Markets		Johnson	Joshua		6165755760					PH-MedicareSystemsContact@PriorityHealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	07/18/2016	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Third Party Administrator (TPA) Liaison	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					cindy.rollenhagen@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/06/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	User Access Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Utilization Management Contact	Director, Utilization Mgmt PH Pre-Service		Mahoney	Diana		8439068561					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	12/06/2022	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2320	Utilization Review Contact	Director, Medicare Care Management		Scovel	Janet		6164648656					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2019	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2322	Agent/Broker Compensation Data Contact	Director, Producer Relations		Howard	Michelle		2484438530					mhoward@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2018	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Automated TrOOP Balance Transfer Contact	Medicare Part D Manager		Smith	Leah		3136648724					lsmith17@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/04/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Backup User Access Contact	Compliance Specialist		Burks	Erica		2487763543					eburks@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Best Available Evidence Contact	Manager, Membership & Billing		Mullins	Rhonda		2484437532					rmullins@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	12/22/2017	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Bid Audit Contact	Lead Product Consultant		Simerau	Jennie		8109558244					jsimerau@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/16/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Bid Audit Site Contact	Lead Product Consultant		Simerau	Jennie		8109558244					jsimerau@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/16/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Bid Primary Contact	Associate Actuary, Actuarial & HC Analytics	Ms.	Vrantsidis	Katherine	A	2484432022					KVrants1@HAP.ORG	1414 E Maple Road		Troy	MI	48083	05/25/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	CAP Report Contact for Public Website	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	CEO - CMS Administrator Contact	President and CEO	Dr.	Genord	Mike		3136648361					mgenord@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	CEO - Senior Official for Contracting	President and CEO	Dr.	Genord	Mike		3136648361					mgenord@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Chief Financial Officer	SVP, Chief Financial Officer	Mr.	Hausenfluck	Merrill		2487763530					mhausen1@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	08/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Chief Operating Officer	Chief Operating Officer	Mr	Treash	Mike		3136648855					mtreash@hap.org	2850 West Grand Blvd		Detroit	MI	48202	03/17/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Chief Information Officer	CIO	Ms	Marcath	Annette		3136648166					amarcath@hap.org	2850 W Grand Blvd		Detroit	MI	48202	05/04/2017	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Chief Information Security Officer	Interim	Ms	Skolnik	Johanna		3138746635					jskolni1@hfhs.org	One Ford Place, 2A		Detroit	MI	48202	07/30/2018	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	CMS Casework Communication Contact	Appeals & Grievances Analyst	Ms.	Abazid	Wassan		3136648495				3136645845	wabazid@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/28/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Complaints Tracking Contact	Appeals & Grievances Analyst	Ms.	Abazid	Wassan		3136648495				3136645845	wabazid@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/28/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Contact for Fraud Investigations	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Coordination of Benefits Contact	VP- Claim Services		Palermo	Charles		2484438830					cpalermo@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Corporate Mailing						3136648048					kvanduse@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	03/16/2018	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst	Ms.	NASSER	ZEINAT		2487764040					ZNASSER@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/18/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Customer Service Operations Contact	Director	Ms	Pope	Venus		3136648933				3136648433	vpope@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	08/16/2017	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	DIR Contact	Medicare Part D Manager		Smith	Leah		3136648724				3136645965	lsmith17@hap.org	2850 West Grand Blvd		Detroit	MI	48202	01/04/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	DIR Contact (Secondary)	Coor- Pharmacy Benefits		Peterson	Jennifer		3136648125					jpeterso@hap.org	2850 W Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Emergency Part D Contact	VP- Amb Clinical Pharmacy Svcs		Pirkola	Natalie		5865241175					npirkol2@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Emergency Part D Contact (Secondary)	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 West Grand Blvd		Detroit	MI	48202	04/22/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Employer Waiver Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Encounter Data & Risk Adjustment Operations Contact	Manager, RMRA Data Management & Analytics	Mr.	Voss	James		2487763480					jvoss3@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/27/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Enrollment Contact	Manager, Membership & Billing		Mullins	Rhonda		2484437532					rmullins@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	12/22/2017	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	EOB Transfer Contact	Director, Producer Relations		Howard	Michelle		2484438530				2484438530	mhoward@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2018	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Financial Audit Contact	Director of Financial Operations	Mr.	Koslakiewicz	Glen		2484431094					gkoslaki@HAP.ORG	2850 W. Grand Blvd		Detroit	MI	48202	08/24/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Financial Reporting Contact	Finance Manager	Ms.	Tran	Anh	K	2064533049					atran7@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Formulary Contact	Pharmacy Analyst		Wade	Marsalis		2487764726					mwade@hap.org	2850 West Grand Blvd		Detroit	MI	48202	05/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Formulary Contact (Secondary)	Medicare Part D Manager		Yaldo	Traci		3136648607					tyaldo@hap.org	2850 West Grand Blvd		Detroit	MI	48202	01/04/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	General Contact	Director, Government Programs Compliance	Mr.	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/14/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Government Relations Contact	Director, Government Programs Compliance	Ms	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	HIPAA Privacy Officer	Interim	Ms	Skolnik	Johanna		3138746635					jskolni1@hfhs.org	One Ford Place, 2A		Detroit	MI	48202	07/30/2018	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	HIPAA Security Officer	Deputy Information Security Officer		Fowler	John		3138749150					jfowler2@hfhs.org	One Ford Place, 2A		Detroit	MI	48202	07/30/2018	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Hospice Contact	Medicare Part D Manager		Smith	Leah		3136648724					lsmith17@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	01/04/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Interoperability Contact	VP - Chief Information Officer		Marcath	Annette		3136648166					amarcath@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	02/15/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	MA Appeals/Grievances Contact	Director, Appeals & Grievance		Krzyske	Heather		2485572370					hkrzyske@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	MA Claims Processing Contact for Public Website	Director, Claims Admin		Boyle	Therese		2484432035					tboyle@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/06/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Marketing Contact	Dir- Digital Engagement		Donelko	Stephanie	C	2484434080					sdonelk1@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Medical Director	Chief Medical Officer	Dr.	Watson	Peter		2486633842					pwatson3@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	12/17/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Medicare Compliance Officer	Director	Mr.	Randle	Johnathan		5123507810					jrandle4@hap.org	1414 E Maple		Troy	MI	48303	08/25/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Medicare Coordinator	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	05/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Medicare Part D Opioid Overutilization Contact	Mgr. Pharmacy Benefits		Barta	Kelly		2487763556					kbarta@hap.org	Coordinator, Pharmacy Benefits		Detroit	MI	48202	05/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Medication Therapy Management Contact	VP , Ambulatory Clinical Pharmacy Services		Pirkola	Natalie		2487764097					npirkol2@hap.org	2850 West Grand Blvd		Detroit	MI	48202	08/09/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	OffShore Subcontractor Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/22/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Online Enrollment Center Contact (Back-up)	Dir, Commercial Enrollment		Rader	Tracie		2484431154					trader2@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	07/24/2019	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Online Enrollment Center Contact (Optional)	Manager, Medicare Operations		Mullins	Rhonda		2484437532					rmullins@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	12/22/2017	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Online Enrollment Center Contact (Primary)	Director, Producer Relations		Howard	Michelle		2484438530					mhoward@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2018	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Part C Application Contact	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	05/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Part C Reporting Contact	Director, Government Programs Compliance	Mr	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/17/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Part D Appeals	Director - Utilization Management	Ms.	Krzyske	Heather							hkrzyske@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/08/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active	2485572370				PPO - BBA		C	Chicago
H2322	Part D Appeals Contact (Secondary)	Appeals and Grievance Manager		Baringhaus	Christophe							cbaringh@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active	2485573141				PPO - BBA		C	Chicago
H2322	Part D Application Contact	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	05/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Part D Benefits Contact	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd		Detroit	MI	48202	05/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Part D Claims Submission Contact	Medicare Part D Manager		Smith	Leah		3136648724					lsmith17@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/04/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Part D Exceptions Contact	Coordinator, Pharmacy Benefits		Yaldo	Traci							tyaldo@hap.org	2850 West Grand Blvd		Detroit	MI	48202	07/23/2019	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active	3136648607				PPO - BBA		C	Chicago
H2322	Part D Exceptions Contact (Secondary)	Mgr. Pharmacy Benefits		Barta	Kelly							kbarta@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	05/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active	2487763556				PPO - BBA		C	Chicago
H2322	Part D Price File Contact (Back-up)	Sr. Manager, Government Programs		Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2018	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Part D Price File Contact (Optional)	Coordinator, Pharmacy Benefits		Peterson	Jennifer		3136648125					jpeterso@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	07/24/2019	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Part D Price File Contact (Primary)	Director, Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	7909 S Hardy Drive Suite 106		Tempe	AZ	85284	12/31/2018	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Part D Quality Assurance Contact	Mgr. Pharmacy Benefits		Barta	Kelly		2487763556					kbarta@hap.org	2850 West Grand Blvd		Detroit	MI	48202	05/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Part D Reporting Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 West Grand Blvd		Detroit	MI	48202	04/22/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Patient Safety Contact	VP-Amb Clinical Pharmacy Svcs		Pirkola	Natalie		3136648501					npirkol2@hap.org	2850 West Grand Blvd		Detroit	MI	48202	05/02/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Payment Contact	VP-Financial Services		Ronan	Dianna		2484431093					dronan@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/06/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Personal Health Record Contact	Chief Information Officer		Marcath	Annette		3136648166					amarcath@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	12/29/2015	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Pharmacy Director	VP, Pharmacy Health Plan Administration		Pirkola	Natalie		2487764097					apetitta@hap.org	2850 West Grand Blvd		Detroit	MI	48202	12/14/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra		Kelly	Heather		3146921866					hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2018	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Pharmacy Network Management Contact (Secondary)	Pharmacy Specialist		Webb	Marcia		3136648860					mwebb2@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	12/21/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Pharmacy Technical Help Desk Contact	Director Customer Service		Monroe	LaTasha							latasha_monroe@express-scripts.com	13051 N. Telecom Parkway	Suite 150	Temple Terrace	FL	33637	12/14/2022	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active	8009221557				PPO - BBA		C	Chicago
H2322	PHR Beneficiary Contact																	02/04/2013	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO	Health Alliance Plan of Michigan	Henry Ford Health System	122	Yes	Active	8008011770				PPO - BBA		C	Chicago
H2322	Physician Incentive Contact	Director, Government Programs Compliance	Mr	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/17/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Plan Directory Contact for Public Website	VP-Enterprise Operations		Spencer	Heather		2487763808					hspence2@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Plan to Plan Reconciliation Contact	Finance Manager	Ms.	Tran	Anh	K	2064533049					atran7@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Processor Contact	Medicare Part D Manager		Smith	Leah		3136648724					lsmith17@hap.org	2850 West Grand Blvd		Detroit	MI	48202	01/04/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Quality Contact	Senior Director		Germain	Carrie		8102302299					cgermain@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/19/2021	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Reconciliation Contact	Finance Manager	Ms.	Tran	Anh	K	2064533049					atran7@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Reconciliation Contact (Secondary)	Principal Financial Analyst	Mr.	Puscas	Gerald		2484432023				2484431163	gpuscas@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Recovery Audit Contact	Finance Manager	Ms.	Tran	Anh	K	2064533049				2484431163	atran7@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Surveillance Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	System Contact	Chief Information Officer		Marcath	Annette		3136648166					amarcath@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	12/29/2015	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Third Party Administrator (TPA) Liaison	Finance Manager	Ms.	Tran	Anh	K	2064533049					atran7@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/18/2023	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	User Access Contact	Sr. Compliance Consultant		Burnett	Barb		8102302173					bburnett@hap.org	2050 S. Linden Road		Flint	MI	48532	10/15/2019	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Utilization Management Contact	VP Utilization Management		Bloom, M.D.	Charles		2485576298					cbloom@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	12/22/2017	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2322	Utilization Review Contact	VP Utilization Management		Bloom, M.D.	Charles		2485576298					cbloom@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	12/22/2017	2023	ALLIANCE HEALTH AND LIFE INSURANCE COMPANY	Local CCP	HAP Senior Plus (PPO)	Local PPO		Henry Ford Health System	122	Yes	Active					PPO - BBA		C	Chicago
H2334	Agent/Broker Compensation Data Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/07/2023	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Automated TrOOP Balance Transfer Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Backup User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Best Available Evidence Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Bid Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Bid Audit Site Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/27/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Bid Primary Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	CAP Report Contact for Public Website	Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/28/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	8773841241				PPO - BBA		C	Chicago
H2334	CEO - CMS Administrator Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	CEO - Senior Official for Contracting	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Chief Financial Officer	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Chief Operating Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Chief Information Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Chief Information Security Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	CMMI Model Point of Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	CMS Casework Communication Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Complaints Tracking Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Contact for Fraud Investigations	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Coordination of Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Corporate Mailing						8476968500					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway		Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	Thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Customer Service Operations Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	DIR Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	DIR Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Electronic Health Record Contact		Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/07/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Emergency Part D Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Emergency Part D Contact (Secondary)	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Encounter Data & Risk Adjustment Operations Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/18/2023	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Enrollment Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	EOB Transfer Contact	Claims Manager	Mr.	Salgado	Miguel		8476968578				8008861082	Miguel.Salgado@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	10/04/2021	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Financial Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Financial Reporting Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Formulary Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3308886015	Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Formulary Contact (Secondary)	Pharmacy Director		Lopez	Eduardo		7542085867					elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/07/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	General Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Government Relations Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	HIPAA Privacy Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	HIPAA Security Officer	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539				8555158166	Eric.Annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Hospice Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Interoperability Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	MA Appeals/Grievances Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	MA Claims Processing Contact for Public Website	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Marketing Contact	VP of Marketing	Ms.	Branco	Margaret		7187957495					margaret.branco@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/06/2023	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Medical Director		Dr	Butt	Tariq		3125458471					tariq.butt@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	11/09/2021	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Medicare Compliance Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Medicare Coordinator	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Medicare Part D Opioid Overutilization Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Medication Therapy Management Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3304058084	Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	OffShore Subcontractor Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Online Enrollment Center Contact (Primary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 302	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Part C Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Part C Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Part D Appeals			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy	Suite 450	Dublin	OH	43017	12/28/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	8003443405	733326			PPO - BBA		C	Chicago
H2334	Part D Appeals Contact (Secondary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica							Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue		Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	7542085865				PPO - BBA		C	Chicago
H2334	Part D Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Part D Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Part D Claims Submission Contact			Dovico	Rosario		2012696398					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Part D Exceptions Contact			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	6143363326				PPO - BBA		C	Chicago
H2334	Part D Price File Contact (Back-up)			Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Part D Price File Contact (Optional)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Part D Price File Contact (Primary)			Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Part D Quality Assurance Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Part D Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Patient Safety Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Payment Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Pharmacy Director	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Pharmacy Network Management Contact			Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Pharmacy Network Management Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Pharmacy Technical Help Desk Contact			Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	08/04/2021	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	8009221557				PPO - BBA		C	Chicago
H2334	Plan Directory Contact for Public Website	Vice President, Provider Operations	Ms.	Cuevas	Elizabeth		7542085880					Elizabeth.Cuevas@clearspringhealthcare.com	250 South Northwest Highway Suite 302	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Plan to Plan Reconciliation Contact	Senior Accountant	Ms.	Wrenn	Alisa		2249855588				3124290194	Alisa.Wrenn@Clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Processor Contact			Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Quality Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Reconciliation Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Recovery Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Surveillance Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	System Contact	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539					eric.annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Third Party Administrator (TPA) Liaison	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Utilization Management Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2334	Utilization Review Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H2354	Agent/Broker Compensation Data Contact	Director, Producer Relations		Howard	Michelle		2484438530					mhoward@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2018	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Automated TrOOP Balance Transfer Contact	Medicare Part D Manager		Smith	Leah		3136648724					lsmith17@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/04/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Backup User Access Contact	Contract Administrator		Burks	Erica		2487763543					eburks@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	01/03/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Best Available Evidence Contact	Manager, Membership & Billing		Mullins	Rhonda		2484437532					rmullins@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	12/22/2017	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Bid Audit Contact	Lead Product Consultant		Simerau	Jennie		8109558244					jsimerau@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/16/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Bid Audit Site Contact	Lead Product Consultant		Simerau	Jennie		8109558244					jsimerau@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/16/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Bid Primary Contact	Associate Actuary, Actuarial & HC Analytics	Ms.	Vrantsidis	Katherine	A	2484432022					KVrants1@HAP.ORG	1414 E Maple Road		Troy	MI	48083	05/25/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	CAP Report Contact for Public Website	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	CEO - CMS Administrator Contact	President and CEO	Dr.	Genord	Mike		3136648361					mgenord@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	CEO - Senior Official for Contracting	President and CEO	Dr.	Genord	Mike		3136648361					mgenord@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Chief Financial Officer	SVP, Chief Financial Officer	Mr.	Hausenfluck	Merrill		2487763530					mhausen1@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	08/02/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Chief Operating Officer	Chief Operating Officer	Mr	Treash	Mike		3136648855					mtreash@hap.org	2850 West Grand Blvd		Detroit	MI	48202	03/17/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Chief Information Officer	CIO	Ms	Marcath	Annette		3136648166					amarcath@hap.org	2850 W Grand Blvd		Detroit	MI	48202	07/23/2019	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Chief Information Security Officer	Interim	Ms	Skolnik	Johanna		3138746635					jskolni1@hfhs.org	One Ford Place, 2A		Detroit	MI	48202	07/30/2018	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	CMS Casework Communication Contact	Appeals & Grievances Analyst	Ms.	Abazid	Wassan		3136648495				3136645845	wabazid@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/28/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Complaints Tracking Contact	Appeals & Grievances Analyst	Ms.	Abazid	Wassan		3136648495				3136645845	wabazid@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/28/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Contact for Fraud Investigations	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Coordination of Benefits Contact	VP- Claim Services		Palermo	Charles		2484438830					cpalermo@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Corporate Mailing						3136648048					kvanduse@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	03/16/2018	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst	MS.	NASSER	ZEINAT		2487764040					ZNASSER@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Customer Service Operations Contact	Director	Ms	Pope	Venus		3136648933				3136648433	vpope@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	08/16/2017	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	DIR Contact	Medicare Part D Manager		Smith	Leah		3136648724				3136645965	lsmith17@hap.org	2850 West Grand Blvd		Detroit	MI	48202	01/04/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	DIR Contact (Secondary)	Coor - Pharmacy Benefits		Peterson	Jennifer		3136648125					jpeterso@HAP.ORG	2850 W Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Emergency Part D Contact	VP, Pharmacy Health Plan Administration		Pirkola	Natalie		5865241175					npirkol2@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	12/22/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Emergency Part D Contact (Secondary)	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 West Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Employer Waiver Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Encounter Data & Risk Adjustment Operations Contact	Manager, RMRA Data Management & Analytics	Mr.	Voss	James		2487763480					jvoss3@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/27/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Enrollment Contact	Manager, Membership & Billing		Mullins	Rhonda		2484437532					rmullins@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	12/22/2017	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	EOB Transfer Contact	Director, Producer Relations		Howard	Michelle		2484438530				2484438530	mhoward@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2018	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Financial Audit Contact	Director Finance	Mr.	Koslakiewicz	Glen		1248443109					gkoslaki@HAP.ORG	2850 W. Grand Blvd		Detroit	MI	48202	12/23/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Financial Reporting Contact	Principal Financial Analyst	Mr.	Puscas	Gerald		2484432023				2484431163	gpuscas@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Formulary Contact	Pharmacy benefits coordinator		Thomas	Jennifer		3136648737					jthomas9@hap.org	1414 E Maple rd		Troy	MI	48083	08/25/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Formulary Contact (Secondary)	Pharmacy Manager		Getz	Stuart		8106008032					sgetz@hap.org	1414 E Maple rd		Troy	MI	48083	08/25/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	General Contact	Director, Government Programs Compliance	Mr.	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/14/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Government Relations Contact	Director, Government Programs Compliance	Ms	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	HIPAA Privacy Officer	Interim	Ms	Skolnik	Johanna		3138746635					jskolni1@hfhs.org	One Ford Place, 2A		Detroit	MI	48202	07/30/2018	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	HIPAA Security Officer	Deputy Information Security Officer		Fowler	John		3138749150					jfowler2@hfhs.org	One Ford Place, 2A		Detroit	MI	48202	07/30/2018	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Hospice Contact	Medicare Part D Manager		Smith	Leah		3136648724					lsmith17@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	01/04/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Interoperability Contact	VP - Chief Information Officer		Marcath	Annette		3136648166					amarcath@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	02/15/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	MA Appeals/Grievances Contact	Interim Director		Krzyske	Heather		2485572370					hkrzyske@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/19/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	MA Claims Processing Contact for Public Website	Director, Claims Admin		Boyle	Therese		2484432035				3136648433	tboyle@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/06/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Marketing Contact	Dir- Digital Engagement		Donelko	Stephanie	C	2484434080					sdonelk1@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Medical Director	Chief Medical Officer	Dr.	Watson	Peter		2486633842					pwatson3@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	12/14/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Medicare Compliance Officer	Director	Mr.	Randle	Johnathan		5123507810					jrandle4@hap.org	1414 E Maple		Troy	MI	48303	08/25/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Medicare Coordinator	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	05/06/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Medicare Part D Opioid Overutilization Contact	Mgr. Pharmacy Benefits		Barta	Kelly		2487763556					kbarta@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	05/10/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Medication Therapy Management Contact	VP, Ambulatory Clinical Pharmacy Services		Pirkola	Natalie		2487764097					npirkol2@hap.org	2850 West Grand Blvd		Detroit	MI	48202	08/09/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	OffShore Subcontractor Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/22/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Online Enrollment Center Contact (Back-up)	Dir, Commercial Enrollment		Rader	Tracie		2484431154					trader2@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	07/24/2019	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Online Enrollment Center Contact (Optional)	Manager, Medicare Operations		Mullins	Rhonda		2484437532					rmullins@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	12/22/2017	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Online Enrollment Center Contact (Primary)	Director, Producer Relations		Howard	Michelle		2484438530					mhoward@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2018	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Part C Application Contact	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Part C Reporting Contact	Director, Government Programs Compliance	Mr	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/17/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Appeals	Director - Utilization Management	Ms.	Krzyske	Heather							hkrzyske@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/08/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active	2485572370				HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Appeals Contact (Secondary)	Appeals and Grievance Manager		Baringhaus	Christophe							cbaringh@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active	2485573141				HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Application Contact	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Benefits Contact	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd		Detroit	MI	48202	05/10/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Claims Submission Contact	Medicare Part D Manager		Smith	Leah		3136648724					lsmith17@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/04/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Exceptions Contact	Medicare Part D Manager		Yaldo	Traci							tyaldo@hap.org	2850 West Grand Blvd		Detroit	MI	48202	01/04/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active	3136648607				HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Exceptions Contact (Secondary)	Mgr. Pharmacy Benefits		Barta	Kelly							kbarta@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	05/10/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active	2487763556				HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Price File Contact (Back-up)	Sr. Manager, Government Programs		Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2018	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Price File Contact (Optional)	Coordinator, Pharmacy Benefits		Peterson	Jennifer		3136648125					jpeterso@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	07/24/2019	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Price File Contact (Primary)	Director, Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	7909 S Hardy Drive Suite 106		Tempe	AZ	85284	12/31/2018	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Quality Assurance Contact	Mgr. Pharmacy Benefits		Barta	Kelly		2487763556					kbarta@hap.org	2850 West Grand Blvd		Detroit	MI	48202	05/10/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Part D Reporting Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 West Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Patient Safety Contact	VP - Amb Clinical Pharmacy Services		Pirkola	Natalie		3136648501					npirkol2@HAP.ORG	2850 West Grand Blvd		Detroit	MI	48202	12/23/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Payment Contact	VP-Financial Services		Ronan	Dianna		2484431093					dronan@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Personal Health Record Contact	Chief Information Officer		Marcath	Annette		3136648166					amarcath@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	12/29/2016	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Pharmacy Director	VP, Pharmacy Health Plan Administration		Pirkola	Natalie		3136648838					npirkol2@hap.org	2850 West Grand Blvd		Detroit	MI	48202	12/14/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra		Kelly	Heather		3146921866					hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2018	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Pharmacy Network Management Contact (Secondary)	Pharmacy Specialist		Webb	Marcia		3136648860					mwebb2@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	12/21/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Pharmacy Technical Help Desk Contact	Director Customer Service		Monroe	LaTasha							latasha_monroe@express-scripts.com	13051 N. Telecom Parkway	Suite 150	Temple Terrace	FL	33637	12/14/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H2354	PHR Beneficiary Contact																	12/29/2016	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS	Health Alliance Plan of Michigan	Henry Ford Health System	122	Yes	Active	8008011770				HMO - Health Maintenance Organization		C	Chicago
H2354	Physician Incentive Contact	Director, Government Programs Compliance	Mr.	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/14/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Plan Directory Contact for Public Website	VP-Enterprise Operations		Spencer	Heather		2487763808					hspence2@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/08/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Plan to Plan Reconciliation Contact	Financial Analyst	Ms.	NASSER	ZEINAT		2487764040					ZNASSER@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Processor Contact	Medicare Part D Manager		Smith	Leah		3136648724					lsmith17@hap.org	2850 West Grand Blvd		Detroit	MI	48202	01/04/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Quality Contact	Senior Director		Germain	Carrie		8102302299					cgermain@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/19/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Reconciliation Contact	Finance Manager	Ms.	Tran	Anh	K	2064533049					atran7@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Reconciliation Contact (Secondary)	Principal Financial Analyst		Puscas	Gerald	K	2484432023					gpuscas@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Recovery Audit Contact	Principal Financial Analyst	Mr.	Puscas	Gerald		2484432023				2484431163	gpuscas@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	SNP Application Contact	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	06/28/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	SNP State Contact	Director of Medicaid Programs		Davis	Nancy		8004224641					ndavis@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	06/09/2021	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Surveillance Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	System Contact	Chief Information Officer		Marcath	Annette		3136648166					amarcath@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	12/29/2016	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Third Party Administrator (TPA) Liaison	Finance Manager	Ms.	Tran	Anh	K	2064533049					atran7@hap.org	2850 W. Grand Boulevard		Detroit	MI	48202	05/25/2022	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	User Access Contact	Sr. Compliance Consultant		Burnett	Barb		8102302173					bburnett@hap.org	2050 S. Linden Road		Flint	MI	48532	10/15/2019	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Utilization Management Contact	VP Utilization Management		Bloom, M.D.	Charles		2485576298					cbloom@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	12/22/2017	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2354	Utilization Review Contact	VP Utilization Management		Bloom, M.D.	Charles		2485576298					cbloom@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	12/22/2017	2023	HEALTH ALLIANCE PLAN OF MICHIGAN	Local CCP	HAP Senior Plus	HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2368	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Backup User Access Contact	Chief Information Officer		Babachicos	Cara		7209746739					cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Best Available Evidence Contact	Finance and Compliance Analyst	Mr.	Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Bid Primary Contact	Finance and Compliance Analyst	Mr.	Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	CAP Report Contact for Public Website	VP Clinical Compliance Audit Management		Teter	Lezlie		7206829848				3039961600	Lteter@innovage.com	3870 Rosin Court		Sacremento	CA	95834	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active	9096779517				PACE - Nat		C	San Francisco
H2368	CEO - CMS Administrator Contact	President & CEO	Mr.	Blair	Patrick		7209746704				3039961600	PBlair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	CEO - Senior Official for Contracting	President & CEO	Mr.	Blair	Patrick		7209746704				3039961600	PBlair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Chief Financial Officer	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Chief Operating Officer	COO	Ms.	Bent	Christine		7209742356				3039961600	cbent@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Chief Information Officer	CIO	Ms	Babachicos	Cara		3037202994					cbabachicos@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Chief Information Security Officer	Chief Information Security Officer	Mr	Smith	Alvin		7207896084				3039961600	ASmith2@innovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	CMS Casework Communication Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Complaints Tracking Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Contact for Fraud Investigations	Chief Legal Officer		D'Amato	Nicole		3038694664				3039961600	ndamato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Coordination of Benefits Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Corporate Mailing						3038694664				3039961600	bgutierrez@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Customer Service Operations Contact	Regional VP Operations COO	Mr.	Lohr	Clint		7209829868				3039961600	clohr@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	DIR Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Emergency Part D Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Encounter Data & Risk Adjustment Operations Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Enrollment Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	EOB Transfer Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Financial Audit Contact	Director of Finance	Ms.	Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Financial Reporting Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Formulary Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	General Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Government Relations Contact	Executive VP Government Relations		Steckel	Carol		7207896157				3039961600	CSteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	HIPAA Privacy Officer	Associate General Counsel	Mr.	Moxon	Jeff		7206613727				3039961600	crobertson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	HIPAA Security Officer	Chief Information Security Officer		Smith	Alvin		7207896084					asmith2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Interoperability Contact	SVP, Application Systems		Zierolf	Kris		7209742380					kzierolf@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	MA Appeals/Grievances Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	MA Claims Processing Contact for Public Website	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Marketing Contact	SVP, Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Medical Director	Chief Medical Officer	Dr.	Feifer	Rich		7206827305				3039961600	RFeifer@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Medicare Compliance Officer	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Medicare Coordinator	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Medicare Part D Opioid Overutilization Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 E. Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Medication Therapy Management Contact	SVP of Clinical Strategic Partnerships	Mrs.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Part C Application Contact	Executive VP Government Relations	Ms.	Steckel	Carol		7207896157				3039961600	CSteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Part D Appeals	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	San Francisco
H2368	Part D Application Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Part D Benefits Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Part D Claims Submission Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Part D Exceptions Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	San Francisco
H2368	Part D Price File Contact (Back-up)	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Part D Price File Contact (Primary)	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Part D Quality Assurance Contact	SVP of Clinical Strategic Partnerships		Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Part D Reporting Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Patient Safety Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Payment Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Pharmacy Director	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Pharmacy Network Management Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Pharmacy Technical Help Desk Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	San Francisco
H2368	PHR Beneficiary Contact																	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE	Total Longterm Care, Inc.	Total Community Options, Inc.	230	Yes	Active	8772776163	732			PACE - Nat		C	San Francisco
H2368	Plan Directory Contact for Public Website	Director of Marketing		Stavros	Sarah		3033006904				3039961600	sstavros@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Plan to Plan Reconciliation Contact	Financial and Compliance Analyst		Kizewski	Alex		7207896171				7209173390	AKizewsk@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Processor Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Quality Contact	Vice President of Quality		Curry	Jill		2153782123					JCurry@innovage.com	2000 Market Street	Suite 780	Philadelphia	PA	19103	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Reconciliation Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Recovery Audit Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817					mcinque@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Surveillance Contact	SVP, Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	System Contact	Director, PACE Finance		Hewitt	Jessica		7209746767					jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Third Party Administrator (TPA) Liaison	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	User Access Contact	Corporate Director of Compliance		Dickerson	Anzio		7208687356					adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Utilization Management Contact	Chief Quality & Population Health Officer	Dr.	Wells	Ann		7206827305				3039961600	awells@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2368	Utilization Review Contact	Chief Quality & Population Health Officer	Dr.	Wells	Ann		7206827305				3039961600	awells@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	INNOVAGE CALIFORNIA PACE-SACRAMENTO, LLC	National PACE	InnovAge California PACE - Sacramento	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H2384	Automated TrOOP Balance Transfer Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Backup User Access Contact		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Best Available Evidence Contact			Cadena	Maria		6505022961					maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Bid Primary Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	CAP Report Contact for Public Website			Wilds	Mindy		8037603916					melinda.wilds@welbehealth.com	1649 Van Ness Ave		Fresno	CA	93721	02/16/2022	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	CEO - CMS Administrator Contact		Ms.	Wilds	Mindy		8037603916					melinda.wilds@welbehealth.com	1649 Van Ness Ave		Fresno	CA	93721	07/27/2022	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	CEO - Senior Official for Contracting		Ms.	Wilds	Mindy		8037603916					melinda.wilds@welbehealth.com	1649 Van Ness Ave		Fresno	CA	93721	02/16/2022	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Chief Financial Officer		Mr.	Epstein	Ethan		2036951178					ethan.epstein@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Chief Operating Officer		Ms.	Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 North Barranca Ave #4051	#4051	Covina	CA	91723	09/29/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Chief Information Officer		Ms.	O'Leary	Kate		9733031835					kate.oleary@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Chief Information Security Officer		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	CMS Casework Communication Contact	Compliance Director		Costigan	Bobbie		2192106392					Bobbie.Costigan@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Complaints Tracking Contact	Compliance Director		Costigan	Bobbie		2192106392					Bobbie.Costigan@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Contact for Fraud Investigations			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Coordination of Benefits Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Corporate Mailing						6508626371					matt.patterson@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Coverage Gap Discount Program (CGDP) Payment Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Customer Service Operations Contact			Wilds	Mindy		8037603916					Melinda.Wilds@welbehealth.com	1649 Van Ness Avenue		Fresno	CA	93721	02/16/2022	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	DIR Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Emergency Part D Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Emergency Part D Contact (Secondary)			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Encounter Data & Risk Adjustment Operations Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Enrollment Contact			Cadena	Maria		6505022961					maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	EOB Transfer Contact			Cadena	Maria		6505022961				6263600082	maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Financial Audit Contact	Senior Accounting Manager	Ms.	Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Financial Reporting Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Formulary Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	655 Oak Grove Ave #1279		Menlo Park	CA	94205	12/15/2021	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	General Contact			Wilds	Mindy		8037603916					Melinda.Wilds@welbehealth.com	1649 Van Ness Avenue		Fresno	CA	93721	02/16/2022	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Government Relations Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	HIPAA Privacy Officer			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	HIPAA Security Officer		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Interoperability Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	MA Appeals/Grievances Contact	Quality Improvement Director		Stefanova	Elisaveta		8034485708					elisaveta.stefanova@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	MA Claims Processing Contact for Public Website			Grant	Alexsa		6503360300					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Marketing Contact			Castro	Marta		6509186233					marta.castro@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Medical Director	Chief Medical Officer		Le	Mike		7146086457					mike.le@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Medicare Compliance Officer		Ms.	Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Medicare Coordinator			Wilds	Mindy		8037603916					Melinda.Wilds@welbehealth.com	1649 Van Ness Avenue		Fresno	CA	93721	02/16/2022	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Medicare Part D Opioid Overutilization Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Medication Therapy Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Part C Application Contact			Harden	Gabriele		3037754823					gabriele.harden@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Part D Appeals	Quality Improvement Director		Stefanova	Elisaveta							elisaveta.stefanova@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8034485708				PACE - Nat		C	San Francisco
H2384	Part D Appeals Contact (Secondary)			Wilds	Mindy							melinda.wilds@welbehealth.com	1649 Van Ness Ave		Fresno	CA	93721	02/16/2022	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8037603916				PACE - Nat		C	San Francisco
H2384	Part D Application Contact			Harden	Gabriele		3037754823					gabriele.harden@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Part D Benefits Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Part D Claims Submission Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Part D Exceptions Contact			Grant	Alexsa							alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8006373187				PACE - Nat		C	San Francisco
H2384	Part D Price File Contact (Back-up)			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Part D Price File Contact (Primary)			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Part D Quality Assurance Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Part D Reporting Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Patient Safety Contact	Quality Improvement Director		Stefanova	Elisaveta		8034485708					elisaveta.stefanova@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Payment Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Pharmacy Director			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Pharmacy Network Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Pharmacy Technical Help Desk Contact			Grant	Alexsa							alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8006373187				PACE - Nat		C	San Francisco
H2384	Plan Directory Contact for Public Website			Grant	Alexsa		6503360300					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Plan to Plan Reconciliation Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Processor Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Quality Contact	Quality Improvement Director		Stefanova	Elisaveta		8034485708					elisaveta.stefanova@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Reconciliation Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Recovery Audit Contact	VP Compliance	Ms.	Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Surveillance Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	System Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Third Party Administrator (TPA) Liaison			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	User Access Contact		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Utilization Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2384	Utilization Review Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/23/2023	2023	SEQUOIA PACE, LLC	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H2386	Automated TrOOP Balance Transfer Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Backup User Access Contact	Chief Information Officer	Mr.	Lane	Aaron		2769644915	7110			2769630130	alane@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	10/12/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Best Available Evidence Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Bid Primary Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	CAP Report Contact for Public Website	Program Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	03/24/2011	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active	8006562272	7152			PACE - Nat		C	Philadelphia
H2386	CEO - CMS Administrator Contact	CEO	Mr.	Beck	Brian		2769644915	7101			2769630130	bbeck@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	10/12/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	CEO - Senior Official for Contracting	CEO	Mr.	Beck	Brian		2769644915	7101			2769630130	bbeck@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	10/12/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Chief Financial Officer	Chief Financial Officer	Ms.	Counts	Carolyn		2769644915	7103			2769630130	ccounts@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	10/12/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Chief Operating Officer	Program Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	02/22/2016	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Chief Information Officer	Chief Information Officer	Mr.	Lane	Aaron		2769644915	7110			2769630130	alane@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	10/12/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Chief Information Security Officer	Chief Information Officer	Mr.	Lane	Aaron		2769644915	7110			2769630130	alane@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	10/12/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	CMS Casework Communication Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Complaints Tracking Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	03/24/2011	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Contact for Fraud Investigations	Program Director		Collins	Dana		2769647152	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	03/24/2011	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Coordination of Benefits Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Corporate Mailing						2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	08/15/2011	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Coverage Gap Discount Program (CGDP) Payment Contact			Collins	Dana		2769647152					dcollins@aasc.org	P.O. Box 765		Cedar Bluff	VA	24609	05/02/2016	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Customer Service Operations Contact	Program Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	DIR Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O. Box 765		Cedar Bluff	VA	24609	03/24/2011	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Emergency Part D Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Encounter Data & Risk Adjustment Operations Contact	PACE Director		Collins	Dana		2769647152				2769647157	dcollins@aasc.org	P O Box 765	216 College Ridge Road	Cedar Bluff	VA	24609	10/18/2019	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Enrollment Contact	Program Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	EOB Transfer Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Financial Audit Contact	PACE Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	03/11/2020	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Financial Reporting Contact	Chief Financial Officer	Ms.	Counts	Carolyn		2769644915	7103			2769630130	ccounts@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	10/12/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Formulary Contact	Program Director		Collins	Dana		2769644915	7152			2769647157	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	03/24/2011	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	General Contact	Program Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Government Relations Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	HIPAA Privacy Officer	Chief Information Officer		Lane	Aaron		2769644915	7110			2769630130	alane@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	10/12/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	HIPAA Security Officer	Chief Information Officer		Lane	Aaron		2769644915	7110			2769630130	alane@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	10/12/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Interoperability Contact			Collins	Dana	M	2769647152					dcollins@aasc.org	PO Box 765	216 College Ridge Road	Cedar Bluff	VA	24609	04/04/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	MA Appeals/Grievances Contact	Program Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	03/24/2011	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	MA Claims Processing Contact for Public Website	PACE Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	03/11/2020	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Marketing Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Medical Director	Medical Director	Dr.	Parker	David		2769647176	7173			2769647157	dparker@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	08/24/2015	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Medicare Compliance Officer	Program Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Medicare Coordinator	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Medicare Part D Opioid Overutilization Contact	Program Director	Ms.	Collins	Dana	M	2769647152				2769630130	dcollins@aasc.org	P.O. Box 765	216 College Ridge Road	Cedar Bluff	VA	24609	03/20/2019	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Medication Therapy Management Contact	Clinical Pharmacist		Hackney	Jacqueline		2769647176				2769647157	jhackney@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/29/2013	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Part C Application Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Part D Appeals	Program Director		Collins	Dana						2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active	8006562272	7152			PACE - Nat		C	Philadelphia
H2386	Part D Application Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Part D Benefits Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Part D Claims Submission Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Part D Exceptions Contact	Program Director		Collins	Dana						2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active	8006562272	7152			PACE - Nat		C	Philadelphia
H2386	Part D Price File Contact (Back-up)	Chief Financial Officer		Counts	Carolyn		2769644915	7103			2769630130	ccounts@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	10/12/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Part D Price File Contact (Primary)	Program Director	Ms.	Collins	Dana	M	2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	02/14/2011	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Part D Quality Assurance Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Part D Reporting Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	03/24/2011	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Patient Safety Contact	Clinical Pharmacist		Hackney	Jacqueline		2769647176				2769647157	jhackney@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/29/2013	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Payment Contact	Chief Financial Officer	Ms.	Counts	Carolyn		2769644915	7103			2769630130	ccounts@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	10/12/2022	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Pharmacy Director	Clinical Pharmacist		Hackney	Jacqueline		2769647176				2769647157	jhackney@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/29/2013	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Pharmacy Network Management Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Pharmacy Technical Help Desk Contact	Clinical Pharmacist		Hackney	Jacqueline						2769647157	jhackney@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/29/2013	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active	8668287723				PACE - Nat		C	Philadelphia
H2386	Plan Directory Contact for Public Website	Program Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	03/24/2011	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Plan to Plan Reconciliation Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Processor Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Quality Contact	Program Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Reconciliation Contact	PACE Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O. Box 765		Cedar Bluff	VA	24609	03/20/2019	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Recovery Audit Contact	Program Director	Ms.	Collins	Dana	M	2769644915	7152			2769630130	dcollins@aasc.org	P.O. Box 765	216 College Ridge Road	Cedar Bluff	VA	24609	05/08/2012	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Surveillance Contact	Program Director		Collins	Dana	M	2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	03/24/2011	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	System Contact	Program Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Third Party Administrator (TPA) Liaison			Coleman	Kelli		2769647166					kcoleman@aasc.org	P.O. Box 765		Cedar Bluff	VA	24609	10/27/2017	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	User Access Contact	Program Director	Ms.	Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Utilization Management Contact	Program Director		Collins	Dana		2769644915	7152			2769630130	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	04/14/2010	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2386	Utilization Review Contact	PACE Director		Collins	Dana		2769647176	7152			2769647157	dcollins@aasc.org	P.O.B. 765		Cedar Bluff	VA	24609	03/11/2020	2023	APPALACHIAN AGENCY FOR SENIOR CITIZENS, INC.	National PACE	Appalachian Agency for Senior Citizens, Inc,	National PACE		Appalachian Agency for Senior Citizens, Inc.	365	Yes	Active					PACE - Nat		C	Philadelphia
H2392	Agent/Broker Compensation Data Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Automated TrOOP Balance Transfer Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Backup User Access Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Best Available Evidence Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Bid Audit Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Bid Audit Site Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Bid Primary Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	CAP Report Contact for Public Website	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	CEO - CMS Administrator Contact	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	CEO - Senior Official for Contracting	CEO	Mr.	Bailey	Michael	D	6157518131				8442805360	mbailey@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Chief Financial Officer	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Chief Operating Officer	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Chief Information Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Chief Information Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	CMMI Model Point of Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	CMS Casework Communication Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/16/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Complaints Tracking Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/16/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Contact for Fraud Investigations	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/16/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Coordination of Benefits Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Corporate Mailing						6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/16/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Customer Service Operations Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	05/18/2020	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	DIR Contact	VP Formulary & Rebate Economics		Ellermeir	Nicole		9133875120					nellermeir@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	DIR Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Electronic Health Record Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Emergency Part D Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Emergency Part D Contact (Secondary)	Pharmacy Operations	Mrs.	Sanchez	Lynn		4056014429				8442805360	lsanchez@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Encounter Data & Risk Adjustment Operations Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Enrollment Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	EOB Transfer Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Financial Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Financial Reporting Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Formulary Contact	Clinical Formulary Pharmacist	Ms.	Quinn	Kelsey		3304864954					kquinn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Formulary Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	General Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Government Relations Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/16/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	HIPAA Privacy Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	HIPAA Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Hospice Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Interoperability Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	MA Appeals/Grievances Contact	A&G Team Lead	Mrs.	Henderson	Maya		6156268442				8442805360	mhenderson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	MA Claims Processing Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		8003997524				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Marketing Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Medical Director	Medical Director	Dr.	Misra	Sumathi		6156365478					SMisra@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/17/2022	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Medicare Compliance Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/16/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Medicare Coordinator	Executive Director	Ms.	Kukuljan	Shiloh		3143549940				8442805360	skukuljan@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Medicare Part D Opioid Overutilization Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Medication Therapy Management Contact	Director of Clinical Product Development and Strat	Ms.	Miller	Holly		3304866457				3304058094	hrmiller@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	OffShore Subcontractor Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Online Enrollment Center Contact (Back-up)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Online Enrollment Center Contact (Primary)	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Part C Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Part C Reporting Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Appeals	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations	Mr	Binegar	Sam						3304058081	appeals@ElixirSolutions.com	2181 E Aurora Road	Building B, Suite 201	Twinsburg	OH	44087	02/16/2022	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active	8003997524				HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Benefits Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Claims Submission Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Exceptions Contact	Associate VP of Clinical Operations	Ms.	Lavignette	Amanda						3304864801	alavignette@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Exceptions Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Price File Contact (Back-up)	Sr Financial Manager Reporting & Analytics	Mr	Campbell	Tim		3308886988					tcampbell@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Price File Contact (Optional)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Price File Contact (Primary)	Senior Director Rebates, Trade Relations	Mr.	Bonus	Jason		3304864841				3304864801	jbonus@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/16/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Quality Assurance Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Part D Reporting Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Patient Safety Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Pharmacy Director	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Pharmacy Network Management Contact	Director of Pharmacy Network Development and Ops	Ms	Profio	Lauren		3304864864				3304058094	lprofio@EnvisionRx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Pharmacy Network Management Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active	8335026757				HMO - Health Maintenance Organization		C	Dallas
H2392	Pharmacy Technical Help Desk Contact (Secondary)			Sanchez	Lynn						4056015627	lsanchez@amhealthplans.com	909 S. Meridian Ave. Ste 425		Oklahoma City	OK	73108	02/16/2022	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active	8555210627				HMO - Health Maintenance Organization		C	Dallas
H2392	Plan Directory Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Plan to Plan Reconciliation Contact	Sr. Manager,  Financial Accounting	Ms.	Tilley	Stephanie		9312420499					stilley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	08/30/2023	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Processor Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Quality Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Reconciliation Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Reconciliation Contact (Secondary)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Recovery Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	SNP Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	SNP State Contact	Executive Director	Ms.	Kukuljan	Shiloh		3143549940				8442805360	skukuljan@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Surveillance Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/16/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	System Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Third Party Administrator (TPA) Liaison	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	User Access Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Utilization Management Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2392	Utilization Review Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	KANSAS SUPERIOR SELECT, INC.	Local CCP	Kansas Health Advantage	HMO/HMOPOS		Kansas Superior Select	680	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2400	Agent/Broker Compensation Data Contact	CEO		Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Automated TrOOP Balance Transfer Contact			Meza	Josie		9169413501				9169413501	jmeza@envisionrx.com	EnvisionRx	1100 Investment Blvd.	El Dorado Hills	CA	95762	12/18/2017	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Backup User Access Contact	Chief Compliance Officer	Ms.	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Best Available Evidence Contact	Director of Operations		Jackson	Samantha		6366141344					samantha.jackson@pillarrx.com	1061 Peruque Crossing Court		O'Fallon	MO	63366	08/27/2019	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Bid Audit Contact		Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Bid Audit Site Contact		Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Bid Primary Contact		Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	CAP Report Contact for Public Website			Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active	5024106859				HMO - Health Maintenance Organization		C	Philadelphia
H2400	CEO - CMS Administrator Contact	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	CEO - Senior Official for Contracting	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Chief Financial Officer	CFO	Mr.	Aschenbeck	James		5023813442					jaschenbeck@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Chief Operating Officer	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Chief Information Officer	CEO	Ms	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Chief Information Security Officer	Chief Compliance Officer	Ms	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	CMS Casework Communication Contact	Chief Compliance Officer	Ms.	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Complaints Tracking Contact	Chief Compliance Officer		Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Contact for Fraud Investigations	Chief Compliance Officer	Ms.	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	Signature Advantage, LLC, 201 Jordan Road	Suite 200	Franklin	TN	37067	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Coordination of Benefits Contact	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Corporate Mailing						8442148633				8008803263	customerservice@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	12/21/2018	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Coverage Gap Discount Program (CGDP) Payment Contact	CFO		Aschenbeck	James		5023813442					jaschenbeck@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Customer Service Operations Contact	CEO	Ms	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	DIR Contact	Senior Director , Government Programs		Farmer	Jim		3308886098					jfarmer@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/01/2022	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	DIR Contact (Secondary)			Dwyer	Michele		6366141346					michele.dwyer@pillarrx.com	1061 Peruque Crossing Court		O'Fallon	MO	63366	09/10/2019	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Emergency Part D Contact	VP, Clinical Services		Probus	Candice		5027090893					candice.probus@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	07/01/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Encounter Data & Risk Adjustment Operations Contact	CEO	Ms	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Enrollment Contact	CEO	Ms	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	EOB Transfer Contact	CEO	Ms.	Haering	Shawna		5025687236				8008803263	s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Financial Audit Contact	CFO	Mr.	Aschenbeck	James		5023813442					jaschenbeck@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Financial Reporting Contact	CFO	Mr.	Aschenbeck	James		5023813442					jaschenbeck@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Formulary Contact	Formulary Operations Clinical Pharmacist		Ewigman	Andrea		3304866311					aewigman@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/10/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Formulary Contact (Secondary)	Directory Formulary Operations		Rossi	David		3304866311					drossi@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	02/09/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	General Contact	Chief Compliance Officer	Ms.	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Government Relations Contact	Chief Compliance Officer	Ms.	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	HIPAA Privacy Officer	Chief Compliance Officer	Ms.	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	HIPAA Security Officer	Chief Compliance Officer	Ms.	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Hospice Contact	VP, Clinical Services		Probus	Candice		5027090893					Candice.Probus@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	07/01/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Interoperability Contact			Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	MA Appeals/Grievances Contact	VP Clinical Operations		Probus	Candice		5027090893					Appeals@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	02/09/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	MA Claims Processing Contact for Public Website	CEO	Ms.	Haering	Shawna		8442148633					customerservice@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	08/05/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Marketing Contact	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Medical Director		Dr.	Nazir	Arif		5027184004					anazir@shcmedicalpartners.com	Signature Advantage	12201 Bluegrass Parkway	Louisville	KY	40299	05/29/2018	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Medicare Coordinator	Chief Compliance Officer	Ms.	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Medicare Part D Opioid Overutilization Contact	Compliance Audit Specialist		Caprara	Lisa		6366141344					lisa.caprara@pillarrx.com	1061 Peruque Crossing Court		O'Fallon	MO	63366	12/23/2020	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Medication Therapy Management Contact	VP, Pharmacy Solutions		Miller	Holly		3302931916					hrmiller@healthdialog.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/01/2022	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Online Enrollment Center Contact (Primary)	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part C Application Contact	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part C Reporting Contact	Chief Compliance Officer	Ms.	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Appeals	VP Clinical Services		Probus	Candice							candice.probus@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	12/01/2022	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active	5027090893				HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Appeals Contact (Secondary)			Binegar	Sam							Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/01/2022	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Application Contact	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Benefits Contact	VP, Clinical Services		Probus	Candice		5027090893					Candice.Probus@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	07/01/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Claims Submission Contact			Ehrenzeller	Vicki		3308886869					vehrenzeller@elixirsolutions.com	Elixir	7835 Freedom Avenue NW	North Canton	OH	44720	12/01/2022	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Exceptions Contact	AVP, Clinical Ops		Lavignette	Amanda							acollins@envisionrx.com	EnvisionRx, 2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	12/23/2020	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active	2342123643				HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Exceptions Contact (Secondary)	Compliance Audit Specialist		Caprara	Lisa							lisa.caprara@pillarrx.com	1061 Peruque Crossing Court		O'Fallon	MO	63366	12/23/2020	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active	8442148633				HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Price File Contact (Back-up)	Financial Analyst III		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/01/2022	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Price File Contact (Optional)	Financial Analyst III		Wentz	Christophe		3304864910					cwentz@elixirsolutions.com	8957 Canyon Falls Blvd.		Twinsburg	OH	44087	06/09/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Price File Contact (Primary)	Sr. Manager Reporting & Analytics		Campbell	Tim		3308886988					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/01/2022	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Quality Assurance Contact	VP, Clinical Services		Probus	Candice		5027090893					Candice.Probus@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	07/01/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Part D Reporting Contact	Chief Compliance Officer		Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Patient Safety Contact	VP, Clinical Services	Ms.	Probus	Candice		5027090893					candice.probus@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	07/01/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Payment Contact	CFO		Aschenbeck	James		5023813442					jaschenbeck@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Pharmacy Director	Pharmacy Consultant		Sandhu	Bibek		6366141344					bibek.sandhu@pillarrx.com	1061 Peruque Crossing Court		O'Fallon	MO	63366	12/23/2020	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Pharmacy Network Management Contact	Director Pharmacy Network Development & Operations		Profio	Lauren		3304864864					lprofio@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/01/2022	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Pharmacy Network Management Contact (Secondary)	VP, Clinical Services		Probus	Candice		5027090893					candice.probus@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	07/01/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Pharmacy Technical Help Desk Contact	Vice President Operations		Conn	Todd							tconn@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/01/2022	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active	8338034397				HMO - Health Maintenance Organization		C	Philadelphia
H2400	Pharmacy Technical Help Desk Contact (Secondary)	VP, Clinical Services		Probus	Candice							candice.probus@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	07/16/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active	8442148633				HMO - Health Maintenance Organization		C	Philadelphia
H2400	Physician Incentive Contact	CEO	Ms	Haering	Shawna		8442148633					networksupport@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	08/13/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Plan Directory Contact for Public Website	CEO	Ms.	Hearing	Shawna		8442148633					customerservice@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	05/06/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Plan to Plan Reconciliation Contact	CFO		Aschenbeck	James		5023813442					jaschenbeck@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Processor Contact			Meza	Josie		9139412571				9169413501	jmeza@envisionrx.com	EnvisionRx	1100 Investment Blvd	El Dorado Hills	CA	95762	12/18/2017	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Quality Contact	VP, Clinical Services	Ms.	Probus	Candice		5027090893					Candice.Probus@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	07/01/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Reconciliation Contact	CFO		Aschenbeck	James		5023813442					jaschenbeck@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Reconciliation Contact (Secondary)	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Recovery Audit Contact	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	SNP Application Contact	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	SNP State Contact	Chief Compliance Officer	Ms	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Surveillance Contact	Chief Compliance Officer	Ms.	Ingram	Kristie		5024106859					kristie.ingram@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	System Contact	CEO	Ms.	Haering	Shawna		5025687236					s.haering@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Third Party Administrator (TPA) Liaison	Director, Operations		Jackson	Samantha		6366141344					samantha.jackson@pillarrx.com	1061 Peruque Crossing Court		O'Fallon	MO	63366	12/24/2020	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	User Access Contact	EPOC	Mr.	Hofmann	Daniel		5025687193					daniel.hofmann@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	01/20/2023	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Utilization Management Contact	VP, Clinical Services	Ms.	Probus	Candice		5027090893					candice.probus@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	07/01/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2400	Utilization Review Contact	VP, Clinical Services	Ms.	Probus	Candice		5027090893					UMInquiryRequest@signatureadvantageplan.com	12201 Bluegrass Parkway		Louisville	KY	40299	07/01/2021	2023	SIGNATURE ADVANTAGE, LLC	Local CCP	Signature Advantage (HMO SNP)	HMO/HMOPOS		SA Plan, LLC	620	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2406	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H2406	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H2406	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H2406	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H2406	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2406	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2416	Agent/Broker Compensation Data Contact	Director of Membership & Program Development	Mr.	Magnuson	Matt		3203355243				3203355223	matt.magnuson@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Automated TrOOP Balance Transfer Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Backup User Access Contact	Director of IS&T / HIPAA Security Officer	Mr.	Hess	Jamie		3203355225				3207628750	jamie.hess@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Best Available Evidence Contact	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3203355223	becky.jirik@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	04/02/2018	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Bid Audit Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Bid Audit Site Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500,	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Bid Primary Contact	Managing Actuary	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500,	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	CAP Report Contact for Public Website	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3207628750	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Przybilla	James		3204913334				3207622912	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3207622912	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Chief Financial Officer	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500,	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Chief Operating Officer	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Chief Information Officer	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	3905 Dakota Street		Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Chief Information Security Officer	Director of IS&T/HIPAA Security Officer	Mr.	Hess	Jamie		3203355225				3207628750	jamie.hess@primewest.org	3905 Dakkota Street		Alexandria	MN	56308	05/03/2016	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	CMS Casework Communication Contact	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Complaints Tracking Contact	Director of Quality & UM	Ms.	Zimmerman	Robin		3203355213				8776004912	robin.zimmerman@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Contact for Fraud Investigations	Corporate Compliance/HIPAA Privacy Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/11/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Coordination of Benefits Contact	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3203355223	MedicareCOB@primewest.org	PrimeWest Health	3905 Dakota Street	Alexandria	MN	56309	04/12/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Corporate Mailing						3207634135				3207628750	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc	444 Cedar St, Suite 500	St Paul	MN	55101	12/08/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Customer Service Operations Contact	Director of Membership & Program Development	Mr.	Magnuson	Matt		3203355243				3203355223	matt.magnuson@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	DIR Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	DIR Contact (Secondary)	Consulting Actuary	Ms.	Stensland	Katherine		6513894592				6512289893	katherine.stensland@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Electronic Health Record Contact	Director of Business IT & Claims Administration	Mr.	Harris	Jeramie		3203355241				3207628750	jeramie.harris@primewest.org	3905 Dakota St		Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	8885884420				HMO - Health Maintenance Organization		C	Chicago
H2416	Emergency Part D Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Emergency Part D Contact (Secondary)	Pharmacy Manager	Ms.	Brand	Katie		3203355246				3207625945	katie.brand@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/27/2021	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Encounter Data & Risk Adjustment Operations Contact	Chief Financial Officer	Mr	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paum	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Enrollment Contact	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3203355223	becky.jirik@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/27/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	EOB Transfer Contact	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3207628750	becky.jirik@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/27/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Financial Audit Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health System	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Financial Reporting Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Formulary Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Formulary Contact (Secondary)	Manager, Formulary Administration & Maintenance	Ms.	Nyawabila	Christina		8587906297					FMT@MedImpact.com	MedImpact HealthCare Systems, Inc.	10181 Scripps Gateway Court	San Diego	CA	92131	12/13/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	General Contact	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Government Relations Contact	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3203355339	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	HIPAA Privacy Officer	Corporate Compliance/HIPAA Privacy Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/11/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	HIPAA Security Officer	Director of IS&T / HIPAA Security Officer	Mr.	Hess	Jamie		3203355225				3207628750	jamie.hess@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Hospice Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota Street	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Interoperability Contact	Director Business IT & Claims Adminstration	Mr	Harris	Jeramie		3203355241				3207628750	jeramie.harris@primewest.org	3905 Dakota St		Alexandria	MN	56308	10/27/2021	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	MA Appeals/Grievances Contact	Director of Quality & UM	Ms.	Zimmerman	Robin		3203355213				8776004912	robin.zimmerman@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	MA Claims Processing Contact for Public Website	Director Business IT & Claims Adminstration	Mr.	Harris	Jeramie		3203355241				3207628750	jeramie.harris@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	02/24/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Marketing Contact	Managing Editor	Ms.	Sim	Elizabeth		3207634135				3207628750	elizabeth.sim@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/11/2020	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Medical Director	Chief Senior Medical Director	Dr.	Hegstad	Scott		3203355286				3207628750	scott.hegstad@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/06/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Medicare Compliance Officer	Corporate Compliance/HIPAA Privacy Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/11/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Medicare Coordinator	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3203355319	becky.jirik@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/24/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Medication Therapy Management Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Online Enrollment Center Contact (Primary)	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3203355319	becky.jirik@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/24/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Part C Application Contact	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3203355339	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Part C Reporting Contact	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Appeals	Appeals & Grievance Supervisor	Ms.	Creasman	Kachiri						8587906060	kachiri.creasman@medimpact.com	MedImact HealthCare Systems, Inc.	10181 Scripps Gateway CT	San Diego	CA	92131	12/13/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	8582915164				HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Appeals Contact (Secondary)	Appeals & Grievance Lead	Ms.	Lindberg	Laura						8587906060	Laura.Lindberg@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Court	San Diego	CA	92131	12/13/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	8582915528				HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Application Contact	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3203355339	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Benefits Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Claims Submission Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota Street	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Exceptions Contact	Director of Pharmacy	Ms.	Ehlert	Ann						3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	3207594154				HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Exceptions Contact (Secondary)	Pharmacy Manager	Ms	Brand	Katie						3207625945	katie.brand@primewest.org	3905 Dakota St		Alexandria	MN	56308	10/27/2021	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	3203355246				HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Price File Contact (Back-up)	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota Street	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Price File Contact (Optional)	Pharmacy Manager	Ms	Brand	Katie		3203355246					katie.brand@primewest.org	3905 Dakota St		Alexandria	MN	56308	10/27/2021	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Price File Contact (Primary)	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55111	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Quality Assurance Contact	Director of Pharmacy Management	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Part D Reporting Contact	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Patient Safety Contact	Director of Pharmacy Management	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Payment Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Personal Health Record Contact	Corporate Compliance Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Pharmacy Director	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Pharmacy Network Management Contact	Dir Pharmacy Network Administration	Mr.	Hunt	Brian		8587907092					Brian.Hunt@MedImpact.com	MedImpact HealthCare Systems Inc.	10181 Scripps Gateway Court	San Diego	CA	92131	12/13/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905  Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Pharmacy Technical Help Desk Contact	Director Customer Contact Services	Ms.	Brewer	Kathy							customerservice@medimpact.com	MedImpact HealthCare Systems, Inc.	10181 Scripps Gateway Court	San Diego	CA	92131	06/17/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	8773919294				HMO - Health Maintenance Organization		C	Chicago
H2416	Pharmacy Technical Help Desk Contact (Secondary)	Director of Pharmacy	Ms.	Ehlert	Ann						3207625945	ann.ehlert@primewest.org	3905 Dakota St	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	3207594154				HMO - Health Maintenance Organization		C	Chicago
H2416	PHR Beneficiary Contact																	11/10/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS	PrimeWest Health	PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	8003662906				HMO - Health Maintenance Organization		C	Chicago
H2416	Physician Incentive Contact	Corporate Compliance Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Plan Directory Contact for Public Website			Contact Center	Provider		8664310802					providercontactcenter@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/24/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Processor Contact	Director Business IT & Claims Adminstration	Mr	Harris	Jeramie		3203355241				3207628750	jeramie.harris@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/27/2021	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Quality Contact	Director of Quality & UM	Ms.	Zimmerman	Robin		3203355213				3207628750	robin.zimmerman@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Reconciliation Contact	Consulting Acturary	Ms.	Stensland	Katherine		6512289891				6512289893	katherine.stensland@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	03/31/2020	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Reconciliation Contact (Secondary)	Consulting Actuary	Ms.	Stensland	Katherine		6513894592				6512289893	katherine.stensland@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Recovery Audit Contact	Corporate Compliance/HIPAA Privacy Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/11/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	SNP Application Contact	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3207622912	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	SNP State Contact	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3207622912	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Surveillance Contact	Corporate Compliance/HIPAA Privacy Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/11/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	System Contact	Chief Operating Officer	Mrs.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/06/2023	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	Saint Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	User Access Contact	Director of IS&T	Mr.	Hess	Jamie		3203355225				3207628750	jamie.hess@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Utilization Management Contact	Director of Quality & UM	Ms.	Zimmerman	Robin		3203355213				3207628750	robin.zimmerman@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2416	Utilization Review Contact	Director of Quality & UM	Ms.	Zimmerman	Robin		3203355213				3207628750	robin.zimmerman@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Agent/Broker Compensation Data Contact	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Automated TrOOP Balance Transfer Contact	Data/Project Coordinator		Erickson	Myranda		2183276157				2183275545	myranda.erickson@co.itasca.mn.us	1219 SE 2nd Avenue		Grand Rapids	MN	55744	10/18/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Backup User Access Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	04/20/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Best Available Evidence Contact	Data/Project Coordinator		Chambers	Mary		2183275505				2183275545	mary.chambers@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	03/07/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Bid Audit Contact	A.S.A.		Marotz	Jake		6512289891					jake.marotz@cirdanhealth.com	444 Cedar Street	Suite 500	St. Paul	MN	55101	05/29/2018	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Bid Primary Contact	A.S.A.		Marotz	Jake		6512289891					jake.marotz@cirdanhealth.com	444 Cedar Street	Suite 500	St. Paul	MN	55101	05/29/2018	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	CAP Report Contact for Public Website	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	04/20/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	CEO - CMS Administrator Contact	CEO	Ms.	Anderson	Sarah		2183983530				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	CEO - Senior Official for Contracting	CEO	Ms.	Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Chief Financial Officer	CFO	Mr.	Alstad	Matthew		2183275517				2183275545	matthew.alstad@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/19/2019	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Chief Operating Officer	Utilization Management Director	Ms.	Rosik	Peggy		2183276199				2183275545	peggy.rosik@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/15/2021	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Chief Information Officer	CEO	Ms.	Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Chief Information Security Officer	Contract Compliance Officer	Ms	Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	04/20/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	CMS Casework Communication Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	04/20/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Complaints Tracking Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Avenue		Grand Rapids	MN	55744	04/20/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Contact for Fraud Investigations	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2ND AVENUE		GRAND RAPIDS	MN	55744	09/28/2021	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Coordination of Benefits Contact	Data/Project Coordinator		Chambers	Mary		2183275505				2183275545	imcareenrollment@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	05/10/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Corporate Mailing						8008439536				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	557443983	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Coverage Gap Discount Program (CGDP) Payment Contact	CFO		Alstad	Matthew		2183275517				2183275545	matthew.alstad@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/19/2019	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Customer Service Operations Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	04/20/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	DIR Contact	CFO		Alstad	Matthew		2183275517				2183275545	matthew.alstad@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/19/2019	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	DIR Contact (Secondary)	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Emergency Part D Contact	CEO		Anderson	Sarah		2183983530				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Emergency Part D Contact (Secondary)	Utilization Management Director		Rosik	Peggy		2182562038				2183275545	peggy.rosik@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	12/21/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Encounter Data & Risk Adjustment Operations Contact	Claims Supervisor		Huffman	Kimberly		2183276118				2183275545	kimberly.huffman@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	02/24/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Enrollment Contact	Data/Project Coordinator		Chambers	Mary		2183275505				2183275545	mary.chambers@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	03/07/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	EOB Transfer Contact	Data/Project Coordinator		Chambers	Mary		2183275505				2183275545	mary.chambers@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	03/07/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Financial Audit Contact	CFO	Mr.	Alstad	Matthew		2183275517				2183275545	matthew.alstad@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/19/2019	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Financial Reporting Contact	CFO		Alstad	Matthew		2183275517				2183275545	matthew.alstad@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/19/2019	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Formulary Contact	Pharmacy Director		Pavek	Adam		2183276765				2183275545	adam.pavek@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	12/18/2015	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Formulary Contact (Secondary)	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	General Contact	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Government Relations Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	04/20/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	HIPAA Privacy Officer	ICHHS Director		Villeneuve	Eric		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	HIPAA Security Officer	MIS Director		Gunderson	Chris		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Hospice Contact	Data/Project Coordinator		Chambers	Mary		2183275505				2183275545	mary.chambers@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	03/07/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Interoperability Contact	CEO		Anderson	Sarah		2183276789					sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	05/09/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	MA Appeals/Grievances Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	04/20/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	MA Claims Processing Contact for Public Website	Claims Supervisor		Huffman	Kimberly		2183276118				2183275545	kimberly.huffman@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	02/24/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Marketing Contact	Health Plan Compliance Coordinator		Huso	Leah		2183276183				2183275545	leah.huso@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	02/24/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Medical Director	Medical Director		Friedlieb, MD	Peter		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/15/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Medicare Compliance Officer	Contract Compliance Officer	Ms.	Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	04/20/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Medicare Coordinator	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Avenue		Grand Rapids	MN	55744	01/03/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Medicare Part D Opioid Overutilization Contact	Pharmacy Director		Pavek	Adam		2183276765				8008439536	adam.pavek@co.itasca.mn.us	1219 SE 2nd Avneue		Grand Rapids	MN	55744	10/17/2018	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Medication Therapy Management Contact	Sr Advisor, MTM		Pundik	Elina		4017708553				4012625955	elina.pundik@CVSHealth.com	1 CVS Drive		Woonsocket	RI	02895	02/28/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Online Enrollment Center Contact (Back-up)	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Online Enrollment Center Contact (Primary)	Data/Project Coordinator		Chambers	Mary		2183275505				2183275545	mary.chambers@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	03/07/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Part C Application Contact	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Part C Reporting Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Avenue		Grand Rapids	MN	55744	07/09/2014	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Appeals	Health Plan Compliance Coordinator		Huso	Leah						2183275545	leah.huso@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	02/24/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active	8008439536	2183			HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Appeals Contact (Secondary)	Contract Compliance Officer		Grover	Laura						2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	01/07/2021	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active	8008439536	2769			HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Application Contact	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Benefits Contact	Utilization Management Director		Rosik	Peggy		2183276199				2183275545	peggy.rosik@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/15/2021	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Claims Submission Contact	Pharmacy Director		Pavek	Adam		2183276765				2183275545	adam.pavek@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	01/03/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Exceptions Contact	Utilization Management Director		Rosik	Peggy						2183275545	peggy.rosik@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/15/2021	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active	8008439536	2199			HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Exceptions Contact (Secondary)	Quality Director		Silliman	Amber						2183275545	amber.silliman@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	03/22/2021	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active	8008439536	2199			HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Price File Contact (Back-up)	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Price File Contact (Optional)	Medicare Client Advisor		Wiltfong	Yvette		4803148335					yvette.wiltfong@caremark.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	04/01/2015	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Price File Contact (Primary)	Analyst Medicare Operations		Nichols	Kristy		4806147668					kristy.nichols@caremark.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	04/01/2015	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Quality Assurance Contact	Quality Director		Silliman	Amber		2183276180				2183275545	amber.silliman@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	03/22/2021	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Part D Reporting Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Avenue		Grand Rapids	MN	55744	07/09/2014	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Patient Safety Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	04/20/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Payment Contact	CFO		Alstad	Matthew		2183275517				2183275545	matthew.alstad@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/19/2019	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Pharmacy Director	Pharmacy Director		Pavek	Adam		2183276765				2183275545	adam.pavek@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	01/03/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Pharmacy Network Management Contact	Director Network Systems and Standard		Tressler	Damon		4803914702					damon.tressler@caremark.com	9501 E Shea Blvd.		Scottsdale	AZ	85260	12/15/2006	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Pharmacy Technical Help Desk Contact	IMCARE MEMBER SERVICES		SERVICES	MEMBER						2183275545		1219 SE 2ND AVENUE		GRAND RAPIDS	MN	55744	02/28/2019	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active	8008439536				HMO - Health Maintenance Organization		C	Chicago
H2417	Physician Incentive Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Avenue		Grand Rapids	MN	55744	01/03/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Plan Directory Contact for Public Website	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Plan to Plan Reconciliation Contact	Data/Project Coordinator		Chambers	Mary		2183275505				2183275545	mary.chambers@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	03/07/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Processor Contact	Claims Supervisor		Huffman	Kimberly		2183276118				2183275545	kimberly.huffman@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	02/24/2022	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Quality Contact	Quality Director		Silliman	Amber		2183276180				2183275545	amber.silliman@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	03/22/2021	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Reconciliation Contact	CFO		Alstad	Matthew		2183275517				2183275545	matthew.alstad@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/19/2019	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Reconciliation Contact (Secondary)	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Recovery Audit Contact	CFO	Mr.	Alstad	Matthew		2183275517				2183275545	matthew.alstad@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/19/2019	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	SNP Application Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Avenue		Grand Rapids	MN	55744	07/01/2021	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Surveillance Contact	Contract Compliance Officer		Grover	Laura		2183276769				2183275545	laura.grover@co.itasca.mn.us	1219 SE 2nd Avenue		Grand Rapids	MN	55744	04/20/2017	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	System Contact	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Third Party Administrator (TPA) Liaison	CFO		Alstad	Matthew		2183275517				2183275545	matthew.alstad@co.itasca.mn.us	1219 SE 2nd Ave		Grand Rapids	MN	55744	11/19/2019	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	User Access Contact	CEO		Anderson	Sarah		2183276789				2183275545	sarah.anderson@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	12/14/2020	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Utilization Management Contact	Utilization Management Director		Rosik	Peggy		2183276199				2183275545	peggy.rosik@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	11/15/2021	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2417	Utilization Review Contact	Utilization Management Director		Rosik	Peggy		2183276199				2183275545	peggy.rosik@co.itasca.mn.us	1219 SE 2nd Ave.		Grand Rapids	MN	55744	11/15/2021	2023	ITASCA MEDICAL CARE	Local CCP	Itasca Medical Care/IMCare Classic	HMO/HMOPOS		Itasca County	136	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Agent/Broker Compensation Data Contact	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Automated TrOOP Balance Transfer Contact	Manager of Technical Delivery and Oversight		Gajarajan	Nivi		2678258648					ngajarajan2@performrx.com	PerformRx	200 Steven Dr.	Philadelphia	PA	19113	05/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Backup User Access Contact	Compliance Officer		Marks	Jeff		5074316068				5074447774	jmarks@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Best Available Evidence Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Bid Audit Contact	Chief Financial Officer		Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Bid Audit Site Contact	Chief Financial Officer		Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Bid Primary Contact	Chief Financial Officer		Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	CAP Report Contact for Public Website	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	CEO - CMS Administrator Contact	Chief Executive Officer	Ms	Lind	Leota		5074447772				5074447774	llind@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	CEO - Senior Official for Contracting	Chief Executive Officer	Ms	Lind	Leota		5074447772				5074447774	llind@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Chief Financial Officer	Chief Financial Officer	Mr	Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Chief Operating Officer	Chief Executive Officer	Ms	Lind	Leota		5074447772				5074447774	llind@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Chief Information Officer		Mr	Hoenck	Matt		5074316391				5074447774	mhoenck@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Chief Information Security Officer		Mr	Hoenck	Matt		5074316391				5074447774	mhoenck@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	CMS Casework Communication Contact	Grievance and Appeals Manager		Miller	Suzette		5074316373				5074447774	sumiller@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Complaints Tracking Contact	Grievance and Appeals Manager		Miller	Suzette		5074316373				5074447774	sumiller@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Contact for Fraud Investigations	Compliance Officer		Marks	Jeff		5074316068				5074447774	jmarks@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Coordination of Benefits Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Corporate Mailing						5074447770				5074447774	amcgregor@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	06/22/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Customer Service Operations Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	DIR Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	06/22/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	DIR Contact (Secondary)	Director of Operations		Lewer	Cheryl		5074316377				5074447477	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	02/18/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Emergency Part D Contact	Pharmacy Manager		Bailey	Sarah		5074315477				5074447774	sbailey@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Emergency Part D Contact (Secondary)	Director of Operations		Lewer	Cheryl		5074316377					clewer@mnscha.org	6380 West Frontage Road		Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Encounter Data & Risk Adjustment Operations Contact	Chief Financial Officer		Schufman	Scott		5074316599				5074447770	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Enrollment Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	CLewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	EOB Transfer Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Financial Audit Contact	Chief Financial Officer	Mr	Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Financial Reporting Contact	Controller		Toquam	Erica		5074316591				5074447774	etoquam@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Formulary Contact	Director of Clinical Services		Megargell	Lauren		2159374135					lmegargell@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	06/02/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Formulary Contact (Secondary)	Manager, Formulary/DUR		DeHoratius	Patrick		2159375078					patrick.dehoratius@performrx.com	PerformRx	200 Steven Drive	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	General Contact	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Government Relations Contact	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	HIPAA Privacy Officer	Compliance Officer		Marks	Jeff		5074316068				5074447774	jmarks@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	HIPAA Security Officer			Hoenck	Matt		5074316391				5074447774	mhoenck@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Hospice Contact	Director of Health Services		Worrall	Kim		5074316397				5074447774	kworrall@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Interoperability Contact	Director of IT and Analytics		Hoenck	Matt		5074316391					mhoenck@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	MA Appeals/Grievances Contact	Grievance and Appeals Manager		Miller	Suzette		5074316373				5074447774	sumiller@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	MA Claims Processing Contact for Public Website	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Marketing Contact	Director of Community Engagement		Braaten	Kelly		5074316572				5074447774	kbraaten@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Medical Director	Chief Medical Director	Dr.	Miller	Timothy		5074316388	6388			5074447774	tmiller@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Medicare Compliance Officer	Compliance Officer	Mr	Marks	Jeff		5074316068				5074447774	jmarks@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Medicare Coordinator	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Medicare Part D Opioid Overutilization Contact	Director Clinical Outcomes & Therapeutic Optimizat		McMahon	Courtney		2159378563					cmcmahon@performrx.com	PerformRx	200 Steven Dr.	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Medication Therapy Management Contact	Director Clinical Outcomes & Therapeutic Opt.		McMahon	Courtney		2159378563					cmcmahon@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Online Enrollment Center Contact (Primary)	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Part C Application Contact	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Part C Reporting Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Appeals	Clinical Parmacist, Manager of Pharmacy Prior Auth		Unterbrink	Elizabeth						8772918760	eunterbrink@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	4844967688				HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Appeals Contact (Secondary)	Clinical Pharmacist, Manager of Pharmacy Prior Aut		McHale	Shawn						8772918760	smchale@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/29/2020	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	2158636370				HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Application Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/25/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Benefits Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Claims Submission Contact	Director of Clinical Operations		Ortiz	Noel		2159375352					nortiz@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	05/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Exceptions Contact	Manager Pharmacy Prior Auth		Unterbrink	Elizabeth						2158635100	eunterbrink@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	4844967688				HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Exceptions Contact (Secondary)	Clinical Pharmacist, Manager of Pharmacy Prior Aut		McHale	Shawn						2158635100	smchale@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/23/2015	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	2158636370				HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Price File Contact (Back-up)	Medicare Financial Operations Analyst III		Weihe	Heather		7875231212					heather.weihe@abarcahealth.com	Abarca Health	650 Ave Munoz Rivera	San Juan	PR	00918	05/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Price File Contact (Optional)	Medicare Financial Operations Analyst III		Gonzalez	Brittany		7875231212	144				brittany.gonzalez@abarcahealth.com	Abarca Health	650 Ave Munoz Rivera	San Juan	PR	00918	04/28/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Price File Contact (Primary)	Director, Service Operations		Leal	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	04/28/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Quality Assurance Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Part D Reporting Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Patient Safety Contact	Director Clinical Outcomes & Therapeutic Opt.		McMahon	Courtney		2159378563					cmcmahon@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Payment Contact	Controller		Toquam	Erica		5074316591				5074447774	etoquam@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Personal Health Record Contact			Hoenck	Matt		5074316391				5074447774	mhoenck@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Pharmacy Director	VP Clinical Programs, Pharmacy Clinical Services		Maiorini	Andrew		2159378565					Amaiorini@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/01/2016	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Pharmacy Network Management Contact	Director, Service Operations		Leal	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	04/28/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Pharmacy Technical Help Desk Contact	Director, Service Operations		Leal	Avelina							aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/04/2015	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	8669356681				HMO - Health Maintenance Organization		C	Chicago
H2419	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Care Center		Lee	Pamela							plee@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	11/08/2017	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	8669356681				HMO - Health Maintenance Organization		C	Chicago
H2419	Plan Directory Contact for Public Website	Communications Manager		Gartner	Chris		5074313021				5074447774	cgartner@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Plan to Plan Reconciliation Contact	Controller		Toquam	Erica		5074316591				5074447774	etoquam@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Processor Contact	Director of Clinical Operations		Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	05/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Quality Contact	Manager of Quality		Smith	Justin		5074316387				5074447774	jsmith@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Reconciliation Contact	Controller		Toquam	Erica		5074316591				5074447774	etoquam@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Reconciliation Contact (Secondary)	Chief Financial Officer		Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Recovery Audit Contact	Chief Financial Officer	Mr	Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	SNP Application Contact	Chief Executive Officer		Lind	Leota		5074447772				5074447774	llind@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	SNP State Contact	Chief Executive Officer		Lind	Leota		5074447772				5074447774	llind@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Surveillance Contact	Director of Community Engagement		Braaten	Kelly		5074316572				5074447774	kbraaten@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	System Contact			Hoenck	Matt		5074316391				5074447774	mhoenck@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Third Party Administrator (TPA) Liaison	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	06/22/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	User Access Contact	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Utilization Management Contact	Manager of Utilization Management		Beckel	Ashley		5074316583				5074447774	abeckel@mnscha.org	6380 West Frontage Road		Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2419	Utilization Review Contact	Manager of Utilization Management		Beckel	Ashley		5074316583				5074447774	abeckel@mnscha.org	6380 West Frontage Road		Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Agent/Broker Compensation Data Contact	VP Government Programs		Clelland	Jennifer	J	9529675119					jennifer.j.clelland@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	11/04/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Automated TrOOP Balance Transfer Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Backup User Access Contact	Coordinator Government Programs		Yu	Chao		9528827240					chao.x.yu@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	04/20/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Best Available Evidence Contact	Manager Membership Accounting		Marty	Amanda	E	9529677685					amanda.e.marty@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/05/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Bid Audit Contact	VP Internal Audit Comp Officer		Bunde	Steven	D	9528836541				9528835522	steven.d.bunde@healthpartners.com	8170 33rd Avenue South		Bloomington	MN	55425	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Bid Audit Site Contact	Director Monitoring and Compliance		Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS:  21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Bid Primary Contact	Corporate Actuary		Stewart	Sara		9528835049					sara.m.stewart@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21105H	Minneapolis	MN	554401309	07/24/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	CAP Report Contact for Public Website	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	CEO - CMS Administrator Contact	President and CEO	Ms.	Walsh	Andrea	M	9528835343				9528835350	wendy.r.kobe@healthpartners.com	8170 33rd Avenue South	MS: 21110A	Minneapolis	MN	55425	01/05/2023	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	CEO - Senior Official for Contracting	President and CEO	Ms.	Walsh	Andrea	M	9528835343				9528835350	wendy.r.kobe@healthpartners.com	8170 33rd Avenue South	MS: 21110A	Minneapolis	MN	55425	01/04/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Chief Financial Officer	SVP & Chief Financial Officer	Ms.	Johnson	Kathleen	A	9528836531					kathy.a.johnson1@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110T	Minneapolis	MN	554401309	03/29/2023	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Chief Operating Officer	EVP and Chief Health Plan Officer	Ms.	Danielson	Jennifer	B	9528835573					victoria.j.slates@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110A	Minneapolis	MN	554401309	07/06/2023	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Chief Information Officer	Senior Vice President and CTO	Mr.	Zuzek	Dennis	M	9528837045					dennis.m.zuzek@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Chief Information Security Officer	VP Technology Infrastructure & Security	Mr.	Muller	Frank	J	9529676070					frank.j.muller@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	CMS Casework Communication Contact	Manager, Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Complaints Tracking Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Contact for Fraud Investigations	Senior Manager Claims Cost Management		Hove	Ryan	M	6512651573					ryan.m.hove@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  25510F	Minneapolis	MN	55101	07/24/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Coordination of Benefits Contact	Manager, Claims Production		Prine	Chantelle	M	9529677335					RVSCCOBTECHS@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	04/20/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Corporate Mailing						9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	05/21/2015	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant		Knights	Michelle	M	9528836532					michelle.m.knights@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21109A	Minneapolis	MN	554401309	12/03/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Customer Service Operations Contact	Director Member Services		Renneke	Alison		9529677668					alison.m.renneke@healthpartners.com	8170 33rd Avenue South, PO Box 9463	MS:  21103R	Minneapolis	MN	554409463	01/29/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	DIR Contact	Pharmacy Plan Contract Manager		Reinhardt	Sandra	L	9528836739					sandra.l.reinhardt@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/29/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	DIR Contact (Secondary)	Health Informatics Analyst Pcp		Binsfeld	David	T	9529675950					david.t.binsfeld@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS 21108Q	Minneapolis	MN	554401309	05/09/2013	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Emergency Part D Contact	Sr. Director Pharmacy Services		Strahl	Christine	L	9528835022				9529676667	christine.l.strahl@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/04/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Emergency Part D Contact (Secondary)	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9529675826				9529676667	dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/29/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Employer Waiver Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Encounter Data & Risk Adjustment Operations Contact	Senior Director Operational Integrity		Anderson	Larin	D	9528835796					larin.d.anderson@healthpartners.com	8170 33rd Avenue South	MS: 21103J	Minneapolis	MN	55425	10/22/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Enrollment Contact	Director Membership Accounting		McWell	Carrie	J	9529675487					carrie.j.mcwell@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	11/30/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	EOB Transfer Contact	Sr. Manager Claims Production		Huseby	Pam	J	9529675530				9528837666	pam.j.huseby@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	08/30/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Financial Audit Contact	Director Monitoring and Compliance	Ms.	Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Financial Reporting Contact	Director Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21109A	Minneapolis	MN	554401309	03/14/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Formulary Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Formulary Contact (Secondary)	Formulary Administration Pharmacist		Savage	Robert		8587906426					robert.savage@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	07/24/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	General Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Government Relations Contact	VP Government Programs		Clelland	Jennifer	J	9529675119					jennifer.j.clelland@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	08/27/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	HIPAA Privacy Officer	Sr. Director Integrity Compliance Privacy Officer		Wells	Prasanta	K	9528837325					prasanta.k.wells@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103K	Minneapolis	MN	554401309	07/23/2015	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	HIPAA Security Officer	VP Technology Infrastructure & Security	Mr.	Muller	Frank	J	9529676070					frank.j.muller@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Hospice Contact	Pharmacy Compliance Specialist		Riggs	Ben	H	9528518421					benjamin.h.riggs@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Interoperability Contact	Program Manager		Geisler	Chris	J	6122479067					Chris.J.Geisler@HealthPartners.Com	8170 33rd Avenue S		Bloomington	MN	55425	06/20/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	MA Appeals/Grievances Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	MA Claims Processing Contact for Public Website	Manager Claims Production		Huseby	Pam	J	9529675530					RVSCProviderInquiry@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	03/14/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Marketing Contact	Mgr Govt Prog Materials & Regulatory Comm		Her-Vang	Xong		9529675061					xong.x.hervang@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	11/16/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Medical Director	Health Plan Chief Medical Officer	Dr.	Kakacek	Virginia	L	9528837120					virginia.l.kakacek@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110Q	Minneapolis	MN	554401309	09/21/2023	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Medicare Compliance Officer	VP Internal Audit Comp Officer	Mr.	Bunde	Steven	D	9528836541				9528835522	steven.d.bunde@healthpartners.com	8170 33rd Avenue South		Bloomington	MN	55425	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Medicare Coordinator	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Medicare Part D Opioid Overutilization Contact	Pharmacy Compliance Specialist		Riggs	Ben		9528518421					Benjamin.H.Riggs@HealthPartners.Com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/29/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Medication Therapy Management Contact	Senior Manager Med Therapy Management Program		Rehrauer	Daniel	J	9529675133					daniel.j.rehrauer@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/11/2018	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Online Enrollment Center Contact (Back-up)	Director Membership Accounting		McWell	Carrie	J	9529675487					carrie.j.mcwell@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/30/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Online Enrollment Center Contact (Optional)	Admin Product Implementation Manager		Wessel	Sara	C	9529677623					sara.c.wessel@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/29/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Online Enrollment Center Contact (Primary)	Manager Membership Accounting		Marty	Amanda	E	9529677685					amanda.e.marty@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	01/09/2018	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Part C Application Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Part C Reporting Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Part D Appeals	Manager Member Rights and Benefits		Kruse	Morgan	L						Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS:  21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active	8007963806				HMO - Health Maintenance Organization		C	Chicago
H2422	Part D Appeals Contact (Secondary)	Senior Rights & Benefits Project Lead		Schneider	Crystal	L						crystal.l.schneider@healthpartners.com	8170 33rd Avenue South	MS: 21103R	Bloomington	MN	55425	01/05/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active	8007963806				HMO - Health Maintenance Organization		C	Chicago
H2422	Part D Application Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Part D Benefits Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Part D Claims Submission Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Part D Exceptions Contact	Supervisor, Clinical Review		Whelan	Hillary	A					9528538700	hillary.a.whelan@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/30/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active	8004927259				HMO - Health Maintenance Organization		C	Chicago
H2422	Part D Price File Contact (Back-up)			Communications	Planfinder		8587905849				8587906052	PlanFinderCommunications@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	08/17/2015	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Part D Price File Contact (Primary)	Pharmacy Compliance Specialist		Riggs	Ben	H	9528518421					benjamin.h.riggs@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Part D Quality Assurance Contact	Senior Manager Quality and Compliance		Book	Anne	M	9528835128					anne.m.book@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21108T	Minneapolis	MN	554401309	01/09/2018	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Part D Reporting Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Patient Safety Contact	Senior Manager Med Therapy Management Program		Rehrauer	Daniel	J	9529675133					daniel.j.rehrauer@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/14/2018	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Payment Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/09/2013	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Pharmacy Director	VP Pharmacy		Busch	David	L	9529675049					david.l.busch@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	06/25/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Pharmacy Network Management Contact	Director Pharmacy Sales & Product Support		Friday	Ken	R	9529675826				9529676667	kenneth.r.friday@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Administration		Hunt	Brian		8587907092					Brian.Hunt@MedImpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/29/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Pharmacy Technical Help Desk Contact	Manager Health Plan Pharmacy Customer Service		Whelan	Hillary	A					8888835434	Hillary.A.Whelan@HealthPartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/19/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active	8004927259				HMO - Health Maintenance Organization		C	Chicago
H2422	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Contact Services		Brewer	Kathy							Customerservice@Medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/15/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active	8887831779				HMO - Health Maintenance Organization		C	Chicago
H2422	Plan Directory Contact for Public Website			Services	Provider		9528837699					RVSCProviderInquiry@HealthPartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	06/10/2013	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Plan to Plan Reconciliation Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584				9528836500	kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/09/2013	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Processor Contact	Director Pharmacy Sales & Product Support		Friday	Ken	R	9529675826				9529676667	kenneth.r.friday@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Quality Contact	Senior Manager Quality and Compliance		Book	Anne	M	9528835128					anne.m.book@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	03/14/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Reconciliation Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	03/14/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Reconciliation Contact (Secondary)	Senior Accountant		Knights	Michelle	M	9528833532					michelle.m.knights@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/19/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Recovery Audit Contact	Director Monitoring and Compliance	Ms.	Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	SNP Application Contact	Manager State Public Programs		BennettVo	Emi	M	9529677382					emi.m.bennettvo@healthpartners.com	8170 33rd Avenue South	PO Box 1309 MS:  21103C	Minneapolis	MN	55440	08/30/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	SNP State Contact	Manager State Public Programs		BennettVo	Emi	M	9529677382					emi.m.bennettvo@healthpartners.com	8170 33rd Avenue South	PO Box 1309 MS:  21103C	Minneapolis	MN	55440	08/30/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Surveillance Contact	Director Monitoring and Compliance		Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	System Contact	Senior Director Operational Integrity		Anderson	Larin	D	9528835796					larin.d.anderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21193J	Minneapolis	MN	554401309	03/14/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Third Party Administrator (TPA) Liaison	Senior Accountant		Knights	Michelle	M	9528833532					michelle.m.knights@healthpartners.com	8170 33rd Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/19/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	User Access Contact	Mgr Govt Prog Materials & Regulatory Comm		Her-Vang	Xong		9529675061					xong.x.hervang@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	11/16/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Utilization Management Contact	Director Utilization Management		Gunderson	Susan	C	9528835576					susan.c.gunderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	12/10/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2422	Utilization Review Contact	Director Utilization Management		Gunderson	Susan	C	9528835576					susan.c.gunderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	12/10/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	HMO/HMOPOS		HealthPartners, Inc.	117	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Agent/Broker Compensation Data Contact	Director, Channel Management and Oversight		Lopez	Kris		6516627792					kris.lopez@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/13/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Automated TrOOP Balance Transfer Contact	Director, PBM Operations		Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/21/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Backup User Access Contact	Government Compliance Officer		Hogan	Carrie		6516621900					carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Best Available Evidence Contact	Manager, Business Services		Daniels	Cassandra		6516623468					Cassandra.Daniels@bluecrossmn.com	3400 Yankee Dr		Eagan	MN	55121	02/02/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Bid Audit Contact	Asst. Actuary		Zeterlu	Angela		6516620420					angela.zeterlu@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Bid Audit Site Contact	Asst. Actuary		Zeterlu	Angela		6516620420					angela.zeterlu@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Bid Primary Contact	Asst. Actuary		Zeterlu	Angela		6516620420					angela.zeterlu@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	CAP Report Contact for Public Website	Government Compliance Officer		Hogan	Carrie		6516621900					carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	CEO - CMS Administrator Contact	CEO, Blue Plus	Ms.	Engel	Monica		6516627329					monica.engel@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	CEO - Senior Official for Contracting	President Government Markets, SVP	Ms.	Engel	Monica		6516627329					monica.engel@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Chief Financial Officer	Senior Vice President, Chief Financial Officer	Mr.	Uribe	John		6516629501					John.Uribe@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Chief Operating Officer	President	Ms.	Erickson	Dana		6516621000					dana.erickson@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Chief Information Officer	Director	Mr.	Wike	Tim		6516629066					tim.wike@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Chief Information Security Officer	VP Digital Platforms & Cybersecurity	Mr	Groshong	Chris		6516628786					Christopher.Groshong@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/12/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	CMS Casework Communication Contact	Manager Appeals & Grievances		Bazzarre	Tom		6516629643					Tom.bazzarre@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	07/14/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Complaints Tracking Contact	Manager Appeals & Grievances		Bazzarre	Tom		6516629643					Tom.bazzarre@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	07/14/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Contact for Fraud Investigations	Director Operational Risk Management Performance		Dickinson	Richard		6516623532					richard.dickinson@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Coordination of Benefits Contact	Director, PBM Operations		Allie	Cindy		6127776722				6127776705	COBmedd@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/21/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Corporate Mailing						8663408654					contact@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/18/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst Sr		Voves	Alex		6516623606					Alex.Voves@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Customer Service Operations Contact	Director, Business Transformation		Hovick	Denise		6516628864					denise.hovick@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	DIR Contact	Actuary		Legatt	Sarah		6516626757					sarah.legatt@bluecrossmn.com	3535 Blue Cross Rd		Eagan	MN	55122	02/27/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	DIR Contact (Secondary)	Financial Analyst, Sr		Voves	Alex		6516623606					alex.voves@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	02/27/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Electronic Health Record Contact	Medical Director	Dr	Fendrich	Amy		6516620584					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/04/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Emergency Part D Contact	Manager, Pharmacy Operations		Ibrahim	Sonya		6516627412					sonya.ibrahim@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/13/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Emergency Part D Contact (Secondary)	Director, Pharmacy Operations		Mitchell	Angela		6516623607					angela.mitchell@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/13/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Employer Waiver Contact	Director Gov't Program Management for Medicare		Hower	Sara		6516624156					Sara.Hower@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/04/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Encounter Data & Risk Adjustment Operations Contact	Director, Enterprise Risk Adjustment		Lee	Rachel		6516629701					Rachel.Lee@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/18/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Enrollment Contact	Mgr Business Infrastructure Services		McWaters	Alisha		6516621755					alisha.mcwaters@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	12/29/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	EOB Transfer Contact	Director, PBM Operations		Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/21/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Financial Audit Contact	Manager, Regulatory Internal Audit	Mr	Haile-Selassie	Moguss		6516628966					moguss.haile-selassie@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/09/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Financial Reporting Contact	Dir Sr Corporate Controller		Long	Darlene		6516621704					Darlene.Long@bluecrossmn.com	3535 Blue Cross Rd		Eagan	MN	55122	12/29/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Formulary Contact	Pharmacist Business Segment Director		Boreen	Donna		6516621264					donna.boreen@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	01/28/2018	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/14/2020	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	General Contact	Director, Gov't Programs Partner Relations		Kosel	Karla		6516624166					Karla.Kosel@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Government Relations Contact	Chief Lobbyist		Nelson	Lin		6516627123					lin.nelson@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55121	02/23/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	HIPAA Privacy Officer	Deputy General Counsel/Privacy Officer	Ms	Roberge	Kathy		6516622890					kathleen.roberge@bluecrossmn.com	3535 Blue Cross Drive		Eagan	MN	55122	02/23/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	HIPAA Security Officer	SVP Chief Operating Officer		Smith	Carey		6516622739					carey.smith@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/23/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Hospice Contact	Operations Business Analyst		Dick	Beth		6516629644					beth.dick@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	03/11/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Interoperability Contact	Government Compliance Officer		Hogan	Carrie		6516621900					Carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/03/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	MA Appeals/Grievances Contact	Manager Consumer Service Center		Brown	Robyn		6516627446					robyn.brown@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	MA Claims Processing Contact for Public Website	Manager, Business Services		Daniels	Cassandra		6516623468					cassandra.daniels@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Marketing Contact	Compliance Manager- Government Markets		Danisch	Gary		6516622072					Gary.danisch@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/15/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Medical Director	Medical Director	Dr	Fendrich	Amy		6516620584					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/04/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Medicare Compliance Officer	Government Compliance Officer	Ms.	Hogan	Carrie		6516621900					carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Medicare Coordinator	Director Medicare Operations		Lee	Rachel		6516629701					Rachel.lee@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Medicare Part D Opioid Overutilization Contact	Supv Pharmacists		Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/07/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Medication Therapy Management Contact	Mgr. Pharmacy Services		Sharma	Anita		6516629221					anita.sharma@bluecrossmn.com	3400 Yankee Doodle Drive		Eagan	MN	55121	02/02/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	OffShore Subcontractor Contact	Director Government Markets Audit	Mr	Longar	Tom		6516629724					Thomas.Longar@bluecrossmn.com	3400 Yankee Drive	R337	Eagan	MN	55121	04/13/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Online Enrollment Center Contact (Back-up)	Manager, Business Services		Daniels	Cassandra		6516623468				6516623500	cassandra.daniels@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Online Enrollment Center Contact (Primary)	Mgr Business Infrastructure Services		McWaters	Alisha		6516621755					alisha.mcwaters@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	12/29/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Part C Application Contact	Product Consultant, Pr		Snyder	Amanda		6516623774					Amanda.Snyder@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/07/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Part C Reporting Contact	Director Medicare Operations		Littrell	Sue		6516622670					sue.littrell@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Appeals	Regulatory Director		Davis	Megan						8006936651	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/07/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/07/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Application Contact	Product Consultant, Pr		Snyder	Amanda		6516623774					Amanda.Snyder@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/07/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Benefits Contact	Director, Benefit Operations		Gergen	Ashley		6517772506					agergen@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/14/2020	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Claims Submission Contact	Functional Business Consultant - Gov't Programs		Brooke	Lance		4026862603				4029702545	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/14/2020	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Exceptions Contact	Med D Coverage		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/31/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/07/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active	8006936651	5393			HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Price File Contact (Back-up)	Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/14/2020	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Price File Contact (Optional)			Tastad	Emily		6518085779					emily.tastad@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	02/16/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Price File Contact (Primary)			Aschoff	Ted		6516628777					theodore.aschoff@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Quality Assurance Contact	Director, Pharmacy Ops Support		Ibrahim	Sonya		6516627412					Sonya.Ibrahim@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Part D Reporting Contact	Director Medicare Operations		Littrell	Sue		6516622670					sue.littrell@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Patient Safety Contact	Pharmacist Business Segment Director		Boreen	Donna		6516621264					donna.boreen@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/13/2020	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Payment Contact	Dir Sr Corporate Controller		Long	Darlene		6516621704					Darlene.Long@bluecrossmn.com	3535 Blue Cross Rd		Eagan	MN	55122	12/29/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Pharmacy Director	Pharmacist Business Segment Director		Boreen	Donna		6516621264					Donna.Boreen@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	01/29/2018	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Pharmacy Network Management Contact	AVP, Network Mangement		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/31/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Pharmacy Network Management Contact (Secondary)	Sr Dir, Network Management		Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/29/2020	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Pharmacy Technical Help Desk Contact	Director, Member Services		Pretlow	Jennifer							jennifer.pretlow@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	06/30/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active	8006482778				HMO - Health Maintenance Organization		C	Chicago
H2425	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	06/30/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active	8006482778				HMO - Health Maintenance Organization		C	Chicago
H2425	PHR Beneficiary Contact																	10/18/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS	Blue Cross and Blue Shield of Minnesota	Aware Integrated, Inc.	642	Yes	Active	8003822000				HMO - Health Maintenance Organization		C	Chicago
H2425	Physician Incentive Contact	Director, Gov''t Prog Partner Relations		Kosel	Karla		6516624166					Karla.Kosel@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/03/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Plan Directory Contact for Public Website	Digital Content Strategist		Cosgrove	Patrick		6516623727					patrick.cosgrove@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Plan to Plan Reconciliation Contact	Manager, Financial Reporting		Harrelson	Michael		6516628490				6516622200	Michael.Harrelson@bluecrossmn.com	3535 Blue Cross Rd		Eagan	MN	55122	10/18/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Processor Contact	Director, PBM Operations		Allie	Cindy		6127776722				6127777606	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/21/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Quality Contact	Director Program Management		Galle Franklin	Jeanne		6516628837					jeanne.gallefranklin@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/23/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Reconciliation Contact	Financial Analyst, Sr		Voves	Alex		6516623606					alex.voves@bluecrossmn.com	3535 Blue Cross Rd		Eagan	MN	55122	02/27/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Reconciliation Contact (Secondary)	Actuary		Legatt	Sarah		6516626757					sarah.legatt@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	02/27/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Recovery Audit Contact	Director, Government Markets Audit	Mr.	Longar	Tom		6516629724					thomas.longar@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/18/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	SNP Application Contact	Product Consultant, Pr		Snyder	Amanda		6516623774					Amanda.Snyder@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/07/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	SNP State Contact	Director, Gov't Prog Partner Relations		Kosel	Karla		6516624166					Karla.Kosel@bluecrossmn.com	3400 Yankee Doodle Road		Eagan	MN	55121	02/02/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Surveillance Contact	Director , Channel Management and Oversight		Lopez	Kris		6516627792					Kris.Lopez@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/03/2022	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	System Contact	Director		Wike	Tim		6516629066					tim.wike@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55121	02/23/2023	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Third Party Administrator (TPA) Liaison	Financial Analyst Senior		Voves	Alex		6516623606					Alex.Voves@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/13/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	User Access Contact	Compliance Manager Government Markets		Danisch	Gary		6516622072					Gary.danisch@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	04/13/2021	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Utilization Management Contact	Medical Director	Dr	Fendrich	Amy		6516620584					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/04/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2425	Utilization Review Contact	Medical Director	Dr	Fendrich	Amy		6516620854					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/04/2019	2023	HMO Minnesota	Local CCP	Blue Plus	HMO/HMOPOS		Aware Integrated, Inc.	642	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2450	Agent/Broker Compensation Data Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Automated TrOOP Balance Transfer Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Backup User Access Contact			Berg	Lynnsey		6126326655					lynnsey.berg@optum.com	P.O. Box 9472		Minneapolis	MN	554409472	11/30/2018	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Best Available Evidence Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Bid Primary Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/05/2013	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	CAP Report Contact for Public Website			Jacobson	Marissa		9529922093					marissa.jacobson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	CEO - CMS Administrator Contact	Interm President & CFO	Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	CEO - Senior Official for Contracting		Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Chief Financial Officer		Ms	Quist	Mary		9529922058					mary.quist@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Chief Operating Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Chief Information Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Chief Information Security Officer		Mr	Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	CMS Casework Communication Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Complaints Tracking Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Contact for Fraud Investigations			Monson	Peter		9529921149					peter.monson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/03/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Coordination of Benefits Contact			Vilendrer	Krista		9529923252					krista.vilendrer@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	04/22/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Corporate Mailing						9529922900					ann.kinsella@medica.com	401 Carlson Parkway	P.O. Box 9310 CP320	Minnetonka	MN	55305	02/28/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Cost Report Contact			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Coverage Gap Discount Program (CGDP) Payment Contact			Ricaurte	Angela		9529923748					angela.ricaurte@medica.com	401 Carlson Pkwy		Minnetonka	MN	55305	05/16/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Customer Service Operations Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	DIR Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/31/2011	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	DIR Contact (Secondary)			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	03/13/2019	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Emergency Part D Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Emergency Part D Contact (Secondary)			Janes	Kathy		9529928989					kathy.janes@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Employer Waiver Contact			Alness	Stacy		9529923825					stacy.alness@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/19/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Encounter Data & Risk Adjustment Operations Contact			Leth	Maria		9529928366					Maria.Leth@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/29/2019	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Enrollment Contact			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/26/2018	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	EOB Transfer Contact			Bourdages	Kathy		9529923653				9529923636	kathy.bourdages@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/03/2014	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Financial Reporting Contact			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Formulary Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Formulary Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/28/2016	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	General Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Government Relations Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	HIPAA Privacy Officer			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/20/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	HIPAA Security Officer		Mr	Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Hospice Contact			Bourdages	Kathy		9529923653				9529923636	PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/31/2018	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Interoperability Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/14/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	MA Appeals/Grievances Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	MA Claims Processing Contact for Public Website			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Marketing Contact			Teff	Melissa		9529923972					melissa.teff@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/05/2020	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Medical Director	Chief Clinical & Provider Strategy Officer		Webster	David		9529922801					david.webster@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/15/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Medicare Compliance Officer		Mrs	Koranteng	Milly		9529922090					mildred.koranteng@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/22/2020	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Medicare Coordinator			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Medicare Part D Opioid Overutilization Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Medication Therapy Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	OffShore Subcontractor Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Online Enrollment Center Contact (Primary)			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/15/2014	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Part C Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Part C Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/29/2017	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Part D Appeals			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/28/2016	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active	9529922353				Cost1		1	Kansas City
H2450	Part D Appeals Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active	9529923448				Cost1		1	Kansas City
H2450	Part D Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Part D Benefits Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/09/2020	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Part D Claims Submission Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Part D Exceptions Contact			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/28/2016	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active	9529922353				Cost1		1	Kansas City
H2450	Part D Exceptions Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active	9529923448				Cost1		1	Kansas City
H2450	Part D Price File Contact (Back-up)			Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Farifield	OH	45014	11/17/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Part D Price File Contact (Optional)			Bourdages	Kathy		9529923653					PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/26/2018	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Part D Price File Contact (Primary)			Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/17/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Part D Quality Assurance Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Part D Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/29/2017	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Patient Safety Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Payment Contact			Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/11/2019	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Pharmacy Director			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/10/2020	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Pharmacy Network Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Pharmacy Network Management Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/03/2014	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	La Tasha							LaTasha_Monroe@expressscripts.com	13051 N. Telecom Pkwy		Temple Terrace	FL	33637	11/17/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active	8009221557				Cost1		1	Kansas City
H2450	Pharmacy Technical Help Desk Contact (Secondary)			Bourdages	Kathy							PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/09/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active	8009221557				Cost1		1	Kansas City
H2450	Plan Directory Contact for Public Website			Service	Customer		8002348755					AskGovtPrograms@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Plan to Plan Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Processor Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Quality Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Reconciliation Contact (Secondary)			Schenten	Paul		9529928875					Paul.Schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	07/07/2017	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Surveillance Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	System Contact			Schwartz	Pamela		9529922584					pamela.schwartz@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Third Party Administrator (TPA) Liaison			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	User Access Contact			Sherman	Autumn		9529923483					autumn.sherman@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	05/08/2017	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Utilization Management Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/10/2016	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2450	Utilization Review Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/10/2016	2023	MEDICA INSURANCE COMPANY	1876 Cost	Medica	1876 Cost		Medica Holding Company	439	Yes	Active					Cost1		1	Kansas City
H2456	Agent/Broker Compensation Data Contact	Associate Vice President Sales		Eck	Brian		6126763380					beck@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/08/2018	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Automated TrOOP Balance Transfer Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					FIR_Transactions@ucare.org	500 Stinson Boulevard NE		Minnneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Backup User Access Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Best Available Evidence Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Bid Audit Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Bid Audit Site Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Bid Primary Contact	Corporate Actuary		Uding	Chris		6126763372					bids@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	CAP Report Contact for Public Website	Senior Regulatory  Auditor		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/14/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Chief Financial Officer	SVP and Chief Financial Officer	Ms.	Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/30/2015	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Chief Operating Officer	SVP and Chief Administrative Officer	Ms.	Schmitt	Pat		6126763460					pschmitt@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Chief Information Officer	Chief Information Officer	Mr	McDonald	Darin		9493098524					dmcdonald@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	06/13/2021	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Chief Information Security Officer	Chief Information Security Officer, Director	Mr	Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	CMS Casework Communication Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Complaints Tracking Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Contact for Fraud Investigations	Manager SIU		Weidemann	Angie		6128171655					aweidemann@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Coordination of Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Corporate Mailing						6126766500				6126766501	sschwartz@ucare.org	UCare	500 Stinson Boulevard NE	Minneapolis	MN	55413	11/23/2015	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Senior		Ly	Tong		6126277157					tly@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/17/2021	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Customer Service Operations Contact	CS Support Services Sr Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	DIR Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	DIR Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Emergency Part D Contact	Customer Service Workforce Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Emergency Part D Contact (Secondary)	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	600 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Encounter Data & Risk Adjustment Operations Contact			Olberding	Milissia		6126763205					molberding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/29/2019	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Enrollment Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	EOB Transfer Contact	CS Support Services Sr Manager		Vang	Pakou		6126763585				6128842145	pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Financial Audit Contact	Controller	Mr.	Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/04/2013	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Financial Reporting Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/04/2013	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Formulary Contact	Pharmacy Supervisor		Merk	Zachariah		6126763483					zmerk@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	07/29/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Formulary Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	General Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Government Relations Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	HIPAA Privacy Officer	Associate General Counsel - Privacy Officer		Heacox	Katie		5073408378					kheacox@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	HIPAA Security Officer	Chief Information Security Officer, Director		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Hospice Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Interoperability Contact	VP, Deputy General Counsel		Owen	Elizabeth		6513992800					eowen@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	MA Appeals/Grievances Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	MA Claims Processing Contact for Public Website	CCO Audit & Compliance Manager		Tenhoff	Reed		6126763664					rtenhoff@ucare.og	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/11/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Marketing Contact	Government Relations Materials Coordinator		Morales	Ana Sophia		6122945641					amorales@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/22/2021	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Medical Director	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	McMahon	Jane		6124567817					federalgrleadershipteam@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/30/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Medicare Coordinator	Federal Government Relations Manager		Mitchell	Milonda		6122945143					mmitchell1@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/12/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030					anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Medication Therapy Management Contact	Pharmacy Quality Manager		Bower	Erika		6122945800				6128842321	ebower@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/10/2021	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	OffShore Subcontractor Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Online Enrollment Center Contact (Back-up)	MBE Operations Manager		Rooney	Courtney		6126763468					crooney@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	11/12/2020	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Part C Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/23/2015	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Part C Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/13/2021	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Appeals	A&G Regulatory and Compliance Specialist		Wood	Nakia							cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945668				HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Appeals Contact (Secondary)	Manager Appeals & Grievances		Paciorek	Joshua							jpaciorek@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945225				HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Claims Submission Contact	Data Analyst Sr.		Krishnan	Kamali		6122945146					kkrishnan@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/30/2019	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Exceptions Contact	Vice President Pharmacy Management		Mitsch	Patrick						6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945051				HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Exceptions Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam						6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945030				HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Price File Contact (Back-up)	Pharmacy Operations Manager Sr.		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Price File Contact (Optional)	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Price File Contact (Primary)	Sr Manager, Government Programs		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	01/18/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Quality Assurance Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Part D Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/13/2019	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Patient Safety Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Payment Contact	Chief Financial Officer		Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	05/30/2008	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Pharmacy Director	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	patmitsch@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Pharmacy Network Management Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Pharmacy Technical Help Desk Contact	Director, Customer Service		Moore	LaTasha							LaTasha_Monroe@expressscripts.com	13051 N Telecom Parkway	Suite 150	Temple Terrace	FL	33637	01/18/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H2456	PHR Beneficiary Contact																	07/01/2011	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS	UCare	UCare Minnesota	238	Yes	Active	8775231515				HMO - Health Maintenance Organization		C	Chicago
H2456	Physician Incentive Contact	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/06/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Plan Directory Contact for Public Website	CS Support Services Sr Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Plan to Plan Reconciliation Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/04/2013	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Processor Contact	Pharmacy Operations Manager Sr		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Quality Contact	Vice President Quality Management		Hanley	Greg		6122945296					ghanley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/28/2016	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Reconciliation Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Reconciliation Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Recovery Audit Contact	Audit Director	Mr.	Schach	Steve		6126763562					sschach@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	554132615	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	SNP Application Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	SNP State Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Surveillance Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	System Contact	Chief Information Security Officer, Director		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Third Party Administrator (TPA) Liaison	Accountant		Zator	Chris		6126763563					czator@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/15/2021	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	User Access Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/19/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Utilization Management Contact	VP Clinical Services		Wickman	Amy		6126763418					awickman@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2456	Utilization Review Contact	Clinical Regulatory Specialist		Brown	Julie	B	6126763433					jbbrown@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare's MSHO	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2458	Agent/Broker Compensation Data Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Automated TrOOP Balance Transfer Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Backup User Access Contact			Berg	Lynnsey		6126326655					lynnsey.berg@optum.com	P.O. Box 9472		Minneapolis	MN	554409472	11/30/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Best Available Evidence Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Bid Audit Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/11/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Bid Audit Site Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/11/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Bid Primary Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/05/2013	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	CAP Report Contact for Public Website			Jacobson	Marissa		9529922093					marissa.jacobson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	CEO - CMS Administrator Contact	Interm President & CFO	Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	CEO - Senior Official for Contracting		Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Chief Financial Officer		Ms	Quist	Mary		9529922058					mary.quist@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Chief Operating Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Chief Information Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Chief Information Security Officer		Mr	Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	CMMI Model Point of Contact			Schaefer	Jennifer		9529912803					jennifer.schaefer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	CMS Casework Communication Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Complaints Tracking Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Contact for Fraud Investigations			Monson	Peter		9529921149					peter.monson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/03/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Coordination of Benefits Contact			Vilendrer	Krista		9529923252					krista.vilendrer@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	04/22/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Corporate Mailing						9529922900					ann.kinsella@medica.com	401 Carlson Parkway	P.O. Box 9310 CP320	Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Coverage Gap Discount Program (CGDP) Payment Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Customer Service Operations Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	DIR Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/31/2011	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	DIR Contact (Secondary)			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	03/13/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Emergency Part D Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Emergency Part D Contact (Secondary)			Janes	Kathy		9529928989					kathy.janes@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Employer Waiver Contact			Alness	Stacy		9529923825					stacy.alness@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/19/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Encounter Data & Risk Adjustment Operations Contact			Leth	Maria		9529928366					Maria.Leth@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/29/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Enrollment Contact			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/28/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	EOB Transfer Contact			Bourdages	Kathy		9529923653				9529923636	kathy.bourdages@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/03/2014	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Financial Audit Contact	Director of Finance	Ms	Faig	Sara		9529928358					sara.faig@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/21/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Financial Reporting Contact			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Formulary Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Formulary Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/28/2016	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	General Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Government Relations Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	HIPAA Privacy Officer			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/20/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	HIPAA Security Officer			Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Hospice Contact			Bourdages	Kathy		9529923653					PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/28/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Interoperability Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/14/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	MA Appeals/Grievances Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	MA Claims Processing Contact for Public Website			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Marketing Contact			Teff	Melissa		9529923972					melissa.teff@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Medical Director	Chief Clinical & Provider Strategy Officer		Webster	David		9529922801					david.webster@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/15/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Medicare Compliance Officer		Mrs	Koranteng	Milly		9529922090					mildred.koranteng@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/22/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Medicare Coordinator			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Medicare Part D Opioid Overutilization Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Medication Therapy Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	OffShore Subcontractor Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Online Enrollment Center Contact (Primary)			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/15/2014	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Part C Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Part C Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/29/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Appeals			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/28/2016	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529922353				HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Appeals Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529923448				HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Benefits Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/09/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Claims Submission Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Exceptions Contact			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/28/2016	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529922353				HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Exceptions Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529923448				HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Price File Contact (Back-up)			Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Farifield	OH	45014	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Price File Contact (Optional)			Bourdages	Kathy		9529923653					PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/28/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Price File Contact (Primary)			Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Quality Assurance Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Part D Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/29/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Patient Safety Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Payment Contact			Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/11/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Pharmacy Director			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/10/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Pharmacy Network Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Pharmacy Network Management Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/03/2014	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	La Tasha							LaTasha_Monroe@expressscripts.com	13051 N. Telecom Pkwy		Temple Terrace	FL	33637	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Kansas City
H2458	Pharmacy Technical Help Desk Contact (Secondary)			Bourdages	Kathy							PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/09/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Kansas City
H2458	Plan Directory Contact for Public Website			Service	Customer		8002348755					AskGovtPrograms@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Plan to Plan Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Processor Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Quality Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Reconciliation Contact (Secondary)			Schenten	Paul		9529928875					Paul.Schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	06/27/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Recovery Audit Contact	Manager Claims Operations	Mr	Foley	Steve		9529924160					steven.foley@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	SNP Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	SNP State Contact			Zillhardt	John		9529922290					John.Zillhardt@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Surveillance Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	System Contact			Schwartz	Pamela		9529922584					pamela.schwartz@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Third Party Administrator (TPA) Liaison			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	User Access Contact			Sherman	Autumn		9529923483					autumn.sherman@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	05/08/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Utilization Management Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/10/2016	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2458	Utilization Review Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/10/2016	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2459	Agent/Broker Compensation Data Contact	Associate Vice President Sales		Eck	Brian		6126763380					beck@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/08/2018	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Automated TrOOP Balance Transfer Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					FIR_Transactions@ucare.org	500 Stinson Boulevard NE		Minnneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Backup User Access Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Best Available Evidence Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Bid Audit Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Bid Audit Site Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Bid Primary Contact	Corporate Actuary		Uding	Chris		6126763372					bids@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	CAP Report Contact for Public Website	Senior Regulatory  Auditor		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/14/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Chief Financial Officer	SVP and Chief Financial Officer	Ms.	Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/30/2015	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Chief Operating Officer	SVP and Chief Administrative Officer	Ms.	Schmitt	Pat		6126763460					pschmitt@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Chief Information Officer	Executive VP, Chief Information Officer	Mr	McDonald	Darin		9493098524					dmcdonald@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Chief Information Security Officer	Chief Information Security Officer, Director	Mr	Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	CMS Casework Communication Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Complaints Tracking Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Contact for Fraud Investigations	Manager SIU		Weidemann	Angie		6128171655					aweidemann@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Coordination of Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Corporate Mailing						6126766500				6126766501	sschwartz@ucare.org	UCare	500 Stinson Boulevard NE	Minneapolis	MN	55413	11/23/2015	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Senior		Ly	Tong		6126277157					tly@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/17/2021	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Customer Service Operations Contact	CS Support Services Sr Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	DIR Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	DIR Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Emergency Part D Contact	Customer Service Workforce Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Emergency Part D Contact (Secondary)	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	600 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Encounter Data & Risk Adjustment Operations Contact			Olberding	Milissia		6126763205					molberding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/29/2019	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Enrollment Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	EOB Transfer Contact	CS Support Services Sr Manager		Vang	Pakou		6126763585				6128842145	pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Financial Audit Contact	Controller	Mr.	Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/04/2013	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Financial Reporting Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/04/2013	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Formulary Contact	Pharmacy Supervisor		Merk	Zachariah		6126763483					zmerk@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	07/29/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Formulary Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	General Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Government Relations Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	HIPAA Privacy Officer	Associate General Counsel - Privacy Officer		Heacox	Katie		5073408378					kheacox@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	HIPAA Security Officer	Chief Information Security Officer, Director		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Hospice Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Interoperability Contact	VP, Deputy General Counsel		Owen	Elizabeth		6513992800					eowen@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	MA Appeals/Grievances Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	MA Claims Processing Contact for Public Website	CCO Audit & Compliance Manager		Tenhoff	Reed		6126763664					rtenhoff@ucare.og	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/11/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Marketing Contact	Government Relations Materials Coordinator		Morales	Ana Sophia		6122945641					amorales@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/22/2021	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Medical Director	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	McMahon	Jane		6124567817					federalgrleadershipteam@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/30/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Medicare Coordinator	Federal Government Relations Manager		Mitchell	Milonda		6122945143					mmitchell1@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/12/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030					anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Medication Therapy Management Contact	Pharmacy Quality Manager		Bower	Erika		6122945800				6128842321	ebower@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/10/2021	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	OffShore Subcontractor Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Online Enrollment Center Contact (Back-up)	MBE Operations Manager		Rooney	Courtney		6126763468					crooney@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	11/12/2020	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Part C Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/23/2015	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Part C Reporting Contact	Senior Regulatory Auditor		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/30/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Appeals	A&G Regulatory and Compliance Specialist		Wood	Nakia							cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945668				HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Appeals Contact (Secondary)	Manager Appeals & Grievances		Paciorek	Joshua							jpaciorek@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945225				HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Claims Submission Contact	Data Analyst Sr.		Krishnan	Kamali		6122945146					kkrishnan@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/30/2019	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Exceptions Contact	Vice President Pharmacy Management		Mitsch	Patrick						6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945051				HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Exceptions Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam						6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945030				HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Price File Contact (Back-up)	Pharmacy Clinical Operations Supervisor		Mooney	Jennifer		6122945295					PharmacyFormulary@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	05/16/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Price File Contact (Optional)	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Price File Contact (Primary)	Sr Manager, Government Programs		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	01/18/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Quality Assurance Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Part D Reporting Contact	Senior Regulatory Auditor		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/30/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Patient Safety Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Payment Contact	Chief Financial Officer		Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	05/30/2008	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Pharmacy Director	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	patmitsch@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Pharmacy Network Management Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Pharmacy Technical Help Desk Contact	Director, Customer Service		Moore	LaTasha							LaTasha_Monroe@expressscripts.com	13051 N Telecom Parkway	Suite 150	Temple Terrace	FL	33637	01/18/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H2459	PHR Beneficiary Contact																	07/01/2011	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS	UCare	UCare Minnesota	238	Yes	Active	8775231515				HMO - Health Maintenance Organization		C	Chicago
H2459	Physician Incentive Contact	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/06/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Plan Directory Contact for Public Website	CS Support Services Sr Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Plan to Plan Reconciliation Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/04/2013	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Processor Contact	Pharmacy Operations Manager Sr		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Quality Contact	Vice President Quality Management		Hanley	Greg		6122945296					ghanley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/28/2016	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Reconciliation Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Reconciliation Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Recovery Audit Contact	Audit Director	Mr.	Schach	Steve		6126763562					sschach@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	554132615	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	SNP Application Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	SNP State Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Surveillance Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	System Contact	Chief Information Security Officer, Director		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Third Party Administrator (TPA) Liaison	Accountant		Zator	Chris		6126763563					czator@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/15/2021	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	User Access Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/19/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Utilization Management Contact	VP Clinical Services		Wickman	Amy		6126763418					awickman@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2459	Utilization Review Contact	Clinical Regulatory Specialist		Brown	Julie	B	6126763433					jbbrown@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2461	Agent/Broker Compensation Data Contact	Director, Channel Management and Oversight		Lopez	Kris		6516627792					kris.lopez@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/03/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Automated TrOOP Balance Transfer Contact	Director PBM Operations		Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/21/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Backup User Access Contact	Government Compliance Officer		Hogan	Carrie		6516621900					carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Best Available Evidence Contact	Manager, Business Services		Daniels	Cassandra		6516623468					Cassandra.Daniels@bluecrossmn.com	3400 Yankee Dr		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Bid Primary Contact	Asst. Actuary		Zeterlu	Angela		6516620420					angela.zeterlu@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	06/12/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	CAP Report Contact for Public Website	Government Compliance Officer		Hogan	Carrie		6516621900					carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	CEO - CMS Administrator Contact	President & CEO	Ms	Erickson	Dana		6516628904					Dana.erickson@bluecrossmn.com	1800 Yankee Doodle Road		Eagan	MN	55121	12/13/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	CEO - Senior Official for Contracting	President Government Markets, SVP	Ms.	Engel	Monica		6516627329					monica.engel@bluecrossmn.com	1800 Yankee Doodle Road		Eagan	MN	55121	01/22/2020	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Chief Financial Officer	Senior Vice President, Chief Financial Officer	Mr.	Uribe	John		6516629501					John.Uribe@bluecrossmn.com	1800 Yankee Doodle Road		Eagan	MN	55121	06/03/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Chief Operating Officer	President Government Markets, SVP	Ms.	Engel	Monica		6516627329					monica.engel@bluecrossmn.com	1800 Yankee Doodle Road		Eagan	MN	55121	07/26/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Chief Information Officer	Director	Mr.	Wike	Tim		6516629066					tim.wike@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	02/23/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Chief Information Security Officer	VP Digital Platforms & Cybersecurity	Mr	Groshong	Chris		6516622878					Christopher.Groshong@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/12/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	CMS Casework Communication Contact	Manager Appeals & Grievances		Bazzarre	Tom		6516629643					Tom.bazzarre@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	07/14/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Complaints Tracking Contact	Manager Appeals & Grievances		Bazzarre	Tom		6516629643					Tom.bazzarre@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	07/14/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Contact for Fraud Investigations	Director Operational Risk Management Performance		Dickinson	Richard		6516623532					richard.dickinson@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	01/12/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Coordination of Benefits Contact	Business Services  Mgr		Daniels	Cassandra		6516623468					government.program.service.request@bcbsmn.com	3400 Yankee Dr		Eagan	MN	55122	06/28/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Corporate Mailing						8663408654					contact@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/16/2017	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Cost Report Contact	Manager, Financial Reporting & Accounting		Harrelson	Michael		6516628490					Michael.Harrelson@bluecrossmn.com	3535 Blue Cross Rd		Eagan	MN	55122	01/27/2018	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst Sr		Voves	Alex		6516623606					Alex.Voves@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	04/15/2016	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Customer Service Operations Contact	Director, Business Transformation		Hovick	Denise		6516628864					denise.hovick@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	04/21/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	DIR Contact	Actuary		Legatt	Sarah		6516626757					sarah.legatt@bluecrossmn.com	3535 Blue Cross Rd		Eagan	MN	55122	02/27/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	DIR Contact (Secondary)	Financial Analyst, Sr		Voves	Alex		6516623606					alex.voves@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	02/27/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Emergency Part D Contact	Manager, Pharmacy Operations		Ibrahim	Sonya		6516627412					sonya.ibrahim@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/13/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Emergency Part D Contact (Secondary)	Director, Pharmacy Operations		Mitchell	Angela		6516623607					angela.mitchell@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Employer Waiver Contact	Director, Gov't Program Management for Medicare		Hower	Sara		6516624156					sara.hower@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Encounter Data & Risk Adjustment Operations Contact	Director, Enterprise Risk Adjustment		Lee	Rachel		6516629701					Rachel.Lee@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/18/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Enrollment Contact	Mgr Business Infrastructure Services		McWaters	Alisha		6516621755					alisha.mcwaters@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	12/29/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	EOB Transfer Contact	Director, PBM Operations		Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/21/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Financial Reporting Contact	Dir Sr Corporate Controller		Long	Darlene		6516621704					Darlene.Long@bluecrossmn.com	3535 Blue Cross Rd		Eagan	MN	55122	12/29/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Formulary Contact	Pharmacist Business Segment Director		Boreen	Donna		6516621264					donna.boreen@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	01/27/2018	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/14/2020	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	General Contact	Director Medicare Operations		Snegosky	Jeff		6127194387					jeff.snegosky@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Government Relations Contact	Chief Lobbyist		Nelson	Lin		6516627123					lin.nelson@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55121	02/23/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	HIPAA Privacy Officer	Deputy General Counsel/Privacy Officer		Roberge	Kathy		6516622890					kathleen.roberge@bluecrossmn.com	3535 Blue Cross Drive		Eagan	MN	55122	02/23/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	HIPAA Security Officer	SVP Chief Operating Officer		Smith	Carey		6516622739					carey.smith@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	02/23/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Hospice Contact	Operations Business Analyst		Dick	Beth		6516629644					beth.dick@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	03/19/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Interoperability Contact	Government Compliance Officer		Hogan	Carrie		6516621900					Carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/03/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	MA Appeals/Grievances Contact	Manager Consumer Service Center		Brown	Robyn		6516627446					robyn.brown@bluecrossmn.com	1800 Yankee Doddle Road		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	MA Claims Processing Contact for Public Website	Manager, Business Services		Daniels	Cassandra		6516623468					cassandra.daniels@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Marketing Contact	Compliance Manager- Government Markets		Danisch	Gary		6516622072					Gary.danisch@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/15/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Medical Director	Medical Director	Dr.	Fendrich	Amy		6516620584					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/17/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Medicare Compliance Officer	Government Compliance Officer	Ms.	Hogan	Carrie		6516621900					carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Medicare Coordinator	Director Medicare Operations		Daniels	Cassie		6516623468					cassandra.daniels@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Medicare Part D Opioid Overutilization Contact	Supv Pharmacists		Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/07/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Medication Therapy Management Contact	Mgr. Pharmacy Services		Sharma	Anita		6516629221					anita.sharma@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	OffShore Subcontractor Contact	Compliance Manager- Government Markets		Danisch	Gary		6516622072					Gary.danisch@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/21/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Online Enrollment Center Contact (Back-up)	Manager, Business Services		Daniels	Cassandra		6516623468				6516623500	cassandra.daniels@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Online Enrollment Center Contact (Primary)	Mgr Business Infrastructure Services		McWaters	Alisha		6516621755					alisha.mcwaters@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	12/29/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Part C Application Contact	Product Consultant, Pr		Snyder	Amanda		6516623774					Amanda.Snyder@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/07/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Part C Reporting Contact	Director Medicare Operations		Littrell	Sue		6516622670					sue.littrell@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Part D Appeals	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/31/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active	8006936651				Cost1		1	Chicago
H2461	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/07/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active	8006936651				Cost1		1	Chicago
H2461	Part D Application Contact	Product Consultant, Pr		Snyder	Amanda		6516623774					Amanda.Snyder@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/07/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Part D Benefits Contact	Director, Benefits Operations		Gergen	Ashley		6517772506					agergen@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/14/2020	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Part D Claims Submission Contact	Functional Business Consultant - Gov't Programs		Brooke	Lance		4026862603				4029702545	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/14/2020	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Part D Exceptions Contact	Med D Coverage		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/31/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active	8006936651				Cost1		1	Chicago
H2461	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/07/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active	8006936651				Cost1		1	Chicago
H2461	Part D Price File Contact (Back-up)	Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/14/2020	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Part D Price File Contact (Optional)			Tastad	Emily		6518085779					emily.tastad@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	02/16/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Part D Price File Contact (Primary)			Aschoff	Ted		6516628777					theodore.aschoff@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Part D Quality Assurance Contact	Director, Pharmacy Ops Support		Ibrahim	Sonya		6516627412					Sonya.Ibrahim@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Part D Reporting Contact	Director Medicare Operations		Littrell	Sue		6516622670					sue.littrell@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Patient Safety Contact	Pharmacist Business Segment Director		Boreen	Donna		6516621264					donna.boreen@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/13/2020	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Payment Contact	Dir. Sr. Corporate Controller		Long	Darlene		6516621704					Darlene.Long@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Pharmacy Director	Pharmacist Business Segment Director		Boreen	Donna		6516621264					Donna.Boreen@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	01/28/2018	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Pharmacy Network Management Contact	AVP, Network Mangement		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/31/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Pharmacy Network Management Contact (Secondary)	Sr Dir, Network Management		Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/29/2020	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Pharmacy Technical Help Desk Contact	Director, Member Services		Pretlow	Jennifer							jennifer.pretlow@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	06/30/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active	8006482778				Cost1		1	Chicago
H2461	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	06/30/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active	8006482778				Cost1		1	Chicago
H2461	PHR Beneficiary Contact																	07/17/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost	Blue Cross and Blue Shield of Minnesota	Aware Integrated, Inc.	642	Yes	Active	8003822000				Cost1		1	Chicago
H2461	Plan Directory Contact for Public Website	Digital Content Strategist		Cosgrove	Patrick		6516623727					patrick.cosgrove@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Plan to Plan Reconciliation Contact	Manager, Financial Reporting		Harrelson	Michael		6516628490				6516622200	Michael.Harrelson@bluecrossmn.com	3535 Blue Cross Rd		Eagan	MN	55122	01/28/2018	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Processor Contact	Director, PBM Operations		Allie	Cindy		6127776722				6127777606	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/21/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Quality Contact	Director Program Management		Galle Franklin	Jeanne		6516628837					jeanne.gallefranklin@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/23/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Reconciliation Contact	Financial Analyst, Sr		Voves	Alex		6516623606					alex.voves@bluecrossmn.com	3535 Blue Cross Rd		Eagan	MN	55122	02/27/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Reconciliation Contact (Secondary)	Actuary		Legatt	Sarah		6516626757					sarah.legatt@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	02/27/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Surveillance Contact	Director , Channel Management and Oversight		Lopez	Kris		6516627792					Kris.Lopez@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/03/2022	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	System Contact	Director	Mr.	Wike	Tim		6516629066					tim.wike@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55122	02/23/2023	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Third Party Administrator (TPA) Liaison	Financial Analyst Senior		Voves	Alex		6516623606					Alex.Voves@bluecrossmn.com	3535 Blue Cross Road		Eagan	MN	55121	12/13/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	User Access Contact	Compliance Manager Government Markets		Danisch	Gary		6516622072					Gary.danisch@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	04/13/2021	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Utilization Management Contact	Medical Director	Dr.	Fendrich	Amy		6516620584					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/17/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2461	Utilization Review Contact	Medical Director	Dr.	Fendrich	Amy		6516620584					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/17/2019	2023	BCBSM, Inc.	1876 Cost	Blue Cross and Blue Shield of Minnesota	1876 Cost		Aware Integrated, Inc.	642	Yes	Active					Cost1		1	Chicago
H2462	Agent/Broker Compensation Data Contact	VP Government Programs		Clelland	Jennifer	J	9529675119					jennifer.j.clelland@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	11/04/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Automated TrOOP Balance Transfer Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Backup User Access Contact	Coordinator Government Programs		Yu	Chao		9528837240					Chao.X.Yu@HealthPartners.com	8170 33rd Avenue South		Minneapolis	MN	554401309	04/20/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Best Available Evidence Contact	Manager Membership Accounting		Marty	Amanda	E	9529677685					amanda.e.marty@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/05/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Bid Primary Contact	Corporate Actuary		Stewart	Sara	M	9528835049					sara.m.stewart@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21105H	Minneapolis	MN	554401309	07/24/2019	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	CAP Report Contact for Public Website	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	CEO - CMS Administrator Contact	President and CEO	Ms.	Walsh	Andrea	M	9528835343				9528835350	wendy.r.kobe@healthpartners.com	8170 33rd Avenue South	MS: 21110A	Minneapolis	MN	55425	01/05/2023	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	CEO - Senior Official for Contracting	President and CEO	Ms.	Walsh	Andrea	M	9528835343				9528835350	wendy.r.kobe@healthpartners.com	8170 33rd Avenue South	MS: 21110A	Minneapolis	MN	55425	01/04/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Chief Financial Officer	SVP & Chief Financial Officer	Ms.	Johnson	Kathleen	A	9528836531					kathy.a.johnson1@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110T	Minneapolis	MN	554401309	03/29/2023	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Chief Operating Officer	EVP and Chief Health Plan Officer	Ms.	Danielson	Jennifer	B	9528835573					victoria.j.slates@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110A	Minneapolis	MN	554401309	07/06/2023	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Chief Information Officer	Senior Vice President and CTO	Mr.	Zuzek	Dennis	M	9528837045					dennis.m.zuzek@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Chief Information Security Officer	VP Technology Infrastructure & Security	Mr.	Muller	Frank	J	9529676070					frank.j.muller@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	CMS Casework Communication Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Complaints Tracking Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Contact for Fraud Investigations	Senior Manager Claims Cost Management		Hove	Ryan	M	6512651573					ryan.m.hove@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  25510F	Minneapolis	MN	55101	07/24/2019	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Coordination of Benefits Contact	Manager, Claims Production		Prine	Chantelle	M	9529677335					RVSCCOBTECHS@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	04/20/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Corporate Mailing						9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	05/21/2015	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Cost Report Contact	Director Corporate Finance Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, P.O. Box 1309	MS: 21109A	Bloomington	MN	554251309	12/07/2016	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant		Knights	Michelle	M	9528836532					michelle.m.knights@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21109A	Minneapolis	MN	554401309	12/03/2020	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Customer Service Operations Contact	Director Member Services		Renneke	Alison		9529677668					alison.m.renneke@healthpartners.com	8170 33rd Avenue South, PO Box 9463	MS:  21103R	Minneapolis	MN	554409463	01/29/2020	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	DIR Contact	Pharmacy Plan Contract Manager		Reinhardt	Sandra	L	9528836739					sandra.l.reinhardt@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/29/2020	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	DIR Contact (Secondary)	Health Informatics Analyst Pcp		Binsfeld	David	T	9529675950					david.t.binsfeld@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS 21108Q	Minneapolis	MN	554401309	05/09/2013	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Emergency Part D Contact	Sr. Director Pharmacy Services		Strahl	Christine	L	9528835022				9529676667	christine.l.strahl@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/04/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Emergency Part D Contact (Secondary)	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9529675826				9529676667	dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/29/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Employer Waiver Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Encounter Data & Risk Adjustment Operations Contact	Senior Director Operational Integrity		Anderson	Larin	D	9528835796					larin.d.anderson@healthpartners.com	8170 33rd Avenue South	MS: 21103J	Minneapolis	MN	55425	10/22/2019	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Enrollment Contact	Director Membership Accounting		McWell	Carrie	J	9529675487					carrie.j.mcwell@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	11/30/2017	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	EOB Transfer Contact	Sr. Manager Claims Production		Huseby	Pam	J	9529675530				9528837666	pam.j.huseby@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	08/30/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Financial Reporting Contact	Director Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21109A	Minneapolis	MN	554401309	05/21/2015	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Formulary Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Formulary Contact (Secondary)	Formulary Administration Pharmacist		Savage	Robert		8587906426					robert.savage@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	07/24/2019	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	General Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Government Relations Contact	VP Government Programs		Clelland	Jennifer	J	9529675119					jennifer.j.clelland@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	08/30/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	HIPAA Privacy Officer	Sr. Director Integrity Compliance Privacy Officer		Wells	Prasanta	K	9528837325					prasanta.k.wells@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103K	Minneapolis	MN	554401309	05/27/2015	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	HIPAA Security Officer	VP Technology Infrastructure & Security	Mr.	Muller	Frank	J	9529676070					frank.j.muller@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Hospice Contact	Pharmacy Compliance Specialist		Riggs	Ben	H	9528518421					benjamin.h.riggs@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/03/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Interoperability Contact	Program Manager		Geisler	Chris	J	6122479067					Chris.J.Geisler@HealthPartners.Com	8170 33rd Avenue S		Bloomington	MN	55425	06/20/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	MA Appeals/Grievances Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	MA Claims Processing Contact for Public Website	Manager Claims Production		Huseby	Pam	J	9529675530					RVSCProviderInquiry@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	12/07/2016	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Marketing Contact	Mgr Govt Prog Materials & Regulatory Comm		Her-Vang	Xong		9529675061					xong.x.hervang@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	11/16/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Medical Director	Health Plan Chief Medical Officer	Dr.	Kakacek	Virginia	L	9528837120					virginia.l.kakacek@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110Q	Minneapolis	MN	554401309	09/21/2023	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Medicare Compliance Officer	VP Internal Audit Comp Officer	Mr.	Bunde	Steven	D	9528836541				9528835522	steven.d.bunde@healthpartners.com	8170 33rd Avenue South		Bloomington	MN	55425	12/03/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Medicare Coordinator	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Medicare Part D Opioid Overutilization Contact	Pharmacy Compliance Specialist		Riggs	Ben		9528518421					Benjamin.H.Riggs@HealthPartners.Com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/29/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Medication Therapy Management Contact	Senior Manager Med Therapy Management Program		Rehrauer	Daniel	J	9529675133					daniel.j.rehrauer@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/11/2018	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Online Enrollment Center Contact (Back-up)	Director Membership Accounting		McWell	Carrie	J	9529675487					carrie.j.mcwell@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/30/2017	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Online Enrollment Center Contact (Optional)	Admin Product Implementation Manager		Wessel	Sara	C	9529677623					sara.c.wessel@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/29/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Online Enrollment Center Contact (Primary)	Manager Membership Accounting		Marty	Amanda	E	9529677685					amanda.e.marty@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	01/09/2018	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Part C Application Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Part C Reporting Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Part D Appeals	Manager Member Rights and Benefits		Kruse	Morgan	L						Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS:  21103R	Minneapolis	MN	554409463	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active	8007963806				Cost1		1	Chicago
H2462	Part D Appeals Contact (Secondary)	Senior Rights & Benefits Project Lead		Schneider	Crystal	L						crystal.l.schneider@healthpartners.com	8170 33rd Avenue South	MS: 21103R	Bloomington	MN	55425	01/05/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active	8007963806				Cost1		1	Chicago
H2462	Part D Application Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Part D Benefits Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Part D Claims Submission Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Part D Exceptions Contact	Supervisor, Clinical Review		Whelan	Hillary	A					8888835434	hillary.a.whelan@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active	8004927259				Cost1		1	Chicago
H2462	Part D Price File Contact (Back-up)			Communications	Planfinder		8587905849				8587906052	PlanFinderCommunications@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	08/17/2015	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Part D Price File Contact (Primary)	Pharmacy Compliance Specialist		Riggs	Ben	H	9528518421					benjamin.h.riggs@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/03/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Part D Quality Assurance Contact	Senior Manager Quality and Compliance		Book	Anne	M	9528835128					anne.m.book@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21108T	Minneapolis	MN	554401309	01/09/2018	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Part D Reporting Contact	Director Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Patient Safety Contact	Senior Manager Med Therapy Management Program		Rehrauer	Daniel	J	9529675133					daniel.j.rehrauer@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/14/2018	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Payment Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/09/2013	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Pharmacy Director	VP Pharmacy		Busch	David	L	9529675049					david.l.busch@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	06/25/2020	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Pharmacy Network Management Contact	Director Pharmacy Sales & Product Support		Friday	Ken	R	9529675826				9529676667	kenneth.r.friday@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Administration		Hunt	Brian		8587907092					Brian.Hunt@MedImpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/29/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Pharmacy Technical Help Desk Contact	Manager Health Plan Pharmacy Customer Service		Whelan	Hillary	A					8888835434	Hillary.A.Whelan@HealthPartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/19/2022	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active	8004927259				Cost1		1	Chicago
H2462	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Contact Services		Brewer	Kathy							Customerservice@Medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/15/2017	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active	8887831779				Cost1		1	Chicago
H2462	Plan Directory Contact for Public Website			Services	Provider		9528837699					RVSCProviderInquiry@HealthPartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	06/10/2013	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Plan to Plan Reconciliation Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584				9528836500	kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/09/2013	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Processor Contact	Director Pharmacy Sales & Product Support		Friday	Ken	R	9529675826				9529676667	kenneth.r.friday@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Quality Contact	Senior Manager Quality and Compliance		Book	Anne	M	9528835128					anne.m.book@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	01/09/2018	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Reconciliation Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/09/2013	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Reconciliation Contact (Secondary)	Senior Accountant		Knights	Michelle	M	9528833532					michelle.m.knights@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/19/2020	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Surveillance Contact	Director Monitoring and Compliance		Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	System Contact	Senior Director Operational Integrity		Anderson	Larin	D	9528835796					larin.d.anderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21193J	Minneapolis	MN	554401309	12/05/2014	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Third Party Administrator (TPA) Liaison	Senior Accountant		Knights	Michelle	M	9528833532					michelle.m.knights@healthpartners.com	8170 33rd Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/19/2020	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	User Access Contact	Mgr Govt Prog Materials & Regulatory Comm		Her-Vang	Xong		9529675061					xong.x.hervang@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	11/16/2021	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Utilization Management Contact	Director Utilization Management		Gunderson	Susan	C	9528835576					susan.c.gunderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	12/10/2019	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2462	Utilization Review Contact	Director Utilization Management		Gunderson	Susan	C	9528835576					susan.c.gunderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	12/10/2019	2023	GROUP HEALTH PLAN, INC. (MN)	1876 Cost	HealthPartners	1876 Cost		HealthPartners, Inc.	117	Yes	Active					Cost1		1	Chicago
H2463	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H2463	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H2463	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2463	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN OF TEXAS, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2478	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Automated TrOOP Balance Transfer Contact	MHI- VP, Medicare Finance, CFO		Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	CAP Report Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Chief Financial Officer	MHI- VP, Medicare Finance, CFO	Mrs.	Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	DIR Contact	MHI- VP, Medicare Finance, CFO		Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	05/23/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Financial Reporting Contact	MHI- VP, Medicare Finance, CFO		Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	MA Claims Processing Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H2478	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H2478	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H2478	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H2478	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H2478	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H2478	Physician Incentive Contact	MHI- VP, Medicare Finance, CFO		Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Plan Directory Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Plan to Plan Reconciliation Contact	MHI- VP, Medicare Finance, CFO		Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2478	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF NEVADA INC	Local CCP	Molina Healthcare of Nevada	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2486	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H2486	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H2486	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2486	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF UTAH, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2491	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/27/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Rd		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H2491	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H2491	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8774577621				HMO - Health Maintenance Organization		C	Dallas
H2491	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Rd	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2491	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2506	Agent/Broker Compensation Data Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	01/09/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/22/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Best Available Evidence Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	01/09/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	12/19/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	12/19/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Bid Primary Contact	Sr. Manager, Project Program Mgmnt		Fahrner	Melanie		6186061189					mafahrner@aetna.com	7400 W. Campus Road		New Albany	OH	43054	06/20/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	05/04/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	CMS Casework Communication Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Complaints Tracking Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Coordination of Benefits Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/28/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Corporate Mailing						4107525721				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/01/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Customer Service Operations Contact	Director, Service Operations		Phillips	Tish		8666002139					PhillipsL1@aetna.com	7400 Camous Road		New Albany	OH	43054	07/19/2019	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Emergency Part D Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/28/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Emergency Part D Contact (Secondary)	Director, Pharmacy		Stekol	Ilona		3478806082					stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Employer Waiver Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	01/09/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Encounter Data & Risk Adjustment Operations Contact	Director, Informatics		Sevchik	Melissa		6026591404					sevchikm@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	12/17/2019	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Enrollment Contact	Director, Service Operations		Truitt	Michelle		7176716847					MLTruitt@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	07/01/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Formulary Contact	Pharmacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/28/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Formulary Contact (Secondary)	Director, Pharmacy		Stekol	Ilona		3478806082					stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	General Contact	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/13/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Government Relations Contact	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/13/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	HIPAA Privacy Officer	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	01/09/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Hospice Contact	Director, Service Operations		Truitt	Michelle		7176716847					MLTruitt@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	07/01/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	MA Appeals/Grievances Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	09/06/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	09/06/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Medical Director	Sr.  Medical Director		Hudson, MD	Karla		7739324873					hudsonk2@aetna.com	3200 Highland Ave.	MC F661	Downers Grove	IL	60515	09/06/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Medicare Coordinator	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/13/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Medicare Part D Opioid Overutilization Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	02/07/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Medication Therapy Management Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/28/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	MMP Reporting Requirements Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	01/09/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	MMP Point of Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	01/09/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	OffShore Subcontractor Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	01/09/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part C Application Contact	Exec Dir, Business Operations		Washington	Chaz		3854993702					washingtonc3@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/29/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part D Appeals	Supervisor, Clinical Pharmacy	Ms.	Spencer	Tiffane						8553658109	MedicareCoverageDeterminationMMP-SNP@AETNA.com	4500 E Cotton Center, Blvd	F829	Phoenix	AZ	85040	01/11/2021	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8609004579				Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part D Appeals Contact (Secondary)	Pharmacy Director	Ms.	Vergil	Gina						8553658109	VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/05/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	4026997768				Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	06/24/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part D Benefits Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/28/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part D Claims Submission Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/28/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part D Exceptions Contact	Pharmacy Director		Vergil	Gina							Vergilg@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/13/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	4026997768				Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part D Exceptions Contact (Secondary)	Director, Pharmacy		Stekol	Ilona							stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	3478806082				Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part D Price File Contact (Back-up)	Pharmacy Director		Vergil	Gina		4026997768					Vergilg@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/13/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part D Quality Assurance Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/28/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Patient Safety Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/28/2020	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Payment Contact	Lead Director, FP&A		Stefanich	Anita		3129283105					StefanichA@cvshealth.com	333 West Wacker Drive	Suite 2100	Chicago	IL	60606	12/05/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Personal Health Record Contact	Sr.  Medical Director		Hudson, MD	Karla		7739324873					hudsonk2@aetna.com	3200 Highland Ave.	MC F661	Downers Grove	IL	60515	09/06/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Pharmacy Director	Pharmacy Director		Nkurunziza	Natalie		8609006247					NkurunzizaN@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	09/20/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Pharmacy Network Management Contact	Pharmacy Director		Nkurunziza	Natalie		8609006247					NkurunzizaN@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	09/20/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy		Stekol	Ilona		3478806082					Stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Pharmacy Technical Help Desk Contact	Phamacy Director		Nkurunziza	Natalie							NkurunzizaN@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	09/20/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8553642974				Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Physician Incentive Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	01/09/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Plan Directory Contact for Public Website	Senior Manager, Duals	Ms.	Brown	Anne Marie		7272720427					browna36@aetna.com	3482 Maclaren Dr.		Palm Harbor	FL	34684	09/08/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Processor Contact	Vice President, Duals Markets	Mr.	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/13/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Reconciliation Contact (Secondary)	Lead Director, FP&A	Ms.	Stefanich	Anita		3129283105					StefanichA@cvshealth.com	333 W. Wacker Drive	Suite 2100	Chicago	IL	60606	12/05/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	01/31/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Surveillance Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	01/09/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	System Contact	Director Business Information Magement	Ms.	Tanzillo	Hollie	M	7407398501					tanzilloh@aetna.com	7400 Campus Road		New Albany	OH	43054	07/07/2021	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Utilization Management Contact	Sr. Director Straregic Programs, AMA COE Clinical		Hawkins	Erin		8175288743					hawkinse@aetna.com	4300 Centreway Place		Arlington	TX	76018	07/07/2021	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2506	Utilization Review Contact	Duals Utilization Mgmt Principal Clinical Leader		Jones	Leslye		8606870283					JonesL12@cvshealth.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/19/2022	2023	Aetna Better Health Premier Plan MMAI Inc.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2509	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H2509	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H2509	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H2509	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H2509	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/27/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2509	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF FLORIDA, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2526	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H2526	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H2526	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H2526	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H2526	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H2526	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H2526	PHR Beneficiary Contact																	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H2526	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2526	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH PLAN OF OHIO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2531	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	CEO - CMS Administrator Contact	CEO UHC Community Plan of OH, Inc	Mr.	Waulters	Scott		6146983430					swaulters@uhc.com	5900 Parkwood Place		Dublin	OH	43016	09/15/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	CEO - Senior Official for Contracting	CEO UHC Community Plan of OH, Inc	Mr.	Waulters	Scott		6146983430					swaulters@uhc.com	5900 Parkwood Place		Dublin	OH	43016	09/15/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	MMP Reporting Requirements Contact			Berardi	Christophe		7632833501					chris.berardi@uhc.com	PO Box 9472		Minneapolis	MN	554409472	04/01/2021	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	MMP Point of Contact			Thompson	Sterling		9522026419					sterling. thompson@uhc.com	PO BOX 9472		MINNEAPOLIS	MN	55440	12/13/2021	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2531	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF OHIO, INC.	Demo	UnitedHealthcare Community Plan	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H2533	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	CAP Report Contact for Public Website			Services	Member		8557355831					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Government Relations Contact	Director, Government Contracts		Simmons	LaDawn		8435019132					Ladawn.Simmons@molinahealthcare.com	4105 Faber Place Dr		North Charleston	SC	29405	01/25/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	MA Claims Processing Contact for Public Website			Services	Member		8557355831					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	MMP Reporting Requirements Contact	MHI - Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate Suite 100		Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	MMP Point of Contact	MHI - Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate Suite 100		Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	09/13/2018	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Plan Directory Contact for Public Website			Services	Member		8557355831					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2533	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA, INC.	Demo	Molina Healthcare of South Carolina	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H2537	Automated TrOOP Balance Transfer Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Backup User Access Contact	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Best Available Evidence Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Bid Primary Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	CAP Report Contact for Public Website	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	CEO - CMS Administrator Contact	CEO	Mr.	Smith	Shaun		5705223889				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	CEO - Senior Official for Contracting	CEO	Mr.	Smith	Shaun		5705223880				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Chief Financial Officer	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Chief Operating Officer	President/CEO	Mr.	Smith	Shaun		5705223880				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Chief Information Officer	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Chief Information Security Officer	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	CMS Casework Communication Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Complaints Tracking Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Contact for Fraud Investigations	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Coordination of Benefits Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Corporate Mailing						5705223880				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Coverage Gap Discount Program (CGDP) Payment Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Customer Service Operations Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	DIR Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	DIR Contact (Secondary)	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Emergency Part D Contact	CEO	Mr.	Smith	Shaun		5705223889				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Emergency Part D Contact (Secondary)	Medicare Compliance Officer	Mrs.	Shively	LouAnn		5705223853				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Encounter Data & Risk Adjustment Operations Contact	LIFE DON		Byrne	Belinda		5705223880				5705249068	belinda.byrne@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Enrollment Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	EOB Transfer Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Financial Audit Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Financial Reporting Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Formulary Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Formulary Contact (Secondary)	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	General Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Government Relations Contact	CEO	Mr.	Smith	Shaun		5705223880				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	HIPAA Privacy Officer	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	HIPAA Security Officer	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Interoperability Contact	VP of LIFE Finance	Mr.	Blessing	John		5705223880					john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	MA Appeals/Grievances Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	MA Claims Processing Contact for Public Website	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Marketing Contact	Albright LIFE Marketing Director	Mrs.	Miller	Chris		7177567004				5705249068	chmiller@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Medical Director	Medical Director	Dr	Diduszyn	Jorge		7172645433				7172643279	jdiduszyn@spiritrustlutheranlife.org	840 Fifth Avenue		Chambersburg	PA	17201	11/25/2020	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Medicare Compliance Officer	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Medicare Coordinator	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Medicare Part D Opioid Overutilization Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Medication Therapy Management Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Online Enrollment Center Contact (Back-up)	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Online Enrollment Center Contact (Optional)	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Online Enrollment Center Contact (Primary)	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Part C Application Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Part D Appeals	Corporate Compliance Officer	Mrs.	Shively	Louann						5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active	8887910094				PACE - Nat		C	Philadelphia
H2537	Part D Appeals Contact (Secondary)	Sr. Director of Operations	Mr.	McDonough	John						5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active	8887910094				PACE - Nat		C	Philadelphia
H2537	Part D Application Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Part D Benefits Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Part D Claims Submission Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Part D Exceptions Contact	Corporate Compliance Officer	Mrs.	Shively	Louann						5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active	5705223880				PACE - Nat		C	Philadelphia
H2537	Part D Exceptions Contact (Secondary)	Treasurer/VP of Finance	Mr.	Blessing	John						5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active	8887910094				PACE - Nat		C	Philadelphia
H2537	Part D Price File Contact (Back-up)	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Part D Price File Contact (Optional)	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Part D Price File Contact (Primary)	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Part D Quality Assurance Contact	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Part D Reporting Contact	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Patient Safety Contact	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Payment Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Personal Health Record Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Pharmacy Director	Director of Pharmacy	Mrs.	Beitz	Krystal		5705233108				5705233109	krystal.beitz@albrightcare.org	110 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Pharmacy Network Management Contact	Director of Pharmacy	Mrs.	Beitz	Krystal		5705233108				5705233109	krystal.beitz@albrightcare.org	110 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Pharmacy Network Management Contact (Secondary)	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Pharmacy Technical Help Desk Contact	Director of Pharmacy	Mrs.	Beitz	Krystal						5705233109	krystal.beitz@albrightcare.org	110 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active	5705233108				PACE - Nat		C	Philadelphia
H2537	Pharmacy Technical Help Desk Contact (Secondary)	Corporate Compliance Officer	Mrs.	Shively	Louann						5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active	5705223880				PACE - Nat		C	Philadelphia
H2537	PHR Beneficiary Contact																	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE	ALBRIGHT CARE SERVICES	SpiritTrust Lutheran	390	Yes	Active	5705223880				PACE - Nat		C	Philadelphia
H2537	Plan Directory Contact for Public Website	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Plan to Plan Reconciliation Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Processor Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Quality Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Reconciliation Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Reconciliation Contact (Secondary)	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Recovery Audit Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Surveillance Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	System Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Third Party Administrator (TPA) Liaison	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	User Access Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Utilization Management Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2537	Utilization Review Contact	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/13/2023	2023	SPIRITRUST LUTHERAN LIFE	National PACE	Albright LIFE	National PACE		SpiritTrust Lutheran	390	Yes	Active					PACE - Nat		C	Philadelphia
H2541	Automated TrOOP Balance Transfer Contact	Finance Director	Ms	Mok	Jane		7076154437				7076156955	jmok@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Backup User Access Contact	Executive Director	Mr	Whitacre	Derrick		7076154437				7076156955	dwhitacre@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	03/20/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Best Available Evidence Contact	Executive Director	Mr	Whitacre	Derrick		7076154437				7076156955	dwhitacre@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	03/20/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Bid Primary Contact	Executive Director	Mr	Whitacre	Derrick		7076154437				7076156955	dwhitacre@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	03/20/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	CAP Report Contact for Public Website	Executive Director	Mr	Whitacre	Derrick		7076154437					dwhitacre@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	03/20/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	CEO - CMS Administrator Contact	Executive Director	Mr	Whitacre	Derrick		7076154437				7076156955	dwhitacre@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	03/20/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	CEO - Senior Official for Contracting	Executive Director	Mr	Whitacre	Derrick		7076154437				7076156955	dwhitacre@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	03/20/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Chief Financial Officer	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/14/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Chief Operating Officer	Center Director	Ms	Falley	Chris		7076154437					cfalley@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/14/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Chief Information Officer	Onboarding and Payroll Coordinator	Mr	Bridgewater	Jared		7076154437					jbridgewater@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/14/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Chief Information Security Officer	Onboarding and Payroll Coordinator	Mr	Bridgewater	Jared		7076154437					jbridgewater@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/14/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	CMS Casework Communication Contact	Quality Assurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/14/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Complaints Tracking Contact	Quality Assurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/14/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Contact for Fraud Investigations	Quality Assurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/14/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Coordination of Benefits Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/14/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Corporate Mailing						7076154437					dwhitacre@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	03/20/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Customer Service Operations Contact	Community Relations Director	Ms	Horta	Ana		7076154437					ahorta@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	DIR Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	DIR Contact (Secondary)	Health Plan Specialist	Ms	Galisanao	Sharon		7076154437					sgalisanao@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Emergency Part D Contact	Quality Assurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Emergency Part D Contact (Secondary)	Health Plan Specialist	Ms	Galisanao	Sharon		7076154437					sgalisanao@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Encounter Data & Risk Adjustment Operations Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Enrollment Contact	Community Relations Director	Ms	Horta	Ana		7076154437					ahorta@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	EOB Transfer Contact	Finance Director	Ms	Mok	Jane		7076154437				7076156955	jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Financial Audit Contact	Executive Director	Mr	Whitacre	Derrick		7076154437				7076156955	dwhitacre@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	03/20/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Financial Reporting Contact	Finance Director	Ms	Mok	Jane		7076154437				7076156955	jmok@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Formulary Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Formulary Contact (Secondary)	Health Plan Specialist	Ms	Galisanao	Sharon		7076154437					sgalisanao@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	General Contact	Executive Director	Mr	Whitacre	Derrick		7076154437					dwhitacre@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Government Relations Contact	Executive Director	Mr	Whitacre	Derrick		7076154437					dwhitacre@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	HIPAA Privacy Officer	Quality Assurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	HIPAA Security Officer	Quality Assurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Interoperability Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	MA Appeals/Grievances Contact	Quality Assurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	MA Claims Processing Contact for Public Website	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Marketing Contact	Community Relations Director	Ms	Horta	Ana		7076154437					ahorta@agewell.org	5789 State Farm Dr Suite 110		Rohnert	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Medical Director	Medical Director	Ms	Yurkiewicz	Shara		7076154437					syurkiewicz@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Medicare Compliance Officer	Executive Director	Mr	Whitacre	Derrick		7076154437					dwhitacre@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Medicare Coordinator	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Medicare Part D Opioid Overutilization Contact	Pharmacist	Ms	Duong	Truc		7076154437					tduong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Medication Therapy Management Contact	Pharmacist	Ms	Duong	Truc		7076154437					tduong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	OffShore Subcontractor Contact	Geriatric Services Director	Ms	Stambaugh	Kathryn		5109814156				4158971585	kstambaugh@lifelongmedical.org	2344 Sixth Street		Berkeley	CA	94710	12/07/2021	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Online Enrollment Center Contact (Back-up)	Geriatric Services Director	Ms	Stambaugh	Kathryn		5109814156				4158971585	kstambaugh@lifelongmedical.org	2344 Sixth Street		Berkeley	CA	94710	12/07/2021	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Online Enrollment Center Contact (Optional)	Special Population Progams Director	Mr	Leroi	Ben		7073033600				7073873234	benl@srhealth.org	3569 Round Barn Circle		Santa Rosa	CA	95403	12/07/2021	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Online Enrollment Center Contact (Primary)	Geriatric Services Director	Ms	Stambaugh	Kathryn		5109814156				4158971585	kstambaugh@lifelongmedical.org	2344 Sixth Street		Berkeley	CA	94710	12/07/2021	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Part C Application Contact	Executive Director	Mr	Whitacre	Derrick		7076154437				7076156955	dwhitacre@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	03/20/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Part D Appeals	Finance Director	Ms	Mok	Jane							jmok@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active	7076154437				PACE - Nat		C	San Francisco
H2541	Part D Appeals Contact (Secondary)	Health Plan Specialist	Ms	Galisanao	Sharon							sgalisanao@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active	7076154437				PACE - Nat		C	San Francisco
H2541	Part D Application Contact	Executive Director	Mr	Whitacre	Derrick		7076154437				7076156955	dwhitacre@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	03/20/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Part D Benefits Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Part D Claims Submission Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Part D Exceptions Contact	Pharmacist	Ms	Duong	Truc							jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active	7076154437				PACE - Nat		C	San Francisco
H2541	Part D Exceptions Contact (Secondary)	Finance Director	Ms	Mok	Jane							jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active	7076154437				PACE - Nat		C	San Francisco
H2541	Part D Price File Contact (Back-up)	Health Plan Specialist	Ms	Galisanao	Sharon		7076154437					sgalisanao@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Part D Price File Contact (Optional)	Geriatric Services Director	Ms	Stambaugh	Kathryn		5109814156				4158971585	kstambaugh@lifelongmedical.org	2344 Sixth Street		Berkeley	CA	94710	12/07/2021	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Part D Price File Contact (Primary)	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Part D Quality Assurance Contact	Quality Accurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Part D Reporting Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Patient Safety Contact	Quality Assurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Payment Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Personal Health Record Contact	Geriatric Services Director	Ms	Stambaugh	Kathryn		5109814156				4158971585	kstambaugh@lifelongmedical.org	2344 Sixth Street		Berkeley	CA	94710	12/07/2021	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Pharmacy Director	Pharmacist	Ms	Duong	Truc		7076154437					tduong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Pharmacy Network Management Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Pharmacy Network Management Contact (Secondary)	Health Plan Specialist	Ms	Galisanao	Sharon		7076154437					sgalisanao@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Pharmacy Technical Help Desk Contact	Pharmacist	Ms	Duong	Truc							tduong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active	7076154437				PACE - Nat		C	San Francisco
H2541	Pharmacy Technical Help Desk Contact (Secondary)	Special Populations Program Director	Mr	Leroi	Ben							benl@srhealth.org	3569 Round Barn Circle		Santa Rosa	CA	95403	12/07/2021	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active	7073033600				PACE - Nat		C	San Francisco
H2541	Plan Directory Contact for Public Website	Community Relations Director	Ms	Horta	Ana		7076154437					ahorta@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Plan to Plan Reconciliation Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Processor Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Quality Contact	Quality Assurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Reconciliation Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Reconciliation Contact (Secondary)	Geriatric Services Director	Ms	Stambaugh	Kathryn		5109814156				4158971585	kstambaugh@lifelongmedical.org	2344 Sixth Street		Berkeley	CA	94710	12/07/2021	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Recovery Audit Contact	Executive Director	Mr	Whitacre	Derrick		7076154437				7076156955	dwhitacre@agewell.org	5789 State Farm Dr Ste 110		Rohnert Park	CA	94928	03/20/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Surveillance Contact	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	System Contact	Executive Director	Mr	Whitacre	Derrick		7076154437					dwhitacre@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Third Party Administrator (TPA) Liaison	Finance Director	Ms	Mok	Jane		7076154437					jmok@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	User Access Contact	Community Relations Director	Ms	Horta	Ana		7076154437					ahorta@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Utilization Management Contact	Quality Assurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2541	Utilization Review Contact	Quality Assurance Director	Ms	Mangosong-Shankle	Jennifer		7076154437					jmangosong@agewell.org	5789 State Farm Dr Suite 110		Rohnert Park	CA	94928	09/18/2023	2023	AGEWELL PACE	National PACE	AgeWell PACE	National PACE		AgeWell PACE	810	Yes	Active					PACE - Nat		C	San Francisco
H2563	Agent/Broker Compensation Data Contact	Director, Sales		McVey	Kathy		7574181231					kemcvey@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/06/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Benefits		Strickland	Brandi		7572528193				7579625575	RxBenefits@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Backup User Access Contact	Compliance Consultant		Harvey	Kimberly		8046134890	20178				kdharvey@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Best Available Evidence Contact	Director Enrollment & Disenrollment		Brown	Sheila		7572528015				7576925575	sxbrown29@sentara.com	4456 Corporation Lane	Suite 210	Virginia Beach	VA	23462	11/12/2021	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Bid Audit Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Bid Audit Site Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Bid Primary Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	CAP Report Contact for Public Website	Medicare Contract Administrator		MEDICARE	OPTIMA		7576876160				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	8009276048				HMO - Health Maintenance Organization		C	Philadelphia
H2563	CEO - CMS Administrator Contact	VP, Medicare Government Programs	Mrs	Gerald	Alicia		5704920915				7575527396	aagerald@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	CEO - Senior Official for Contracting	VP, Medicare Government Programs	Mrs	Gerald	Alicia		5704920915				7575527396	aagerald@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Chief Financial Officer	Director Medicare Finance	Ms.	Eagleson	Leigh		4438516654				7575527396	laeagles@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Chief Operating Officer	VP, Medicare Government Programs	Mrs	Gerald	Alicia		5704920915				7575527396	aagerald@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Chief Information Officer	VP Information Systems	Ms.	Kaszubowski	Natalie		7572520436					nakaszub@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Chief Information Security Officer	VP, Chief Information Security Officer	Mr.	Siddiqui	Zishan		7572520015				7579638689	zasiddiq@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	CMS Casework Communication Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Complaints Tracking Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Contact for Fraud Investigations	Director Finance & Risk Mgt		Robbins	Janet		7572528012					jlrobbin@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Coordination of Benefits Contact	Sr. Compliance Consultant	Ms	Goddette	Maricelis		8048195151				7576876231	mxcintro@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Corporate Mailing						5704920915				7575527116	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Coverage Gap Discount Program (CGDP) Payment Contact	Director Accounting Operations		Duncan	April		7572528055				7572528039	acmorgan@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Customer Service Operations Contact	Director, Customer Services		Lucas-Bain	Shenna		8133348871				7575527116	sxlucasb@sentara.com	10800 Nuckols Road		Glen Allen	VA	23060	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	DIR Contact	Director Pharmacy Performance		Hartzell	Lindsay		8048195179				7579625575	LEHARTZE@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/01/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	DIR Contact (Secondary)	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/01/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Emergency Part D Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park	Suite 210	Virginia Beach	VA	23464	09/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Emergency Part D Contact (Secondary)	Manager Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Encounter Data & Risk Adjustment Operations Contact	Director, Actuary		Ratzlaff	Dean		7576876018					daratzla@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Enrollment Contact	Director, Enrollment		Brown	Sheila		7572528015					sxbrown29@sentara.com	4456 Corporation Lane		Virginia Beach	VA	23462	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	EOB Transfer Contact	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625576	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Financial Audit Contact	Director, Medicare Compliance	Ms.	Green	Janet		8133682227					jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Financial Reporting Contact	VP & Controller		Snyder	Jeff		7572528023				7572528030	jcsnyder@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Formulary Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23462	09/01/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Formulary Contact (Secondary)	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/01/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	General Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Government Relations Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	HIPAA Privacy Officer	Director, Compliance	Ms.	Dajon	Sharon	M	7575527485				7575527116	smdajon@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	HIPAA Security Officer	VP, Chief Information Security Officer	Mr.	Siddiqui	Zishan		7572520015				7579638689	zasiddiq@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Hospice Contact	Director Pharmacy Ops & Compliance		May	Crystal		8666037514				7579625575	ccmay2@sentara.com	10800 Nuckols		Glen Allen	VA	23060	09/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Interoperability Contact	IT Project Manager		Larkins	Eddie		8048195151					ellarkin@sentara.com	4456 Corporation Lane		Virginia Beach	VA	23462	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	MA Appeals/Grievances Contact	Director Appeals & Grievance		Byrd	Natasha		8048195151				7576876232	nxbyrd@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	MA Claims Processing Contact for Public Website	Director Ops Support		Rodriguez	Joseph		7579834333				7572528030	jxrodr10@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Marketing Contact	Director Sales Enablement		Fiero	Asleigh		7572528505				7576876135	akfiero@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Medical Director	CMO Health Plan	Dr.	Greifer	Kristyn		6782748402				7575527108	KXGREIFE@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Medicare Compliance Officer	Director, Medicare Compliance	Ms.	Green	Janet		8133682227					jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Medicare Coordinator	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Medicare Part D Opioid Overutilization Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Medication Therapy Management Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Online Enrollment Center Contact (Back-up)	Sr. Business Analyst, Medicare		Ashar	Satish		8048195151	302				sdashar@sentara.com	4456 Corporate Lane		Virginia Beach	VA	23462	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Online Enrollment Center Contact (Primary)	Director, Enrollment		Brown	Sheila		7572528015					sxbrown29@sentara.com	4456 Corporation Lane		Virginia Beach	VA	23462	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part C Application Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part C Reporting Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Appeals	Manager Clinical Pharmacy		Snow	Michael						7579625576	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	7579834243				HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Appeals Contact (Secondary)	Manager Pharmacy Compliance		Allen	Emily						7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	8048144500				HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Application Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Benefits Contact	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Claims Submission Contact	Manager, Pharmacy Benefits		Strickland	Brandi		7572528193				7579625575	RxBenefits@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Exceptions Contact	Manager Clinical Pharmacy		Snow	Michael						7579625576	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	7579834243				HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Exceptions Contact (Secondary)	Manager Pharmacy Compliance		Allen	Emily						7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	8048144500				HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Price File Contact (Back-up)	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Price File Contact (Optional)	Director Pharmacy Performance		Hartzell	Lindsay		8048195179				7579625575	LEHARTZE@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Price File Contact (Primary)	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Quality Assurance Contact	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Part D Reporting Contact	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7576925576	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Patient Safety Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625576	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Payment Contact	Director, Accounting	Ms.	Albert	Rinda		7572528015					realbert@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Pharmacy Director	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Pharmacy Network Management Contact	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Pharmacy Technical Help Desk Contact	Director Customer Service		Monroe	LaTasha						8882358551	LaTasha_Monroe@express-scripts.com	11780 U.S. Hwy Suite N107		Palm Beach Gardens	FL	33408	01/08/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Philadelphia
H2563	Pharmacy Technical Help Desk Contact (Secondary)	Director Pharmacy Ops & Compliance		May	Crystal						7579625575	ccmay2@sentara.com	10800 Nuckols		Glen Allen	VA	23060	09/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active	8666037514				HMO - Health Maintenance Organization		C	Philadelphia
H2563	Physician Incentive Contact	VP Value Based Care		Krebbs	Robert		8045728832				7575527576	rlkrebbs@sentara.com	1300 Sentara Park		Virgnia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Plan Directory Contact for Public Website	Member Services		MEMBER SERVICES	OPTIMA		8009276048					members@optimahealth.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Plan to Plan Reconciliation Contact	Director Accounting Operations		Duncan	April		7572528055				7572528039	acmorgan@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Processor Contact	Director Ops Support		Rodriguez	Joseph		7579834333				7572528030	jxrodr10@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Quality Contact	Director Quality & Regulatory		Taylor	Tonya		8046136524				8048195186	tptaylor@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Reconciliation Contact	Director, Medicare Finance		Richardson	Scott		9542587586					sxricha3@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Reconciliation Contact (Secondary)	Manager Actuarial Support		Wimalendran	Shane		7575528944					uxwimale@sentara.com	4456 Corporation Lane	Suite 210	Virginia Beach	VA	23462	03/07/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Recovery Audit Contact	Director, Accounting	Ms.	Albert	Rinda		7572528015					realbert@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	SNP Application Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	SNP State Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Surveillance Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	System Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Third Party Administrator (TPA) Liaison	Director Accounting Operations		Duncan	April		7572528055				7572528039	acmorgan@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/05/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	User Access Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Utilization Management Contact	Director Utilization Management		Barton	Jamie		4342948816				7575527108	jcbarton@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2563	Utilization Review Contact	Director Utilization Management		Barton	Jamie		4342948816				7575527108	jcbarton@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	OPTIMA HEALTH PLAN	Local CCP	Sentara Medicare	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2577	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H2577	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H2577	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H2577	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H2577	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2577	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H2582	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Exceptions Contact (Secondary)			Fernandez	Marilyn							marilyn_fernandez1@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	03/14/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7633615037				HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Personal Health Record Contact			Service	Customer		8882821420					CS_Leads@rmhp.org	PO Box 10600		Grand Junction	CO	81506	02/06/2019	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H2582	PHR Beneficiary Contact																	01/17/2020	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS	Customer Service	UnitedHealth Group, Inc.	239	Yes	Active	8003464643				HMO - Health Maintenance Organization		C	San Francisco
H2582	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/14/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2582	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	ROCKY MOUNTAIN HEALTH MAINTENANCE ORGANIZATION INC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2591	Agent/Broker Compensation Data Contact	Director of Consumer Sales and Retention		Jones	Jeremy		2179028167					Jeremy.Jones@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Automated TrOOP Balance Transfer Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Backup User Access Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Best Available Evidence Contact	Medicare Enrollment Manager		Kirby	Rae		2179029108					rae.kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Bid Audit Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Bid Audit Site Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Bid Primary Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	CAP Report Contact for Public Website	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active	8009654022				PPO - BBA		C	Chicago
H2591	CEO - CMS Administrator Contact	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	CEO - Senior Official for Contracting	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Chief Financial Officer	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/18/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Chief Operating Officer	Chief Operating Officer	Mr.	McPhearson	Les		2179029740				2179029740	Les.McPhearson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Chief Information Officer		Ms.	Griffith	Kim		2179029004				2179029740	kim.griffith@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Chief Information Security Officer	Director of Information Security	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	CMS Casework Communication Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Complaints Tracking Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Contact for Fraud Investigations	Corporate Compliance and ERM Mgr		Adamson	Susan		2179029137					Susan.Adamson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Coordination of Benefits Contact	Director of Claims & Recovery		Parker	Lisa		2179028353				2179029786	lisa.parker@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Corporate Mailing						2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/03/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Coverage Gap Discount Program (CGDP) Payment Contact			Boyce	Heather		2179029467					heather.boyce@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Customer Service Operations Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	DIR Contact	Director of Accounting		Deane	Laura		2179028322				2179029740	laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/03/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	DIR Contact (Secondary)			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Emergency Part D Contact	VP, Chief Compliance Officer		Wilson	Hollie		2176214156				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Emergency Part D Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368					Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Employer Waiver Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224					Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Encounter Data & Risk Adjustment Operations Contact	Director, System Config and Technical Services		Walsh	Pam		2179029449				2173657111	Pam.Walsh@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Enrollment Contact	Medicare Enrollment Manager		Kirby	Rae		2179029108					rae.kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	EOB Transfer Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Financial Audit Contact	Executive Director of Finance	Mr.	Maxwell	Jamey		2179028321				2179029740	jamey.maxwell@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Financial Reporting Contact	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/18/2021	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Formulary Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Formulary Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368				2179029798	Jena.Deschler@healthalliance.org	3310 Fields South		Champaign	IL	61822	11/19/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	General Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Government Relations Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	HIPAA Privacy Officer	Director, Corporate Compliance and Privacy Officer		Jensen	Traci		2179029152				2179029794	traci.jensen@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	HIPAA Security Officer	Director of Information Security	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Hospice Contact	Director of Pharmacy		Buhr	Aimee		2179029366					Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Interoperability Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	MA Appeals/Grievances Contact	Member / Provider Relations Manager		Regal	Wendi		2179028017				2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	MA Claims Processing Contact for Public Website		Ms.	Griffith	Kim		2179029004				2179029740	kim.griffith@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/03/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Marketing Contact	VP, Products and Marketing		Perry	Jana	L	2179028101				2179029740	jana.perry@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Medical Director	Associate Chief Medical Officer	Dr.	Revai	Krystal		2179028301				2179029740	Krystal.Revai@healthalliance.org	3310 Fields South Drive		Champaign	IL	61821	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Medicare Compliance Officer	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Medicare Coordinator	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Medicare Part D Opioid Overutilization Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Medication Therapy Management Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	OffShore Subcontractor Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Online Enrollment Center Contact (Back-up)	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Online Enrollment Center Contact (Optional)	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Online Enrollment Center Contact (Primary)	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Part C Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Part C Reporting Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Part D Appeals	Member / Provider Relations Manager		Regal	Wendi						2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active	2179028017				PPO - BBA		C	Chicago
H2591	Part D Appeals Contact (Secondary)	CEO		Madigan	Sinead						2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active	8008513379				PPO - BBA		C	Chicago
H2591	Part D Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Part D Benefits Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029740	Hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Part D Claims Submission Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Part D Exceptions Contact	VP, Chief Compliance Officer		Wilson	Hollie						2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active	2179028224				PPO - BBA		C	Chicago
H2591	Part D Exceptions Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena						2179029798	Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active	2179029368				PPO - BBA		C	Chicago
H2591	Part D Price File Contact (Back-up)	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Part D Price File Contact (Optional)	PBM Contact		Lyman	Dorothy		6126326265					DL-MedOpsPlanFinder@catamaranrx.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Part D Price File Contact (Primary)	Lead IT Operations		Walker	Kathy		2179025198				2173657111	kathy.walker@healthalliance.org	3310 Fields South		Champaign	IL	61822	01/03/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Part D Quality Assurance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Part D Reporting Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Patient Safety Contact	Medicare Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Payment Contact	Director of BECS		Kleinert	Traci		2179029508				2179029797	Traci.Kleinert@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Pharmacy Director	Director of Pharmacy		Buhr	Aimee		2179029366				2179029798	Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Pharmacy Network Management Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Pharmacy Network Management Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368				2179029798	Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Pharmacy Technical Help Desk Contact	VP, Chief Compliance Officer		Wilson	Hollie						2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active	8442651876				PPO - BBA		C	Chicago
H2591	Physician Incentive Contact	VP, Provider Network Management		Walker	Randy		2179029106				2179029701	Randy.Walker@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Plan Directory Contact for Public Website	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Plan to Plan Reconciliation Contact			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Dr		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Processor Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029497	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Quality Contact	Quality Management Director		Migut	Tamara		2179028012				2179029789	tamara.migut@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Reconciliation Contact	Director of Accounting		Deane	Laura		2179078322				2179029740	laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Reconciliation Contact (Secondary)			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Recovery Audit Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	SNP Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Surveillance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	System Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Third Party Administrator (TPA) Liaison			Johnson	Danica		2179028322				2173657494	danica.johnson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/03/2019	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	User Access Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Utilization Management Contact	Director, Utilization management and Systems		Fossier	Lori		2179029025				2179029703	lori.fossier@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2591	Utilization Review Contact	Directo, Utilization Management and Systems		Fossier	Lori		2179029025				2179029703	lori.fossier@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE - MIDWEST, INC.	Local CCP	Health Alliance Medicare	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H2593	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	01/09/2019	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/06/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/09/2019	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Electronic Health Record Contact	Dir I Technology	Mr.	Vellala	Nagaraju		7574732737	34790				Nagaraju.Vellala@amerigroup.com	5800 Northhampton Blvd		Norfolk	VA	23502	01/05/2017	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H2593	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H2593	PHR Beneficiary Contact																	02/07/2019	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H2593	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Reconciliation Contact (Secondary)			Li	Zhiru		5622073707					Zhiru.Li@caremore.com	12900 Park Plaza Drive	Suite 150	Cerritos	CA	90703	03/09/2016	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2593	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	AMERIGROUP TEXAS, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2610	Agent/Broker Compensation Data Contact	SVP Health Plan Operations		Cochran	Rick		4026306924					rcochran@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/18/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Automated TrOOP Balance Transfer Contact	Director Enrollment, Eligibility &B OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/05/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Backup User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Best Available Evidence Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Bid Audit Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Bid Audit Site Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Bid Primary Contact	ACTUARY	Mr.	Copeland	Joe		3142095834					jcopeland@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/24/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	CAP Report Contact for Public Website	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	CEO - CMS Administrator Contact	COO	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/08/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	CEO - Senior Official for Contracting	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Chief Financial Officer	Chief Financial Officer	Mr.	Grabski	Ben		7633007611					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/28/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Chief Operating Officer	Chief Operating Officer	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	02/07/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Chief Information Officer	Chief Information Officer	Mr.	Saghabini	JeanClaude		6173124659					jsaghbini@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/10/2021	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Chief Information Security Officer	Chief Information Security Officer	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/10/2021	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	CMMI Model Point of Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	CMS Casework Communication Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Complaints Tracking Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Contact for Fraud Investigations	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Coordination of Benefits Contact			Inquiries	COB		8665979560					COBInquiry@lumeris.com	P O BOX 5907		TROY	MI	48007	12/06/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Corporate Mailing						8665979560					customerservice@essencehealthcare.com	CUSTOMER SERIVCE	P O BOX 5907	TROY	MI	48007	12/06/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Coverage Gap Discount Program (CGDP) Payment Contact	Sr Manager, Health Plan Finance		Williams	Kliopatra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Customer Service Operations Contact	Vice President, Health Plan Operations	Ms.	Meyerhoffer	Linda		6366869682					rmeyerhoffer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	DIR Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	DIR Contact (Secondary)	Sr. Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly		3142092795					pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/23/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Emergency Part D Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		6307425966					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Emergency Part D Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Encounter Data & Risk Adjustment Operations Contact	VP Risk Adjustment Services	Mr.	Eschbach	Jason		6144397608					jeschbach@lumeris.com	13900 Riverport Drive		St. Louis	MO	63043	12/08/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Enrollment Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	EOB Transfer Contact	Director, Claims	Ms.	Wasserman	Rachelle		3147703520				3147706096	rwasserman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	08/05/2021	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Financial Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Financial Reporting Contact	Corporate Accountng Director	Ms.	Pinkerton	Amanda		3145183519					apinkertaon@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/05/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Formulary Contact		Ms	Nyawabila	Christina		8447906297					FAS@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	07/13/2020	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Formulary Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	General Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Government Relations Contact	Chief Legal Officer	Ms.	Halterman	Gail		3142092717					ghalterman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/17/2019	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Davis	Amy		3142093945					adavis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/10/2021	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	HIPAA Security Officer	CISO	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/26/2020	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Hospice Contact	Vice President, Clinical Operations		Cruz	Jennifer		3147703556					pharmacy@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Interoperability Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Darnell	Erika		3144382410					ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/09/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	MA Claims Processing Contact for Public Website			Service	Customer		8665979560				8884802577	customerservice@essencehealthcare.com	P O BOX 5907		TROY	MI	48007	12/06/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Marketing Contact	Manager, Compliance Marketing	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/28/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Medical Director	Senior Medical Officer, UM	Dr.	Fusco	Michael		3147703770					mfusco@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/08/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Medicare Compliance Officer	VP Compliance, Medicare Compliance Officer	Mr,	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Medicare Coordinator	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Medicare Part D Opioid Overutilization Contact	Snr. Clinical Pharmacist	Ms.	Pasagic	Melita		3147703775					mpasagic@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	01/06/2021	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Medication Therapy Management Contact	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	OffShore Subcontractor Contact	SVP Corporate Accounting & Chief Compliance Office	Ms.	Venable	Erin		3142093957					evenable@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Online Enrollment Center Contact (Back-up)	Manager, Compliance	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	11/10/2021	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Online Enrollment Center Contact (Optional)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Online Enrollment Center Contact (Primary)	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Part C Application Contact	Sr. Director CMS Applications & PBP submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/10/2021	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Part C Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Appeals	Director, Appeals & Grievances	Ms.	Darnell	Erika							ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/09/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	3144382410				HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Appeals Contact (Secondary)	Sr. Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly	M						pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	08/11/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	3142092795				HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/10/2021	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Benefits Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Claims Submission Contact		Ms.	Scherlippens	Carine		8587907415					Carine.Scherlippens@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/29/2014	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Exceptions Contact		Ms.	Byers	June							June.Byers@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/29/2014	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Exceptions Contact (Secondary)		Mr	Elias	Jason							Jason.Elias@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	07/13/2020	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Price File Contact (Back-up)	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Price File Contact (Optional)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Price File Contact (Primary)		Ms.	Finder	Plan		8445136003					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	07/13/2020	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Quality Assurance Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Part D Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Patient Safety Contact	Sr Manager, Clinical Pharmcist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Payment Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/17/2019	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Pharmacy Director	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Pharmacy Network Management Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Pharmacy Network Management Contact (Secondary)			Operations	Pharmacy		8445136003					PharmacyOperationsSups@MedImpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	03/17/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services	Ms.	Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	01/02/2020	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				HMO - Health Maintenance Organization		C	Kansas City
H2610	Pharmacy Technical Help Desk Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly							ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	3147703788				HMO - Health Maintenance Organization		C	Kansas City
H2610	Physician Incentive Contact	Sr. Manager, Health Plan Finance	Mr.	Privott	David		3147703732					dprivott@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Plan Directory Contact for Public Website			Service	Customer		8665979560					customerservice@essencehealthcare.com	1P O BOX 5907		TROY	MI	48007	12/06/2022	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Plan to Plan Reconciliation Contact	Sr Manager, Health Plan Finance		Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Processor Contact		Ms.	Scott	Susan		8447906565					Susan.Scott@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/09/2020	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Quality Contact	Snr. Director, Quality Improvement		Pattison	Lisa		5082728692					lpattison@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	01/06/2021	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Reconciliation Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/17/2019	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Reconciliation Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Recovery Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	SNP Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/10/2021	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	SNP State Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Surveillance Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	System Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Third Party Administrator (TPA) Liaison	Client AP Specialist	Ms.	Brock	Letecea		3142548778					lbrock@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/16/2021	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Utilization Management Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/09/2020	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2610	Utilization Review Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/09/2020	2023	ESSENCE HEALTHCARE, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2624	Agent/Broker Compensation Data Contact	Director, Sales & Marketing		Dunn	John		3363651395					jdunn@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Automated TrOOP Balance Transfer Contact	Manager, Business Systems & Data		rao	Chanukya		5088046892					chanukya.rao@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Backup User Access Contact	Chief Pharmacy Officer	Dr	Homer	Deanna	M	3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Best Available Evidence Contact	Business Analyst		Bhupatiraju	Adarsh		5088047430					Adarsh.Bhupatiraju@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Bid Audit Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Bid Primary Contact	Chief Financial Officer		Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	CAP Report Contact for Public Website	President & CEO		Hodges	Brendan		3367904392					bhodges@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	CEO - CMS Administrator Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	CEO - Senior Official for Contracting	President & CEO	Mr.	Hodges	Brendan		3367904392					bhodges@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Chief Financial Officer	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Chief Operating Officer	Vice President of Operations	Ms.	Katula	Joleen		3367904378					jkatula@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Chief Information Officer	Director of IT	Mr	Soomro	Sikander		8135028100					ssoomro@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Chief Information Security Officer	Director of IT	Mr	Soomro	Sikander		8135028100					ssoomro@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	CMS Casework Communication Contact	Director of Operations		Leppin	Amy		3366600562					aleppin@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Complaints Tracking Contact	Director of Operations		Leppin	Amy		3366600562					aleppin@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Contact for Fraud Investigations	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Coordination of Benefits Contact	Manager, Business Systems & Data		Rao	Chanukya		5088046892					chanukya.rao@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Corporate Mailing						3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Customer Service Operations Contact	Director of Operations	Ms.	Velez	Ashley		8889651965					avelez@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	DIR Contact	Chief Administrative Officer		Wickremeratne	Aruna		5088046923					aruna.w@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	DIR Contact (Secondary)	Manager, Pharmacy Network Analytics		Chaudhary	Sudhakar		5085973931					sudhakar.chaudhary@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Emergency Part D Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Emergency Part D Contact (Secondary)	Pharmacy Manager	Dr.	Ruedinger	Kevin		3366602249					kruedinger@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Encounter Data & Risk Adjustment Operations Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Enrollment Contact	Manager, Business Systems & Data		Rao	Chanukya		5088046892					chanukya.rao@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	EOB Transfer Contact	Manager of Benefits & Implementations		Ika	Amit		5088046961	7142			5088046961	amit.ika@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Financial Audit Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Financial Reporting Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Formulary Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna	M	9546127434					dhomer@htanc.com	300 East Wendover Avenue	STE 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Formulary Contact (Secondary)	Clinical Account Manager		Murray	Andy		7863018823					andy.murray@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	04/03/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	General Contact	President & CEO		Hodges	Brendan		3367904392					bhodges@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Government Relations Contact	President & CEO		Hodges	Brendan		3367904392					bhodges@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	HIPAA Privacy Officer	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	HIPAA Security Officer	Director of IT	Mr	Soomro	Sikander		8135028100					ssoomro@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Hospice Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Interoperability Contact	Director of IT	Mr	Soomro	Sikander		8135028100					ssoomro@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	MA Appeals/Grievances Contact	Director of Operations		Leppin	Amy		3366600562					aleppin@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	MA Claims Processing Contact for Public Website	Director of Operations		Leppin	Amy		3366600562					aleppin@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Marketing Contact	Medicare Marketing & Communications Manager		Robbins	Nan		3368604098					nrobbins@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Medical Director	Medical Director	Dr.	Evans	Stephen		3369006094					sevans@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Medicare Compliance Officer	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Medicare Coordinator	VP of Operations		Katula	Joleen		3367904378					jkatula@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Medicare Part D Opioid Overutilization Contact	Pharmacy Manager	Dr.	Ruedinger	Kevin		3366602249					kruedinger@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Medication Therapy Management Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna	M	3367904385					dhomer@htanc.com	300 East Wendover Avenue	STE 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	OffShore Subcontractor Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Online Enrollment Center Contact (Back-up)	Manager, Business Systems & Data		Rao	Chanukya		5088046892					chanukya.rao@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Online Enrollment Center Contact (Primary)	Director, IT Operations		Inavilli	Ram		5088046964	7260				ram.inavilli@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Part C Application Contact	Manager of Product Development		McCloy	Tracey		3367904525					tmccloy@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Part C Reporting Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Appeals	Pharmacy Manager	Dr.	Ruedinger	Kevin							kruedinger@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active	3366602249				HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Appeals Contact (Secondary)	Chief Pharmacy Officer	Dr	Homer	Deanna							dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active	3367904385				HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Application Contact	Manager of Product Development		McCloy	Tracey		3367904525					tmccloy@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Benefits Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Claims Submission Contact	Manager, Business Systems & Data		Rao	Chanukya		5088046892					chanukya.rao@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Exceptions Contact	Senior Manager, PA Operations		Davies	Brian						8668718565	Brian.davies@rxadvance.com	136 Turnpike Road		Southborough	MA	01772	05/24/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active	8002371992				HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Exceptions Contact (Secondary)	Pharmacy Manager		Ruedinger	Kevin							kruedinger@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active	3366602249				HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Price File Contact (Back-up)	Manager, Business Systems & Data		Chaudhary	Sudhakar		5085973931					sudhakar.chaudhary@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Price File Contact (Optional)	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Price File Contact (Primary)	Technical Business Analyst		Parmar	Vihan		5085973999					vihan.parmar@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Quality Assurance Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Part D Reporting Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Patient Safety Contact	Pharmacy Manager		Ruedinger	Kevin		3366602249					kruedinger@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Payment Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Pharmacy Director	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Pharmacy Network Management Contact	Chief Administrative Officer		Wickremeratne	Aruna		5088046923				3304058094	aruna.w@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Pharmacy Network Management Contact (Secondary)	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Pharmacy Technical Help Desk Contact	VP of Consumer Services		Kota	Rupa							rupa.kota@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active	8004590984				HMO - Health Maintenance Organization		C	Atlanta
H2624	Pharmacy Technical Help Desk Contact (Secondary)	Chief Pharmacy Officer	Dr.	Homer	Deanna							dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active	3367904385				HMO - Health Maintenance Organization		C	Atlanta
H2624	Plan Directory Contact for Public Website			Service	Customer		8889651965					conciergehta@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Plan to Plan Reconciliation Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Processor Contact	Technical Business Analyst		Vichare	Devyani		5088047328					devyani.vichare@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Quality Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Reconciliation Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Recovery Audit Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	SNP Application Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Surveillance Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	System Contact	Director of IT	Mr	Soomro	Sikander		8135028100					ssoomro@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	User Access Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Utilization Management Contact	Medical Director	Dr.	Evans	Steve		3366606094					sevans@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2624	Utilization Review Contact	Medical Director	Dr.	Evans	Steve		3366606094					sevans@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	HMO/HMOPOS		HTA Holdings, LLC	623	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2663	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8887369118				8885547668	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/03/2018	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/05/2017	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/07/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/07/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H2663	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Plan Directory Contact for Public Website			Customer Service	Aetna		8005330367					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	11/25/2014	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2663	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF MISSOURI, INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H2686	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H2686	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H2686	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H2686	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H2686	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H2686	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H2686	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H2686	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2686	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF HAWAII INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H2694	Agent/Broker Compensation Data Contact	Senior Director, Marketing		Cardinal	Brittany		4136524780					brittany.cardinal@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Automated TrOOP Balance Transfer Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Backup User Access Contact	CCO		Ross	Cheyenne		6239103321					Cheyenne.Ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Best Available Evidence Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Bid Audit Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Bid Audit Site Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Bid Primary Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	CAP Report Contact for Public Website	Chief Compliance Officer		Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Ika	Pooja	V	5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Ika	Pooja	V	5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Chief Financial Officer	Chief Financial Officer	Mr.	Lawless	Tom		6085091628					tom.lawless@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Chief Operating Officer	Chief Operating Officer	Mr.	Price	John		2158806876					john.price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Chief Information Officer	IT Manager	Mr.	Harsha	Vijay		6176657331					vijay.harsha@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Chief Information Security Officer	IT Manager	Mr.	Harsha	Vijay		6176657331					vijay.harsha@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	CMS Casework Communication Contact	Medical Director	Dr.	Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Complaints Tracking Contact	Chief Compliance Officer		Ross	Cheyenne		6239103321					Cheyenne.Ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Contact for Fraud Investigations	Chief Compliance Officer		Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Coordination of Benefits Contact	VP of Finance		Texeria	Edward		6176657430					edward.texeria@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Corporate Mailing						5088046904					pooja.sammeta@rxadvance.com	136 Turnpike Road		Southborough	MA	01772	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Coverage Gap Discount Program (CGDP) Payment Contact	CFO		Lawless	Tom		6172450509					Tom.Lawless@eternalhealth.com	31 St James Ave	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Customer Service Operations Contact	Chief Operating Officer		Price	John		2158806876					john.price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	DIR Contact	CFO		Lawless	Tom		6085091628					Tom.Lawless@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	DIR Contact (Secondary)	Pharmacy Director		Wingerchuk	Caron		4804923852					Caron.Wingerchuk@eternal.com	31 St. James Ave	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Electronic Health Record Contact	Chief Medical Officer		Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Emergency Part D Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Emergency Part D Contact (Secondary)	Chief Medical Officer		Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Encounter Data & Risk Adjustment Operations Contact	CFO		Lawless	Tom		6085091628					Tom.Lawless@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Enrollment Contact	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	EOB Transfer Contact	Chief Operating Officer		Price	John		2158806876				8664371627	john.price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Financial Audit Contact	CFO	Mr.	Lawless	Tom		6085091628					Tom.Lawless@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Financial Reporting Contact	VP of Finance		Texeria	Edward		6176657430					edward.texeria@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Formulary Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Formulary Contact (Secondary)	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	32 St. James Ave	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	General Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Government Relations Contact	Chief Compliance Officer		Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	HIPAA Privacy Officer	Chief Compliance Officer		Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	HIPAA Security Officer	IT Manager	Mr.	Harsha	Vijay		6176657331					vijay.harsha@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Hospice Contact	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Interoperability Contact	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428					Chandra.Lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	MA Appeals/Grievances Contact	Operations Manager		Sosa-Alvarado	Steven		7875029188					steven.sosa-alvarado@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	MA Claims Processing Contact for Public Website	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Marketing Contact	Senior Director, Marketing		Cardinal	Brittany		4136524780					brittany.cardinal@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Medical Director	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Medicare Coordinator	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Medicare Part D Opioid Overutilization Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Medication Therapy Management Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	OffShore Subcontractor Contact	Chief Compliance Officer		Ross	Cheyenne		6239103321					Cheyenne.Ross@eternalhealth.com	31 St. James Ave		Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Online Enrollment Center Contact (Back-up)	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Online Enrollment Center Contact (Primary)			Rao	Chanukya		8565031661					chanukya.rao@rxadvance.com	136 Turnpike Rd.		Southborough	MA	01772	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Part C Application Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Part C Reporting Contact	Chief Compliance Officer		Ross	Cheyenne	L	6239103321					cheyenne.ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Part D Appeals	Manager		Bricker	Bryce							bryce.m.bricker@optum.com	2441 Warrenville Road		Lisle	IL	60532	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active	6126326838				PPO - BBA		C	New York
H2694	Part D Appeals Contact (Secondary)	Appeals & Grievance Program Director		Sosa-Alvarado	Steven							steven.sosa-alvarado@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active	8006519613				PPO - BBA		C	New York
H2694	Part D Application Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Part D Benefits Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Part D Claims Submission Contact	Director		Pereira	Michael		9494753456					pereira.mj@optum.com	2300 Main Street		Irvine	CA	92614	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Part D Exceptions Contact	Manager		Bricker	Bryce							bryce.m.bricker@optum.com	2441 Warrenville Road		Lisle	IL	60532	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active	6126326838				PPO - BBA		C	New York
H2694	Part D Price File Contact (Back-up)			Moore-Elliot	Shalandria		6514955363					mailto:MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Pkwy		Schaumburg	IL	60173	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Part D Price File Contact (Optional)			Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Pkwy		Schaumburg	IL	60173	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Part D Price File Contact (Primary)			Rx	Optum		6514955363					medops_planfinder@optum.com	1600 McConnor Pkwy		Schaumburg	IL	60173	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Part D Quality Assurance Contact	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Part D Reporting Contact	Chief Compliance Officer		Ross	Cheyenne		6239103321					Cheyenne.Ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Patient Safety Contact	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Payment Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Personal Health Record Contact	Chief Medical Officer		Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Pharmacy Director	Pharmacy Director		Wingerchuk	Caron		4804923852					caron.wingerchuk@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Pharmacy Network Management Contact	Director		Ashby	JoLynn		7637326364					JAshby@optum.com	1600 McConnor Pkwy		Schaumburg	IL	60173	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Pharmacy Technical Help Desk Contact			Villanueva	Juan								755 Research Parkway		Oklahoma City	OK	73104	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active	8007979791				PPO - BBA		C	New York
H2694	Physician Incentive Contact	Director of Network		Abraham	Benita		6173158657					benita.abraham@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Plan Directory Contact for Public Website			Services	Provider		8006809255					providerrelations@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	07/31/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Plan to Plan Reconciliation Contact	VP of Finance		Texeria	Edward		6176657430					edward.texeria@eternalhealth.com	31 St. James Ave.	Suite 950,	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Processor Contact	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Quality Contact	Director of Medical Management		Baker	Christi		6176657430	339				Christi.Baker@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Reconciliation Contact	CFO		Lawless	Tom		6085091628					Tom.Lawless@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Recovery Audit Contact	Chief Financial Officer	Mr.	Lawless	Tom		6085091628					Tom.Lawless@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Surveillance Contact	Chief Compliance Officer		Ross	Cheyenne		6239103321					Cheyenne.Ross@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	System Contact	Chief Operating Officer		Price	John		2158806876					John.Price@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Third Party Administrator (TPA) Liaison			Tati	Anand		5088046920					Anand.tati@rxadvance.com	136 Turnpike Road		Southborough	MA	01772	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	User Access Contact	Chief Executive Officer		Ika	Pooja		5083098810					pooja.ika@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Utilization Management Contact	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428	339				Chandra Lingisetty@eternalhealth.com	31 St. James Ave	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2694	Utilization Review Contact	Chief Medical Officer	Dr.	Lingisetty	Chandra		5018171428					chandra.lingisetty@eternalhealth.com	31 St. James Ave.	Suite 950	Boston	MA	02116	06/07/2023	2023	ETERNALHEALTH, INC.	Local CCP	eternalHealth	Local PPO		Eternal Health of Delaware, Inc.	769	Yes	Active					PPO - BBA		C	New York
H2697	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7812272122					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		7812272123					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7812272124					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		7812272127					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Chief Information Security Officer	Security Officer	Mr.	Careless	Jason		6025764139					Jason.careless@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Contact for Fraud Investigations	Head of SIU		Bowman	John		3144732898					john.bowman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	General Contact	Compliance Manager	Ms.	Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		7812272122					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	HIPAA Privacy Officer	Privacy Officer		Reilly	Emily		4043049090					Emily.reilly@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	HIPAA Security Officer	Information Security Officer		Careless	Jason		6025764139					Jason.careless@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Marketing Contact	Marketing Manager		Lord	Austin		5085964196					Austin.lord@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Medicare Coordinator	Compliance Manager	Ms.	Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H2697	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H2697	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H2697	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H2697	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Payment Contact	CFO	Mr.	Yale	Brad		7812272124					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H2697	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H2697	PHR Beneficiary Contact																	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H2697	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Processor Contact	Chief Operating Officer		Henry	Larry		7812272127					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Surveillance Contact	Chief Compliance Officer		OKane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	User Access Contact	Chief Compliance Officer	Ms.	OKane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2697	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF OHIO, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2715	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Automated TrOOP Balance Transfer Contact	MHI- VP, Medicare Finance, CFO		Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	CAP Report Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Chief Financial Officer	MHI- VP, Medicare Finance, CFO	Mrs.	Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	DIR Contact	MHI- VP, Medicare Finance, CFO		Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	05/23/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Financial Reporting Contact	MHI- VP, Medicare Finance, CFO		Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	MA Claims Processing Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/15/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H2715	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	Chicago
H2715	Physician Incentive Contact	MHI- VP, Medicare Finance, CFO		Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Plan Directory Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Plan to Plan Reconciliation Contact	MHI- VP, Medicare Finance, CFO		Wilson	David	S	5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/16/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2715	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2022	2023	MOLINA HEALTHCARE OF ILLINOIS INC	Local CCP	Molina Healthcare of Illinois	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2722	Agent/Broker Compensation Data Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Automated TrOOP Balance Transfer Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Backup User Access Contact	Medicare Advantage Compliance Program Manager	Mrs.	Rainer	Sally		3183720214					Sally.Rainer@bcbsla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Best Available Evidence Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Bid Audit Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccpuit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Bid Audit Site Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Bid Primary Contact	Vice President, Monroe Operations	Mrs.	Self	Jessica		3189982853					jself@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	CEO - CMS Administrator Contact	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	130 DeSiard Street, Suite 300		Monroe	LA	71201	12/13/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	CEO - Senior Official for Contracting	CEO	Mr.	Camerlinck	Bryan		2252952537					Bryan.Camerlinck@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/23/2023	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Chief Financial Officer	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Chief Operating Officer	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Chief Information Officer	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Chief Information Security Officer	Chief Information Security Officer	Mr.	Sotnikov	Slava		2252987036					slava.sotnikov@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	CMS Casework Communication Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Complaints Tracking Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Contact for Fraud Investigations	Manager, Special Investigations	Mrs.	Cowart	Kandyce		2252952073					kandyce.cowart@bcbsla.com	5525 Reitz Avnue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Coordination of Benefits Contact	Medicare Enrollment Supervisor	Mrs.	Drake	Michele		3189983083					mdrake@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Corporate Mailing						3183610900					jself@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St. Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Customer Service Operations Contact	Director of Member Services	Mrs.	Trichel	Amy		3189982870					atrichel@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	DIR Contact	Chief Financial Officer	Mrs	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	DIR Contact (Secondary)	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Electronic Health Record Contact	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Emergency Part D Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3185372903					cdearman@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/23/2020	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Emergency Part D Contact (Secondary)	Medicare Compliance Officer	Mr.	Miller	Wesley		2252522096					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Employer Waiver Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Encounter Data & Risk Adjustment Operations Contact	Director of Quality Improvement		Murphy	Paul		3189983098					pmurphy@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	11/07/2019	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Enrollment Contact	Medicare Enrollment Supervisor	Mrs.	Drake	Michele		3189983083					mdrake@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	EOB Transfer Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076				3188129987	ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Financial Audit Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Financial Reporting Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076				3188129987	ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Formulary Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Formulary Contact (Secondary)	Medicare Team Lead, Formulary Services		Paddock	Deanna		6087292628					Deanna.Paddock@Navitus.com	2601 W. Beltline Highway, Suite 600		Madison	WI	53713	01/16/2019	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	General Contact	VP of MA Operations and Plan Performance	Mr.	Gray	Paul		2253549898					paul.gray@bcbsla.com	225 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Government Relations Contact	Deputy General Counsel	Mrs.	Harvey	Korey		2252972762					korey.harvey@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	HIPAA Privacy Officer	VP Internal Audit, Compliance & Privacy	Mrs.	Saporito	Mary		2252981742					mary.saporito@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	HIPAA Security Officer	VP of Internal Audit, Compliance & Privacy	Mrs.	Saporito	Mary		2252981742					mary.saporito@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Hospice Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Interoperability Contact	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	MA Appeals/Grievances Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076				3188129987	ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Marketing Contact	SVP and Marketing Officer	Mr.	Keller	Brian		2252981582					brian.keller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Medical Director	Chief Medical Director	Dr.	Raulerson	Robert		3189983701					rraulerson@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	08/02/2020	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Medicare Coordinator	Medicare Advantage Compliance Program Manager	Mrs.	Rainer	Sally		3183720214					Sally.Rainer@bcbsla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Medication Therapy Management Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	OffShore Subcontractor Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Online Enrollment Center Contact (Back-up)	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Online Enrollment Center Contact (Optional)	Medicare Advantage Compliance Program Manager	Mrs.	Rainer	Sally		3183720214					Sally.Rainer@bcbsla.com	130 DeSiard St	Suite 30	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor	Mrs.	Drake	Michele		3189983083				3188071115	mdrake@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Part C Application Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Part C Reporting Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Part D Appeals	Appeals Supervisor	Mrs.	Olivo	Cassidy							cmolivo@vhpla.com	130 DeSiard Street, Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	3189982859				HMO - Health Maintenance Organization		C	Denver
H2722	Part D Appeals Contact (Secondary)	Senior Appeals Specialist	Mrs.	Stowe	Emily							edstowe@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	3189983193				HMO - Health Maintenance Organization		C	Denver
H2722	Part D Application Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Part D Benefits Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Part D Claims Submission Contact	Supervisor		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	01/16/2019	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Part D Exceptions Contact	Director of Pharmacy	Mr.	Dearman	Clyde							cdearman@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	3189982710				HMO - Health Maintenance Organization		C	Denver
H2722	Part D Exceptions Contact (Secondary)	Medicare Compliance Officer	Mr.	Miller	Wesley							Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	2252987965				HMO - Health Maintenance Organization		C	Denver
H2722	Part D Price File Contact (Back-up)			Dahlke	Nicole		9202214162					plan.finder@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	01/16/2019	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Part D Price File Contact (Optional)	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard St  Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Part D Price File Contact (Primary)			Finder	Plan		6087291578					plan.finder@navitus.com	361 Integrity Drive		Madison	WI	53714	07/13/2020	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Part D Quality Assurance Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Part D Reporting Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Patient Safety Contact	Clinical Pharmacist	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Payment Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Personal Health Record Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Pharmacy Director	Pharmacy Director	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Pharmacy Network Management Contact	Associate Director Pharmacy Network Management		Burdick	Tammy		9202214089					Tammy.Burdick@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	07/13/2020	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Pharmacy Network Management Contact (Secondary)	Pharmacy Director	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard St Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Pharmacy Technical Help Desk Contact	Pharmacy Director	Mr.	Dearman	Clyde							cdearman@vhpla.com	130 DeSiard St Suite 300		monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	8667040109				HMO - Health Maintenance Organization		C	Denver
H2722	Pharmacy Technical Help Desk Contact (Secondary)	Medicare Compliance Officer	Mr.	Miller	Wesley							Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	2252987965				HMO - Health Maintenance Organization		C	Denver
H2722	PHR Beneficiary Contact																	01/16/2019	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS	Vantage Health Plan, Inc	Louisiana Health Service & Indemnity Company	617	Yes	Active	8667040109				HMO - Health Maintenance Organization		C	Denver
H2722	Physician Incentive Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Plan Directory Contact for Public Website	Director of Member Service	Mrs.	Trichel	Amy		8888231910					atrichel@vhpla.com	130 DeSiard Street, Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Processor Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Quality Contact	Director of Quality Improvement	Mr.	Murphy	Paul		3189983098					pmurphy@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Reconciliation Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Recovery Audit Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	SNP Application Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	SNP State Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Surveillance Contact	SVP and Chief Marketing Officer	Mr.	Keller	Brian		2252981582					brian.keller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	System Contact	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St. Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	User Access Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Retiz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Utilization Management Contact	Chief Medical Director	Dr.	Raulerson	Robert		3189983701					rraulerson@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2722	Utilization Review Contact	Chief Medical Director	Dr.	Raulerson	Robert		3189983701					rraulerson@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF ARKANSAS, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H2737	Agent/Broker Compensation Data Contact	Medicare Sales Manager	Ms.	Fernandes	Sarah		4132332222				4132332222	sfernandes@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Automated TrOOP Balance Transfer Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Backup User Access Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Best Available Evidence Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Bid Audit Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Bid Audit Site Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Bid Primary Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	CAP Report Contact for Public Website	Medicare Compliance Program Supervisor	Ms	Blais	Christine	A	4132333424				4132333424	cblais@hne.com	1414 Main Street	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active	4132333424				PPO - BBA		C	New York
H2737	CEO - CMS Administrator Contact	President & CEO	Mr.	Swift	Richard		6024211000					rswift2@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	CEO - Senior Official for Contracting	President & CEO	Mr.	Swift	Richard		4132333050					rswift2@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Chief Financial Officer	Chief Financial Officer	Ms.	Cohen	Lisa		4132333024					lcohen@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Chief Operating Officer	Chief Financial Officer / VP of Operations	Ms.	Cohen	Lisa		4132333024					lcohen@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	06/30/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Chief Information Officer	IT Security Officer and VP of Information  Tech	Mr.	Hossa	Casey		4132333575					chossa@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Chief Information Security Officer	IT Security Officer and VP of Information  Tech	Mr.	Hossa	Casey		4132333575					chossa@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	CMS Casework Communication Contact	Complaints & Appeals Manager	Mr.	Farrell	James		4132333231				4132333231	jfarrell@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Complaints Tracking Contact	Complaints & Appeals Manager	Mr.	Farrell	James		4132333231				4132333231	jfarrell@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Contact for Fraud Investigations	Director of Compliance	Ms.	Tulloch	Charmalee		4132333566				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Coordination of Benefits Contact	Recovery and Reinsurance Manager	Ms.	Carter	Ronda		4132333353				4132333353	rcarter@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Corporate Mailing						4137874000				4137343356	soconnor@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Compliance		Tulloch	Charmalee		8602335656					ctulloch@hne.com	One Monarch Place	Springfield, MA 01144	Springfield	MA	01144	09/21/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Customer Service Operations Contact	Manager Member Services	Ms.	Armstrong	Carolyn		4132333301				4132333301	carmstrong@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	DIR Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	DIR Contact (Secondary)	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Emergency Part D Contact	Director of Pharmacy	Mr.	Tereso	Gary		4135311752				4137343356	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Emergency Part D Contact (Secondary)	Director of Compliance	Ms	Tulloch	Charmalee		8607090397				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Employer Waiver Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Program Manager		Morgan	Stephne		4132333431				4132333431	smorgan@hne.com	One Monarch Place	Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Enrollment Contact	Medicare Enrollment Supervisor	Ms.	Henriques	Christina		4137874000	3232				chenriques@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	EOB Transfer Contact	Claims Analytics & Payment Policy Manager	Ms.	Shaw	Joanne		4132333444				4132333444	jshaw@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Financial Audit Contact	Director of Accounting	Ms	Faford	Rebecca		4132333371				4132333371	rfaford@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Financial Reporting Contact	Chief Financial Officer	Ms.	Cohen	Lisa		4132333024					lcohen@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Formulary Contact		Ms.	Maloney	Julia		2242312718					julia.maloney@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Formulary Contact (Secondary)	Director of Pharmacy	Mr.	Tereso	Gary		4137874000	3420			4137343356	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	General Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Government Relations Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	HIPAA Privacy Officer	Director of Compliance	Ms	Tulloch	Charmalee		4132333566				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	HIPAA Security Officer	IT Security Officer and VP of Information  Tech	Mr.	Hossa	Casey		4132333575					chossa@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Hospice Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Interoperability Contact	IT Security Officer and VP of Information  Tech	Mr.	Hossa	Casey		4132333575					chossa@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	MA Appeals/Grievances Contact	Complaints & Appeals Manager	Mr.	Farrell	James		4132333231				4132333231	jfarrell@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	MA Claims Processing Contact for Public Website	Claims Production Manager	Mr.	Decker	Shawn		4132333087				4132333087	sdecker@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Marketing Contact	Director of Marketing & Digital Strategy	Ms.	Cordial	Melissa		4132333180					mcordial@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Medical Director	VP & Chief Medical Officer	Dr	McIntosh	Kate		4132333052					kmcintosh@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Medicare Compliance Officer	Director of Compliance	Ms	Tulloch	Charmalee		4132333566				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Medicare Coordinator	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Mr.	Tereso	Gary		4132333420				4132333420	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Medication Therapy Management Contact	Clinical Program Manager	Ms.	Russo	Nicole	B	4013441003					nbrusso@magellanhealth.com	Magellan Rx Management	88 Silva Lane, Tech 4	Middletown	RI	02842	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	OffShore Subcontractor Contact	Director of Compliance	Ms	Tulloch	Charmalee		4132333566				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Online Enrollment Center Contact (Back-up)	Medicare Enrollment Supervisor		Henriques	Christina		4137874000	3232			4132333232	chenriques@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Online Enrollment Center Contact (Optional)	Director of Revenue Managemen & Recovery	Mr.	Carabine	Daniel		4132333339				4132333339	dcarabine@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Online Enrollment Center Contact (Primary)	Director of Revenue Management & Recovery	Mr.	Carabine	Daniel		4132333339				4132333339	dcarabine@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Part C Application Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Part C Reporting Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Part D Appeals	Manager, Prior Authorization		Mourad	Hala							hala.mourad@optum.com	2441 Warrenville Rd	Suite 400	Lisle	IL	60532	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active	6303285837				PPO - BBA		C	New York
H2737	Part D Appeals Contact (Secondary)	Complaints & Appeals Supervisor	Mr.	Farrell	James						4132333231	jfarrell@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active	4137874000	3231			PPO - BBA		C	New York
H2737	Part D Application Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Part D Benefits Contact	PharmD, Clinical Pharmacist	Mr.	Tereso	Gary		4137874000	3420			4137343356	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Part D Claims Submission Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Part D Exceptions Contact	Manager, Prior Authorization		Mourad	Hala							hala.mourad@optum.com	2441 Warrenville Rd	Suite 400	Lisle	IL	60532	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active	6303285837				PPO - BBA		C	New York
H2737	Part D Exceptions Contact (Secondary)	Director of Pharmacy	Mr.	Tereso	Gary						4127343356	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active	8008424464	3420			PPO - BBA		C	New York
H2737	Part D Price File Contact (Back-up)	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Part D Price File Contact (Optional)	Director of Pharmacy	Mr.	Tereso	Gary		4137874000	3420			4137343356	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Part D Price File Contact (Primary)	Sr. Business Analyst	Ms.	Moore-Elliott	Shalandria		7637974305					MedOps-planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Part D Quality Assurance Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Part D Reporting Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Patient Safety Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Payment Contact	Chief Financial Officer	Ms.	Cohen	Lisa		4132333024				4132333024	lcohen@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Personal Health Record Contact	Director Population Health Clinical Programs	Ms.	Perracchio	Margaret		4132333058				4132333058	mperracchio@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Pharmacy Director	Director of Pharmacy	Mr.	Tereso	Gary		4132333420				4132333420	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Pharmacy Network Management Contact			Pham	Katie		8178469722					katie.pham@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Pharmacy Network Management Contact (Secondary)	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk		Summers	Todd							todd.summers@optum.com	755 Research Parkway	Suite 300	Oklahoma City	OK	73104	06/06/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active	8003930395				PPO - BBA		C	New York
H2737	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Services Specialist	Ms.	Bacaj	Blerina						4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active	8774433314	3423			PPO - BBA		C	New York
H2737	PHR Beneficiary Contact																	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO	Health New England, Inc.	Baystate Health, Inc.	381	Yes	Active	8008424464	3439			PPO - BBA		C	New York
H2737	Physician Incentive Contact	VP & Chief Medical Officer	Dr.	McIntosh	Kate		4132333052					kmcintosh@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Plan Directory Contact for Public Website			Services	Member		8774433314					memberservices@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Plan to Plan Reconciliation Contact	Assistant Controller	Ms.	King	Katie		4137874000	3008				kking2@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Processor Contact	Senior Manager, Benefits Administration		Cassata	Mercedes		6307809152					mercedes.cassata@optum.com	1600  McConnor Parkway		Schaumburg	IL	60173	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Quality Contact	Healthcare Quality Improvement Manager	Mr	Rogers	Benjamin		4132333360					brogers@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Reconciliation Contact	Director of Pharmacy	Mr	Tereso	Gary		4132333420					gtereso@hne.com	One Monarch Place	Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Reconciliation Contact (Secondary)	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Recovery Audit Contact	Director of Revenue Managemen & Recovery	Mr.	Carabine	Daniel		4132333339				4132333339	dcarabine@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Surveillance Contact	Director of Compliance	Ms	Tulloch	Charmalee		4132333566				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	System Contact	IT Security Officer and VP of Information  Tech	Mr.	Hossa	Casey		4132333575					chossa@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Third Party Administrator (TPA) Liaison	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	User Access Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Utilization Management Contact	Director Population Health Clinical Programs	Ms.	Perracchio	Margaret		4132333058				4132333058	mperracchio@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2737	Utilization Review Contact	Director Population Health Clinical Programs	Ms.	Perracchio	Margaret		4132333058				4132333058	mperracchio@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	Local PPO		Baystate Health, Inc.	381	Yes	Active					PPO - BBA		C	New York
H2752	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H2752	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H2752	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H2752	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H2752	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H2752	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H2752	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2752	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CONNECTICUT INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2765	Agent/Broker Compensation Data Contact	Sr. Medicare Product Manager	Mrs.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	06/04/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Automated TrOOP Balance Transfer Contact	Supervisor Enrollment & Eligibility	Ms.	Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/11/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Backup User Access Contact	Medicare Compliance Auditor	Ms.	Siegfried-Roads	Carey		5032654719				5032654790	carey.siegfriedroads@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Best Available Evidence Contact	Supervisor Membership Accounting		Black	Colby		5032655606					colby.black@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Bid Audit Contact	Senior Medicare Product Manager	Ms.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Bid Audit Site Contact	Director Actuarial Pricing	Mr.	Danburg-Wyld	Mark		5039525020					mark.danburgwyld@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Bid Primary Contact	Senior Medicare Product Manager	Ms.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/08/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	CEO - CMS Administrator Contact	CEO & Chairman of the Board	Mr.	Richardson	Robin		5032434491					robin.richardson@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/16/2023	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	CEO - Senior Official for Contracting	CEO & Chairman of the Board	Mr.	Richardson	Robin		5032434491					robin.richardson@modahealth.com	601 S.W. Second Ave Suite 900		Portland	OR	97204	01/07/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Chief Financial Officer	CFO	Mr.	Evans	Dave		5032433952				5039485557	dave.evans@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Chief Operating Officer	President	Mr.	Jessup	Sean		5032654748					sean.jessup@modahealth.com	601 S.W. Second Ave		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Chief Information Officer	Chief Information Officer	Ms.	Hansen	Sue		5032655705	5705				sue.hansen@modahealth.com	601 SW Second Ave.		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Chief Information Security Officer	Director, Information Security	Mr	James	Dale		5039485597					dayle.james@modahealth.com	601 SW Second Ave.		Portland	OR	97204	06/24/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	CMS Casework Communication Contact	Lead Appeals Coordinator	Ms.	Shattuck	Mica		5034124021				8339491888	mica.shattuck@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/11/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Complaints Tracking Contact	Lead Appeals Coordinator	Ms.	Shattuck	Mica		5034124021				8339491888	mica.shattuck@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/11/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Contact for Fraud Investigations	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Coordination of Benefits Contact			Service	Customer		8448272355				8554667208	MedicalMedicare@yoursummithealth.com	PO Box 820070		Portland	OR	97282	04/19/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Corporate Mailing						8448272355				8554667208	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Coverage Gap Discount Program (CGDP) Payment Contact	Corporate Controller	Ms.	Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 SW Second Ave		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Customer Service Operations Contact	Customer Service Manager	Ms.	Duncan	Colleen		5037653424					colleen.duncan@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	DIR Contact	Manager, Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/28/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	DIR Contact (Secondary)	Rx Government Programs Analyst		Beebe	Colin		5034124175					colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	02/23/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Emergency Part D Contact	Manager Pharmacy Operations		Kraemer	Laura		5034688790					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/13/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Emergency Part D Contact (Secondary)	Pharmacy PAC Govt Programs II		Beebe	Colin		7276566998					colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/13/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Employer Waiver Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Encounter Data & Risk Adjustment Operations Contact	Manager Risk Adjustment	Ms.	Eckenrodt	Brianne		5032286554	1144				brianne.echenrodt@modahealth.com	601 S.W. Second Ave		Portland	OR	97204	04/19/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Enrollment Contact	Membership Accounting Supervisor	=	Black	Colby		5032655606					colby.black@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	EOB Transfer Contact	Supervisor, Rx Quality and Compliance		Brokaw	Katie		5032654771				8339491891	katie.brokaw@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Financial Audit Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Financial Reporting Contact	Corporate Controller	Ms.	Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Formulary Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					RXGovernmentPrograms@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Formulary Contact (Secondary)	Formulary Team Lead	Ms.	Paddock	Deanna		6087291628				6087292628	deanna.paddock@navitus.com	361 Integrity Drive		Madison	WI	53713	02/11/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	General Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Government Relations Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	HIPAA Privacy Officer	Privacy Officer	Mr.	White	Scott		5039525044					scott.white@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	06/24/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	HIPAA Security Officer	Director, Information Security		James	Dayle		5039485597					dayle.james@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	06/24/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Hospice Contact	Rx Government Programs Analyst	Mr.	Beebe	Colin		5034124175	4175			8339491889	colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	06/04/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Interoperability Contact	Director Regulatory Affairs and Privacy Officer	Mr	White	Scott		5039525044					scott.white@modahealth.com	601 SW Second Ave		Portland	OR	97204	04/17/2023	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	MA Appeals/Grievances Contact	Manager Medical Claims		Craft	Jessica		5032193675					jessica.craft@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/30/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	MA Claims Processing Contact for Public Website	Customer Service		Service	Customer		8772999062				5039485577	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Marketing Contact	Director Product Development & Market Intelligence	Mr.	Skyba	Richard		5034124215					richard.skyba@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Medical Director	Medical Director	Dr.	Popowich	Yale		5039525022					Yale.Popowich@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/06/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Medicare Coordinator	Medicare Compliance Analyst	Ms.	Seon Hye	Jangmie		5039525245	5245				jangmie.seonhyemcinnes@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Medication Therapy Management Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/28/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Online Enrollment Center Contact (Back-up)	Membership Accounting Trainer	Mr.	Schamber	Jacob		5032286554	1518				jacob.schamber@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Online Enrollment Center Contact (Optional)	Membership Accounting Specialist II		Pahlka	Chelsea		5032654729					chelsea.pahlka@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Online Enrollment Center Contact (Primary)	Supervisor Membership Accounting		Black	Colby		5032655606					colby.black@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Part C Application Contact	Senior Medicare Product Manager	Mrs.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Part C Reporting Contact	Medicare Compliance Analyst	Ms.	Seon Hye	Jangmie	T	5039525245	5245				jangmie.seonhyemcinnes@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Part D Appeals	Manager Medical Claims		Craft	Jessica							jessica.craft@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/30/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active	5032193675				HMO - Health Maintenance Organization		C	Seattle
H2765	Part D Appeals Contact (Secondary)	Lead Appeals Coordinator	Ms.	Shattuck	Mica						8339491888	mica.shattuck@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/11/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active	8772999062				HMO - Health Maintenance Organization		C	Seattle
H2765	Part D Application Contact	Senior Medicare Product Manager	Mrs.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Part D Benefits Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/28/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Part D Claims Submission Contact	Manager Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/11/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Part D Exceptions Contact	Pharmacy, Customer Service		Service	Customer						8339497889	PharmacyMedicare@modahealth.com	601 S.W. Second Ave.		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active	8448272355				HMO - Health Maintenance Organization		C	Seattle
H2765	Part D Exceptions Contact (Secondary)	Manager Pharmacy Operations		Kraemer	Laura							Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active	5032654759				HMO - Health Maintenance Organization		C	Seattle
H2765	Part D Price File Contact (Back-up)	Supervisor Pharmacy Operations	Mr.	Beebe	Colin		5034124175	4175			8339491889	colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	02/11/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	plan.finder@navitus.com	361 Integrity Drive		Madison	WI	53713	02/11/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Part D Quality Assurance Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Part D Reporting Contact	Medicare Compliance Analyst		Seon Hye	Jangmie	T	5039525245	5245				jangmie.seonhyemcinnes@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Patient Safety Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Payment Contact	Corporate Controller		Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Pharmacy Director	Director, Pharmacy		Rodriguez	Carly		5039525011					carly.rodriguez@modahealth.com	601 SW Second Ave		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688				6087292688	Jan.Robinson@navitus.com	361 Integrity Drive		Madison	WI	53717	03/31/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Operations Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Ave		Portland	OR	97204	12/28/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Pharmacy Technical Help Desk Contact	Sr. Manager, Customer Care Accounts		Nett	Danielle						9202214724	Danielle.Nett@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/27/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active	8662703877				HMO - Health Maintenance Organization		C	Seattle
H2765	Plan Directory Contact for Public Website			Service	Customer		8448272355				8554667208	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Plan to Plan Reconciliation Contact	Lead Pharmacy Benefit Formulary Coordinator	Ms.	Brokaw	Katie		5032654771	4771				katie.brokaw@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Processor Contact	Manager, Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Ave		Portland	OR	97204	12/28/2021	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Quality Contact	Manager, Quality Metrics		Trenholme	Nathan		5032652935				8339491890	nathan.trenholme@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Reconciliation Contact	Supervisor, Rx Quality and Compliance		Brokaw	Katie		5032654771					katie.brokaw@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	02/23/2022	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Reconciliation Contact (Secondary)	Manager, Underwriting	Mr.	Danburg-Wyld	Mark		5039525020					mark.danburgwyld@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Recovery Audit Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Surveillance Contact	Medicare Compliance Officer		McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	System Contact	Medicare Compliance Officer		McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Third Party Administrator (TPA) Liaison	Corporate Controller	Ms.	Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 SW Second Ave		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	User Access Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Utilization Management Contact			Services	Healthcare		8448272355				8339491890	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2765	Utilization Review Contact			Services	Healthcare		8448272355				8339491890	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/27/2020	2023	SUMMIT HEALTH PLAN, INC.	Local CCP	Summit Health Plan, Inc.	HMO/HMOPOS		Moda Partners, Inc.	226	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H2775	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Corporate Mailing						8132063477					crysten.troutman@wellcare.com	P. O. Box 31386		Tampa	FL	33631	10/02/2020	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H2775	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H2775	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H2775	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H2775	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road Tampa,FL 33634		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H2775	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H2775	PHR Beneficiary Contact																	09/27/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H2775	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road, Ren 1, 3rd Floor		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/16/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2775	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H2782	Agent/Broker Compensation Data Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Automated TrOOP Balance Transfer Contact	Business Analyst - Systems Coord, Pharmacy	Ms.	Cintron	Alicia		5035748064				5035748646	alicia.cintron@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/09/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Backup User Access Contact	Executive Administrator	Ms	Richardson	Andrea		5035745723					a.richardson@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Best Available Evidence Contact	Supervisor - Medicare Membership Accounting	Ms.	Saucedo	Sonya		5033622818					Sonya.saucedo@phtech.com	550 Hawthorne Ave, Ste 220		Salem	OR	97301	04/13/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Bid Audit Contact	Actuarial Services Director	Ms	Ingram	Mary		9165632231				9165633182	m.ingram@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	08/16/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Bid Audit Site Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Bid Primary Contact	Actuarial Services Director,	Ms	Ingram	Mary		9165632231				9165633182	m.ingram@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/17/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	CEO - CMS Administrator Contact	President and Chief Executive Officer	Mr	Maisel	Garry		9168048232				9165633182	g.maisel@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	CEO - Senior Official for Contracting	Chief Financial Officer	Ms	Ruecker	Mariette	D	9166903769				9165633182	r.ruecker@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Chief Financial Officer	Chief Financial Officer	Ms	Ruecker	Mariette	D	9166903769				9165633182	r.ruecker@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Chief Operating Officer	Chief Financial Officer	Ms	Ruecker	Mariette	D	9166903769				9165633182	r.ruecker@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Chief Information Officer	Chief Information Officer	Mr	Hamburg	Glenn		9166146030				9165633182	g.hamburg@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/18/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Chief Information Security Officer	Chief Information Officer	Mr	Hamburg	Glenn		9166146030				9165633182	g.hamburg@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/18/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	CMMI Model Point of Contact	Chief Medical Officer	Dr	Arif	Khuram		9165633186				9165633182	k.arif@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	02/03/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	CMS Casework Communication Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Complaints Tracking Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Contact for Fraud Investigations	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Coordination of Benefits Contact	Manager - OFT	Ms.	Torres	Angie		5035842127					angie.torres@phtech.com	550 Hawthorne Ave, Ste 220		Salem	OR	97301	04/13/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Corporate Mailing						9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Coverage Gap Discount Program (CGDP) Payment Contact	Principal Healthcare Data Analyst	Mr.	Rodgers	Tyler		5035746351					tyler.rodgers@providence.org	4400 NE Halsey Street	Bldg. 2, Suite 690	Portland	OR	97213	02/24/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Customer Service Operations Contact	Supervisor Serice Ops- Customer Service	Ms.	Aronson	Elizabeth		5035746589					Elizabeth.Aronson@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	DIR Contact	Principal Healthcare Data Analyst	Mr.	Rodgers	Tyler		5035746351					tyler.rodgers@providence.org	4400 NE Halsey Street	Bldg. 2, Suite 690	Portland	OR	97213	02/24/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	DIR Contact (Secondary)	Business Analyst - Systems Coord, Pharmacy	Ms.	Williams	Teresa		5035747308				5035748646	Teresa.Williams@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	01/30/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Electronic Health Record Contact	Chief Information Officer	Mr	Hamburg	Glenn		9166146030				9165633182	g.hamburg@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	01/20/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Emergency Part D Contact	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M	5035443208				5035748646	Helen.Noonan-Harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Emergency Part D Contact (Secondary)	Director, Pharmacy	Dr.	Clark	James		3609537484				5035748646	jim.clark2@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	04/24/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Employer Waiver Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Encounter Data & Risk Adjustment Operations Contact	Supervisor - Informatics Data Management	Ms.	Yutzie-Holloway	Keri		5035844244					Keri.yutzie@phtech.com	550 Hawthorne Ave Ste 220		Salem	OR	97301	04/13/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Enrollment Contact	Supervisor - Medicare Membership Accounting	Ms	Saucedo	Sonya		5033622818					Sonya.saucedo@phtech.com	550 Hawthorne Ave Ste 220		Salem	OR	97301	04/13/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	EOB Transfer Contact	Director, Pharmacy	Dr.	Clark	James		5035746571				8002497714	James.Clark2@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	03/11/2022	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Financial Audit Contact	Finance Director	Ms	Madsen	Stephanie		9165633193				9165633182	s.madsen@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/18/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Financial Reporting Contact	Chief Financial Officer	Ms	Ruecker	Mariette	D	9165633188				9165633182	r.ruecker@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/17/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Formulary Contact	Program Manager - Clinical Pharmacy Outcomes	Dr.	Smith	Jenifer		5035747829				5035748646	Jenifer.Smith@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	01/30/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Formulary Contact (Secondary)	Senior Pharmacy Technician	Ms.	Frost	Sarah		5035747158					Sarah.Frost@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	General Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Government Relations Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	HIPAA Privacy Officer	Chief Legal Officer	Ms	Downing	Rebecca		9165633183				9165633182	r.downing@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/18/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	HIPAA Security Officer	Chief Information Officer	Mr	Hamburg	Glenn		9166146030				9165633182	g.hamburg@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/18/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Hospice Contact	Pharmacy Director	Ms	Biring	Kiran		9165632273				9165633182	k.biring@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/06/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Interoperability Contact			Warshaw	Jessica		9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive	Suite 100	Sacramento	CA	95833	02/07/2022	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	MA Appeals/Grievances Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	MA Claims Processing Contact for Public Website	Manager Public Programs Claims	Ms.	Jointer	Priscilla		5035745626					Priscilla.jointer@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Marketing Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Medical Director	Chief Medical Officer	Dr	Arif	Khuram		9165633186				9165633182	k.arif@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	02/03/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Medicare Compliance Officer	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Medicare Coordinator	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Medicare Part D Opioid Overutilization Contact	Program Manager - Quality & UM Programs		Wallenslager	Danny		5035745628				5035748646	PHPRxMedicare@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	06/17/2022	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Medication Therapy Management Contact	Manager, Pharmacy	Dr.	Criswell-Cacho	John		5413878245				5035748646	John.criswell-cacho2@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	04/24/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Online Enrollment Center Contact (Optional)	Manager Medicare Membership Accounting	Ms.	Torres	Angie		5035842127					angie.torres@phtech.com	550 Hawthorne Ave Ste 220		Salem	OR	97301	04/13/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Online Enrollment Center Contact (Primary)	Supervisor - Medicare Membership Accounting	Ms	Saucedo	Sonya		5033622818					Sonya.saucedo@phtech.com	550 Hawthorne Ave Ste 220		Salem	OR	97301	04/13/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Part C Application Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Part C Reporting Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Appeals	Manager Part D Appeals	Ms.	Nichuals	Ronni							Ronni.Nichuals@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	03/15/2022	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active	8008784445				HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Appeals Contact (Secondary)	Auditor Part D Appeals	Ms.	Chastain	Sandy						5035748757	Sandy.Chastain@providence.org	PO Box 4158		Portland	OR	97208	03/15/2022	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active	8008784445				HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Application Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Benefits Contact	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M	5035443208				5035748646	Helen.Noonan-Harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Claims Submission Contact	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M	5035443208				5035748646	Helen.Noonan-Harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Exceptions Contact	Director, Pharmacy	Dr.	Clark	James							James.Clark2@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	03/11/2022	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active	8772163644				HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Exceptions Contact (Secondary)	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M					5035748646	Helen.Noonan-Harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active	8772163644				HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Price File Contact (Back-up)	Business Analyst - Systems Coord, Pharmacy	Ms.	Williams	Teresa		5035747308				5035748646	Teresa.Williams@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	01/30/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Price File Contact (Optional)	DST Health Systems	Ms.	Boileau	Tiffany		5165510627					tiffany.boileau@sscinc.com	210 10th Street		Kansas City	MO	64105	01/06/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Price File Contact (Primary)	DST Health Systems	Ms.	Joslin	Karen		8167567860					karen.joslin@sscinc.com	210 10th Street		Kansas City	MO	64105	01/06/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Quality Assurance Contact	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M	5035745708				5035748646	Helen.Noonan-Harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Part D Reporting Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Patient Safety Contact	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M	5035745708				5035748646	Helen.Noonan-Harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Payment Contact	Chief Financial Officer	Ms	Ruecker	Mariette	D	9165633188				9165633182	r.ruecker@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/17/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Pharmacy Director	Pharmacy Director	Ms	Biring	Kiran		9165632273				9165633182	k.biring@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/12/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Pharmacy Network Management Contact	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M	5035745708				5035748646	Helen.Noonan-Harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Business	Ms.	Joffer	Kathleen	M	5035746485				5035748646	kathleen.joffer@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	01/30/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Pharmacy Technical Help Desk Contact	Pharmacy Director		Clark	James						8002497714	James.clark2@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/08/2022	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active	8884455518				HMO - Health Maintenance Organization		C	San Francisco
H2782	Pharmacy Technical Help Desk Contact (Secondary)	DST Health Systems	Ms.	Andrade	Chris							CEAndrade@dsthealth.com	210 10th Street		Kansas City	MO	64105	01/30/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active	8164352321				HMO - Health Maintenance Organization		C	San Francisco
H2782	Physician Incentive Contact	Finance Director	Ms	Madsen	Stephanie		9165633193				9165633182	s.madsen@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/18/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Plan Directory Contact for Public Website			Member Services	WHA		8885632250				9165680126	memberservices@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	09/20/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Plan to Plan Reconciliation Contact	Healthcare Data  Analyst	Ms.	Williams	Rachelle		5035746316					rachelle.williams@providence.org	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	09/09/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Processor Contact	Manager, Analytics Business Intelligence, Pharmacy		Perry	Jeffrey		5035747154				5035748646	jeffrey.perry@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	04/24/2023	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Quality Contact	Chief Medical Officer	Dr	Arif	Khuram		9165633186				9165633182	k.arif@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	02/03/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Reconciliation Contact	Actuarial Services Director,	Ms	Ingram	Mary		9165632231				9165633182	m.ingram@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/17/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Reconciliation Contact (Secondary)	Finance Director	Ms	Madsen	Stephanie		9165633193				9165633182	s.madsen@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/18/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Recovery Audit Contact	Finance Director	Ms	Madsen	Stephanie		9165633193				9165633182	s.madsen@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/18/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Surveillance Contact	Medicare Compliance Officer	Ms	Warshaw	Jessica	A	9165632234				9165633182	j.warshaw@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	04/15/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	System Contact	Chief Information Officer	Mr	Hamburg	Glenn		9166146030				9165633182	g.hamburg@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	01/20/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Third Party Administrator (TPA) Liaison	Healthcare Data  Analyst	Ms.	Williams	Rachelle		5035746316					rachelle.williams@providence.org	4400 NE Halsey Street	Bldg. 2, Suite 690	Portland	OR	97213	09/09/2021	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	User Access Contact	Executive Administrator	Ms	Richardson	Andrea		9166146014				9165633182	a.richardson@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	12/18/2019	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Utilization Management Contact	Chief Medical Officer	Dr	Arif	Khuram		9165633186				9165633182	k.arif@westernhealth.com	2349 Gateway Oaks Drive, Suite 100		Sacramento	CA	95833	02/03/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2782	Utilization Review Contact	Chief Medical Officer	Dr	Arif	Khuram		9165633186				9165633182	k.arif@westernhealth.com	2349 Gateway Oaks Drive, Suite100		Sacramento	CA	95833	06/03/2020	2023	WESTERN HEALTH ADVANTAGE	Local CCP	Western Health Advantage	HMO/HMOPOS		Western Health Advantage	260	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2793	Agent/Broker Compensation Data Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Automated TrOOP Balance Transfer Contact	Clinical Pharmacist		Cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Backup User Access Contact	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Best Available Evidence Contact	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Bid Audit Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Bid Audit Site Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Bid Primary Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	CAP Report Contact for Public Website	Compliance Officer	Ms	Ruiz	Erica		8007087903					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	CEO - CMS Administrator Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	CEO - Senior Official for Contracting	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Chief Financial Officer	Chief Financial Officer	Mrs.	Bindra	Meeta		6268385100	5155				Meeta.Bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Chief Operating Officer		Dr	TBD	TBD		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Chief Information Officer	Information System Manager	Mr	Lam	Wilfred		6268385100	701			6265216028	wlam@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Chief Information Security Officer	Information System Manager	Mr	Lam	Wilfred		6268385126				6265216028	wlam@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	CMS Casework Communication Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Complaints Tracking Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Contact for Fraud Investigations	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Coordination of Benefits Contact	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Corporate Mailing						6267080333					pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director of Finance	Ms	McCloud	Georgetta		6268385100	919				georgetta.mccloud@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Customer Service Operations Contact	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	DIR Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	DIR Contact (Secondary)	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Electronic Health Record Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Emergency Part D Contact	Clinical Pharmacist		Cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Emergency Part D Contact (Secondary)	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Encounter Data & Risk Adjustment Operations Contact	Information System Manager	Mr	Lam	Wilfred		6268385100	701			6265216028	wlam@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Enrollment Contact	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	EOB Transfer Contact	Information System Manager	Mr	Lam	Wilfred		6268385100	701			6265216028	wlam@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Financial Audit Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675				6265216028	eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Financial Reporting Contact	Controller	Mrs	Bindra	Meeta		6268385100	5155			6265216028	meeta.bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Formulary Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Formulary Contact (Secondary)	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	General Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Government Relations Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	HIPAA Privacy Officer	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	HIPAA Security Officer	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Hospice Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Interoperability Contact	Vice president Operations		Lao	Pablo		6266965712					pablo.lau@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	MA Appeals/Grievances Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	MA Claims Processing Contact for Public Website		Dr	TBD	TBD		6267558831				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Marketing Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Medical Director	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Medicare Compliance Officer	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Medicare Coordinator	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Medication Therapy Management Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	OffShore Subcontractor Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Online Enrollment Center Contact (Back-up)	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Online Enrollment Center Contact (Optional)	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Online Enrollment Center Contact (Primary)	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Part C Application Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Part C Reporting Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Part D Appeals	Compliance Officer	Ms	Ruiz	Erica							eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated	8008388271				HMO - Health Maintenance Organization		C	San Francisco
H2793	Part D Appeals Contact (Secondary)	Clinical Services Supervisor	RN	Lane	Nichole						6263809049	nichole.lane@iictx.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated	8008388271				HMO - Health Maintenance Organization		C	San Francisco
H2793	Part D Application Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Part D Benefits Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Part D Claims Submission Contact	Compliance Officer		Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Part D Exceptions Contact	Clinical Pharmacist		Cho	Evelyn							evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated	8336673497				HMO - Health Maintenance Organization		C	San Francisco
H2793	Part D Exceptions Contact (Secondary)	Compliance Officer	Ms	Ruiz	Erica							eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated	8008388271				HMO - Health Maintenance Organization		C	San Francisco
H2793	Part D Price File Contact (Back-up)	Manger Rebates		Davidson	Erin		8086261950					edavison@elixirsolutions.com	8957 Canyon Falls Blvd.		Twinsburg	OH	44087	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Part D Price File Contact (Primary)	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Part D Quality Assurance Contact	Clinical Pharmacist		cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Part D Reporting Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Patient Safety Contact	Clinical Pharmacist		cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Payment Contact	CFO	Mrs	Bindra	Meeta		6268385100	5155			6265216028	meeta.bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Personal Health Record Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Pharmacy Director	Clinical Pharmacist		cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Pharmacy Network Management Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Pharmacy Network Management Contact (Secondary)	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Pharmacy Technical Help Desk Contact	Vice president Operations		Conn	Todd							tconn@elixirsolutions.com	2181 E. Aurora Road	Suite 201	Twinsburg	OH	44087	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated	8336673497				HMO - Health Maintenance Organization		C	San Francisco
H2793	Pharmacy Technical Help Desk Contact (Secondary)	Compliance Officer	Ms	Ruiz	Erica							eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated	8008388271				HMO - Health Maintenance Organization		C	San Francisco
H2793	Plan Directory Contact for Public Website	Compliance Officer	Ms	Ruiz	Erica		8007087903					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Plan to Plan Reconciliation Contact	Controller	Mrs	Bindra	Meeta		6268385100	5155			6265216028	meeta.bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Processor Contact	Clinical Pharmacist		cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Quality Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Reconciliation Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Reconciliation Contact (Secondary)	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Recovery Audit Contact	Controller	Mrs	Bindra	Meeta		6268385100	5155				meeta.bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	SNP Application Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	SNP State Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Surveillance Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	System Contact	Information System Manager	Mr	Lam	Wilfred		6268385100	701			6265216028	wlam@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Third Party Administrator (TPA) Liaison	CFO	Mrs	Bindra	Meeta		6268385100	5155			6265216028	meeta.bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	User Access Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Utilization Management Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2793	Utilization Review Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	09/22/2023	2023	IMPERIAL INSURANCE COMPANIES INC.	Local CCP	Imperial Insurance Companies, Inc	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Terminated					HMO - Health Maintenance Organization		C	San Francisco
H2802	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H2802	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H2802	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H2802	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H2802	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2802	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H2815	Automated TrOOP Balance Transfer Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	04/18/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Backup User Access Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Best Available Evidence Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Bid Primary Contact	Business Office Manager		Cox	Terra		9709643500	3556			9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	CAP Report Contact for Public Website	Executive Director		Howell	Keith		9709643504				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	12/30/2020	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	CEO - CMS Administrator Contact	Chief of Community Healthcare	Mr	Soczynski	Paul		4144068843				9529417097	PSoczynski@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	CEO - Senior Official for Contracting	Chief of Community Healthcare	Mr	Soczynski	Paul		4144068843				9529417097	PSoczynski@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Chief Financial Officer	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124287858				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Chief Operating Officer	Executive Director	Mr	Howell	Keith		9708358500				9702520166	KEHowell@voa.org	2377 Robins Way		Montrose	CO	81401	06/08/2020	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Chief Information Officer	VP of Information & Resources Technology	Mr	Osborne	David		9529834258					dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/03/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Chief Information Security Officer	VP of Information & Resources Technology	Mr	Osborne	David		9529834258					dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/03/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	CMS Casework Communication Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Complaints Tracking Contact	Director Program Integrity/Compliance		Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	10/07/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Contact for Fraud Investigations	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Coordination of Benefits Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	04/18/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Corporate Mailing						9529410305				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Customer Service Operations Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	DIR Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	12/30/2020	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	DIR Contact (Secondary)	Finance Manger	Mr	Raynor	Eddy		9194253053					eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	02/20/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Emergency Part D Contact	Executive Director	Mr	Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Emergency Part D Contact (Secondary)	Director of Program Integrity/Copmpliance	Ms	Linnell	Kathryn		9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Encounter Data & Risk Adjustment Operations Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	11485 Highway 65		Eckert	CO	81418	04/18/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Enrollment Contact	Executive Director	Mr	Howell	Keith		9708358500				9702520166	KEHowell@voa.org	2377 Robins Way		Montrose	CO	81401	06/08/2020	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	EOB Transfer Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	04/18/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Financial Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Financial Reporting Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Formulary Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	General Contact	Executive Director	Mr	Howell	Keith		9708358500				9702520166	KEHowell@voa.org	2377 Robins Way		Montrose	CO	81401	06/08/2020	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Government Relations Contact	Executive Director		Howell	Keith		9709643504				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	12/30/2020	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	HIPAA Privacy Officer	Chief Information & Technology Officer		Osborne	David		6124287900				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/20/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	HIPAA Security Officer	Chief Information & Technology Officer		Osborne	David		6124287900				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/20/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Interoperability Contact	Director of Program Integrity/Compliance		Linnell	Kathryn		9705087757				9702520166	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	04/18/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	MA Appeals/Grievances Contact	Director of Quality		Peterson	Nora		9709643500				9702520166	npeterson@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	MA Claims Processing Contact for Public Website	Claims Administrator	Ms	Ford	Jill		9705087711				9707971984	jford@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Marketing Contact	Marketing&Communication Relations		Rincon	Michelle		5173190740				5173190650	mrincon@voa.org	1921 E Miller Road		Lansing	MI	48911	09/09/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Medical Director	Medical Director	Dr.	Schoo	Caroline		9702520522				9702520166	CSchoo@voa.org	2377 Robins Way		Montrose	CO	81401	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Medicare Compliance Officer	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	09/09/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Medicare Coordinator	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	5400 S. Miami Blvd. Ste 150		Durham	NC	27703	03/07/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Medicare Part D Opioid Overutilization Contact	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9705087757				9702520166	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	09/09/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Medication Therapy Management Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Part C Application Contact	Executive Director		Howell	Keith		9709643504				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	12/30/2020	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Part D Appeals	Compliance Officer	Ms	Linnell	Kathryn	R					8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/10/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active	9705087757				PACE - Nat		C	Denver
H2815	Part D Application Contact	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Part D Benefits Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	12/30/2020	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Part D Claims Submission Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	12/30/2020	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Part D Exceptions Contact	Finance Manager		Raynor	Eddy						9194253001	eraynor@voa.org	5400 S Miami Blvd., Ste 150		Durham	NC	27703	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active	9194253053				PACE - Nat		C	Denver
H2815	Part D Exceptions Contact (Secondary)	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn						8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active	9705087757				PACE - Nat		C	Denver
H2815	Part D Price File Contact (Back-up)	Executive Director	Mr	Howell	Keith		9709643500				9705250166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Part D Price File Contact (Primary)	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Part D Quality Assurance Contact	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn		9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Part D Reporting Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	12/30/2020	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Patient Safety Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Payment Contact	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Personal Health Record Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Pharmacy Director	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Pharmacy Network Management Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Pharmacy Technical Help Desk Contact	Executive Director		Howell	Keith						9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active	9709643500				PACE - Nat		C	Denver
H2815	Plan Directory Contact for Public Website	Executive Director	Mr	Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Plan to Plan Reconciliation Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	04/18/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Processor Contact	Executive Director		Howell	Keith		9709643500				9702520166	KeHowell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Quality Contact	Quality Assurance Manager		English	Debi		9708352900				9708352902	DArterburn02@voa.org	11485 Hwy 65		Eckert	CO	81418	03/13/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Reconciliation Contact	Executive Director		Howell	Keith	H	9709643500				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2022	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Reconciliation Contact (Secondary)	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124257858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Recovery Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Surveillance Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	System Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Third Party Administrator (TPA) Liaison	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	User Access Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Utilization Management Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2815	Utilization Review Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/04/2021	2023	VOANS SENIOR COMMUNITY CARE OF COLORADO, INC	National PACE	Senior CommUnity Care of Colorado	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Denver
H2816	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Corporate Mailing						8132063477					crysten.troutman@wellcare.com	P. O. Box 31386		Tampa	FL	33631	10/02/2020	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/23/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active	8132061716				PFFS - Private Fee for Service		C	Dallas
H2816	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active	8132066534				PFFS - Private Fee for Service		C	Dallas
H2816	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active	8132067152				PFFS - Private Fee for Service		C	Dallas
H2816	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active	6023080218				PFFS - Private Fee for Service		C	Dallas
H2816	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road Tampa,FL 33634		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	PFFS Terms and Conditions of Payment Contact for Public Website	Senior Director, Claims Operations		Everett	Thomas		8132065748					WebClaimsInquiries@wellcare.com	5520 Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active	8888889355				PFFS - Private Fee for Service		C	Dallas
H2816	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active	8555380454				PFFS - Private Fee for Service		C	Dallas
H2816	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active	8555380454				PFFS - Private Fee for Service		C	Dallas
H2816	PHR Beneficiary Contact																	09/27/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS	Member Services	Centene Corporation	351	Yes	Active	8334449088				PFFS - Private Fee for Service		C	Dallas
H2816	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road, Ren 1, 3rd Floor		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2816	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	AMERICAN PROGRESSIVE LIFE & HLTH INS COMPANY OF NY	PFFS	Wellcare	PFFS		Centene Corporation	351	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H2825	Agent/Broker Compensation Data Contact	COO	Mr.	Turner	Travis		5407412248					travis.turner@mwhc.com	2300 Fall Hill Ave.	Suite 308B	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Automated TrOOP Balance Transfer Contact	Director, Enrollment, Eligibility & OHI		Meyer	Jennell		3147703733					Enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Backup User Access Contact	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Best Available Evidence Contact	Director, Enrollment, Eligibility & OHI		Meyer	Jennell		3147703733					Enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Bid Audit Contact	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Bid Audit Site Contact	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Bid Primary Contact	Actuary	Mr.	Copeland	Joe		3142095834					jcopeland@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	CAP Report Contact for Public Website	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	CEO - CMS Administrator Contact	CEO and President	Mr.	McDermott	Michael		5408095565					mike.mcdermott@mwhc.com	1001 Sam Perry Boulevard	Executive Offices	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	CEO - Senior Official for Contracting	CEO and President	Mr.	McDermott	Michael		5407411414					mike.mcdermott@mwhc.com	1001 Sam Perry Boulevard	Executive Offices	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Chief Financial Officer	CFO	Mr.	Barden	Sean		5407411414					sean.barden@mwhc.com	1001 Sam Perry Boulevard	Executive Offices	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Chief Operating Officer	COO	Mr.	Turner	Travis		5407412248					travis.turner@mwhc.com	2300 Fall Hill Ave.	Suite 308B	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Chief Information Officer	COO	Mr.	Turner	Travis		5407412248					travis.turner@mwhc.com	2300 Fall Hill Ave.	Suite 308B	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Chief Information Security Officer	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	CMS Casework Communication Contact	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Complaints Tracking Contact	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Contact for Fraud Investigations	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Coordination of Benefits Contact			Inquiries	COB		8445293760					COBInquiry@lumeris.com	P O BOX 7118		Troy	MI	48007	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Corporate Mailing						5047411821					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Customer Service Operations Contact	Vice President, Health Plan Operations	Ms.	Meyerhoeffer	Linda		6366869682					rmeyerhoeffer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	DIR Contact	COO	Mr.	Turner	Travis		5407412248					travis.turner@mwhc.com	2300 Fall Hill Ave.	Suite 308B	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	DIR Contact (Secondary)	Compliance Officer		Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Avenue	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Emergency Part D Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		6307425966					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Emergency Part D Contact (Secondary)	Compliance Officer	Ms.	Blalock	Lauren		5406451237					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment Services		Eschbach	Jason		6144397608					jeschbach@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Enrollment Contact	Director, Enrollment, Eligibility & OHI		Meyer	Jennell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	EOB Transfer Contact	Director, Claims	Ms.	Wasserman	Rachelle		3147703520				3147706096	rwasserman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Financial Audit Contact	Compliance Officer	Mrs.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Avenue	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Financial Reporting Contact	CFO	Mr.	Barden	Sean		5407411414					sean.barden@mwhc.com	1001 Sam Perry Boulevard	Executive Offices	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Formulary Contact	Sr  Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Formulary Contact (Secondary)	Chief Operating Officer		Turner	Travis		5407412248					travis.turner@mwhc.com	2300 Fall Hill Ave	Suite 308B	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	General Contact	COO	Mr.	Turner	Travis		5407412248					travis.turner@mwhc.com	2300 Fall Hill Ave.	Suite 308B	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Government Relations Contact	COO	Mr.	Turner	Travis		5407412248					travis.turner@mwhc.com	2300 Fall Hill Ave.	Suite 308B	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	HIPAA Privacy Officer	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	HIPAA Security Officer	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Hospice Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Interoperability Contact			Blalock	Lauren	W	5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Darnell	Erika		3144382410					ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	MA Claims Processing Contact for Public Website			Customer Service	Lumeris		8445293760				8443354191	customerservice@mwmaplan.com	P O BOX 7118		Troy	MI	48007	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Marketing Contact	SVP and Chief Marketing Officer	Mr.	Fletcher	Eric		5047410660					eric.fletcher@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Medical Director	Medical Director	Mr.	Lewis	Richard		5407411552					richard.lewis@mwhc.com	2300 Fall Hill Ave.	Suite 308b	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Medicare Compliance Officer	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Medicare Coordinator	COO	Mr.	Turner	Travis		5407412248					travis.turner@mwhc.com	2300 Fall Hill Ave.	Suite 308B	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist	Ms.	Pasagic	Melita		3147703775					mpasagic@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Medication Therapy Management Contact	Sr  Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	OffShore Subcontractor Contact	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Online Enrollment Center Contact (Back-up)	Compliance Manager	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Online Enrollment Center Contact (Optional)	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Online Enrollment Center Contact (Primary)	Director, Enrollment, Eligibility & OHI	Mrs.	Meyer	Jennell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part C Application Contact	Sr. Director, CMS Applications and PBP		Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part C Reporting Contact	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part D Appeals	Director, Appeals & Grievances	Ms.	Darnell	Erika							ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract	3144382410				HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part D Appeals Contact (Secondary)	Sr. Manager, Compliance	Mrs.	Young	Polly							pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract	3142092795				HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part D Application Contact	Sr. Director, CMS Applications and PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Dt		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part D Benefits Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part D Claims Submission Contact	Director, Regulated Markets	Mr.	Dovico	Rosario		9145896300					rosario_dovico@express-scripts.com	100 Parsons Pond Dr		Franklin Lakes	NJ	07417	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian							brian_schumm@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract	8003443405	733326			HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part D Price File Contact (Back-up)	Product Manager Advisor	Ms.	Wililams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Highway		Fairfield	OH	45014	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part D Price File Contact (Optional)	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part D Price File Contact (Primary)	Sr. Manager, Government Programs	Ms.	Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part D Quality Assurance Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Part D Reporting Contact	VP Risk and Regulatory Management	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Patient Safety Contact	Sr  Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Payment Contact	CFO	Mr.	Barden	Sean		5407411414					sean.barden@mwhc.com	1001 Sam Perry Boulevard	Executive Offices	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Pharmacy Director	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Pharmacy Network Management Contact	Ntwk Acct Director, Retail Strategy & Contracting	Ms.	Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		Saint Louis	MO	63121	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Pharmacy Network Management Contact (Secondary)	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Pharmacy Technical Help Desk Contact	Director, Customer Service	Ms.	Monroe	LaTasha							latasha_monroe@express-scripts.com	13051 North Telecom Pkwy	Suite 150	Temple Terrace	FL	33637	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract	8009221557				HMO - Health Maintenance Organization		C	Philadelphia
H2825	Pharmacy Technical Help Desk Contact (Secondary)	Sr  Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly							ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract	3147703788				HMO - Health Maintenance Organization		C	Philadelphia
H2825	Physician Incentive Contact	CFO	Mr.	Barden	Sean		5407411414					sean.barden@mwhc.com	1001 Sam Perry Boulevard	Executive Offices	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Plan Directory Contact for Public Website			Customer Service	Lumeris		8445293760					customerservice@mwmaplan.com	P O BOX 7118		Troy	MI	48007	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Plan to Plan Reconciliation Contact	Sr. Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Processor Contact	Sr. Director, Government Programs, Medicare	Ms.	Gibson	Sharon		8052361175					sggibson@express-scripts.com	One Express Way		St. Louis	MO	63121	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Quality Contact	COO	Mr.	Turner	Travis		5407412248					travis.turner@mwhc.com	2300 Fall Hill Ave.	Suite 308b	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Reconciliation Contact	CFO	Mr.	Barden	Sean		5407411414					sean.barden@mwhc.com	1001 Sam Perry Boulevard	Executive Offices	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Recovery Audit Contact	CFO	Mr.	Barden	Sean		5407411414					sean.barden@mwhc.com	1001 Sam Perry Boulevard	Executive Offices	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Surveillance Contact	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	System Contact	Compliance Officer	Ms.	Blalock	Lauren		5407412459					lauren.blalock@mwhc.com	2300 Fall Hill Ave.	Suite 509	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Third Party Administrator (TPA) Liaison	Client AP Specialist	Ms.	Brock	Letecea		3142548778					lbrock@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	User Access Contact	COO	Mr.	Turner	Travis		5407412248					travis.turner@mwhc.com	2300 Fall Hill Ave.	Suite 308B	Fredericksburg	VA	22401	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Utilization Management Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr.		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2825	Utilization Review Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr.		Maryland Heights	MO	63043	06/01/2023	2023	MARY WASHINGTON HEALTH PLAN	Local CCP	Mary Washington Medicare Advantage	HMO/HMOPOS		Mary Washington Healthcare	737	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Philadelphia
H2835	Automated TrOOP Balance Transfer Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Backup User Access Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Best Available Evidence Contact	Executive Director	Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Bid Primary Contact	Executive Director	Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	CAP Report Contact for Public Website	Executive Director	Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	CEO - CMS Administrator Contact	Executive Director	Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	CEO - Senior Official for Contracting	Executive Director	Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Chief Financial Officer	PACE Director of Finance	Ms	Dukes	Jaclyn		7347553190					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Chief Operating Officer		Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Rd		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Chief Information Officer	Director of Information Services	Mr	Babcock	Paul		7344331000					pbabcock@umrc.com	805 W. Middle		Chelsea	MI	48118	03/10/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Chief Information Security Officer	Director of Information Services	Mr	Babcock	Paul		7344331000					pbabcock@umrc.com	805 W. Middle		Chelsea	MI	48118	03/10/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	CMS Casework Communication Contact	Director of Quality	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Complaints Tracking Contact	Director of Quality	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Contact for Fraud Investigations			Decker	Susan		7347689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	11/16/2015	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Coordination of Benefits Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Corporate Mailing						5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	02/28/2017	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Coverage Gap Discount Program (CGDP) Payment Contact			Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Rd		Jackson	MI	49202	04/25/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Customer Service Operations Contact	Quality Manager	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	12/12/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	DIR Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Emergency Part D Contact	Executive Director	Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Emergency Part D Contact (Secondary)	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Encounter Data & Risk Adjustment Operations Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Enrollment Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	EOB Transfer Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7347553190				5177835223	jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Financial Audit Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7347553190				5177835223	jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Financial Reporting Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7347553190				5177835223	jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Formulary Contact	Executive Director	Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	General Contact	Executive Director	Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Government Relations Contact	Executive Director	Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	HIPAA Privacy Officer	Director of Quality	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	HIPAA Security Officer	Director of Quality	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Interoperability Contact			Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	04/20/2022	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	MA Appeals/Grievances Contact	Director of Quality	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	12/12/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	MA Claims Processing Contact for Public Website	PACE Director of Finance	Ms	Dukes	Jaclyn		7347553190				5177835223	jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Marketing Contact	Community Relations Director		Clark	Jade		5177689791					jclark@thomepace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Medical Director	Medical Director	Dr.	Foust	Michael	A	5177689791					mfoust@thomepace.org	2282 Springport Road		Jackson	MI	49202	02/17/2022	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Medicare Compliance Officer	Director of Quality	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Medicare Coordinator	PACE Director of Finance	Ms	Dukes	Jaclyn		7347553190				5177835223	jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Foust	Michael	A	5177689791					mfoust@thomepace.org	2282 Springport Road		Jackson	MI	49202	02/17/2022	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Medication Therapy Management Contact	Medical Director	Dr.	Foust	Michael	A	5177689791					mfoust@thomepace.org	2282 Springport Road		Jackson	MI	49202	02/17/2022	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Part C Application Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7347553190				5177835223	jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Part D Appeals	PACE Director of Finance	Ms	Dukes	Jaclyn						5177835223	jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active	8448557223				PACE - Nat		C	Chicago
H2835	Part D Appeals Contact (Secondary)	Director of Quality	Ms	Gibbs	Sandy							sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/19/2018	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active	8448557223				PACE - Nat		C	Chicago
H2835	Part D Application Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7347553190				5177835223	jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Part D Benefits Contact	Pharmacist		Schloemer	Rosalyn		5177689791					rschloemer@thomepace.org	Thome PACE	2282 Springport Rd	Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Part D Claims Submission Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7347553190				5177835223	jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Part D Exceptions Contact	Medical Director	Dr.	Foust	Michael	A						mfoust@thomepace.org	2282 Springport Road		Jackson	MI	49202	02/17/2022	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active	8448557223				PACE - Nat		C	Chicago
H2835	Part D Price File Contact (Back-up)	Pharmacist		Schloemer	Rosalyn		5177689791					rschloemer@thomepace.org	Thome PACE	2282 Springport Rd	Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Part D Price File Contact (Primary)	Pharmacist		Schloemer	Rosalyn		5177689791					rschloemer@thomepace.org	Thome PACE	2282 Springport Rd	Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Part D Quality Assurance Contact	Director of Quality	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Part D Reporting Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Patient Safety Contact	Medical Director	Dr.	Foust	Michael	A	5177689791					mfoust@thomepace.org	2282 Springport Road		Jackson	MI	49202	02/17/2022	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Payment Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Pharmacy Director	Pharmacist		Schloemer	Rosalyn		5177689791					rschloemer@thomepace.org	Thome PACE	2282 Springport Rd	Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Pharmacy Network Management Contact	Executive Director	Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Pharmacy Technical Help Desk Contact	Pharmacist		Schloemer	Rosalyn							rschloemer@thomepace.org	Thome PACE	2282 Springport Road	Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active	8448557223				PACE - Nat		C	Chicago
H2835	Plan Directory Contact for Public Website	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Plan to Plan Reconciliation Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Processor Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Quality Contact	Director of Quality	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Reconciliation Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Recovery Audit Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7347553190				5177835223	jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Surveillance Contact	Director of Quality	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	System Contact	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Third Party Administrator (TPA) Liaison	PACE Director of Finance	Ms	Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2282 Springport Road		Jackson	MI	49202	12/09/2020	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	User Access Contact	Executive Director	Ms	Decker	Susan		5177689791					sdecker@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Utilization Management Contact	Director of Quality	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2835	Utilization Review Contact	Director of Quality	Ms	Gibbs	Sandy		5177689791					sgibbs@thomepace.org	2282 Springport Road		Jackson	MI	49202	03/07/2016	2023	THE CASCADE PACE, INC.	National PACE	Thome PACE	National PACE		United Methodist Retirement Communities, Inc.	630	Yes	Active					PACE - Nat		C	Chicago
H2836	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/06/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H2836	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				PPO - BBA		C	Chicago
H2836	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H2836	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				PPO - BBA		C	Chicago
H2836	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@ingenio-rx.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	06/13/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				PPO - BBA		C	Chicago
H2836	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				PPO - BBA		C	Chicago
H2836	PHR Beneficiary Contact																	11/05/2015	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				PPO - BBA		C	Chicago
H2836	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2836	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H2853	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H2853	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	01/31/2020	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	01/31/2020	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	01/31/2020	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Medical Director	Medical Director	Mr	Haake	Karl		9132951245					karl.haake@sunflowerhealthplan.com	77 West Wacker Drive, 14th Floor		Chicago	IL	60601	03/30/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road Tampa,FL 33634		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H2853	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H2853	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8339062876				HMO - Health Maintenance Organization		C	Dallas
H2853	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Plan Directory Contact for Public Website			Services	Provider		8555659519					CorporateMedicareComplianceDept@CENTENE.COM	8325 Lenexa Drive	Suite 200	Lenexa	KS	66214	03/31/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2853	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2879	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	CAP Report Contact for Public Website			Services	Member		8553155663					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		8885625442	113158				shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/05/2019	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	MA Claims Processing Contact for Public Website			Services	Member		8553155663					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H2879	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H2879	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H2879	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H2879	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H2879	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H2879	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Plan Directory Contact for Public Website			Services	Member		8553155663					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/13/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Third Party Administrator (TPA) Liaison	Director, Finance & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2879	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF WISCONSIN, INC.	Local CCP	Molina Healthcare of Wisconsin and Massachusetts	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2882	Automated TrOOP Balance Transfer Contact	Business Office Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Backup User Access Contact	Business Office Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/10/2019	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Best Available Evidence Contact	Quality Manager	Ms	Reeves	Brenda		9899535810					bkreeves@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	11/03/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Bid Primary Contact	Executive Director	Ms	Altom	Dayna		9899535805				9899535801	daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/16/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	CAP Report Contact for Public Website	Executive Director	Ms	Altom	Dayna		9899535805				9899535801	daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/16/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	CEO - CMS Administrator Contact	Chief Operating Officer	Ms	Whitmore	Robin		9894663835					rawhitmore@masonicpathways.com	1200 Wright Avenue		Alma	MI	48801	04/27/2022	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	CEO - Senior Official for Contracting	Executive Director	Ms	Altom	Dayna		9899535805				9899535801	daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/16/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Chief Financial Officer	Chief Financial Officer	Mr	Moeggenborg	Todd		9894663824				9894662796	tmoeggenborg@masonicpathways.com	1200 Wright Avenue		Alma	MI	48801	07/07/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Chief Operating Officer	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/09/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Chief Information Officer	Senior Director of Information Services	Mr	Virgo	Keith		9894663816				9899682615	kvirgo@masonicpathways.com	1200 Wright Avenue		Alma	MI	48801	07/07/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Chief Information Security Officer	Senior Director of Information Services	Mr	Virgo	Keith		9894663816				9899682615	kvirgo@pacecmi.org	1200 Wright Avenue		Alma	MI	48801	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	CMS Casework Communication Contact	Quality Manager	Ms	Reeves	Brenda		9899535810				9899535801	bkreeves@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/16/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Complaints Tracking Contact	Quality Manager	Mr	Reeves	Brenda		9899535810					bkreeves@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	11/03/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Contact for Fraud Investigations	Quality Manager	Ms	Reeves	Brenda		9899535810				9899535802	bkreeves@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/22/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Coordination of Benefits Contact	Community Liasion		Faber	Krista		9899535813				9899535801	kkfaber@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	02/16/2022	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Corporate Mailing						9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/09/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Coverage Gap Discount Program (CGDP) Payment Contact	Business Manager	Ms	LaVigne	Ashley		9899535828				9899535802	alavigne@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/23/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Customer Service Operations Contact	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	DIR Contact	Executive Director	Ms	Altom	Dayna		9899535805				9899535801	daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/16/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	DIR Contact (Secondary)	Business Office Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 E Bellows		Mt. Pleasant	MI	48858	12/10/2019	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Emergency Part D Contact	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/09/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Emergency Part D Contact (Secondary)	Business Office Manager	Ms	LaVigne	Ashley		9899535828				9899535801	alavigne@pacecmi.org	1750 E Bellows		Mt. Pleasant	MI	48858	03/09/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Encounter Data & Risk Adjustment Operations Contact	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Enrollment Contact	Community Liasion		Faber	Krista		9899535813				9899535801	kkfaber@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	02/16/2022	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	EOB Transfer Contact	Business Office Manager	Ms	LaVigne	Ashley		9899535828				9899535802	alavigne@pacecmi.org	1750 E Bellows		Mt. Pleasant	MI	48858	08/16/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Financial Audit Contact	Chief Financial Officer	Mr	Moeggenborg	Todd		9894663824				9894662796	tmoeggenborg@masonicpathways.com	1200 Wright Avenue		Alma	MI	48801	07/07/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Financial Reporting Contact	Chief Financial Officer	Mr	Moeggenborg	Todd		9894663824				9894662796	tmoeggenborg@masonicpathways.com	1200 Wright Avenue		Alma	MI	48801	07/07/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Formulary Contact	Medical Director	Dr.	English	Shannon		9899535839				9899535802	senglish@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	01/05/2023	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Formulary Contact (Secondary)	Business Office Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 E Bellows		Mt. Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	General Contact	Executive Director	Ms	Altom	Dayna		9899535805				9899535801	daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/09/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Government Relations Contact	Executive Director	Ms	Altom	Dayna		9899535805				9899535801	daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	HIPAA Privacy Officer	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	HIPAA Security Officer	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Interoperability Contact	Executive Director		Altom	Dayna		9899535800					daltom@pacecmi.org	1750 E Bellows St		Mount Pleasant	MI	48858	04/15/2022	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	MA Appeals/Grievances Contact	Quality Manager	Ms	Reeves	Brenda		9899535810					bkreeves@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	11/03/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	MA Claims Processing Contact for Public Website	Business Manager	Ms	LaVigne	Ashley		9899535828				9899535802	alavigne@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/22/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Marketing Contact	Community Liasion		Faber	Krista		9899535813				9899535801	kkfaber@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	02/16/2022	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Medical Director	Medical Director	Dr.	English	Shannon		9899535839					senglish@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	01/05/2023	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Medicare Compliance Officer	Quality Manager	Ms	Reeves	Brenda		9899535810				9899535802	bkreeves@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	01/12/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Medicare Coordinator	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	English	Shannon		9899535839				9899535802	senglish@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	01/05/2023	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Medication Therapy Management Contact	Medical Director	Dr.	English	Shannon		9899535839					senglish@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	01/05/2023	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Part C Application Contact	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Part D Appeals	Business Manager	Ms	LaVigne	Ashley						9899535802	alavigne@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/23/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active	9899535828				PACE - Nat		C	Chicago
H2882	Part D Appeals Contact (Secondary)	Executive Director	Ms	Altom	Dayna						9899535802	daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/23/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active	9899535805				PACE - Nat		C	Chicago
H2882	Part D Application Contact	Business Office Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 E Bellows		Mt. Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Part D Benefits Contact	Business Office Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 E Bellows		Mt. Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Part D Claims Submission Contact	Business Office Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 E Bellows		Mt. Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Part D Exceptions Contact	Business Office Manager	Ms	LaVigne	Ashley							alavigne@pacecmi.org	1750 E Bellows		Mt. Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active	9899535828				PACE - Nat		C	Chicago
H2882	Part D Exceptions Contact (Secondary)	Executive Director	Ms	Altom	Dayna							daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active	9899535805				PACE - Nat		C	Chicago
H2882	Part D Price File Contact (Back-up)	Business Office Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 E Bellows		Mt. Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Part D Price File Contact (Primary)	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Part D Quality Assurance Contact	Quality Manager	Ms	Reeves	Brenda		9899535810				9899535802	bkreeves@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/22/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Part D Reporting Contact	Business Office Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 E Bellows		Mt. Pleasant	MI	48858	08/16/2021	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Patient Safety Contact	Quality Manager	Ms	Reeves	Brenda		9899535810				9899535802	bkreeves@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/23/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Payment Contact	Business Office Manager	Mr	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Personal Health Record Contact	Center Manager	Ms	La	Alex		9899535822				9899535802	arla@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	02/16/2022	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Pharmacy Director	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Pharmacy Network Management Contact	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Pharmacy Network Management Contact (Secondary)	LaVigne	Ms	LaVigne	Ashley		9899535828				9899535802	alavigne@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/23/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Pharmacy Technical Help Desk Contact	Pharmacist	Mr	Le	Viet							viet@kltcpharmacy.com	1750 East Bellows Street		Mt Pleasant	MI	48858	12/23/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active	2695984000				PACE - Nat		C	Chicago
H2882	Plan Directory Contact for Public Website	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Plan to Plan Reconciliation Contact	Business Office Manager	Mr	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	08/20/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Processor Contact	Business Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/23/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Quality Contact	Quality Manager	Ms	Reeves	Brenda		9899535810					bkreeves@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	10/13/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Reconciliation Contact	Business Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/23/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Reconciliation Contact (Secondary)	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Recovery Audit Contact	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Surveillance Contact	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	System Contact	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Third Party Administrator (TPA) Liaison	Business Manager	Ms	LaVigne	Ashley		9899535828					alavigne@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	12/23/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	User Access Contact	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/10/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Utilization Management Contact	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/09/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2882	Utilization Review Contact	Executive Director	Ms	Altom	Dayna		9899535805					daltom@pacecmi.org	1750 East Bellows Street		Mt Pleasant	MI	48858	03/11/2020	2023	PACE CENTRAL MICHIGAN, INC.	National PACE	PACE Central Michigan	National PACE		PACE Central Michigan, Inc.	711	Yes	Active					PACE - Nat		C	Chicago
H2915	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/01/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H2915	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/15/2017	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/01/2017	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/01/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/01/2017	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Medical Director	Sr. VP, Medical Affairs	Dr.	Nelson	Vincent		3145056872					vincent.nelson@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/17/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road Tampa,FL 33634		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/01/2017	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H2915	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H2915	PHR Beneficiary Contact																	09/27/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8663309368				HMO - Health Maintenance Organization		C	Dallas
H2915	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Plan Directory Contact for Public Website			Services	Member		8557661452					CorporateMedicareComplianceDept@Centene.com	300 Corporate Center Drive		Camp Hill	PA	17011	03/31/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2915	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	PENNSYLVANIA HEALTH & WELLNESS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2923	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H2923	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H2923	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H2923	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H2923	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H2923	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H2923	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H2923	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2923	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF OREGON INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H2926	Agent/Broker Compensation Data Contact	Director of Membership & Program Development	Mr.	Magnuson	Matt		3203355243				3203355223	matt.magnuson@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Automated TrOOP Balance Transfer Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Backup User Access Contact	Director of IS&T / HIPAA Security Officer	Mr.	Hess	Jamie		3203355225				3207628750	jamie.hess@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Best Available Evidence Contact	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3203355223	becky.jirik@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	04/02/2018	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Bid Audit Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Bid Audit Site Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500,	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Bid Primary Contact	Managing Actuary	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500,	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	CAP Report Contact for Public Website	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3207628750	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Przybilla	James		3204913334				3207622912	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3207622912	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Chief Financial Officer	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500,	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Chief Operating Officer	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Chief Information Officer	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	3905 Dakota Street		Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Chief Information Security Officer	Director of IS&T/HIPAA Security Officer	Mr.	Hess	Jamie		3203355225				3207628750	jamie.hess@primewest.org	3905 Dakkota Street		Alexandria	MN	56308	05/03/2016	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	CMS Casework Communication Contact	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Complaints Tracking Contact	Director of Quality & UM	Ms.	Zimmerman	Robin		3203355213				8776004912	robin.zimmerman@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Contact for Fraud Investigations	Corporate Compliance/HIPAA Privacy Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/11/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Coordination of Benefits Contact	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3203355223	MedicareCOB@primewest.org	PrimeWest Health	3905 Dakota Street	Alexandria	MN	56309	04/12/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Corporate Mailing						3207634135				3207628750	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc	444 Cedar St, Suite 500	St Paul	MN	55101	12/08/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Customer Service Operations Contact	Director of Membership & Program Development	Mr.	Magnuson	Matt		3203355243				3203355223	matt.magnuson@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	DIR Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	DIR Contact (Secondary)	Consulting Actuary	Ms.	Stensland	Katherine		6513894592				6512289893	katherine.stensland@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Electronic Health Record Contact	Director of Business IT & Claims Administration	Mr.	Harris	Jeramie		3203355241				3207628750	jeramie.harris@primewest.org	3905 Dakota St		Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	8885884420				HMO - Health Maintenance Organization		C	Chicago
H2926	Emergency Part D Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Emergency Part D Contact (Secondary)	Pharmacy Manager	Ms.	Brand	Katie		3203355246				3207625945	katie.brand@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/27/2021	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Encounter Data & Risk Adjustment Operations Contact	Chief Financial Officer	Mr	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paum	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Enrollment Contact	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3203355223	becky.jirik@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/27/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	EOB Transfer Contact	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3207628750	becky.jirik@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/30/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Financial Audit Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health System	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Financial Reporting Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Formulary Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Formulary Contact (Secondary)	Manager, Formulary Administration & Maintenance	Ms.	Nyawabila	Christina		8587906297					FMT@MedImpact.com	MedImpact HealthCare Systems, Inc.	10181 Scripps Gateway Court	San Diego	CA	92131	12/13/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	General Contact	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Government Relations Contact	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3203355339	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	HIPAA Privacy Officer	Corporate Compliance/HIPAA Privacy Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/11/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	HIPAA Security Officer	Director of IS&T / HIPAA Security Officer	Mr.	Hess	Jamie		3203355225				3207628750	jamie.hess@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Hospice Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota Street	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Interoperability Contact	Director Business IT & Claims Adminstration	Mr	Harris	Jeramie		3203355241				3207628750	jeramie.harris@primewest.org	3905 Dakota St		Alexandria	MN	56308	10/27/2021	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	MA Appeals/Grievances Contact	Director of Quality & UM	Ms.	Zimmerman	Robin		3203355213				8776004912	robin.zimmerman@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	MA Claims Processing Contact for Public Website	Director Business IT & Claims Adminstration	Ms.	Harris	Jeramie		3203355241				3207628750	jeramie.harris@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/27/2021	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Marketing Contact	Managing Editor	Ms.	Sim	Elizabeth		3207634135				3207628750	elizabeth.sim@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/11/2020	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Medical Director	Chief Senior Medical Director	Dr.	Hegstad	Scott		3203355286				3207628750	scott.hegstad@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/06/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Medicare Compliance Officer	Corporate Compliance/HIPAA Privacy Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/11/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Medicare Coordinator	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3203355319	becky.jirik@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/24/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Medication Therapy Management Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Online Enrollment Center Contact (Primary)	Manager of Enrollment	Ms.	Jirik	Becky		3203355219				3203355319	becky.jirik@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/24/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Part C Application Contact	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3203355339	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Part C Reporting Contact	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Appeals	Appeals & Grievance Supervisor	Ms.	Creasman	Kachiri						8587906060	kachiri.creasman@medimpact.com	MedImact HealthCare Systems, Inc.	10181 Scripps Gateway CT	San Diego	CA	92131	12/13/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	8582915164				HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Appeals Contact (Secondary)	Appeals & Grievance Lead	Ms.	Lindberg	Laura						8587906060	Laura.Lindberg@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Court	San Diego	CA	92131	12/13/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	8582915528				HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Application Contact	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3203355339	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Benefits Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Claims Submission Contact	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota Street	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Exceptions Contact	Director of Pharmacy	Ms.	Ehlert	Ann						3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	3207594154				HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Exceptions Contact (Secondary)	Pharmacy Manager	Ms	Brand	Katie						3207625945	katie.brand@primewest.org	3905 Dakota St		Alexandria	MN	56308	10/27/2021	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	3203355246				HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Price File Contact (Back-up)	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota Street	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Price File Contact (Optional)	Pharmacy Manager	Ms	Brand	Katie		3203355246					katie.brand@primewest.org	3905 Dakota St		Alexandria	MN	56308	10/27/2021	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Price File Contact (Primary)	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55111	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Quality Assurance Contact	Director of Pharmacy Management	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Part D Reporting Contact	Chief Operating Officer	Ms.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Patient Safety Contact	Director of Pharmacy Management	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Payment Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Personal Health Record Contact	Corporate Compliance Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Pharmacy Director	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Pharmacy Network Management Contact	Dir Pharmacy Network Administration	Mr.	Hunt	Brian		8587907092					Brian.Hunt@MedImpact.com	MedImpact HealthCare Systems Inc.	10181 Scripps Gateway Court	San Diego	CA	92131	12/13/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy	Ms.	Ehlert	Ann		3207594154				3207625945	ann.ehlert@primewest.org	PrimeWest Health	3905  Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Pharmacy Technical Help Desk Contact	Director Customer Contact Services	Ms.	Brewer	Kathy							customerservice@medimpact.com	MedImpact HealthCare Systems, Inc.	10181 Scripps Gateway Court	San Diego	CA	92131	06/17/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	8773919294				HMO - Health Maintenance Organization		C	Chicago
H2926	Pharmacy Technical Help Desk Contact (Secondary)	Director of Pharmacy	Ms.	Ehlert	Ann						3207625945	ann.ehlert@primewest.org	3905 Dakota St	3905 Dakota St	Alexandria	MN	56308	09/15/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	3207594154				HMO - Health Maintenance Organization		C	Chicago
H2926	PHR Beneficiary Contact																	11/10/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS	PrimeWest Health	PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active	8776004913				HMO - Health Maintenance Organization		C	Chicago
H2926	Physician Incentive Contact	Corporate Compliance Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/07/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Plan Directory Contact for Public Website			Contact Center	Provider		8664310802					providercontactcenter@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	12/24/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Processor Contact	Director Business IT & Claims Adminstration	Mr	Harris	Jeramie		3203355241				3207628750	jeramie.harris@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/27/2021	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Quality Contact	Director of Quality & UM	Ms.	Zimmerman	Robin		3203355213				3207628750	robin.zimmerman@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Reconciliation Contact	Consulting Acturary	Ms.	Stensland	Katherine		6512289891				6512289893	katherine.stensland@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	03/31/2020	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Reconciliation Contact (Secondary)	Consulting Actuary	Ms.	Stensland	Katherine		6513894592				6512289893	katherine.stensland@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	St. Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Recovery Audit Contact	Corporate Compliance/HIPAA Privacy Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/11/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	SNP Application Contact	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3207622912	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	SNP State Contact	Chief Executive Officer	Mr.	Przybilla	James		3203355250				3207622912	jim.przybilla@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/23/2015	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Surveillance Contact	Corporate Compliance/HIPAA Privacy Officer	Ms.	Adams	Sandra		3203355399				3207625937	sandra.adams@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	10/11/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	System Contact	Chief Operating Officer	Mrs.	Krafthefer	Bethany		3203355392				3207628750	bethany.krafthefer@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	03/06/2023	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mr.	Tava	Alex		6513894570				6512289893	alex.tava@cirdanhealth.com	Cirdan Health Systems, Inc.	444 Cedar Street, Suite 500	Saint Paul	MN	55101	10/24/2019	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	User Access Contact	Director of IS&T	Mr.	Hess	Jamie		3203355225				3207628750	jamie.hess@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Utilization Management Contact	Director of Quality & UM	Ms.	Zimmerman	Robin		3203355213				3207628750	robin.zimmerman@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2926	Utilization Review Contact	Director of Quality & UM	Ms.	Zimmerman	Robin		3203355213				3207628750	robin.zimmerman@primewest.org	PrimeWest Health	3905 Dakota St	Alexandria	MN	56308	09/30/2022	2023	PRIMEWEST RURAL MN HEALTH CARE ACCESS INITIATIVE	Local CCP	PrimeWest Health	HMO/HMOPOS		PrimeWest Rural MN Health Care Access Initiative	189	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H2936	Automated TrOOP Balance Transfer Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Backup User Access Contact	Executive Director	Ms.	Gras	Heidi		6165823111				2313328600	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Best Available Evidence Contact	Executive Director	Ms.	Gras	Heidi		6165823111				2313328600	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Bid Primary Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	CAP Report Contact for Public Website	Quality Improvement Manager	Ms.	Pena	Eva		2312918709				2313328600	epena@lifecircles-pace.org	560 Seminole Rd		Muskegon	MI	49444	07/16/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	CEO - CMS Administrator Contact	Executive Director	Ms.	Gras	Heidi		6165823111				2313328600	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	CEO - Senior Official for Contracting	Executive Director	Ms.	Gras	Heidi		6165823111				2313328600	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Chief Financial Officer	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Chief Operating Officer	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James St		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Chief Information Officer	Program Integrity Manager	Ms.	Whitney	Erin		6164836825				6165823149	ewhitney@lifecircles-pace.org	12330 James Street		Holland	MI	49424	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Chief Information Security Officer	Program Integrity Manager	Ms.	Whitney	Erin		6164836825				6165823149	ewhitney@lifecircles-pace.org	12330 James Street		Holland	MI	49424	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	CMS Casework Communication Contact	Executive Director	Ms.	Gras	Heidi		6165823111				2317338683	hgras@lifecircles-pace.org	560 Seminole Rd		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Complaints Tracking Contact	Quality Improvement Manager	Ms.	Pena	Eva		2312918709				2313328600	epena@lifecircles-pace.org	560 Seminole Rd		Muskegon	MI	49444	07/16/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Contact for Fraud Investigations	Program Integrity Manager	Ms.	Whitney	Erin		6164836825					ewhitney@lifecircles-pace.org	12330 James St.		Holland	MI	49424	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Coordination of Benefits Contact	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Corporate Mailing						6165823111				6165823149	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Customer Service Operations Contact	Executive Director	Ms.	Gras	Heidi		6165823111				2313328600	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	DIR Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Emergency Part D Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Encounter Data & Risk Adjustment Operations Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Road		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Enrollment Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	EOB Transfer Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Financial Audit Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Financial Reporting Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Formulary Contact	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	General Contact	Executive Director	Ms.	Gras	Heidi		6165823111				2313328600	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Government Relations Contact	Executive Director	Ms.	Gras	Heidi		6165823111				2313328600	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	HIPAA Privacy Officer	Quality Improvement Manager	Ms.	Pena	Eva		2312918709				2313328600	epena@lifecircles-pace.org	560 Seminole Rd		Muskegon	MI	49444	07/16/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	HIPAA Security Officer	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	03/02/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Interoperability Contact	Executive Director	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	560 Seminole Road		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	MA Appeals/Grievances Contact	Quality Improvement Manager	Ms.	Pena	Eva		2312918709				2313328600	epena@lifecircles-pace.org	560 Seminole Rd		Muskegon	MI	49444	07/16/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	MA Claims Processing Contact for Public Website	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Marketing Contact	Marketing & Enrollment Manager	Ms.	Milanowski	Sarah		6165823114					smilanowski@lifecircles-pace.org	12330 James St.		Holland	MI	49424	07/16/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Medical Director	Medical Director	Dr.	Boettcher	Iris		2317338682				2313328600	iboettcher@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/25/2016	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Medicare Compliance Officer	Program Integrity Manager	Ms.	Whitney	Erin		6164836825				2313328600	ewhitney@lifecircles-pace.org	12330 James St.		Holland	MI	49424	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Medicare Coordinator	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	03/02/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Medicare Part D Opioid Overutilization Contact	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Medication Therapy Management Contact	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Part C Application Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Part D Appeals	Program Integrity Manager	Ms.	Whitney	Erin						6165823149	ewhitney@lifecircles-pace.org	12330 James St.		Holland	MI	49424	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active	2317338650				PACE - Nat		C	Chicago
H2936	Part D Application Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Part D Benefits Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Part D Claims Submission Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Part D Exceptions Contact	Finance Manager	Ms.	Murar	Ann						6169497886	amurar@lifecircles-pace.org	560 Seminole Rd		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active	2317338650				PACE - Nat		C	Chicago
H2936	Part D Price File Contact (Back-up)	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Part D Price File Contact (Primary)			Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Part D Quality Assurance Contact			Gras	Heidi		6165823111					hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Part D Reporting Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Patient Safety Contact	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111					hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	03/02/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Payment Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Pharmacy Director	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Pharmacy Network Management Contact			Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Pharmacy Technical Help Desk Contact			Gras	Heidi						6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active	6165823111				PACE - Nat		C	Chicago
H2936	Plan Directory Contact for Public Website			Gras	Heidi		6165823111					hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Plan to Plan Reconciliation Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Processor Contact	Executive Director	Ms.	Gras	Heidi		6165823111				2313328600	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Quality Contact	Quality Improvement Manager	Ms.	Pena	Eva		2312918709				2313328600	epena@lifecircles-pace.org	560 Seminole Rd		Muskegon	MI	49444	07/16/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Reconciliation Contact	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Recovery Audit Contact	Executive Director	Ms.	Gras	Heidi		6165823111				2313328600	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Surveillance Contact	Executive Director	Ms.	Gras	Heidi		6165823111				2313328600	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	System Contact	Executive Director	Ms.	Gras	Heidi		6165823111				2313328600	hgras@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	12/28/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Third Party Administrator (TPA) Liaison	Finance Manager	Ms.	Murar	Ann		6163786469				6169497886	amurar@lifecircles-pace.org	560 Seminole Rd.		Muskegon	MI	49444	04/15/2022	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	User Access Contact	Clinical Data Analyst	Ms.	Blake	Nikki		6165823133				6165823149	nblake@lifecircles-pace.org	12330 James St		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Utilization Management Contact	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2936	Utilization Review Contact	Strategic Director Health Plan Operations	Ms.	Gras	Heidi		6165823111				6165823149	hgras@lifecircles-pace.org	12330 James Street		Holland	MI	49424	01/08/2021	2023	LIFECIRCLES	National PACE	LIFECIRCLES	National PACE		LifeCircles	373	Yes	Active					PACE - Nat		C	Chicago
H2937	Automated TrOOP Balance Transfer Contact	NA	Mr.	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Backup User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Best Available Evidence Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Bid Primary Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	CAP Report Contact for Public Website	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Chief Financial Officer	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Chief Operating Officer	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Chief Information Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Chief Information Security Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	CMS Casework Communication Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Complaints Tracking Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Contact for Fraud Investigations	Executive Director	Ms	Moreth	Carla		8145356000	22139			8142487902	CMORETH@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Coordination of Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Corporate Mailing						8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Coverage Gap Discount Program (CGDP) Payment Contact			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Customer Service Operations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	DIR Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Emergency Part D Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Encounter Data & Risk Adjustment Operations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	10/18/2019	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Enrollment Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	EOB Transfer Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Financial Audit Contact	CFO	Mr	Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Financial Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Formulary Contact			N/A	N/A		1234567890	123				N/A@n/a.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	General Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Government Relations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	HIPAA Privacy Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	HIPAA Security Officer	IT Director		Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Interoperability Contact	Chief Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	MIrwin@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	02/16/2022	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	MA Appeals/Grievances Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Marketing Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Medical Director	Medical Director		Abalos	Joseph		7248388300					Jabalos@physiciansolutionsgrp.com	123 Triangle Drive		Greensburg	PA	15601	04/18/2023	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Medicare Compliance Officer	Executive Director	Ms	Guty	Genene		7248388300					GGuty@seniorlifegreensburg.com	123 Triangle Drive		Greensburg	PA	15601	10/08/2019	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Medicare Coordinator	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Medicare Part D Opioid Overutilization Contact	Medical Director		Abalos	Joseph		7248388300					Jabalos@physiciansolutionsgrp.com	123 Triangle Drive		Greensburg	PA	15601	04/18/2023	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Medication Therapy Management Contact	Chief Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	03/13/2019	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Part C Application Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Part D Appeals	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H2937	Part D Appeals Contact (Secondary)	Chief Executive Officer	Mr.	Irwin	Mark						8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	12/29/2020	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active	8145356000	22101			PACE - Nat		C	Philadelphia
H2937	Part D Application Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Part D Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Part D Claims Submission Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Part D Exceptions Contact	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H2937	Part D Price File Contact (Back-up)			N/A	N/A		1234567890	123				N/A@N/A.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Part D Price File Contact (Primary)			N/A	N/A		1234567890	123				N/A@N/A.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Part D Quality Assurance Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Part D Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Patient Safety Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Payment Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Pharmacy Director			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Pharmacy Network Management Contact			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Pharmacy Technical Help Desk Contact			Rowland	Bob							Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active	7242751203	219			PACE - Nat		C	Philadelphia
H2937	Plan Directory Contact for Public Website	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Processor Contact	Claims Manager		Best	Karen		8145356000	22104			8142487902	KBest@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Quality Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Reconciliation Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Recovery Audit Contact	CFO	Mr	Dodson	David	M	8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Surveillance Contact			Irwin	Mark		8145356000	22101				Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	System Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Third Party Administrator (TPA) Liaison			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Utilization Management Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2937	Utilization Review Contact	ChieExecutive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE GREENSBURG, INC.	National PACE	Senior LIFE Greensburg	National PACE		Senior LIFE Greensburg, Inc.	543	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Automated TrOOP Balance Transfer Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Backup User Access Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Best Available Evidence Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Bid Primary Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	CAP Report Contact for Public Website	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	CEO - CMS Administrator Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	CEO - Senior Official for Contracting	VP, Chief Nurse Executive - SE	Mrs.	Bradley	Kim		7575533105				7573824957	ksbradle@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/26/2021	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Chief Financial Officer	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Chief Operating Officer	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Chief Information Officer	Quality Improvement, Team Lead	Mrs.	Krenisky	Paige		7573922661				7573824957	pnkreni1@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Chief Information Security Officer	Quality Improvement, Team Lead	Mrs.	Krenisky	Paige		7573922661				7573824957	pnkreni1@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	CMS Casework Communication Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Complaints Tracking Contact	Quality Improvement, Team Lead	Mrs.	Krenisky	Paige		7573922661				7573824957	pnkreni1@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Contact for Fraud Investigations	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Coordination of Benefits Contact	Business Office Specialist	Mrs.	Earl	Adrian		7575533423				7573824957	atpace@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Corporate Mailing						7575533105				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/26/2021	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Customer Service Operations Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	DIR Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Emergency Part D Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Encounter Data & Risk Adjustment Operations Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Enrollment Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	EOB Transfer Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533105				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/26/2021	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Financial Audit Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Financial Reporting Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Formulary Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	General Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Government Relations Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	HIPAA Privacy Officer	Quality Improvement, Team Lead	Mrs.	Krenisky	Paige		7573922661				7573824957	pnkreni1@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	HIPAA Security Officer	Quality Improvement, Team Lead	Mrs.	Krenisky	Paige		7573922661				7573824957	pnkreni1@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Interoperability Contact			Ford	Merinda	B	7575533410					mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23323	01/28/2022	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	MA Appeals/Grievances Contact	Quality Improvement, Team Lead	Mrs.	Krenisky	Paige		7573922661				7573824957	pnkreni1@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	MA Claims Processing Contact for Public Website	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Marketing Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Medical Director	Medical Director		Robichaud	Kate		7572527810				7573824957	mrrobich@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Medicare Compliance Officer	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Medicare Coordinator	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Medicare Part D Opioid Overutilization Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Medication Therapy Management Contact	Medical Director		Robichaud	Kate		7572527810				7573824957	mrrobich@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Part C Application Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Part D Appeals	Program Director	Mrs.	Ford	Merinda						7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/26/2021	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active	7575533105				PACE - Nat		C	Philadelphia
H2941	Part D Application Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Part D Benefits Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Part D Claims Submission Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Part D Exceptions Contact	Finance Manager	Mrs.	Brennaman	Courtney						7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/26/2021	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active	7575533105				PACE - Nat		C	Philadelphia
H2941	Part D Price File Contact (Back-up)	Finance Manager	Mrs.	Brennaman	Courtney		7575533105				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/26/2021	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Part D Price File Contact (Primary)	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Part D Quality Assurance Contact	Quality Improvement, Team Lead	Mrs.	Krenisky	Paige		7573922661				7573824957	pnkreni1@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Part D Reporting Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Patient Safety Contact	Quality Improvement, Team Lead	Mrs.	Krenisky	Paige		7573922661				7573824957	pnkreni1@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Payment Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Pharmacy Director	Manager, Pharmacy		Lee	Doug		7573880347				7573884018	dhlee@sentara.com	600 Gresham Drive		Norfolk	VA	23507	05/26/2021	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Pharmacy Network Management Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Pharmacy Technical Help Desk Contact	Manager, Pharmacy		Lee	Doug						7573884018	dhlee@sentara.com	600 Gresham Drive		Norfolk	VA	23507	05/26/2021	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active	7573880347				PACE - Nat		C	Philadelphia
H2941	Plan Directory Contact for Public Website	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Plan to Plan Reconciliation Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Processor Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Quality Contact	Quality Improvement, Team Lead	Mrs.	Krenisky	Paige		7573922661				7573824957	pnkreni1@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Reconciliation Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Recovery Audit Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Surveillance Contact	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	System Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Third Party Administrator (TPA) Liaison	Finance Manager	Mrs.	Brennaman	Courtney		7575533171				7573824957	crbrenna@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	User Access Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Utilization Management Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2941	Utilization Review Contact	Program Director	Mrs.	Ford	Merinda		7575533410				7573824957	mbford2@sentara.com	535 Independence Parkway	Suite 100	Chesapeake	VA	23320	05/25/2023	2023	SENTARA LIFE CARE CORPORATION, INC	National PACE	Sentara PACE	National PACE		Sentara Health Care (SHC)	345	Yes	Active					PACE - Nat		C	Philadelphia
H2942	Agent/Broker Compensation Data Contact	VP of Sales		Stead	Bart		4172692843				4172692949	bstead@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Automated TrOOP Balance Transfer Contact	VP of Health Services		O'Connell	Daniel		4172692966				4172692919	doconnell@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Backup User Access Contact	CIO		Butts	Susan		4172692968				4172692949	sbutts@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Best Available Evidence Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Bid Audit Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Bid Primary Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	CAP Report Contact for Public Website	Director of Govt Programs		Hammond	Kaitlyn		4172692827				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	CEO - CMS Administrator Contact	CEO/President	Mr.	Aug	Matthew		4172692936					maug@coxhealthplans.com	PO Box 5750		Sprinfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	CEO - Senior Official for Contracting	CEO/President	Mr.	Aug	Matthew		4172692936					maug@coxhealthplans.com	PO Box 5750		Sprinfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Chief Financial Officer	CEO/President	Mr.	Aug	Matthew		4172692936					maug@coxhealthplans.com	PO Box 5750		Sprinfield	MO	65801	06/12/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Chief Operating Officer	CEO/President	Mr.	Aug	Matthew		4172692936					maug@coxhealthplans.com	PO Box 5750		Sprinfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Chief Information Officer	CIO	Ms.	Butts	Susan		4172692968				4172692949	sbutts@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Chief Information Security Officer	CIO	Ms.	Butts	Susan		4172692968				4172692949	sbutts@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	CMS Casework Communication Contact	Grievance and Subrogation Coordinator		Mathis	Earlisha		4172692905				4172692949	emathis@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	12/15/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Complaints Tracking Contact	Grievance and Subrogation Coordinator		Mathis	Earlisha		4172692905				4172692949	emathis@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	12/15/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Contact for Fraud Investigations	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Coordination of Benefits Contact	Director of Member and Provider Services		Hopkins	Sandy		4172692920				4172692949	shopkins@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Corporate Mailing						4172692827					khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Coverage Gap Discount Program (CGDP) Payment Contact	Risk Adjustment Manager	Ms.	Thompson	Jo	A	4172694969					jthompson@coxhealthplans.com	PO Box 5750		Springfield	MO	658015750	11/17/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Customer Service Operations Contact	Director of Member and Provider Services		Hopkins	Sandy		4172692920					shopkins@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	DIR Contact	Financial Analyst		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Ave NW		North Canton	OH	44720	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	DIR Contact (Secondary)	Sr Financial Manager Reporting & Analytics		Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Ave NW		North Canton	OH	44720	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Emergency Part D Contact	VP of Health Services		O'Connell	Daniel		4172692966					doconnell@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Emergency Part D Contact (Secondary)	Pharmacy Technician		Faungo	Bianca		4173706191					bfaugno@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Manager	Ms.	Thompson	Jo	A	4172694969					jthompson@coxhealthplans.com	PO Box 5750		Springfield	MO	658015750	01/20/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Enrollment Contact	Director of Member and Provider Services		Hopkins	Sandy		4172692920				4172692949	shopkins@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	EOB Transfer Contact	CIO		Butts	Susan		4172692968				4172692949	sbutts@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Financial Audit Contact	Risk Adjustment Manager	Ms.	Thompson	Jo Anne		4172694969					jthompson@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	06/12/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Financial Reporting Contact	Risk Adjustment Manager	Ms.	Thompson	Jo Anne		4172694969					jthompson@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	06/12/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Formulary Contact	Formulary Operations Clinical Pharmacist		Shaw	Andrea		4405038080					anshaw@elixirsolutions.com	7835 Freedom Ave NW		North Canton	OH	44720	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Formulary Contact (Secondary)	Director Clinical Audits		Rossi	David		3304866311					drossi@coxhealthplans.com	7835 Freedom Ave NW		North Canton	OH	44720	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	General Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Government Relations Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	HIPAA Privacy Officer	CIO		Butts	Susan		4172692968				4172692949	sbutts@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	HIPAA Security Officer	CIO		Butts	Susan		4172692968				4172692949	sbutts@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Hospice Contact	VP of Health Services		O'Connell	Daniel		4172692966					doconnell@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Interoperability Contact	CIO		Butts	Susan		4172692968				4172692949	sbutts@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	MA Appeals/Grievances Contact	Grievance and Subrogation Coordinator		Mathis	Earlisha		4172692905				4172692949	emathis@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	06/12/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	MA Claims Processing Contact for Public Website	Director of Member and Provider Services		Hopkins	Sandy		4172692920				4172692949	shopkins@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Marketing Contact	VP of Sales		Stead	Bart		4172692843				4172692949	bstead@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Medical Director	Medical Director	Dr.	Flax	Julia		4172691362					Julia.Flax@coxhealth.com	PO Box 5750		Springfield	MO	65801	01/20/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Medicare Compliance Officer	Director of Govt Programs	Mrs.	Hammond	Kaitlyn		4172692827					khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Medicare Coordinator	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Medicare Part D Opioid Overutilization Contact	VP of Health Services		O'Connell	Daniel		4172692966					doconnell@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	02/10/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Medication Therapy Management Contact	Director of Clinical Programs		Poore	Richard		6036285133					rpoore@healthdialog.com	7835 Freedom Ave NW		North Canton	OH	44720	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Online Enrollment Center Contact (Primary)	CIO		Butts	Susan		4172692968				4172692949	sbutts@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Part C Application Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Part C Reporting Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Part D Appeals	Grievance and Subrogation Coordinator		Mathis	Earlisha							emathis@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active	8557523796				HMO - Health Maintenance Organization		C	Kansas City
H2942	Part D Appeals Contact (Secondary)	Supervisor Clinical Operations		Herald	Samantha							appeals@elixirsolutions.com	7835 Freedom Ave NW		North Canton	OH	44720	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active	3303449574	0409			HMO - Health Maintenance Organization		C	Kansas City
H2942	Part D Application Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Part D Benefits Contact	VP of Health Services		O'Connell	Daniel		4172692966					doconnell@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Part D Claims Submission Contact	Sr. Account Manager		Meyocks	Kristen		9547672690					kmeyocks@elixirsolutions.com	7835 Freedom Ave NW		North Canton	OH	44720	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Part D Exceptions Contact			O'Connell	Daniel							doconnell@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	02/10/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active	8006641244				HMO - Health Maintenance Organization		C	Kansas City
H2942	Part D Price File Contact (Back-up)	Government Programs Finance Analyst		Wentz	Chris		9547672633					cwentz@elixirsolutions.com	7835 Freedom Ave NW		North Canton	OH	44720	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Part D Price File Contact (Primary)	Sr Financial Manager Reporting & Analytics		Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Ave NW		North Canton	OH	44720	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Part D Quality Assurance Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Part D Reporting Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Patient Safety Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Payment Contact	Risk Adjustment Manager	Ms.	Thompson	Jo Anne		4172694969					jthompson@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	06/12/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Pharmacy Director	VP of Health Services		O'Connell	Daniel		4172692966					doconnell@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Pharmacy Network Management Contact	Director Pharmacy Network Devlment and Operations		Profio	Lauren		3304864864					lprofio@elixirsolutions.com	7835 Freedom Ave NW		North Canton	OH	44720	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Pharmacy Technical Help Desk Contact	VP Operations		Conn	Todd							tconn@elixirsolutions.com	7835 Freedom Ave NW		North Canton	OH	44720	05/23/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active	8554765985				HMO - Health Maintenance Organization		C	Kansas City
H2942	Plan Directory Contact for Public Website	Director of Member and Provider Services		Hopkins	Sandy		4172692920					shopkins@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Plan to Plan Reconciliation Contact	Risk Adjustment Manager	Ms.	Thompson	Jo Anne		4172694969					jthompson@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	06/12/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Processor Contact	CIO		Butts	Susan		4172692968				4172692949	sbutts@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Quality Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Reconciliation Contact	Risk Adjustment Manager	Ms.	Thompson	Jo Anne		4172694969					jthompson@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	06/12/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Reconciliation Contact (Secondary)	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	06/12/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Recovery Audit Contact	Risk Adjustment Manager	Ms.	Thompson	Jo Anne		4172694969					jthompson@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	06/12/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Surveillance Contact	CIO		Butts	Susan		4172692968				4172692949	sbutts@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	System Contact	CIO		Butts	Susan		4172692968				4172692949	sbutts@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Third Party Administrator (TPA) Liaison	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	06/12/2023	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	User Access Contact	Director of Govt Programs		Hammond	Kaitlyn		4172692728				4172692919	khammond@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Utilization Management Contact	VP of Health Services		O'Connell	Daniel		4172692966					doconnell@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2942	Utilization Review Contact	VP of Health Services		O'Connell	Daniel		4172692966					doconnell@coxhealthplans.com	PO Box 5750		Springfield	MO	65801	01/20/2022	2023	COX HEALTH SYSTEMS HMO INC	Local CCP	Cox HealthPlans	HMO/HMOPOS		CoxHealth	793	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H2944	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	5025809138				PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	5025807929				PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	5025809138				PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	5024682494				PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	PFFS Terms and Conditions of Payment Contact for Public Website			Hunt	Stephanie		5024766060					InquiriesForPFFS@humana.com	PO Box 14601		Lexington	KY	40512	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	8008658715				PFFS - Private Fee for Service		C	Kansas City
H2944	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	5025800475				PFFS - Private Fee for Service		C	Kansas City
H2944	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2944	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H2960	Agent/Broker Compensation Data Contact	Senior Director of Government Programs	Mr	Bawden	CJ		7759823218				7759823743	cj.bawden@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Zlotkus	Steve		8587906250					partdcat@medimpact.com	MedImpact	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/31/2019	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Backup User Access Contact	Compliance Analyst	Ms	Breckner	Michelle		7759823123					michelle.breckner@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Best Available Evidence Contact	Manager of Revenue_Enrollment Servics	Ms	Foote	Tammi		7759823186					Tammi.Foote@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Bid Audit Contact	Compliance Manager	Ms	Linzey	Lenee		7759823216					lenee.linzey@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Bid Audit Site Contact	Product Development Coordinator	Ms	Eddy	Tabatha		7759823721				7759823743	tabatha.eddy@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Bid Primary Contact	Product Development Coordinator	Ms	Eddy	Tabatha		7759823721				7759823743	tabatha.eddy@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	CAP Report Contact for Public Website	Senior Director of Government Programs	Mr	Bawden	CJ		7759823218				7759823743	cj.bawden@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Sexton	Bethany	J	7759824640					Bethany.Sexton@renown.org	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Sexton	Bethany	J	7759824640					Bethany.Sexton@renown.org	10315 Professional Circle		Reno	NV	89521	10/04/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Chief Financial Officer	Chief Financial Officer_Homtown Health	Ms.	Winter	Rebekah		7759825309					Rebekah.Winter@renown.org	10315 Professional Circle		Reno	NV	89521	02/21/2023	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Chief Operating Officer	Chief Executive Officer	Ms.	Sexton	Bethany		7759824640					Bethany.Sexton@renown.org	10315 Professional Circle		Reno	NV	89521	09/13/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Chief Information Officer	Chief Information Officer	Mr.	Podesta	Chuck		7759824328					chuck.podesta@renown.org	50 Liberty Street		Reno	NV	89501	01/05/2023	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Chief Information Security Officer	Chief Information Security Officer, IT General	Mr.	Ramirez	Steven		7759825000					Steven.Ramirez@renown.org	1000 Ryland St	Ste 204	Reno	NV	89502	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	CMS Casework Communication Contact	Compliance Manger	Ms	Linzey	Lenee		7759823025					Lenee.Linzey@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Complaints Tracking Contact	Manager of Appeals and Grievance	Ms	Eastman	Devany		7759823115					Devany.Eastman@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Contact for Fraud Investigations	Compliance Manager	Ms	Linzey	Lenee		7759823025					Lenee.Linzey@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Coordination of Benefits Contact	COB_Subrogation Specialist Services	Ms	Wold	Patricia		7759823225					Patricia.Wold@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Corporate Mailing						7759823223				7759823743	CJ.Bawden@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	03/05/2020	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant-HTH	Mr	Goodloe	Ricky		7759826052					Ricky.Goodloe@renown.org	1000 Ryland	Ste 301	Reno	NV	89502	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Customer Service Operations Contact	Manager of Contact Center	Ms	Garcia	Nallely		7759822661				7759823748	nallely.garcia@renown.org	10315 Professional Circle		Reno	NV	89502	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	DIR Contact	Financial Reporting Analyst	Mr	Plain	Adam		7759826275				7759826275	Adam.Plain@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	DIR Contact (Secondary)	Director of Finance	Ms	Ramelli	Mary		7759823190					Mary.Ramelli@renown.org	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Emergency Part D Contact	Director of Pharmacy	Ms	Gouchenour	Christie		7752335750				7759823745	christie.gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	12/27/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Emergency Part D Contact (Secondary)	Senior Director of Government Programs	Mr	Bawden	CJ		7756901700				7759823743	CJ.Bawden@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	12/27/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Employer Waiver Contact	Product Development Coordinator	Ms	Eddy	Tabatha		7759823721				7759823743	tabatha.eddy@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Encounter Data & Risk Adjustment Operations Contact	Manager of Risk Adjustment	Ms	Paquette	Erika		7759824402					Erika.Paquette@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Enrollment Contact	Manager of Revenue_Enrollment Services	Ms	Foote	Tammi		7759823186					Tammi.Foote@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	EOB Transfer Contact	Director of Pharmacy	Ms	Gouchenour	Christie		7759823085				7759823745	christie.gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Financial Audit Contact	Compliance Analyst	Ms	Breckner	Michelle		7759823123					Michelle.Breckner@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Financial Reporting Contact	Director of Finance_Hometown Health	Ms.	Ramelli	Mary		7759823190					Mary.Ramelli@renown.org	10315 Professional Circle		Reno	NV	89521	01/05/2023	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Formulary Contact	Director of Pharmacy		Gouchenour	Christie		7759823085				7759823745	christie.gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Formulary Contact (Secondary)	VP Formulary Services		Nguyen	Kaitlin		8587906367					fmt@medimpact.com	MedImpact	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/11/2019	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	General Contact	Senior Director of Government Programs	Mr	Bawden	CJ		7759823218					CJ.bawden@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Government Relations Contact	Senior Director of Government Programs	Mr	Bawden	CJ		7759823218				7759823743	CJ.bawden@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	HIPAA Privacy Officer	Director of Compliance	Mr	Colonna	Brian		7759826487					Brian.Colonna@renown.org	1000 Ryland		Reno	NV	89502	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	HIPAA Security Officer	Director of Compliance	Mr	Colonna	Brian		7759826487					Brian.Colonna@renown.org	1000 Ryland		Reno	NV	89502	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Hospice Contact	Director of Pharmacy	Ms	Gouchenour	Christie		7759823085					christie.gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Interoperability Contact	Director of Reimbursement Services	Mr	Hutchcraft	Christian		7759823145					Christian.Hutchcraft@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	MA Appeals/Grievances Contact	Manager of Appeals and Grievance	Ms	Eastman	Devany		7759823115					Devany.Eastman@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	MA Claims Processing Contact for Public Website	Director of Reimbursement Services	Mr	Hutchcraft	Christian		7759823145					Christian.Hutchcraft@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Marketing Contact	Product Development Coordinator	Ms	Eddy	Tabatha		7759823721				7759823743	tabatha.eddy@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Medical Director	Chief Medical Officer	Dr.	Beenfeldt	Derek		7759826280					Derek.Beenfeldt@renown.org	10315 Professional Circle		Reno	NV	89521	01/27/2021	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Medicare Compliance Officer	Compliance Manager	Ms	Linzey	Lenee		7759823025					Lenee.Linzey@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	09/24/2020	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Medicare Coordinator	Compliance Analyst	Ms	Breckner	Michelle	A	7759823123					Michelle.Breckner@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Ms	Gouchenour	Christie		7759823085				7759823745	Christie.Gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Medication Therapy Management Contact	Director of Pharmacy	Ms	Gouchenour	Christie		7759823085				7759823745	christie.gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	OffShore Subcontractor Contact	Compliance Manager	Ms	Linzey	Lenee		7759823025					lenee.linzey@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Online Enrollment Center Contact (Back-up)	Supervisor of Revenue and Enrollment Revenue	Ms	Edwall	Pat		7759823181					Pat.Edwall@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Online Enrollment Center Contact (Optional)	Enrollment Assistant	Ms	Krager	Annette		7759823162					Annette.Krager@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Online Enrollment Center Contact (Primary)	Supervisor of Revenue & Enrollment	Ms	Edwall	Pat		7759823181				7759823749	pat.edwall@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Part C Application Contact	Product Development Coordinator	Ms	Eddy	Tabatha		7759823721				7759823743	tabatha.eddy@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Part C Reporting Contact	Operations & Capability Program Manager	Ms	Low	Gabby		7759825000					Gabby.Low@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Appeals	Director of Pharmacy	Ms	Gouchenour	Christie						7759823745	christie.gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active	7759823085				HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Appeals Contact (Secondary)	Managed Care Pharmacy Manager	Ms	Giel	Amber						7759823745	Amber.Giel@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	02/21/2023	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active	7759823354				HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Application Contact	Product Development Coordinator	Ms	Eddy	Tabatha		7759823721				7759823743	tabatha.eddy@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Benefits Contact	Product Development Coordinator	Ms	Eddy	Tabatha		7759823721				7759823743	tabatha.eddy@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Claims Submission Contact	Director, Medicare Programs	Mrs.	Scherlippens	Carine		8587907415					Carine.Scherlippens@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/03/2014	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Exceptions Contact	Director of Pharmacy	Ms	Gouchenour	Christie							christie.gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active	7759823085				HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Exceptions Contact (Secondary)	Managed Care Pharmacy Manager	Ms	Giel	Amber						7759823745	Amber.Giel@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	02/21/2023	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active	7759823354				HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Price File Contact (Back-up)	Director of Pharmacy	Ms	Gouchenour	Christie		7759823085					christie.gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Price File Contact (Optional)	Product Development Coordinator	Ms	Eddy	Tabatha		7759823721				7759823743	tabatha.eddy@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Price File Contact (Primary)	Medicare Programs		Niemi	Kirstin		8587906455					planfindercommunications@medimpact.com	MedImpact	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/11/2019	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Quality Assurance Contact	Director of Pharmacy	Ms	Gouchenour	Christie		7759823085				7759823745	christie.gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Part D Reporting Contact	Operations & Capability Program Manager	Ms	Low	Gabby		7759825000					Gabby.Low@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Patient Safety Contact	Director of Pharmacy	Ms	Gouchenour	Christie		7759823085				7759823745	christie.gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Payment Contact	Director of Finance_Hometown Health	Ms.	Ramelli	Mary		7759823190					Mary.Ramelli@renown.org	10315 Professional Circle		Reno	NV	89521	01/05/2023	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Pharmacy Director	Director of Pharmacy	Ms	Gouchenour	Christie		7759823085				7759823745	christie.gouchenour@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Pharmacy Network Management Contact	Manager, Pharmacy Network Support & Drug Data Mgt		Robertson	Jeanine		8587906108					jeanine.robertson@medimpact.com	MedImpact	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/11/2019	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Pharmacy Network Management Contact (Secondary)	Sr. Account Executive		Tong	Glen		8587906471				8587806349	Corey.Tracy@medimpact.com	MedImpact	10181 Scripps Blvd	San Diego	CA	92131	12/31/2019	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Pharmacy Technical Help Desk Contact	Director, Corporate Development		Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/17/2020	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active	8006819585				HMO - Health Maintenance Organization		C	Dallas
H2960	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacist		McKinley	Brian							brian.mckinley@medimpact.com	MedImpact Health Care Systems, Inc	10181 Scripps Blvd	San Diego	CA	92131	12/11/2019	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active	8582011302				HMO - Health Maintenance Organization		C	Dallas
H2960	PHR Beneficiary Contact																	04/10/2018	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS	Hometown Health (Senior Care Plus)	Renown Health	256	Yes	Active	8887757003				HMO - Health Maintenance Organization		C	Dallas
H2960	Physician Incentive Contact	Director of Quality	Ms	Gonsalves	Savannah		7759823056					Savannah.Gonsalves@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Plan Directory Contact for Public Website	Senior Director of Government Programs	Mr.	Bawden	CJ		7759823218				7759823743	cj.bawden@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Plan to Plan Reconciliation Contact	Senior Financial Analyst	Mr	Wingfield	Joseph		7759823190					Joseph.Wingfield@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Processor Contact	VP Government programs and Services		Davis-Jones	DeLona		8587906229					MedicarePartDProjectManagers@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/31/2019	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Quality Contact	Director of Quality	Ms	Gonsalves	Savannah		7759823056					Savannah.Gonsalves@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Reconciliation Contact	Director of Finance	Ms	Ramelli	Mary		7759823190					Mary.Ramelli@renown.org	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Reconciliation Contact (Secondary)	Financial Reporting Analyst	Mr	Plain	Adam		7759826275					Adam.Plain@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Recovery Audit Contact	Compliance Manager	Ms	Linzey	Lenee		7759823025					lenee.linzey@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	12/17/2021	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	SNP Application Contact	Product Development Coordinator	Ms.	Eddy	Tabatha		7759823721				7759823743	tabatha.eddy@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	SNP State Contact	Senior Director of Government Programs	Mr.	Bawden	CJ		7759823218				7759823743	cj.bawden@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Surveillance Contact	Manager of the Contact Center	Ms.	Garcia	Nallely		7759822661				7759823748	nallely.garcia@renown.org	10315 Professional Circle		Reno	NV	89502	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	System Contact	IT Manager	Mr.	Jaquette	Edward		7759823146				7759823746	Edward.Jaquette@Renown.org	830 Harvard Way		Reno	NV	89502	12/17/2021	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Third Party Administrator (TPA) Liaison	Supervisor of Accounts Payable	Ms.	Phillips	Sarah		7759826052					Sarah.Phillips@renown.org	1000 Ryland	Ste 301	Reno	NV	89502	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	User Access Contact	Compliance Manager	Ms	Linzey	Lenee		7759823025					lenee.linzey@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	12/17/2021	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Utilization Management Contact	Director of Healthcare Utlization Management	Ms	Weissman	Storie		7759823078				7759823740	Storie.Weissman@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2960	Utilization Review Contact	Director of Healthcare Utlization Management	Ms	Weissman	Storie		7759823078				7759823740	Storie.Weissman@hometownhealth.com	10315 Professional Circle		Reno	NV	89521	11/30/2022	2023	HOMETOWN HEALTH PLAN, INC.	Local CCP	Senior Care Plus	HMO/HMOPOS		Renown Health	256	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H2962	Agent/Broker Compensation Data Contact	Director Sales & Marketing	Mr.	Sessa	Wayne		3525155940				3528357169	wsessa@ulthp.com	2713 Forest Rd		Spring Hill	FL	346063377	05/19/2020	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Automated TrOOP Balance Transfer Contact	CEO		Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Backup User Access Contact	Chief Information Officer	Mr.	VanWyk	Johan		8554428401				3528357169	jvanwyk@mirrahealthcare.com	1244 Mariner Blvd.		Spring Hill	FL	34609	02/26/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Best Available Evidence Contact	COO	Mrs	Debi	Darilu		3525155912				3528357169	ddebi@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	07/17/2017	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Bid Audit Contact	CEO		Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Bid Audit Site Contact	Chief Compliance Officer	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Bid Primary Contact	CEO		Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	CAP Report Contact for Public Website	CEO	Ms.	Gareau	Nancy		8137659154					ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	CEO - CMS Administrator Contact	CEO	Ms.	Gareau	Nancy		8137659154					ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	12/21/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	CEO - Senior Official for Contracting	CEO	Ms.	Gareau	Nancy		8137659154					ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Chief Financial Officer	CEO	Mrs.	Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Chief Operating Officer	COO	Mrs.	Debi	Darilu		3525155912					DDebi@ulthp.com	1244 Mariner Blvd		Spring Hill	FL	34609	01/06/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Chief Information Officer	Information Systems/Technology Director	Mr.	Mieles	Justin		3528357151	6045			3528357169	jmieles@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	12/27/2022	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Chief Information Security Officer	Information Systems/Technology Director	Mr.	Mieles	Justin		3528357151	6045			3528357169	jmieles@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	12/27/2022	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	CMS Casework Communication Contact	Chief Compliance Officer	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Complaints Tracking Contact	COO	Mrs.	Debi	Darilu		3528357151	5912			3528357169	ddebi@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/18/2019	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Contact for Fraud Investigations	Chief Compliance Officer	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Coordination of Benefits Contact	COO	Ms.	Debi	Darilu		3525155912				3528357169	ddebi@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/12/2016	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Corporate Mailing						3528357151				3528357169	ngareau@ulthp.com	1244  Mariner Blvd.		Spring Hill	FL	34609	12/30/2019	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Supervisor	Mr.	Browning	Emily		1352515593				3528357169	eBrowning@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	06/15/2020	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Customer Service Operations Contact	COO	Mrs	Debi	Darilu		3525155912				3528357169	ddebi@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/18/2019	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	DIR Contact	CCO	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	DIR Contact (Secondary)	CEO		Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Electronic Health Record Contact	Chief Information Officer	Mr.	VanWyk	Johan		8554428401	4428401			3528357169	jvanwyk@mirrahealthcare.com	1244 Mariner Blvd.		Spring Hill	FL	34609	02/26/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active	8557307925	4428401			HMO - Health Maintenance Organization		C	Atlanta
H2962	Emergency Part D Contact	Pharmacy Director	Mrs	Allen	Coree		8134951657					callen@ulthp.com	1244 Mariner Blvd		Spring Hill	FL	34609	12/22/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Emergency Part D Contact (Secondary)	Chief Medical Director	Dr.	Shah	Pragnesh		9258198779					pshah@ulthp.com	1244 Mariner Blvd		Springhill	FL	34609	12/22/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Encounter Data & Risk Adjustment Operations Contact	CEO		Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Enrollment Contact	COO	Mrs.	Debi	Darilu		3528357151	5912			3528357169	ddebi@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/12/2016	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	EOB Transfer Contact	COO	Ms.	Debi	Darilu		3528357151	5912			3528357169	ddebi@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/12/2016	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Financial Audit Contact	CEO	Mrs.	Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Financial Reporting Contact			Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Formulary Contact	Manager, Clinical Pharmacy		Mehta	Anand		6124747424					Anand.mehta@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	01/11/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Formulary Contact (Secondary)	Pharmacy Director	Mrs.	Allen	Coree		3525155966				3528357169	callen@ulthp.com	1244 Mariner Blvd		Spring Hill	FL	34609	10/05/2020	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	General Contact	CEO	Ms.	Gareau	Nancy		8137659154					ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Government Relations Contact	Chief Compliance Officer	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	HIPAA Privacy Officer	Chief Compliance Officer	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	HIPAA Security Officer		Mr.	VanWyk	Johan		8554428401	4428401			3528357169	jvanwyk@mirrahealthcare.com	1244 Mariner Blvd.		Spring Hill	FL	34609	02/26/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Hospice Contact	Chief Medical Director	Dr.	Shah	Pragnesh		3525155954				3528357169	pshah@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	11/12/2020	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Interoperability Contact	Chief Information Officer		VanWyk	Johan		3528357151					jvanwyk@mirrahealthcare.com	1244 Mariner Blvd		Springhill	FL	34609	02/16/2022	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	MA Appeals/Grievances Contact	COO	Ms	Debi	Darilu		3525155912					DDebi@ulthp.com	1244 Mariner Blvd		Spring Hill	FL	34609	10/24/2019	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	MA Claims Processing Contact for Public Website	Sr. Director, Provider Network Relations	Mrs.	Hackney	Sheri		8886574171				3525155976	provider_relations@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	04/21/2020	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Marketing Contact	Director Sales & Marketing	Mr.	Sessa	Wayne		3525155940				3528357169	wsessa@ulthp.com	2713 Forest Rd		Spring Hill	FL	346063377	05/18/2020	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Medical Director	Chief Medical Director	Dr.	Shah	Pragnesh		3525155954				3528357169	pshah@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	11/12/2020	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Medicare Compliance Officer	Chief Compliance Officer	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Medicare Coordinator			Patel	Nirali		7276862938				3528357169	npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/23/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Medicare Part D Opioid Overutilization Contact	Pharmacy Director	Mrs.	Allen	Coree		3525155966				3528357169	callen@ulthp.com	1244 Mariner Blvd		Springhill	FL	34609	10/05/2020	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Medication Therapy Management Contact	Pharmacy Director	Mrs.	Allen	Coree		3525155966					callen@ulthp.com	1244 Mariner Blvd		Spring Hill	FL	34609	01/11/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Online Enrollment Center Contact (Back-up)	COO	Mrs.	Debi	Darilu		3528357151	5912			3528357169	ddebi@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/18/2019	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Online Enrollment Center Contact (Optional)	Director Sales & Marketing	Mr.	Sessa	Wayne		3525155940				3528357169	wsessa@ulthp.com	2713 Forest Rd		Spring Hill	FL	346063377	11/02/2016	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Online Enrollment Center Contact (Primary)	CEO	Ms.	Gareau	Nancy		8137659154					ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Part C Application Contact	CEO	Ms.	Gareau	Nancy		8137659154					ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Part C Reporting Contact	Chief Compliance Officer	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Part D Appeals	Manager, Prior Authorization		Bricker	Bryce							bryce.m.bricker@optum.com	9040 S. Rita Rd		Tucson	AZ	85747	01/11/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active	6126326838				HMO - Health Maintenance Organization		C	Atlanta
H2962	Part D Appeals Contact (Secondary)	Pharmacy Director	Mrs	Allen	Coree						3528357169	callen@ulthp.com	1244 Mariner Blvd		Spring Hill	FL	34609	01/11/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active	3525155966				HMO - Health Maintenance Organization		C	Atlanta
H2962	Part D Application Contact	COO	Mrs	Debi	Darilu		3525155912				3528357169	ddebi@ulthp.com	1244 Mariner Blvd		Spring Hill	FL	34609	05/18/2020	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Part D Benefits Contact	COO	Ms	Debi	Darilu		3525155912				3528357169	ddebi@ulthp.com	1244 Mariner Blvd		Spring Hill	FL	34609	07/17/2017	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Part D Claims Submission Contact	PharmD		Davelis	Mia		4022101214					Mia.davelis@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	01/11/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Part D Exceptions Contact	Manager, Prior Authorization		Bricker	Bryce							bryce.m.bricker@optum.com	9040 S. Rita Rd		Tucson	AZ	85747	01/11/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active	6126326838				HMO - Health Maintenance Organization		C	Atlanta
H2962	Part D Exceptions Contact (Secondary)	Pharmacy Director	Mrs.	Allen	Coree						3528357169	callen@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	01/11/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active	3525155966				HMO - Health Maintenance Organization		C	Atlanta
H2962	Part D Price File Contact (Back-up)	Pharmacy Director		Allen	Coree		3525155966				3528357169	callen@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	11/08/2022	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Part D Price File Contact (Primary)			Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	60173	11/08/2022	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Part D Quality Assurance Contact	Pharmacy Director	Mrs.	Allen	Coree		3525155966				3528357169	callen@ulthp.com	1244 Mariner Blvd		Spring Hill	FL	34609	01/11/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Part D Reporting Contact	Chief Compliance Officer	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Patient Safety Contact	Chief Medical Director	Dr.	Shah	Pragnesh		3525155954				3528357169	pshah@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	11/12/2020	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Payment Contact			Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Pharmacy Director	Pharmacy Director	Mrs.	Allen	Coree		3525155966				3528357169	callen@ulthp.com	1244 Mariner Blvd		Springhill	FL	34609	10/05/2020	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	01/05/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Pharmacy Network Management Contact (Secondary)	CEO	Ms.	Gareau	Nancy		8137659154					ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk	Mr.	Summers	Todd							todd.summer@optum.com	1000 Optum Cir.		Eden Prairie	MN	55344	12/16/2022	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active	8003117517				HMO - Health Maintenance Organization		C	Atlanta
H2962	PHR Beneficiary Contact																	09/06/2012	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS	Ultimate Health Plans, Inc.	Ultimate Healthcare Holdings, LLC	489	Yes	Active	8886574171				HMO - Health Maintenance Organization		C	Atlanta
H2962	Physician Incentive Contact	CEO	Ms.	Gareau	Nancy		8137659154					ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Plan Directory Contact for Public Website			Service	Customer		8886574170					communications@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	04/05/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Plan to Plan Reconciliation Contact	CEO		Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Processor Contact	COO	Ms	Debi	Darilu		3525155912				3528357169	ddebi@ulthp.com	1244 Mariner Blvd		Spring Hill	FL	34609	10/24/2019	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Quality Contact	COO	Ms	Debi	Darilu		3525155912				3528357169	ddebi@ulthp.com	1244 Mariner Blvd		Spring Hill	FL	34609	01/11/2017	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Reconciliation Contact	CEO		Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Reconciliation Contact (Secondary)	CEO	Ms.	Gareau	Nancy		8137659154					ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Recovery Audit Contact	Chief Compliance Officer	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	SNP Application Contact	COO	Mrs.	Debi	Darilu		3528357151	5912			3528357169	ddebi@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	10/24/2019	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	SNP State Contact	COO	Mrs.	Debi	Darilu		3528357151	5912			3528357169	ddebi@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	10/24/2019	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Surveillance Contact	Chief Compliance Officer	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	System Contact		Mr.	VanWyk	Johan		8554428401	4428401			3528357169	jvanwyk@mirrahealthcare.com	1244 Mariner Blvd.		Spring Hill	FL	34609	02/26/2021	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Third Party Administrator (TPA) Liaison	CEO		Gareau	Nancy		3528357151				3528357169	ngareau@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	05/11/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	User Access Contact	Chief Compliance Officer	Mrs.	Patel	Nirali		7276862938					npatel@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/08/2023	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Utilization Management Contact	COO	Mrs.	Debi	Darilu		3528357151	5912			3528357169	ddebi@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/18/2019	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2962	Utilization Review Contact	COO	Mrs.	Debi	Darilu		3528357151	5912			3528357169	ddebi@ulthp.com	1244 Mariner Blvd.		Spring Hill	FL	34609	03/18/2019	2023	ULTIMATE HEALTH PLANS, INC.	Local CCP	Ultimate Health Plans	HMO/HMOPOS		Ultimate Healthcare Holdings, LLC	489	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H2986	Agent/Broker Compensation Data Contact	SVP Health Plan Operations		Cochran	Rick		4026306924					rcochran@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/18/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Automated TrOOP Balance Transfer Contact	Director Enrollment, Eligibility &B OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Backup User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Best Available Evidence Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Bid Audit Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Bid Audit Site Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Bid Primary Contact	ACTUARY	Mr.	Copeland	Joe		3142095834					jcopeland@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	CAP Report Contact for Public Website	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	CEO - CMS Administrator Contact	COO	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	CEO - Senior Official for Contracting	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Chief Financial Officer	Chief Financial Officer	Mr.	Grabski	Ben		7633007611					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Chief Operating Officer	Chief Operating Officer	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Chief Information Officer	Chief Information Officer	Mr.	Saghabini	JeanClaude		6173124659					jsaghbini@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Chief Information Security Officer	Chief Information Security Officer	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	CMMI Model Point of Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	CMS Casework Communication Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Complaints Tracking Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Contact for Fraud Investigations	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Coordination of Benefits Contact			Inquiries	COB		8665979560					COBInquiry@lumeris.com	CUSTOMER SERIVCE	P O BOX 5904	TROY	MI	48007	09/29/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Corporate Mailing						8665979560					customerservice@essencehealthcare.com	CUSTOMER SERIVCE	P O BOX 5904	TROY	MI	48007	09/29/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Client Payments		Williams	Kliopatra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Customer Service Operations Contact	Vice President, Engagement	Ms.	Meyerhoffer	Linda		6366839682					rmeyerhoffer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	DIR Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	DIR Contact (Secondary)	Sr. Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly		3142092795					pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Emergency Part D Contact	Director, Pharmacy	Ms.	Cruz	Jennifer		6307425966					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Emergency Part D Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment Services	Mr.	Eschbach	Jason		6144397608					jeschbach@lumeris.com	13900 Riverport Drive		St. Louis	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Enrollment Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	EOB Transfer Contact	Director, Claims	Ms.	Wasserman	Rachelle		3142092800				3147706096	rwasserman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Financial Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Financial Reporting Contact	Corporate Accounting Director	Ms.	Pinkerton	Amanda		3145183519					apinkerton@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Formulary Contact		Ms	Nyawabila	Christina		8447906297					FAS@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Formulary Contact (Secondary)	Manager, Pharmacy	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	General Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Government Relations Contact	Chief Legal Officer	Ms.	Halterman	Gail		3142092717					ghalterman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Davis	Amy		3142093945					adavis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	HIPAA Security Officer	CISO	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Hospice Contact	Director, Pharmacy		Cruz	Jennifer		3147703556					pharmacy@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Interoperability Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Darnell	Erika		3144382410					ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	MA Claims Processing Contact for Public Website			Services	Customer		8665979560				8334070025	customerservice@essencehealthcare.com	P O BOX 5904		TROY	MI	48007	09/29/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Marketing Contact	Manager, Compliance Marketing	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Medical Director	Senior Medical Officer, UM	Dr.	Fusco	Michael		3147703770					mfusco@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Medicare Compliance Officer	VP Compliance, Medicare Compliance Officer	Mr,	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Medicare Coordinator	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Medicare Part D Opioid Overutilization Contact	Sr. Clinical Pharmacist		Pasagic	Melita		3147703775					mpasagic@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Medication Therapy Management Contact	Manager, Pharmacy	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	OffShore Subcontractor Contact	SVP Corporate Accounting & Chief Compliance Office	Ms.	Venable	Erin		3142093957					evenable@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Online Enrollment Center Contact (Back-up)	Manager, Compliance	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Online Enrollment Center Contact (Optional)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Online Enrollment Center Contact (Primary)	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Part C Application Contact	Sr. Director CMS Applications & PBP submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Part C Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Appeals	Director, Appeals & Grievances	Ms.	Darnell	Erika							ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	3144382410				HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Appeals Contact (Secondary)	Sr. Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly	M						pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	3142092795				HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Benefits Contact	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Claims Submission Contact		Ms.	Scherlippens	Carine		8587907415					Carine.Scherlippens@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Exceptions Contact		Ms.	Byers	June							June.Byers@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	8445136003				HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Exceptions Contact (Secondary)		Mr	Elias	Jason							Jason.Elias@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	8445136003				HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Price File Contact (Back-up)	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Price File Contact (Optional)	Manager, Pharmacy	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Price File Contact (Primary)		Ms.	Finder	Plan		8445136003					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Quality Assurance Contact	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Part D Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Patient Safety Contact	Manager, Pharmacy	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Payment Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Pharmacy Director	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Pharmacy Network Management Contact	Director, Pharmacy	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Pharmacy Network Management Contact (Secondary)			Operations	Pharmacy		8587907148					PharmacyOperationsSups@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services	Ms.	Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	8002432051				HMO - Health Maintenance Organization		C	Kansas City
H2986	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Manager	Ms.	Summerfield	Kelly							ksummerfield@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	3147703788				HMO - Health Maintenance Organization		C	Kansas City
H2986	Physician Incentive Contact	Sr. Manager, Health Plan Finance	Mr.	Privott	David		3147703732					dprivott@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/21/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Plan Directory Contact for Public Website	Customer Services		Services	Customer		8665979560					customerservice@essencehealthcare.com	P O BOX 5904		TROY	MI	48007	09/29/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Plan to Plan Reconciliation Contact	Manager, Client Payments		Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Processor Contact		Ms.	Scott	Susan		8447906565					Susan.Scott@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Quality Contact	Snr. Director, Quality Improvement		Pattison	Lisa		5082728692					lpattison@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Reconciliation Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Reconciliation Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Recovery Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	SNP Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	SNP State Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Surveillance Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	System Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Third Party Administrator (TPA) Liaison	Client AP Specialist	Ms.	Brock	Letecea		3142548778					lbrock@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Utilization Management Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2986	Utilization Review Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	Essence Healthcare of California, Inc.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H2992	Automated TrOOP Balance Transfer Contact	NA	Mr.	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Backup User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Best Available Evidence Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Bid Primary Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	CAP Report Contact for Public Website	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	CEO - CMS Administrator Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	CEO - Senior Official for Contracting	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Chief Financial Officer	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Chief Operating Officer	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Chief Information Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Chief Information Security Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	CMS Casework Communication Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Complaints Tracking Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Contact for Fraud Investigations	Executive Director	Ms	Moreth	Carla		8145356000	22139			8142487902	CMORETH@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Coordination of Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Corporate Mailing						8145356000	22101			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Coverage Gap Discount Program (CGDP) Payment Contact			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Customer Service Operations Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	DIR Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Emergency Part D Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Encounter Data & Risk Adjustment Operations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	10/18/2019	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Enrollment Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	EOB Transfer Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Financial Audit Contact	CFO	Mr	Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Financial Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Formulary Contact			N/A	N/A		1234567890	123				N/A@n/a.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	General Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Government Relations Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	HIPAA Privacy Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	HIPAA Security Officer	IT Director		Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Interoperability Contact	Chief Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	MIrwin@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	02/16/2022	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	MA Appeals/Grievances Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Marketing Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Medical Director	Medical Director		Anderson	Sheila		7242225433					SMAnderson@physiciansolutionsgrp.com	2114 North Franklin Drive		Washington	PA	15301	10/05/2018	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Medicare Compliance Officer	Executive Director	Ms	Detwiler	Megan		7242225433	101			8142487902	SLWDirectors@seniorlifewashington.com	2114 North Franklin Drive		Washington	PA	15301	08/19/2019	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Medicare Coordinator	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Medicare Part D Opioid Overutilization Contact	Medical Director		Anderson	Sheila		7242225433					SMAnderson@physiciansolutionsgrp.com	2114 North Franklin Drive		Washington	PA	15301	11/27/2018	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Medication Therapy Management Contact	Cheif Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	03/13/2019	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Part C Application Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Part D Appeals	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H2992	Part D Appeals Contact (Secondary)	Chief Executive Officer	Mr.	I	Mark						8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	12/29/2020	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active	8145356000	22101			PACE - Nat		C	Philadelphia
H2992	Part D Application Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Part D Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Part D Claims Submission Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Part D Exceptions Contact	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H2992	Part D Price File Contact (Back-up)			N/A	N/A		1234567890	123				N/A@N/A.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Part D Price File Contact (Primary)			N/A	N/A		1234567890	123				N/A@N/A.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Part D Quality Assurance Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Part D Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Patient Safety Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Payment Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Pharmacy Director			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Pharmacy Network Management Contact			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Pharmacy Technical Help Desk Contact			Rowland	Bob							Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active	7242751203	219			PACE - Nat		C	Philadelphia
H2992	Plan Directory Contact for Public Website	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Processor Contact	Claims Manager		Hoffman	Lindsey		8145356000	22654			8142487902	Lhoffman@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	04/18/2023	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Quality Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Reconciliation Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Recovery Audit Contact	CFO	Mr	Dodson	David	M	8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Surveillance Contact			Irwin	Mark		8145356000	22101				Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	System Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Third Party Administrator (TPA) Liaison			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Utilization Management Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H2992	Utilization Review Contact	Cheif Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIORLIFE WASHINGTON, INC.	National PACE	Senior LIFE Washington / Uniontown / Greene	National PACE		SeniorLife Washington, Inc.	409	Yes	Active					PACE - Nat		C	Philadelphia
H3015	Agent/Broker Compensation Data Contact	Manager Broker Administration	Mrs.	Logan	Lynne		4235356550				4235353178	Lynne_Logan@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Automated TrOOP Balance Transfer Contact	Advisor Business CVS		Davis	Brittany		4806064613					FIRSupport@CVSHealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	12/21/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Backup User Access Contact	Medicare Compliance Officer	Ms.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Best Available Evidence Contact	VP Internal Operations		Purcell	Tracy		6292046740					Tracy_Purcell@Sharedhealth.com	2501 McGavock Pike Suite 600		Nashville	TN	37214	12/15/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Bid Audit Contact	Medicare Compliance Officer	Mrs	Womble	Charriet		6292046752					Charriet_Womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	374022011	12/15/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Bid Primary Contact	Medicaid Account		Ray	Hope		6292046707					Hope_Ray@Sharedhealth.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/15/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	CAP Report Contact for Public Website	Medicare Compliance Officer		Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	CEO - CMS Administrator Contact	CEO	Mr.	Cole	John		6155985612					John_Cole@Sharedhealth.com	1 Cameron Hill Circle		Chattanooga	TN	37402	03/21/2023	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	CEO - Senior Official for Contracting	CEO	Mr.	Cole	John		6155985612					John_Cole@Sharedhealth.com	1 Cameron Hill Circle		Chattanooga	TN	37402	03/21/2023	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Chief Financial Officer	VP Controller & Chief Accounting Officer	Mr	Gregory	Daniel		4235358224					Daniel_Gregory@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	08/02/2023	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Chief Operating Officer	VP Internal Operations	Ms	Purcell	Tracy		6292046740					Tracy_Purcell@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	01/22/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Chief Information Officer	CIO	Ms	Jackson	Barbara		4235357580				4236190778	Barbara_Jackson@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/14/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Chief Information Security Officer	Chief Information Security Officer	Ms	Jackson	Barbara		4235357580				4236190778	Barbara_Jackson@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/14/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	CMS Casework Communication Contact	Clinical Management		Pugh	Donna		4235356563					Donna_Pugh@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/15/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Complaints Tracking Contact	Clinical Management		Pugh	Donna		4235356563					Donna_Pugh@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/15/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Contact for Fraud Investigations	Director Special Investigations Unit	Mr.	Tidwell	Norman		6153483005				4235357024	Norman_Tidwell@bcbst.com	1 Cameron Hill Circle, Bldg 1.4		Chattanooga	TN	37402	05/02/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Coordination of Benefits Contact	Manger Revenue Reconciliation		Camp	Jan		4235353639					jan_camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	04/20/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Corporate Mailing						6292046740					Tracy_Purcell@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	06/19/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr Investments & Financial Mgt		Conway	Kendrick		4236819483					Kendrick_Conway@BCBST.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/10/2023	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Customer Service Operations Contact	VP External Operations		Boswell	Brooke		6292046709					Brooke_Boswell@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	01/22/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	DIR Contact	Pharmacy Operations Manager	Mrs	Moore	Mary-Marga		4235356116					Mary-Margaret_Moore@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/28/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	DIR Contact (Secondary)	Director Pharmacy Operations	Mrs	Owen	Rebecca		4235358347					Rebecca_Owen@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/19/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Emergency Part D Contact	VP of Pharmacy		Tate	Natalie		4234437868				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Emergency Part D Contact (Secondary)	Sr Account Manager CVS		Hale	Amy		4803277718					Amy.Hale2@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Encounter Data & Risk Adjustment Operations Contact	Director Medicare Advantage Risk Adjustment		Livingood	Eric		4235357352					Richard_Livingood@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Enrollment Contact	VP Internal Operations		Purcell	Tracy		6292046740					Tracy_Purcell@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	12/15/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	EOB Transfer Contact	VP Internal Operations		Purcell	Tracy		6292046740				6292046799	Tracy_Purcell@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	01/22/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Financial Audit Contact	External Audit Coordinator	Ms	Grafe	Kimberly		4232909053					Kimberly_Grafe@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/21/2023	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Financial Reporting Contact	VP Finance	Mr.	Rankin	William		6159613555					William_Rankin@bcbst.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	02/16/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Formulary Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Formulary Contact (Secondary)	Clinical Advisor Med D CVS		Tolbert	Myla		4698656265					Myla.Tolbert@CVSHealth.com	750 W John Carpenter Frwy		Irving	TX	75039	12/20/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	General Contact	Medicare Compliance Officer	Ms.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Government Relations Contact	Medicare Compliance Officer	Ms.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	HIPAA Privacy Officer	Chief Operating Officer		Purcell	Tracy		6292046740					Tracy_Purcell@sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	11/11/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	HIPAA Security Officer	COO	Mr.	Purcell	Tracy		6292046740					Tracy_Purcell@sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	12/28/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Hospice Contact	VP Internal Operations		Purcell	Tracy		6292046740					Tracy_Purcell@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	01/22/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Interoperability Contact	Application Manager		Foust	Adam		4235356672					Adam_Foust@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/28/2023	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	MA Appeals/Grievances Contact	Clinical Management		Pugh	Donna		4235356563					Donna_Pugh@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/15/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	MA Claims Processing Contact for Public Website	VP Internal Operations		Purcell	Tracy		6292046740					Tracy_Purcell@Sharedhealth.com	2501 McGavock Pike	Suite 600	Chattanooga	TN	37214	02/11/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Marketing Contact	Ethics & Compliance Manager		Clements	Amy		4235358225					Amy_Clements@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/15/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Medical Director	Medical Director	Dr.	Meier IV	Louis		4235352863					Louis_Meier@BCBST.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/15/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Medicare Coordinator	VP Internal Operations		Purcell	Tracy		6292046740					Tracy_Purcell@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	04/14/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Medicare Part D Opioid Overutilization Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Medication Therapy Management Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	OffShore Subcontractor Contact	Medicare Compliance Officer	Mrs	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Online Enrollment Center Contact (Primary)	Operations Supervisor II (QIP)		Lloyd	Jennifer		4235357800					Jennifer_Lloyd@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/08/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Part C Application Contact	Medicaid Account Manager		Ray	Hope		6292046707					Hope_Ray@Sharedhealth.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Part C Reporting Contact	VP Internal Operations		Purcell	Tracy		6292046740					Tracy_Purcell@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	12/15/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Part D Appeals	Clinical Pharmacy Director		Moss	Portia							Portia_Moss@bcbst.com	1 Cameron Hill Circle	Suite 51	Chattanooga	TN	37402	09/22/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8444746477				HMO - Health Maintenance Organization		C	Atlanta
H3015	Part D Appeals Contact (Secondary)	Coverage Review Pharmacist		Holloway	Angela							Angela_Holloway@BCBST.com	1 Cameron Hill Circle	Suite 51	Chattanooga	TN	37402	12/31/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8444746477				HMO - Health Maintenance Organization		C	Atlanta
H3015	Part D Application Contact	Medicaid Account Manager		Ray	Hope		6292046707					Hope_Ray@Sharedhealth.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Part D Benefits Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Part D Claims Submission Contact	Sr Account Manager CVS		Mesa	Samantha		4803492867					Samantha.Mesa@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Part D Exceptions Contact	Manager Coverage Reviews 1		Moss	Portia							Portia_Moss@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				HMO - Health Maintenance Organization		C	Atlanta
H3015	Part D Exceptions Contact (Secondary)	Coverage Review Pharmacist		Dillon	Celia							Celia_Dillon@BCBST.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/12/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				HMO - Health Maintenance Organization		C	Atlanta
H3015	Part D Price File Contact (Back-up)	Manager PBM Finance Operations CVS		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Part D Price File Contact (Primary)	Pharmacy Operations Manager		Moore	Mary	M	4235356116				4235357599	Mary-Margaret_Moore@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Part D Quality Assurance Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Part D Reporting Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Patient Safety Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Payment Contact	Manager Revenue Reconciliation		Camp	Jan		4235353639					Jan_Camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Pharmacy Director	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Pharmacy Network Management Contact	Advisor Network Products CVS		Lowe	David		4807449231				8773875800	David.Lowe2@CVSHealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	12/20/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Pharmacy Technical Help Desk Contact	Vendor Management		Horton	Kasena							Kasena.Horton@CVSHealth.com	2401 Cherahala  Blvd		Knoxville	TN	37932	12/21/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Atlanta
H3015	Pharmacy Technical Help Desk Contact (Secondary)	VP of Pharmacy		Tate	Natalie							Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/31/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8444746477				HMO - Health Maintenance Organization		C	Atlanta
H3015	Plan Directory Contact for Public Website			Service	Customer		8772583002					info@sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	11/22/2021	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Plan to Plan Reconciliation Contact	Business Analyst Associate		Stinnett	James		4235351624					P2PAdministration_GM@bcbst.com	Attn: P2P Coordinator	1 Cameron Hill Circle Suite 0050	Chattanooga	TN	374020050	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Processor Contact	VP Internal Operations		Purcell	Tracy		6292046740					Tracy_Purcell@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	01/22/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Quality Contact	VP Population Health Management		Sutton	Jennifer		6292046725					Jennifer_Sutton@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	09/20/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Reconciliation Contact	Manager Revenue Reconciliation		Camp	Jan		4235353639					Jan_Camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	SNP Application Contact	VP Internal Operations	Mrs.	Purcell	Tracy		6155840769					tracy_purcell@sharedhealth.com	2501  McGavock Pike	Suite 600	Nashville	TN	37214	02/09/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Surveillance Contact	Medicare Compliance Officer	Ms.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	System Contact	Mgr Applications Systems & Pro	Mrs.	Jackson	Barbara		4235357580				4236190778	Barbara_Jackson@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Third Party Administrator (TPA) Liaison	Accountant		Gillenwater	Jonathan		4235351259					Jonathan_Gillenwater@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/06/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	User Access Contact	Compliance Monitor Consultant		Underwood	Jackie		4235354424					Jackie_Underwood@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/10/2019	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Utilization Management Contact	VP Population Health		Sutton	Jennifer		6292046725					Jennifer_Sutton@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	01/22/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3015	Utilization Review Contact	VP Population Health		Sutton	Jennifer		6292046725					Jennifer_Sutton@Sharedhealth.com	2501 McGavock Pike	Suite 600	Nashville	TN	37214	01/22/2020	2023	SHARED HEALTH MISSISSIPPI, INC.	Local CCP	Shared Health Dual Plus	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3041	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H3041	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H3041	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H3041	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H3041	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H3041	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H3041	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H3041	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3041	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF SOUTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3047	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/24/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Medical Director	Chief Medical Director	Dr.	Lucas	Brad		8662464356					blucas@centene.com	3700 Embassy Parkway, Suite 200		Akron	OH	44333	11/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H3047	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H3047	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H3047	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H3047	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road Tampa,FL 33634		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H3047	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H3047	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H3047	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road, Ren 1, 3rd Floor		Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3047	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF LOUISIANA	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3060	Automated TrOOP Balance Transfer Contact	Director Financial Management	Mr.	Hamm	David		7247761100					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	05/23/2022	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Backup User Access Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Best Available Evidence Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Bid Primary Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	07/05/2018	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	CAP Report Contact for Public Website	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	08/09/2016	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	CEO - CMS Administrator Contact	CEO	Mr	Hamm	David	A	7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/19/2023	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	CEO - Senior Official for Contracting	CEO	Mr	Hamm	David	A	7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/19/2023	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Chief Financial Officer	CFO	Mr.	Carraway	Jeffrey		7247761100					jeffrey.carraway@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	02/02/2018	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Chief Operating Officer	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	04/19/2023	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Chief Information Officer	VP Technology and Quality	Mr	Lamb	Charles		7247209202					charles.lamb@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	09/16/2016	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Chief Information Security Officer	VP Technology and Quality	Mr	Lamb	Charles		7247209202					charles.lamb@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	09/16/2016	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	CMS Casework Communication Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Complaints Tracking Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Contact for Fraud Investigations	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Coordination of Benefits Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Corporate Mailing						4123561668					leslie.kisow@lutheranseniorlife.org	740 Blackburn Rd, Suite 300		Sewickley	PA	15143	06/07/2023	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Customer Service Operations Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	DIR Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Emergency Part D Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Emergency Part D Contact (Secondary)	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Encounter Data & Risk Adjustment Operations Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Enrollment Contact	Accounting Manager	Ms.	Cionni	Jane		7247422202					maryjane.cionni@lutheranseniorlife.org	1323 Freedom Road		Cranberry Township	PA	16066	01/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	EOB Transfer Contact	Director of Financial Management	Mr.	Hamm	David		7247422226				7247722960	dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Financial Audit Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Financial Reporting Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Formulary Contact	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	04/21/2017	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	General Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Government Relations Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	HIPAA Privacy Officer	Compliance Officer	Ms.	Kaminski	Leean		7247422295					leean.kaminski@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/11/2016	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	HIPAA Security Officer	Director MIS	Mr.	Gilson	Dennis		7246254841					dennis.gilson@lutheranseniorlife.org	500 Wittenberg Way	P. O. Box 928	Mars	PA	16046	08/09/2016	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Interoperability Contact			Hamm	David		7247761100					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	05/23/2022	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	MA Appeals/Grievances Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	MA Claims Processing Contact for Public Website	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Marketing Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Medical Director	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	04/21/2017	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Medicare Compliance Officer	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Medicare Coordinator	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	10/15/2018	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Medication Therapy Management Contact	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	04/21/2017	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Part C Application Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Part D Appeals	Director of Financial Management	Mr.	Hamm	David							dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active	7247422226				PACE - Nat		C	Philadelphia
H3060	Part D Appeals Contact (Secondary)	Accounting Manager	Ms.	Cionni	Jane							maryjane.cionni@lutheranseniorlife.org	1323 Freedom Road		Cranberry Township	PA	16066	01/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active	7247422202				PACE - Nat		C	Philadelphia
H3060	Part D Application Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/11/2016	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Part D Benefits Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Part D Claims Submission Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Part D Exceptions Contact	Director of Financial Management	Mr.	Hamm	David							dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active	7247422226				PACE - Nat		C	Philadelphia
H3060	Part D Exceptions Contact (Secondary)	Accounting Manager		Cionni	Jane							Maryjane.cionni@lutheranseniorlife.org	Lutheran SeniorLife	1323 Freedom Road	Cranberry Township	PA	16066	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active	7247422202				PACE - Nat		C	Philadelphia
H3060	Part D Price File Contact (Back-up)	Accounting Manager	Ms.	Cionni	Jane		7247422202					Maryjane.cionni@lutheranseniorlife.org	1323 Freedom Road		Cranberry Township	PA	16066	01/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Part D Price File Contact (Optional)	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/11/2016	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Part D Price File Contact (Primary)	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/11/2016	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Part D Quality Assurance Contact	Director, Quality Assurance & Education	Ms.	Hankey	Laura		7243022017					laura.hankey@lutheranseniorlife.org	740 Blackburn Rd, Suite 300		Sewickley	PA	15143	04/08/2019	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Part D Reporting Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Patient Safety Contact	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	04/21/2017	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Payment Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/11/2016	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Personal Health Record Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Pharmacy Director	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	04/21/2017	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Pharmacy Network Management Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Pharmacy Network Management Contact (Secondary)	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/11/2016	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Pharmacy Technical Help Desk Contact	Medical Director	Dr.	Hanna	Abeer							abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	04/21/2017	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active	7242875433				PACE - Nat		C	Philadelphia
H3060	Pharmacy Technical Help Desk Contact (Secondary)	Medical Director	Dr.	Hanna	Abeer							abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	04/21/2017	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active	7242875433				PACE - Nat		C	Philadelphia
H3060	PHR Beneficiary Contact																	01/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE	Lutheran SeniorLife	Lutheran SeniorLife	352	Yes	Active	7247421100				PACE - Nat		C	Philadelphia
H3060	Plan Directory Contact for Public Website	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Plan to Plan Reconciliation Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Processor Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Quality Contact	Director, Quality Assurance & Education	Ms.	Hankey	Laura		7243022017					laura.hankey@lutheranseniorlife.org	740 Blackburn Rd, Suite 300		Sewickley	PA	15143	04/08/2019	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Reconciliation Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Recovery Audit Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Surveillance Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	System Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Third Party Administrator (TPA) Liaison	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	05/21/2016	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	User Access Contact	Director of Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	03/10/2020	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Utilization Management Contact	Utilization Review Coordinator	Ms.	Nemec	Dawn		4123561653					dawn.nemec@lutheranseniorlife.org	740 Blackburn Road, Suite 300		Sewickley	PA	15143	04/08/2019	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3060	Utilization Review Contact	Utilization Review Coordinator	Ms.	Nemec	Dawn		4123561653					dawn.nemec@lutheranseniorlife.org	740 Blackburn Road, Suite 300		Sewickley	PA	15143	04/08/2019	2023	VIECARE BUTLER, LLC	National PACE	LIFE Butler County	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H3069	Automated TrOOP Balance Transfer Contact	CFO		Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Backup User Access Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Best Available Evidence Contact	CFO		Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Bid Primary Contact	CPO		Hernandez	Jorge		9544737112					jfhernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	CAP Report Contact for Public Website			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending	9544737483				PACE - Nat		C	Atlanta
H3069	CEO - CMS Administrator Contact	CEO	Mr	Strum	Shane		9544737070					sstrum@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	CEO - Senior Official for Contracting	CEO	Mr	Strum	Shane		9544737070					sstrum@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Chief Financial Officer	CFO	Mr.	Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Chief Operating Officer	CFO	Mr.	Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Chief Information Officer	CIO	Mrs.	Ross	Kathy		9548474082					ksross@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Chief Information Security Officer		Mrs.	Ross	Kathy		9548474082					ksross@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	CMS Casework Communication Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Complaints Tracking Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Contact for Fraud Investigations			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Coordination of Benefits Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Corporate Mailing						9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Coverage Gap Discount Program (CGDP) Payment Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Customer Service Operations Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	DIR Contact			Lacknauth	Dave		9544737078					dlacknauth@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Emergency Part D Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Encounter Data & Risk Adjustment Operations Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Enrollment Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	EOB Transfer Contact			Fernandez	Alexander		9544737483				9544737009	amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Financial Audit Contact	CFO	Mr.	Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Financial Reporting Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Formulary Contact			Lacknauth	Dave		9544737078					dlacknauth@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	General Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Government Relations Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	HIPAA Privacy Officer			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	HIPAA Security Officer			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Interoperability Contact			Ross	Kathy		9548474082					ksross@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	MA Appeals/Grievances Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	MA Claims Processing Contact for Public Website			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Marketing Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Medical Director		Dr.	Calvo	Aldo		9547611020					acalvo@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Medicare Compliance Officer	CFO	Mr.	Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Medicare Coordinator	CFO		Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Medicare Part D Opioid Overutilization Contact			Lacknauth	Dave		9544737078					dlacknauth@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Medication Therapy Management Contact			Lacknauth	Dave		9544737078					dlacknauth@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Part C Application Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	10/16/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Part D Appeals			Fernandez	Alexander							amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending	9544737483				PACE - Nat		C	Atlanta
H3069	Part D Application Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	10/16/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Part D Benefits Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Part D Claims Submission Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Part D Exceptions Contact			Fernandez	Alexander							amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending	9544737483				PACE - Nat		C	Atlanta
H3069	Part D Price File Contact (Back-up)			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Part D Price File Contact (Primary)			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Part D Quality Assurance Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Part D Reporting Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Patient Safety Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Payment Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Pharmacy Director			Lacknauth	Dave		9544737078					dlacknauth@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Pharmacy Network Management Contact			Lacknauth	Dave		9544737078					dlacknauth@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Pharmacy Technical Help Desk Contact			Lacknauth	Dave							dlacknauth@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending	9544737078				PACE - Nat		C	Atlanta
H3069	Plan Directory Contact for Public Website	CFO		Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Plan to Plan Reconciliation Contact	CFO		Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Processor Contact	CFO		Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Quality Contact	VP of Quality	Mr.	Gallison	Barry		9544737151					bgallison@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Reconciliation Contact	CFO		Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Recovery Audit Contact	CFO	Mr.	Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Surveillance Contact	CFO		Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	System Contact	CFO		Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Third Party Administrator (TPA) Liaison			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	User Access Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Utilization Management Contact	CFO		Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3069	Utilization Review Contact	CFO		Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1800 NW 49th Street		Fort Lauderdale	FL	33309	12/27/2021	2023	NORTH BROWARD HOSPITAL DISTRICT	National PACE	Broward Health	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3071	Agent/Broker Compensation Data Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/07/2023	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Automated TrOOP Balance Transfer Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Backup User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Best Available Evidence Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Bid Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Bid Audit Site Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/27/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Bid Primary Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	CAP Report Contact for Public Website	Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/28/2020	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8773841241				HMO - Health Maintenance Organization		C	Chicago
H3071	CEO - CMS Administrator Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	CEO - Senior Official for Contracting	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Chief Financial Officer	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Chief Operating Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Chief Information Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Chief Information Security Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	CMMI Model Point of Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	CMS Casework Communication Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Complaints Tracking Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Contact for Fraud Investigations	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Coordination of Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Corporate Mailing						8476968500					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway		Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	Thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Customer Service Operations Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	DIR Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	DIR Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Electronic Health Record Contact		Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/07/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Emergency Part D Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Emergency Part D Contact (Secondary)	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Encounter Data & Risk Adjustment Operations Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/18/2023	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Enrollment Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	EOB Transfer Contact	Claims Manager	Mr.	Salgado	Miguel		8476968578				8008861082	Miguel.Salgado@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	10/04/2021	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Financial Audit Contact	Controller	Mr.	Register	Jeff		3863445519				8476923225	Jeffrey.Register@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	09/21/2023	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Financial Reporting Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Formulary Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3308886015	Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Formulary Contact (Secondary)	Pharmacy Director		Lopez	Eduardo		7542085867					elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/07/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	General Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Government Relations Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	HIPAA Privacy Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	HIPAA Security Officer	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539				8555158166	Eric.Annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Hospice Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Interoperability Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	MA Appeals/Grievances Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	MA Claims Processing Contact for Public Website	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Marketing Contact	VP of Marketing	Ms.	Branco	Margaret		7187957495					margaret.branco@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/06/2023	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Medical Director	Medical Director	Dr.	Butt, MD	Tariq		3125458471					tariq.butt@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	05/18/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Medicare Compliance Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Medicare Coordinator	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Medicare Part D Opioid Overutilization Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Medication Therapy Management Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3304058084	Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	OffShore Subcontractor Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Online Enrollment Center Contact (Primary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 302	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Part C Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Part C Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Appeals			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy	Suite 450	Dublin	OH	43017	12/28/2020	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Appeals Contact (Secondary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica							Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue		Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	7542085865				HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Claims Submission Contact			Dovico	Rosario		2012696398					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	12/31/2020	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Exceptions Contact			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	6143363326				HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Exceptions Contact (Secondary)	Medical Director	Dr.	Butt, MD	Tariq							tbutt@ccaillinois.com	322 South Green Street	Suite 400	Chicago	IL	60607	03/28/2019	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	3128801693				HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Price File Contact (Back-up)			Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Price File Contact (Optional)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Price File Contact (Primary)			Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	12/31/2020	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Quality Assurance Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Part D Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Patient Safety Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Payment Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Pharmacy Director	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Pharmacy Network Management Contact			Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Pharmacy Network Management Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Pharmacy Technical Help Desk Contact			Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	08/04/2021	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H3071	Physician Incentive Contact		Ms.	Wilcox-Lange	Tracie		8476968503				7735988422	tracie.lange@clearspringhealthcare.com	322 South Green Street	Suite 400	Chicago	IL	60607	09/03/2019	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Plan Directory Contact for Public Website	Vice President, Provider Operations	Ms.	Cuevas	Elizabeth		7542085880					Elizabeth.Cuevas@clearspringhealthcare.com	250 South Northwest Highway Suite 302	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Plan to Plan Reconciliation Contact	Senior Accountant	Ms.	Wrenn	Alisa		2249855588				3124290194	Alisa.Wrenn@Clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Processor Contact			Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Quality Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Reconciliation Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Recovery Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	SNP Application Contact		Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	322 South Green Street	Suite 400	Chicago	IL	60607	09/03/2019	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	SNP State Contact		Ms.	Wilcox-Lange	Tracie		8476968502				7735988422	tracie.lange@clearspringhealthcare.com	322 South Green Street	Suite 400	Chicago	IL	60607	09/03/2019	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Surveillance Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	System Contact	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539					eric.annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Third Party Administrator (TPA) Liaison	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Utilization Management Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3071	Utilization Review Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH COMMUNITY CARE, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3080	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H3080	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H3080	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H3080	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H3080	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H3080	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H3080	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H3080	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3080	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF ALABAMA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3084	Automated TrOOP Balance Transfer Contact	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Backup User Access Contact	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Best Available Evidence Contact	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Bid Primary Contact	Chief Financial Officer		Shahbazian	Hermes		2067883618					2hermes@ichs.com	720 8th Ave South		Seattle	WA	98104	12/19/2017	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	CAP Report Contact for Public Website	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	CEO - CMS Administrator Contact	CEO	Ms.	Nomura	Kelli		2067883659					knomura@ichs.com	720 8th Ave South		Seattle	WA	98104	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	CEO - Senior Official for Contracting	CEO	Ms.	Nomura	Kelli		2067883659					knomura@ichs.com	720 8th Ave South		Seattle	WA	98104	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Chief Financial Officer	Chief Financial Officer	Mr.	Shahbazian	Hermes		2067883618					2hermes@ichs.com	720 8th Ave South		Seattle	WA	98104	12/19/2017	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Chief Operating Officer	HAWP Director	Mrs.	Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Chief Information Officer	IT Manager	Mr.	Gonzalez	Joshua		2067883628					joshuag@ichs.com	720 8th Ave South		Seattle	WA	98104	07/02/2021	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Chief Information Security Officer	IT Manager	Mr.	Gonzalez	Joshua		2067883628					joshuag@ichs.com	720 8th Ave South		Seattle	WA	98104	07/02/2021	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	CMS Casework Communication Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Complaints Tracking Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Contact for Fraud Investigations	Compliance Officer		Schippa	Amie		2065214140					amies@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Coordination of Benefits Contact	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Corporate Mailing						2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer		Shahbazian	Hermes		2067883618					2hermes@ichs.com	720 8th Ave South		Seattle	WA	98104	12/19/2017	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Customer Service Operations Contact	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	DIR Contact	Chief Financial Officer		Shahbazian	Hermes		2067883618					2hermes@ichs.com	PO Box 3007		Seattle	WA	98114	03/09/2021	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	DIR Contact (Secondary)	Corporate Compliance Administrator		Zuleta Dupleich	Lisa		2065332698					lisaz@ichs.com	PO Box 3007		Seattle	WA	98104	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Emergency Part D Contact	PACE Medical Director	Dr.	Walia	Mandeep		2064627100					mandeepw@ichs.com	803 S. Lane St		Seattle	WA	98104	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Emergency Part D Contact (Secondary)	PACE Medical Director	Dr.	Yerram	Lakshmi	D	2067883652					lyerram@ichs.com	PO 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Encounter Data & Risk Adjustment Operations Contact	PACE Medical Director	Dr.	Walia	Mandeep		2064627100					lyerram@ichs.com	PO Box 3007		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Enrollment Contact	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	EOB Transfer Contact	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189				2069623301	heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Financial Audit Contact	Chief Financial Officer	Mr.	Shahbazian	Hermes		2067883618					2hermes@ichs.com	720 8th Ave South		Seattle	WA	98104	12/19/2017	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Financial Reporting Contact	Chief Financial Officer		Shahbazian	Hermes		2067883618					2hermes@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Formulary Contact	PACE Medical Director		Walia	Mandeep		2064627100					mandeepw@ichs.com	PO Box 3007		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Formulary Contact (Secondary)	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	General Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Government Relations Contact	CEO		Nomura	Kelli		2067883659					knomura@ichs.com	720 8th Ave South		Seattle	WA	98104	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	HIPAA Privacy Officer	Compliance Officer		Schippa	Amie		2065214140					amies@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	HIPAA Security Officer	IT Manager		Gonzalez	Joshua		2067883628					joshuag@ichs.com	720 8th Ave South		Seattle	WA	98104	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Interoperability Contact	IT Manager		Gonzalez	Joshua		2067883628					joshuag@ichs.com	720 8th Ave S		Seattle	WA	98104	05/19/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	MA Appeals/Grievances Contact	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	MA Claims Processing Contact for Public Website	Chief Financial Officer		Shahbazian	Hermes		2067883618					2hermes@ichs.com	720 8th Ave South		Seattle	WA	98104	12/19/2017	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Marketing Contact	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Medical Director	PACE Medical Director	Dr.	Walia	Mandeep		2064627100					mandeepw@ichs.com	PO Box 3007		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Medicare Compliance Officer	Compliance Officer	Ms.	Schippa	Amie		2065214140					amies@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Medicare Coordinator	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Medicare Part D Opioid Overutilization Contact	PACE Medical Director		Walia	Mandeep		2064627100					mandeepw@ichs.com	PO Box		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Medication Therapy Management Contact	PACE Medical Director		Walia	Mandeep		2064627100					mandeepw@ichs.com	PO Box 3007		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Part C Application Contact	PACE Administrator		Munar	Ian		2067883726					ianm@ichs.com	PO Box 3007		Seattle	WA	981143007	12/19/2017	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Part D Appeals	HAWP Director		Wong	Heidi							heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active	2064627189				PACE - Nat		C	Seattle
H3084	Part D Appeals Contact (Secondary)	HAWP Director		Wong	Heidi							heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active	2064627189				PACE - Nat		C	Seattle
H3084	Part D Application Contact	PACE Administrator		Munar	Ian		2067883726					ianm@ichs.com	PO Box 3007		Seattle	WA	981143007	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Part D Benefits Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	803 S. Lane St		Seattle	WA	98104	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Part D Claims Submission Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	803 S. Lane St		Seattle	WA	98104	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Part D Exceptions Contact	HAWP Director		Wong	Heidi							heidiw@ichs.com	803 S. Lane St		Seattle	WA	98104	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active	2064627189				PACE - Nat		C	Seattle
H3084	Part D Exceptions Contact (Secondary)	PACE Medical Director	Dr.	Chim	Kannie							kanniec@ichs.com	PO Box 3007		Seattle	WA	98114	07/02/2021	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active	2064627185				PACE - Nat		C	Seattle
H3084	Part D Price File Contact (Back-up)	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Part D Price File Contact (Optional)	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	803 S. Lane St		Seattle	WA	98104	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Part D Price File Contact (Primary)	PACE Medical Director		Walia	Mandeep		2064627100					mandeepw@ichs.com	PO Box 3007		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Part D Quality Assurance Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	720 8th Avenue  South	2nd Floor	Seattle	WA	98104	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Part D Reporting Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	803 S. Lane St		Seattle	WA	98104	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Patient Safety Contact	PACE Medical Director		Walia	Mandeep		2064627100					mandeepw@ichs.com	PO Box 3007		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Payment Contact	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Pharmacy Director	Pharmacy Director	Dr.	Lee	JuHui		2067883756					juhuil@ichs.com	PO Box 3007		Seattle	WA	98114	07/02/2021	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Pharmacy Network Management Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Pharmacy Network Management Contact (Secondary)	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Pharmacy Technical Help Desk Contact	HAWP Director		Wong	Heidi							heidiw@ichs.com	803 S. Lane St		Seattle	WA	98104	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active	2064627189				PACE - Nat		C	Seattle
H3084	Plan Directory Contact for Public Website	Healthy Aging & Wellness Program Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Plan to Plan Reconciliation Contact	Chief Financial Officer		Shahbazian	Hermes		2067883618					2hermes@ichs.com	720 8th Ave South		Seattle	WA	98104	12/19/2017	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Processor Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Quality Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Reconciliation Contact	Chief Financial Officer		Shahbazian	Hermes		2067883618					2hermes@ichs.com	720 8th Ave South		Seattle	WA	98104	12/19/2017	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Reconciliation Contact (Secondary)	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	803 S. Lane St		Seattle	WA	98104	11/17/2022	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Recovery Audit Contact	HAWP Director	Ms	Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Surveillance Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	System Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Third Party Administrator (TPA) Liaison	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	User Access Contact	HAWP Director		Wong	Heidi		2064627189					heidiw@ichs.com	PO Box 3007		Seattle	WA	98114	04/04/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Utilization Management Contact	PACE Medical Director		Walia	Mandeep		2064627100					mandeepw@ichs.com	PO Box 3007		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3084	Utilization Review Contact	PACE Medical Director		Walia	Mandeep		2064627100					mandeepw@ichs.com	PO Box 3007		Seattle	WA	98114	07/24/2023	2023	INTERNATIONAL COMMUNITY HEALTH SERVICES	National PACE	International Community Health Services	National PACE		International Community Health Services	718	Yes	Active					PACE - Nat		C	Seattle
H3113	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H3113	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H3113	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H3113	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H3113	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3113	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	OXFORD HEALTH PLANS (NJ), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3132	Agent/Broker Compensation Data Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager	Mr.	Zlotkus	Steve		8587906250					partdcat@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Backup User Access Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Best Available Evidence Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Bid Audit Contact	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Bid Audit Site Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Bid Primary Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	CAP Report Contact for Public Website	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	CEO - CMS Administrator Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	CEO - Senior Official for Contracting	President	Mr.	Weinstein	Michael	A	3238605200				3234678450	michael.weinstein@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Chief Financial Officer	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Chief Operating Officer	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Chief Information Officer	Chief Information Officer	Mr.	Tychicus	Mohandoss		3238605360					mohandoss.tychicus@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Chief Information Security Officer	Director of Compliance, Deputy General Counsel	Mr.	Talukdar	Ashoke		3238605223				3234678450	ashoke.talukdar@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	CMMI Model Point of Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	CMS Casework Communication Contact	Risk Manager, Grievance & Appeals	Ms.	Beneche	Emelyne		9545223132	53292			8889657430	emelyne.beneche@aidshealth.org	700 SE 3rd Ave, 4th Floor		Fort Lauderdale	FL	33316	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Complaints Tracking Contact	Risk Manager, Grievance & Appeals	Ms.	Beneche	Emelyne		9545223132	53292			8889657430	emelyne.beneche@aidshealth.org	700 SE 3rd Ave, 4th Floor		Fort Lauderdale	FL	33316	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Contact for Fraud Investigations	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Coordination of Benefits Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Corporate Mailing						3234365000				3233379141	php@positivehealthcare.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance - Finanical Compliance	Mr.	Vazquez	David		3238605260				3239628513	david.vazquez@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Customer Service Operations Contact	Health Plan Administrator	Mr.	O'Malley	Michael		8884564715				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	DIR Contact	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	DIR Contact (Secondary)	Director of Finance - Finanical Compliance	Mr.	Vazquez	David		3238605260				3239628513	david.vazquez@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Electronic Health Record Contact	Director of Care Coordination	Ms.	Smith	Tiffany		9545223132	3222			8889727976	tiffany.smith@aidshealth.org	700 SE 3rd Ave 4rd Floor		Fort Lauderdale	FL	33316	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Emergency Part D Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		7143287404				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Emergency Part D Contact (Secondary)	Health Plan Administrator	Mr.	O'Malley	Michael		8186487834				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Employer Waiver Contact	Health Plan Administrator	Mr.	O'Malley	Michael		8884564715				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Encounter Data & Risk Adjustment Operations Contact	Associate Director of Risk Adjustment	Mr.	Twentyman	Thomas		3233379147					thomas.twentyman@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Enrollment Contact	Health Plan Administrator	Mr.	O'Malley	Michael		8884564715				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	EOB Transfer Contact	Assoc. Director Data and Information Architecture	Ms.	Adeli	Natalya		3238605317				8882358552	natalya.adeli@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Financial Audit Contact	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Financial Reporting Contact	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Formulary Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Formulary Contact (Secondary)	Manager, Formulary Administration & Maitenance	Ms.	Nyawabila	Christina		8587906297					FAS@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	General Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Government Relations Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	HIPAA Privacy Officer	Director of Compliance, Deputy General Counsel	Mr.	Talukdar	Ashoke		3238605223				3234678450	ashoke.talukdar@aidshealth.org	6255 W. Sunset Blvd., 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	HIPAA Security Officer	Director of Compliance, Deputy General Counsel	Mr.	Talukdar	Ashoke		3238605223				3234678450	ashoke.talukdar@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Hospice Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Interoperability Contact	IT Project Manager	Mr.	Hayek	Joe		3237662176	56034				yousef.hayek@aidshealth.org	2146 W Adams Blvd		Los Angeles	CA	90018	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	MA Appeals/Grievances Contact	Risk Manager, Grievance & Appeals	Ms.	Beneche	Emelyne		9545223132	53292			8889657430	emelyne.beneche@aidshealth.org	700 SE 3rd Ave, 4th Floor		Fort Lauderdale	FL	33316	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	MA Claims Processing Contact for Public Website	Director of Managed Care Operations	Ms.	Carter	Rebecca		8886620626				8882359274	rebecca.carter@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Marketing Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Medical Director	Medical Director	Dr.	Bivins	Marc		9545223132				8889749948	marc.bivins@aidshealth.org	700 SE 3rd Ave., 3rd Floor		Fort Lauderdale	FL	33316	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Medicare Compliance Officer	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Medicare Coordinator	VP of Manged Care Operations	Ms.	Haughey	Karen		3233379170				8882359376	karen.haughey@aidshealth.org	700 SE 3rd Ave 3rd Floor		Fort Lauderdale	FL	33316	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Medicare Part D Opioid Overutilization Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Medication Therapy Management Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	OffShore Subcontractor Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Online Enrollment Center Contact (Back-up)	Director of Member Services	Ms.	Ramos	Melissa		3234365008				8882358552	melissa.ramos2@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Online Enrollment Center Contact (Primary)	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Part C Application Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Part C Reporting Contact	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Appeals	Pharmacy Director - Managed Care	Mr.	Dao	Anthony						8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract	8885541334				HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Appeals Contact (Secondary)	Health Plan Administrator	Mr.	O'Malley	Michael						8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract	8667639096				HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Application Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Benefits Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Claims Submission Contact	Assoc. Director Data and Information Architecture	Ms.	Adeli	Natalya		3238605317					natalya.adeli@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Exceptions Contact	Pharmacy Director - Managed care	Mr.	Dao	Anthony						8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract	8885541334				HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Exceptions Contact (Secondary)	Health Plan Administrator	Mr.	O'Malley	Michael						8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract	8667639096				HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Price File Contact (Back-up)	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Price File Contact (Optional)	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Price File Contact (Primary)	Medicare Part D Project Manager	Ms.	Niemi	Kirstin		8587906544					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Quality Assurance Contact	National Director of Quality	Ms.	Uranaka	Christine		9545940827				8882358482	christine.uranaka@aidshealth.org	1001 N. Martel Ave.		Los Angeles	CA	90046	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Part D Reporting Contact	Medicare Part D Project Manager	Ms.	Scott	Susan		8587906565					medicarepartdprojectmanagers@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Patient Safety Contact	Director of Care Coordination	Ms.	Smith	Tiffany		9545223132	3222			8889727976	tiffany.smith@aidshealth.org	700 SE 3rd Ave., 4rd Floor		Fort Lauderdale	FL	33316	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Payment Contact	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W. Sunset Blvd., 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Personal Health Record Contact	Director of Care Coordination	Ms.	Smith	Tiffany		9545223132	3222			8889727976	tiffany.smith@aidshealth.org	700 SE 3rd Ave 4rd Floor		Fort Lauderdale	FL	33316	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Pharmacy Director	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Pharmacy Network Management Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Pharmacy Network Management Contact (Secondary)	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Pharmacy Technical Help Desk Contact	Pharmacy Director - Managed care	Mr.	Dao	Anthony						8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract	8885541334				HMO - Health Maintenance Organization		C	San Francisco
H3132	Pharmacy Technical Help Desk Contact (Secondary)	Lead Pharmacy Services Coordinator	Ms.	Marquez	Celica						8882382244	pharmacyhelpdesk@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract	8885541334				HMO - Health Maintenance Organization		C	San Francisco
H3132	PHR Beneficiary Contact																	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS	AHF MCO of Florida Inc	AIDS Healthcare Foundation	3	Yes	Withdrawn Contract	8884564715				HMO - Health Maintenance Organization		C	San Francisco
H3132	Physician Incentive Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Plan Directory Contact for Public Website	Health Plan Administrator	Mr.	O'Malley	Michael		8332676768				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3238605283	lyle.honig@aidshealth.org	6255 W. Sunset Blvd., 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Processor Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Quality Contact	National Director of Quality	Ms.	Uranaka	Christine		9545940827				8882358482	christine.uranaka@aidshealth.org	1001 N. Martel Ave.		Los Angeles	CA	90046	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Reconciliation Contact	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Reconciliation Contact (Secondary)	Director of Finance - Finanical Compliance	Mr.	Vazquez	David		3238605260				3239628513	david.vazquez@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Recovery Audit Contact	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	SNP Application Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	SNP State Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Surveillance Contact	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	System Contact	Assoc. Director Data and Information Architecture	Ms.	Adeli	Natalya		3238605317					natalya.adeli@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Third Party Administrator (TPA) Liaison	Director of Finance - Finanical Compliance	Mr.	Vazquez	David		3238605260					david.vazquez@aidshealth.org	6255 W. Sunset Blvd., 21st Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	User Access Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172					michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Utilization Management Contact	Director of Care Coordination	Ms.	Smith	Tiffany		9545223132	3222			8889727976	tiffany.smith@aidshealth.org	700 SE 3rd Ave 4rd Floor		Fort Lauderdale	FL	33316	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3132	Utilization Review Contact	Director of Care Coordination	Ms.	Smith	Tiffany		9545223132	3222			8889727976	tiffany.smith@aidshealth.org	700 SE 3rd Ave 4rd Floor		Fort Lauderdale	FL	33316	06/01/2023	2023	AHF MCO OF FLORIDA, INC.	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H3146	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/07/2018	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/06/2019	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	12/02/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	DIR Contact (Secondary)	Senior Director of Finance	Mr	Passuello	Clifford	A	7178292378				7247417216	CAPassuello@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/22/2021	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	12/07/2018	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H3146	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/07/2018	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/22/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	12/07/2018	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3146	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/06/2015	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H3152	PHR Beneficiary Contact																	02/28/2007	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				HMO - Health Maintenance Organization		C	Philadelphia
H3152	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/11/2015	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3152	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (NJ)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3170	Agent/Broker Compensation Data Contact	Commission Analyst	Ms.	Westley	Tracey		4029828256					tracey.westley@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/01/2016	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Automated TrOOP Balance Transfer Contact	Director PBM Operations	Ms.	Allie	Cindy		6127776755					EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	06/20/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Backup User Access Contact	Medicare Liaison	Ms.	Ellison	LeeAnn		4029826477					leeann.ellison@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/23/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Best Available Evidence Contact	Enrollment and Billing Manager	Ms.	Ware	Anita		5083309500					Anita.Ware@advantasure.com	134 Turnpike Road		Southborough	MA	01772	02/08/2019	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Bid Audit Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Bid Audit Site Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Bid Primary Contact	Senior Consultant	Ms.	Fox	Angela		6027174493					afox@rebellisgroup.com	17090 S Highland Ridge Dr		Village of Loch Lloyd	MO	64012	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Vaughn	Shannon		4029827846					shannon.vaughn@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	CEO - CMS Administrator Contact	Chief Revenue Officer	Mr	Rowe	Ron		4029826013					ron.rowe@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	02/13/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	CEO - Senior Official for Contracting	Chief Revenue Officer	Mr	Rowe	Ron		4029826013					ron.rowe@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	02/13/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Chief Financial Officer	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	10/16/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Chief Operating Officer	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/13/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Chief Information Officer	VP Information Services, CIO	Mr.	Kolli	Rama		4029827556					Rama.Kolli@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/01/2016	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Chief Information Security Officer	Director of Information Assurance and CSO	Mr.	Kremke	Kerry		4029827583					Kerry.Kremke@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/01/2016	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	CMS Casework Communication Contact	Senior Direction, Operations	Ms.	Franke	Dana		5035516818					dfranke@rebellisgroup.com	17090 S Highland Ridge Dr	TC1301	Village of Loch Lloyd	MO	64012	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Complaints Tracking Contact	Project Consultant	Ms.	Hill	Erin		2164829422					ehill@rebellisgroup.com	17090 S Highland Ridge Dr		Village of Loch Lloyd	MO	64012	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Contact for Fraud Investigations	Sr Dir, Associate General Counsel		Nogosek	Kory		4029828936					kory.nogosek@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	01/21/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Coordination of Benefits Contact	Director PBM Operations	Ms.	Allie	Cindy		6127776755					COBMedD@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	06/20/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Corporate Mailing						4029827842					MedicareCompliance@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	06/26/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Coverage Gap Discount Program (CGDP) Payment Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	01/17/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Customer Service Operations Contact	Director, Workforce Management, Analytics & Suppor		Weber	Julie		8885052022					jweber@bcbsm.com	500 Lafayette East		Detroit	MI	48226	04/19/2021	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	DIR Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	01/17/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	DIR Contact (Secondary)	MA Compliance Officer	Ms.	Vaughn	Shannon		4029827846					shannon.vaughn@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Electronic Health Record Contact	Director Clnical Quality Improvement	Ms.	Collins	Shelley		4029828564					Shelley.Collins@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	10/16/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Emergency Part D Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	03/25/2019	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Emergency Part D Contact (Secondary)	MA Compliance Officer	Ms.	Vaughn	Shannon		4029827846					shannon.vaughn@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Employer Waiver Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Encounter Data & Risk Adjustment Operations Contact	Manager Risk Adjustment	Ms.	Boardman	Laura		4029827636					laura.boardman@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	10/16/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Enrollment Contact	Enrollment and COB Manager	Ms.	LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road, Suite 200		Glen Allen	VA	23060	03/22/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	EOB Transfer Contact	Manager, PBM Operations	Ms.	Allie	Cindy		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	06/20/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Financial Audit Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	01/17/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Financial Reporting Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	01/17/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Formulary Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	03/25/2019	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negashl@primetherapeutics.com	29090 Ames Crossing Road		Eagan	MN	55121	10/16/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	General Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Government Relations Contact	Chief Actuary and Analytics Officer	Mr.	Konnath	Steven		4029828862					steven.konnath@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	12/19/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	HIPAA Privacy Officer	Director of Information Assurance and CSO	Mr.	Kremke	Kerry		4029827583					Kerry.Kremke@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	10/16/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	HIPAA Security Officer	Director of Information Assurance and CSO	Mr.	Kremke	Kerry		4029827583					Kerry.Kremke@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	10/16/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Hospice Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	03/25/2019	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Interoperability Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	MA Appeals/Grievances Contact	Manager, MA Grievances and Appeals	Ms.	Catlin	Shelly		3132257317					SCatlin@bcbsm.com	600 East Lafayette		Detroit	MI	48226	10/16/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	MA Claims Processing Contact for Public Website	Operations Manager	Ms.	Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	4121 Cox Road, Suite 200		Glen Allen	VA	23060	03/22/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Marketing Contact	Marketing Specialist, Direct to Consumer	Ms.	Young	Morgan		4029827000					morgan.young@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Medical Director	CMO, VP Healthcare Svcs	Dr.	Gordon-Simet	Josette		4029828925					josette.gordonsimet@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	12/29/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Medicare Compliance Officer	MA Compliance Officer	Ms.	Vaughn	Shannon		4029827846					shannon.vaughn@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	06/18/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Medicare Coordinator	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Medicare Part D Opioid Overutilization Contact	Supv Pharmacists		Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	04/06/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Medication Therapy Management Contact	Manager, MTM and Case/Care Managmeent		Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	2900 Ames Crossing Road		EAgan	MN	55120	04/06/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Online Enrollment Center Contact (Back-up)	Enrollment Business Lead	Mr.	Schulz	Bryan		5084390769					Bryan.Schulz@advantasure.com	134 Turnpike Road		Southborough	MA	01772	03/22/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Online Enrollment Center Contact (Optional)	Sr Market Operations Specialist		Broussard Booker	Dwuane		4029827000					dwuane.broussardbooker@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	06/26/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Online Enrollment Center Contact (Primary)	Enrollment and COB Manager	Ms.	LaMontagne	Amanda		5084399720					Amanda.Lamontagne@advantasure.com	4121 Cox Road, Suite 200		Glen Allen	VA	23060	03/22/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Part C Application Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Part C Reporting Contact	Consultant	Ms.	Purdy	Caitlin		5037980382					cpurdy@rebellisgroup.com	17090 S Highland Ridge Dr	TC 1301	Village of Loch Lloyd	MO	64012	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	04/06/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetheraputics.com	2900 Ames Crossing Road		Eagan	MN	55120	04/06/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active	5054690403				HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Application Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Benefits Contact	Director, Benefit Operations	Ms.	Gergen	Ashley		6127772506					agergeni@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	10/16/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Claims Submission Contact	Functional Business Consultant - Government Progra	Mr.	Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	04/26/2019	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/29/2021	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active	8006936703				HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	04/06/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Price File Contact (Back-up)	Price File Analyst Sr		Trudeau	Ashley		6127771338					ashley.trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	04/06/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Price File Contact (Optional)	QA Analyst	Ms.	Tastad	Emily		6127771699					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	04/06/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Price File Contact (Primary)	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	03/25/2019	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Quality Assurance Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	03/25/2019	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Part D Reporting Contact	Client Relations Compliance Consultant	Ms.	Leon	Megan		2486654675					mleon@bcbsm.com	600 Lafayette East	TC 1301	Detroit	MI	48226	12/21/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Patient Safety Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	10/16/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Payment Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	01/17/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Pharmacy Director	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	02/11/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Pharmacy Network Management Contact	AVP, Network Management	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/29/2021	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Pharmacy Network Management Contact (Secondary)	Sr. Dir Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/21/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/29/2021	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active	8554571351				HMO - Health Maintenance Organization		C	Kansas City
H3170	Pharmacy Technical Help Desk Contact (Secondary)	AVP , Customer Experience & Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/29/2021	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active	8554571351				HMO - Health Maintenance Organization		C	Kansas City
H3170	Physician Incentive Contact	CMO, VP Healthcare Svcs	Dr.	Gordon-Simet	Josette		4029828925					josette.gordonsimet@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	12/29/2022	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Plan Directory Contact for Public Website	Director, Workforce Management, Analytics & Suppor		Weber	Julie		8885052022					jweber@bcbsm.com	500 Lafayette East		Detroit	MI	48226	05/26/2021	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Plan to Plan Reconciliation Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	01/17/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Processor Contact	Director PBM Operations	Ms.	Allie	Cindy		6127776755				6127776706	MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing		Eagan	MN	55121	06/20/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Quality Contact	Director Clnical Quality Improvement	Ms.	Collins	Shelley		4029828564					Shelley.Collins@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	10/16/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Reconciliation Contact	Director, SBD Business Performance & Finance	Ms.	Crawford	Constance		2486654231					ccrawford@bcbsm.com	600 Lafayette East	TC 1301	Detroit	MI	48226	10/16/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Reconciliation Contact (Secondary)	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	01/17/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Recovery Audit Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	01/17/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Surveillance Contact	Executive Consultant	Ms.	Hollie	Diane		2154991417					dhollie@rebellisgroup.com	17090 S. Highland Ridge Dr		Village of Loch Lloyd	MO	64012	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	System Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Third Party Administrator (TPA) Liaison	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	01/17/2020	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	User Access Contact	MA Compliance Officer	Ms.	Vaughn	Shannon		4029827846					shannon.vaughn@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	02/22/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Utilization Management Contact	Managing Director, Clinical Operations, Medicare P	Ms.	Cooper	Kristi		8127866496					kristi.cooper@advantasure.com	4121 Cox Rd.	Ste 200	Glenn Allen	VA	23060	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3170	Utilization Review Contact	Director, Health Management	Mr.	Cooper	Kristi		8127866496					kristi.cooper@advantasure.com	4121 Cox Rd.	Ste 200	Glenn Allen	VA	23060	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	HMO/HMOPOS		Blue Cross Blue Shield of Nebraska	647	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3186	Agent/Broker Compensation Data Contact	Director of Product Development	Ms.	Meyer	Courtney		6053122613					Courtney.Meyer@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Automated TrOOP Balance Transfer Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Backup User Access Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Best Available Evidence Contact	Director of Billing & Enrollment	Mr.	Reichelt	Daniel		6053122624					daniel.reichelt@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Bid Audit Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Bid Audit Site Contact	Director of Acturial Services	Mr.	Pence	Gregory		4156018550					gregory.pence@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Bid Primary Contact	Director of Actuarial Services	Mr.	Pence	Gregory		4156018550					gregory.pence@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	CAP Report Contact for Public Website	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active	6053286806				PPO - BBA		C	Dallas
H3186	CEO - CMS Administrator Contact	President	Mr.	Snyder	John		6053122750					john.snyder@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	CEO - Senior Official for Contracting	President	Mr.	Snyder	John		6053122750					john.snyder@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Chief Financial Officer	Vice President of Finance	Mr.	Maude	Brian		6053286801					Brian.Maude@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Chief Operating Officer	Chief Operating Officer	Ms.	Griese	Emily		6053287020					Emily.Griese@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Chief Information Officer	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Chief Information Security Officer	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	CMMI Model Point of Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	CMS Casework Communication Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 Cherapa place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Complaints Tracking Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Contact for Fraud Investigations	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Coordination of Benefits Contact	Director of Payment Integrity	Ms.	Lieser	Mesa		6053287024					mesa.lieser@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Corporate Mailing						8005354831					sanfordhealthplan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Customer Service Operations Contact	Director of Customer Service	Mr.	Ling	Ryan		6053127459					ryan.ling@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	DIR Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	DIR Contact (Secondary)	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Electronic Health Record Contact	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Emergency Part D Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Emergency Part D Contact (Secondary)	Senior Director of Goverment Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Employer Waiver Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Encounter Data & Risk Adjustment Operations Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Enrollment Contact	Director of Product Development	Ms.	Meyer	Courtney		6053122613					courtney.meyer@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	EOB Transfer Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182				6053286811	aleesa.jansick@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Financial Audit Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Financial Reporting Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Formulary Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Formulary Contact (Secondary)	Principal Pharmacy Benefits Specialist		Chen	Honghua		2242312740					Christine.Chen2@optum.com	1600  McConnor Parkway	Suite 201	Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	General Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Government Relations Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	HIPAA Privacy Officer	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	HIPAA Security Officer	Systems Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Hospice Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Interoperability Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	MA Appeals/Grievances Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	MA Claims Processing Contact for Public Website	Executive Director Operations	Ms.	Guggisberg	Stacey		6053286802					stacey.guggisberg@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Marketing Contact	Director of Marketing	Ms.	McCloskey	Diana		6053122762					diana.mccloskey@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Medical Director	Vice President, Medical Officer	Dr.	Faber	Kevin		6053287192					kevin.faber@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Medicare Compliance Officer	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Medicare Coordinator	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Medication Therapy Management Contact	Clinical Program Manager	Ms.	Liaqat	Tazeen		6305440541					Tazeen.liaqat@optum.com	1240 South Pine Island Rd.		Plantation	FL	33324	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	OffShore Subcontractor Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Online Enrollment Center Contact (Back-up)	Director of Medicare Programs	Mr.	Ovenden	Nathan		6053122606					nathan.ovenden@sanfordhealth.org	300 Cherapa Place, Suite 201		Sioux Falss	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Online Enrollment Center Contact (Optional)	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Online Enrollment Center Contact (Primary)	Senior Director of Development and Distribution	Ms.	Meyer	Courtney		6053122613					courtney.meyer@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Part C Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Part C Reporting Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Part D Appeals	Manager, Prior Authorization Appeals	Ms.	Le	Christina						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active	8884033398				PPO - BBA		C	Dallas
H3186	Part D Appeals Contact (Secondary)	Pharmacy Technician, PA Appeals		Chavez	Kelly						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active	8884033398				PPO - BBA		C	Dallas
H3186	Part D Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Part D Benefits Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Part D Claims Submission Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Part D Exceptions Contact	Manager, Prior Authorization	Ms.	Le	Christina						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active	8884033398				PPO - BBA		C	Dallas
H3186	Part D Exceptions Contact (Secondary)	Pharmacy Technician, PA		Chavez	Kelly						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active	8884033398				PPO - BBA		C	Dallas
H3186	Part D Price File Contact (Back-up)	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615				6053286811	timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Part D Price File Contact (Optional)	Senior Director of Government Program	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Part D Price File Contact (Primary)	Senior Business Analyst	Ms.	Lyman	Dorothy		6514955369					Dorothy.Lyman@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Part D Quality Assurance Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007				6053286811	rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Part D Reporting Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Patient Safety Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Payment Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Personal Health Record Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Pharmacy Director	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615				6053286811	timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations	Ms.	Ashby	Jolynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk	Mr.	Summers	Todd							Todd.Summers@optum.com	1600 McConnor Parkway	Suite 200	Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active	8446429090				PPO - BBA		C	Dallas
H3186	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Service	Mr.	Juarez	Ethan							ethan.juarez@optum.com	3515 Harbor Blvd		Costa Mesaa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active	7148256891				PPO - BBA		C	Dallas
H3186	PHR Beneficiary Contact																	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO	Sanford Health Plan	Sanford Health	740	Yes	Active	8885354831				PPO - BBA		C	Dallas
H3186	Physician Incentive Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Plan Directory Contact for Public Website	Senior Director of Risk & Regulation	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Plan to Plan Reconciliation Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Processor Contact	Senior Manager, Benefit Administration	Ms.	Lievanos	Cassandra		7637974205					cassandra.lievanos@optum.com	5701 Katella Ave		Cypress	CA	90630	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Quality Contact	Senior Director of Risk & Regulation	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Reconciliation Contact	Director of Billing & Enrollment	Mr.	Reichelt	Daniel		6053122624					daniel.reichelt@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Reconciliation Contact (Secondary)	Executive Director of Opertions	Ms.	Guggisberg	Stacey		6053286802					stacey.guggisberg@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Recovery Audit Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	SNP Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	SNP State Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Surveillance Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	System Contact	Systems Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Third Party Administrator (TPA) Liaison	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	User Access Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Utilization Management Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3186	Utilization Review Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN OF MINNESOTA	Local CCP	Sanford Health Plan of Minnesota	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H3189	Agent/Broker Compensation Data Contact	SVP Health Plan Operations		Cochran	Rick		4026306924					rcochran@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/18/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Automated TrOOP Balance Transfer Contact	Director Enrollment, Eligibility &B OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/05/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Backup User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Best Available Evidence Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Bid Audit Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Bid Audit Site Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Bid Primary Contact	ACTUARY	Mr.	Copeland	Joe		3142095834					jcopeland@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/24/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	CAP Report Contact for Public Website	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	CEO - CMS Administrator Contact	COO	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/08/2022	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	CEO - Senior Official for Contracting	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Chief Financial Officer	Chief Financial Officer	Mr.	Grabski	Ben		7633007611					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/28/2022	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Chief Operating Officer	Chief Operating Officer	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	02/08/2022	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Chief Information Officer	Chief Information Officer	Mr.	Saghabini	JeanClaude		6173124659					jsaghbini@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Chief Information Security Officer	Chief Information Security Officer	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	CMMI Model Point of Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	CMS Casework Communication Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Complaints Tracking Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Contact for Fraud Investigations	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Coordination of Benefits Contact			Inquiries	COB		8665979560					COBInquiry@lumeris.com	P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Corporate Mailing						8665979560					customerservice@essencehealthcare.com	CUSTOMER SERIVCE	P O BOX 5907	TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Coverage Gap Discount Program (CGDP) Payment Contact	Sr Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Customer Service Operations Contact	Vice President, Health Plan Operations	Ms.	Meyerhoffer	Linda		6366869682					rmeyerhoffer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	DIR Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	DIR Contact (Secondary)	Sr Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly	M	3142092795					pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Emergency Part D Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		6307425966					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Emergency Part D Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Encounter Data & Risk Adjustment Operations Contact	VP - Risk Adjustment Services	Mr.	Eschbach	Jason		6144397608					jeschbach@lumeris.com	13900 Riverport Drive		St. Louis	MO	63043	12/08/2022	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Enrollment Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	EOB Transfer Contact	Director, Claims	Ms.	Wasserman	Rachelle		3147703520				3147706096	rwasserman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Financial Audit Contact	SVP Corporate Accounting & Chief Compliance Office	Ms.	Venable	Erin		3142093957					evenable@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Financial Reporting Contact	Corporate Accounting Director	Ms.	Pinkerton	Amanda		3145183519					apinkerton@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/05/2022	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Formulary Contact		Ms	Nyawabila	Christina		8447906297					FAS@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Formulary Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	General Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Government Relations Contact	Chief Legal Officer	Ms.	Halterman	Gail		3142092717					ghalterman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Davis	Amy		3142093945					adavis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	HIPAA Security Officer	CISO	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Hospice Contact	Vice President, Clinical Operations		Cruz	Jennifer		3147703556					pharmacy@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Interoperability Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Darnell	Erika		3144382410					ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/09/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	MA Claims Processing Contact for Public Website			Service	Customer		8665979560				8884802577	customerservice@essencehealthcare.com	P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Marketing Contact	Manager, Compliance Marketing	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/28/2022	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Medical Director	Senior Medical Officer, UM	Dr.	Fusco	Michael		3147703770					mfusco@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/08/2022	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Medicare Compliance Officer	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/18/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Medicare Coordinator	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Medicare Part D Opioid Overutilization Contact	Snr. Clinical Pharmacist	Ms.	Pasagic	Melita		3147703775					mpasagic@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	02/16/2022	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Medication Therapy Management Contact	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	OffShore Subcontractor Contact	SVP Corporate Accounting & Chief Compliance Office	Ms.	Venable	Erin		3142093957					evenable@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Online Enrollment Center Contact (Back-up)	Manager, Compliance	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Online Enrollment Center Contact (Optional)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Online Enrollment Center Contact (Primary)	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Part C Application Contact	Sr. Director CMS Applications & PBP submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Part C Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Appeals	Director, Appeals & Grievances	Ms.	Darnell	Erika							ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/09/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	3144382410				HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Appeals Contact (Secondary)	Sr. Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly	M						pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/28/2022	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	3147209279				HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Benefits Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Claims Submission Contact		Ms.	Scherlippens	Carine		8587907415					Carine.Scherlippens@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Exceptions Contact		Ms.	Byers	June							June.Byers@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Exceptions Contact (Secondary)		Mr	Elias	Jason							Jason.Elias@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Price File Contact (Back-up)	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Price File Contact (Optional)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Price File Contact (Primary)		Ms.	Finder	Plan		8445136003					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Quality Assurance Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Part D Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Patient Safety Contact	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Payment Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Pharmacy Director	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Pharmacy Network Management Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Pharmacy Network Management Contact (Secondary)			Pharmacy Operations	MedImpact		8445136003					PharmacyOperationsSups@MedImpact.com	10182 Scripps Gateway Court		San Diego	CA	92131	09/28/2022	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services	Ms.	Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				HMO - Health Maintenance Organization		C	Kansas City
H3189	Pharmacy Technical Help Desk Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly							ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active	3147703788				HMO - Health Maintenance Organization		C	Kansas City
H3189	Physician Incentive Contact	Sr. Manager, Health Plan Finance	Mr.	Privott	David		3147703732					dprivott@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Plan Directory Contact for Public Website			Service	Customer		8665979560					customerservice@essencehealthcare.com	1P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Plan to Plan Reconciliation Contact	Sr Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Processor Contact		Ms.	Scott	Susan		8447906565					Susan.Scott@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Quality Contact	Snr. Director, Quality Improvement		Pattison	Lisa		5082728692					lpattison@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Reconciliation Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Reconciliation Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Recovery Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	SNP Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	SNP State Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Surveillance Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	System Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Third Party Administrator (TPA) Liaison	Client AP Specialist	Ms.	Brock	Letecea		3142548778					lbrock@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Utilization Management Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3189	Utilization Review Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/21/2021	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3192	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/07/2018	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	12/07/2018	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H3192	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/07/2018	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	12/07/2018	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3192	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF MICHIGAN INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3204	Agent/Broker Compensation Data Contact	Director-INDIVIDUAL PLAN PROGRAMS & SALES OPS	Mrs	Montoya	Jessica		5059238241					jemontoya@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	12/16/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Automated TrOOP Balance Transfer Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Backup User Access Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Best Available Evidence Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Bid Audit Contact	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Bid Audit Site Contact	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Bid Primary Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	09/13/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	CAP Report Contact for Public Website	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active	8663887737	8598			HMO - Health Maintenance Organization		C	Dallas
H3204	CEO - CMS Administrator Contact	President, Presbyterian Health Plan	Mr	Fryar	Brandon		5059236366				5059238244	bfryar@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	01/03/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	CEO - Senior Official for Contracting	President, Presbyterian Health Plan	Mr	Fryar	Brandon		5059236366				5059238244	bfryar@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/30/2017	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Chief Financial Officer	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Chief Operating Officer	Vice President and Chief Operations Officer	Mr	Johnson	John		5059235274					jjohnson12@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/15/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Chief Information Officer	Chief Technology Performance Officer	Mr	Fett	Doug		5059238644				5059238244	cfett@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/05/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Chief Information Security Officer	Chief Information Security Officer	Ms	McClung	Barbara		4082197031					bmcclung2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/05/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	CMMI Model Point of Contact	VP, Chief Actuary	Mr	Merz	Charles		5704129351					cmerz@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/01/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	CMS Casework Communication Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Complaints Tracking Contact	Medicare Manager, Appeals and Grievance	Mr	Anaya	Daniel		5059235821				5059236111	danaya@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Contact for Fraud Investigations	Director Program Integrity and RO	Ms	Jamison	Mary Alice		5059236706					mjamison2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/19/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Coordination of Benefits Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Corporate Mailing						5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/26/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Budget and Financial Planning	Ms	Lemmons	Lisa		5059236314				5059238244	llemmons2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Customer Service Operations Contact	Vice President, PCSC	Ms	Garcia	Kelly		5059238580				5059235124	kgarcia3@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/29/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	DIR Contact	Executive Director Pharmacy Services	Mr	Roland	Frank		5059235530					froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/24/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	DIR Contact (Secondary)	Manager Medicare Part D, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	01/27/2020	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Emergency Part D Contact	Executive Director Pharmacy Services	Mr	Roland	Frank		5059235530					froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Emergency Part D Contact (Secondary)	Eprescribe Program Manager, Pharmacy Services	Ms	Van Klaveren	Kasey		5059235533					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Employer Waiver Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Encounter Data & Risk Adjustment Operations Contact	Manager, Risk Adjustment	Mr	Bundy	Andrew		5059236452					abundy@phs.org	9521 San Mateo NE		Albuquerque	NM	87113	03/10/2020	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Enrollment Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	EOB Transfer Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Financial Audit Contact	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Financial Reporting Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Formulary Contact	Manager Medicare Part D, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Formulary Contact (Secondary)	VP Chief Medical Officer	Dr	Clarke	Gray		5059238117				5058433065	gclarke@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/01/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	General Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Government Relations Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	HIPAA Privacy Officer	Privacy Officer	Ms	Collaros	Sophia		5059236176				5059238159	scollaros@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/26/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	HIPAA Security Officer	Chief Information Security Officer	Ms	McClung	Barbara		4082197031					bmcclung2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/05/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Hospice Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Interoperability Contact	Chief Technology Performance Officer	Mr	Fett	Doug		5059238644				5059238244	cfett@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/05/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	MA Appeals/Grievances Contact	Medicare Manager, Appeals and Grievance	Mr	Anaya	Daniel		5059235821				5059236111	danaya@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	MA Claims Processing Contact for Public Website	Presbyterian Customer Service Center		Provider Care Unit	PCSC		5059236060				5059235124	info@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	12/28/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Marketing Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Medical Director	VP Chief Medical Officer	Dr	Clarke	Gray		5059238117				5058433065	gclarke@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/01/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Medicare Compliance Officer	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Medicare Coordinator	Manager, Medicare Programs	Ms	Jamael	Rosie		5059238203				5059235866	rjamael@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	12/28/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Medicare Part D Opioid Overutilization Contact	Manager Medicare Part D, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/02/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Medication Therapy Management Contact	Manager Medicare Part D, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/02/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Online Enrollment Center Contact (Back-up)	Director, Enrollment Operations	Mr	Myers	Richard		5059236169				5059235385	rmyers4@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	12/16/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Online Enrollment Center Contact (Optional)	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/28/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Online Enrollment Center Contact (Primary)	Manager, Enrollment Operations	Ms	Bracamonte	Susie		5059236017				5059235385	sbracamo@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/15/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Part C Application Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Part C Reporting Contact	Medicare Reporting Data Specialist	Ms	Tapia	Ashley		5059236153				5059235866	atapia10@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/29/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Appeals	Medicare Manager, Appeals and Grievance	Mr	Anaya	Daniel						5059236111	danaya@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active	5059235821				HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Appeals Contact (Secondary)	Director, Appeals and Grievance	Ms	Napoleone Salazar	Sara						5059236111	snapoleon@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/19/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active	5059238064				HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Application Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Benefits Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Claims Submission Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Exceptions Contact	Executive Director, Pharmacy Services	Mr	Roland	Frank							froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/28/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active	5059235530				HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Exceptions Contact (Secondary)	Medicare Part D Manager, Pharmacy Services	Ms	Padilla	Melissa							mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active	5059235533				HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Price File Contact (Back-up)			Rx	Optum		6514955363					medops_planfinder@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	10/12/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Price File Contact (Optional)	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235526				5059235540	kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/29/2020	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Price File Contact (Primary)	Executive Director, Pharmacy Services	Mr	Roland	Frank		5059235530					froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/28/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Quality Assurance Contact	Executive Director, Pharmacy Services	Mr	Roland	Frank		5059235530					froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/28/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Part D Reporting Contact	Medicare Programs Reporting Specialist	Ms	Tapia	Ashley		5059236153				5059235866	atapia10@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/31/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Patient Safety Contact	Manager Medicare Part D, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/02/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Payment Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Pharmacy Director	Executive Director, Pharmacy Services	Mr	Roland	Frank		5059235530					froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/28/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Pharmacy Network Management Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Pharmacy Network Management Contact (Secondary)	Medicare Part D Manager, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Pharmacy Technical Help Desk Contact	Executive Director, Pharmacy Services	Mr	Roland	Frank							froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/28/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active	8665285829				HMO - Health Maintenance Organization		C	Dallas
H3204	Pharmacy Technical Help Desk Contact (Secondary)	Medicare Part D Manager, Pharmacy Services	Ms	Padilla	Melissa							mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active	8665285829				HMO - Health Maintenance Organization		C	Dallas
H3204	Physician Incentive Contact	Vice President, Provider Network Management	Mr	Gear	Brady		5059235805				5059235400	bgear@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/29/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Plan Directory Contact for Public Website	Presbyterian Customer Service Center		Provider Care Unit	PCSC		5059235757				5059235124	info@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	01/18/2018	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Plan to Plan Reconciliation Contact	Data Reporting Specialist, Risk Adjustment	Ms	Pham	Sindy		5059236012				5059238244	rpham@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/13/2019	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Processor Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Quality Contact	Director, PHP Quality Management	Ms	Taylor	Susan		5059238040				5058433841	staylor7@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/07/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Reconciliation Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Reconciliation Contact (Secondary)	Director, Financial Planning and Analysis	Ms	Andersen	Stacy		5059238307				5059238252	kandersen@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/29/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Recovery Audit Contact	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	SNP Application Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	09/13/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Surveillance Contact	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	System Contact	Chief Technology Performance Officer	Mr	Fett	Doug		5059238644				5059238244	cfett@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/05/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Third Party Administrator (TPA) Liaison	Manager, Budget and Financial Planning	Ms	Lemmons	Lisa		5059236314				5059235540	llemmons2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	User Access Contact	Manager, Medicare Programs	Ms	Jamael	Rosie		5059238203				5059235866	rjamael@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/29/2022	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Utilization Management Contact	VP Associate Chief Medical Officer	Dr	White	Clinton		5059235875					cwhite13@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/14/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3204	Utilization Review Contact	VP Associate Chief Medical Officer	Dr	White	Clinton		5059235875					cwhite13@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/14/2023	2023	PRESBYTERIAN HEALTH PLAN	Local CCP	Presbyterian Health Plan	HMO/HMOPOS		Presbyterian Healthcare Services	188	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3206	Agent/Broker Compensation Data Contact	Director-INDIVIDUAL PLAN PROGRAMS & SALES OPS	Mrs	Montoya	Jessica		5059238241					jemontoya@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	12/16/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Automated TrOOP Balance Transfer Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Backup User Access Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Best Available Evidence Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Bid Audit Contact	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Bid Audit Site Contact	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Bid Primary Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	09/13/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	CAP Report Contact for Public Website	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active	8663887737	8598			PPO - BBA		C	Dallas
H3206	CEO - CMS Administrator Contact	President, Presbyterian Health Plan	Mr	Fryar	Brandon		5059236366				5059238244	bfryar@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	01/03/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	CEO - Senior Official for Contracting	President, Presbyterian Health Plan	Mr	Fryar	Brandon		5059236366				5059238244	bfryar@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/30/2017	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Chief Financial Officer	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Chief Operating Officer	Vice President and Chief Operations Officer	Mr	Johnson	John		5059235274					jjohnson12@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/15/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Chief Information Officer	Chief Technology Performance Officer	Mr	Fett	Doug		5059238644				5059238244	cfett@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/05/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Chief Information Security Officer	Chief Information Security Officer	Ms	McClung	Barbara		4082197031					bmcclung2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/05/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	CMMI Model Point of Contact	VP, Chief Actuary	Mr	Merz	Charles		5704129351					cmerz@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/01/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	CMS Casework Communication Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Complaints Tracking Contact	Medicare Manager, Appeals and Grievance	Mr	Anaya	Daniel		5059235821				5059236111	danaya@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Contact for Fraud Investigations	Director Program Integrity and RO	Ms	Jamison	Mary Alice		5059236706					mjamison2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/19/2021	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Coordination of Benefits Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Corporate Mailing						5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/26/2021	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Budget and Financial Planning	Ms	Lemmons	Lisa		5059236314				5059238244	llemmons2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Customer Service Operations Contact	Vice President, PCSC	Ms	Garcia	Kelly		5059238580				5059235124	kgarcia3@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/29/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	DIR Contact	Executive Director Pharmacy Services	Mr	Roland	Frank		5059235530					froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/14/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	DIR Contact (Secondary)	Manager Medicare Part D, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	03/12/2020	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Emergency Part D Contact	Executive Director Pharmacy Services	Mr	Roland	Frank		5059235530					froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	01/03/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Emergency Part D Contact (Secondary)	Eprescribe Program Manager, Pharmacy Services	Ms	Van Klaveren	Kasey		5059235533					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Employer Waiver Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Encounter Data & Risk Adjustment Operations Contact	Manager, Risk Adjustment	Mr	Bundy	Andrew		5059236452					abundy@phs.org	9521 San Mateo NE		Albuquerque	NM	87113	03/12/2020	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Enrollment Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	EOB Transfer Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Financial Audit Contact	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Financial Reporting Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Formulary Contact	Manager Medicare Part D, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Formulary Contact (Secondary)	VP Chief Medical Officer	Dr	Clarke	Gray		5059238117				5058433065	gclarke@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/01/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	General Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Government Relations Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	HIPAA Privacy Officer	Privacy Officer	Ms	Collaros	Sophia		5059236176				5059238159	scollaros@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/26/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	HIPAA Security Officer	Chief Information Security Officer	Ms	McClung	Barbara		4082197031					bmcclung2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/05/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Hospice Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Interoperability Contact	Chief Technology Performance Officer	Mr	Fett	Doug		5059238644				5059238244	cfett@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/05/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	MA Appeals/Grievances Contact	Medicare Manager, Appeals and Grievance	Mr	Anaya	Daniel		5059235821				5059236111	danaya@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	MA Claims Processing Contact for Public Website	Presbyterian Customer Service Center		Provider Care Unit	PCSC		5059236060				5059235124	info@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	12/28/2021	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Marketing Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Medical Director	VP Chief Medical Officer	Dr	Clarke	Gray		5059238117				5058433065	gclarke@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/01/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Medicare Compliance Officer	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Medicare Coordinator	Manager, Medicare Programs	Ms	Jamael	Rosie		5059238203				5059235866	rjamael@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	12/28/2021	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Medicare Part D Opioid Overutilization Contact	Manager Medicare Part D, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/02/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Medication Therapy Management Contact	Manager Medicare Part D, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/02/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Online Enrollment Center Contact (Back-up)	Director, Enrollment Operations	Mr	Myers	Richard		5059236169				5059235385	rmyers4@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	12/16/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Online Enrollment Center Contact (Optional)	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Online Enrollment Center Contact (Primary)	Manager, Enrollment Operations	Ms	Bracamonte	Susie		5059236017				5059235385	sbracamo@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/15/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Part C Application Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Part C Reporting Contact	Medicare Reporting Data Specialist	Ms	Tapia	Ashley		5059236153				5059235866	atapia10@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/29/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Part D Appeals	Medicare Manager, Appeals and Grievance	Mr	Anaya	Daniel						5059236111	danaya@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active	5059235821				PPO - BBA		C	Dallas
H3206	Part D Appeals Contact (Secondary)	Director, Appeals and Grievance	Ms	Napoleone Salazar	Sara						5059236111	snapoleon@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/14/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active	5059238064				PPO - BBA		C	Dallas
H3206	Part D Application Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/12/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Part D Benefits Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Part D Claims Submission Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Part D Exceptions Contact	Executive Director, Pharmacy Services	Mr	Roland	Frank							froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/14/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active	5059235530				PPO - BBA		C	Dallas
H3206	Part D Exceptions Contact (Secondary)	Medicare Part D Manager, Pharmacy Services	Ms	Padilla	Melissa							mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active	5059235533				PPO - BBA		C	Dallas
H3206	Part D Price File Contact (Back-up)			Rx	Optum		6514955363					medops_planfinder@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	10/12/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Part D Price File Contact (Optional)	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235526				5059235540	kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	10/29/2020	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Part D Price File Contact (Primary)	Executive Director, Pharmacy Services	Mr	Roland	Frank		5059235530					froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/14/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Part D Quality Assurance Contact	Executive Director, Pharmacy Services	Mr	Roland	Frank		5059235530					froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/14/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Part D Reporting Contact	Medicare Programs Reporting Specialist	Ms	Tapia	Ashley		5059236153				5059235866	atapia10@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/31/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Patient Safety Contact	Manager Medicare Part D, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/02/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Payment Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Pharmacy Director	Executive Director, Pharmacy Services	Mr	Roland	Frank		5059235530					froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/14/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Pharmacy Network Management Contact	Eprescribe Program Manager, Pharmacy Services	Mr	Van Klaveren	Kasey		5059235530					kvanklave@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/11/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Pharmacy Network Management Contact (Secondary)	Medicare Part D Manager, Pharmacy Services	Ms	Padilla	Melissa		5059235533					mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Pharmacy Technical Help Desk Contact	Executive Director, Pharmacy Services	Mr	Roland	Frank							froland2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	07/14/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active	8665285829				PPO - BBA		C	Dallas
H3206	Pharmacy Technical Help Desk Contact (Secondary)	Medicare Part D Manager, Pharmacy Services	Ms	Padilla	Melissa							mpadilla28@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active	8665285829				PPO - BBA		C	Dallas
H3206	Physician Incentive Contact	Vice President, Provider Network Management	Mr	Gear	Brady		5059235805				5059235400	bgear@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/29/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Plan Directory Contact for Public Website	Presbyterian Customer Service Center		Provider Care Unit	PCSC		5059235757				5059235124	info@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	02/16/2018	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Plan to Plan Reconciliation Contact	Data Reporting Specialist, Risk Adjustment	Ms	Pham	Sindy		5059236012				5059238244	rpham@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/13/2019	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Processor Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Quality Contact	Director, PHP Quality Management	Ms	Taylor	Susan		5059238040				5058433841	staylor7@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/07/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Reconciliation Contact	Vice President, Chief Financial Officer	Ms	Brannin	Amor		5059235201				5059238244	abrannin@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	05/11/2018	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Reconciliation Contact (Secondary)	Director, Financial Planning and Analysis	Ms	Andersen	Stacy		5059238307				5059238252	kandersen@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/29/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Recovery Audit Contact	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	SNP Application Contact	Vice President, Medicare Programs	Mr	Ayerza	Gabriel		2066618676					gayerza@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	09/13/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Surveillance Contact	Compliance Officer	Ms	Quintana Clyde	Alejandra		5059237496				5059238159	aquintana30@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	11/09/2021	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	System Contact	Chief Technology Performance Officer	Mr	Fett	Doug		5059238644				5059238244	cfett@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	04/05/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Third Party Administrator (TPA) Liaison	Manager, Budget and Financial Planning	Ms	Lemmons	Lisa		5059236314				5059235540	llemmons2@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/04/2020	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	User Access Contact	Manager, Medicare Programs	Ms	Jamael	Rosie		5059238203				5059235866	rjamael@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	06/29/2022	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Utilization Management Contact	VP Associate Chief Medical Officer	Dr	White	Clinton		5059235875					cwhite13@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/14/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3206	Utilization Review Contact	VP Associate Chief Medical Officer	Dr	White	Clinton		5059235875					cwhite13@phs.org	9521 San Mateo Blvd NE		Albuquerque	NM	87113	08/14/2023	2023	PRESBYTERIAN INSURANCE COMPANY, INC.	Local CCP	Presbyterian Insurance Company, Inc.	Local PPO		Presbyterian Healthcare Services	188	Yes	Active					PPO - BBA		C	Dallas
H3219	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	06/21/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8887369118				8885547668	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/03/2018	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Wieland	Robert		6128597257					WielandR@AllinaHealthAetna.com	1550 Utica Avenue South	Suite 250	St. Louis Park	MN	55416	11/12/2021	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Wieland	Robert		6128597257					WielandR@AllinaHealthAetna.com	1550 Utica Avenue South	Suite 250	St. Louis Park	MN	55416	11/12/2021	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Chief Financial Officer	Chief Financial Officer	Mr.	Jacobsen	Jeffrey		6513507639					JacobsenJ1@AllinaHealthAetna.com	1550 Utica Ave. S	Suite 250	St. Louis Park	MN	55416	12/18/2018	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Chief Operating Officer	Chief Operating Officer	Ms.	Nierengarten	Monica		6513507640					nierengartenm@AllinaHealthAetna.com	1550 Utica Avenue South,	Suite 250	St. Louis Park	MN	55416	12/16/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Corporate Mailing						6513507649					MolitorL@AllinaHealthAetna.com	1550 Utica Avenue South	Suite 250	St. Louis Park	MN	55416	12/18/2018	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/21/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Financial Reporting Contact	Chief Financial Officer	Mr.	Jacobsen	Jeffrey		6513507639					JacobsenJ1@AllinaHealthAetna.com	1550 Utica Ave. S	Suite 250	St. Louis Park	MN	55416	04/02/2019	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active	8042966237				PPO - BBA		C	Philadelphia
H3219	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active	7132085765				PPO - BBA		C	Philadelphia
H3219	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/02/2018	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active	6026183945				PPO - BBA		C	Philadelphia
H3219	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active	6122633491				PPO - BBA		C	Philadelphia
H3219	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active	8002386279				PPO - BBA		C	Philadelphia
H3219	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Plan Directory Contact for Public Website			Customer Service	Aetna		8669014692					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	02/02/2018	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/21/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Reconciliation Contact (Secondary)	Chief Financial Officer	Mr.	Jacobsen	Jeffrey		6513507639					JacobsenJ1@AllinaHealthAetna.com	1550 Utica Ave. S	Suite 250	St. Louis Park	MN	55416	04/02/2019	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	02/09/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	02/09/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	06/21/2022	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3219	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	ALLINA HEALTH AND AETNA INSURANCE COMPANY	Local CCP	Allina Health Aetna Medicare	Local PPO		Allina Health and Aetna Insurance Holding Company	687	Yes	Active					PPO - BBA		C	Philadelphia
H3239	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/06/2019	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/25/2018	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H3239	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/25/2018	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3239	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH, INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3240	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/06/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Bid Primary Contact	Product Management Director		Gray	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	02/16/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/16/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/16/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H3240	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H3240	PHR Beneficiary Contact																	02/07/2019	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H3240	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3240	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	AMERIGROUP NEW JERSEY, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3251	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	11/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	12/04/2018	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	02/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/04/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	06/30/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3251	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3251	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	08/09/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3251	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3251	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	11/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/22/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8772777898				HMO - Health Maintenance Organization		C	Denver
H3251	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	0000000000				HMO - Health Maintenance Organization		C	Denver
H3251	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	11/06/2015	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	07/29/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	04/26/2016	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3251	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	04/26/2016	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of New Mexico	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3256	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H3256	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H3256	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H3256	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H3256	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3256	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3259	Agent/Broker Compensation Data Contact	Manager Broker Administration	Mrs.	Logan	Lynne		4235356550				4235353178	Lynne_Logan@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/14/2016	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Automated TrOOP Balance Transfer Contact	Advisor Business CVS		Davis	Brittany		4806064613					FIRSupport@CVSHealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	12/21/2021	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Backup User Access Contact	Medicare Compliance Officer		Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Best Available Evidence Contact	Director Service Operations		Scissom	Melissa		4235358356					Melissa_Scissom@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Bid Audit Contact	Medicare Compliance Officer	Mrs	Womble	Charriet		6292046752					Charriet_Womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	374022011	12/09/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Bid Primary Contact	BlueCare Plus Director of Sales		Burchette	Kevin		4236023013					Kevin_Burchette@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/06/2023	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	CAP Report Contact for Public Website	Medicare Compliance Officer		Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	CEO - CMS Administrator Contact	President	Mr	Dungan	Casey		4235355635					Casey_Dungan@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/11/2023	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	CEO - Senior Official for Contracting	President	Mr	Dungan	Casey		4235355635					Casey_Dungan@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/11/2023	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Chief Financial Officer	CFO	Mr.	Gregory	Daniel		4235358224					daniel_gregory@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	06/27/2023	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Chief Operating Officer	Chief Operating Officer	Mr	Sullivan	Patrick		4235357192					Patrick_Sullivan@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/01/2015	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Chief Information Officer	VP Infrastructure & Operations	Ms	Weaver	Jennifer		4235355173				4235359109	Jennifer_Weaver@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/16/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Chief Information Security Officer	VP Infrastructure & Operations	Ms	Weaver	Jennifer		4235355173				4235359109	Jennifer_Weaver@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/16/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	CMS Casework Communication Contact	Clinical Management		Pugh	Donna		4235356563					Donna_Pugh@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/09/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Complaints Tracking Contact	Manager Clinical Management		Pugh	Donna		4235356563					Donna_Pugh@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/09/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Contact for Fraud Investigations	Director Special Investigations Unit	Mr.	Tidwell	Norman		6153483005				4235357024	Norman_Tidwell@bcbst.com	1 Cameron Hill Circle, Bldg 1.4		Chattanooga	TN	37402	05/02/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Coordination of Benefits Contact	Manger Revenue Reconciliation		Camp	Jan		4235353639					jan_camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	04/20/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Corporate Mailing						4235356914				4235357567	Jason_Lloyd@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/12/2012	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr Investments & Financial Mgt		Conway	Kendrick		4236819483					Kendrick_Conway@BCBST.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/10/2023	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Customer Service Operations Contact	Director Service Operations		Scissom	Melissa		4235358356				4235919109	Melissa_Scissom@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	DIR Contact	Pharmacy Operations Manager	Mrs	Moore	Mary-Marga		4235356116					Mary-Margaret_Moore@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	DIR Contact (Secondary)	Director Pharmacy Operations	Mrs	Owen	Rebecca		4235358347					Rebecca_Owen@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/19/2021	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Emergency Part D Contact	VP of Pharmacy		Tate	Natalie		4234437868				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/20/2016	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Emergency Part D Contact (Secondary)	Sr Account Manager CVS		Hale	Amy		4803277718					Amy.Hale2@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Encounter Data & Risk Adjustment Operations Contact	Director Medicare Advantage Risk Adjustment		Livingood	Eric		4235357352					Richard_Livingood@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/18/2019	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Enrollment Contact	Manager  MedAdv Member & Recon		Mills	Aaron		4235353848					Aaron_Mills@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	04/06/2018	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	EOB Transfer Contact	Director Service Operations		Scissom	Melissa		4235358356				4235919109	Melissa_Scissom@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Financial Audit Contact	External Audit Coordinator	Ms	Grafe	Kimberly		4232909053					Kimberly_Grafe@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/21/2023	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Financial Reporting Contact	Principal Consultant, Financial Reporting		Harris	Bernard		4235353829					Bernard_Harris@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	04/17/2020	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Formulary Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Formulary Contact (Secondary)	Clinical Advisor Med D CVS		Tolbert	Myla		4698656265					Myla.Tolbert@CVSHealth.com	750 W John Carpenter Frwy		Irving	TX	75039	12/20/2021	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	General Contact	Medicare Compliance Officer		Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Government Relations Contact	Medicare Compliance Officer		Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	HIPAA Privacy Officer	VP & Deputy General Counsel		Oliver	Alicia		4235352922					Alicia_Oliver@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	07/26/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	HIPAA Security Officer	VP & Deputy General Counsel		Oliver	Alicia		4235352922					Alicia_Oliver@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	01/11/2023	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Hospice Contact	Director Service Operations		Scissom	Melissa		4235358356				4235919109	Melissa_Scissom@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Interoperability Contact	Application Manager		Foust	Adam		4235356672					Adam_Foust@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/28/2023	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	MA Appeals/Grievances Contact	Manager Clinical Management		Pugh	Donna		4235356563					Donna_Pugh@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/09/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	MA Claims Processing Contact for Public Website	Director Service Operations		Scissom	Melissa		4235358356				4235919109	Melissa_Scissom@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Marketing Contact	Ethics & Compliance Manager		Clements	Amy		4235358225					Amy_Clements@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/09/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Medical Director	Medical Director	Dr.	Pate	Linda		4235357171					Linda_Pate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/09/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Medicare Coordinator	Director Service Operations		Farriss	Rhonda		4235354887				4235919109	Rhonda_Farriss@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Medicare Part D Opioid Overutilization Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/19/2018	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Medication Therapy Management Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	OffShore Subcontractor Contact	Medicare Compliance Officer		Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Online Enrollment Center Contact (Back-up)	Business Analyst		Sharp	Dana		4235354453					Dana_Sharp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/04/2013	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Online Enrollment Center Contact (Optional)	Manager MedAdv Member & Recon		Mills	Aaron		4235353848					Aaron_Mills@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/04/2013	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Online Enrollment Center Contact (Primary)	Operations Supervisor II (QIP)		Bowling	Jameekah		4235356646					Jameekah_Bowling@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/15/2023	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Part C Application Contact	BlueCare Plus Director of Sales		Burchette	Kevin		4236023013					Kevin_Burchette@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	03/27/2023	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Part C Reporting Contact	Business Analytics Manager		Carson	Mindy		4235358476					Mindy_Carson@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Appeals	Clinical Pharmacy Director		Moss	Portia							Portia_Moss@bcbst.com	1 Cameron Hill Circle	Suite 51	Chattanooga	TN	37402	09/22/2021	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8003325762				HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Appeals Contact (Secondary)	Coverage Review Pharmacist		Holloway	Angela							Angela_Holloway@BCBST.com	1 Cameron Hill Circle	Suite 51	Chattanooga	TN	37402	12/31/2020	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8003325762				HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Application Contact	BlueCare Plus Director of Sales		Burchette	Kevin		4236023013					Kevin_Burchette@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	03/27/2023	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Benefits Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Claims Submission Contact	Sr Account Manager CVS		Mesa	Samantha		4803492867					Samantha.Mesa@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Exceptions Contact	Manager Coverage Reviews 1		Moss	Portia							Portia_Moss@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/08/2019	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Exceptions Contact (Secondary)	Coverage Review Pharmacist		Dillon	Celia							Celia_Dillon@BCBST.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/12/2020	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Price File Contact (Back-up)	Manager PBM Finance Operations CVS		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Price File Contact (Optional)	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Price File Contact (Primary)	Pharmacy Operations Manager		Moore	Mary	M	4235356116				4235357599	Mary-Margaret_Moore@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	07/12/2019	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Quality Assurance Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Part D Reporting Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Patient Safety Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Payment Contact	Manager Revenue Reconciliation		Camp	Jan		4235353639					Jan_Camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Pharmacy Director	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Pharmacy Network Management Contact	Advisor Network Products CVS		Lowe	David		4807449231				8773875800	David.Lowe2@CVSHealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	12/20/2021	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Pharmacy Network Management Contact (Secondary)	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Pharmacy Technical Help Desk Contact	Vendor Management		Horton	Kasena							Kasena.Horton@CVSHealth.com	2401 Cherahala  Blvd		Knoxville	TN	37932	12/21/2021	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Atlanta
H3259	Pharmacy Technical Help Desk Contact (Secondary)	VP of Pharmacy		Tate	Natalie							Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/31/2020	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active	8003325762				HMO - Health Maintenance Organization		C	Atlanta
H3259	Plan Directory Contact for Public Website			Service	Customer		8002991407					BlueCarePlus_GM@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/14/2016	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Plan to Plan Reconciliation Contact	Business Analyst Associate		Stinnett	James		4235351624					P2PAdministration_GM@bcbst.com	Attn: P2P Coordinator	1 Cameron Hill Circle Suite 0050	Chattanooga	TN	374020050	02/07/2018	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Processor Contact	Director Service Operations		Scissom	Melissa		4235358356				4235919109	Melissa_Scissom@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Quality Contact	Director Servicer Operations		Farriss	Rhonda		4235354887					Rhonda_Farriss@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	07/26/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Reconciliation Contact	Manager Revenue Reconciliation		Camp	Jan		4235353639					Jan_Camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Reconciliation Contact (Secondary)	Acturial Consultant		Styga	Chris		4235353276				4235353467	Christopher_Styga@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	03/08/2016	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Recovery Audit Contact	Medicare Compliance Officer	Mrs.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	SNP Application Contact	Medicare Compliance Officer		Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Surveillance Contact	Medicare Compliance Officer		Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	System Contact	Mgr Applications Systems & Pro	Mrs.	Jackson	Barbara		4235357580				4236190778	Barbara_Jackson@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/14/2016	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Third Party Administrator (TPA) Liaison	Accountant		Gillenwater	Jonathan		4235351259					Jonathan_Gillenwater@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/06/2020	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	User Access Contact	Sr Ethics & Compliance Specialist		Underwood	Jackie		4235354424					Jackie_Underwood@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Utilization Management Contact	Manager Clinical Management		Pugh	Donna		4235356563				4235919109	Donna_Pugh@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2021	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3259	Utilization Review Contact	Manager Clinical Management		Pugh	Donna		4235356563				4235919109	Donna_Pugh@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2021	2023	VOLUNTEER STATE HEALTH PLAN	Local CCP	BlueCare Plus Tennessee	HMO/HMOPOS		BlueCross BlueShield of Tennessee	34	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3274	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Backup User Access Contact	Medicare Compliance Officer, Plan Partner Support	Ms.	Bouyer	Valorie		6159161254					valorie.bouyer@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	CEO - CMS Administrator Contact	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	CEO - Senior Official for Contracting	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Chief Financial Officer	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Chief Operating Officer	Chief Operating Officer/General Manager	Mr.	Emami	John		7038837508					john.emami@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Contact for Fraud Investigations	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Corporate Mailing						8443053879					customerservice@alignseniorcare.com	PO BOX 4440		Glen Allen	VA	23058	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Coverage Gap Discount Program (CGDP) Payment Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment	Mr.	Hassenstab	Mark		5072697711					Mark.Hassenstab@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	EOB Transfer Contact			Lowry	Kristy		8443053879				8336102390	kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Financial Audit Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Financial Reporting Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	General Contact	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	HIPAA Privacy Officer	Chief Compliance Officer and HIPAA Privacy Officer	Ms.	Crowe	Melanie		4049330409					melanie.crowe@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	HIPAA Security Officer	Sr. Director Cybersecurity	Mr	Brogdon	Clevelen		6158094476					Clevelen.Brogdon@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	MA Claims Processing Contact for Public Website	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Medical Director	VP Medical Affairs		Dahlgren	Andrew		8042968288					Andrew.Dahlgren@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	06/14/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Medicare Coordinator	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/14/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	03/09/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part C Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	06/21/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Payment Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Philadelphia
H3274	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/10/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H3274	Physician Incentive Contact	Executive Director	Ms.	Katz	Sherri		8052179946					sherri.katz@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Plan Directory Contact for Public Website			Sindlinger	Rocio		8443053879					rocio.sindlinger@allyalign.com	PO BOX 4440		Glen Allen	VA	23058	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Plan to Plan Reconciliation Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	06/21/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Quality Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	03/09/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Reconciliation Contact		Mr.	Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Reconciliation Contact (Secondary)	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Recovery Audit Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Third Party Administrator (TPA) Liaison	Manager of Regulatory Accounting	Ms.	Weis	Katelyn		6073294042					kate.weis@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	User Access Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3274	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE CALIFORNIA INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3276	Agent/Broker Compensation Data Contact	Medicare Sales Director		Casas	Edward		3472138107					ecasas@emblemhealth.com	55 Water Street		New York	NY	10041	06/02/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Automated TrOOP Balance Transfer Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water St		New York	NY	10041	05/23/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Backup User Access Contact	Director, Compliance		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Best Available Evidence Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/23/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Bid Audit Contact	Director, Medicare Audit & Assessment		Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	05/09/2019	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Bid Audit Site Contact	Sr. Medicare Audit Spec.		Chan	Tat		6464470218					tchan@emblemhealth.com	55 Water Street		New York	NY	10041	05/25/2020	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Bid Primary Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	CAP Report Contact for Public Website	Dir., Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	CEO - CMS Administrator Contact	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin-Corp Exec. Office	New York	NY	10041	12/14/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	CEO - Senior Official for Contracting	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin - Corp Exec. Office	New York	NY	10041	12/14/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Chief Financial Officer	Chief Financial Officer	Ms.	Tamborino	Heather		6464476174					htamborino@emblemhealth.com	55 Water Street		New York	NY	10041	07/02/2020	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Chief Operating Officer	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Chief Information Officer	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	06/28/2018	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Chief Information Security Officer	AVP., IT Governance	Mr.	McDermott	Thomas	M	6464474110	34110				tmcdermott@emblemhealth.com	55 Water Street		New York	NY	10041	06/28/2018	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	CMMI Model Point of Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	CMS Casework Communication Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Complaints Tracking Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Contact for Fraud Investigations	Director, Special Investigations	Mr.	Lupo	Chris		6318442453					clupo@emblemhealth.com	395 North Service Road		Melville	NY	11747	10/31/2018	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Coordination of Benefits Contact	Director, Payment Integrity & Financial Recovery		LaPlante	Brian		8606742840					blaplante@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	01/10/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Corporate Mailing						8604096415					TBenoit@ConnectiCare.com	175 Scott Swamp Road		Farmington	CT	06034	02/08/2018	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Coverage Gap Discount Program (CGDP) Payment Contact	Treasury Operations Analyst		Saint-Hilaire	Ana		6464474279					asaint-hilaire@emblemhealth.com	55 Water Street		New York	NY	10041	03/22/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Customer Service Operations Contact	VP, Ops Strategy & Service Delivery		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	02/11/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	DIR Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	DIR Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Emergency Part D Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Emergency Part D Contact (Secondary)	Pharm. Govt. Programs Manager		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Employer Waiver Contact	AVP, Product Dev., Admin., & Perf. Analysis		Averyanova	Nataliya		6464475044					naveryanova@emblemhealth.com	55 Water Street		New York	NY	10041	05/23/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Encounter Data & Risk Adjustment Operations Contact	Enterprise Director of Gov''t		Guenther	Anne Marie		8606745847					aconnors@connecticare.com	175 Scott Swamp Rd		Farmington	CT	06034	11/01/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Enrollment Contact	Dir, Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 water Street	P.O. Box 405	New York	NY	10041	05/23/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	EOB Transfer Contact	Director, Claims Processing & Provider File Mgmt		Meka	Joann		8604098915				8604098455	jmeka@connecticare.com	175 South Swamp Road		Farmington	CT	06034	05/26/2020	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Financial Audit Contact	Director, Medicare Audit & Assessment	Mr	Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	07/29/2019	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Financial Reporting Contact	Dir., Financial Reporting		Heitzer	Frances		6464477885					fheitzer@emblemhealth.com	55 Water Street		New York	NY	10041	07/11/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Formulary Contact	Sr. Formulary Specialist		Sitilides Cimino	Irene		6864477926					isitilidescimino@emblemhealth.com	55 Water Street		New York	NY	10041	11/15/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Formulary Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	05/12/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	General Contact	Director, Medicare Compliance		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Government Relations Contact	Director, Medicare Compliance		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	HIPAA Privacy Officer	VP, Corporate Compliance		Lurin	Joseph		6464475203					jlurin@emblemhealth.com	55 Water Street		New York	NY	10041	07/29/2019	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	HIPAA Security Officer	AVP, IT Governance		McDermott	Thomas		6464474110					TMcDermott@emblemhealth.com	55 Water Street		New York	NY	10041	07/29/2019	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Hospice Contact	Senior Medicare Pharmacy Specialist		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	08/08/2018	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Interoperability Contact	Dir., Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	MA Appeals/Grievances Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	MA Claims Processing Contact for Public Website	VP, Claims Operations		Henderson	Linda		6464476795					lhenderson@emblemhealth.com	175 Scott Swamp Road		Farmington	CT	06032	10/23/2020	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Marketing Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Medical Director	Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2020	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Medicare Compliance Officer	Director, Medicare Compliance/MCO	Ms.	Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Medicare Coordinator	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Medicare Part D Opioid Overutilization Contact	Dir., Pharm. Quality Provider and Safety Prgms.		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road		Farmington	CT	06034	05/24/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Medication Therapy Management Contact	Clinical Pharmacy Program Leader		Mhajan	Ruby		6464477632					rumhajan@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	OffShore Subcontractor Contact	Lead Admin., Regulatory Pgm.		Kelly	Veronica		6464477494					vkelly@emblemhealth.com	55 Water Street		New York	NY	10041	11/26/2019	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Online Enrollment Center Contact (Back-up)	Knowledge Manager, Enroll. & Bill.		Gonzalez	Gabriel		6464477722					gabriel.gonzalez@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Online Enrollment Center Contact (Optional)	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/23/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Online Enrollment Center Contact (Primary)	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/23/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Part C Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Part C Reporting Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Part D Appeals	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464477215				HMO - Health Maintenance Organization		C	New York
H3276	Part D Appeals Contact (Secondary)	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464477215				HMO - Health Maintenance Organization		C	New York
H3276	Part D Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Part D Benefits Contact	Sr. Pharm. Gov't. Prog. Spec		Dean	Wendy		8604098966					wdean@connecticare.com	175 Scott Swamp Road		Farmington	CT	06034	05/23/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Part D Claims Submission Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Part D Exceptions Contact	VP, Pharmacy Solutions		Colby	Andrew							acolby@emblemhealth.com	55 Water street		New York	NY	10041	05/23/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464473340				HMO - Health Maintenance Organization		C	New York
H3276	Part D Exceptions Contact (Secondary)	Sr.  Govt Prog. Pharm. Spec.		Kerman	Jeff							jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	05/23/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	3475410287				HMO - Health Maintenance Organization		C	New York
H3276	Part D Price File Contact (Back-up)	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Part D Price File Contact (Optional)	Sr. Govt Prog. Pharm Spec.		Kerman	Jeff		3475410287					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	05/23/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Part D Price File Contact (Primary)	Sr. Manager Regulated Markets		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/11/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Part D Quality Assurance Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Part D Reporting Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Patient Safety Contact	Dir., Pharm Quality and Provider		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road	P.O. Box 4050	Farmington	CT	060344050	10/10/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Payment Contact	VP Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Personal Health Record Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Pharmacy Director	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Pharmacy Network Management Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Pharmacy Network Management Contact (Secondary)	Sr. Govt Prog. Pharm. Specialist		Kerman	Jeff		6464477698					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	01/12/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	8009221557	2			HMO - Health Maintenance Organization		C	New York
H3276	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Client Ops Director		Brown	Gregory							grbrown@emblemhealth.com	55 Water street		New York	NY	10041	10/10/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	4015251683				HMO - Health Maintenance Organization		C	New York
H3276	PHR Beneficiary Contact																	05/11/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS	ConnectiCare Inc	EmblemHealth, Inc.	361	Yes	Active	8002242273				HMO - Health Maintenance Organization		C	New York
H3276	Plan Directory Contact for Public Website	VP, Ops Strategy & Service Delivery		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	05/23/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Plan to Plan Reconciliation Contact	Accounts Payable Manager		Siozios	Jacqueline		6464473017					jsiozios@emblemhealth.com	55 Water Street		New York	NY	10041	08/16/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Processor Contact	AVP, Claims Operations		Gauthier	Kathleen		8604096435					kgauthier@connecticare.com	175 Scott Swamp Rd		Farmington	CT	06034	07/17/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Quality Contact	Data Analytics & Reporting Leader		Goldfarb	Julie		6315775110	65110				jgoldfarb@emblemhealth.com	55 Water Street		New York	NY	10041	01/10/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Reconciliation Contact	Dir., Enrollment & Billing		Ewen	Jillian	L	8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	07/15/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Reconciliation Contact (Secondary)	VP Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Recovery Audit Contact	Dir., Medicare Audit & Assess.	Mr.	Greene	Joseph		5184468045					jgreene@emblemhealth.com	80 Wolf Road		Albany	NY	12205	11/26/2019	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	SNP Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	SNP State Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Surveillance Contact	Director, Medicare Compliance/MCO	Ms.	Borenkind	Carly		3479784977					Cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	System Contact	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	06/28/2018	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Third Party Administrator (TPA) Liaison	Treasury Operations Analyst		Saint-Hilaire	Ana		6464474279					asaint-hilaire@emblemhealth.com	55 Water Street		New York	NY	10041	03/22/2022	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	User Access Contact	Lead Medicare Regulatory Spec.		Handy	Michelle		5184466949					mhandy@EmblemHealth.com	80 Wolf Road		Albany	NY	12205	03/21/2019	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Utilization Management Contact	SVP Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3276	Utilization Review Contact	SVP Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2020	2023	CONNECTICARE INSURANCE COMPANY, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3284	Automated TrOOP Balance Transfer Contact	Executive Director		Stengel	Laura		2534597270				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Backup User Access Contact	Executive Director		Stengel	Laura		2534597270				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Best Available Evidence Contact	CFO		Schramm	Steve		2534037614				2534726833	steve.schramm@multicare.org	6442 S Yakima Avenue		Tacoma	WA	98408	07/28/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Bid Primary Contact	CFO		Schramm	Steve		2534037614				2534726833	steve.schramm@multicare.org	6442 S Yakima Avenue		Tacoma	WA	98408	07/28/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	CAP Report Contact for Public Website	Executive Director		System	MultiCare	H	2534597970				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active	2534597970				PACE - Nat		C	Seattle
H3284	CEO - CMS Administrator Contact	VP-Care Continuum	Ms	System	MultiCare	H	2534597970				2534726833	lynn.siedenstrang@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	CEO - Senior Official for Contracting	VP-Care Continuum	Ms	System	MultiCare	H	2534597970				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Chief Financial Officer	CFO	Mr	Schramm	Steve		2534037614				2534726833	steve.schramm@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	07/28/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Chief Operating Officer	Executive Director	Mrs	Stengel	Laura		2534597270				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Chief Information Officer	Executive Director	Mrs	Stengel	Laura		2534597270				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Chief Information Security Officer	Executive Director	Mrs	System	MultiCare	H	2534597970				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	CMS Casework Communication Contact	Compliance Officer		Clay	Chelsea		6054644821				2534726833	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Complaints Tracking Contact	Compliance Officer		Clay	Chelsea		6054644821				2534726833	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Contact for Fraud Investigations	Compliance Officer		Clay	Chelsea		6054644821				2534726833	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Coordination of Benefits Contact	CFO		Schramm	Steve		2534037614				2534726833	steve.schramm@multicare.org	6442 S Yakima Avenue		Tacoma	WA	98408	01/12/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Corporate Mailing						4153616395				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	01/14/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Coverage Gap Discount Program (CGDP) Payment Contact	CFO		Schramm	Steve		4259857716				2534726833	steve.schramm@multicare.org	6442 S Yakima Avenue		Tacoma	WA	98408	07/28/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Customer Service Operations Contact	Executive Director		Stengel	Laura		2534597270				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	DIR Contact	Executive Director		Stengel	Laura		2534597271				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	02/23/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Emergency Part D Contact	Executive Director		Stengel	Laura		2534597271				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	02/23/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Emergency Part D Contact (Secondary)			Stengel	Laura		2534726833					laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	02/22/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Encounter Data & Risk Adjustment Operations Contact	Executive Director		Stengel	Laura		2534597271				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	02/23/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Enrollment Contact	Executive Director	Mrs	Stengel	Laura		2534597270				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	EOB Transfer Contact	Fomulary and Plan Benefit Coordinator		Biren	Alicia		7158522061				7158367683	abiren@pharmastarpbm.com	Pharmastar PO Box 3217		Eau Claire	WI	54702	12/23/2020	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Financial Audit Contact	Quality and Compliance DIrector	Mrs	Clay	Chelsea		2534597270				2534726833	chelsea.clay@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Financial Reporting Contact	Executive Director		Stengel	Laura		2534597270				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Formulary Contact	Executive Director		Stengel	Laura		2534597271				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	02/23/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	General Contact	Compliance Officer		Clay	Chelsea		6054644821				2534733117	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Government Relations Contact	Executive Director		Stengel	Laura		2534597270				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	HIPAA Privacy Officer	Privacy Officer		Bhatia	Shilpa		2534597865				2534733117	shilpa.bhatia@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	01/12/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	HIPAA Security Officer	Privacy Officer		Bhatia	Shilpa		2534597865				2534733117	shilpa.bhatia@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	01/12/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Interoperability Contact	Identity and Access Manager	Ms	Weisberg	Kathy		2534597384					kathy.weisberg@multicare.org	315 Martin Luther King Jr Way		Tacoma	WA	98415	10/19/2021	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	MA Appeals/Grievances Contact	Compliance Officer		Clay	Chelsea		6054644821				2534726833	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	MA Claims Processing Contact for Public Website	Executive Director		Stengel	Laura		2534597270				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Marketing Contact	Executive Director		Stengel	Laura		4154597270				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	09/21/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Medical Director	Medical Director	Mrs	Van Fleet-Green	Jessica		2534597270				2534726833	Jessica.VanFleet-Green@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	01/14/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Medicare Compliance Officer	Compliance Officer	Mrs	Clay	Chelsea		2533122773				2534726833	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Medicare Coordinator	Compliance Officer		Clay	Chelsea		6054644821				2534726833	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Medicare Part D Opioid Overutilization Contact	Compliance Officer		Clay	Chelsea		6054644821				2534726833	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Medication Therapy Management Contact	Executive Director		Stengel	Laura		2534597271				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	02/23/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Part C Application Contact	Compliance Officer		Clay	Chelsea		6054644821				2534726833	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Part D Appeals	Compliance Officer		Clay	Chelsea							Chelsea.Clay@multicare.org	6442 S Yakima St		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active	8662646121				PACE - Nat		C	Seattle
H3284	Part D Application Contact	Compliance Officer		Clay	Chelsea		6054644821				2534733117	Chelsea.Clay@multicare.org	6442 S Yakima Avenue		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Part D Benefits Contact	Compliance Officer		Clay	Chelsea		6054644821				2534733117	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Part D Claims Submission Contact	Client Support Supervisor	Ms	Vang	Jane		7158522064				7158367683	jvang@pharmastaronline.com	2503 North Hillcrest Parkway		Altoona	WI	54720	12/23/2020	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Part D Exceptions Contact	Compliance Officer		Clay	Chelsea							Chelsea.Clay@multicare.org	6442 S Yakima St		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active	8662646121				PACE - Nat		C	Seattle
H3284	Part D Price File Contact (Back-up)	Client Support Manager	Ms	Slowiak	Andrea		7158522983					asloiak@pharmastarpbm.com	Pharmastar PO Box 3217		Eau Claire	WI	54702	12/23/2020	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Part D Price File Contact (Primary)	Formulary and Plan Benefit Coordinator	Ms	Biren	Alicia		7158522061					abiren@pharmastarpbm.com	Pharmastar PO Box 3217		Eau Claire	WI	54702	12/23/2020	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Part D Quality Assurance Contact	Compliance Officer		Clay	Chelsea		6054644821				2534733117	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Part D Reporting Contact	Compliance Officer		Clay	Chelsea		6054644821				2534733117	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Patient Safety Contact	Compliance Officer		Clay	Chelsea		6054644821				2534733117	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Payment Contact	Executive Director		Stengel	Laura		2534597271				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	02/23/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Pharmacy Director	Executive Director	Mrs	Stengel	Laura		4153616395				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	07/28/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Pharmacy Network Management Contact	Compliance Officer		Clay	Chelsea		6054644821				2534733117	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Pharmacy Technical Help Desk Contact	Compliance Officer		Clay	Chelsea							Chelsea.Clay@multicare.org	6442 S Yakima St		Tacoma	WA	98408	04/24/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active	6054644821				PACE - Nat		C	Seattle
H3284	Plan Directory Contact for Public Website	Executive Director	Mrs	Stengel	Laura		4153616395				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	07/28/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Plan to Plan Reconciliation Contact	Executive Director	Mrs	Stengel	Laura		2534597271				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	02/23/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Processor Contact	Client Support Supervisor	Ms	Vang	Jane		7158522064				7158367683	jvang@pharmastaronline.com	2503 North Hillcrest Parkway		Altoona	WI	54720	12/23/2020	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Quality Contact	Compliance Officer		Clay	Chelsea		6054644821				2534733117	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Reconciliation Contact	Executive Director	Mrs	Stengel	Laura		2534597271				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	02/23/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Recovery Audit Contact	Executive Director	Mrs	Stengel	Laura		2534597271				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	02/23/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Surveillance Contact	Compliance Officer		Clay	Chelsea		6054644821				2534733117	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	System Contact	Executive Director	Mrs	Stengel	Laura		4153616395				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	07/28/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Third Party Administrator (TPA) Liaison	Executive Director	Mrs	Stengel	Laur		2534597271				2534726833	laura.stengel@multicare.org	6442 S. Yakima Ave.		Tacoma	WA	98408	02/23/2023	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	User Access Contact	Executive Director	Mrs	Stengel	Laura		4153616395				2534726833	Laura.Stengel@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	07/28/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Utilization Management Contact	Compliance Officer		Clay	Chelsea		6054644821				2534733117	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3284	Utilization Review Contact	Compliance Officer		Clay	Chelsea		6054644821				2534733117	Chelsea.Clay@multicare.org	6442 S Yakima Ave		Tacoma	WA	98408	03/18/2022	2023	PNW PACE PARTNERS, LLC	National PACE	Pacific Northwest PACE Partners	National PACE		MultiCare Health Systems	780	Yes	Active					PACE - Nat		C	Seattle
H3288	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/10/2018	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8042966237				PPO - BBA		C	Philadelphia
H3288	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	7132085765				PPO - BBA		C	Philadelphia
H3288	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	12/10/2018	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6026183945				PPO - BBA		C	Philadelphia
H3288	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6122633491				PPO - BBA		C	Philadelphia
H3288	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8002386279				PPO - BBA		C	Philadelphia
H3288	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/10/2018	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	12/10/2018	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	06/21/2022	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/04/2023	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3288	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H3291	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	12/31/2019	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Backup User Access Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/01/2019	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Christopher	Laura	K	4046944897					Kelly.Christopher@pruitthealth.com	1626 Jeurgens Court		Norcross	GA	30093	06/09/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	CEO - CMS Administrator Contact		Mr.	Pruitt	Neil		7708066893					npruitt@pruitthealth.com	1626 Jeurgens Court		Norcross	GA	30093	02/04/2019	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	CEO - Senior Official for Contracting		Mr.	Pruitt	Neil		7708066893					npruitt@pruitthealth.com	1626 Jeurgens Court		Norcross	GA	30093	02/04/2019	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Chief Financial Officer	CFO	Mr	Small	Phil		7702796200					PhSmall@pruitthealth.com	1626 Jeurgens Ct		Norcross	GA	30093	05/05/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Chief Operating Officer	Chief Operating Officer	Mr.	Beddingfield	Ryan		6785336300					rbeddingfield@pruitthealth.com	1626 jeurgens ct		norcross	GA	30093	09/08/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Contact for Fraud Investigations	Medicare Compliance Officer	Ms.	Christopher	Laura	K	4046944897					Kelly.Christopher@pruitthealth.com	1626 Jeurgens C0urt		Norcross	GA	30093	06/09/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/01/2019	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Corporate Mailing						8442243659					customerservice@pruitthealthpremier.com	P.O. Box 2190		Glen Allen	VA	230582190	01/28/2017	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Encounter Data & Risk Adjustment Operations Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/02/2019	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	EOB Transfer Contact			Lowry	Kristy		8448546883				8003756496	customerservice@pruitthealthpremier.com	P.O. Box 2190		Glen Allen	VA	230582190	01/15/2020	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Financial Audit Contact	CFO	Mr.	Small	Phil		7702796200					phsmall@pruitthealth.com	1626 Jeurgens Court		Norcross	GA	30093	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Financial Reporting Contact	CFO	Mr.	Small	Phil		7702796200					phsmall@pruitthealth.com	1626 Jeurgens Court		Norcross	GA	30093	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	12/31/2019	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	General Contact			Tolbert	Angie		7068367966					atolbert@pruitthealth.com	1626 jeurgens Court		Norcross	GA	30093	09/05/2018	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	HIPAA Privacy Officer	Medicare Compliance Officer	Ms.	Christopher	Laura	K	4046944897					Kelly.Christopher@pruitthealth.com	1626 Jeurgens COurt		Norcross	GA	30093	06/09/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	HIPAA Security Officer	Medicare Compliance Officer	Ms.	Christopher	Laura	K	4046944897					Kelly.Christopher@pruitthealth.com	1626 Jeurgens Court		Norcross	GA	30093	06/09/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Medical Director		Dr.	Stallings	Ravelle		6785336300					rstallings@pruitthealth.com	PruittHealth Premier	1626 Jeurgens Court	Norcross	GA	30093	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Christopher	Laura	K	4046944897					Kelly.Christopher@pruitthealth.com	1626 Jeurgens Court		Norcross	GA	30093	06/09/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Medicare Coordinator	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/03/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Part C Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Part C Reporting Contact			Rennie	Lynda		8043966383					lynda@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/06/2018	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	12/31/2019	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Payment Contact	CFO	Mr.	Ragland	Robert		8042663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Atlanta
H3291	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Atlanta
H3291	Physician Incentive Contact			French	Kirk		8048402618					kirk.french@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Plan Directory Contact for Public Website			Sindlinger	Rocio		8558550668					rocio.sindlinger@allyalign.com	P.O. Box 2190		Glen Allen	VA	230582190	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Plan to Plan Reconciliation Contact	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/06/2017	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Quality Contact			Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/02/2019	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Reconciliation Contact		Mr.	Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/15/2020	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Reconciliation Contact (Secondary)	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Christopher	Laura	K	4046944897					compliance@pruitthealthpremier.com	1626 Jeurgens Court		Norcross	GA	30093	06/07/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Third Party Administrator (TPA) Liaison	CFO	Mr	Small	Phil		7702796200					PhSmall@pruitthealth.com	1626 Jeurgens Ct		Norcross	GA	30093	09/28/2022	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	User Access Contact	Medicare Compliance Officer	Ms.	Christopher	kelly		4046944897					kelly.christopher@pruitthealth.com	1626 jeurgens ct		norcross	GA	30093	02/06/2023	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3291	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER, INC.	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3305	Agent/Broker Compensation Data Contact	Medicare Sales & Broker		Osborn	Valerie		5183951245					vosborn@mvphealthcare.com	625 State St		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Backup User Access Contact	Compliance Coordinator		Carter	Marlo		5189913814					mcarter@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Best Available Evidence Contact	Leader, Medicare Enrollment Operations		Moxley	Radija		5858852361				5853272227	RMoxley@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Bid Audit Contact	Corporate Compliance Officer		Borges	Linda		5189913803					mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Bid Audit Site Contact	Sr. Leader, Actuarial Services		Fish	Kathleen		5189913826				5183882311	kfish@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Bid Primary Contact	Sr. Leader, Medicare & Govt Programs Strategy		Hungate	Nicole		5858852394					nhungate@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	CAP Report Contact for Public Website	Corporate Compliance Officer		Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	CEO - CMS Administrator Contact	President and CEO	Mr.	Delvecchio	Chris		5189010624				5853272319	cdelvecchio@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	CEO - Senior Official for Contracting	President and CEO	Mr.	Delvecchio	Chris		5189010624				5853272319	cdelvecchio@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Chief Financial Officer	Chief Financial Officer	Ms.	Austen	Karla		5183882357					kausten@mvphealthcare.com	625 State Street		Schenectady	NY	12305	06/26/2014	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Chief Operating Officer	President and CEO	Mr.	Delvecchio	Chris		5189010624				5853272319	cdelvecchio@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Chief Information Officer	Sr Leader, Information Technology & Transformation	Mr.	Della Villa	Michael		5183882323					mdellavilla@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/22/2020	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Chief Information Security Officer	Sr, Leader, Information Technology & Transformatio	Mr.	Della Villa	Michael		5183882323					mdellavilla@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/22/2020	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	CMS Casework Communication Contact	Leader, Medicare Appeals		Allen	Amy		5852588096				5853275724	aallen@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Complaints Tracking Contact	Leader, Medicare Appeals		Allen	Amy		5852588096				5853275724	aallen@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	11/24/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Contact for Fraud Investigations	Leader, Special Investigations Unit		Cordato	Rocco		5189010613					rcordato@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Coordination of Benefits Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Corporate Mailing						8006657924					memberservices@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	12/04/2009	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Coverage Gap Discount Program (CGDP) Payment Contact	Analyst, Revenue Data Management		Canlas	Natasha	M	9144298480					ncanlas@mvphealthcare.com	303 South Broadway	Suite 321	Tarrytown	NY	10591	08/07/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Customer Service Operations Contact	Sr. Leader, Customer Care & Support Services		Greenberg	Melissa		5189913731					mgreenberg@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	DIR Contact	Leader, State & Federal Plan BIlling		Marcus	Yael		9144298496					ymarcus@mvphealthcare.com	625 State Street		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	DIR Contact (Secondary)	Sr. Director, Actuary		Jaiman	Rajshree		5189913834					rjaiman@mvphealthcare.com	625 State St.		Schenectady	NY	12305	02/28/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Emergency Part D Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Emergency Part D Contact (Secondary)	Leader, Pharmacy Clinical Operations		Massoudi	Layla		5188363126					lmassoudi@mvphealthcare.com	625 State St		Schenectady	NY	12305	09/27/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Encounter Data & Risk Adjustment Operations Contact	Director, Ops Vendor Compliance & Transaction Mgt		Shader	Michelle		5189913778					mshader@mvphealthcare.com	625 State Street		Schenectady	NY	12305	09/30/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Enrollment Contact	Leader, Medicare Enrollment Operations		Moxley	Radija		5858852361				5853272227	rmoxley@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	EOB Transfer Contact	Director, Pharmacy Management		Colin	Wendy		5858852435				8004010915	wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Financial Audit Contact	Sr. Director, Internal Audit	Mr.	Hillerman	Stephen		5189913995				5188363202	shillerman@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Financial Reporting Contact	Sr. Leader, Accounting & Assistant Controller		Cenzano	Jennifer		5189010623					jcenzano@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Formulary Contact	Professional, Pharmacy Program Management		Harrington	Courtney		5188363195					charrington@mvphealthcare.com	625 State St		Schenectady	NY	12305	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Formulary Contact (Secondary)	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	General Contact	Leader, Gov''''t Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State St		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Government Relations Contact	Medicare Compliance Officer		Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	HIPAA Privacy Officer	Corporate Compliance Officer		Borges	Linda		5189913803				5183882311	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	HIPAA Security Officer	Corporate Compliance Officer		Borges	Linda		5189913803				5183882311	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Hospice Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					WColin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Interoperability Contact	Leader, Gov''''t Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State St		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	MA Appeals/Grievances Contact	Leader, Medicare Appeals		Allen	Amy		5852588096				5853275724	aallen@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	MA Claims Processing Contact for Public Website	Sr. Leader, Govt Programs, Commercial & IH Claims		Santilli	RJ		5189913775					rsantilli@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Marketing Contact	Sr. Leader, Marketing & Communications		Wiseman	Sarah		5189913654					swiseman@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Medical Director	Chief Medical Officer		Cameron	Carl		5853272200					ccameron@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	11/24/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Medicare Coordinator	Leader, Gov''''t Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State St		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy Management		Colin	Wendy		5858852435				8004010915	wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Medication Therapy Management Contact	Leader, Pharmacy Clinical Operations - Medicare		Massoudi	Layla		5188363126					lmassoudi@mvphealthcare.com	625 State St.		Schenectady	NY	12305	11/09/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms	Borges	Linda		5189913803					mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Online Enrollment Center Contact (Optional)			Moxley	Radija		5858852361					rmoxley@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Online Enrollment Center Contact (Primary)	Leader, Medicare Enrollment Operations		Moxley	Radija		5858852361				5853272227	rmoxley@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Part C Application Contact	Sr. Leader, Medicare & Govt Programs Strategy		Hungate	Nicole	M	5858852394					nhungate@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Part C Reporting Contact	Medicare Process Manager		Gallagher	Linda		5858852441					lgallagher@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Part D Appeals	Leader, Medicare Appeals		Allen	Amy						5853275724	aallen@mvphealthcare.com	220 Alexander  St		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active	5852588096				HMO - Health Maintenance Organization		C	New York
H3305	Part D Appeals Contact (Secondary)	Compliance Coordinator, Medicare Appeals		Stepnowski	Ashley							astepnowski@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active	5857208126				HMO - Health Maintenance Organization		C	New York
H3305	Part D Application Contact	Sr. Leader, Medicare & Govt Programs Strategy		Hungate	Nicole	M	5858852394					nhungate@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Part D Benefits Contact	Professional, Product Strategy		Hart	Andrew		5858852391					ahart@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Part D Claims Submission Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Part D Exceptions Contact	Director, Pharmacy Management		Colin	Wendy							wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active	5858852435				HMO - Health Maintenance Organization		C	New York
H3305	Part D Exceptions Contact (Secondary)	Leader, Pharmacy Clinical Operations		Massoudi	Layla							lmassoudi@mvphealthcare.com	625 State St		Schenectady	NY	12305	09/27/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active	5188363126				HMO - Health Maintenance Organization		C	New York
H3305	Part D Price File Contact (Back-up)	Leader, Pharmacy Clinical Operations		Massoudi	Layla		5188363126					lmassoudi@mvphealthcare.com	625 State St		Schenectady	NY	12305	09/27/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Part D Price File Contact (Optional)	Professional, Pharmacy Compliance Coordinator		Dunham	Kristina		5857208250					KDunham@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	05/24/2019	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Part D Price File Contact (Primary)	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Part D Quality Assurance Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Part D Reporting Contact	Professional, Pharmacy Compliance Coordinator		Dunham	Kristina		5857208250					Kdunham@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	05/24/2019	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Patient Safety Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Payment Contact	Leader, State & Federal Plan Billing		Marcus	Yael		9144298496					ymarcus@mvphealthcare.com	625 State Street		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Pharmacy Director	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Pharmacy Network Management Contact	Director Network Operations		Smith	Shawn		4803914844					shawn.smith@cvshealth.com	9501 E. Shea Blvd. MC 080		Scottsdale	AZ	85260	07/18/2018	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Pharmacy Technical Help Desk Contact	Director, Client Operations		Leeper	Shonda							Shonda.Leeper@CVSHealth.com	445 Great Circle Rd		Nashville	TN	37228	12/03/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H3305	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy Management		Colin	Wendy							wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active	5858852435				HMO - Health Maintenance Organization		C	New York
H3305	Physician Incentive Contact	Sr. Leader, Network Management		MacKinnon	Matthew		5858852485					mmackinnon@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Plan Directory Contact for Public Website	Associate, Care Center Senior Representative		Garrett	Scott		5183867647					sgarrett@mvphealthcare.com	625 State St		Schenectady	NY	12305	12/27/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Plan to Plan Reconciliation Contact	Leader, State & Federal Plan Billing		Marcus	Yael		9144298496					ymarcus@mvphealthcare.com	625 State Street		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Processor Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Quality Contact	Sr. Leader, Quality Performance & Reporting		Rocklein	Lisa		5858852510					lrocklein@mvphealthcare.com	220 Alexander Street		rochester	NY	14607	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Reconciliation Contact	Leader, State & Federal Plan Billing		Marcus	Yael		9144298496					YMarcus@mvphealthcare.com	625 State St		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Reconciliation Contact (Secondary)	Sr. Director, Actuarial		Jaiman	Rajshree		5189913834					rjaiman@mvphealthcare.com	625 State St.		Schenectady	NY	12305	02/28/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	SNP Application Contact	Sr. Leader, Medicare & Govt Programs Strategy		Hungate	Nicole	M	5858852394					nhungate@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Surveillance Contact	Medicare Compliance Officer		Borges	Linda		5189913803				5183882311	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	System Contact	Sr Leader, CISO and Enterprise Computer Svcs		Swits	David		5189913694					dswits@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Third Party Administrator (TPA) Liaison	Analyst, Revenue Data Management		Canlas	Natasha	M	9144298480					ncanlas@mvphealthcare.com	303 South Broadway	Suite 321	Tarrytown	NY	10591	08/07/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	User Access Contact	Leader, Gov''''t Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State St		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Utilization Management Contact	Sr. Leader Health and Medical Management		McCabe	Lisa		5189913854					lmccabe@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3305	Utilization Review Contact	Sr. Leader Health and Medical Management		McCabe	Lisa		5189913854					lmccabe@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	HMO/HMOPOS		MVP Health Care, Inc.	197	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3307	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H3307	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H3307	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H3307	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H3307	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3307	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	OXFORD HEALTH PLANS (NY), INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3312	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/06/2015	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H3312	PHR Beneficiary Contact																	11/15/2012	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				HMO - Health Maintenance Organization		C	Philadelphia
H3312	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/11/2015	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3312	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (NY)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3321	Automated TrOOP Balance Transfer Contact	Director of Quality Management		Barrington	Michele		3154134595				3157033599	mbarrington@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Backup User Access Contact	Executive Director		Button	Stephanie		3154525800				3154597113	sbutton@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	08/16/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Best Available Evidence Contact	Director of Quality Management		Barrington	Michele		3154134595				3157033599	mbarrington@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Bid Primary Contact			Kopenski	Frank		2627842250					frank.kopenski@milliman.com	15800 Bluemound Road	Suite 400	Brookfield	WI	530056069	06/18/2005	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	CAP Report Contact for Public Website	Director of Quality Management		Barrington	Michele		3154134595				3157033599	mbarrington@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	CEO - CMS Administrator Contact	Executive Director	Mrs.	Button	Stephanie		3154525800				3154597113	sbutton@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	CEO - Senior Official for Contracting	Executive Director	Mrs.	Button	Stephanie		3154525800				3154597113	sbutton@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Chief Financial Officer	Corporate Controller	Mr.	Murray	John	G	3154133206					jmurray@lorettosystem.org	700 E. Brighton Ave		Syracuse	NY	13205	09/26/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Chief Operating Officer	Executive Director	Mrs.	Button	Stephanie		3154525800				3154597113	sbutton@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Chief Information Officer	Chief Information Officer	Mr	Claps	Brandon		3154133633					bclaps@lorettosystem.org	700 East Brighton Ave		Syracuse	NY	13205	09/26/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Chief Information Security Officer	Compliance Officer/ Med Rec Dir	Ms	Nutting	Barbara		3154133126				3154694737	bnutting@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	CMS Casework Communication Contact	Executive Director		Button	Stephanie		3154525800				3154597113	sbutton@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	08/16/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Complaints Tracking Contact	Director of Quality Management	Ms.	Barrington	Michele		3154134595					mbarrington@lorettosystem.org	109 Lawrence Ave		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Contact for Fraud Investigations	Compliance Officer/ Med Rec Dir		Nutting	Barbara		3154133126				3154694737	bnutting@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Coordination of Benefits Contact	Compliance Officer/Med Rec Dir		Nutting	Barbara		3154133126				3154694737	bnutting@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	04/07/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Corporate Mailing						3154525800				3154525739	sbutton@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	08/16/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Quality Management	Ms.	Barrington	Michele		3154134595				3157033599	mbarrington@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Customer Service Operations Contact	Marketing Director	Mrs.	Natoli	Tammy		3154134579				3154597113	tnatoli@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	05/03/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	DIR Contact	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Emergency Part D Contact	Medical Director	Dr	Heisig	David		3154133914				3154597113	dheisig@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Emergency Part D Contact (Secondary)	Corporate Controller	Mr.	Murray	John	G	3154133206					jmurray@lorettosystem.org	700 E. Brighton Ave		Syracuse	NY	13205	09/26/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Encounter Data & Risk Adjustment Operations Contact			Nutting	Barbara		3154133126				3154694737	bnutting@lorettosystem.org	115 Creek Circle		East Syracuse	NY	13057	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Enrollment Contact	Executive Director		Button	Stephanie		3154525800				3154597113	sbutton@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	08/16/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	EOB Transfer Contact	Account Manager		Page	Heather		3154134546				3154033599	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Financial Audit Contact	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Financial Reporting Contact	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Formulary Contact	Medical Director	Dr	Heisig	David		3154133914				3154597113	dheisig@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	General Contact	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Government Relations Contact	Executive Director	Mrs.	Button	Stephanie		3154133437				3157033599	sbutton@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	HIPAA Privacy Officer	Compliance Officer/ Med Rec Dir		Nutting	Barbara		3154133126				3154694737	bnutting@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	HIPAA Security Officer	Compliance Officer/ Med Rec Dir		Nutting	Barbara		3154133126				3154694737	bnutting@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Interoperability Contact	Executive Director		Button	Stephanie		3154133437					sbutton@lorettosystem.org	109 Lawrence Rd. East		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	MA Appeals/Grievances Contact	Director of Quality Management	Ms.	Barrington	Michele		3154134595				3157033599	mbarrington@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	MA Claims Processing Contact for Public Website	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Marketing Contact	Director of Marketing		Natoli	Tammy		3154134579				3156712680	tnatoli@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	05/03/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Medical Director	Medical Director	Dr	Heisig	David		3154133914				3154597113	dheisig@lorettosystem.org	177 Lawrence Rd East		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Medicare Compliance Officer	Compliance Officer/ Med Rec Dir	Ms	Nutting	Barbara		3154133126				3154694737	bnutting@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Medicare Coordinator	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Medicare Part D Opioid Overutilization Contact	Medical Director		Heisig	David		3154525800					dheisig@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Medication Therapy Management Contact	Medical Director	Dr	Heisig	David		3154133914				3154597113	dheisig@lorettosystem.org	177 Lawrence Rd East		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Online Enrollment Center Contact (Back-up)	Corporate Controller	Mr.	Murray	John	G	3154133206					jmurray@lorettosystem.org	700 E. Brighton Ave		Syracuse	NY	13205	09/26/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Online Enrollment Center Contact (Primary)	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Part C Application Contact	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Part D Appeals	Director of Quality Management		Barrington	Michele						3154597113	mbarrington@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active	8887287223	4595			PACE - Nat		C	New York
H3321	Part D Appeals Contact (Secondary)	Compliance Officer		Nutting	Barbara						3154597113	bnutting@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	01/05/2021	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active	8887287223	3126			PACE - Nat		C	New York
H3321	Part D Application Contact			Kopenski	Frank		2627842250				2627844116	frank.kopenski@milliman.com	15800 Bluemound Road	Suite 400	Brookfield	WI	530056069	06/18/2005	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Part D Benefits Contact	Medical Director	Dr	Heisig	David		3154133914				3154597113	dheisig@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Part D Claims Submission Contact	Director of Quality Management		Barrington	Michele		3154134595					mbarrington@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Part D Exceptions Contact	Director of Quality Management		Barrington	Michele							mbarrington@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active	8887287223				PACE - Nat		C	New York
H3321	Part D Price File Contact (Back-up)	Systems Analyst	Mr	Porter	Jeff		3154134586					jporter@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	04/20/2016	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Part D Price File Contact (Primary)	Director of Quality Management		Barrington	Michele		3154134595					mbarrington@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Part D Quality Assurance Contact	Director of Quality Management	Ms.	Barrington	Michele		3154134595					mbarrington@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Part D Reporting Contact	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Patient Safety Contact	Executive Director		Button	Stephanie		3154525800				3154597113	sbutton@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	08/16/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Payment Contact	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Personal Health Record Contact	Compliance Officer/ Med Rec Dir		Nutting	Barbara		3154133126				3154694737	bnutting@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Pharmacy Director			Heisig	David		3154133914					dheisig@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Pharmacy Network Management Contact	Director of Quality Management	Ms.	Barrington	Michele		3154134595					mbarrington@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Pharmacy Network Management Contact (Secondary)	Corporate Controller	Mr.	Murray	John	G	3154133206					jmurray@lorettosystem.org	700 E. Brighton Ave		Syracuse	NY	13205	09/26/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Pharmacy Technical Help Desk Contact	Medical Director		Heisig	David							dheisig@lorettosystem.org	109 Lawrence Road		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active	8887287223				PACE - Nat		C	New York
H3321	PHR Beneficiary Contact																	03/23/2015	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE	Independent Living Services of Central NY	Loretto Rest Realty Corporation	133	Yes	Active	8772085284				PACE - Nat		C	New York
H3321	Plan Directory Contact for Public Website	Marketing Director	Mrs.	Natoli	Tammy		3154134579					tnatoli@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	05/03/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Plan to Plan Reconciliation Contact	Director of Quality Management	Ms.	Barrington	Michele		3154134595				3157033599	mbarrington@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Processor Contact	Systems Analyst	Mr	Porter	Jeff		3154134586					jporter@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	04/20/2016	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Quality Contact	Director of Quality Management	Ms.	Barrington	Michele		3154134595					mbarrington@lorettosystem.org	109 Lawrence Road		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Reconciliation Contact	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Recovery Audit Contact	Executive Director	Mrs.	Button	Stephanie		3154525800				3154597113	sbutton@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	08/29/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Surveillance Contact	Executive Director		Button	Stephanie		3154525800				3154597113	sbutton@lorettosystem.org	109 Lawrence Rd East		North Syracuse	NY	13212	08/16/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	System Contact	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Third Party Administrator (TPA) Liaison	Executive Director		Button	Stephanie		3154133437					sbutton@lorettosystem.org	109 Lawrence Road		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	User Access Contact	Accounting Manager	Ms.	Page	Heather		3154134546				3154597113	hpage@lorettosystem.org	109 Lawrence Road East		North Syracuse	NY	13212	09/28/2017	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Utilization Management Contact	Compliance Officer/ Med Rec Dir		Nutting	Barbara		3154133126				3154694737	bnutting@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3321	Utilization Review Contact	Compliance Officer/ Med Rec Dir		Nutting	Barbara		3154133126				3154694737	bnutting@lorettosystem.org	100 Malta Lane		North Syracuse	NY	13212	02/24/2022	2023	LORETTO INDEPENDENT LIVING SERVICES, INC.	National PACE	Independent Living Srvcs Of Central Ny	National PACE		Loretto Rest Realty Corporation	133	Yes	Active					PACE - Nat		C	New York
H3322	Automated TrOOP Balance Transfer Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Backup User Access Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Best Available Evidence Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Bid Primary Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182748129	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	CAP Report Contact for Public Website	Database Specialist	Ms.	Lin	Dian		5182701732				5182748129	Dian.Lin@sphp.com	1938 Curry Road		Schenectady	NY	12303	02/18/2023	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active	8553767888				PACE - Nat		C	New York
H3322	CEO - CMS Administrator Contact	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	CEO - Senior Official for Contracting	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Chief Financial Officer	Finance Director	Mrs.	Turo	Lynette		5182701346				5182742908	Lynette.Turo@sphp.com	Eddy SeniorCare	433 River Street, 3rd Floor	Troy	NY	12180	12/01/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Chief Operating Officer	Director of Operations	Mrs.	Wolken	Sherri		5183823290				5183823398	Sherri.Wolken@sphp.com	1938 Curry Road		Schenectady	NY	12303	02/24/2022	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Chief Information Officer	Application Manager	Mr.	Clark	Patrick		5185251182					patrick.clark@sphp.com	315 S. Manning Boulevard, St. Peters Health Partners	6 Cusack Building	Albany	NY	12208	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Chief Information Security Officer	Application Manager	Mr.	Clark	Patrick		5185251182					patrick.clark@sphp.com	315 S. Manning Boulevard, St. Peter's Health Partners	6 Cusack Building	Albany	NY	12208	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	CMS Casework Communication Contact	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Complaints Tracking Contact	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Albany	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Contact for Fraud Investigations	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Coordination of Benefits Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182748129	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Corporate Mailing						5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Customer Service Operations Contact	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	DIR Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	DIR Contact (Secondary)	Financial Analyst	Mr.	O'Brien	Paul	P	5182701733				5182748129	Paul.P.Obrien@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Emergency Part D Contact	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Emergency Part D Contact (Secondary)	Director of Operations	Mrs.	Wolken	Sherri		5183823290				5183823398	Sherri.Wolken@sphp.com	1938 Curry Road		Schenectady	NY	12303	02/18/2023	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Encounter Data & Risk Adjustment Operations Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Enrollment Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182748129	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	EOB Transfer Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182748129	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Financial Audit Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Financial Reporting Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Formulary Contact	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	General Contact	Executive Director	Ms.	Mazzacco	Michelle		5183823290				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	02/18/2023	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Government Relations Contact	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	HIPAA Privacy Officer	Privacy Officer	Mr.	Smith	Lance		5185251309				5189442661	Lance.Smith@sphp.com	315 South Manning Boulevard		Albany	NY	12208	02/17/2022	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	HIPAA Security Officer	Privacy Officer	Mr.	Smith	Lance		5185251309				5189442661	Lance.Smith@sphp.com	315 South Manning Boulevard		Albany	NY	12208	02/17/2022	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Interoperability Contact	Application Manager	Mr.	Clark	Patrick		5185251182					Patrick.Clark@sphp.com	315 South Manning Boulevard	6 Cusack Building	Albany	NY	12208	02/17/2022	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	MA Appeals/Grievances Contact	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	MA Claims Processing Contact for Public Website	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Marketing Contact	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Medical Director	DO		Ricker	Kerry	E	5183823290				5183823398	Kerry.Ricker@sphp.com	1938 Curry Road		Schenectady	NY	12303	12/06/2022	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Medicare Compliance Officer	Compliance Liaison	Mrs.	Mazzacco	Michelle		5183823290					Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	03/24/2022	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Medicare Coordinator	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Medicare Part D Opioid Overutilization Contact	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Medication Therapy Management Contact	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Online Enrollment Center Contact (Primary)	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Part C Application Contact	Executive Director	Ms.	Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Part D Appeals	Executive Director	Ms.	Mazzacco	Michelle						5183828001	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active	8553767888				PACE - Nat		C	New York
H3322	Part D Appeals Contact (Secondary)	Finance Supervisor	Ms.	Wittman	Michele						5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active	8553767888				PACE - Nat		C	New York
H3322	Part D Application Contact	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Part D Benefits Contact	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Part D Claims Submission Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Part D Exceptions Contact	Finance Supervisor	Ms.	Wittman	Michele						5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active	8553767888				PACE - Nat		C	New York
H3322	Part D Exceptions Contact (Secondary)	Finance Analyst	Mr.	O'Brien	Paul						5182741829	Paul.P.Obrien@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active	8553767888				PACE - Nat		C	New York
H3322	Part D Price File Contact (Back-up)	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Part D Price File Contact (Optional)	Finance Analyst	Mr.	O'Brien	Paul		5182701733				5182741829	Paul.P.Obrien@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Part D Price File Contact (Primary)	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Part D Quality Assurance Contact	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Part D Reporting Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Patient Safety Contact	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Payment Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Personal Health Record Contact	EMR Administrator	Ms	Hollner	Sarah		5183823290				5183828001	Sarah.Hollner@sphp.com	1938 Curry Road		Schenectady	NY	12303	12/01/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Pharmacy Director	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Pharmacy Network Management Contact	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Pharmacy Network Management Contact (Secondary)	Finance Manager	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Pharmacy Technical Help Desk Contact	Executive Director		Mazzacco	Michelle						5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active	8553767888				PACE - Nat		C	New York
H3322	Pharmacy Technical Help Desk Contact (Secondary)	Finance Manager	Mrs.	Wittman	Michele						5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active	8553767888				PACE - Nat		C	New York
H3322	PHR Beneficiary Contact																	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE	Eddy SeniorCare	Trinity Health Corporation	234	Yes	Active	8553767888				PACE - Nat		C	New York
H3322	Plan Directory Contact for Public Website	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Plan to Plan Reconciliation Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Processor Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Quality Contact	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Reconciliation Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Reconciliation Contact (Secondary)	Finance Analyst	Mr.	OBrien	Paul		5182701733				5182741829	Paul.P.Obrien@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Recovery Audit Contact	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Surveillance Contact	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	System Contact	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Third Party Administrator (TPA) Liaison	Finance Supervisor	Ms.	Wittman	Michele		5182701734				5182741829	Michele.Wittman@sphp.com	1938 Curry Road		Schenectady	NY	12303	01/03/2021	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	User Access Contact	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Utilization Management Contact	Executive Director		Mazzacco	Michelle		5186692694				5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3322	Utilization Review Contact	Executive Director		Mazzacco	Michelle		5183823290	6361			5183823398	Michelle.Mazzacco@sphp.com	1938 Curry Road		Schenectady	NY	12303	09/20/2020	2023	SENIOR CARE CONNECTION, INC.	National PACE	Eddy SeniorCare	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3329	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Rivera-Aquino	Denisse		8582915269					partdcat@medimpact.com	136-65 37th Ave.		Flushing	NY	11354	01/03/2023	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Backup User Access Contact	Security Administrator	Mr.	Hsu	Lester		7185194182					lhsu@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Best Available Evidence Contact	CFO	Ms.	Tirtasaputra	Leny		3475012901					ltirtasaputra@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Bid Primary Contact	Chief Executive Officer	Mrs.	Buonocore-Rut	Tara		6464831796					tbrut@centerlight.org	136-65 37th Ave		Flushing	NY	11354	03/24/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	CAP Report Contact for Public Website	Chief Compliance Officer		Nelson Jones	Alicia		3474430157					anjones@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active	3474430157				PACE - Nat		C	New York
H3329	CEO - CMS Administrator Contact	Chief Executive Officer	Mrs.	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th Ave		Flushing	NY	11354	03/24/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	CEO - Senior Official for Contracting	Chief Executive Officer	Mrs.	Buonocore-Rut	Tara		6464831796					tbrut@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Chief Financial Officer	CFO	Ms..	Tirtasaputra	Leny		3475012901					ltirtasaputra@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Chief Operating Officer	Chief Operating Officer	Mrs.	Buonocore-Rut	Tara		6464831796					tbrut@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Chief Information Officer	VP of Performance Improvement	Mr.	Walter	Justin		9295363686					jwalter@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Chief Information Security Officer	Security Administrator	Mr.	Hsu	Lester		7185194182					lhsu@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	CMS Casework Communication Contact	VP of Quality	Ms.	St Fleur	Gilda		3473877782					gstfleur@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Complaints Tracking Contact	Director Appeals & Grievances	Ms.	Singh	Devi		9298371582					desingh@centerlight.org	555 Albany Ave		Amityville	NY	11701	12/21/2021	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Contact for Fraud Investigations	Chief Compliance Officer	Ms.	Nelson Jones	Alicia		3474430157					anjones@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Coordination of Benefits Contact	Chief Executive Officer	Mrs.	Buonocore-Rut	Tara		6464831796					tbrut@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Corporate Mailing						3476406000					tbrut@centerlight.org	136-65 37th Ave		Flushing	NY	11354	03/24/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Executive Officer	Mrs.	Buonocore-Rut	Tara		6464831796					tbrut@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Customer Service Operations Contact	VP of Operations	Ms.	Tabakovic	Emina		3479206110				6172236932	etabakovic@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	DIR Contact	Chief Executive Officer	Mrs.	Buonocore-Rut	Tara		6464831796					tbrut@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	DIR Contact (Secondary)	CFO		Tirtasaputra	Leny		3475012901					ltirtasaputra@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Emergency Part D Contact	Pharmacy Director	Ms	Jing	Shu		9176977979				3157504990	Sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Encounter Data & Risk Adjustment Operations Contact	Medical Economics Manager	Ms.	Riley	Alla		3476406057	1289				alriley@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Enrollment Contact	VP of Business Development	Ms.	Doherty Benckwit	Jeannie		9177330413					JDohertyB@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	EOB Transfer Contact	Chief Executive Officer	Mrs.	Buonocore-Rut	Tara		6464831796				3157503336	tbrut@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Financial Audit Contact	CFO	Ms	Tirtasaputra	Leny		6464831796					ltirtasaputra@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Financial Reporting Contact	CFO	Ms	Tirtasaputra	Leny		3475012901					ltirtasaputra@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Formulary Contact	Pharmacy Director	Ms.	Jing	Shu		9176977979				3157504990	sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Formulary Contact (Secondary)			Nyawabila	Christina		8587906297					fas@medimpact.com	136-65 37th Ave.		Flushing	NY	11354	12/30/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	General Contact	Chief Compliance Officer		Nelson Jones	Alicia		3474430157					anjones@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Government Relations Contact	Director Of Compliance	Mr.	Fairweather	Adrian		9295051346					afairweather@centerlight.org	136-65 37th Avenue		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	HIPAA Privacy Officer	Chief Compliance Officer		Nelson Jones	Alicia		3474430157					anjones@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	HIPAA Security Officer	Security Administrator	Mr.	Hsu	Lester		7185194182					lhsu@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Interoperability Contact	Mrs.		Buonocore-Rut	Tara		6464831796					TBRUT@centerlight.org	136-65 37th Ave.		Flushing	NY	11354	05/23/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	MA Appeals/Grievances Contact	Director Appeals & Grievances	Ms.	Singh	Devi		9298371582					desingh@centerlight.org	555 Albany Ave	2nd Floor	Amityville	NY	11701	12/21/2021	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	MA Claims Processing Contact for Public Website	Chief Executive Officer	Mrs.	Buonocore-Rut	Tara		6464831796					tbrut@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Marketing Contact	VP of Business Development	Ms.	Doherty Benckwit	Jeannie		9177330413					JDohertyB@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Medical Director	Chief Medical Officer	Dr.	Farah	Ziad		9298164443					zfarah@centerlight.org	216 East 99th Street		New York	NY	10029	07/03/2023	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Medicare Compliance Officer	Chief Compliance Officer	Ms	Nelson Jones	Alicia		3474430157					anjones@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Medicare Coordinator	Director of Compliance	Mr.	Fairweather	Adrian		9295051346					afairweather@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Medicare Part D Opioid Overutilization Contact	Pharmacy Director	Ms.	Jing	Shu		9176977979					Sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	01/24/2023	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Medication Therapy Management Contact	Pharmacy Director	Ms.	Jing	Shu		9176977979					Sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Online Enrollment Center Contact (Back-up)	VP of Business Development	Ms.	Doherty Benckwit	Jeannie		9177330413				7189441243	JDohertyB@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Online Enrollment Center Contact (Primary)		Ms	Doherty Benckwit	Jeannie		9177330413					JdohertyB@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Part C Application Contact	Chief Compliance Officer	Ms.	Nelson Jones	Alicia		3474430157					anjones@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Part D Appeals	Director, Appeal&Grievances	Ms.	Singh	Devi							desingh@centerlight.org	555 Albany Ave		Amityville	NY	11701	12/21/2021	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active	8772268500	4033			PACE - Nat		C	New York
H3329	Part D Appeals Contact (Secondary)	VP of Quality	Ms.	St Fleur	Gilda							gstfleur@centerlight.org	136-65 37th Ave		Flushing	NY	11354	01/24/2023	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active	8772268500				PACE - Nat		C	New York
H3329	Part D Application Contact	Pharmacy Director	Ms.	Jing	Shu		9176977979					sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Part D Benefits Contact	Pharmacy Director	Ms.	Jing	Shu		9176977979					sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Part D Claims Submission Contact	Supervisor of Medicare Operations		Distel	Chris		8582915269					pde@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/13/2023	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Part D Exceptions Contact	Director of PA & UM Programs	Ms.	Emoto	Julianne							julianne.emoto@medimpact.com	136-65 37th Ave.		Flushing	NY	11354	01/03/2023	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active	8587905846				PACE - Nat		C	New York
H3329	Part D Exceptions Contact (Secondary)	Pharmacy Director	Ms.	Jing	Shu						3157504990	sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active	9176977979				PACE - Nat		C	New York
H3329	Part D Price File Contact (Back-up)	Revenue Cycle Manager	Mr..	Sarnov	William		9178287921					wsarnov@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Part D Price File Contact (Optional)	Medicare Part D Project Manager		Keller	Shanon		8587907104					medicarepartdmanagers@medimpact.com	136-65 37th Ave.		Flushing	NY	11354	12/30/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Part D Price File Contact (Primary)	Revenue Cycle Manager	Mr..	Sarnov	William		9178287921					wsarnov@centerlight.org	136-65 37th Ave		Flushing	NY	11354	12/30/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Part D Quality Assurance Contact	Pharmacy Director	Ms.	Jing	Shu		9176977979					Sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Part D Reporting Contact	Pharmacy Director	Ms.	Jing	Shu		3476406615					sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Patient Safety Contact	Pharmacy Director	Ms.	Jing	Shu		9176977979					sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Payment Contact	CFO		Tirtasaputra	Leny		3475012901					ltirtasaputra@centerlight.org	136-65 37th Ave		FLUSHING	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Pharmacy Director	Pharmacy Director	Ms.	Jing	Shu		9176977979					sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Pharmacy Network Management Contact	Pharmacy Director	Ms.	Jing	Shu		9176977979					sjing@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Pharmacy Network Management Contact (Secondary)		Ms.	Frey	Jessica		8582915348					jessica.frey@medimpact.com	136-65 37th Ave.		Flushing	NY	11354	12/30/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services		Brewer	Kathy							customerservice@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/24/2023	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active	8443362681				PACE - Nat		C	New York
H3329	Plan Directory Contact for Public Website	Customer Service Team (CST)		.	.		8332522737					customerserviceteam@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Plan to Plan Reconciliation Contact	Sr. Accountant		Barsamyan	Anahit		2016555825					abarsamyan@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Processor Contact	VP Medicare Programs	Mrs.	Davis-Jones	De'Lona		8587906229					delona.davis-jones@medimpact.com	136-65 37th Ave		Flushing	NY	11354	01/03/2023	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Quality Contact	VP of Quality	Ms.	St Fleur	Gilda		3473877782					gstfleur@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Reconciliation Contact	Chief Executive Officer	Mrs.	Buonocore-Rut	Tara		6464831796					tbrut@centerlight.org	137-65 37th Ave.		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Reconciliation Contact (Secondary)	CFO		Tirtasaputra	Leny		3475012901					ltirtasaputra@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Recovery Audit Contact	Chief Compliance Officer	Ms.	Nelson Jones	Alicia		3474430157					anjones@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Surveillance Contact	Chief Compliance Officer	Ms.	Nelson Jones	Alicia		3474430157					anjones@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	System Contact	Security Administrator	Mr	Hsu	Lester		7182008377					lhsu@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Third Party Administrator (TPA) Liaison	Chief Executive Officer	Mrs.	Buonocore-Rut	Tara		6464831796					tbrut@centerlight.org	136-65 37th Ave		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	User Access Contact	Chief Compliance Officer	Ms.	Nelson-Jones	Alicia		3474430157					anjones@centlight.org	136-65 37th Ave.		Flushing	NY	11354	05/11/2022	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Utilization Management Contact	Director of PA & UM Programs	Ms.	Emoto	Julianne		8587905846					julianne.emoto@medimpact.com	136-65 37th Ave.		Flushing	NY	11354	01/03/2023	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3329	Utilization Review Contact	Medical Director	Dr.	Ogando	Heather		6465651834					hogando@centerlight.org	555 Albany Ave		Amityville	NY	11701	12/21/2021	2023	CENTERLIGHT HEALTHCARE, INC.	National PACE	CenterLight Healthcare PACE	National PACE		CenterLight Health System, Inc.	65	Yes	Active					PACE - Nat		C	New York
H3330	Agent/Broker Compensation Data Contact	Medicare Sales Director		Casas	Edward		3472138107					ecasas@emblemhealth.com	55 Water Street		New York	NY	10041	06/02/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Automated TrOOP Balance Transfer Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					JEwen@emblemhealth.com	55 Water St		New York	NY	10041	06/25/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Backup User Access Contact	Director, Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Best Available Evidence Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Bid Audit Contact	Director, Medicare Audit & Assessment		Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	11/26/2014	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Bid Audit Site Contact	Sr. Medicare Audit Spec.		Chan	Tat		6464470218					tchan@emblemhealth.com	55 Water Street		New York	NY	10041	05/28/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Bid Primary Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	CAP Report Contact for Public Website	Dir., Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	CEO - CMS Administrator Contact	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin-Corp Exec. Office	New York	NY	10041	12/14/2015	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	CEO - Senior Official for Contracting	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin - Corp Exec. Office	New York	NY	10041	03/21/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Chief Financial Officer	Chief Financial Officer	Ms.	Tamborino	Heather		6464476174					htamborino@emblemhealth.com	55 Water Street		New York	NY	10041	07/02/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Chief Operating Officer	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Chief Information Officer	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Chief Information Security Officer	VP, Technology and CISO	Mr.	McDermott	Thomas	M	6464474110					tmcdermott@emblemhealth.com	55 Water Street		New York	NY	10041	05/23/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	CMMI Model Point of Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	CMS Casework Communication Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Complaints Tracking Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Contact for Fraud Investigations	Director, Special Investigations		Lupo	Chris		6318442453					Clupo@EmblemHealth.com	395 North Service Road		Melville	NY	11747	03/02/2017	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Coordination of Benefits Contact	Director, Payment Integrity & Financial Recovery		LaPlante	Brian		8606742840					blaplante@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	01/10/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Corporate Mailing						6464475044					Cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Coverage Gap Discount Program (CGDP) Payment Contact	Treasury Operations Analyst		Saint-Hilaire	Ana		6464474279					ASaint-Hilaire@emblemhealth.com	55 Water St		New York	NY	10041	04/01/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Customer Service Operations Contact	VP, Ops Strategy & Service Delivery		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	DIR Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	DIR Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Emergency Part D Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Emergency Part D Contact (Secondary)	Pharm. Govt. Programs Manager		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Employer Waiver Contact	AVP, Product Dev., Admin., & Perf. Analysis		Averyanova	Nataliya		6464475044					naveryanova@emblemhealth.com	55 Water Street		New York	NY	10041	05/23/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Encounter Data & Risk Adjustment Operations Contact	Dir., Enterprise Gov't Submissions		Guenther	Anne Marie		8606745847					aconnors@connecticare.com	175 Scott Swamp Rd		Farmington	CT	06034	05/23/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Enrollment Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	175 Scott Swamp Road		New York	NY	10041	05/23/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	EOB Transfer Contact	Director, Claims Processing & Provider File Mgmt		Meka	Joann		8604098915				8604098455	jmeka@connecticare.com	175 South Swamp Road		Farmington	CT	06034	05/28/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Financial Audit Contact	Director, Medicare Audit & Assessment	Mr	Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	11/26/2014	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Financial Reporting Contact	Director, Financial Reporting		Heitzer	Frances		6464477885					FHeitzer@emblemhealth.com	55 Water Street		New York	NY	10041	07/11/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Formulary Contact	Sr. Formulary Specialist		Sitilides Cimino	Irene		6864477926					isitilidescimino@emblemhealth.com	55 Water Street		New York	NY	10041	11/15/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Formulary Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	05/12/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	General Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Government Relations Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	HIPAA Privacy Officer	VP, Corporate Compliance		Lurin	Joseph		6464475203					jlurin@emblemhealth.com	55 Water Street		New York	NY	10041	07/29/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	HIPAA Security Officer	AVP, IT Governance		McDermott	Thomas		6464474110					TMcDermott@emblemhealth.com	55 Water Street		New York	NY	10041	06/29/2018	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Hospice Contact	Senior Medicare Pharmacy Specialist		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Interoperability Contact	Dir., Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	MA Appeals/Grievances Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	MA Claims Processing Contact for Public Website	VP, Claims Operations		Henderson	Linda		6464476795					lhenderson@emblemhealth.com	175 Scott Swamp Road		Farmington	CT	06032	10/23/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Marketing Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Medical Director	Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	05/28/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Medicare Compliance Officer	Director, Medicare Compliance/MCO	Ms.	Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Medicare Coordinator	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Medicare Part D Opioid Overutilization Contact	Dir., Pharm. Quality Provider and Safety Prgms		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road		Farmington	CT	06034	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Medication Therapy Management Contact	Clinical Pharmacy Program Leader		Mhajan	Ruby		6464477632					rumhajan@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	OffShore Subcontractor Contact	Lead Admin., Regulatory Pgm.		Kelly	Veronica		6464477494					vkelly@emblemhealth.com	55 Water Street		New York	NY	10041	11/26/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Online Enrollment Center Contact (Back-up)	Knowledge Manager, Enroll. & Bill.		Gonzalez	Gabriel		6464477722					gabriel.gonzalez@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Online Enrollment Center Contact (Optional)	Dir, Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com.com	55 water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Online Enrollment Center Contact (Primary)	Dir, Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	175 Scott Swamp Road		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Part C Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Part C Reporting Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Part D Appeals	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464477215				HMO - Health Maintenance Organization		C	New York
H3330	Part D Appeals Contact (Secondary)	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464477215				HMO - Health Maintenance Organization		C	New York
H3330	Part D Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Part D Benefits Contact	Sr. Pharm. Gov't. Prog. Spec		Dean	Wendy		8604098966					wdean@connecticare.com	175 Scott Swamp Road		Farmington	CT	06034	07/17/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Part D Claims Submission Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Part D Exceptions Contact	VP, Pharmacy Solutions		Colby	Andrew							acolby@emblemhealth.com	55 Water street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464473340				HMO - Health Maintenance Organization		C	New York
H3330	Part D Exceptions Contact (Secondary)	Sr.  Govt Prog. Pharm. Spec.		Kerman	Jeff							jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	05/12/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464477698				HMO - Health Maintenance Organization		C	New York
H3330	Part D Price File Contact (Back-up)	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Part D Price File Contact (Optional)	Sr. Govt Prog. Pharm Spec.		Kerman	Jeff		6464477698					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Part D Price File Contact (Primary)	Sr. Manager Regulated Markets		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/11/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Part D Quality Assurance Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Part D Reporting Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Patient Safety Contact	Dir., Pharm Quality and Provider		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road	P.O. Box 4050	Farmington	CT	060344050	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Payment Contact	VP Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Personal Health Record Contact	Director, Medicare Compliance		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Pharmacy Director	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Pharmacy Network Management Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Pharmacy Network Management Contact (Secondary)	Sr. Govt Prog. Pharm. Specialist		Kerman	Jeff		6464477698					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	01/12/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	8009221557	2			HMO - Health Maintenance Organization		C	New York
H3330	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Client Ops Director		Brown	Gregory							grbrown@emblemhealth.com	55 Water street		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	4015251683				HMO - Health Maintenance Organization		C	New York
H3330	PHR Beneficiary Contact																	04/20/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS	EmblemHealth	EmblemHealth, Inc.	361	Yes	Active	8773447364				HMO - Health Maintenance Organization		C	New York
H3330	Plan Directory Contact for Public Website	Sr. VP Operations		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Plan to Plan Reconciliation Contact	Accounts Payable Manager		Siozios	Jacqueline		6464473017					jsiozios@emblemhealth.com	55 Water Street		New York	NY	10041	08/16/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Processor Contact	AVP, Claims Operations		Gauthier	Kathleen	H	8604096435					kgauthier@connecticare.com	175 Scott Swamp Road	PO BOX 4050	Farmington	CT	06034	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Quality Contact	Data Analytics & Reporting Leader		Goldfarb	Julie		6315775110	65110				jgoldfarb@emblemhealth.com	55 Water Street		New York	NY	10041	01/10/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Reconciliation Contact	Dir., Enrollment & Billing		Ewen	Jillian	L	8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	07/15/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Reconciliation Contact (Secondary)	VP Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	07/15/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Recovery Audit Contact	Director, Medicare Audit & Assessment	Mr.	Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road		Albany	NY	12205	12/03/2014	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	SNP Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	SNP State Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Surveillance Contact	Director, Medicare Compliance	Ms.	Borenkind	Carly		3479784977					Cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	System Contact	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	05/09/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Third Party Administrator (TPA) Liaison	Lead Accountant		Simochkina	LUDMILA		7185599146					lsimochkina@emblemhealth.com	2151 Ocean Ave	apt 2 B	Brooklyn	NY	11229	04/23/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	User Access Contact	Lead Medicare Regulatory Spec.		Handy	Michelle		5184466949					mhandy@EmblemHealth.com	80 Wolf Road		Albany	NY	12205	11/14/2016	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Utilization Management Contact	Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3330	Utilization Review Contact	Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3331	Automated TrOOP Balance Transfer Contact	Pharmacy Administrative Coordinator	Ms.	Van den Bosch	Sarah		5859220080					Sarah.van-den-Bosch@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Backup User Access Contact	Regulatory Compliance Specialist	Ms.	Miller	Amanda		5853135824				5859222864	Amanda.miller4@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Best Available Evidence Contact	Vice President	Mr.	Aroesty	Robert		5859229950					robert.aroesty@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/16/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Bid Primary Contact	Manager, Finance Reporting	Ms.	Franca	Kathryn		5859221038					kathryn.franca@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	CAP Report Contact for Public Website	Vice President	Mr.	Aroesty	Robert		5859229950					Robert.Aroesty@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/16/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	CEO - CMS Administrator Contact	Vice President	Mr.	Aroesty	Robert		5859229950					Robert.aroesty@rochesterregional.org	490 East Ridge Rd		Rochester	NY	14621	05/16/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	CEO - Senior Official for Contracting	Vice President	Mr.	Aroesty	Robert		5859229950					Robert.aroesty@rochesterregional.org	490 East Ridge Rd		Rochester	NY	14621	05/16/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Chief Financial Officer	CFO, Extended Acute Care Services	Mr.	Caprino	Albert		5859221796					Albert.Caprino@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	12/22/2022	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Chief Operating Officer	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	09/09/2019	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Chief Information Officer	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	09/09/2019	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Chief Information Security Officer	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	09/09/2019	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	CMS Casework Communication Contact	Regulatory Compliance Specialist	Ms.	Miller	Amanda		5853135824				5859222864	Amanda.miller4@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Complaints Tracking Contact	Regulatory Compliance Specialist	Ms.	Miller	Amanda		5853135824					amanda.miller4@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Contact for Fraud Investigations	Lead Compliance Coordinator		Marciano	Sheila		5859224749					sheila.marciano@rochesterregional.org	100 Kings Highway South		Rochester	NY	14617	07/13/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Coordination of Benefits Contact	Pharmacy Administrative Coordinator	Ms.	Van den Bosch	Sarah		5859220080					Sarah.van-den-Bosch@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Corporate Mailing						5859229950					Robert.aroesty@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/16/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Finance Reporting	Ms.	Franca	Kathryn		5859221038					kathryn.franca@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Customer Service Operations Contact	Regulatory Compliance Specialist	Ms.	Miller	Amanda		5853135824					amanda.miller4@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	DIR Contact	CFO, Extended Acute Care Services	Mr.	Caprino	Albert		5859221796					Albert.Caprino@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	12/22/2022	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	DIR Contact (Secondary)	Manager, Financial Reporting	Ms.	Franca	Kathryn		5859221038					kathryn.franca@rochesterregional.org	100 Kings Highway South		Rochester	NY	14617	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Emergency Part D Contact	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Emergency Part D Contact (Secondary)	Pharmacy Administrative Coordinator	Ms.	Van den Bosch	Sarah		5859220080					Sarah.van-den-Bosch@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Encounter Data & Risk Adjustment Operations Contact	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					JeanMarie.Mangione@RochesterRegional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Enrollment Contact	Director of Business Development	Ms.	Ralston	Kathy		5859222812					katherine.ralston@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/16/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	EOB Transfer Contact	Pharmacy Administrative Coordinator	Ms.	Van den Bosch	Sarah		5859220080				5859222864	Sarah.van-den-Bosch@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Financial Audit Contact	Vice President CFO, Extended Care Services	Mr.	Caprino	Albert		5859221796					Albert.Caprino@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	12/22/2022	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Financial Reporting Contact	Manager, Finance Reporting	Ms.	Franca	Kathryn		5859221038					kathryn.franca@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Formulary Contact			formulary	not using		5859222200				5859222864	notusing@rochestergeneral.org	2066 Hudson Avenue		Rochester	NY	14617	02/23/2022	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	General Contact	Vice President	Mr.	Aroesty	Robert		5859229950					Robert.aroesty@rochesterregional.org	490 East Ridge Rd		Rochester	NY	14621	05/16/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Government Relations Contact	Regulatory Compliance Specialist	Ms.	Miller	Amanda		5853135824				5859222864	Amanda.miller4@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	HIPAA Privacy Officer	Regulatory Compliance Specialist	Ms.	Miller	Amanda		5853135824				5859222864	Amanda.miller4@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	HIPAA Security Officer	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	09/09/2019	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Interoperability Contact	Director of Health Plan Operations		Mangione	Jean Marie		5859222867					JeanMarie.Mangione@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	02/23/2022	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	MA Appeals/Grievances Contact	Regulatory Compliance Specialist	Ms.	Miller	Amanda		5853135824					amanda.miller4@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	MA Claims Processing Contact for Public Website	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Marketing Contact	Director of Business Development	Ms.	Ralston	Kathy		5859222812				5859222864	Katherine.Ralston@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/16/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Medical Director	Medical Director	Dr.	Ryan	Stephen		5859222855				5859222864	Steve.Ryan@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Medicare Compliance Officer	VP Internal Audit & Corporate Compliance	Mrs.	Gallagher	K Ellen		5859224947					Sheila.Marciano@RochesterRegional.org	100 Kings Highway South		Rochester	NY	14617	07/13/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Medicare Coordinator	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/16/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Ryan	Stephen		5859222855				5859222864	Steve.Ryan@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Medication Therapy Management Contact	Medical Director	Dr.	Ryan	Stephen		5859222855				5859222864	Steve.Ryan@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Part C Application Contact	Regulatory Compliance Specialist	Ms.	Miller	Amanda		5853135824				5859222864	Amanda.miller4@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14617	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Part D Appeals	Administrative Pharmacy Coordinator	Ms.	Van den Bosch	Sarah							Sarah.van-den-Bosch@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active	5859220080				PACE - Nat		C	New York
H3331	Part D Application Contact	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Part D Benefits Contact	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Part D Claims Submission Contact	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Part D Exceptions Contact	Medical Director	Dr.	Ryan	Stephen						5859222855	stephen.ryan@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active	8554574636				PACE - Nat		C	New York
H3331	Part D Price File Contact (Back-up)	Manager, Finance Reporting	Ms.	Franca	Kathryn		5859221038					kathryn.franca@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Part D Price File Contact (Primary)	CFO, Extended Acute Care Services	Mr.	Caprino	Albert		5859221796					Albert.Caprino@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	12/22/2022	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Part D Quality Assurance Contact	Administrative Pharmacy Coordinator	Ms.	Van den Bosch	Sarah		5859220080					Sarah.van-den-Bosch@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Part D Reporting Contact	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Patient Safety Contact	Medical Director	Dr.	Ryan	Stephen		5859222855				5859222864	stephen.ryan@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	01/27/2021	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Payment Contact	Manager, Finance Reporting	Ms.	Franca	Kathryn		5859221038					kathryn.franca@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Pharmacy Director	Medical Director		Ryan	Stephen		5859222855				5859222864	Stephen.Ryan@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	01/27/2021	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Pharmacy Network Management Contact	Provider Network Coordinator	Mr.	Mastrella	Frank		5859222828					Frank.Mastrella@rochesterregional.org	490 East Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Pharmacy Network Management Contact (Secondary)	Consulting Clinical Pharmacist	Ms.	Dorward	Kathryn		5856426004					Kathryn.Dorward@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Pharmacy Technical Help Desk Contact	Administrative Pharmacy Coordinator	Ms.	Van den Bosch	Sarah							Sarah.van-den-Bosch@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active	5859220080				PACE - Nat		C	New York
H3331	Pharmacy Technical Help Desk Contact (Secondary)	Consulting Clinical Pharmacist	Ms.	Dorward	Kathryn								490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active	5856426004				PACE - Nat		C	New York
H3331	Plan Directory Contact for Public Website	Vice President	Mr.	Aroesty	Robert		5859229950					Robert.aroesty@rochesterregional.org	490 East Ridge Rd		Rochester	NY	14621	05/16/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Plan to Plan Reconciliation Contact	Administrative Pharmacy Coordinator	Ms.	Van den Bosch	Sarah		5859220080					Sarah.van-den-Bosch@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Processor Contact	Senior Accountant	Ms.	Ingrassia	Maria		5859221037					Maria.Ingrassia@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Quality Contact	Senior Performance Improvement Coordinator	Mr.	Langenfeld	Edward		5859919975				5859222864	Edward.Langenfeld@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Reconciliation Contact	Senior Accountant	Ms.	Ingrassia	Maria		5859221037					Maria.Ingrassia@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Reconciliation Contact (Secondary)	Manager, Finance Reporting	Ms.	Franca	Kathryn		5859221038					kathryn.franca@rochesterregional.org	100 Kings Highway		Rochester	NY	14617	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Recovery Audit Contact	Director of Health Plan Operations	Ms.	Mangione	Jean Marie		5859222867					jeanmarie.mangione@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Surveillance Contact	Vice President	Mr.	Aroesty	Robert		5859229950					Robert.aroesty@rochesterregional.org	490 East Ridge Rd		Rochester	NY	14621	05/16/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	System Contact	Regulatory Compliance Specialist	Ms.	Miller	Amanda		5853135824					amanda.miller4@rochesterregional.org	490 E. Ridge Rd		Rochester	NY	14621	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Third Party Administrator (TPA) Liaison		Ms.	Lantigua	Deneb		3149449011					dlantigua@careventionhc.com	345 Marshall Avenue	Suite 101	St. Louis	MO	63119	05/30/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	User Access Contact	Regulatory Compliance Specialist	Ms.	Miller	Amanda		5853135824					Amanda.miller4@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Utilization Management Contact	Director, PACE Operations	Ms.	Mihaly	Crystol		5857038287				5859222864	crystol.mihaly@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3331	Utilization Review Contact	Director, PACE Operations	Ms.	Mihaly	Crystol		5857038287				5859222864	crystol.mihaly@rochesterregional.org	490 E. Ridge Road		Rochester	NY	14621	03/02/2023	2023	INDEPENDENT LIVING FOR SENIORS, INC.	National PACE	ElderONE an Affiliate of Rochester Regional Health	National PACE		Rochester Regional Health	132	Yes	Active					PACE - Nat		C	New York
H3335	Agent/Broker Compensation Data Contact	Manager, Broker Administration and Operations		McBride	Kelly		5857396683					Kelly.McBride@Excellus.com	165 Court Street		Rochester	NY	14647	04/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Automated TrOOP Balance Transfer Contact	Medicare Product Operations Specialist		Laird	Jennifer		5853397717					Jennifer.Laird@excellus.com	165 Court Street		Rochester	NY	14647	04/26/2014	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Backup User Access Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court Street		Rochester	NY	14647	11/02/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Best Available Evidence Contact	Supervisor Medicare Operations		Piershalski	Dana		7168574435				7168576160	medicare.reconciliation.unit@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Bid Audit Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	09/14/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Bid Audit Site Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	09/14/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Bid Primary Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	CEO - CMS Administrator Contact	Executive Vice President & Chief Financial Officer	Mr	Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	CEO - Senior Official for Contracting	President and Chief Executive Officer	Mr.	Reed	Jim		3156716406					Jim.Reed@excellus.com	333 Butternut Drive		Syracuse	NY	13214	05/03/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Chief Financial Officer	Executive Vice President & Chief Financial Officer	Mr.	Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Chief Operating Officer	President and Chief Executive Officer	Mr.	Reed	Jim		3156716406					Jim.Reed@excellus.com	333 Butternut Drive		Syracuse	NY	13214	05/03/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Chief Information Officer	Vice President, IT Finance and Corporate System	Ms	Walker	Angela		5853276529					Angela.Walker@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Chief Information Security Officer	Vice President, Chief Information Security Officer	Mr.	Pickup	Jason		5853397620	25511				Jason.Pickup@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	CMS Casework Communication Contact	Medicare Compliance Program Administrator		Gomez	Rafael		7168576226					Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Complaints Tracking Contact	Medicare Compliance Program Administrator		Gomez	Rafael		7168576226					Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Contact for Fraud Investigations	Corporate Director of Special Investigations		Paris	Meg		5852384425				5854536346	Meg.Paris@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Coordination of Benefits Contact	Manager, Analysis and Recovery		May	Mary		3157928873					Mary.May@excellus.com	12 Rhoads Dr.		Utica	NY	13502	07/17/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Corporate Mailing						5852384505					CCiardi@excellus.com	165 Court Street		Rochester	NY	14647	02/07/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Coverage Gap Discount Program (CGDP) Payment Contact	Director Treasury Business Process Management		Weiser	Heidi		5853397791					Heidi.Weiser@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Customer Service Operations Contact	Vice President, Customer Care		Levi	Alexander		5853996683					Alexander.Levi@excellus.com	300 Main St.		East Rochester	NY	14445	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	DIR Contact	Actuarial Analyst		LaMantia	John		8726007942					John.LaMantia@excellus.com	165 Court Street		Rochester	NY	14647	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	DIR Contact (Secondary)	Manager, Actuarial Services		Khaper	Susan		3156716451					Susan.Khaper@excellus.com	333 Butternut Drive		Syracuse	NY	13214	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Emergency Part D Contact	Executive Vice President & Chief Financial Officer		Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court St		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Emergency Part D Contact (Secondary)	Director, Pharmacy Operations		Rocco	Darlene		5852613857				8778125306	Darlene.Rocco@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Encounter Data & Risk Adjustment Operations Contact	Manager, Health Plan Risk Adjustment		Palmer	Benjamin		3156717270					Benjamin.Palmer@excellus.com	333 Butternut Drive		Dewitt	NY	13214	10/22/2019	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Enrollment Contact	Director, Medicare Enrollment and Reconciliation		Della Rocco	Kimberly		5853393876					Kimberly.DellaRocco@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	EOB Transfer Contact	Pharmacy Product Ops Specialist		Ammons	Andrea		5853397986				8778125306	Andrea.Ammons@excellus.com	165 Court Street		Rochester	NY	14647	09/14/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Financial Audit Contact	Manager Financial Compliance	Mr.	Mau	Ahren		5854785535					Ahren.Mau@excellus.com	165 Court Street		Rochester	NY	14647	08/26/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Financial Reporting Contact	Manager, Medicare and SN Finance		Stalzer	Virginia		5852384428					Virginia.Stalzer@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Formulary Contact	Medicare Part D Formulary Manager		Woodruff	Eric		7167832740					Eric.Woodruff@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Formulary Contact (Secondary)	Medicare Part D Formulary Manager		Banaszak	Danielle		7166145704					Danielle.Banaszak@excellus.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	General Contact	VP Retail Markets Operations		Bodley	Karen		5854559038					Karen.Bodley@excellus.com	165 Court Street		Rochester	NY	14647	08/05/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Government Relations Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	HIPAA Privacy Officer	VP, Ethics & Privacy Officer		Hill	Timothy	J	3156716663					Timothy.Hill@excellus.com	333 Butternut Drive		Dewitt	NY	13214	08/01/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	HIPAA Security Officer	Vice President, Chief Information Security Officer		Pickup	Jason		5853397620					Jason.Pickup@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Hospice Contact	Manager, Pharmacy Utilization Management		Khan	Joe		7168437881					Joe.Khan@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	09/29/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Interoperability Contact	Program Manager		Ozminkowski	David		5855305532					David.Ozminkowski@excellus.com	165 Court Street		Rochester	NY	14647	02/07/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	MA Appeals/Grievances Contact	Medicare Compliance Program Administrator		Gomez	Rafael		7168576226					Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	10/09/2017	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	MA Claims Processing Contact for Public Website	Manager, Customer Operations		Amato	Heather		7162505162					Heather.Amato@Univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Marketing Contact	Marketing Manager		Reardon	Elizabeth		5853276504					Elizabeth.Reardon@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Medical Director	Senior VP and Corporate Medical Director		Cohen	Stephen		5854536366					Stephen.Cohen@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Medicare Coordinator	VP Retail Markets Operations		Bodley	Karen		5854559038					Karen.Bodley@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Medicare Part D Opioid Overutilization Contact	Quality Improvement Clinical Pharmacist		Morano	Melissa		7166145705					melissa.morano@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Medication Therapy Management Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Online Enrollment Center Contact (Back-up)	Enrollment Operation Project Manager II		Abiusi	Amy		7166145787					Amy.Abiusi@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	09/23/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Online Enrollment Center Contact (Optional)	Manager, EDI & Enrollment Governance		Field	Eric		3154360215					Eric.Field@excellus.com	333 Butternut Drive		Syracuse	NY	13214	10/09/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Online Enrollment Center Contact (Primary)	Enrollment Operations Analyst II		Conway	Michael		7165045512					Michael.Conway@univerahealthcare.com	205 Park Club Lane		Williamsville	NY	14221	09/23/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Part C Application Contact	Product Implementation and Operations Project Mgr		McParlane	Kelli		7164910233					Kelli.McParlane@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	11/19/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Part C Reporting Contact	Medicare Compliance Program Administrator		Dewa	Renate		3155732791					Renate.Dewa@excellus.com	165 Court Street		Rochester	NY	14647	01/04/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Part D Appeals	Compliance Program Administrator III		Gomez	Rafael							Rafael.Gomez@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active	7168576226				PPO - BBA		C	New York
H3335	Part D Appeals Contact (Secondary)	Manager of Advocacy and Compliance Ops		Jobe	Jessica							Jessica.Jobe@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/05/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active	7162902570				PPO - BBA		C	New York
H3335	Part D Application Contact	Product Implementation and Operations Project Mgr		McParlane	Kelli		7164910233					Kelli.McParlane@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	11/19/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Part D Benefits Contact	Medicare Product Operations Specialist		Laird	Jennifer		5853397717					Jennifer.Laird@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Part D Claims Submission Contact	Medicare Product Operations Specialist		Kohlmeier	Charity		5853277540				8778125306	Charity.Kohlmeier@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Part D Exceptions Contact	Manager, Pharmacy Utiization Management		Khan	Joe							Joe.Khan@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	09/29/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active	7168437881				PPO - BBA		C	New York
H3335	Part D Exceptions Contact (Secondary)	Clinical Pharmacist		Murajda	Lauren							Lauren.Murajda@excellus.Com	165 Court Street		Rochester	NY	14647	10/31/2018	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active	5853397607				PPO - BBA		C	New York
H3335	Part D Price File Contact (Back-up)	Pharmacy Product Ops Specialist		Kohlmeier	charity		5854536463					Charity.Kohlmeier@excellus.com	165 Court Street		Rochester	NY	14647	07/05/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Part D Price File Contact (Optional)	Director of Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	07/23/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Part D Price File Contact (Primary)	Medicare Product Operations Specilist		Ciaramaglia	Shannon		5852384506					shannon.ciaramaglia@excellus.com	165 Court Street		Rocheser	NY	14647	05/03/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Part D Quality Assurance Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Part D Reporting Contact	Medicare Compliance Program Administrator		Dewa	Renate		3155732791					Renate.Dewa@excellus.com	165 Court Street		Rochester	NY	14647	01/04/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Patient Safety Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Payment Contact	Director, Medicare Enrollment and Reconciliation		Della Rocco	Kimberly		5853393876					Kimberly.DellaRocco@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Pharmacy Director	Director, Pharmacy Operations		Rocco	Darlene		5853277544					Darlene.Rocco@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Pharmacy Network Management Contact	Pharmacy Operations Support		Brown	Burt		5853277530				5853396640	Burt.Brown@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Pharmacy Network Management Contact (Secondary)	Network Account Directory Retail Strategy and Cont		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		ST Louis	MO	63121	02/14/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkway	Ste 150	Temple Terrace	FL	33637	11/19/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active	8009221557				PPO - BBA		C	New York
H3335	Pharmacy Technical Help Desk Contact (Secondary)	SR Director Goverment Programs, Medicare		Gibson	Sharon							SGGibson@Express-scripts.Com	One Express Way		St Louis	MO	63121	12/31/2019	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active	8009221557				PPO - BBA		C	New York
H3335	Physician Incentive Contact	VBP Clinical Programs Manager		Ferris	Laura		3156717134				3156716752	Laura.Ferris@excellus.com	333 Butternut Drive		Syracuse	NY	13214	03/31/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Plan Directory Contact for Public Website	Manager, Customer Operations		Myrto	Colleen		3156718498					Colleen.Myrto@Excellus.com	333 Butternut Drive		Dewitt	NY	13214	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Plan to Plan Reconciliation Contact	Manager, Finance Operations		Simmons	Jennifer		5852316874					Jennifer.Simmons@excellus.com	165 Court Street		Rochester	NY	14647	12/08/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Processor Contact	SR Directory Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St Louis	MO	63121	11/07/2018	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Quality Contact	Director, Accreditation and Quality Programs		Walters	Michele		3154012582					Michele.Walters@excellus.com	333 Butternut Dr.		Syracuse	NY	13214	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Reconciliation Contact	Actuarial Analyst		LaMantia	John		8726007942					John.LaMantia@excellus.com	165 Court Street		Rochester	NY	14647	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Khaper	Susan		3156716451					Susan.Khaper@excellus.com	333 Butternut Drive		Syracuse	NY	13214	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Recovery Audit Contact	Manager Financial Compliance	Mr.	Mau	Ahren		5854785535					Ahren.Mau@excellus.com	165 Court St		Rochester	NY	14647	08/26/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Surveillance Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	System Contact	VP Information Technology		Leonard	LaRhonda		5854142258					LaRhonda.Leonard@excellus.com	300 Main St.		East Rochester	NY	14445	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Third Party Administrator (TPA) Liaison	Financial Analyst		McManus	Michael		5853397789					Michael.Mcmanus@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	User Access Contact	Medicare Compliance Program Administrator		Conte	Elva		7163168569					Elva.Conte@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Utilization Management Contact	UM Accreditation & Compliance Administrator		Burnop	Elizabeth		3152721088					Elizabeth.Burnop@excellus.com	12 Rhoads Drive		Utica	NY	13502	08/02/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3335	Utilization Review Contact	UM Accreditation & Compliance Administrator		Burnop	Elizabeth		3152721088					Elizabeth.Burnop@excellus.com	12 Rhoads Drive		Utica	NY	13502	08/02/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	Local PPO		Lifetime Healthcare, Inc.	87	Yes	Active					PPO - BBA		C	New York
H3342	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/06/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/06/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H3342	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				PPO - BBA		C	Chicago
H3342	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H3342	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				PPO - BBA		C	Chicago
H3342	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				PPO - BBA		C	Chicago
H3342	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				PPO - BBA		C	Chicago
H3342	PHR Beneficiary Contact																	02/07/2019	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				PPO - BBA		C	Chicago
H3342	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/06/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	SNP State Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	11/14/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3342	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	Local CCP	Anthem BlueCross BlueShield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H3344	Agent/Broker Compensation Data Contact	Director Government Sales		Aquino	Cathy		7166354948				7166318857	cathy.aquino@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/29/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Automated TrOOP Balance Transfer Contact	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Backup User Access Contact	Risk Operations Analyst		Carr	Sarah Jane		7166313001					SarahJane.Carr@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/19/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Best Available Evidence Contact	Manager - Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Bid Audit Contact	Director - Underwriting		Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/04/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Bid Audit Site Contact	Chief Compliance Officer		Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Bid Primary Contact	Director - Underwriting		Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/04/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	CAP Report Contact for Public Website	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	CEO - CMS Administrator Contact	President, CEO	Dr.	Cropp, MD	Michael		7166353995				7162507135	Michael.Cropp@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/03/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	CEO - Senior Official for Contracting	President, CEO	Dr.	Cropp, MD	Michael		7166353995				7162507135	Michael.Cropp@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/28/2013	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Chief Financial Officer	Executive Vice President - Chief Financial Officer	Mr.	Dunlop	James		7166313001					James.Dunlop@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	07/06/2021	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Chief Operating Officer	Exec Vice President and Chief Operating Officer	Mr.	Rodgers	John		7166353630					john.rodgers@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/11/2015	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Chief Information Officer	Chief Information Security Officer	Mr.	Jabrucki	Peter		7162507383					Peter.Jabrucki@Independenthealth.com	511 Farber lakes		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Chief Information Security Officer	Chief Information Security Officer	Mr.	Jabrucki	Peter		7162507383					Peter.Jabrucki@Independenthealth.com	511 Farber lakes		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	CMS Casework Communication Contact	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Complaints Tracking Contact	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Contact for Fraud Investigations	Vice President, Claims and Recovery Operations		Shute	David		7166354814					David.Shute@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/12/2015	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Coordination of Benefits Contact	Manager - Corporate Recoveries		Abou-Said	Kelly		7166353758					Kelly.Abou-Said@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/07/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Corporate Mailing						7166313001					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Coverage Gap Discount Program (CGDP) Payment Contact	Manager - Treasury Services		Fisher	Dave		7166353561					Dave.Fisher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/28/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Customer Service Operations Contact	Manager - Servicing		Plotner	Jenna		7162504424					Jenna.Plotner@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	12/22/2021	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	DIR Contact	Director - Pharmacy Services and Operations		Malcolm	Jillian		7165121604					jillian.malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/03/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	DIR Contact (Secondary)	VP - Pharmacy Services		Burruano	Martin		7162257559				7166310149	martin.burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/03/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Emergency Part D Contact	VP Pharmacy Services		Burruano	Martin		7162257559				7166319636	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Emergency Part D Contact (Secondary)	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Employer Waiver Contact	VP, Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	12/28/2020	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Encounter Data & Risk Adjustment Operations Contact	Manager - Government Programs Implementation		Everett	Wade		7162507367					Wade.Everett@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/03/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Enrollment Contact	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	EOB Transfer Contact	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604				7166319636	Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Financial Audit Contact	Director-Underwriting	Ms.	Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/23/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Financial Reporting Contact	Accountant Regulatory Reporting-Senior		Smith	Evan		7166353798					Evan.Smith@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/01/2021	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Formulary Contact	Clinical Pharmacist		Wrobel	Mark		7166353831					Mark.Wrobel@independenthealth.com	511 Farber Lakes Dr		Buffalo	NY	14221	03/01/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Formulary Contact (Secondary)	Pharmacy Services Compliance & Product Specialist		Basher	Lindsay		7166353547					Lindsay.Basher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	05/21/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	General Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Government Relations Contact	SVP Government Programs		Tracy	Robert		7166354904					Robert.Tracy@independenthealth.com	511 Farber Lakes Drive		Williamsville	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	HIPAA Privacy Officer	Chief Information Security Officer		Jabrucki	Peter		7162507383				7162507115	peter.jabrucki@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	HIPAA Security Officer	Chief Information Security Officer		Jabrucki	Peter		7162507383				7162507115	peter.jabrucki@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Hospice Contact	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Interoperability Contact	VP-IT Application Delivery		Haak	Lesley		7162504443					Lesley.Haak@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	MA Appeals/Grievances Contact	Director, Benefit Administration and Compliance		Kieser	Michelle		7166353938					Michelle.Kieser@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/11/2015	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	MA Claims Processing Contact for Public Website			Relations Dept	Provider		7166313282				7166353890	Provider@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	06/06/2008	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Marketing Contact	Director Government Sales		Aquino	Cathy		7166354948				7166318857	cathy.aquino@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Medical Director	EVP - Chief Medical Officer	Dr.	Billittier, MD	Anthony		7166353635					Anthony.Billittier@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	06/19/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Medicare Compliance Officer	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/20/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Medicare Coordinator	VP Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Brim	Karen		7166353617					karen.brim@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/29/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Medication Therapy Management Contact	Director Pharmacy, Quality and MTM		Verrall	Kelly		7166354885				7166310149	kelly.verrall@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	OffShore Subcontractor Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Online Enrollment Center Contact (Back-up)	Operations and System Analyst-Mbrs Operations		Cole	Jenn		7166313001	2274				jenn.cole@independenthealth.com	511 Farber Lakes Drive		Williamsville	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Online Enrollment Center Contact (Optional)	Supervisor-Enrollment		Kindred	Amanda		7166352157					Amanda.Kindred@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Online Enrollment Center Contact (Primary)	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Part C Application Contact	Product Manager		Morgan	Evan		7166353740					Evan.Morgan@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/12/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Part C Reporting Contact	Medicare Programs Implementation Manager		Laubacker	Jeremy		7166354994				7162507197	jeremy.laubacker@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/06/2020	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Part D Appeals	Director - Benefit Administration and Compliance		Kieser	Michelle							michelle.kieser@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/11/2015	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active	8006651502				PPO - BBA		C	New York
H3344	Part D Appeals Contact (Secondary)	Director, Benefit Administration and Compliance		Kieser	Michelle							Michelle.Kieser@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	07/15/2016	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active	8007365771				PPO - BBA		C	New York
H3344	Part D Application Contact	Product Manager		Morgan	Evan		7166353740					Evan.Morgan@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/12/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Part D Benefits Contact	VP, Pharmacy Services		Burruano	Martin		7162257559				7166319636	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Part D Claims Submission Contact	Director-Pharmacy Services and Operations		Malcolm	Jillian		7166353754					Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Part D Exceptions Contact	VP- Pharmacy Services		Burruano	Martin						7166310149	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active	8002471466	5311			PPO - BBA		C	New York
H3344	Part D Exceptions Contact (Secondary)	Director-Pharmacy Services and Operations		Malcolm	Jillian						7166310149	Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active	8002471466	5311			PPO - BBA		C	New York
H3344	Part D Price File Contact (Back-up)	Pharmacy Services Compliance & Product Specialist		Basher	Lindsay		7166353547					Lindsay.Basher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	05/21/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Part D Price File Contact (Optional)	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Part D Price File Contact (Primary)	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Part D Quality Assurance Contact	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Part D Reporting Contact	Medicare Programs Implementation Manager		Laubacker	Jeremy		7166354994				7162507197	jeremy.laubacker@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/06/2020	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Patient Safety Contact	Director, Pharmacy, Quality and MTM		Verrall	Kelly		7166354885				7162507121	kelly.verrall@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Payment Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354980				7162507197	Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Pharmacy Director	VP Pharmacy Services		Burruano	Martin		7162257559				7166310149	martin.burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Pharmacy Network Management Contact	VP Pharmacy Services		Burruano	Martin		7162257559				7166319636	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Pharmacy Network Management Contact (Secondary)	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Pharmacy Technical Help Desk Contact	Supervisor-Member Servicing		Bates	Taylor							Taylor.Bates@pbdrx.com	511 Farber Lakes Drive		Buffalo	NY	14221	12/02/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active	8009939898				PPO - BBA		C	New York
H3344	Pharmacy Technical Help Desk Contact (Secondary)	VP-Pharmacy Services		Burruano	Martin							Martin.Burruano@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/15/2016	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active	8009939898				PPO - BBA		C	New York
H3344	PHR Beneficiary Contact																	07/24/2009	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO	Independent Health - Member Services	Independent Health Association, Inc.	131	Yes	Active	8006651502				PPO - BBA		C	New York
H3344	Physician Incentive Contact	Director-Value-Based Reimbursement		Ghil	Peter		7166353840					Peter.Ghil@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/23/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Plan Directory Contact for Public Website			Services	Member		8006651502					wnyms@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/08/2008	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Plan to Plan Reconciliation Contact	Pharmacy Systems Gov. Programs Manager		Miszuk	Jane		7166357857					Jane.Miszuk@pbdrx.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/11/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Processor Contact	VP-Claims & Recovery Operations		Shute	David		7166354814					David.Shute@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/15/2016	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Quality Contact	Population Health Science and Quality Lead		Thomas	Jessica		7162504431					Jessica.Thomas@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/26/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Reconciliation Contact	Director - Underwriting		Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/16/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Reconciliation Contact (Secondary)	VP - Medicare Programs		Odrzywolski	Dawn		7166354980					dawn.odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Recovery Audit Contact	VP Medicare Programs	Mrs.	Odrzywolski	Dawn		7164406950				7162507197	Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	12/28/2020	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	SNP Application Contact	Product Manager		Morgan	Evan		7166353740					Evan.Morgan@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/12/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Surveillance Contact	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	System Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354980				7162507197	Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Third Party Administrator (TPA) Liaison	Manager - Treasury Services		Fisher	Dave		7166353561					Dave.Fisher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/28/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	User Access Contact	Medicare Programs Implementation Manager		Laubacker	Jeremy		7166354994				7162507197	Jeremy.Laubacker@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/06/2020	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Utilization Management Contact	Director, Utilization Quality Ops Improvement Mgt		Salemi	Phil		7166353908					Philip.Salemi@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3344	Utilization Review Contact	Director, Utilization Quality Ops Improvement Mgt		Salemi	Phil		7166353908					Philip.Salemi@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	Local CCP	Independent Health	Local PPO		Independent Health Association, Inc.	131	Yes	Active					PPO - BBA		C	New York
H3347	Agent/Broker Compensation Data Contact	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Automated TrOOP Balance Transfer Contact	Assistant Director Pharmacy Services		Sahani	Ankit		7189218841					asahani@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Backup User Access Contact			Chan	Lauren		7186302561					lchan@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Best Available Evidence Contact	Director of Member Operations		Lewis	Alison		7186302608				7186301709	alewis@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Bid Audit Contact	Chief Financial Officer		Koschitzki	David		7184917208					dkoschit@mjhs.org	6323 Seventh Avenue	3rd Floor	Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Bid Audit Site Contact	VP, Medicaid & Integrated Products		Johnson	John-Chad		7189217922					jcjohnso@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Bid Primary Contact	VP, Medicaid & Integrated Products		Johnson	John-Chad		7189217922					jcjohnso@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	CAP Report Contact for Public Website	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	CEO - CMS Administrator Contact	President & CEO	Mr.	Wagner	David		7184917209				7184917138	dwagner@mjhs.org	6323 Seventh Avenue	3rd Floor	Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	CEO - Senior Official for Contracting	President & CEO	Mr.	Wagner	David		7184917209				7184917138	dwagner@mjhs.org	6323 Seventh Avenue	3rd Floor	Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Chief Financial Officer	Chief Financial Officer	Mr.	Koschitzki	David		7184917208					dkoschit@mjhs.org	6323 Seventh Avenue	3rd Floor	Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Chief Operating Officer	President & CEO	Mr.	Wagner	David		7184917209				7184917138	dwagner@mjhs.org	6323 Seventh Avenue	3rd Floor	Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Chief Information Officer	Senior VP of Health Plan Information Services	Mr.	Azoff	Craig		7189217826					cazoff@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Chief Information Security Officer	Senior VP of Health Plan Information Services	Mr.	Azoff	Craig		7189217826					cazoff@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	CMS Casework Communication Contact	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Complaints Tracking Contact	Regulatory Compliance Coordinator		Hernandez	Dawn		7186302598					dhernand@mjhs.org	6323 Seventh Avenue	3rd Floor	Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Contact for Fraud Investigations	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Coordination of Benefits Contact	Director of Member Operations		Lewis	Alison		7186302608				7186301709	alewis@mjhs.org	6323 Seventh Avenue	3rd Floor	Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Corporate Mailing						7189218066				7189211616	jcjohnso@mjhs.org	Elderplan, Inc.	6323 Seventh Avenue	Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Coverage Gap Discount Program (CGDP) Payment Contact	Assistant Director Pharmacy Services		Sahani	Ankit		7189218841					asahani@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Customer Service Operations Contact	Director of Member Services		Alston	Doretha		7189217830					DALSTON@MJHS.ORG	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	DIR Contact	VP, Pharmacy		Ference	Eunice		7186302691				7187652106	eference@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	02/12/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	DIR Contact (Secondary)	Chief Financial Officer		Koschitzki	David		7184917208					dkoschit@mjhs.org	6323 Seventh Avenue	3rd Floor	Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Emergency Part D Contact	VP, Pharmacy	Ms	Ference	Eunice		7186302691					eference@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	02/12/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Employer Waiver Contact	VP, Medicaid & Integrated Products		Johnson	John-Chad		7189217922					jcjohnso@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	10/20/2022	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Encounter Data & Risk Adjustment Operations Contact	VP, Health Economics		O'Brien	Jaclyn		7189217717					JOBRIEN@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	11/04/2019	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Enrollment Contact	Director of Member Operations		Lewis	Alison		7186302608				7186301709	alewis@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/18/2019	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	EOB Transfer Contact	VP of Compliance & Privacy		Weatherly	Candice		7187594260				7187595262	cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Financial Audit Contact	VP of Finance	Mr.	Coleman	John		7187594482					johcolem@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Financial Reporting Contact	VP of Finance	Mr.	Coleman	John		7187594482					johcolem@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Formulary Contact	VP, Pharmacy		Ference	Eunice		7186302691					eference@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	02/12/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Formulary Contact (Secondary)	Assistant Director Pharmacy Services		Sahani	Ankit		7189218841					asahani@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	General Contact	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Government Relations Contact	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	HIPAA Privacy Officer	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	HIPAA Security Officer	Senior VP of Health Plan Information Services		Azoff	Craig		7189217826					cazoff@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	12/22/2021	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Hospice Contact	VP, Pharmacy		Ference	Eunice		7186302691					eference@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	02/12/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Interoperability Contact	SVP, Elderplan Information Services		Azoff	Craig		7189217826					cazoff@mjhs.org	6323 Seventh Avenue Brooklyn, NY		Brooklyn	NY	11220	02/15/2022	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	MA Appeals/Grievances Contact	Director of Appeals and Grievances		Arzu	Marcela		7187594054					marzu@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	12/16/2020	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	MA Claims Processing Contact for Public Website	VP Claims & Call Center		Ditkowsky	Lee		7187594601					lditkows@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	11/30/2021	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Marketing Contact	Chief Marketing Officer		Ashley	Diane		7187594343					dashley@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Medical Director	Executive Director of Medical Affairs	Dr.	Burgos	Gilbert		3476753297					gburgos@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	06/30/2020	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Medicare Compliance Officer	VP of Compliance & Privacy	Ms.	Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	11220	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Medicare Coordinator	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Medicare Part D Opioid Overutilization Contact	VP, Pharmacy		Ference	Eunice		7186302691					eference@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	10/15/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Medication Therapy Management Contact	VP, Pharmacy		Ference	Eunice		7186302691					eference@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	02/12/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	OffShore Subcontractor Contact	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Online Enrollment Center Contact (Back-up)	Supervisor Member Operations		Fowling	Pedetta		7184917295					pfowling@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	05/27/2016	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Online Enrollment Center Contact (Primary)	Director of Member Operations		Lewis	Alison		7186302608				7187652473	alewis@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	03/12/2019	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Part C Application Contact	VP, Medicaid & Integrated Products		Johnson	John-Chad		7189217922					jcjohnso@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	10/20/2022	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Part C Reporting Contact	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Part D Appeals			Beyda	Trista						7326914838	_REReconsideration@cvscaremark.com	620 Epsilon Dr		Pittsburgh	PA	15238	03/04/2021	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active	4129672300	71910			HMO - Health Maintenance Organization		C	New York
H3347	Part D Appeals Contact (Secondary)			Gabor Lyon	Pam						7326914838	Trista.Beyda@cvshealth.com	620 Epsilon Dr		Pittsburgh	PA	15238	03/04/2021	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active	4123960695				HMO - Health Maintenance Organization		C	New York
H3347	Part D Application Contact	VP, Medicaid & Integrated Products		Johnson	John-Chad		7189217922					jcjohnso@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	10/20/2022	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Part D Benefits Contact	VP, Medicaid & Integrated Products		Johnson	John-Chad		7189217922					jcjohnso@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Part D Claims Submission Contact	VP, Pharmacy		Ference	Eunice		7186302691					eference@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	02/12/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Part D Exceptions Contact	VP, Pharmacy		Ference	Eunice							eference@mjhs.org	Elderplan, Inc.	6323 Seventh Avenue	Brooklyn	NY	11220	02/12/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active	7186302691				HMO - Health Maintenance Organization		C	New York
H3347	Part D Exceptions Contact (Secondary)	Assistant Director Pharmacy Services		Sahani	Ankit							ASAHANI@MJHS.ORG	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active	7189218841				HMO - Health Maintenance Organization		C	New York
H3347	Part D Price File Contact (Back-up)	VP, Pharmacy		Ference	Eunice		7186302691					eference@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	02/12/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Part D Price File Contact (Primary)	Manager		Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	CVS Health	9501 E Shea Blvd, MC042	Scottsdale	AZ	85260	12/16/2020	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Part D Quality Assurance Contact	VP, Pharmacy		Ference	Eunice		7186302691					eference@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	02/12/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Part D Reporting Contact	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Patient Safety Contact	VP, Quality and Performance Improvement		Frisari	Josephine		7189217984				7182088858	jfrisari@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	12/16/2020	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Payment Contact	VP of Health Economics		O'Brien	Jaclyn		7189217717				7186301709	jobrien@mjhs.org	6323 Seventh Avenue		Brookyn	NY	11220	12/16/2020	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Pharmacy Director	VP, Pharmacy		Ference	Eunice		7186302691					eference@mjhs.org	Elderplan, Inc.	6323 Seventh Avenue	Brooklyn	NY	11220	02/12/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Pharmacy Network Management Contact	VP, Pharmacy		Ference	Eunice		7186302691					eference@mjhs.org	Elderplan, Inc.	745 64th Street	Brooklyn	NY	11220	02/12/2018	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Pharmacy Network Management Contact (Secondary)	Assistant Director Pharmacy Services		Sahani	Ankit		7189218841					asahani@mjhs.org	Elderplan, Inc.	6323 Seventh Avenue	Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Pharmacy Technical Help Desk Contact	Advisor		Rodriguez	Alex							Alex.rodriguez@cvshealth.com	CVS Health	9501 E Shea Blvd	Scottsdale	AZ	85260	12/16/2020	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H3347	Plan Directory Contact for Public Website	Director of Member Services		Alston	Doretha		7189217979					dalston@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Plan to Plan Reconciliation Contact	VP, Medicaid & Integrated Products		Johnson	John-Chad		7189217922					jcjohnso@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	10/20/2022	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Processor Contact	VP Claims & Call Center		Ditkowsky	Lee		7187594601					lditkows@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	11/30/2021	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Quality Contact	VP of Quality & Performance Improvement		Frisari	Josephine		7189217984					JFRISARI@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	12/16/2020	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Reconciliation Contact	VP of Health Economics		O'Brien	Jaclyn		7189217717					JOBRIEN@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	03/23/2020	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Reconciliation Contact (Secondary)	Director of Actuarial Services		Myers	Daniel		7189863384					DMYERS@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	03/23/2020	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Recovery Audit Contact	VP of Revenue Cycle	Ms.	Robeck	Marina		7186302510					MROBECK@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	12/16/2020	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	SNP Application Contact	VP, Medicaid & Integrated Products		Johnson	John-Chad		7189217922					jcjohnso@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	10/20/2022	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	SNP State Contact	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Surveillance Contact	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	System Contact	Director of Member Operations		Lewis	Alison		7186302608				7187652473	alewis@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	03/12/2019	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Third Party Administrator (TPA) Liaison	Assistant Director Pharmacy Services		Sahani	Ankit		7189218841					asahani@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	01/13/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	User Access Contact	VP of Compliance & Privacy		Weatherly	Candice		7187594260					cweather@mjhs.org	55 Water Street	46th Floor	New York	NY	10041	08/16/2023	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Utilization Management Contact	VP of Medical Management & Case Management		Bennett	Robert		7189217611				7187595105	rbennett@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	05/27/2016	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3347	Utilization Review Contact	VP of Medical Management & Case Management		Bennett	Robert		7189217611				7187595105	rbennett@mjhs.org	6323 Seventh Avenue		Brooklyn	NY	11220	05/27/2016	2023	ELDERPLAN, INC.	Local CCP	Elderplan	HMO/HMOPOS		Elderplan, Inc.	395	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Agent/Broker Compensation Data Contact	Manager, Broker Administration and Operations		McBride	Kelly		5857396683					Kelly.McBride@Excellus.com	165 Court Street		Rochester	NY	14647	04/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Automated TrOOP Balance Transfer Contact	Medicare Product Operations Specialist		Laird	Jennifer		5853397717					Jennifer.Laird@excellus.com	165 Court Street		Rochester	NY	14647	04/28/2014	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Backup User Access Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court Street		Rochester	NY	14647	11/02/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Best Available Evidence Contact	Supervisor Medicare Operations		Piershalski	Dana		7168574435				7168576160	medicare.reconciliation.unit@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Bid Audit Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	09/14/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Bid Audit Site Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	09/14/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Bid Primary Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	CEO - CMS Administrator Contact	Executive Vice President & Chief Financial Officer	Mr	Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	CEO - Senior Official for Contracting	President and Chief Executive Officer	Mr.	Reed	Jim		3156716406					Jim.Reed@excellus.com	333 Butternut Drive		Syracuse	NY	13214	05/19/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Chief Financial Officer	Executive Vice President & Chief Financial Officer	Mr.	Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Chief Operating Officer	President and Chief Executive Officer	Mr.	Reed	Jim		3156716406					Jim.Reed@excellus.com	333 Butternut Drive		Syracuse	NY	13214	05/19/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Chief Information Officer	Vice President, IT Finance and Corporate System	Ms	Walker	Angela		5853276529					Angela.Walker@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Chief Information Security Officer	Vice President, Chief Information Security Officer	Mr.	Pickup	Jason		5853397620	25511				Jason.Pickup@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	CMS Casework Communication Contact	Medicare Compliance Program Administrator		Gomez	Rafael		7168576226					Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Complaints Tracking Contact	Medicare Compliance Program Administrator		Gomez	Rafael		7168576226					Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Contact for Fraud Investigations	Corporate Director of Special Investigations		Paris	Meg		5852384425				5854536346	Meg.Paris@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Coordination of Benefits Contact	Manager, Analysis and Recovery		May	Mary		3157928873					Mary.May@excellus.com	12 Rhoads Dr.		Utica	NY	13502	07/17/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Corporate Mailing						5852384505					CCiardi@excellus.com	165 Court Street		Rochester	NY	14647	02/07/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Coverage Gap Discount Program (CGDP) Payment Contact	Director Treasury Business Process Management		Weiser	Heidi		5853397791					Heidi.Weiser@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Customer Service Operations Contact	Vice President, Customer Care		Levi	Alexander		5853996683					Alexander.Levi@excellus.com	300 Main St.		East Rochester	NY	14445	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	DIR Contact	Actuarial Analyst		LaMantia	John		8726007942					John.LaMantia@excellus.com	165 Court Street		Rochester	NY	14647	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	DIR Contact (Secondary)	Manager, Actuarial Services		Khaper	Susan		3156716451					Susan.Khaper@excellus.com	333 Butternut Drive		Syracuse	NY	13214	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Emergency Part D Contact	Executive Vice President & Chief Financial Officer		Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court St		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Emergency Part D Contact (Secondary)	Director, Pharmacy Operations		Rocco	Darlene		5852613857				8778125306	Darlene.Rocco@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Encounter Data & Risk Adjustment Operations Contact	Manager, Health Plan Risk Adjustment		Palmer	Benjamin		3156717270					Benjamin.Palmer@excellus.com	333 Butternut Drive		Dewitt	NY	13214	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Enrollment Contact	Director, Medicare Enrollment and Reconciliation		Della Rocco	Kimberly		5853393876					Kimberly.DellaRocco@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	EOB Transfer Contact	Pharmacy Product Ops Specialist		Ammons	Andrea		5853397986				8778125306	Andrea.Ammons@excellus.com	165 Court Street		Rochester	NY	14647	09/14/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Financial Audit Contact	Manager Financial Compliance	Mr.	Mau	Ahren		5854785535					Ahren.Mau@excellus.com	165 Court Street		Rochester	NY	14647	08/26/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Financial Reporting Contact	Manager, Medicare and SN Finance		Stalzer	Virginia		5852384428					Virginia.Stalzer@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Formulary Contact	Medicare Part D Formulary Manager		Woodruff	Eric		7167832740					Eric.Woodruff@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Formulary Contact (Secondary)	Medicare Part D Formulary Manager		Banaszak	Danielle		7166145704					Danielle.Banaszak@excellus.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	General Contact	VP Retail Markets Operations		Bodley	Karen		5854559038					Karen.Bodley@excellus.com	165 Court Street		Rochester	NY	14647	08/05/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Government Relations Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	HIPAA Privacy Officer	VP, Ethics & Privacy Officer		Hill	Timothy	J	3156716663					Timothy.Hill@excellus.com	333 Butternut Drive		Dewitt	NY	13214	08/01/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	HIPAA Security Officer	Vice President, Chief Information Security Officer		Pickup	Jason		5853397620					Jason.Pickup@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Hospice Contact	Manager, Pharmacy Utilization Management		Khan	Joe		7168437881					Joe.Khan@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Interoperability Contact	Program Manager		Ozminkowski	David		5855305532					David.Ozminkowski@excellus.com	165 Court Street		Rochester	NY	14647	02/07/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	MA Appeals/Grievances Contact	Medicare Compliance Program Administrator		Gomez	Rafael		7168576226					Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	10/30/2018	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	MA Claims Processing Contact for Public Website	Manager, Customer Operations		Amato	Heather		7162505162					Heather.Amato@Univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Marketing Contact	Marketing Manager		Reardon	Elizabeth		5853276504					Elizabeth.Reardon@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Medical Director	Senior VP and Corporate Medical Director		Cohen	Stephen		5854536366					Stephen.Cohen@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Medicare Coordinator	VP Retail Markets Operations		Bodley	Karen		5854559038					Karen.Bodley@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Medicare Part D Opioid Overutilization Contact	Quality Improvement Clinical Pharmacist		Morano	Melissa		7166145705					melissa.morano@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Medication Therapy Management Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Online Enrollment Center Contact (Back-up)	Enrollment Operation Project Manager II		Abiusi	Amy		7166145787					Amy.Abiusi@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Online Enrollment Center Contact (Optional)	Manager, EDI & Enrollment Governance		Field	Eric		3154360215					Eric.Field@excellus.com	333 Butternut Drive		Syracuse	NY	13214	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Online Enrollment Center Contact (Primary)	Enrollment Operations Analyst II		Conway	Michael		7165045512					Michael.Conway@univerahealthcare.com	205 Park Club Lane		Williamsville	NY	14221	09/23/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Part C Application Contact	Product Implementation and Operations Project Mgr		McParlane	Kelli		7164910233					Kelli.McParlane@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	11/19/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Part C Reporting Contact	Medicare Compliance Program Administrator		Dewa	Renate		3155732791					Renate.Dewa@excellus.com	165 Court Street		Rochester	NY	14647	01/04/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Part D Appeals	Compliance Program Administrator III		Gomez	Rafael							Rafael.Gomez@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	7168576226				HMO - Health Maintenance Organization		C	New York
H3351	Part D Appeals Contact (Secondary)	Manager of Advocacy and Compliance Ops		Jobe	Jessica							Jessica.Jobe@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	7162902570				HMO - Health Maintenance Organization		C	New York
H3351	Part D Application Contact	Product Implementation and Operations Project Mgr		McParlane	Kelli		7164910233					Kelli.McParlane@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	11/19/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Part D Benefits Contact	Medicare Product Operations Specialist		Laird	Jennifer		5853397717					Jennifer.Laird@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Part D Claims Submission Contact	Medicare Product Operations Specialist		Kohlmeier	Charity		5853277540				8778125306	Charity.Kohlmeier@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Part D Exceptions Contact	Manager, Pharmacy Utiization Management		Khan	Joe							Joe.Khan@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	09/29/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	7168437881				HMO - Health Maintenance Organization		C	New York
H3351	Part D Exceptions Contact (Secondary)	Clinical Pharmacist		Murajda	Lauren							Lauren.Murajda@excellus.Com	165 Court Street		Rochester	NY	14647	10/31/2018	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	5853397607				HMO - Health Maintenance Organization		C	New York
H3351	Part D Price File Contact (Back-up)	Pharmacy Product Ops Specialist		Kohlmeier	charity		5854536463					Charity.Kohlmeier@excellus.com	165 Court Street		Rochester	NY	14647	07/05/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Part D Price File Contact (Optional)	Director of Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Part D Price File Contact (Primary)	Medicare Product Operations Specilist		Ciaramaglia	Shannon		5852384506					shannon.ciaramaglia@excellus.com	165 Court Street		Rocheser	NY	14647	05/03/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Part D Quality Assurance Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Part D Reporting Contact	Medicare Compliance Program Administrator		Dewa	Renate		3155732791					Renate.Dewa@excellus.com	165 Court Street		Rochester	NY	14647	01/04/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Patient Safety Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Payment Contact	Director, Medicare Enrollment and Reconciliation		Della Rocco	Kimberly		5853393876					Kimberly.DellaRocco@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Pharmacy Director	Director, Pharmacy Operations		Rocco	Darlene		5853277544					Darlene.Rocco@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Pharmacy Network Management Contact	Pharmacy Operations Support		Brown	Burt		5853277530				5853396640	Burt.Brown@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Pharmacy Network Management Contact (Secondary)	Network Account Directory Retail Strategy and Cont		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		ST Louis	MO	63121	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkway	Ste 150	Temple Terrace	FL	33637	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H3351	Pharmacy Technical Help Desk Contact (Secondary)	SR Director Goverment Programs, Medicare		Gibson	Sharon							SGGibson@Express-scripts.Com	One Express Way		St Louis	MO	63121	12/31/2019	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H3351	Physician Incentive Contact	VBP Clinical Programs Manager		Ferris	Laura		3156717134				3156716752	Laura.Ferris@excellus.com	333 Butternut Drive		Syracuse	NY	13214	03/31/2020	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Plan Directory Contact for Public Website	Manager, Customer Operations		Myrto	Colleen		3156718498					Colleen.Myrto@Excellus.com	333 Butternut Drive		Dewitt	NY	13214	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Plan to Plan Reconciliation Contact	Manager, Finance Operations		Simmons	Jennifer		5852316874					Jennifer.Simmons@excellus.com	165 Court Street		Rochester	NY	14647	12/08/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Processor Contact	SR Directory Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St Louis	MO	63121	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Quality Contact	Director, Accreditation and Quality Programs		Walters	Michele		3154012582					Michele.Walters@excellus.com	333 Butternut Dr.		Syracuse	NY	13214	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Reconciliation Contact	Actuarial Analyst		LaMantia	John		8726007942					John.LaMantia@excellus.com	165 Court Street		Rochester	NY	14647	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Khaper	Susan		3156716451					Susan.Khaper@excellus.com	333 Butternut Drive		Syracuse	NY	13214	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Recovery Audit Contact	Manager Financial Compliance	Mr.	Mau	Ahren		5854785535					Ahren.Mau@excellus.com	165 Court St		Rochester	NY	14647	08/26/2021	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Surveillance Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	System Contact	VP Information Technology		Leonard	LaRhonda		5854142258					LaRhonda.Leonard@excellus.com	300 Main St.		East Rochester	NY	14445	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Third Party Administrator (TPA) Liaison	Financial Analyst		McManus	Michael		5853397789					Michael.Mcmanus@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	User Access Contact	Medicare Compliance Program Administrator		Conte	Elva		7163168569					Elva.Conte@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Utilization Management Contact	UM Accreditation & Compliance Administrator		Burnop	Elizabeth		3152721088					Elizabeth.Burnop@excellus.com	12 Rhoads Drive		Utica	NY	13502	08/02/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3351	Utilization Review Contact	UM Accreditation & Compliance Administrator		Burnop	Elizabeth		3152721088					Elizabeth.Burnop@excellus.com	12 Rhoads Drive		Utica	NY	13502	08/02/2023	2023	EXCELLUS HEALTH PLAN, INC.	Local CCP	Excellus Health Plan, Inc	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Agent/Broker Compensation Data Contact	VP, Associate General Counsel	Ms.	Jan	Munizeh		6467675166					mjan@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	03/04/2019	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Automated TrOOP Balance Transfer Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/23/2019	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Backup User Access Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Best Available Evidence Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/23/2019	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Bid Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/01/2014	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Bid Audit Site Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/01/2014	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Bid Primary Contact	Manager, Product Implementation	Mr.	Buntin	Bryant		2125192962					bbuntin@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/07/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	CAP Report Contact for Public Website	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/15/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	CEO - CMS Administrator Contact	President & CEO	Ms.	Wang	Pat		2128011500					pwang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	01/04/2023	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	CEO - Senior Official for Contracting	President & CEO	Ms.	Wang	Pat		2128011500					pwang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	01/03/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Chief Financial Officer	Chief Financial Officer	Mr.	Bermel	John		2124792777					jbermel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	05/05/2016	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Chief Operating Officer	SVP, Operations	Ms.	Weinseiss	Karen		6466773595					kweinseiss@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	03/10/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Chief Information Officer	SVP, CIO	Mr.	Sweeney	GT		6467675199					gtsweeney@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	03/03/2016	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Chief Information Security Officer	VP, Chief Security Information Officer	Mr.	Miller	Brian		6467675750					bmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	03/03/2016	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	CMS Casework Communication Contact	Complaints Manager	Ms.	Gabriel	Charisse		6467675697					cgabriel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/18/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Complaints Tracking Contact	Complaints Manager	Ms.	Gabriel	Charisse		6467675697					cgabriel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/18/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Contact for Fraud Investigations	VP, Associate General Counsel	Mr.	Kianovsky	Nahum		2128013240					nkianovsky@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	03/03/2016	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Coordination of Benefits Contact	Director, Payment Integrity Team	Ms.	Hutchinson	Chris		9176982415					chutchinson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	04/08/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Corporate Mailing						6463138967					clogreira@healthfirst.org	Healthfirst Medicare Plan	100 Church Street, 18th Floor	New York	NY	10007	12/01/2014	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Manager, Accounting	Ms.	Tyme	Denise		6462732814					dtyme@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Customer Service Operations Contact	VP,  Member Services	Ms.	O'Connor	Kimberly		2128011639					koconnor@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	DIR Contact	Sr. Manager, Pharmacy Finance	Mr.	Denman	Hunter		2128013297					hdenman@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	DIR Contact (Secondary)	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					Tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	02/24/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Emergency Part D Contact	VP, Pharmacy	Mr.	Modi	Bhavesh		9734494186					bmodi@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/28/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Emergency Part D Contact (Secondary)	Director, Pharmacy Regulatory & Compliance	Ms.	Andreu	Kim		3475743277					kandreu@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/28/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters	Mr.	Miller	Robert		2125193011					rmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	10/21/2019	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Enrollment Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/23/2019	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	EOB Transfer Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753				6463134645	jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/23/2019	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Financial Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/02/2017	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Financial Reporting Contact	Chief Financial Officer	Mr.	Bermel	John		2124792777					jbermel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	02/21/2017	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Formulary Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Formulary Contact (Secondary)	Medicare Clinical Pharmacist	Ms.	Baja	Melodie		6468565983					mbaja@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	05/24/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	General Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/01/2014	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Government Relations Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/01/2014	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	HIPAA Privacy Officer	AVP, Chief Privacy Officer	Ms.	Radler	Laurie		9172863902					lradler@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	10/27/2020	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	HIPAA Security Officer	VP, Chief Security Information Officer	Mr.	Miller	Brian		6467675750					bmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	03/03/2016	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Hospice Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Interoperability Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/29/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	MA Appeals/Grievances Contact	VP, Appeals & Grievances	Ms.	Johnston	Meredith		6467674748					mjohnston@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/15/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	MA Claims Processing Contact for Public Website	VP, Claims	Mr.	Johnson	Eric		2127292245					ejohnson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/04/2018	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Marketing Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/15/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Medical Director	Chief Clinical Officer	Dr.	Schechtman	Jay		2128016170					jschechtman@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	07/11/2017	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Medicare Compliance Officer	Chief Compliance Officer & Head of Internal Audit	Mr.	Hackendorn	John		2124534495					jhackendorn@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	01/16/2020	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Medicare Coordinator	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/15/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Medication Therapy Management Contact	Sr. Pharmacy Manager	Mr.	Wiggall	Alex		2125198212					awiggall@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	03/10/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Online Enrollment Center Contact (Primary)	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/23/2019	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Part C Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/02/2017	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Part C Reporting Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Part D Appeals	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah							hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H3359	Part D Appeals Contact (Secondary)	Sr. Manager, Pharmacy Regulatory & Compliance	Ms.	Alenkina	Karolina							kalenkina@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/15/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H3359	Part D Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/02/2017	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Part D Benefits Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/06/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Part D Claims Submission Contact	Manager, Pharmacy Benefits	Ms.	Grodzitsky	Janet		6467675231					jparedes@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Part D Exceptions Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah							hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H3359	Part D Exceptions Contact (Secondary)	Medicare Clinical Pharmacist	Ms.	Baja	Melodie							mbaja@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/06/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H3359	Part D Price File Contact (Back-up)	Senior Manager, PBM Financial Operations	Ms.	Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	CVS Health	9501 E. Shea Blvd	Scottsdale	AZ	85260	01/25/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Part D Price File Contact (Optional)	Advisor, Med D Finance	Mr.	Pertgen	Richard		8045258502					richard.pertgen@cvshealth.com	CVS Health	9501 E Shea Blvd, MC121	Scottsdale	AZ	85260	06/15/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Part D Price File Contact (Primary)	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/06/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Part D Quality Assurance Contact	AVP, Pharmacy	Ms.	Kourlas	Helen		2122096456					hkourlas@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	10/30/2019	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Part D Reporting Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Patient Safety Contact	Manager, Pharmacy	Ms.	Gandara Rodriguez	Alexandra		2124792775					agandararodriguez@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	09/01/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Payment Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/01/2014	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Pharmacy Director	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/15/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Pharmacy Network Management Contact	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/15/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist	Ms.	An	Diana		3476911405					dan@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Pharmacy Technical Help Desk Contact	Director, Client Operations	Ms.	Dayoub	Joselyn							dayoubj@cvshealth.com	CVS Health	800 NW Chipman Rd, Ste 5830	Lees Summit	MO	64063	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H3359	Physician Incentive Contact	VP, Deputy General Counsel	Mr.	Schiller	Robert		2124974347					rschiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	05/11/2018	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Plan Directory Contact for Public Website			Services	Provider		8888011660					hfprovsrvs@healthfirst.org	P.O. Box 5168		New York	NY	102745168	08/20/2014	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Plan to Plan Reconciliation Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor	Attn:  Treasury Department	New York	NY	10007	04/25/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Processor Contact	Director of Client Services Adjudication Solutions	Mr.	Mangin	Marty		3124981167					martin.mangin@cvshealth.com	CVS Health	2211 Sanders Road, 2215-5	Northbrook	IL	60062	06/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Quality Contact	VP, Clinical Quality	Ms.	Washington	Laisha		2128016186					lawashington@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	07/22/2014	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Reconciliation Contact	VP, Actuarial Services	Ms.	Liang	Angela		2124535538					aliang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	09/20/2011	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Recovery Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/02/2017	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	SNP Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/01/2014	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	SNP State Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	03/18/2016	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Surveillance Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/15/2021	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	System Contact	SVP, CIO	Mr.	Sweeney	GT		6467675199					gtsweeney@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/02/2017	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Third Party Administrator (TPA) Liaison	Sr. Manager, Accounting	Ms.	Tyme	Denise		6462732814					dtyme@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/02/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	User Access Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	10/06/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Utilization Management Contact	VP, Utilization Management	Ms.	Gunderson	Christine		2123242688					cgunderson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/07/2017	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3359	Utilization Review Contact	VP, Utilization Management	Ms.	Gunderson	Christine		2123242688					cgunderson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	06/07/2017	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Agent/Broker Compensation Data Contact	Director Government Sales		Aquino	Cathy		7166354948				7166318857	cathy.aquino@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/29/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Automated TrOOP Balance Transfer Contact	Manager-Pharmacy Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Backup User Access Contact	Risk Operations Analyst		Carr	Sarah Jane		7166313001					SarahJane.Carr@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/19/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Best Available Evidence Contact	Manager - Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Bid Audit Contact	Director - Underwriting		Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/04/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Bid Audit Site Contact	Chief Compliance Officer		Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Bid Primary Contact	Director - Underwriting		Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/04/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	CAP Report Contact for Public Website	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	CEO - CMS Administrator Contact	President, CEO	Dr.	Cropp, MD	Michael		7166353995				7162507135	Michael.Cropp@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/03/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	CEO - Senior Official for Contracting	President, CEO	Dr.	Cropp, MD	Michael		7166353995				7162507135	Michael.Cropp@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/28/2013	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Chief Financial Officer	Executive Vice President - Chief Financial Officer	Mr.	Dunlop	James		7166313001					James.Dunlop@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	07/06/2021	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Chief Operating Officer	Exec Vice President and Chief Operating Officer	Mr.	Rodgers	John		7166353630					john.rodgers@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/17/2015	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Chief Information Officer	Chief Information Security Officer	Mr.	Jabrucki	Peter		7162507383					Peter.Jabrucki@Independenthealth.com	511 Farber lakes		Buffalo	NY	14221	04/06/2020	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Chief Information Security Officer	Chief Information Security Officer	Mr.	Jabrucki	Peter		7162507383					Peter.Jabrucki@Independenthealth.com	511 Farber lakes		Buffalo	NY	14221	04/06/2020	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	CMS Casework Communication Contact	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Complaints Tracking Contact	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Contact for Fraud Investigations	Vice President, Claims and Recovery Operations		Shute	David		7166354814					David.Shute@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/12/2015	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Coordination of Benefits Contact	Manager - Corporate Recoveries		Abou-Said	Kelly		7166353758					Kelly.Abou-Said@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/07/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Corporate Mailing						7166313001					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Coverage Gap Discount Program (CGDP) Payment Contact	Manager - Treasury Services		Fisher	Dave		7166353561					Dave.Fisher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/28/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Customer Service Operations Contact	Manager - Servicing		Plotner	Jenna		7162504424					Jenna.Plotner@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	12/22/2021	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	DIR Contact	Director - Pharmacy Services and Operations		Malcolm	Jillian		7165121604					jillian.malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/03/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	DIR Contact (Secondary)	VP - Pharmacy Services		Burruano	Martin		7162257559				7166310149	martin.burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/03/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Emergency Part D Contact	VP Pharmacy Services		Burruano	Martin		7162257559				7166319636	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Emergency Part D Contact (Secondary)	Manager, Pharmacy Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	12/21/2017	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Employer Waiver Contact	VP, Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Encounter Data & Risk Adjustment Operations Contact	Manager - Government Programs Implementation		Everett	Wade		7162507367					Wade.Everett@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/03/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Enrollment Contact	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	EOB Transfer Contact	Manager-Pharmacy Operations		Malcolm	Jillian		7165121604				7166319636	Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Financial Audit Contact	Director-Underwriting	Ms.	Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/23/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Financial Reporting Contact	Accountant Regulatory Reporting-Senior		Smith	Evan		7166353798					Evan.Smith@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/01/2021	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Formulary Contact	Clinical Pharmacist		Wrobel	Mark		7166353831					Mark.Wrobel@independenthealth.com	511 Farber Lakes Dr		Buffalo	NY	14221	03/01/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Formulary Contact (Secondary)	Pharmacy Services Compliance & Product Specialist		Basher	Lindsay		7166353547					Lindsay.Basher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	05/21/2019	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	General Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Government Relations Contact	SVP Government Programs		Tracy	Robert		7166354904					Robert.Tracy@independenthealth.com	511 Farber Lakes Drive		Williamsville	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	HIPAA Privacy Officer	Chief Information Security Officer		Jabrucki	Peter		7162507383				7162507115	peter.jabrucki@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/06/2020	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	HIPAA Security Officer	Chief Information Security Officer		Jabrucki	Peter		7162507383				7162507115	peter.jabrucki@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/06/2020	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Hospice Contact	Manager- Pharmacy Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Interoperability Contact	VP-IT Application Delivery		Haak	Lesley		7162504443					Lesley.Haak@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	MA Appeals/Grievances Contact	Director, Benefit Administration and Compliance		Kieser	Michelle		7166353938					Michelle.Kieser@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/17/2015	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	MA Claims Processing Contact for Public Website			Relations Dept	Provider		7166313282				7166353890	Provider@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	06/06/2008	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Marketing Contact	Director Government Sales		Aquino	Cathy		7166354948				7166318857	cathy.aquino@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/29/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Medical Director	EVP - Chief Medical Officer	Dr.	Billittier, MD	Anthony		7166353635					Anthony.Billittier@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	06/19/2019	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Medicare Compliance Officer	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/20/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Medicare Coordinator	VP Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Brim	Karen		7166353617					karen.brim@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/29/2019	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Medication Therapy Management Contact	Director Pharmacy, Quality and MTM		Verrall	Kelly		7166354885				7166310149	kelly.verrall@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	OffShore Subcontractor Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Online Enrollment Center Contact (Back-up)	Advocate - Medicare Enrollment Operations		Cole	Jenn		7166353960	2274				Jenn.cole@independenthealth.com	511 Farber Lakes Drive		Williamsville	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Online Enrollment Center Contact (Optional)	Supervisor Quality Assurance		Kindred	Amanda		7166352157					Amanda.Kindred@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Online Enrollment Center Contact (Primary)	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Part C Application Contact	Product Manager		Morgan	Evan		7166353740					Evan.Morgan@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/12/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Part C Reporting Contact	Medicare Programs Implementation Manager		Laubacker	Jeremy		7166354994				7162507197	jeremy.laubacker@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/06/2020	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Part D Appeals	Director - Benefit Administration and Compliance		Kieser	Michelle							michelle.kieser@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/11/2015	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active	8006651502				HMO - Health Maintenance Organization		C	New York
H3362	Part D Appeals Contact (Secondary)	Director, Benefit Administration and Compliance		Kieser	Michelle							Michelle.Kieser@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/17/2015	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active	8007365771				HMO - Health Maintenance Organization		C	New York
H3362	Part D Application Contact	Product Manager		Morgan	Evan		7166353740					Evan.Morgan@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/12/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Part D Benefits Contact	VP, Pharmacy Services		Burruano	Martin		7162257559				7166319636	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Part D Claims Submission Contact	Manager-Pharmacy Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Part D Exceptions Contact	VP- Pharmacy Services		Burruano	Martin						7166310149	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active	8002471466	5311			HMO - Health Maintenance Organization		C	New York
H3362	Part D Exceptions Contact (Secondary)	Manager- Pharmacy Operations		Malcolm	Jillian						7166310149	Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active	8002471466	5311			HMO - Health Maintenance Organization		C	New York
H3362	Part D Price File Contact (Back-up)	Pharmacy Services Compliance & Product Specialist		Basher	Lindsay		7166353547					Lindsay.Basher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	05/21/2019	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Part D Price File Contact (Optional)	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Part D Price File Contact (Primary)	Manager-Pharmacy Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Part D Quality Assurance Contact	Manager-Pharmacy Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Part D Reporting Contact	Medicare Programs Implementation Manager		Laubacker	Jeremy		7166354994				7162507197	jeremy.laubacker@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/06/2020	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Patient Safety Contact	Director, Pharmacy, Quality and MTM		Verrall	Kelly		7166354885				7162507121	kelly.verrall@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Payment Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354980				7162507197	Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Pharmacy Director	VP Pharmacy Services		Burruano	Martin		7162257559				7166310149	martin.burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Pharmacy Network Management Contact	VP Pharmacy Services		Burruano	Martin		7162257559				7166319636	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Pharmacy Network Management Contact (Secondary)	Manager- Pharmacy Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Pharmacy Technical Help Desk Contact	Supervisor-Member Servicing		Bates	Taylor							Taylor.Bates@pbdrx.com	511 Farber Lakes Drive		Buffalo	NY	14221	12/02/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active	8009939898				HMO - Health Maintenance Organization		C	New York
H3362	Pharmacy Technical Help Desk Contact (Secondary)	VP-Pharmacy Services		Burruano	Martin							Martin.Burruano@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/15/2016	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active	8009939898				HMO - Health Maintenance Organization		C	New York
H3362	PHR Beneficiary Contact																	07/28/2009	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS	Independent Health - Member Services	Independent Health Association, Inc.	131	Yes	Active	8006651502				HMO - Health Maintenance Organization		C	New York
H3362	Physician Incentive Contact	Director-Value-Based Reimbursement		Ghil	Peter		7166353840					Peter.Ghil@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/23/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Plan Directory Contact for Public Website			Services	Member		8006651502					wnyms@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/08/2008	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Plan to Plan Reconciliation Contact	Pharmacy Systems Gov. Programs Manager		Miszuk	Jane		7166357857					Jane.Miszuk@pbdrx.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/11/2019	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Processor Contact	VP-Claims & Recovery Operations		Shute	David		7166354814					David.Shute@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/15/2016	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Quality Contact	Population Health Science and Quality Lead		Thomas	Jessica		7162504431					Jessica.Thomas@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/26/2023	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Reconciliation Contact	Director - Underwriting		Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/16/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Reconciliation Contact (Secondary)	VP - Medicare Programs		Odrzywolski	Dawn		7166354980					dawn.odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/14/2019	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Recovery Audit Contact	VP Medicare Programs	Mrs.	Odrzywolski	Dawn		7166354980				7162507197	Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	SNP Application Contact	Product Manager		Morgan	Evan		7166353740					Evan.Morgan@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/12/2022	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Surveillance Contact	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	System Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354804				7162507197	Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Third Party Administrator (TPA) Liaison	Manager - Treasury Services		Fisher	Dave		7166353561					Dave.Fisher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/28/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	User Access Contact	Medicare Programs Implementation Manager		Laubacker	Jeremy		7166354994				7162507197	Jeremy.Laubacker@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/17/2020	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Utilization Management Contact	Director, Utilization Quality Ops Improvement Mgt		Salemi	Phil		7166313001	3434				Philip.Salemi@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	06/08/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3362	Utilization Review Contact	Director, Utilization Quality Ops Improvement Mgt		Salemi	Phil		7166313001	3434				Philip.Salemi@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	06/08/2018	2023	INDEPENDENT HEALTH ASSOCIATION, INC.	Local CCP	Independent Health	HMO/HMOPOS		Independent Health Association, Inc.	131	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3379	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H3379	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H3379	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H3379	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H3379	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3379	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3384	Agent/Broker Compensation Data Contact	Manager, Sales Support & Operations	Mr.	Thompson	Seth		4128883167					Seth.Thompson@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	10/03/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Backup User Access Contact	Sr. Risk and Regulatory Intelligence Analyst	Ms.	Hegedus	Emily		6078219034					emily.hegedus@highmarkhealth.org	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Best Available Evidence Contact	Manager		Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Bid Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	03/18/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Bid Audit Site Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	03/21/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Bid Primary Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	08/03/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	07/28/2021	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	CEO - CMS Administrator Contact	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	CEO - Senior Official for Contracting	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Chief Financial Officer	CFO Highmark Health Plan	Mr.	Bridges	Ja'Ron		4125441452					JaRon.Bridges@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/27/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Chief Operating Officer	SVP, Government Business Segment President	Ms.	Miller	Alexis	A	4125447389					Alexis.Miller@Highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/10/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Chief Information Officer	Senior Vice President, Infrastructure & Architectu	Mr.	Krebs	Mark		7173026255					mark.krebs@goenGen.com	120 Fifth Avenue		Pittsbrugh	PA	15222	09/25/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Chief Information Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	CMMI Model Point of Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/15/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	CMS Casework Communication Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	09/25/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Complaints Tracking Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne		4125444579				7176354209	Lynne.Walsh@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Contact for Fraud Investigations	VP Financial Investigation & Provider Review	Mr.	Spear	Kurt		4125447069					Kurt.Spear@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	03/21/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Coordination of Benefits Contact	Sr. Process Analyst	Ms.	Cassidy	Christina		4125444417					Christina.Cassidy@highmark.com	120 Fifth Avenue	PAP P5111	Pittsburgh	PA	15222	06/03/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Corporate Mailing						4125447031					Thomas.Boettler@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant	Mr.	DeVan	Walter		7173026609					Walter.DeVanJr@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Customer Service Operations Contact	Manager, Member Customer Service		Sheridan	Rebecca	L	5182205661				5184232294	rebecca.sheridan@highmark.com	40 Century Hill Drive		Latham	NY	12110	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	DIR Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	DIR Contact (Secondary)	Senior Risk & Compliance Case Manager		Stetson	Kelsey		4125445816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	02/23/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Emergency Part D Contact	Manager, Member Customer Service		Sheridan	Rebecca	L	5182205661				5184232294	rebecca.sheridan@highmark.com	40 Century Hill Drive		Latham	NY	12110	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Emergency Part D Contact (Secondary)	Supervisor, Pharmacy Customer Service	Ms.	Bouck	Sarah	R	5182205632					sarah.bouck@highmark.com	40 Century Hill Drive		Latham	NY	12110	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Employer Waiver Contact	Manager, Product Development & Management		Connors	Vince		7168877129				7168877022	Vincent.Connors@highmark.com	257 West Genesee Street		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Encounter Data & Risk Adjustment Operations Contact	Director, Actuarial Services	Mr.	DelPrince	Vincent	M	4125443939					Vincent.Delprince@highmark.com	501 Penn Avenue		Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Enrollment Contact	Federal Programs Eligibility & Billing Manager		Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	EOB Transfer Contact	Manager, Claims	Ms.	Johannes	Karin		7168876875				7168876875	karin.johannes@highmark.com	257 West Genesee St.		Buffalo	NY	14202	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Financial Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/15/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Financial Reporting Contact	Vice President, Accounting & Reportin	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	10/06/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Formulary Contact	Senior Pharmacist, Clinical Pharmacy Services		DiTullio	Kelly		4128884336					Kelly.DiTullio@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Formulary Contact (Secondary)	Senior Pharmacist, Clinical Pharmacy Services		Humphries	Jessica		4128884890					jessica.humphries@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	General Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Government Relations Contact	SVP, Government Affiars	Mr.	Warfel	Michael	G	7173023979					michael.warfel@highmark.com	1800 Center St.		Camp Hill	PA	17011	03/18/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	HIPAA Privacy Officer	Chief Privacy and Data Ethics Officer	Ms.	Patrick	Justine		4125444643					Justine.Patrick@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	01/03/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	HIPAA Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Hospice Contact	Intake Coordinator		Welker	Jessica		7178883043					DrugHelp_Authorizations@highmark.com	120 5th Avenue Place		Pittsburgh	PA	15222	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Interoperability Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	MA Appeals/Grievances Contact	Manager, Appeals & Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	MA Claims Processing Contact for Public Website	Manager, Claims	Ms.	Johannes	Karin		7168876875					Karin.Johannes@highmark.com	257 West Genesee St.		Buffalo	NY	14202	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Marketing Contact	Government Compliance		Gormley	Megan	E	7168878968					Megan.Gormley@highmarkhealth.org	257 West Genesee Street		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Medical Director	VP, Executive Medical Director	Dr,	Law	Timothy		4125446445					timothy.law@highmark.com	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	07/28/2021	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Medicare Coordinator	Director, Government Compliance	Ms.	Carl	Kathleen	A	4125447156					Kathleen.Carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Medicare Part D Opioid Overutilization Contact	Pharmacist	Ms.	Ali	Dewaa		4129040214					Dewaa.ali@highmark.com	120 Fifth Avenue PAP P4207		Pittsburgh	PA	15222	07/31/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Medication Therapy Management Contact	Senior Pharmacist	Ms.	Adlesic	Meredith		4128883749					Meredith.Adlesic@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	OffShore Subcontractor Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Online Enrollment Center Contact (Back-up)	Sr. Rep		Shear	Sally		6077663075				8882822583	Sally.Shear@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Online Enrollment Center Contact (Primary)	Manager		Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part C Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part C Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Appeals	Manager, Member Appeals & Grievances	Ms.	Walsh	Lynne	M					7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	4125444579				HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Appeals Contact (Secondary)	Supervisor, Appeals & Grievances	Ms.	Miller	Rachel	M					7176354209	Rachel.Miller@highmark.com	Fifth Ave Place	120 Fifth Avenue, Ste 5322	Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	4125441596				HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Benefits Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Claims Submission Contact	Director Regulated Marketing Medicare Solutions		Dovico	Rosario		9145896300				8882822583	Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Exceptions Contact			Affairs	Pharmacy							drughelp@highmark.com	120 Fifth Avenue	Suite SPECARE	Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	8006002227				HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Exceptions Contact (Secondary)	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Price File Contact (Back-up)	Director, Government Programs	Ms	Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Price File Contact (Optional)	Pharmacy Analyst		Nolder	Tim		4125448137					timothy.nolder@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/14/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Price File Contact (Primary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Quality Assurance Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Part D Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Patient Safety Contact	Director, Clinical Pharmacy Operations	Mr.	Causer	Derek		4125445835					Derek.Causer@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	12/20/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Payment Contact	Federal Programs Eligibility & Billing Manager	Ms.	Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Pharmacy Director	Manager, Pharmacy Programs		Winterhalter	Christa		4128884108					Christa.Winterhalter@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Pharmacy Network Management Contact	Network Account Director, Retail Strategy&Contract		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	11/30/2016	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	12/17/2021	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Philadelphia
H3384	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Government Operations	Ms	Lynn Schill	Jodie							Jodie.LynnSchill@highmark.com	120 Fifth Avenue Pittsburgh, PA 15222		Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	5705783579				HMO - Health Maintenance Organization		C	Philadelphia
H3384	PHR Beneficiary Contact																	10/28/2021	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS	Highmark Western and Northeastern New York Inc	Highmark Health	123	Yes	Active	8003292792				HMO - Health Maintenance Organization		C	Philadelphia
H3384	Physician Incentive Contact	VP Prov Reimbursement & Network	Mr.	McDonald	Brendan		4125446611					brendan.mcdonald@highmarkhealth.org	120 5th Avenue Place		Pittsburgh	PA	152223099	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Plan Directory Contact for Public Website			Service	Customer		8773271395					customerservice@bcbswny.com	PO Box 13599		Albany	NY	12212	02/21/2020	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Plan to Plan Reconciliation Contact	Manager, Operational Accounting		Stehr	Brett		7173022748					P2Precon@highmark.com	Highmark, Inc. Attn: Cashier	PO Box 898820	Camp Hill	PA	17089	06/28/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Processor Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Quality Contact	VP, Clinical Quality and Medical Policy	Dr.	Onuoha-Obilor	Stella		4125444335					Stella.Onuoha-Obilor@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/02/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Reconciliation Contact	Director, Pricing & Risk Revenue & EI & Analytics		Deponceau	Aaron		7168877124					Aaron.Deponceau@highmark.com	257 West Genesee St.		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Reconciliation Contact (Secondary)	Senior Risk * Compliance Case manager		Stetson	Kelsey		4125448816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	02/23/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Recovery Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	SNP Application Contact	Program Manager, Federal  Programs		Mariacher	Jill		7168877940					Jill.Mariacher@highmark.com	257 West Genesee Street		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Surveillance Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					jillian.pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	System Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Third Party Administrator (TPA) Liaison	Accountant		Jurgiewicz	Kimberly		5707807969					kimberly.jurgiewicz@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/02/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	User Access Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Utilization Management Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3384	Utilization Review Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3387	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H3387	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H3387	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H3387	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H3387	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3387	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF NEW YORK, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3388	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Automated TrOOP Balance Transfer Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Backup User Access Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Best Available Evidence Contact	Manager, Membership & Billing		Salzer	Cheryl		5186414170					cheryl.salzer@cdphp.com	500 Patroon Creek Blvd.		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Bid Audit Contact	Medicare Actuary	Mr	Budhiraja	Puneet		5186415568				5186414605	Puneet.Budhiraja@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	12/01/2014	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Bid Audit Site Contact	Medicare Actuary	Mr	Budhiraja	Puneet		5186415568				5186414605	Puneet.Budhiraja@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	12/01/2014	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Bid Primary Contact	Medicare Actuary	Mr	Budhiraja	Puneet		5186415568				5186414605	Puneet.Budhiraja@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	12/01/2014	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	CAP Report Contact for Public Website	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	01/07/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	CEO - CMS Administrator Contact	President and CEO	Dr	Bennett	John		5186415550				5186415506	john.bennett@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	02/06/2023	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	CEO - Senior Official for Contracting	President and CEO	Dr	Bennett	John		5186415550				5186415506	john.bennett@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	02/06/2023	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Chief Financial Officer	EVP/Finance/CFO	Mr	Kahlon	Paul		5186414050					paul.kahlon@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/16/2023	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Chief Operating Officer	President - Health Plan Markets	Mr.	OGrady	Bryan		5186415110				5186415506	brian.ogrady@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	02/06/2023	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Chief Information Officer	VP Enterprise Application Solutions	CIO	Rege	Umesh		5186414550					umesh.rege@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	05/23/2018	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Chief Information Security Officer	VP Audit and Assurance/CISO/CRO	CISO	Rehm	Tammy		5186415575					tammy.rehm@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/18/2016	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	CMS Casework Communication Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Complaints Tracking Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Contact for Fraud Investigations	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Coordination of Benefits Contact	Medicare Reimbursement Coordinator		Moye	Nancy		5186415274				5186414605	Medicare_Compliance_Inquiries@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	04/18/2022	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Corporate Mailing						5186413000				5186414605	info@cdphp.com	Capital District Physicians' Health Plan	500 Patroon Creek Blvd	Albany	NY	12206	07/29/2009	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Coverage Gap Discount Program (CGDP) Payment Contact	Accounts Receivable Accountant		Ogden	Wendy		5186414057					wendy.ogden@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	05/09/2018	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Customer Service Operations Contact	Director, Member Services		Spinner	Carmen		5186413741				5186413507	carmen.spinner@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	DIR Contact	Revenue Accounting Supervisor		Keller	Alexis		5183414012					Alexis.Keller@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/03/2017	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	DIR Contact (Secondary)	Medicare Actuary	Mr	Budhiraja	Puneet		5186415568				5186414605	Puneet.Budhiraja@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	12/01/2014	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Emergency Part D Contact			On Call	Manager		5183387262				5186413207	dennis.schoonmaker@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	12/30/2019	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Employer Waiver Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Encounter Data & Risk Adjustment Operations Contact	VP Risk Adjustment and Encounter Operations		Chieco	Philip		5186415221					phil.chieco@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	10/18/2019	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Enrollment Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	EOB Transfer Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Financial Audit Contact	Medicare Compliance Coordinator	Mrs	Noonan	Michelle		5186415282				5186414605	michelle.noonan@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	09/01/2017	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Financial Reporting Contact	CFO	Mr	Kahlon	Paul		5186414050				5186414006	paul.kahlon@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Formulary Contact	Clinical Pharmacist		Reed	Lisa		5186413231				5186413208	Lisa.Reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	05/16/2016	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Formulary Contact (Secondary)	Lead Managed Care Pharmacist		Reed	Lisa		5186413231				5186413208	lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	05/16/2016	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	General Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Government Relations Contact	VP Communications and External Affairs		Skinner	Ali		5186415035				5186415506	ali.skinner@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	11/16/2022	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	HIPAA Privacy Officer	Privacy Officer		Hinman	Todd		5186415261				5186415505	todd.hinman@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	HIPAA Security Officer	Information Security Officer		Rehm	Tammy		5186415575				5186414004	tammy.rehm@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Hospice Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664					luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	01/30/2018	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Interoperability Contact	Mgr. Medicare Operations		Kozak	Stephanie		5186414661					stephanie.kozak@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	MA Appeals/Grievances Contact	Administrative Assistant		Krusienski	Melissa		5186413371				5186413203	melissa.krusienski@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	MA Claims Processing Contact for Public Website	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Marketing Contact	Mgr. Medicare Operations		Kozak	Stephanie		5186414661					stephanie.kozak@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Medical Director	EVP/Chief Medical Officer		Warner	Elizabeth		5186413309				5186413205	Elizabeth.Warner@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	11/16/2022	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Medicare Compliance Officer	Medicare Compliance Officer	Mr	Schoonmaker	Dennis	M	5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	05/18/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Medicare Coordinator	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Medicare Part D Opioid Overutilization Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	01/08/2019	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Medication Therapy Management Contact	Lead Managed Care Pharmacist		Reed	Lisa		5186413231				5186413208	lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	OffShore Subcontractor Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Online Enrollment Center Contact (Back-up)	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Online Enrollment Center Contact (Optional)	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Online Enrollment Center Contact (Primary)	Manager, Web Services		Monthony	Regina		5186415023				5186415506	regina.monthony@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Part C Application Contact	Product Manager Sales Innovation		Kozak	Stephanie		5186414661					Stephanie.kozak@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Part C Reporting Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Part D Appeals	Administrative Assistant		Krusienski	Melissa						5186413203	melissa.krusienski@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active	8882486522				HMO - Health Maintenance Organization		C	New York
H3388	Part D Appeals Contact (Secondary)	Clinical Appeals Specialist		Julian	Lisa						5186413401	lisa.julian@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	01/05/2021	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active	5186413343				HMO - Health Maintenance Organization		C	New York
H3388	Part D Application Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Part D Benefits Contact	Lead Managed Care Pharmacist		Reed	Lisa		5186413231				5186413208	lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	05/16/2016	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Part D Claims Submission Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Part D Exceptions Contact	Lead Managed Care Pharmacist		Reed	Lisa						5186413208	lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	05/16/2016	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active	5186413231				HMO - Health Maintenance Organization		C	New York
H3388	Part D Exceptions Contact (Secondary)	Lead Managed Care Pharmacist		Reed	Lisa						5186413208	lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	05/16/2016	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active	5186413231				HMO - Health Maintenance Organization		C	New York
H3388	Part D Price File Contact (Back-up)	Pharmacy Enterprise Medicare Advisor Lead		Sgambati	John		5186413313					John.Sgambati@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	07/11/2022	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Part D Price File Contact (Optional)	Dir. Comm Pharmacy Prgrms and Medicare		Reed	Lisa		5186413231					lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	07/11/2022	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Part D Price File Contact (Primary)	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Part D Quality Assurance Contact	Vice President of Pharmacy & Health Quality Pgms		Wood	Eileen		5186413215				5186413208	eileen.wood@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Part D Reporting Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Patient Safety Contact	Vice President, Health Care Quality		Golderman	Renee		5186413240				5186413208	renee.golderman@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Payment Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Pharmacy Director	Vice President of Pharmacy & Health Quality Pgms		Wood	Eileen		5186413215				5186413208	eileen.wood@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Pharmacy Network Management Contact	Vice President of Pharmacy & Health Quality Pgrms		Wood	Eileen		5186413215				5186413508	eileen.wood@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Pharmacy Network Management Contact (Secondary)	Medicare Compliance Officer	Mr.	Schoonmaker	Dennis		5186415275				5186413208	dennis.schoonmaker@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	01/07/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Pharmacy Technical Help Desk Contact	Director, Customer Care		Ellerhorst	Lisa							lellerhorst@cap-rx.com	228 Park Avenue South	Suite 87234	New York	NY	10003	12/28/2022	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active	8335991018				HMO - Health Maintenance Organization		C	New York
H3388	Physician Incentive Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Plan Directory Contact for Public Website	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Plan to Plan Reconciliation Contact	Dir. Risk Adjustment and Recovery		Nasadoski	Tom		5186414601				5186414102	P2PADMIN@cdphp.com	Attn Risk Management - P2P	500 Patroon Creek Blvd	Albany	NY	12206	06/20/2019	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Processor Contact	Manager, Membership and Billing		Salzer	Cheryl		5186414170				5186414008	cheryl.salzer@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Quality Contact	Director, Health Care Quality		Golderman	Renee		5186413240				5186413208	renee.golderman@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Reconciliation Contact	Actuarial Director		Budhiraja	Puneet		5186415568					puneet.budhiraja@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	05/16/2016	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Reconciliation Contact (Secondary)	Senior Healthcare Analyst		Vadyala	Sushma		5186414078					SushmaReddy.Vadyala@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	09/15/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Recovery Audit Contact	Medicare Compliance Officer	mr	Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	SNP Application Contact	Product Manager Sales Innovation		Spicer	Michael		5186415031					Michael.Spicer@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	11/09/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Surveillance Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	System Contact	Director, Product Performance		Chieco	Philip		5186415221				5186414605	phil.chieco@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/27/2015	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Third Party Administrator (TPA) Liaison	Revenue Accountant		Ogden	Wendy		5186414057					wendy.ogden@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	04/18/2016	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	User Access Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/16/2020	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Utilization Management Contact	Director Utilization Management		Hannan	Priscilla		5186413423				5186413205	Priscilla.Hannan@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	11/16/2022	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3388	Utilization Review Contact	Director Utilization Management		Hannan	Priscilla		5186413423					Priscilla.Hannan@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	11/16/2022	2023	CAPITAL DISTRICT PHYSICIANS' HEALTH PLAN, INC.	Local CCP	CDPHP Medicare Advantage	HMO/HMOPOS		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3404	Agent/Broker Compensation Data Contact	Director, Financial Systems		Lazar	Lisa		9197653359					Lisa.Lazar@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/28/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Automated TrOOP Balance Transfer Contact	Director, Operations		Allie	Cindy		6127776772					CAllie@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/21/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Backup User Access Contact	EDI Analyst		Umstead	Kamala		9197654363					kamala.umstead@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27707	08/29/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Best Available Evidence Contact	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Bid Audit Contact	AVP, Head of Actuarial & Pricing Services		Turner	Danica		9847775665					danica.turner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Bid Audit Site Contact	AVP, Head of Actuarial & Pricing Services		Turner	Danica		9847775665					danica.turner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Bid Primary Contact	Director, Actuarial Services		Vander Berg	Lucas		9842193485					Lucas.VanderBerg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	CAP Report Contact for Public Website	Principal Communications Advisor		Stinneford	Mark		9197653005					media.inquiry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	CEO - CMS Administrator Contact	President and CEO	Mr.	Sotunde	Tunde		9197657160					Tunde.Sotunde@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	02/08/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	CEO - Senior Official for Contracting	President and CEO	Mr.	Sotunde	Tunde		9197657160					Tunde.Sotunde@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	02/08/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Chief Financial Officer	SVP, Chief Financial Officer and Treasurer	Mr.	Perry	Mitchell	W	9197653923					mitch.perry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/21/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Chief Operating Officer	SVP, Chief Operations & Member Experience Officer	Ms.	Mizelle	Karla		9849603787					karla.mizelle@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	02/09/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Chief Information Officer	Chief Information Officer	Ms.	Abernathy	Jo		9197652383					Jo.Abernathy@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	277022291	01/15/2016	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Chief Information Security Officer	Chief Information Security Officer	Mr.	Chilton	Richard		9197652021					Rick.Chilton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	277022291	01/15/2016	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	CMS Casework Communication Contact	Director, Stakeholder Escalations		Holder	Nicole		9197651320					Caseworker@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/28/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Complaints Tracking Contact	Director, Stakeholder Escalations		Holder	Nicole		9197651320					Nicole.Holder@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/20/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Contact for Fraud Investigations	VP, Audit		Bennett	Tracy		3362014290					tracyr.bennett@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Coordination of Benefits Contact	Team Lead, Operations		Pridgen	David		3362014141					David. Pridgen@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Corporate Mailing						3362014460				3366592969	deborah.washington-mcneill@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Accounting & Reporting		Varshney	Monisha		3528705750					Monisha.Varshney@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Customer Service Operations Contact	Sr. Manager, Contact Center		Woods	Renita		9197657057					Renita.Woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/18/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	DIR Contact	AVP, Head of Actuarial Services & Valuation		Pigg	Ryland		9196168313					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P. O. Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	DIR Contact (Secondary)	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Emergency Part D Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Emergency Part D Contact (Secondary)	VP, Government Markets Ops		Perry	Endya		9197775504					endya.perry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/06/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Employer Waiver Contact	Manager, Medicare Plan Administration		Brown	Alison		9196728994					alison.brown@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/28/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Encounter Data & Risk Adjustment Operations Contact	Manager, Risk Adjustment		Kimbrell	Tammy		9844448393					Tammy.Kimbrell2@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	05/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Enrollment Contact	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	EOB Transfer Contact	Sr Pharmacy Operations Analyst		Edwards	Chrissie		9197653536				9197657291	Corporate.pharmacy@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Financial Audit Contact	Director, Audit	Ms.	Ferrell	Kim		3362014038					kim.ferrell@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Financial Reporting Contact	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Formulary Contact	Manager, Pharmacy		Hiller	Debra		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics Inc	2900 Ames Crossing Road	Eagan	MN	55121	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	General Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Government Relations Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	HIPAA Privacy Officer	Director, Privacy, Ethics & Corp Policies		Hamlet	Lynn		9197657416					lynn.hamlet@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/24/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	HIPAA Security Officer	Chief Information Security Official		Chilton	Rick		9197652021					rick.chilton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2014	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Hospice Contact	Pharmacy Services Specialist		Leggett	Ursula		9197654599					Ursula.Leggett@bcbsnc.com	PO Box 2291		Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Interoperability Contact	Director, Corporate Compliance Official		Haith	Elenor		9842125897					Elenor.Haith@bcbsnc.com	PO Box 2291		Durham	NC	27702	07/20/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	MA Appeals/Grievances Contact	Director, Commercial and Medicare Appeals & Griev		McFall	Adonna		9197654061					Adonna.McFall@bcbsnc.com	Blue Cross Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/12/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	MA Claims Processing Contact for Public Website	Sr Manager, Contact Center		Woods	Renita		8882969790					Renita.Woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Marketing Contact	Manager, Medicare Plan Administration		Brown	Alison		9196728994					alison.brown@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/28/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Medical Director	AVP, Sr Medical Director	Dr	Rao-Patel	Anuradha		9197651690					anuradha.rao-patel@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/25/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Medicare Compliance Officer	Director, Corporate Compliance	Mrs.	Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/09/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Medicare Coordinator	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Medicare Part D Opioid Overutilization Contact	Sr Pharmacy Operations Analyst		Edwards	Chrissie		9197653536					chrissie.edwards@bcbsnc.com	Blue Cross Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Medication Therapy Management Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	OffShore Subcontractor Contact	Director, Corporate Compliance		Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Online Enrollment Center Contact (Back-up)	Sr Business Solutions Architect		Povathingal	Raj		9197654138					Raj.Povathingal@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Online Enrollment Center Contact (Optional)	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Online Enrollment Center Contact (Primary)	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Part C Application Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Part C Reporting Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Part D Appeals	Director, Commercial and Medicare Appeals & Griev		McFall	Adonna							Adonna.McFall@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/08/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882987520				PPO - BBA		C	Atlanta
H3404	Part D Appeals Contact (Secondary)	Mgr, MA and PDP Appeals and Grievances		Lanier	Paige						8883758836	paige.lanier@bcbsnc.com	PO Box 17509	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8774947647				PPO - BBA		C	Atlanta
H3404	Part D Application Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Part D Benefits Contact	Manager, Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Part D Claims Submission Contact	Functional Business Consultant - Govt Prgms		Brooke	Lance		4026862603					lbrooke@primetherapeutics.com	Prime Therapeutics LLC	2900  Ames Crossing Road	Eagan	MN	55121	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Part D Exceptions Contact	Manager, Pharmacy		Swanson	Ryan							PartDExceptions@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882969790				PPO - BBA		C	Atlanta
H3404	Part D Exceptions Contact (Secondary)	Team Leader, Clinical Pharmacy Reviews - Medicare		Parikh	Swati							PartDExceptions@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	01/03/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882969790				PPO - BBA		C	Atlanta
H3404	Part D Price File Contact (Back-up)	Manager, Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Part D Price File Contact (Optional)	Price File Analyst Sr		Trudeau	Ashley		6127771338					ashley.trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Part D Price File Contact (Primary)	Sr. Pharmacy Operations Analyst		Edwards	Chrissie		9197653536					chrissie.edwards@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Part D Quality Assurance Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Part D Reporting Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3362014460					deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Patient Safety Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Payment Contact	AVP, Head of Actuarial Services & Valuation		Pigg Jr.	Ryland		9847776107					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/11/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Pharmacy Director	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Pharmacy Network Management Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy		Hiller	Debra		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Pharmacy Technical Help Desk Contact			Helpdesk	Pharmacy							MGarzarodriguez@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/13/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8772777893				PPO - BBA		C	Atlanta
H3404	Physician Incentive Contact	VP, Provider Network & Transformation		Werner	Mark		9197654700					mark.werner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	10/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Plan Directory Contact for Public Website	Call Center support		Services	Member		8882969790					renita.woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Plan to Plan Reconciliation Contact	Manager, Financial Accounting & Reporting		Hitchcock	Grace		9197657999					grace.hitchcock@bcbsnc.com	ATTN:  Sheila Adams or Yvonne Stancil (Medicare P2P)	PO Box 30060 Mailstop 700-1AP	Durham	NC	27702	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Processor Contact	Director, Operations		Allie	Cindy		6127776772					CAllie@primetherapeutics.com	Prime Therapeutics, LLC	2655 Eagan Woods Drive	Eagan	MN	55122	09/21/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Quality Contact	VP, Strategy, Planning and Performance		Moon	Gregory		9847775524					Gregory.Moon@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Reconciliation Contact	AVP, Head of Actuarial Services & Valuation		Pigg	Ryland		9196168313					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P. O. Box 2291	Durham	NC	27702	09/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Reconciliation Contact (Secondary)	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Recovery Audit Contact	Director, Corporate Compliance	Mrs	Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina,	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Surveillance Contact	Director, Corporate Compliance		Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	System Contact	Director, IT Solution Delivery		Holbrook	Janice		3362014101					janice.holbrook@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Third Party Administrator (TPA) Liaison	AVP, Head of Actuarial Services & Valuation		Pigg Jr.	Ryland		9847776107					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/11/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	User Access Contact	Electronic Data Interchange Analyst		Dunn	Lorrie		9197653669					lorrie.dunn@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27707	08/22/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Utilization Management Contact	Director, Clinical Teams		Perdue	Angela		3362014352					angela.perdue@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3404	Utilization Review Contact	Director, Clinical Teams		Perdue	Angela		3362014352					angela.perdue@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	Local PPO		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					PPO - BBA		C	Atlanta
H3407	Agent/Broker Compensation Data Contact	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Automated TrOOP Balance Transfer Contact			Sherman	Mandy		9202214083				9202214583	Relay.Health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/05/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Backup User Access Contact			Martinez	Jesus		9152987198	1061				jmartinez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/24/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Best Available Evidence Contact	Senior Director of Member Operations		Martinez	Edgar		9152987198	1064				edmartinez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/20/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Bid Audit Contact	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Bid Audit Site Contact	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Bid Primary Contact	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	CAP Report Contact for Public Website			Gibson	Catherine		9152987198	1258				cgibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/07/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	CEO - CMS Administrator Contact	President & CEO	Mrs.	Smallwood	Carol	G	9152987198	1257				csmallwood@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/25/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	CEO - Senior Official for Contracting	President & CEO	Mrs.	Smallwood	Carol	G	9152987198	1257				csmallwood@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/25/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Chief Financial Officer	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/23/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Chief Operating Officer	President & CEO	Mrs.	Smallwood	Carol	G	9152987198	1257				csmallwood@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/25/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Chief Information Officer	Chief Information Officer	Ms,	Perkins	Sharon		9152987198	1103				sperkins@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/21/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Chief Information Security Officer	Chief Information Officer	Ms,	Perkins	Sharon		9152987198	1103				sperkins@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/21/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	CMS Casework Communication Contact			Gibson	Catherine		9152987198	1258				cgibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/07/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Complaints Tracking Contact	Complaints and Appeals Manager		Diaz	Corina		9152987198	1092				cdiaz@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Contact for Fraud Investigations	Chief Compliance Officer	Ms	Gibson	Catherine		9152987198	1258				cgibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Coordination of Benefits Contact	Chief Finanical Officer		Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	09/26/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Corporate Mailing						9152987198	1258				CGibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/19/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/23/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Customer Service Operations Contact	Sr. Director of Member Operations		Martinez	Edgar		9152987198	1064				edmartinez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	DIR Contact	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/23/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Electronic Health Record Contact	Chief Information Officer	Ms,	Perkins	Sharon		9152987198	1103				sperkins@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/21/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Emergency Part D Contact			Saucedo	Perla		9152987198	1035				psaucedo@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	02/06/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Encounter Data & Risk Adjustment Operations Contact			Sanchez	Javier		9152897198	1229				jsanchez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Enrollment Contact			Sanchez	Javier		9152987198	1229				jsanchez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	EOB Transfer Contact			Diaz	Patricia		9152987198	1171			9155322877	pdiaz@elpasohealth.com	1145 Westmoreland		El Paso	TX	79928	01/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Financial Audit Contact	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/23/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Financial Reporting Contact	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/23/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Formulary Contact			Saucedo	Perla		9152987198	1035				psaucedo@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/16/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Formulary Contact (Secondary)			Paddock	Deanna		6087291628				6087292628	deanna.paddock@navitus.com	2601 West Beltine Highway	Suite 600	Madison	WI	53713	04/16/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	General Contact	Chief Compliance Officer	Ms	Gibson	Catherine		9152987198	1258				cgibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/07/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Government Relations Contact	Chief Compliance Officer	Ms	Gibson	Catherine		9152987198	1258				cgibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	HIPAA Privacy Officer	Chief Compliance and Privacy Officer		Gibson	Catherine		9152987198	1109				cgibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	09/09/2021	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	HIPAA Security Officer	Chief Information Officer	Ms,	Perkins	Sharon		9152987198	1103				sperkins@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/21/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Hospice Contact	Director of Health Services		Navedo-Sanchez	Vianka		9152987198	1135				VSanchez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	07/19/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Interoperability Contact	Chief Information Officer		Perkins	Sharon		9152987198	1103				sperkins@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	12/16/2021	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	MA Appeals/Grievances Contact			Diaz	Corina		9152987198	1092				cdiaz@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	11/07/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	MA Claims Processing Contact for Public Website			Diaz	Patricia		9152987198	1171			9155322877	pdiaz@elpasohealth.com	1145 Westmoreland		El Paso	TX	79928	01/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Marketing Contact			Garcia	Viridiana		9152987198	1079				vrodriguez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	03/08/2021	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Medical Director	Chief Medical Officer	MD	Gonzalez	Jose	L	9152987198	1227				JGonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/19/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Medicare Compliance Officer	Chief Compliance and Privacy Officer	Ms.	Gibson	Catherine		9152987198	1258				cgibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Medicare Coordinator	President & CEO	Mrs.	Smallwood	Carol	G	9152987198	1257				csmallwood@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/25/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Medicare Part D Opioid Overutilization Contact	Director Of Health Services		Navedo-Sanchez	Vianka		9152987198	1135				VSanchez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	07/19/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Medication Therapy Management Contact			Saucedo	Perla		9152987198	1035				psaucedo@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/25/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	OffShore Subcontractor Contact	Chief Compliance Officer	Ms	Gibson	Catherine		9152987198	1258				cgibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Online Enrollment Center Contact (Back-up)	Chief Information Officer		Perkins	Sharon		9152987198	1103				sperkins@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Online Enrollment Center Contact (Optional)	Enrollment & Eligibility Manager		Ramirez	Juanita		9152987198	1063				jramirez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/27/2021	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Online Enrollment Center Contact (Primary)	Director of IS applications		Sanchez	Javier		9152987198	1229				jsanchez@elpasohealth.com	1145 Westmorealnd		El Paso	TX	79925	04/27/2021	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Part C Application Contact	Chief Compliance Officer		Gibson	Catherine		9155323778	1258				cgibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Part C Reporting Contact		Mr	Sanchez	Javier		9152987198	1229				jsanchez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	03/05/2021	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Part D Appeals	Complaints and Appeals Manager		Diaz	Corina							cdiaz@elpasohealth.com	1145 Westmoreland Dr.		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active	9152987872	1092			HMO - Health Maintenance Organization		C	Denver
H3407	Part D Application Contact	Chief Compliance Officer	Ms	Gibson	Catherine		9155323778	1258				cgibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Part D Benefits Contact			Saucedo	Perla		9152987198	1035				psaucedo@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/25/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Part D Claims Submission Contact			Derks	Bob		9202214404				9202214904	DL-TP-PDE@NAVITUS.COM	1025 West Navitus Drive		Appleton	WI	54913	02/03/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Part D Exceptions Contact			LeClair	Christophe						9202214676	Christopher.LeClair@Navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/17/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Denver
H3407	Part D Exceptions Contact (Secondary)			Kurznski	Adam							adam.kurznski@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	01/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active	9202214122				HMO - Health Maintenance Organization		C	Denver
H3407	Part D Price File Contact (Back-up)	Navitus Plan Finder		Plan Finder	Navitus		6087291578					Plan.Finder@navitus.com	2601 West Beltline Highway Suite 600		Madison	WI	53713	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Part D Price File Contact (Primary)			Plan Finder	Navitus		1608729157					plan.finder@navitus.com	2601 West Beltline Highway		Madiso	WI	53713	02/06/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Part D Quality Assurance Contact	Sr. Director of Quality Improvement		Gillis	Donald		9152987198	1231				dgillis@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Part D Reporting Contact		Ms,	Saucedo	Perla		9152987198	1035				psaucedo@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Patient Safety Contact	Chief Medical Officer	MD	Gonzalez	Jose	L	9152987198	1227				JGonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/19/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Payment Contact	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Personal Health Record Contact	Chief Compliance and Privacy Officer	Ms	Gibson	Catherine		9152987198					cgibson@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	09/09/2021	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Pharmacy Director			Kurznski	Adam		9202214272					adam.kurznski@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/06/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Pharmacy Network Management Contact			Robinson	Jan		6087291688				6087292688	Jan.Robinson@Navitus.com	361 Integrity Drive		Madison	WI	53717	05/17/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Pharmacy Network Management Contact (Secondary)	Associate Director		Miller	Steven		9202214272				9202214772	steven.miller@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/05/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Pharmacy Technical Help Desk Contact			Nett	Danielle						9202214724	Danielle.nett@navitus.com	1025 West Navitus		Appleton	WI	54913	05/17/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Denver
H3407	Physician Incentive Contact	President & CEO	Mrs.	Smallwood	Carol	G	9152987198	1257				csmallwood@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/25/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Plan Directory Contact for Public Website			Garcia	Viridiana		9152987198	1079				vrodriguez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/08/2021	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Plan to Plan Reconciliation Contact			Saucedo	Perla		9152987198	1035				psaucedo@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/25/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Processor Contact			Diaz	Patricia		9152987198	1171			9155322877	pdiaz@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2022	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Quality Contact	Director of Quality Improvement		Chagolla	Angelica		9152987198	1165				abaca@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Reconciliation Contact	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	04/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Recovery Audit Contact	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	SNP Application Contact	Sr. Director of Member & Community Engagement		Lopez-Holguin	Maritza		9152987198	1071				mlopez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	SNP State Contact	Sr. Director of Member & Community Engagment		Lopez-Holguin	Martiza		9152987198	1071				mlopez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Surveillance Contact	Compliance Supervisor		Berrios	Vanessa		9152987198	1040				vberrios@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/18/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	System Contact	Chief Information Officer	Ms,	Perkins	Sharon		9152987198	1103				sperkins@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	05/21/2019	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mr.	Gonzalez	Gustavo		9152987198	1117				ggonzalez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	01/24/2020	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	User Access Contact	Chief Information Officer	Ms	Perkins	Sharon		9152987198	1103				sperkins@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	09/09/2021	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Utilization Management Contact	Director of Health Services		Navedo-Sanchez	Vianka		9152987198	1135				VSanchez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	07/19/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3407	Utilization Review Contact	Director of Health Services		Navedo-Sanchez	Vianka		9152987198	1135				VSanchez@elpasohealth.com	1145 Westmoreland		El Paso	TX	79925	07/19/2023	2023	EL PASO FIRST HEALTH PLANS, INC.	Local CCP	El Paso Health Medicare Advantage	HMO/HMOPOS		El Paso County Hospital District	736	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3416	Agent/Broker Compensation Data Contact	VP Government Programs		Clelland	Jennifer	J	9529675119					jennifer.j.clelland@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	11/04/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Automated TrOOP Balance Transfer Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Backup User Access Contact	Coordinator Government Programs		Yu	Chao		9528837240					chao.x.yu@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	04/20/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Best Available Evidence Contact	Manager Membership Accounting		Marty	Amanda	E	9529677685					amanda.e.marty@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/05/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Bid Audit Contact	VP Internal Audit Comp Officer		Bunde	Steven	D	9528836541				9528835522	steven.d.bunde@healthpartners.com	8170 33rd Avenue South		Bloomington	MN	55425	12/03/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Bid Audit Site Contact	Director Monitoring and Compliance		Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Bid Primary Contact	Corporate Actuary		Stewart	Sara	M	9528835049					sara.m.stewart@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21105H	Minneapolis	MN	554401309	07/24/2019	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	CAP Report Contact for Public Website	Director of Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	CEO - CMS Administrator Contact	President and CEO	Ms.	Woody	Rebecca	A	5156953811					rebecca.a.woody@healthpartners.com	3737 Woodland Avenue	Suite 310	West Des Moines	IA	50266	01/05/2023	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	CEO - Senior Official for Contracting	President and CEO	Ms.	Woody	Rebecca	A	5156953811					rebecca.a.woody@healthpartners.com	3737 Woodlane Avenue	Suite 310	West Des Moines	IA	50266	04/19/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Chief Financial Officer	SVP, CFO	Ms.	Johnson	Kathy	A	9528836531					Kathy.A.Johnson1@HealthPartners.Com	8170 33rd Avenue South, PO Box 1309	MS:  21110T	Minneapolis	MN	554401309	09/11/2023	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Chief Operating Officer	President	Ms.	Woody	Rebecca	A	5156953811					rebecca.a.woody@healthpartners.com	3737 Woodland Avenue	Suite 310	West Des Moines	IA	50266	01/19/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Chief Information Officer	Senior Vice President and CTO	Mr.	Zuzek	Dennis	M	9528837045					dennis.m.zuzek@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Chief Information Security Officer	VP Technology Infrastructure & Security	Mr.	Muller	Frank	J	9529676070					frank.j.muller@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	CMS Casework Communication Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Complaints Tracking Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Contact for Fraud Investigations	Senior Manager Claims Cost Management		Hove	Ryan	M	6512651573					ryan.m.hove@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  25510F	Minneapolis	MN	55101	07/24/2019	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Coordination of Benefits Contact	Manager, Claims Production		Prine	Chantelle	M	9529677335					RVSCCOBTECHS@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	04/20/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Corporate Mailing						9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/07/2016	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant		Knights	Michelle	M	9528836532					michelle.m.knights@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21109A	Minneapolis	MN	554401309	12/03/2020	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Customer Service Operations Contact	Director  Manager Member Services		Renneke	Alison		9529677668					alison.m.renneke@healthpartners.com	8170 33rd Avenue South, PO Box 9463	MS:  21103R	Minneapolis	MN	554409463	01/29/2020	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	DIR Contact	Pharmacy Plan Contract Manager		Reinhardt	Sandra	L	9528836739					sandra.l.reinhardt@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/29/2020	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	DIR Contact (Secondary)	Health Informatics Analyst Pcp		Binsfeld	David	T	9529675950					david.t.binsfeld@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS 21108Q	Minneapolis	MN	554401309	01/15/2016	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Emergency Part D Contact	Sr. Director Pharmacy Services		Strahl	Christine	L	9528835022				9529676667	christine.l.strahl@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/04/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Emergency Part D Contact (Secondary)	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9529675826				9529676667	dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/29/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Employer Waiver Contact	Director of Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Encounter Data & Risk Adjustment Operations Contact	Senior Director Operational Integrity		Anderson	Larin	D	9528835796					larin.d.anderson@healthpartners.com	8170 33rd Avenue South	MS: 21103J	Minneapolis	MN	55425	10/22/2019	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Enrollment Contact	Director Membership Accounting		McWell	Carrie	J	9529675487					carrie.j.mcwell@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	11/30/2017	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	EOB Transfer Contact	Sr. Manager Claims Production		Huseby	Pam	J	9529675530				9528837666	pam.j.huseby@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	08/30/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Financial Audit Contact	Director Monitoring and Compliance	Ms.	Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Financial Reporting Contact	Director Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21109A	Minneapolis	MN	554401309	01/15/2016	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Formulary Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Formulary Contact (Secondary)	Formulary Administration Pharmacist		Savage	Robert		8587906426					robert.savage@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	07/24/2019	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	General Contact	Director of Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Government Relations Contact	VP Government Programs		Clelland	Jennifer	J	9529675119					jennifer.j.clelland@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	08/30/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	HIPAA Privacy Officer	Sr. Director Integrity Compliance Privacy Officer		Wells	Prasanta	K	9528837325					prasanta.k.wells@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103K	Minneapolis	MN	554401309	01/15/2016	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	HIPAA Security Officer	VP Technology Infrastructure & Security	Mr.	Muller	Frank	J	9529676070					frank.j.muller@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Hospice Contact	Pharmacy Compliance Specialist		Riggs	Ben	H	9528518421					benjamin.h.riggs@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Interoperability Contact	Program Manager		Geisler	Chris	J	6122479067					Chris.J.Geisler@HealthPartners.Com	8170 33rd Avenue S		Bloomington	MN	55425	06/20/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	MA Appeals/Grievances Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	MA Claims Processing Contact for Public Website	Manager Claims Production		Huseby	Pam	J	9529675530					RVSCProviderInquiry@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	03/14/2019	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Marketing Contact	Mgr Govt Prog Materials & Regulatory Comm		Her-Vang	Xong		9529675061					xong.x.hervang@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	11/16/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Medical Director	Health Plan Chief Medical Officer	Dr.	Kakacek	Virginia	L	9528837120					virginia.l.kakacek@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110Q	Minneapolis	MN	554401309	09/21/2023	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Medicare Compliance Officer	VP Internal Audit Comp Officer	Mr.	Bunde	Steven	D	9528836541				9528835522	steven.d.bunde@healthpartners.com	8170 33rd Avenue South		Bloomington	MN	55425	12/03/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Medicare Coordinator	Director of Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Medicare Part D Opioid Overutilization Contact	Pharmacy Compliance Specialist		Riggs	Ben		9528518421					Benjamin.H.Riggs@HealthPartners.Com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/29/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Medication Therapy Management Contact	Senior Manager Med Therapy Management Program		Rehrauer	Daniel	J	9529675133					daniel.j.rehrauer@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/11/2018	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Online Enrollment Center Contact (Back-up)	Director Membership Accounting		McWell	Carrie	J	9529675487					carrie.j.mcwell@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/30/2017	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Online Enrollment Center Contact (Optional)	Admin Product Implementation Manager		Wessel	Sara	C	9529677623					sara.c.wessel@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/29/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Online Enrollment Center Contact (Primary)	Manager Membership Accounting		Marty	Amanda	E	9529677685					amanda.e.marty@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	01/09/2018	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Part C Application Contact	Director of Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Part C Reporting Contact	Director of Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Part D Appeals	Manager Member Rights and Benefits		Kruse	Morgan	L						Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS:  21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active	8007963806				PPO - BBA		C	Chicago
H3416	Part D Appeals Contact (Secondary)	Senior Rights & Benefits Project Lead		Schneider	Crystal	L						crystal.l.schneider@healthpartners.com	8170 33rd Avenue South	MS: 21103R	Bloomington	MN	55425	01/05/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active	8007963806				PPO - BBA		C	Chicago
H3416	Part D Application Contact	Director of Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Part D Benefits Contact	Director of Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Part D Claims Submission Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Part D Exceptions Contact	Supervisor, Clinical Review		Whelan	Hillary	A					8888835434	hillary.a.whelan@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active	8004927259				PPO - BBA		C	Chicago
H3416	Part D Price File Contact (Back-up)			Communications	Planfinder		8587905849				8587906052	PlanFinderCommunications@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	01/15/2016	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Part D Price File Contact (Primary)	Pharmacy Compliance Specialist		Riggs	Ben	H	9528518421					benjamin.h.riggs@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Part D Quality Assurance Contact	Senior Manager Quality and Compliance		Book	Anne	M	9528835128					anne.m.book@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21108T	Minneapolis	MN	554401309	01/09/2018	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Part D Reporting Contact	Director of Medicare and Government Program		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Patient Safety Contact	Senior Manager Med Therapy Management Program		Rehrauer	Daniel	J	9529675133					daniel.j.rehrauer@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/14/2018	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Payment Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21109A	Minneapolis	MN	554401309	01/15/2016	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Pharmacy Director	VP Pharmacy		Busch	David	L	9529675049					david.l.busch@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	06/25/2020	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Pharmacy Network Management Contact	Director Pharmacy Sales & Product Support		Friday	Ken	R	9529675826				9529676667	kenneth.r.friday@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Administration		Hunt	Brian		9587907092					Brian.Hunt@MedImpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/29/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Pharmacy Technical Help Desk Contact	Manager Health Plan Pharmacy Customer Service		Whelan	Hillary	A					8888835434	Hillary.A.Whelan@HealthPartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/19/2022	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active	8004927259				PPO - BBA		C	Chicago
H3416	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Contact Services		Brewer	Kathy							Customerservice@Medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/15/2017	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active	8887831779				PPO - BBA		C	Chicago
H3416	Plan Directory Contact for Public Website			Services	Provider		9528837699					RVSCProviderInquiry@HealthPartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	01/15/2016	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Plan to Plan Reconciliation Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584				9528836500	kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21109A	Minneapolis	MN	554401309	01/15/2016	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Processor Contact	Director Pharmacy Sales & Product Support		Friday	Ken	R	9529675826				9529676667	kenneth.r.friday@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Quality Contact	Senior Manager Quality and Compliance		Book	Anne	M	9528835128					anne.m.book@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	01/09/2018	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Reconciliation Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	01/15/2016	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Reconciliation Contact (Secondary)	Senior Accountant		Knights	Michelle	M	9528833532					michelle.m.knights@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/19/2020	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Recovery Audit Contact	Director Monitoring and Compliance	Ms.	Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Surveillance Contact	Director Monitoring and Compliance		Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	System Contact	Senior Director Operational Integrity		Anderson	Larin	D	9528835796					larin.d.anderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21193J	Minneapolis	MN	554401309	01/15/2016	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Third Party Administrator (TPA) Liaison	Senior Accountant		Knights	Michelle	M	9528833532					michelle.m.knights@healthpartners.com	8170 33rd Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/19/2020	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	User Access Contact	Mgr Govt Prog Materials & Regulatory Comm		Her-Vang	Xong		9529675061					xong.x.hervang@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	11/16/2021	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Utilization Management Contact	Director Utilization Management		Gunderson	Susan	C	9528835576					susan.c.gunderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	12/10/2019	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3416	Utilization Review Contact	Director Utilization Management		Gunderson	Susan	C	9528835576					susan.c.gunderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	12/10/2019	2023	HEALTHPARTNERS UNITYPOINT HEALTH, INC.	Local CCP	HealthPartners UnityPoint Health	Local PPO		HealthPartners UnityPoint Health, Inc.	648	Yes	Active					PPO - BBA		C	Chicago
H3418	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H3418	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H3418	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H3418	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H3418	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3418	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H3419	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Backup User Access Contact	Medicare Compliance Officer, Plan Partner Support	Ms.	Bouyer	Valorie		6159161254					valorie.bouyer@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	CAP Report Contact for Public Website	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Rd	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	CEO - CMS Administrator Contact	Executive Director	Ms.	Elam	Jennifer		5132757952					jennifer.elam@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	03/17/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	CEO - Senior Official for Contracting	Executive Director	Ms.	Elam	Jennifer		5132757952					jennifer.elam@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	03/17/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Chief Financial Officer	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Chief Operating Officer	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Contact for Fraud Investigations	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Rd. Suite 300		Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Corporate Mailing						8447886959					customerservice@perennialadvantage.com	P.O. Box 2190		Glen Allen	VA	230582190	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Encounter Data & Risk Adjustment Operations Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	EOB Transfer Contact			Lowry	Kristy		8447886959				8336102390	kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Financial Audit Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Financial Reporting Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	General Contact	Executive Director	Ms.	Elam	Jennifer		5132757952					jennifer.elam@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	HIPAA Privacy Officer	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Rd	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	HIPAA Security Officer	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Rd	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Medical Director		Dr.	Papernek	Holly		9374703285					holly.papanek@perennialadvantage.com	9200 Worthington Rd	Suite 300	Westerville	OH	43082	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Medicare Compliance Officer	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Medicare Coordinator	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/13/2023	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Part C Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Part C Reporting Contact			Rennie	Lynda		8043966383					lynda@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	01/08/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/08/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Payment Contact	CFO	Mr.	Ragland	Robert		8042663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Chicago
H3419	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Chicago
H3419	Physician Incentive Contact	Executive Director	Ms.	Elam	Jennifer		5132757952					jennifer.elam@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Plan Directory Contact for Public Website			Sindlinger	Rocio		8447886959					rocio.sindlinger@allyalign.com	P.O. Box 2190		Glen Allen	VA	230582190	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Plan to Plan Reconciliation Contact	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Quality Contact			Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Reconciliation Contact		Mr.	Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Reconciliation Contact (Secondary)	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Recovery Audit Contact	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Rd	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Third Party Administrator (TPA) Liaison	Manager of Regulatory Accounting	Ms.	Weis	Katelyn		6073294042					kate.weis@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	User Access Contact	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3419	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF COLORADO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3430	Automated TrOOP Balance Transfer Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204				7275233345	jeannecrevier@empathhealth.org	6774 102nd Ave.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Backup User Access Contact	VP of IT	Mr	Clark	Arthur		7275234050				7275234006	arthurclark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Best Available Evidence Contact	Executive Director		Messersmith	Christoph		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Bid Primary Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	CAP Report Contact for Public Website	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Fleece	Jonathan		9415527525				9415565800	jonathanfleece@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Fleece	Jonathan		9415527525				9415565800	jonathanfleece@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Chief Financial Officer	Chief Financial Officer	Ms.	Bouhamid	Saida		7275233339				7275232122	sbouhamid@tidewell.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	06/09/2021	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Chief Operating Officer	Chief Executive Officer	Mr	Fleece	Jonathan		9415527525				9415565800	jonathanfleece@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Chief Information Officer	VP IT	Mr.	Clark	Arthur		9413743213					ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	05/02/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Chief Information Security Officer	VP IT	Mr.	Clark	Arthur		9413743213					ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	05/02/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	CMS Casework Communication Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858					christophermessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Complaints Tracking Contact	Quality Assurance/Compliance Coordinator	Ms.	McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Contact for Fraud Investigations	Executive Director	Mr.	Messersmith	Christophe		7272890062					ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Coordination of Benefits Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Corporate Mailing						9415527525				9415565800	jonathanfleece@empathhealth.org	5771 Roosevelt Blvd.	Suite 625	Clearwater	FL	33760	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Coverage Gap Discount Program (CGDP) Payment Contact	Executive Director	Mr.	Messersmith	Christophe		7272890062					ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Customer Service Operations Contact	Health Plan Operations Manager	Ms.	Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	DIR Contact	Executive Director		Crevier	Jeanne		7272599204				7275232497	jeannecrevier@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	DIR Contact (Secondary)	Executive Director	Mr.	Messersmith	Christophe		7272890062					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	04/06/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Emergency Part D Contact	Health Plan Operations Manager	Mr	Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Emergency Part D Contact (Secondary)	Executive Director	Mr.	Messersmith	Christophe		7272890062					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	04/06/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Encounter Data & Risk Adjustment Operations Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Enrollment Contact	Health Plan Operations Manager	Mr	Crevier	Jeanne		7272599204				7273241866	jeannecrevier@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	EOB Transfer Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204				7273241866	jeannecrevier@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Financial Audit Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Financial Reporting Contact	CFO	Ms	Bouhamid	Saida		7275233339					SaidaBouhamid@EmpathHealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Formulary Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	General Contact	Executive Director	Mr	Messersmith	Christoph		7273241858					christophermessersmith@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	04/06/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Government Relations Contact	SVP	Mr.	Reiter	Thomas		7205304082					thomasreiter@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	HIPAA Privacy Officer	Chief Executive Officer	Mr	Fleece	Jonathan		9415527525				9415565800	jonathanfleece@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	HIPAA Security Officer	Director of Organizational Integrity	Ms	Mosby	Laura		7275232106					lauramosby@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	05/15/2017	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Interoperability Contact	SVP		Reiter	Thomas		7205304082					thomasreiter@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	MA Appeals/Grievances Contact	Quality Assurance/Compliance Coordinator	Ms.	McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	10/16/2020	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	MA Claims Processing Contact for Public Website	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Marketing Contact	VP of Marketing and Communications	Ms.	Allen	Kelly		7275233395					kellyallen@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	11/23/2022	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Medical Director	Medical Director	Mr	Burt	William		7272890062				7275232122	williamburt@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	03/05/2019	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Medicare Compliance Officer	Director of Organizational Integrity	Ms	Mosby	Laura		7275232106				7275232122	lauramosby@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	10/17/2016	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Medicare Coordinator	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Medicare Part D Opioid Overutilization Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Medication Therapy Management Contact	Medical Director	Mr	Burt	William		7272890062				7275232122	williamburt@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	03/05/2019	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Online Enrollment Center Contact (Back-up)	VP of PACE and Elder Services	Mr.	Pettry	Jason		7272890062					jasonpettry@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Online Enrollment Center Contact (Primary)	Executive Director	Mr	Messersmith	Christophe		7273241858				7273241866	christophermessersmith@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	04/06/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Part C Application Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Part D Appeals	Health Plan Operations Manager		Crevier	Jeanne						7273241866	jeannecrevier@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active	7272599204				PACE - Nat		C	Atlanta
H3430	Part D Appeals Contact (Secondary)	Executive Director	Mr	Messersmith	Christophe						7273241866	christophermessersmith@empathhhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	04/06/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active	7273241858				PACE - Nat		C	Atlanta
H3430	Part D Application Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Part D Benefits Contact	Executive Director	Mr	Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Part D Claims Submission Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204				7273241866	jeannecrevier@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Part D Exceptions Contact	Health Plan Operations Manager		Crevier	Jeanne						7273241866	jeannecrevier@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active	7272599204				PACE - Nat		C	Atlanta
H3430	Part D Exceptions Contact (Secondary)	Executive Director	Mr.	Messersmith	Christophe							ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	04/06/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active	7273241858				PACE - Nat		C	Atlanta
H3430	Part D Price File Contact (Back-up)	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Part D Price File Contact (Primary)	Executive Director		Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Part D Quality Assurance Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Part D Reporting Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Patient Safety Contact	Executive Director	Mr	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Payment Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Personal Health Record Contact	VP of PACE and Elder Services	Mr.	Pettry	Jason		7272890062	1843				jasonpettry@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	11/23/2022	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Pharmacy Director	Director of Pharmacy	Mr.	Rigali	Aaron		7275232550					aaronrigali@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	10/17/2016	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Pharmacy Network Management Contact	Manager Client Services	Mr.	Summers	Todd		8664431095					todd.summers@optum.com	1600 McConnor Parkway		Schaumberg	IL	60173	01/07/2022	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Pharmacy Network Management Contact (Secondary)	VP of PACE and Elder Services	Mr	Pettry	Jason		7273241843				7273241866	jasonpettry@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	11/23/2022	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Pharmacy Technical Help Desk Contact	Manager Client Services	Mr.	Summers	Todd							todd.summers@optum.com	1600 McConnor Parkway		Schaumberg	IL	60173	01/07/2022	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active	8664431095				PACE - Nat		C	Atlanta
H3430	Pharmacy Technical Help Desk Contact (Secondary)	CSM Analyst		Gonzalez-Ortiz	Jennifer							jennifer.gonzalez230@optum.com	1600 McConnor Parkway		Schaumberg	IL	60173	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active	6124766053				PACE - Nat		C	Atlanta
H3430	Plan Directory Contact for Public Website	Executive Director	Mr.	Messersmith	Chris		7273241858					ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Plan to Plan Reconciliation Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	5771 Roosevelt Blvd		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Processor Contact	Manager Client Services	Mr.	Summers	Todd		8664431095					todd.summers@optum.com	1600 McConnor Parkway	Suite 100	Schaumberg	IL	60173	01/07/2022	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Quality Contact	Quality Assurance/Compliance Coordinator	Ms.	McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	10/16/2020	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Reconciliation Contact	Executive Director	Mr	Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Reconciliation Contact (Secondary)	Executive Director		Messersmith	Christophe		7272890062					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	04/06/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Recovery Audit Contact	Director of Organizational Integrity	Ms	Mosby	Laura		7275232106					lauramosby@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	05/15/2017	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Surveillance Contact	Director of Organizational Integrity	Ms	Mosby	Laura		7275232106					lauramosby@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	05/22/2017	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	System Contact	VP of IT	Mr	Clark	Arthur		7275234050				7275234006	ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Third Party Administrator (TPA) Liaison	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/01/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	User Access Contact	VP of IT	Mr	Clark	Arthur		7275234050				7275234006	arthurclark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	01/19/2023	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Utilization Management Contact	Quality Assurance/Compliance Coordinator	Ms.	McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	10/16/2020	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3430	Utilization Review Contact	Quality Assurance/Compliance Coordinator	Ms.	McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	10/16/2020	2023	SUNCOAST PACE, INC.	National PACE	Suncoast PACE, Inc.	National PACE		Empath Health, Inc.	635	Yes	Active					PACE - Nat		C	Atlanta
H3442	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	6126562187				PPO - BBA		C	San Francisco
H3442	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	7632832653				PPO - BBA		C	San Francisco
H3442	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	8005959532				PPO - BBA		C	San Francisco
H3442	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	8007887871				PPO - BBA		C	San Francisco
H3442	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3442	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H3443	Agent/Broker Compensation Data Contact	VP, Sales		Simonds	Kristina		6572187635					KSimonds@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Automated TrOOP Balance Transfer Contact	PBM - Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Backup User Access Contact	Compliance Director		Spitzer	Chandra		6572745530					CSpitzer@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Best Available Evidence Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Bid Audit Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Bid Audit Site Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Bid Primary Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	CAP Report Contact for Public Website	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	CEO - CMS Administrator Contact	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	CEO - Senior Official for Contracting	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Chief Financial Officer	Chief Financial Officer	Mr.	Freeman	Thomas		6572187604					TFreeman@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Chief Operating Officer	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Kardes	Hakan		6572187772					hkardes@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	03/29/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Chief Information Security Officer	VP, Technology Delivery & CISO	Mr.	MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	CMMI Model Point of Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	CMS Casework Communication Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Complaints Tracking Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Contact for Fraud Investigations	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Coordination of Benefits Contact	AVP, Membership & Eligibility		Torres	Carrie		6572187409	2109				CArreola@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Corporate Mailing						6572187713				8443202247	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/15/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122			5622074634	adelatorre@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Customer Service Operations Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	DIR Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	DIR Contact (Secondary)	AVP, Pharmacy		Liu	Ruby		3237287232	2316				RLiu@AHCUSA.com	1100 W. Town & Country Rd., Suite 1600		Orange	CA	92868	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Electronic Health Record Contact	AVP, Platform Product		Brown Hayes	Michael		7144979628					MBrown-Hayes@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	04/01/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Emergency Part D Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Emergency Part D Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		3108667966				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Employer Waiver Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Encounter Data & Risk Adjustment Operations Contact	VP Risk Adjustment		Bogdanov	Eyosef		5623666179					ebogdanov@ahcusa.com	1100 W. Town and Country Rd.	Suite 1600	Orange	CA	92868	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Enrollment Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	EOB Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Financial Audit Contact	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Financial Reporting Contact	Sr. Director, Accounting & Reporting		Tran	Sue Anne		6572187673	7673				stran@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Formulary Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Formulary Contact (Secondary)	PBM - Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/19/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	General Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Government Relations Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	HIPAA Privacy Officer	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	HIPAA Security Officer	VP, Technology & CISO		MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Hospice Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Interoperability Contact	VP, Data Engineering & BI CTO Data and Al		Sam	Georgie		8188807212					gsam@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	MA Appeals/Grievances Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	MA Claims Processing Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Marketing Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Medical Director	SVP Market Management WCR	Dr.	Kim	John		6572187640				5622074617	JKim@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Medicare Compliance Officer	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy	B	6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Medicare Coordinator	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Medicare Part D Opioid Overutilization Contact	PBM - Supv Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Medication Therapy Management Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	OffShore Subcontractor Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	CLynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Online Enrollment Center Contact (Back-up)	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Online Enrollment Center Contact (Optional)	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Online Enrollment Center Contact (Primary)	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Part C Application Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Part C Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Appeals	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Appeals Contact (Secondary)	Sr. Manager, Appeals & Grievance		Jimenez	Gudelia							GJimenez@ahcusa.com	1100 W. Town and Country Road, Suite #300		Orange	CA	92868	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187488	2188			HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Application Contact	CEO		Maroney	Dawn		5623346192				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/03/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Benefits Contact	PBM - Director, Benefit Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/19/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Claims Submission Contact	PBM - Functional Business Consultant Govt Programs		Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	03/19/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Exceptions Contact	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Exceptions Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali							AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187709				HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Price File Contact (Back-up)	PBM - Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/19/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Price File Contact (Optional)	PBM - QA Analyst		Tastad	Emily		6127776931					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Price File Contact (Primary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Quality Assurance Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Part D Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Patient Safety Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Payment Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Personal Health Record Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Pharmacy Director	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Pharmacy Network Management Contact	PBM - AVP, Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	03/31/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Pharmacy Network Management Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/21/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H3443	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	07/09/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H3443	PHR Beneficiary Contact																	02/15/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS	Alignment Health Plan	Alignment Healthcare USA, LLC	612	Yes	Active	8666342247				HMO - Health Maintenance Organization		C	San Francisco
H3443	Physician Incentive Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Plan Directory Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Plan to Plan Reconciliation Contact	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122			5622074266	adelatorre@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Processor Contact	Manager, PBM Operations		Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Quality Contact	Sr. Director, Quality Management/Credentialing		Lacock	Lisa		6572187638					LLacock@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Reconciliation Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Reconciliation Contact (Secondary)	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122				adelatorre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Recovery Audit Contact	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	SNP Application Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	SNP State Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Surveillance Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	System Contact	VP, AVA Health Plan Systems & Operations		Bates	Patrick		6572187636	7636				PBates@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Third Party Administrator (TPA) Liaison	Manager. Financial Operations		De La Torre	Angelo		8443102247	2122				adelatorre@ahcusa.com	1100 W. Town and Country Rd, Suite 1600		Orange	CA	92868	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	User Access Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Utilization Management Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3443	Utilization Review Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/09/2023	2023	ALIGNMENT HEALTH PLAN OF ARIZONA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3447	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/06/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/06/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/24/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/24/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H3447	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H3447	PHR Beneficiary Contact																	02/07/2019	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H3447	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/06/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3447	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	HEALTHKEEPERS, INC.	Local CCP	Anthem HealthKeepers	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3449	Agent/Broker Compensation Data Contact	Director, Financial Systems		Lazar	Lisa		9197653359					Lisa.Lazar@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/28/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Automated TrOOP Balance Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776706					eobp2p@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Backup User Access Contact	EDI Analyst		Umstead	Kamala		9197654363					kamala.umstead@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27707	09/26/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Best Available Evidence Contact	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Bid Audit Contact	Director, Actuarial Services		Turner	Danica		9847775665					danica.turner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/27/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Bid Audit Site Contact	Director, Actuarial Services		Turner	Danica		9847775665					danica.turner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/27/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Bid Primary Contact	Director, Actuarial Services		Vander Berg	Lucas		9842193485					Lucas.VanderBerg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	CAP Report Contact for Public Website	Sr Communications Advisor		Stinneford	Mark		9197653005					media.inquiry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/31/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	CEO - CMS Administrator Contact	President and CEO	Mr.	Sotunde	Tunde		9197657160					Tunde.Sotunde@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	01/31/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	CEO - Senior Official for Contracting	President and CEO	Mr.	Sotunde	Tunde		9197657160					Tunde.Sotunde@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	01/31/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Chief Financial Officer	SVP, Chief Financial Officer and Treasurer	Mr.	Perry	Mitchell	W	9197653923					mitch.perry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/21/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Chief Operating Officer	SVP, Chief Operations & Member Experience Officer	Ms.	Mizelle	Karla		9849603787					karla.mizelle@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Chief Information Officer	Chief Information Officer	Ms.	Abernathy	Jo		9197652383					Jo.Abernathy@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	277022291	01/15/2016	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Chief Information Security Officer	Chief Information Security Officer	Mr.	Chilton	Richard		9197652021					Rick.Chilton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	277022291	01/15/2016	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	CMS Casework Communication Contact	Director, Stakeholder Escalations		Holder	Nicole		9197651320					Caseworker@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/28/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Complaints Tracking Contact	Director, Stakeholder Escalations		Holder	Nicole		9197651320					Nicole.Holder@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/28/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Contact for Fraud Investigations	VP, Audit		Bennett	Tracy		3362014290					tracyr.bennett@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Coordination of Benefits Contact	Team Lead, Operations		Pridgen	David		3362014141					David. Pridgen@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Corporate Mailing						3362014460				3366592969	deborah.washington-mcneill@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Coverage Gap Discount Program (CGDP) Payment Contact	Principal Financial Accounting & Reporting Analyst		Varshney	Monisha		3528705750					Monisha.Varshney@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	12/04/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Customer Service Operations Contact	Sr. Manager, Contact Center		Woods	Renita		9197657057					Renita.Woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/18/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	DIR Contact	Director, Actuarial Services		Pigg	Ryland		9196168313					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P. O. Box 2291	Durham	NC	27702	03/15/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	DIR Contact (Secondary)	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Emergency Part D Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Emergency Part D Contact (Secondary)	VP, Government Markets Ops		Perry	Endya		9197775504					endya.perry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/06/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Employer Waiver Contact	Manager, Medicare Plan Administration		Brown	Alison		9196728994					alison.brown@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/28/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Encounter Data & Risk Adjustment Operations Contact	Manager, Risk Adjustment		Kimbrell	Tammy		9844448393					Tammy.Kimbrell2@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	05/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Enrollment Contact	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	EOB Transfer Contact	Medicare Pharmacy Operations Admin		Edwards	Chrissie		9197653536				9197657291	Corporate.pharmacy@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	11/20/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Financial Audit Contact	Director, Audit	Ms.	Ferrell	Kim		3362014038					kim.ferrell@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Financial Reporting Contact	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Formulary Contact	Clinical Pharmacist		Hiller	Debra		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/31/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics Inc	2900 Ames Crossing Road	Eagan	MN	55121	10/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	General Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Government Relations Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	HIPAA Privacy Officer	Director, Privacy, Ethics & Corp Policies		Hamlet	Lynn		9197657416					lynn.hamlet@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/24/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	HIPAA Security Officer	Chief Information Security Official		Chilton	Rick		9197652021					rick.chilton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2014	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Hospice Contact	Pharmacy Services Coordinator		Leggett	Ursula		9197654599					Ursula.Leggett@bcbsnc.com	PO Box 2291		Durham	NC	27702	02/01/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Interoperability Contact	Director, Corporate Compliance Official		Haith	Elenor		9842125897					Elenor.Haith@bcbsnc.com	PO Box 2291		Durham	NC	27702	07/20/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	MA Appeals/Grievances Contact	Director, Commercial and Medicare Appeals & Griev		McFall	Adonna		9197654061					Adonna.McFall@bcbsnc.com	Blue Cross Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/12/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	MA Claims Processing Contact for Public Website	Call Center Support		Woods	Renita		8882969790					Renita.Woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/18/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Marketing Contact	Manager, Medicare Plan Administration		Brown	Alison		9196728994					alison.brown@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/28/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Medical Director	Lead Medical Director	Dr.	Campbell	John		9197652718					john.campbell@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/05/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Medicare Compliance Officer	Director, Corporate Compliance	Mrs.	Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/09/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Medicare Coordinator	Director, CMS Contract Administration		Washington-McNeill	Deborah		3362014460				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Medicare Part D Opioid Overutilization Contact	Medicare Part D Operations Administrator		Edwards	Chrissie		9197653536					chrissie.edwards@bcbsnc.com	Blue Cross Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/31/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Medication Therapy Management Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	OffShore Subcontractor Contact	Director, Corporate Compliance		Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Online Enrollment Center Contact (Back-up)	Business Solutions Architect		Povathingal	Raj		9197654138					Raj.Povathingal@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	10/17/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Online Enrollment Center Contact (Optional)	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Online Enrollment Center Contact (Primary)	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Part C Application Contact		Ms.	Washington-McNeill	Deborah		3362014460					deborah.washington-mcneill@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Part C Reporting Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Appeals	Director, Commercial and Medicare Appeals & Griev		McFall	Adonna							Adonna.McFall@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/08/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882987520				HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Appeals Contact (Secondary)	Mgr, MA and PDP Appeals and Grievances		Lanier	Paige						8883758836	paige.lanier@bcbsnc.com	PO Box 17509	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8774947647				HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Application Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Benefits Contact	Team Leader, Clinical Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Claims Submission Contact	Functional Business Consultant - Govt Prgms		Brooke	Lance		4026862603					lbrooke@primetherapeutics.com	Prime Therapeutics LLC	2900  Ames Crossing Road	Eagan	MN	55121	10/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Exceptions Contact	Manager		Swanson	Ryan							PartDExceptions@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/30/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882969790				HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Exceptions Contact (Secondary)	Team Leader, Clinical Pharmacy Reviews - Medicare		Parikh	Swati							PartDExceptions@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	01/04/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882969790				HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Price File Contact (Back-up)	Team Leader, Clinical Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Price File Contact (Optional)	Price File Analyst Sr		Trudeau	Ashley		6127771338					ashley.trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Price File Contact (Primary)	Medicare Pharmacy Operations Administrator		Edwards	Chrissie		9197653536					chrissie.edwards@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Quality Assurance Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Part D Reporting Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3362014460					deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Patient Safety Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Payment Contact	AVP, Head of Actuarial Services & Valuation		Pigg Jr.	Ryland		9847776107					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/11/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Pharmacy Director	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Pharmacy Network Management Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Pharmacy Network Management Contact (Secondary)	Team Leader, Clinical Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Pharmacy Technical Help Desk Contact			Helpdesk	Pharmacy							bret.schultz@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8772777893				HMO - Health Maintenance Organization		C	Atlanta
H3449	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathan.bunch@primetherapeutics.com	Prime Therapeutics, LLC 2900 Ames Crossing Road		Eagan	MN	55121	12/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8772777893				HMO - Health Maintenance Organization		C	Atlanta
H3449	Physician Incentive Contact	VP, Provider Network & Transformation		Werner	Mark		9197654700					mark.werner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	10/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Plan Directory Contact for Public Website	Call Center support		Services	Member		8882969790					renita.woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Plan to Plan Reconciliation Contact	Manager, Financial Accounting & Reporting		Hitchcock	Grace		9197657999					grace.hitchcock@bcbsnc.com	ATTN:  Sheila Adams or Yvonne Stancil (Medicare P2P)	PO Box 30060 Mailstop 700-1AP	Durham	NC	27702	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Processor Contact	Dir Govt Programs & Ops		Zeien	Daniel		6127776775					daniel.zeien@primetherapeutics.com	Prime Therapeutics, LLC	2655 Eagan Woods Drive	Eagan	MN	55122	05/31/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Quality Contact	Dir, Quality and Risk Mgmt		Moon	Gregory		9847775524					Gregory.Moon@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/28/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Reconciliation Contact	Director, Actuarial Services		Pigg	Ryland		9196168313					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P. O. Box 2291	Durham	NC	27702	03/11/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Reconciliation Contact (Secondary)	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Recovery Audit Contact	Director, Corporate Compliance	Mrs	Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina,	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Surveillance Contact	Director, Corporate Compliance		Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	System Contact	Director, IT Solution Delivery		Holbrook	Janice		3362014101					janice.holbrook@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Third Party Administrator (TPA) Liaison	AVP, Head of Actuarial Services & Valuation		Pigg Jr.	Ryland		9847776107					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/11/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	User Access Contact	Electronic Data Interchange Analyst		Dunn	Lorrie		9197653669					lorrie.dunn@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27707	09/26/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Utilization Management Contact	Director, Clinical Teams		Perdue	Angela		3362014352					angela.perdue@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3449	Utilization Review Contact	Director, Clinical Teams		Perdue	Angela		3362014352					angela.perdue@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3464	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H3464	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H3464	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H3464	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H3464	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3464	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MIDLANDS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H3467	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	12/31/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Backup User Access Contact	Medicare Compliance Officer, Plan Partner Support	Ms.	Bouyer	Valorie		6159161254					valorie.bouyer@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/23/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	CAP Report Contact for Public Website	Compliance Officer		Vasto	Nancy		2149544114					nroht@procareadvantageplan.com	2537 Golden Bear Drive		Carollton	TX	75006	04/22/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	CEO - CMS Administrator Contact	CEO, Procare Advantage	Ms.	Underhill	Robin		2146639263					runderhill@cantexcc.com	2537 Golden Bear Drive		Carollton	TX	75006	12/31/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	CEO - Senior Official for Contracting	CEO, Procare Advantage	Ms.	Underhill	Robin		2149544114					runderhill@cantexcc.com	2537 Golden Bear Drive		Carollton	TX	75006	03/20/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Chief Financial Officer	Chief Financial Officer, ProCare Advantage	Mr.	Hladky	Sean		2127584311	117				shladky@lbbelon.com	430 Park Avenue	7th Floor	New York	NY	10022	02/02/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Chief Operating Officer	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Contact for Fraud Investigations	Compliance Officer		Vasto	Nancy		2149544114					nroht@procareadvantageplan.com	2537 Golden Bear Drive		Carollton	TX	75006	05/06/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	10/07/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Corporate Mailing						8442063719					procarecustomerservice@allyalign.com	P.O. Box 5849		Glen Allen	VA	230585849	02/16/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Encounter Data & Risk Adjustment Operations Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/23/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	EOB Transfer Contact			Lowry	Kristy		8448546883				8003756496	kristy.lowry@allyalign.com	P.O. Box 2190		Glen Allen	VA	230582190	01/15/2020	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Financial Audit Contact	Chief Financial Officer, ProCare Advantage	Mr.	Hladky	Sean		2127584311	117				shladky@lbbelon.com	430 Park Avenue	7th Floor	New York	NY	10022	02/02/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Financial Reporting Contact	Chief Financial Officer, ProCare Advantage	Mr.	Hladky	Sean		2127584311	117				shladky@lbbelon.com	430 Park Avenue	7th Floor	New York	NY	10022	02/02/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	12/31/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	General Contact	CEO, Procare Advantage		Underhill	Robin		2149544114					runderhill@cantexcc.com	2537 Golden Bear Drive		Carollton	TX	75006	01/23/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	HIPAA Privacy Officer	Compliance Officer		Vasto	Nancy		2149544114					nroht@procareadvantageplan.com	2537 Golden Bear Drive		Carollton	TX	75006	05/06/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	HIPAA Security Officer	Compliance Officer		Vasto	Nancy		2149544114					nroht@procareadvantageplan.com	2537 Golden Bear Drive		Carollton	TX	75006	05/06/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Medical Director	Chief Medical Officer		Kamali	Robert		2145667766					rkamali@procareadvantageplan.com	2537 Golden Bear Drive		Carollton	TX	75006	08/18/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Medicare Compliance Officer	Medicare Compliance Officer, ProCare Advantage	Ms	Vasto	Nancy		2149544114	114				nroht@procareadvantageplan.com	2537 Golden Bear Drive		Carollton	TX	75006	05/06/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Medicare Coordinator	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Part C Application Contact	Chief Financial Officer, ProCare Advantage	Mr.	Hladky	Sean		2127584311	117				shladky@lbbelon.com	430 Park Avenue 7th Floor		New York	NY	10022	02/02/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Part C Reporting Contact			Rennie	Lynda		8043966383					lynda@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/23/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	12/31/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Payment Contact	Chief Financial Officer, ProCare Advantage	Mr.	Hladky	Sean		2127584311	117				shladky@lbbelon.com	430 Park Avenue	7th Floor	New York	NY	10022	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Dallas
H3467	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Dallas
H3467	Physician Incentive Contact			Kaszak	Amy		2817734973					amy.kaszak@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/23/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Plan Directory Contact for Public Website			Sindlinger	Rocio		8442063719					rocio.sindlinger@allyalign.com	P.O. Box 2190		Glen Allen	VA	230582190	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Plan to Plan Reconciliation Contact	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/23/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Quality Contact			Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/23/2019	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Reconciliation Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/15/2020	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Reconciliation Contact (Secondary)	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Recovery Audit Contact	Medicare Compliance Officer, ProCare Advantage	Ms.	Vasto	Nancy		2149544114	114				nroht@procareadvantageplan.com	2537 Golden Bear Drive		Carollton	TX	75006	05/06/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Third Party Administrator (TPA) Liaison	Chief Financial Officer, ProCare Advantage	Mr.	Hladky	Sean		2127584311	117				shladky@lbbelon.com	430 Park Avenue	7th Floor	New York	NY	10022	09/28/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	User Access Contact	Medicare Compliance Officer, ProCare Advantage	Ms	Vasto	Nancy		2149544114	114				nroht@procareadvantageplan.com	2537 Golden Bear Drive		Carollton	TX	75006	05/06/2022	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3467	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PROCARE ADVANTAGE, LLC	Local CCP	ProCare Advantage	HMO/HMOPOS		First Sacramento Capital Funding LLC	735	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3471	Agent/Broker Compensation Data Contact	Director of Consumer Sales and Retention		Jones	Jeremy		2179028167					Jeremy.Jones@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Automated TrOOP Balance Transfer Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Backup User Access Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Best Available Evidence Contact	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Bid Audit Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Bid Audit Site Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Bid Primary Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	CAP Report Contact for Public Website	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8009654022				HMO - Health Maintenance Organization		C	Chicago
H3471	CEO - CMS Administrator Contact	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	CEO - Senior Official for Contracting	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Chief Financial Officer	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/18/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Chief Operating Officer	Chief Operating Officer	Mr.	McPhearson	Les		2179029740				2179029740	Les.McPhearson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Chief Information Officer		Ms.	Griffith	Kim		2179029004				2179029740	kim.griffith@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/21/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Chief Information Security Officer	Director of Information Security	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	CMS Casework Communication Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Complaints Tracking Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Contact for Fraud Investigations	Corporate Compliance and ERM Mgr		Adamson	Susan		2179029137					Susan.Adamson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Coordination of Benefits Contact	Director of Claims & Recovery		Parker	Lisa		2179028353				2179029786	lisa.parker@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Corporate Mailing						2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/21/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Coverage Gap Discount Program (CGDP) Payment Contact			Boyce	Heather		2179029467					heather.boyce@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Customer Service Operations Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	DIR Contact	Director of Accounting		Deane	Laura		2179028322				2179029740	laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/21/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	DIR Contact (Secondary)			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Emergency Part D Contact	VP, Chief Compliance Officer		Wilson	Hollie		2176214156				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Emergency Part D Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368					Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Employer Waiver Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224					Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Encounter Data & Risk Adjustment Operations Contact	Applications Services Manager		Walsh	Pam		2179029449				2173657111	Pam.Walsh@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/01/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Enrollment Contact	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	EOB Transfer Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Financial Audit Contact	Executive Director of Finance	Mr.	Maxwell	Jamey		2179028321				2179029740	jamey.maxwell@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Financial Reporting Contact	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/18/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Formulary Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Formulary Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368				2179029798	Jena.Deschler@healthalliance.org	3310 Fields South		Champaign	IL	61822	11/19/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	General Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Government Relations Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	HIPAA Privacy Officer	Director, Corporate Compliance and Privacy Officer		Jensen	Traci		2179029152				2179029794	traci.jensen@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	HIPAA Security Officer	Director of Information Security	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Hospice Contact	Director of Pharmacy		Buhr	Aimee		2179029366				2179029798	Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Interoperability Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	MA Appeals/Grievances Contact	Member / Provider Relations Manager		Regal	Wendi		2179028017				2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	MA Claims Processing Contact for Public Website		Ms.	Griffith	Kim		2179029004				2179029740	kim.griffith@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/21/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Marketing Contact	VP, Products and Marketing		Perry	Jana	L	2179028101				2179029740	jana.perry@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Medical Director	Associate Chief Medical Officer	Dr.	Revai	Krystal		2179028301				2179029740	Krystal.Revai@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Medicare Compliance Officer	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Medicare Coordinator	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Medicare Part D Opioid Overutilization Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Medication Therapy Management Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	OffShore Subcontractor Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Online Enrollment Center Contact (Back-up)	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Online Enrollment Center Contact (Optional)	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Online Enrollment Center Contact (Primary)	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Part C Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Part C Reporting Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Appeals	Member / Provider Relations Manager		Regal	Wendi						2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	2179028017				HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Appeals Contact (Secondary)	CEO		Madigan	Sinead						2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8008513379				HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Benefits Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029740	Hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Claims Submission Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Exceptions Contact	VP, Chief Compliance Officer		Wilson	Hollie						2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	2179028224				HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Exceptions Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena							Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	2179029368				HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Price File Contact (Back-up)	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Price File Contact (Optional)	PBM Contact		Lyman	Dorothy		6126326265					DL-MedOpsPlanFinder@catamaranrx.com	1600 McConnor Parkway		Schaumburg	IL	60173	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Price File Contact (Primary)	Lead IT Operations		Walker	Kathy		2179025198				2173657111	kathy.walker@healthalliance.org	3310 Fields South		Champaign	IL	61822	01/22/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Quality Assurance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Part D Reporting Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Patient Safety Contact	Medicare Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Payment Contact	Director of BECS		Kleinert	Traci		2179029508				2179029797	Traci.Kleinert@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Pharmacy Director	Director of Pharmacy		Buhr	Aimee		2179029366				2179029798	Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Pharmacy Network Management Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Pharmacy Network Management Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368					Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/29/2021	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Pharmacy Technical Help Desk Contact	VP, Chief Compliance Officer		Wilson	Hollie						2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8442651876				HMO - Health Maintenance Organization		C	Chicago
H3471	Physician Incentive Contact	VP, Provider Network Management		Walker	Randy		2179029106				2179029701	Randy.Walker@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Plan Directory Contact for Public Website	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Plan to Plan Reconciliation Contact			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Dr		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Processor Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029497	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Quality Contact	Quality Management Director		Migut	Tamara		2179028012				2179029789	tamara.migut@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/01/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Reconciliation Contact	Director of Accounting		Deane	Laura		2179078322				2179029740	laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Reconciliation Contact (Secondary)			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Recovery Audit Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	SNP Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Surveillance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	System Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Third Party Administrator (TPA) Liaison			Johnson	Danica		2179028224				2173657494	danica.johnson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/22/2019	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	User Access Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Utilization Management Contact	Director, Utilization management and Systems		Fossier	Lori		2179029025				2179029703	lori.fossier@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3471	Utilization Review Contact	Directo, Utilization Management and Systems		Fossier	Lori		2179029025				2179029703	lori.fossier@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE NORTHWEST HEALTH PLAN	Local CCP	Health Alliance Northwest	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3473	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Backup User Access Contact	Chief Information Officer		Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Best Available Evidence Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Bid Primary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	CAP Report Contact for Public Website	VP of Clinical Compliance		Teter	Lezlie		7203929719				3039961600	lteter@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	CEO - CMS Administrator Contact	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	CEO - Senior Official for Contracting	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Chief Financial Officer	CFO	Mr	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Chief Operating Officer	Senior Advisor	Ms.	Lozzano	Maria		9098902854				3039961600	mlozzano@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Chief Information Officer	Chief Information Officer	Ms.	Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Chief Information Security Officer	SVP of Information Technology	Mr.	Naus	Cole		7209210443				3039961600	MNaus@innovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	CMS Casework Communication Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Complaints Tracking Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Contact for Fraud Investigations	Chief Legal Officer		D'Amato	Nicole		6154732250				3039961600	NDAmato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Coordination of Benefits Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Corporate Mailing						3038694664				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Customer Service Operations Contact	Senior Advisor		Lozanno	Maria		9098902854				3039961600	mlozanno@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	DIR Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	DIR Contact (Secondary)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Emergency Part D Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Emergency Part D Contact (Secondary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Encounter Data & Risk Adjustment Operations Contact	Director of PACE Finance		Hewitt	Jessica		7209746767					jhewitt@innovage.com	8950 E Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Enrollment Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	EOB Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Financial Audit Contact	Director of PACE Finance	Ms	Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Financial Reporting Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Formulary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Formulary Contact (Secondary)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	General Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	08/24/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Government Relations Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	HIPAA Privacy Officer	Corporate Counsel		Moxon	Jeff		3038694664				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	HIPAA Security Officer	SVP of Information Technology		Naus	Cole		7209210443				3039961600	MNaus@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Interoperability Contact	SVP of Applications		Zierolf	Kris		7209742380					kzierolf@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	MA Appeals/Grievances Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	MA Claims Processing Contact for Public Website	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Marketing Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Medical Director	Medical Director		Ferrance	Randy		2159514586				3039961600	rferrance@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Medicare Compliance Officer	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Medicare Coordinator	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Medicare Part D Opioid Overutilization Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 E. Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Medication Therapy Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Online Enrollment Center Contact (Back-up)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Online Enrollment Center Contact (Primary)	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Part C Application Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Part D Appeals	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H3473	Part D Application Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Part D Benefits Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Part D Claims Submission Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Part D Exceptions Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H3473	Part D Price File Contact (Back-up)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Part D Price File Contact (Primary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Part D Quality Assurance Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Part D Reporting Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Patient Safety Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Personal Health Record Contact	VP Associate of General Counsel		Moxon	Jeff		3033006930				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Pharmacy Director	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Pharmacy Network Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Pharmacy Technical Help Desk Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H3473	PHR Beneficiary Contact																	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE	Total Longterm Care Inc	Total Community Options, Inc.	230	Yes	Active	8772776163	732			PACE - Nat		C	Philadelphia
H3473	Plan Directory Contact for Public Website	Director of Marketing		Stavros	Sarah		3033006904				3039961600	sstavros@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Plan to Plan Reconciliation Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				7209173390	akizewski@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Processor Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Quality Contact	VP of Quality		Curry	Jill		2153782123				3039961600	jcurry@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Reconciliation Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Recovery Audit Contact	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444404					mcinque@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Surveillance Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	System Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Third Party Administrator (TPA) Liaison	Medicare Compliance Manager		Brown	Lauren		7209746767				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	User Access Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Utilization Management Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3473	Utilization Review Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE-CHARLOTTESVILLE, LLC	National PACE	InnovAge Virginia PACE - Blue Ridge	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H3493	Automated TrOOP Balance Transfer Contact	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Backup User Access Contact	Executive Director	Sr.	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Best Available Evidence Contact	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Bid Primary Contact	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	CAP Report Contact for Public Website	Executive Director		Sullivan	margaret		8566753654				8566753666	marge.sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	CEO - CMS Administrator Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	CEO - Senior Official for Contracting	Executive Director	Sr.	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	02/20/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Chief Financial Officer	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	07/27/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Chief Operating Officer	Chief Operating Officer	Ms.	Lewis	Anne		4066472980				8566753659	anne.lewis@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	04/23/2019	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Chief Information Officer	Director Enterprise IT Operations	Mr	Gillespie	Jeff		6142348636					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Chief Information Security Officer	VP Information Security	Mr	Jennings	Preston		6105503083					Preston.Jennings@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	CMS Casework Communication Contact	Executive Director	Sr.	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Complaints Tracking Contact	Director Quality Assurance	Mr	Singer	Vincent		8566753654				8566753666	vincent.singer@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Contact for Fraud Investigations	Director Quality Assurance	Mr	Singer	Vincent		8566753654				8566753666	vincent.singer@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Coordination of Benefits Contact	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Corporate Mailing						8566753643				8566753659	jruprecht@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	01/17/2019	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Coverage Gap Discount Program (CGDP) Payment Contact	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Customer Service Operations Contact	Executive Director	Sr.	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	DIR Contact	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Emergency Part D Contact	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Encounter Data & Risk Adjustment Operations Contact	Director of Coding and Documentation		Creaney	Emy		7343431939					creaneye@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	10/25/2019	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Enrollment Contact	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	EOB Transfer Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533				2679917618	David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Financial Audit Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Financial Reporting Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Formulary Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2679917601				2679917618	joseph.garbarino@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	General Contact	Executive Director	Sr	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	02/20/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Government Relations Contact	Executive Director	Sr	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	02/20/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	HIPAA Privacy Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	HIPAA Security Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Interoperability Contact	Director Enterprise IT Operations		Gillespie	Jeff		7343433079					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	MA Appeals/Grievances Contact	Director Quality Assurance	Mr	Singer	Vincent		8566753654				8566753666	vincent.singer@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	03/10/2020	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	MA Claims Processing Contact for Public Website	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Marketing Contact	Director Marketing & Communications	Ms	Lark	Azia		9735182754					azia.lark@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	02/03/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Medical Director	Medical Director	Dr	Chan-Ting	Rengena		8566753662				8566753659	chan-tingr@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	01/17/2019	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Medicare Compliance Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Medicare Coordinator	Executive Director	Sr.	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/04/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362				4134932024	joseph.garbarino@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	09/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362				4134932024	joseph.garbarino@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	09/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Part C Application Contact	Executive Director	Sr.	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Part D Appeals	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad Street		Philadelphia	PA	19145	09/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	New York
H3493	Part D Appeals Contact (Secondary)	Director Quality & Compliance		Singer	Vincent							Vincent.Singer@trinity-health.org	2475 McClellan Ave	Bldg C	Pennsauken	NJ	08109	12/31/2020	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active	8566753654				PACE - Nat		C	New York
H3493	Part D Application Contact	Executive Director	Sr.	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Part D Benefits Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Part D Claims Submission Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Part D Exceptions Contact	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad Street		Philadelphia	PA	19145	09/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	New York
H3493	Part D Exceptions Contact (Secondary)	Director Quality & Compliance		Singer	Vincent							Vincent.Singer@trinity-health.org	2475 McClellan Ave	Bldg C	Pennsauken	NJ	08109	12/31/2020	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active	8566753654				PACE - Nat		C	New York
H3493	Part D Price File Contact (Back-up)	Executive Director	Sr.	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Part D Price File Contact (Primary)	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Part D Quality Assurance Contact	Director Quality Assurance	Mr	Singer	Vincent		8566753654				8566753666	vincent.singer@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	03/10/2020	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Part D Reporting Contact	Finance Director	Ms	Ruprecht	Janice	K	8566753643				8566753659	jruprecht@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	01/16/2019	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Patient Safety Contact	Director Quality Assurance	Mr	Singer	Vincent		8566753654				8566753666	vincent.singer@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Payment Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Pharmacy Director	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@mercyhealth.org	1930 South Broad Street		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Pharmacy Network Management Contact	Manager Part D Compliance		Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Pharmacy Technical Help Desk Contact	Manager Part D Compliance		Garbarino	Joseph							joseph.garbarino@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	New York
H3493	Plan Directory Contact for Public Website	Executive Director	Sr.	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Plan to Plan Reconciliation Contact	Director of Finance	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Processor Contact	Director of Finance	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Quality Contact	Director Quality Assurance	Mr	Singer	Vincent		8566753654				8566753666	vincent.singer@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	03/10/2020	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Reconciliation Contact	Director of Finance	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Recovery Audit Contact	Director of Finance	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Surveillance Contact	Executive Director	Sr.	Sullivan	Margaret		8566753663				8566753659	Marge.Sullivan@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	System Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Third Party Administrator (TPA) Liaison	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	User Access Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Utilization Management Contact	Medical Director	Dr	Chan-Ting	Rengena		8566753662				8566753659	chan-tingr@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3493	Utilization Review Contact	Medical Director	Dr	Chan-Ting	Rengena		8566753662				8566753659	chan-tingr@trinity-health.org	2475 McClellan Avenue	Building C	Pennsauken	NJ	08109	08/02/2023	2023	LIFE AT LOURDES, INC.	National PACE	Trinity Health LIFE New Jersey	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	New York
H3499	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H3499	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/07/2018	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/15/2017	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Medical Director	Chief Medical Director	Dr.	Lucas	Brad		8662464356					blucas@centene.com	3700 Embassy Parkway, Suite 200		Akron	OH	44333	03/30/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road Tampa,FL 33634		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Price File Contact (Optional)	Senior Manager, Provider Network Management Operat	Mr.	Ackerman	Jeffrey		8476878989					Jeffrey.Ackerman@WellCare.com	1870 W. Rio Salado Pkwy, Ste 2A		Tempe	AZ	85281	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H3499	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H3499	PHR Beneficiary Contact																	09/27/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8557661541				HMO - Health Maintenance Organization		C	Dallas
H3499	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Plan Directory Contact for Public Website			Services	Provider		8557661541					CorporateMedicareComplianceDept@CENTENE.COM	550 N. Meridian Street	Suite 101	Indianapolis	IN	46204	03/31/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3499	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3517	Automated TrOOP Balance Transfer Contact	Finance Director, Redwood Coast PACE	Ms.	Simpson	Cindy		7074439747	1214				csimpson@humsenior.org	1910 California Street		Eureka	CA	95501	02/14/2023	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Backup User Access Contact	Director, Redwood Coast PACE	Ms	LaHaie	Barbara		7074439747	3221			7074433498	blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	09/18/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Best Available Evidence Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221				blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Bid Primary Contact	Director of Finance	Ms.	Simpson	Cindy		7074439747	1214			7074433498	csimpson@humsenior.org	1910 California Street		Eureka	CA	95501	09/18/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	CAP Report Contact for Public Website	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221				blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	CEO - CMS Administrator Contact	Chief Executive Officer	Ms	Hooven	Melissa		7074439747	1213			7074433498	mhooven@humsenior.org	1910 California Street		Eureka	CA	95501	08/10/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	CEO - Senior Official for Contracting	Chief Executive Officer	Ms	Hooven	Melissa		7074439747	1213			7074433498	mhooven@humsenior.org	1910 California Street		Eureka	CA	95501	08/10/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Chief Financial Officer	Director of Finance	Ms	Simpson	Cindy		7074439747	1214			7074433498	csimpson@humsenior.org	1910 California St		Eureka	CA	95501	02/27/2017	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Chief Operating Officer	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221			7074433498	blahaie@humsenior.org	1910 California St.		Eureka	CA	95501	11/17/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Chief Information Officer	Director of Communication and Marketing	Ms.	Arche	Rene		7074439747	1256				rarche@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Chief Information Security Officer	Director of Communication and Marketing	Ms.	Arche	Rene		7074439747	1256				rarche@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	CMS Casework Communication Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221				blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Complaints Tracking Contact	Quality Assurance Manager		Hunsucker	Laurel		7074439747					lhunsucker@humsenior.org	1910 California Street		Eureka	CA	95501	02/14/2023	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Contact for Fraud Investigations	Quality Assurance Manager		Hunsucker	Laurel		7074439747					lhunsucker@humsenior.org	1910 California Street		Eureka	CA	95501	02/14/2023	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Coordination of Benefits Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221				blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Corporate Mailing						7074439747					reception@humsenior.org	1910 California Street		Eureka	CA	95501	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Coverage Gap Discount Program (CGDP) Payment Contact			LaHaie	Barbara		7074439747	3221				blahaie@humsenior.org	1910 California St		Eureka	CA	95501	05/11/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Customer Service Operations Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221				blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	DIR Contact	Director of Finance	Ms.	Simpson	Cindy		7074439747	1214			7074433498	csimpson@humsenior.org	1910 California Street		Eureka	CA	95501	09/18/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	DIR Contact (Secondary)	Chief Executive Officer	Ms	Hooven	Melissa		7074439747	1213			7074433498	mhooven@humsenior.org	1910 California Street		Eureka	CA	95501	08/10/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Emergency Part D Contact	Client support Supervisor		Slowiak	Andrea		7158522983					aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Emergency Part D Contact (Secondary)	Director of Finance	Ms.	Simpson	Cindy		7074439747	1214			7074433498	csimpson@humsenior.org	1910 California St.		Eureka	CA	95501	09/18/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Encounter Data & Risk Adjustment Operations Contact	Analyst	Ms	Simpson	Cindy		7074439747	1214				csimpson@humsenior.org	1910 California St		Eureka	CA	95503	09/09/2021	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Enrollment Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221				blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	EOB Transfer Contact	Director of Finance	Ms.	Simpson	Cindy		7074439747	1214			7074433498	csimpson@humsenior.org	1910 California Street		Eureka	CA	95501	09/18/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Financial Audit Contact	Director of Finance	Ms	Simpson	Cindy		7074439747	1214				csimpson@humsenior.org	1910 California St		Eureka	CA	95501	01/13/2017	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Financial Reporting Contact	Director of Finance	Ms	Simpson	Cindy		7074439747	1214				csimpson@humsenior.org	1910 California St		Eureka	CA	95501	02/27/2017	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Formulary Contact	Medical Director	Dr.	Heidmann	Jennifer		7074439747	3205			7074433498	jheidmann@humsenior.org	1910 California Street		Eureka	CA	95501	09/18/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Formulary Contact (Secondary)	Director, Redwood Coast PACE	Ms	LaHaie	Barbara		7074439747	3221			7074433498	blahaie@humsenior.org	1910 California St		Eureka	CA	95501	09/18/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	General Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221			7072691332	blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Government Relations Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221			7072691332	blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	HIPAA Privacy Officer	Director of Communication and Marketing		Arche	Rene		7074439747	1256				rarche@humsenior.org	1910 California Street		Eureka	CA	95501	01/13/2017	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	HIPAA Security Officer	Director of Communication and Marketing		Arche	Rene		7074439747	1256				rarche@humsenior.org	1910 California Street		Eureka	CA	95501	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Interoperability Contact			LaHaie	Barbara		7074439747	3221			7074433498	blahaie@humsenior.org	1910 California St.		Eureka	CA	95501	05/24/2022	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	MA Appeals/Grievances Contact	Quality Assurance Manager		Hunsucker	Laurel		7074439747	3231			7072691332	lhunsucker@humsenior.org	1910 California Street		Eureka	CA	95501	02/21/2023	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	MA Claims Processing Contact for Public Website	PACE Finance Specialist	Mr	Peterson	Jiro		7074439747	1210				jpeterson@humsenior.org	1910 California St		Eureka	CA	95501	08/20/2018	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Marketing Contact	Director of Communication and Marketing		Arche	Rene		7074439747	1256				rarche@humsenior.org	1910 California Street		Eureka	CA	95501	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Medical Director	Medical Director	Dr	Heidmann	Jennifer		7074439747	3205				jheidmann@humsenior.org	1910 California Street		Eureka	CA	95501	05/08/2014	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Medicare Compliance Officer	Quality Assurance Manager	Ms	Hunsucker	Laurel		7074439747	3231			7072691332	lhunsucker@humsenior.org	1910 California Street		Eureka	CA	95501	02/21/2023	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Medicare Coordinator	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221			7072691332	blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Medicare Part D Opioid Overutilization Contact	Client support Supervisor		Slowiak	Andrea		7158522983					aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	04/02/2019	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Medication Therapy Management Contact	Medical Director	Dr	Heidmann	Jennifer		7074439747	3205				jheidmann@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Part C Application Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221			7072691332	blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Part D Appeals	Client support Supervisor		Slowiak	Andrea							aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active	8882987770				PACE - Nat		C	San Francisco
H3517	Part D Application Contact	Director of Finance	Ms.	Simpson	Cindy		7074439747	1214			7074433498	csimpson@humsenior.org	1910 California Street		Eureka	CA	95501	09/18/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Part D Benefits Contact	Client support Supervisor		Slowiak	Andrea		7158522983					aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Part D Claims Submission Contact	Client support Supervisor		Slowiak	Andrea		7158522983					aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Part D Exceptions Contact	Client support Supervisor		Slowiak	Andrea							aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active	8882987770				PACE - Nat		C	San Francisco
H3517	Part D Price File Contact (Back-up)	Owner		Tanner	Bob		7158522983					btanner@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Part D Price File Contact (Primary)	Client support Supervisor		Slowiak	Andrea		7158522983					aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Part D Quality Assurance Contact	Client support Supervisor		Slowiak	Andrea		7158522983					aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Part D Reporting Contact	Client support Supervisor		Slowiak	Andrea		7158522983					aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Patient Safety Contact	Quality Assurance Manager		Hunsucker	Laurel		7074439747				7072691332	lhunsucker@humsenior.org	1910 California Street		Eureka	CA	95501	02/14/2023	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Payment Contact	Finance Director	Ms	Simpson	Cindy		7074439747	1214				csimpson@humsenior.org	1910 California Street		Eureka	CA	95501	02/27/2017	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Pharmacy Director	Client support Supervisor		Slowiak	Andrea		7158522983					aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Pharmacy Network Management Contact	Client support Supervisor		Slowiak	Andrea		7158522983					aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Pharmacy Technical Help Desk Contact	Client support Supervisor		Slowiak	Andrea							aslowiak@pharmastarpbm.com	PO Box  3127		Eau Claire	WI	54702	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active	8882987770				PACE - Nat		C	San Francisco
H3517	Plan Directory Contact for Public Website	Director of Communication and Marketing		Arche	Rene		7074439747	1256				rarche@humsenior.org	1910 California Street		Eureka	CA	95501	12/20/2013	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Plan to Plan Reconciliation Contact	Director of Finance	Ms.	Simpson	Cindy		7074439747	1214			7074433498	csimpson@humsenior.org	1910 California Street		Eureka	CA	95501	09/18/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Processor Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221			7072691332	blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Quality Contact	Quality Assurance Manager		Hunsucker	Laurel		7074439747				7072691332	lhunsucker@humsenior.org	1910 California Street		Eureka	CA	95501	02/21/2023	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Reconciliation Contact	Finance Analyst	Ms	Simpson	Cindy		7074439747	1314			7074433498	csimpson@humsenior.org	1910 California Street		Eureka	CA	95501	09/09/2021	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Reconciliation Contact (Secondary)	PACE Finance Specialist	Mr	Peterson	Jiro		7074439747	1210				jpeterson@humsenior.org	1910 California St		Eureka	CA	95501	08/20/2018	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Recovery Audit Contact	Finance Director	Ms	Simpson	Cindy		7074439747	1214				csimpson@humsenior.org	1910 California Street		Eureka	CA	95501	02/27/2017	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Surveillance Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221			7072691332	blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	System Contact	Director of Communication and Marketing		Arche	Rene		7074439747	1256			7074433498	rarche@humsenior.org	1910 California Street		Eureka	CA	95501	08/20/2018	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Third Party Administrator (TPA) Liaison	Finance Director	Ms	Simpson	Cindy		7074439747	1214				csimpson@humsenior.org	1910 California Street		Eureka	CA	95501	02/27/2017	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	User Access Contact	Director of Communications and Marketing	Ms.	Arche	Rene		7074439747	1256			7074433498	rarche@humsenior.org	1910 California Street		Eureka	CA	95501	09/18/2020	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Utilization Management Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221			7072691332	blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3517	Utilization Review Contact	Director, Redwood Coast PACE	Ms.	LaHaie	Barbara		7074439747	3221			7072691332	blahaie@humsenior.org	1910 California Street		Eureka	CA	95501	03/28/2016	2023	HUMBOLDT SENIOR RESOURCE CENTER, INC.	National PACE	Redwood Coast PACE	National PACE		Humboldt Senior Resource Center, Inc.	602	Yes	Active					PACE - Nat		C	San Francisco
H3522	Automated TrOOP Balance Transfer Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Backup User Access Contact	Executive Assistant		Marcum	Suzie		7659358812					suzanne.marcum@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Best Available Evidence Contact	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Bid Primary Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	CAP Report Contact for Public Website	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	CEO - CMS Administrator Contact	President	CEO	Kinyon	Craig		7659833224					craig.kinyon@reidhealth.org	1100 Reid Parkway, Administration	Administration	Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	CEO - Senior Official for Contracting	President	CEO	Kinyon	Craig		7659833224					craig.kinyon@reidhealth.org	1100 Reid Parkway, Administration	Administration	Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Chief Financial Officer		CFO	Knight	Chris		7659833225					chris.knight@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Chief Operating Officer	Vice President Continuum of Care	COO	Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Chief Information Officer	Vice President	CIO	Dickman	Angie		7659833412					angie.dickman@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Chief Information Security Officer	Director of Health Information Management	CISO	Morrison	Julie		7659833286					julie.morrison@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	CMS Casework Communication Contact	QA Manager		Nesbitt	Renee		7659358959	2886				renee.nesbitt@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Complaints Tracking Contact	QA Manager		Nesbitt	Renee		7659358959	2886				renee.nesbitt@reidhealth.org	2300 National Road		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Contact for Fraud Investigations	Director of Audit Services	CCO	Bierman	Randall		7659833418					randall.bierman@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Coordination of Benefits Contact	Director		Werner	Ashley		7659358958	17906				ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Corporate Mailing						7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Customer Service Operations Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	DIR Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.com	2300 National Rd W		Richmond	IN	47374	02/22/2022	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	DIR Contact (Secondary)	Business Operations Manager		Glaub	Jared		7659358959					Jared.Glaub@reidhealth.org	2300 National Rd W		Richmond	IN	47374	02/22/2022	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Emergency Part D Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Emergency Part D Contact (Secondary)	Business Operations Manager		Glaub	Jared		7659358959					jared.glaub@reidhealth.org	2300 National Road West		Richmond	IN	47374	02/22/2022	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Encounter Data & Risk Adjustment Operations Contact	Director		Werner	Ashley	M	7659358958				7659358960	Ashley.Werner@ReidHealth.org	2300 National Road West		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Enrollment Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	EOB Transfer Contact	Director		Werner	Ashley		7659358958				7659358960	ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Financial Audit Contact	Director	Mrs.	Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Financial Reporting Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Formulary Contact	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Formulary Contact (Secondary)	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	General Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Government Relations Contact	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	HIPAA Privacy Officer	Director of Health Information Management		Morrison	Julie		7659833286					julie.morrison@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	HIPAA Security Officer	Director of Health Information Management		Morrison	Julie		7659833286					julie.morrison@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Interoperability Contact	Director		Werner	Ashley		7659358958					Ashley.Werner@reidhealth.org	2300 National Rd W		Richmond	IN	47374	05/30/2023	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	MA Appeals/Grievances Contact	QA Manager		Nesbitt	Renee		7659358959	2886				renee.nesbitt@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	MA Claims Processing Contact for Public Website	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Marketing Contact	Director of Marketing & Communications		Willett	Judi		7659358823					judi.willett@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Medical Director	Medical Director of PACE	Dr.	DeSantis	David		7659670104					david.desantis@reidhealth.org	1100 Reid Parkway, Administration	Administration	Richmond	IN	47374	06/02/2022	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Medicare Compliance Officer	Director of Audit Services	CCO	Bierman	Randall		7659833418					randall.bierman@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Medicare Coordinator	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Medicare Part D Opioid Overutilization Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Medication Therapy Management Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Online Enrollment Center Contact (Back-up)	Executive Assistant		Marcum	Suzie		7659358812					suzanne.marcum@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Online Enrollment Center Contact (Primary)	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Part C Application Contact	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Part D Appeals	Director		Werner	Ashley						7659358960	Ashley.Werner@ReidHealth.org	2300 National Road West		Richmond	IN	47374	01/08/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active	7659358958				PACE - Nat		C	Chicago
H3522	Part D Appeals Contact (Secondary)	Quality Assurance Manager		Nesbitt	Renee						7659358969	Renee.Nesbitt@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/08/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active	7659358959	2886			PACE - Nat		C	Chicago
H3522	Part D Application Contact	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Part D Benefits Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.com	2300 National Rd W		Richmond	IN	47374	02/22/2022	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Part D Claims Submission Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Part D Exceptions Contact	Director		Werner	Ashley							ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active	7659358958				PACE - Nat		C	Chicago
H3522	Part D Exceptions Contact (Secondary)	Business Operations Manager		Glaub	Jared							Jared.Glaub@reidhealth.org	2300 National Rd W		Richmond	IN	47374	02/22/2022	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active	7659358959				PACE - Nat		C	Chicago
H3522	Part D Price File Contact (Back-up)	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.com	2300 National Rd W		Richmond	IN	47374	02/22/2022	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Part D Price File Contact (Optional)	Executive Assistant		Marcum	Suzie		7659358812					suzanne.marcum@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Part D Price File Contact (Primary)	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Part D Quality Assurance Contact	QA Manager		Nesbitt	Renee		7659358959	2886				renee.nesbitt@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Part D Reporting Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Patient Safety Contact	QA Manager		Nesbitt	Renee		7659358959	2886				renee.nesbitt@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Payment Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Pharmacy Director	Medical Director of PACE	Dr.	Anderson	Patrick		7659354088					patrick.anderson@reidhealth.org	1100 Reid Parkway, Administration	Administration	Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Pharmacy Network Management Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Pharmacy Network Management Contact (Secondary)	Business Operations Manager		Glaub	Jared		7659358959					Jared.Glaub@reidhealth.org	2300 National Rd W		Richmond	IN	47374	02/22/2022	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Pharmacy Technical Help Desk Contact	Director		Werner	Ashley							ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active	7659358958	3314			PACE - Nat		C	Chicago
H3522	Pharmacy Technical Help Desk Contact (Secondary)	Business Operations Manager		Glaub	Jared							Jared.Glaub@reidhealth.org	2300 National Rd W		Richmond	IN	47374	02/22/2022	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active	7659358959				PACE - Nat		C	Chicago
H3522	Plan Directory Contact for Public Website	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Plan to Plan Reconciliation Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Processor Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Quality Contact	QA Manager		Nesbitt	Renee		7659368959	2886				renee.nesbitt@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Reconciliation Contact	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Reconciliation Contact (Secondary)	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Recovery Audit Contact	Director of Audit Services	CCO	Bierman	Randall		7659833418					randall.bierman@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Surveillance Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	01/19/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	System Contact	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/04/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Third Party Administrator (TPA) Liaison	Director		Werner	Ashley		7659358958					ashley.werner@reidhealth.org	2300 National Road West		Richmond	IN	47374	05/18/2021	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	User Access Contact	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Utilization Management Contact	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3522	Utilization Review Contact	Vice President Continuum of Care		Kester	Billie		7659833314					billie.kester@reidhealth.org	1100 Reid Parkway, Administration		Richmond	IN	47374	03/09/2020	2023	REID HOSPITAL & HEALTH CARE SERVICES, INC.	National PACE	Reid Health PACE Center	National PACE		Reid Hospital & Health Care Services, Inc.	745	Yes	Active					PACE - Nat		C	Chicago
H3528	Agent/Broker Compensation Data Contact	Medicare Sales Director		Casas	Edward		3472138107					ecasas@emblemhealth.com	55 Water Street		New York	NY	10041	06/02/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Automated TrOOP Balance Transfer Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					JEwen@emblemhealth.com	55 Water St		New York	NY	10041	06/25/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Backup User Access Contact	Director, Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Best Available Evidence Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Bid Audit Contact	Director, Medicare Audit & Assessment		Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	02/20/2019	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Bid Audit Site Contact	Sr. Medicare Audit Spec.		Chan	Tat		6464470218					tchan@emblemhealth.com	55 Water Street		New York	NY	10041	05/26/2020	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Bid Primary Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	CAP Report Contact for Public Website	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	CEO - CMS Administrator Contact	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin-Corp Exec. Office	New York	NY	10041	12/14/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	CEO - Senior Official for Contracting	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin - Corp Exec. Office	New York	NY	10041	12/14/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Chief Financial Officer	Chief Financial Officer	Ms.	Tamborino	Heather		6464476174					htamborino@emblemhealth.com	55 Water Street		New York	NY	10041	07/02/2020	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Chief Operating Officer	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Chief Information Officer	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	06/28/2018	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Chief Information Security Officer	AVP., IT Governance	Mr.	McDermott	Thomas	M	6464474110	34110				tmcdermott@emblemhealth.com	55 Water Street		New York	NY	10041	06/28/2018	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	CMMI Model Point of Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	CMS Casework Communication Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Complaints Tracking Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Contact for Fraud Investigations	Director, Special Investigations	Mr.	Lupo	Chris		6318442453					clupo@emblemhealth.com	395 North Service Road		Melville	NY	11747	10/31/2018	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Coordination of Benefits Contact	Director, Payment Integrity & Financial Recovery		LaPlante	Brian		8606742840					blaplante@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	01/10/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Corporate Mailing						8604096415					TBenoit@ConnectiCare.com	175 Scott Swamp Road		Farmington	CT	06034	11/14/2013	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Coverage Gap Discount Program (CGDP) Payment Contact	Treasury Operations Analyst		Saint-Hilaire	Ana		6464474279					asaint-hilaire@emblemhealth.com	55 Water Street		New York	NY	10041	03/22/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Customer Service Operations Contact	VP, Ops Strategy & Service Delivery		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	DIR Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	DIR Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Emergency Part D Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Emergency Part D Contact (Secondary)	Pharm. Govt. Programs Manager		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Employer Waiver Contact	AVP, Product Dev., Admin., & Perf. Analysis		Averyanova	Nataliya		6464475044					naveryanova@emblemhealth.com	55 Water Street		New York	NY	10041	04/18/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Encounter Data & Risk Adjustment Operations Contact	Dir., Enterprise Gov't Submissions		Guenther	Anne Marie		8606745847					aconnors@connecticare.com	175 Scott Swamp Rd		Farmington	CT	06034	05/24/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Enrollment Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	EOB Transfer Contact	Director, Claims Processing & Provider File Mgmt		Meka	Joann		8604098915				8604098455	jmeka@connecticare.com	175 South Swamp Road		Farmington	CT	06034	05/26/2020	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Financial Audit Contact	Director, Medicare Audit & Assessment	Mr	Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	07/29/2019	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Financial Reporting Contact	Director, Financial Reporting		Heitzer	Frances		6464477885					fheitzer@emblemhealth.com	55 Water Street		New York	NY	10041	07/18/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Formulary Contact	Sr. Formulary Specialist		Sitilides Cimino	Irene		6864477926					isitilidescimino@emblemhealth.com	55 Water Street		New York	NY	10041	04/19/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Formulary Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	05/12/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	General Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Government Relations Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	HIPAA Privacy Officer	VP, Corporate Compliance		Lurin	Joseph		6464475203					jlurin@emblemhealth.com	55 Water Street		New York	NY	10041	07/29/2019	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	HIPAA Security Officer	AVP, IT Governance		McDermott	Thomas		6464474110					TMcDermott@emblemhealth.com	55 Water Street		New York	NY	10041	07/29/2019	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Hospice Contact	Senior Medicare Pharmacy Specialist		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	10/10/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Interoperability Contact	Dir., Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	MA Appeals/Grievances Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	MA Claims Processing Contact for Public Website	VP, Claims Operations		Henderson	Linda		6464476795					lhenderson@emblemhealth.com	175 Scott Swamp Road		Farmington	CT	06032	10/23/2020	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Marketing Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Medical Director	Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	07/24/2020	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Medicare Compliance Officer	Director, Medicare Compliance/MCO	Ms.	Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Medicare Coordinator	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Medicare Part D Opioid Overutilization Contact	Dir., Pharm. Quality Provider and Safety Prgms.		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road		Farmington	CT	06034	05/24/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Medication Therapy Management Contact	Clinical Pharmacy Program Leader		Mhajan	Ruby		6464477632					rumhajan@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	OffShore Subcontractor Contact	Lead Admin., Regulatory Pgm.		Kelly	Veronica		6464477494					vkelly@emblemhealth.com	55 Water Street		New York	NY	10041	11/26/2019	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Online Enrollment Center Contact (Back-up)	Knowledge Manager, Enroll. & Bill.		Gonzalez	Gabriel		6464477722					gabriel.gonzalez@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Online Enrollment Center Contact (Optional)	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Online Enrollment Center Contact (Primary)	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Part C Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Part C Reporting Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Part D Appeals	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464477215				HMO - Health Maintenance Organization		C	New York
H3528	Part D Appeals Contact (Secondary)	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464477215				HMO - Health Maintenance Organization		C	New York
H3528	Part D Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Part D Benefits Contact	Sr. Pharm. Gov't. Prog. Spec		Dean	Wendy		8604098966					wdean@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	07/18/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Part D Claims Submission Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Part D Exceptions Contact	Director		Colby	Andrew							acolby@emblemhealth.com	55 Water street		New York	NY	10041	05/12/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464473340				HMO - Health Maintenance Organization		C	New York
H3528	Part D Exceptions Contact (Secondary)	Sr.  Govt Prog. Pharm. Spec.		Kerman	Jeff							jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	05/12/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464477698				HMO - Health Maintenance Organization		C	New York
H3528	Part D Price File Contact (Back-up)	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Part D Price File Contact (Optional)	Sr. Govt Prog. Pharm Spec.		Kerman	Jeff		6464477698					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Part D Price File Contact (Primary)	Sr. Manager Regulated Markets		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/11/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Part D Quality Assurance Contact	Director, Medicare Compliance		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Part D Reporting Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Patient Safety Contact	Dir., Pharm Quality and Provider		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road	P.O. Box 4050	Farmington	CT	060344050	10/10/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Payment Contact	VP Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Personal Health Record Contact	Director, Medicare Compliance		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Pharmacy Director	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Pharmacy Network Management Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Pharmacy Network Management Contact (Secondary)	Sr. Govt Prog. Pharm. Specialist		Kerman	Jeff		6464477698					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	01/12/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	8009221557	2			HMO - Health Maintenance Organization		C	New York
H3528	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Client Ops Director		Brown	Gregory							grbrown@emblemhealth.com	55 Water street		New York	NY	10041	10/10/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	4015251683				HMO - Health Maintenance Organization		C	New York
H3528	PHR Beneficiary Contact																	05/11/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS	ConnectiCare Inc	EmblemHealth, Inc.	361	Yes	Active	8002242273				HMO - Health Maintenance Organization		C	New York
H3528	Plan Directory Contact for Public Website	Sr. VP Operations		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Plan to Plan Reconciliation Contact	Accounts Payable Manager		Siozios	Jacqueline		6464473017					jsiozios@emblemhealth.com	55 Water Street		New York	NY	10041	08/16/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Processor Contact	AVP, Claims Operations		Gauthier	Kathleen		8604096435					kgauthier@connecticare.com	175 Scott Swamp Rd		Farmington	CT	06032	07/18/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Quality Contact	Data Analytics & Reporting Leader		Goldfarb	Julie		6315775110	65110				jgoldfarb@emblemhealth.com	55 Water Street		New York	NY	10041	01/10/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Reconciliation Contact	Dir., Enrollment & Billing		Ewen	Jillian	L	8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	07/15/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Reconciliation Contact (Secondary)	VP Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Recovery Audit Contact	Dir., Medicare Audit & Assess.	Mr.	Greene	Joseph		5184468045					jgreene@emblemhealth.com	80 Wolf Road		Albany	NY	12205	11/26/2019	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	SNP Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	SNP State Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Surveillance Contact	Director, Medicare Compliance	Ms.	Borenkind	Carly		3479784977					Cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	System Contact	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	06/28/2018	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Third Party Administrator (TPA) Liaison	Treasury Operations Analyst		Saint-Hilaire	Ana		6464474279					asaint-hilaire@emblemhealth.com	55 Water Street		New York	NY	10041	03/22/2022	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	User Access Contact	Lead Medicare Regulatory Spec.		Handy	Michelle		5184466949					mhandy@EmblemHealth.com	80 Wolf Road		Albany	NY	12205	03/21/2019	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Utilization Management Contact	SVP Chief medical Officier		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	07/24/2020	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3528	Utilization Review Contact	SVP Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	07/24/2020	2023	CONNECTICARE, INC.	Local CCP	ConnectiCare	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3533	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H3533	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H3533	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3533	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH COMPANY OF NEW YORK, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H3536	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H3536	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H3536	PHR Beneficiary Contact																	11/05/2015	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H3536	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3536	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	MATTHEW THORNTON HEALTH PLAN, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3554	Agent/Broker Compensation Data Contact	Manager, Individual Sales Agent		Creasman	Matthew		5013993923					mdcreasman@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Automated TrOOP Balance Transfer Contact	Eligibility Supervisor		White	William		6127776736					eobp2p@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Backup User Access Contact	Regulatory Compliance System Administrator		Coffman	Clay		5013782559					crcoffman@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Best Available Evidence Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Bid Audit Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 S Gaines St		Little Rock	AR	72201	06/12/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Bid Audit Site Contact	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Bid Primary Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	06/12/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	CAP Report Contact for Public Website	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	CEO - CMS Administrator Contact	Lead Executive, Senior Products	Ms.	Dixon	Laurin	E	9016063429					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	CEO - Senior Official for Contracting	CEO	Mr.	Barnett	Curtis		5013782007					cebarnett@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Chief Financial Officer	CFO	Mr.	Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Chief Operating Officer	Executive VP, Chief Operating Officer	Mr.	Dillard	Gray		5013782436					gddillard@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Chief Information Officer	Chief Information Officer	Ms.	Ryan	Kathy		5013782017					koryan@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Chief Information Security Officer	Chief Information Officer	Ms.	Ryan	Kathy		5013782017					koryan@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	CMS Casework Communication Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Complaints Tracking Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Contact for Fraud Investigations	Director, Performance Mgt. & Investigations		Gunter	Debbie		5013786610					dsgunter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Coordination of Benefits Contact	Eligibility Supervisor		White	William		6127776736					cobmedd@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Corporate Mailing						5013785635					mdvannatta@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Customer Service Operations Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	DIR Contact	Lead Executive, Senior Products		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	DIR Contact (Secondary)	CFO		Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Emergency Part D Contact	Lead Executive, Senior Products		Dixon	Laurin	E	9016063429					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Emergency Part D Contact (Secondary)	Manager, Senior Products		Sherer	Michael		5013786341					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Encounter Data & Risk Adjustment Operations Contact	Director Medicare Risk Adjustment		Serrano	Kacey		5013714238					klserrano@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	03/19/2021	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Enrollment Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	EOB Transfer Contact	Eligibility Supervisor		White	William		6127776736				8776772730	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Financial Audit Contact	Medicare Compliance Officer	Mr.	Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	09/21/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Financial Reporting Contact	Financial Reporting Accountant		Russell	Holly		5013993954					hkrussell@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Formulary Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Formulary Contact (Secondary)			Wahl	Dan		6127776815					dwahl@primetherapeutics.com	Prime Therapeutics 1305 Corporate Drive		Eagan	MN	55121	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	General Contact	Led Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Government Relations Contact	Sr Counsel Gov't Relation		Fenton	Janie		5013782103					jwfenton@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	HIPAA Privacy Officer	Sr Counsel Litigation		Roberts	Chet		5013782375					cxroberts@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	HIPAA Security Officer	Physical Security/Chief Security Officer		Shirley	Devin		5016880747					DMShirley@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	09/11/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Hospice Contact	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Interoperability Contact			Ritchey	Heather		5013782000					hrritchey@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/11/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	MA Appeals/Grievances Contact	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	MA Claims Processing Contact for Public Website	Supervisor, Medicare Claims		Pilkington Ross	Amanda		5013013452					ampilkington@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Marketing Contact	VP Consumer and Retail Markets	Mr.	Vannatta	Matthew		5013785635					mdvannatta@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	05/20/2021	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Medical Director	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/02/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/30/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Medicare Coordinator	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Medicare Part D Opioid Overutilization Contact	Associate Medical Director	Dr.	Becker	Thomas		5013783100					tebecker@arkbluecross.com	601 S Gaines St.		Little Rock	AR	72201	06/12/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Medication Therapy Management Contact	Manager, Stars Pharmacy Lead		Walsh	Tyler		5013993975					trwalsh@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	06/07/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	OffShore Subcontractor Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	05/20/2021	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Online Enrollment Center Contact (Optional)	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 S Gaines		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Online Enrollment Center Contact (Primary)	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Part C Application Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Part C Reporting Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Part D Appeals			Review Dept.	Clinical						8006936703	CRUMed@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active	8006936651				PPO - BBA		C	Dallas
H3554	Part D Appeals Contact (Secondary)	Senior Counsel, Appeals		Phillips	Ashleigh						5013783366	adphillips@arkbluecross.com	PO Box 2181	Attn: Legal Appeals	Little Rock	AR	72203	01/11/2021	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active	5013782025				PPO - BBA		C	Dallas
H3554	Part D Application Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Part D Benefits Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Part D Claims Submission Contact			Brooke	Lance		4026862603				4029702545	lbrooke@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Part D Exceptions Contact			Review Audit & Regul	Clinical						8006936703	clinicalreviewclientinquiries@primetherapeutics.co	Centennial Crossings - Clinical Review 4401 West 76th S		Edina	MN	55435	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active	8006936651				PPO - BBA		C	Dallas
H3554	Part D Exceptions Contact (Secondary)			Review Dept Med D Au	Clinical						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Edina	MN	55435	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active	8006936651				PPO - BBA		C	Dallas
H3554	Part D Price File Contact (Back-up)	Price File Analyst Sr.		Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	06/30/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Part D Price File Contact (Optional)	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Part D Price File Contact (Primary)	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Part D Quality Assurance Contact	Manager Metrics and Reporting		Luukkonen	Lynette		6127775574					lynette.luukkonen@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Part D Reporting Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Patient Safety Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Payment Contact	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Pharmacy Director	Associate Medical Director	Dr.	Becker	Thomas		5013783100					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Pharmacy Network Management Contact	Senior Director Network Provider Relations		Grindsteinner	Bretta		6127774021					bgrinsteinner@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Pharmacy Network Management Contact (Secondary)	Sr. Manager Pharmacy Provider Relations		Ecklund	Elisa		6127774308					eecklund@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Pharmacy Technical Help Desk Contact			Pharmacy Help Desk	Prime						8882852242	MGarzarodriguez@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active	8006933815				PPO - BBA		C	Dallas
H3554	Plan Directory Contact for Public Website			Service	Customer		8442014934					MediPakAdvRx@arkbluecross.com	P O Box 3648		Little Rock	AR	72203	11/02/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Plan to Plan Reconciliation Contact	Financial Analyst		Holt	Susan		5013993958				5013783258	sbholt@arkbluecross.com	P O Box 8084		Little Rock	AR	72203	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Processor Contact	Director Business Service Ops - Govt Programs		Allie	Cindy		6127776772				6127776705	callie@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Quality Contact	Director Quality Programs		Griffin	Brandon		5013782208					jbgriffin@arkbluecross.com	320 W Capitol		Little Rock	AR	72201	03/17/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Reconciliation Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Reconciliation Contact (Secondary)	CFO		Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Recovery Audit Contact	Financial Analyst	Ms.	Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Surveillance Contact	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	System Contact	Manager, Configuration		Spicer	Derek		5013013425					bdspicer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Third Party Administrator (TPA) Liaison	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/06/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	User Access Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387				5013017306	wlbradford@arkbluecross.com	601 Gaines Street	10-South	Little Rock	AR	72201	05/20/2021	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Utilization Management Contact	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/02/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3554	Utilization Review Contact	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/02/2020	2023	USABLE PPO INSURANCE COMPANY	Local CCP	Arkansas Blue Medicare	Local PPO		USAble Mutual Insurance Company	421	Yes	Active					PPO - BBA		C	Dallas
H3557	Agent/Broker Compensation Data Contact	Director, Sales		Mallette	Rebecca		4014591343					rebecca.mallette@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Automated TrOOP Balance Transfer Contact	Director PBM Operations		Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Backup User Access Contact	Senior Compliance Analyst		Giacomini	Elizabeth		4017490690				4014591598	elizabeth.giacomini@bcbsri.org	500 Exchange Street		Providence	RI	02903	05/17/2021	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Best Available Evidence Contact	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721				4014595649	ivona.wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Bid Audit Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Bid Audit Site Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Bid Primary Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Pennypacker	Regan		4017430003				4014591598	mco@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8006373718	2100			PPO - BBA		C	Boston
H3557	CEO - CMS Administrator Contact	CEO	Ms	Wofford	Martha		4014591200					martha.wofford@bcbsri.org	500 Exchange Street		Providence	RI	02903	01/03/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	CEO - Senior Official for Contracting	CEO	Ms	Wofford	Martha		4014591200					martha.wofford@bcbsri.org	500 Exchange Street		Providence	RI	02903	01/03/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Chief Financial Officer	CFO	Mr.	Marrone	Michael		2077522829					michael.marrone@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/24/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Chief Operating Officer	EVP, Chief Administrative Ofcr & Chief Legal Ofcr	Ms.	Lederberg	Michele		4014591202					michele.lederberg@bcbsri.org	500 Exchange Street		Providance	RI	02903	01/21/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Chief Information Officer	Chief Information Officer	Mr.	Comella	David		4014591687					david.comella@bcbsri.org	500 Exchange Street		Providence	RI	02903	01/15/2020	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Chief Information Security Officer	VP and Chief Risk Officer	Mr	Fredrickson	Jon		4014591522					jon.fredrickson@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	CMMI Model Point of Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	CMS Casework Communication Contact	Director, GAU		Antunes	Kathy		4014595136				4014595668	kathy.antunes@bcbsri.org	500 Exchange Street		Providence	RI	02903	09/23/2021	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Complaints Tracking Contact	Director, GAU		Antunes	Kathy		4014595136				4014595668	kathy.antunes@bcbsri.org	500 Exchange Street		Providence	RI	02903	09/23/2021	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Contact for Fraud Investigations	Director, Special Investigations Unit		Casilli	Brian		4014591727				4014591648	brian.casilli@bcbsri.org	500 Exchange Street		Providence	RI	02903	09/23/2021	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Coordination of Benefits Contact	Director PBM Operations		Allie	Cindy		6127776722				6127776706	COBMedD@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Corporate Mailing						4014592100				4014591598	medicarecompliance@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/19/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Treasury Analyst		Gulino	Samuel		4014595968					samuel.gulino@bcbsri.org	500 Exchange Street		Providence	RI	02903	10/25/2019	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Customer Service Operations Contact	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721				4014595089	Ivona.Wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	01/14/2019	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	DIR Contact	Sr. Health Data Analyst		Simas	Heather		4014595286				4014591754	heather.simas@bcbsri.org	500 Exchange Street		Providence	RI	02903	12/13/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	DIR Contact (Secondary)	Director, Actuarial Services		Eynatian	Chris		4014591741					chris.eynatian@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Emergency Part D Contact	Director Pharmacy Operations		Sifakis	Gina		4017418686					gina.sifakis@bcbsri.org	500 Exchange Street		Providence	RI	02903	12/30/2019	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Emergency Part D Contact (Secondary)	Medicare Part D Auditor		Higgins	Aimee		4016168583				4014591754	aimee.higgins@bcbsri.org	500 Exchange Street		Providence	RI	02903	12/30/2019	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Encounter Data & Risk Adjustment Operations Contact	Chief Government Programs Revenue Officer		Rangarajan	Kiran		4014595247					kiran.rangarajan@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/22/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Enrollment Contact	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721					Ivona.Wisniewski@bcbsri.org	500 Exchange St		Providence	RI	02903	01/14/2019	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	EOB Transfer Contact	Director PBM Operations		Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Financial Audit Contact	CFO	Mr.	Marrone	Michael		2077522829					michael.marrone@bcbsri.org	500 Exchange Street		Providence	RI	02903	09/20/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Financial Reporting Contact	Manager, Financial Operations		Bettencourt	Mike		4014595932				4014591875	mike.bettencourt@BCBSRI.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Formulary Contact	Director, Pharmacy Performance		Dunn	David		4014591409				4014591754	david.dunn@bcbsri.org	500 Exchange Street		Providence	RI	02903	09/23/2021	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Formulary Contact (Secondary)	Supervisor Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/25/2020	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	General Contact	Medicare Compliance Officer	Ms.	Pennypacker	Regan		4017430003				4014591598	mco@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Government Relations Contact	SVP Government Programs		Pitney	Christina		4014591103					christina.pitney@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	HIPAA Privacy Officer	VP and Chief Risk Officer		Fredrickson	Jon		4014591522					jon.fredrickson@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	HIPAA Security Officer	VP and Chief Risk Officer		Fredrickson	Jon		4014591522					jon.fredrickson@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Hospice Contact	Lead, Outsourced Medicare Operations		Storti	Jane		4018378818					jane.storti@bcbsri.org	500 Exchange St.		Providence	RI	02903	07/28/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Interoperability Contact	Director, Enterprise Analytics		Pant	Lokesh		6123003095					lokesh.pant@bcbsri.org	500 Exchange St.		Providence	RI	02903	04/25/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	MA Appeals/Grievances Contact	Director, GAU		Antunes	Kathy		4014595136				4014595668	kathy.antunes@bcbsri.org	500 Exchange Street		Providence	RI	02903	09/23/2021	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	MA Claims Processing Contact for Public Website	Managing Director, Claims Operations		McCaughey	Tracy		4014592400					tracy.mccaughey@bcbsri.org	500 Exchange Street		Providence	RI	02903	06/13/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Marketing Contact	Director, Marketing & Communications		Blustein	Amy		4014592595					amy.blustein@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Medical Director	EVP and CMO	Dr.	Shafi	Farah		6178515725					farah.shafi@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/24/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Pennypacker	Regan		4017430003				4014591598	mco@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Medicare Coordinator	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721				4014591813	ivona.wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	01/14/2019	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists		Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Medication Therapy Management Contact	Director		Dunn	David		4014591409				4014591754	David.Dunn@bcbsri.org	500 Exchange St		Providence	RI	02903	05/24/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	OffShore Subcontractor Contact	Senior Compliance Analyst		Giacomini	Elizabeth		4017490690				4014591598	elizabeth.giacomini@bcbsri.org	500 Exchange Street		Providence	RI	02903	05/17/2021	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Online Enrollment Center Contact (Back-up)	Team Leader		Storti	Jane		4014595588				4014595649	jane.storti@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Online Enrollment Center Contact (Primary)	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721				4014595649	Ivona.Wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	01/14/2019	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Part C Application Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Part C Reporting Contact	Sr. Compliance Analyst		Brennan	Jonathan		4014595741				4014591598	jonathan.brennan@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Part D Appeals	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8006936651				PPO - BBA		C	Boston
H3557	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8006936651				PPO - BBA		C	Boston
H3557	Part D Application Contact	Medicare Part D Auditor		Higgins	Aimee		4014595555				4014591754	aimee.higgins@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/31/2019	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Part D Benefits Contact	Director Benefits Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	Prime Therapeutics	1440 Northland Drive	Mendota Heights	MN	55120	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Part D Claims Submission Contact	Functional Business Consultant- Government Program		Brooke	Lance		4026862603					lbrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	07/31/2019	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Part D Exceptions Contact	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8006936651				PPO - BBA		C	Boston
H3557	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8006936651				PPO - BBA		C	Boston
H3557	Part D Price File Contact (Back-up)	Price File Analyst Sr.		Trudeau	Ashley		6127771338					ashley.trudeau@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Part D Price File Contact (Optional)	Network Pricing Data Analyst		Tastad	Emily		6518085779					emily.tastad@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Rd	Eagan	MN	55121	02/08/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Part D Price File Contact (Primary)	Director Pharmacy Performance		Dunn	David		4014591409					david.dunn@bcbsri.org	500 Exchange Street		Providence	RI	02903	09/23/2021	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Part D Quality Assurance Contact	Medicare Part D Auditor		Higgins	Aimee		4014595555					aimee.higgins@bcbsri.org	500 Exchange St		Providence	RI	02903	12/23/2019	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Part D Reporting Contact	Sr. Compliance Analyst		Brennan	Jonathan		4014595741					jonathan.brennan@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Patient Safety Contact	Director of Pharmacy, Pharmacy Performance		Dunn	David		4014591409				4014591754	david.dunn@bcbsri.org	500 Exchange St		Providence	RI	02903	06/03/2020	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Payment Contact	Sr. Financial Analyst		Souza	Cheryl		4014591860					cheryl.souza@bcbsri.org	500 Exchange Street		Providence	RI	02903	09/28/2021	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Pharmacy Director	Director Pharmacy Operations		Sifakis	Gina		4014595704					gina.sifakis@bcbsri.org	500 Exchange Street		Providence	RI	02903	01/10/2020	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Pharmacy Network Management Contact	VP, Network Management		Conlin	Marci		6127772842				8778236373	Marci.Conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Pharmacy Network Management Contact (Secondary)	Senior Director Network Client Services		Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	12/22/2020	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8554571207				PPO - BBA		C	Boston
H3557	Pharmacy Technical Help Desk Contact (Secondary)	Director, Member Services		Bunch	Jon							jonathon.bunch@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	09/23/2021	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8554571207				PPO - BBA		C	Boston
H3557	Plan Directory Contact for Public Website	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721					Ivona.Wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/22/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Plan to Plan Reconciliation Contact	Sr. Health Data Analyst		Simas	Heather		4014595286				4014591198	heather.simas@bcbsri.org	PO Box 1057		Providence	RI	02901	12/13/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Processor Contact	Director PBM Operations		Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Quality Contact	Director, Quality and Stars		Mitchell	Catherine		4014592644					Catherine.Mitchell@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Reconciliation Contact	Sr. Health Data Analyst		Simas	Heather		4014595286				4014591754	heather.simas@bcbsri.org	500 Exchange Street		Providence	RI	02903	12/13/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Reconciliation Contact (Secondary)	Director, Actuarial Services		Eynatian	Chris		4014591741					chris.eynatian@bcbsri.org	500 Exchange Street		Providence	RI	02903	11/23/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Recovery Audit Contact	SVP Government Programs	Ms.	Pitney	Christina		4014591103				4014591598	christina.pitney@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	SNP Application Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	SNP State Contact	Managing Director Duals		Moran	Leanna		4014591331					leanna.moran@bcbsri.org	500 Exchange Street		Providence	RI	02903	09/28/2021	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Surveillance Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	04/12/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	System Contact	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721				4014595649	Ivona.Wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	01/14/2019	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Third Party Administrator (TPA) Liaison	Sr. Health Data Analyst		Simas	Heather		4014595286					heather.simas@bcbsri.org	500 Exchange Street		Providence	RI	02903	12/13/2022	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	User Access Contact	Associate Compliance Officer		Martin	Jordan		4014592845				4014591598	jordan.martin@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/24/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Utilization Management Contact	Director Utilization Review		Labbe	Karen		4014591796				4014595072	Karen.Labbe@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3557	Utilization Review Contact	Director Utilization Review		Labbe	Karen		4014591796				4014595072	Karen.Labbe@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	Local PPO		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					PPO - BBA		C	Boston
H3561	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H3561	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2020	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/07/2018	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Medical Director	Chief Medical Officer	Dr.	Chen	Alex		8186766564					alex.y.chen@healthnet.com	21281 Burbank Blvd		Woodland Hills	CA	91367	03/30/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road Tampa,FL 33634		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2020	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H3561	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Markhan	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	3144450891				HMO - Health Maintenance Organization		C	Dallas
H3561	PHR Beneficiary Contact																	09/27/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8002754737				HMO - Health Maintenance Organization		C	Dallas
H3561	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Plan Directory Contact for Public Website			Services	Provider		8002754737					CorporateMedicareComplianceDept@CENTENE.COM	PO Box 10198		Van Nuys	CA	91410	03/31/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3561	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3563	Automated TrOOP Balance Transfer Contact	QI and Compliance Director	Ms.	Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Backup User Access Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Best Available Evidence Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Bid Primary Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	CAP Report Contact for Public Website	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	CEO - CMS Administrator Contact	President and CEO	Mr.	Lash	Timothy	A	7602802230					tlash@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	CEO - Senior Official for Contracting	President and CEO	Mr.	Lash	Timothy	A	7602802230					tlash@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Chief Financial Officer	CFO	Mr.	Jensen	Robin		7602802230					rjensen@westpace.org	1706 DESCANSO AVE		San Marcos	CA	92078	09/14/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Chief Operating Officer	Executive Director	Ms.	Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Chief Information Officer		Mr.	McBride	David		7606025789					dwmcbride@westdevllc.com	5800 Armada Dr.	Suite 100	Carlsbad	CA	92008	10/02/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Chief Information Security Officer		Mr.	McBride	David		7606025789					dwmcbride@westdevllc.com	5796 Armada Drive	Suite 300	Carlsbad	CA	92008	12/19/2018	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	CMS Casework Communication Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Complaints Tracking Contact	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Contact for Fraud Investigations	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Coordination of Benefits Contact	QI and Compliance Director	Mrs.	Kannan	Kannamma		7602802230					kkannan@westpace.org	1706 DESCANSO AVE		San Marcos	CA	92078	03/15/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Corporate Mailing						7602802230					kkannan@westpace.org	1706 Descanso Avenue		San Marcos	CA	92078	10/02/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Coverage Gap Discount Program (CGDP) Payment Contact	Business and Finance Director		Jensen	Robin		6198074447					rjensen@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	09/14/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Customer Service Operations Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	DIR Contact	Business and Finance Director		Jensen	Robin		6198074447					rjensen@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	09/14/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	DIR Contact (Secondary)	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Emergency Part D Contact	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Emergency Part D Contact (Secondary)	QI and Compliance Director	Mrs.	Kannan	Kannamma		7602802230					kkannan@westpace.org	1706 DESCANSO AVE		San Marcos	CA	92078	03/15/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Encounter Data & Risk Adjustment Operations Contact	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/18/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Enrollment Contact	Outreach Manager		Jurgensen	Mary		7602802236					mjurgensen@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	EOB Transfer Contact	Executive Director		Smith	RENATA		7602802230				7602802277	rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Financial Audit Contact	Business and Finance Director	Ms	Jensen	Robin		6198074447					rjensen@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	09/14/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Financial Reporting Contact	Business and Finance Director		Jensen	Robin		6198074447					rjensen@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	09/14/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Formulary Contact	Medical Director	Dr.	Sampath	Neha		7602802230					nsampath@westpace.org	1706 DESCANSO AVE		San Marcos	CA	92078	07/10/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Formulary Contact (Secondary)	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/02/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	General Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Government Relations Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	HIPAA Privacy Officer	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	HIPAA Security Officer	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Interoperability Contact	QI and Compliance Director		Kannan	Kannamma		7602802230					kkannan@westpace.org	1706 DESCANSO AVE		San Marcos	CA	92078	03/15/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	MA Appeals/Grievances Contact	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	MA Claims Processing Contact for Public Website	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Marketing Contact	Outreach Manager		Jurgensen	Mary		7602802236					mjurgensen@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	06/12/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Medical Director	Medical Director	Dr.	Sampath	Neha		7602802230					nsampath@westpace.org	1706 DESCANSO AVE		San Marcos	CA	92078	07/10/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Medicare Compliance Officer	QI and Compliance Director	Mrs.	Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Medicare Coordinator	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Sampath	Neha		7602802230					nsampath@westpace.org	Descanso Ave		San Marcos	CA	92078	07/10/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Medication Therapy Management Contact	Medical Director	Dr.	Sampath	Neha		7602802230					nsampath@westpace.org	1706 DESCANSO AVE		San Marcos	CA	92078	07/10/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Online Enrollment Center Contact (Optional)	Outreach Manager		Jurgensen	Mary		7602802236					mjurgensen@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	03/09/2020	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Online Enrollment Center Contact (Primary)	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Part C Application Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Part D Appeals	QI and Compliance Director		Kannan	Kannamma							kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active	8009207098				PACE - Nat		C	San Francisco
H3563	Part D Appeals Contact (Secondary)	Business and Finance Director		Jensen	Robin							rjensen@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	09/14/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active	6198074447				PACE - Nat		C	San Francisco
H3563	Part D Application Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Part D Benefits Contact	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Part D Claims Submission Contact	Medical Director	Dr.	Sampath	Neha		7602802230					nsampath@westpace.org	1706 DESCANSO AVE		San Marcos	CA	92078	07/10/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Part D Exceptions Contact	Medical Director	Dr.	Sampath	Neha							nsampath@westpace.org	1706 DESCANSO AVE		San Marcos	CA	92078	07/10/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active	8009207098				PACE - Nat		C	San Francisco
H3563	Part D Exceptions Contact (Secondary)	QI and Compliance Director		Kannan	Kannamma							kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active	8009207098				PACE - Nat		C	San Francisco
H3563	Part D Price File Contact (Back-up)	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Part D Price File Contact (Primary)	Business and Finance Director		Jensen	Robin		6198074447					rjensen@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	09/14/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Part D Quality Assurance Contact	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Part D Reporting Contact	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Patient Safety Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Payment Contact	Business and Finance Director	Mr.	Jensen	Robin		6198074447					rjensen@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	09/14/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Pharmacy Director	Medical Director	Dr.	Sampath	Neha		7602802230					nsampath@westpace.org	Descanso Ave		San Marcos	CA	92078	07/10/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Pharmacy Network Management Contact	Medical Director	Dr.	Sampath	Neha		7602802230					nsampath@westpace.org	Descanso Ave		San Marcos	CA	92078	07/10/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Pharmacy Network Management Contact (Secondary)	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Pharmacy Technical Help Desk Contact	Medical director	Dr.	Sampath	Neha							nsampath@westpace.org	Descanso Ave		San Marcos	CA	92078	07/10/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active	8009207098				PACE - Nat		C	San Francisco
H3563	Pharmacy Technical Help Desk Contact (Secondary)	Executive Director		Smith	RENATA							rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active	8009207098				PACE - Nat		C	San Francisco
H3563	Plan Directory Contact for Public Website	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Plan to Plan Reconciliation Contact	Business and Finance Director		Jensen	Robin		6198074447					rjensen@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	09/14/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Processor Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92708	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Quality Contact	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Reconciliation Contact	Business and Finance Director		Jensen	Robin		6198074447					rjensen@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	09/14/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Reconciliation Contact (Secondary)	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Recovery Audit Contact	QI and Compliance Director	Mrs	Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Surveillance Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	System Contact	QI and Compliance Director		Kannan	Kannamma		7602802232					kkannan@westpace.org	1706 Descanso Ave		San Marcos	CA	92078	10/01/2019	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Third Party Administrator (TPA) Liaison	Business and Finance Director		Jensen	Robin		6198074447					rjensen@westpace.org	1706 DESCANSO AVE		San Marcos	CA	92078	09/14/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	User Access Contact	QI and Compliance Director	Mrs.	Kannan	Kannamma		7602802230					kkannan@westpace.org	1706 DESCANSO AVE		San Marcos	CA	92078	03/15/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Utilization Management Contact	Medical Director	Dr.	Sampath	Neha		7602802230					nsampath@westpace.org	Descanso Ave		San Marcos	CA	92078	07/10/2023	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3563	Utilization Review Contact	Executive Director		Smith	RENATA		7602802230					rsmith@westpace.org	1706 Descanso Ave.		San Marcos	CA	92078	04/12/2022	2023	GARY AND MARY WEST SENIOR SERVICES, INC.	National PACE	Gary and Mary West PACE	National PACE		Gary and Mary West Senior Services, Inc.	714	Yes	Active					PACE - Nat		C	San Francisco
H3597	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/06/2019	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	12/11/2019	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/06/2015	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H3597	PHR Beneficiary Contact																	04/23/2012	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				HMO - Health Maintenance Organization		C	Philadelphia
H3597	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/11/2015	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	12/11/2019	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3597	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (ME)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3613	Automated TrOOP Balance Transfer Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011				lisa.macartney@mcgregoramasa.org	14900 Private Dr		Cleveland	OH	44112	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Backup User Access Contact	CEO	Ms.	Conn	Ann		2168518200	2050				ann.conn@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Best Available Evidence Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011				lisa.macartney@mcgregoramasa.org	14900 Private Dr		Cleveland	OH	44112	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Bid Primary Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011				lisa.macartney@mcgregoramasa.org	14900 Private Dr		Cleveland	OH	44112	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	CAP Report Contact for Public Website	CEO	Ms.	McCoy	Tangi		2167913580					tangi.mccoy@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	11/05/2021	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	CEO - CMS Administrator Contact	CEO	Ms.	McCoy	Tangi		2167913580					tangi.mccoy@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	11/05/2021	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	CEO - Senior Official for Contracting	CEO	Ms.	McCoy	Tangi		2167913580					tangi.mccoy@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	08/13/2020	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Chief Financial Officer	CFO	Ms.	Hayes	Jennifer	L	2168518200	2010				jennifer.hayes@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	08/09/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Chief Operating Officer	CSO	Ms.	Dicesare	Svetlana		2167913580					lana.dicesare@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	03/05/2021	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Chief Information Officer	CFO	Ms.	Hayes	Jennifer	L	2168518200	2010				jennifer.hayes@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	08/09/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Chief Information Security Officer	CSO	Ms.	DiCesare	Svetlana		2167913580					lana.dicesare@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	CMS Casework Communication Contact	Quality Director	Ms.	Miller	Elizabeth		2167913580					elizabeth.miller@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Complaints Tracking Contact	Quality Director	Ms.	Miller	Elizabeth		2167913580					elizabeth.miller@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Contact for Fraud Investigations	Compliance Officer	Ms.	Bentley	Leah		2162688402					Leah.Bentley@mcgregoramasa.org	26310 Emery Rd		Cleveland	OH	44128	01/10/2023	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Coordination of Benefits Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Corporate Mailing						2167913580					tangi.mccoy@mcgregorctr.org	23610 Emery Road		Warrensville Heights	OH	44128	11/05/2021	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Coverage Gap Discount Program (CGDP) Payment Contact	Director of finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Customer Service Operations Contact	Quality Director	Ms.	Miller	Elizabeth		2167913580					elizabeth.miller@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	DIR Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	DIR Contact (Secondary)	CEO	Ms.	Conn	Ann		2168518200	2050				ann.conn@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Emergency Part D Contact	Medical Director		Degolia	Peter		2168443791					Peter.DeGolia@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	04/03/2016	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Emergency Part D Contact (Secondary)	CEO	Ms.	McCoy	Tangi		2167913580					tangi.mccoy@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	11/05/2021	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Encounter Data & Risk Adjustment Operations Contact	Director of Finance	Ms.	macartney	Lisa		2168518200	2011				lisa.macartney@mcgregoramasa.org	14900 Private Dr		Cleveland	OH	44112	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Enrollment Contact	CEO	Ms.	McCoy	Tangi		2167913580					tangi.mccoy@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	EOB Transfer Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Financial Audit Contact	Director of Finance & Health Plan Ops	Ms.	Macartney	Lisa		2162688671				2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	08/09/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Financial Reporting Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Formulary Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	General Contact	CEO	Ms.	McCoy	Tangi		2167913580					tangi.mccoy@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Government Relations Contact	CEO	Ms.	Conn	Ann		2168518200	2050				ann.conn@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	HIPAA Privacy Officer	CSO	Ms.	DiCesare	Svetlana		2167913580					Lana.DiCesare@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	HIPAA Security Officer	CSO	Ms.	DiCesare	Svetlana		2167913580					Lana.DiCesare@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Interoperability Contact	CSO	Ms.	Dicesare	Svetlana		2167913580					lana.dicesare@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	MA Appeals/Grievances Contact	Quality Director	Ms.	Miller	Elizabeth		2167913580					elizabeth.miller@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	MA Claims Processing Contact for Public Website	CEO	Ms.	Conn	Ann		2168518200	2050			2168516634	ann.conn@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Marketing Contact	CEO	Ms.	McCoy	Tangi		2167913580					tangi.mccoy@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Medical Director	Medical Director		Degolia	Peter		2168443791					Peter.DeGolia@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	04/03/2016	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Medicare Compliance Officer	Compliance Officer	Ms.	Bentley	Leah		2162688402					Leah.Bentley@mcgregoramasa.org	26310 Emery Rd		Cleveland	OH	44128	01/10/2023	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Medicare Coordinator	Compliance Officer	Ms.	Bentley	Leah		2163374893					leah.bentley@mcgregoramasa.org	26310 Emery Road		Warrensville Heights	OH	44128	01/10/2023	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Medicare Part D Opioid Overutilization Contact	Medical Director		Degolia	Peter		2168443791					Peter.DeGolia@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	03/13/2019	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Medication Therapy Management Contact	Medical Director		Degolia	Peter		2168443791					Peter.DeGolia@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	04/03/2016	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Online Enrollment Center Contact (Back-up)	CEO	Ms.	McCoy	Tangi		2167913580					tangi.mccoy@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	11/05/2021	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Part C Application Contact	CEO	Ms.	Conn	Ann		2168518200	2050			2168516634	ann.conn@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Part D Appeals	Director of Finance & Health Plan Ops	Ms.	Macartney	Lisa							Lisa.Macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	09/08/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active	2162688671				PACE - Nat		C	Chicago
H3613	Part D Application Contact	CEO	Ms.	Conn	Ann		2168518200	2050			2168516634	ann.conn@mcgregoramasa.org	14900 Private Dr.		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Part D Benefits Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Part D Claims Submission Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Part D Exceptions Contact	Director of Finance	Ms.	Macartney	Lisa						2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active	2168518200	2011			PACE - Nat		C	Chicago
H3613	Part D Exceptions Contact (Secondary)	CEO	Ms.	Conn	Ann							ann.conn@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active	2168518200	2050			PACE - Nat		C	Chicago
H3613	Part D Price File Contact (Back-up)	CEO	Ms.	McCoy	Tangi		2167913580					tangi.mccoy@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	11/05/2021	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Part D Price File Contact (Primary)	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Part D Quality Assurance Contact	Quality Director	Ms.	Miller	Elizabeth		2167913580					elizabeth.miller@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	09/08/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Part D Reporting Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Patient Safety Contact	CSO	Ms.	Dicesare	Svetlana		2167913580					lana.dicesare@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Payment Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Pharmacy Director	Medical Director		Degolia	Peter		2168443791					Peter.DeGolia@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	04/03/2016	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Pharmacy Network Management Contact	Medical Director		Degolia	Peter		2168443791					Peter.DeGolia@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	04/03/2016	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Pharmacy Technical Help Desk Contact	CSO	Ms.	Dicesare	Svetlana							lana.dicesare@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active	2167913580				PACE - Nat		C	Chicago
H3613	Plan Directory Contact for Public Website	CEO	Ms.	McCoy	Tangi		2167913580					tangi.mccoy@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	11/05/2021	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Plan to Plan Reconciliation Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Processor Contact	Director of Finance	Ms.	macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Quality Contact	Quality  Manager	Ms.	Miller	Elizabeth		2167913580					elizabeth.miller@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Reconciliation Contact	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011			2168516634	lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Recovery Audit Contact	CEO	Ms.	Conn	Ann		2168518200	2050			2168516634	ann.conn@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Surveillance Contact	CEO	Ms.	Conn	Ann		2162688680					Ann.conn@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	09/08/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	System Contact	CEO	Ms.	Conn	Ann		2168518200	2050			2168516634	ann.conn@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Third Party Administrator (TPA) Liaison	Director of Finance	Ms.	Macartney	Lisa		2168518200	2011				lisa.macartney@mcgregoramasa.org	14900 Private Drive		Cleveland	OH	44112	02/18/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	User Access Contact	Quality Director	Ms.	Miller	Elizabeth		2167913580					elizabeth.miller@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	02/15/2022	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Utilization Management Contact	Medical Director		Degolia	Peter		2168443791					Peter.DeGolia@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	04/03/2016	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3613	Utilization Review Contact	Medical Director		Degolia	Peter		2168443791					Peter.DeGolia@mcgregorctr.org	26310 Emery Road		Warrensville Heights	OH	44128	04/03/2016	2023	MCGREGOR PACE	National PACE	McGregor PACE	National PACE		McGregor at Overlook	450	Yes	Active					PACE - Nat		C	Chicago
H3632	Agent/Broker Compensation Data Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Automated TrOOP Balance Transfer Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Backup User Access Contact			Berg	Lynnsey		6126326655					lynnsey.berg@optum.com	P.O. Box 9472		Minneapolis	MN	554409472	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Best Available Evidence Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Bid Audit Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Bid Audit Site Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Bid Primary Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	CAP Report Contact for Public Website			Jacobson	Marissa		9529922093					marissa.jacobson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	CEO - CMS Administrator Contact	Interm President & CFO	Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	CEO - Senior Official for Contracting		Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Chief Financial Officer		Ms	Quist	Mary		9529922058					mary.quist@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Chief Operating Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Chief Information Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Chief Information Security Officer		Mr	Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	CMMI Model Point of Contact			Schaefer	Jennifer		9529912803					jennifer.schaefer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	CMS Casework Communication Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Complaints Tracking Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Contact for Fraud Investigations			Monson	Peter		9529921149					peter.monson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/03/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Coordination of Benefits Contact			Vilendrer	Krista		9529923252					krista.vilendrer@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	04/22/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Corporate Mailing						9529922900					ann.kinsella@medica.com	401 Carlson Parkway	P.O. Box 9310 CP320	Minnetonka	MN	55305	02/28/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Coverage Gap Discount Program (CGDP) Payment Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Customer Service Operations Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	DIR Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	DIR Contact (Secondary)			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	03/13/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Emergency Part D Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Emergency Part D Contact (Secondary)			Janes	Kathy		9529928989					kathy.janes@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Employer Waiver Contact			Alness	Stacy		9529923825					stacy.alness@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/19/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Encounter Data & Risk Adjustment Operations Contact			Leth	Maria		9529928366					Maria.Leth@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/29/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Enrollment Contact			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	EOB Transfer Contact			Bourdages	Kathy		9529923653				9529923636	kathy.bourdages@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Financial Audit Contact	Director Finance & Strategy	Mr.	Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/11/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Financial Reporting Contact			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Formulary Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Formulary Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	General Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Government Relations Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	HIPAA Privacy Officer			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/20/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	HIPAA Security Officer			Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Hospice Contact			Bourdages	Kathy		9529923653					PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Interoperability Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/14/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	MA Appeals/Grievances Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	MA Claims Processing Contact for Public Website			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Marketing Contact			Teff	Melissa		9529923972					melissa.teff@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/05/2020	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Medical Director	Chief Clinical & Provider Strategy Officer		Webster	David		9529922801					david.webster@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/15/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Medicare Compliance Officer		Mrs	Koranteng	Milly		9529922090					mildred.koranteng@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/22/2020	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Medicare Coordinator			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Medicare Part D Opioid Overutilization Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Medication Therapy Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	OffShore Subcontractor Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Online Enrollment Center Contact (Primary)			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Part C Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Part C Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Part D Appeals			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation	9529922353				PPO - BBA		C	Kansas City
H3632	Part D Appeals Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation	9529923448				PPO - BBA		C	Kansas City
H3632	Part D Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Part D Benefits Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/09/2020	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Part D Claims Submission Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Part D Exceptions Contact			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation	9529922353				PPO - BBA		C	Kansas City
H3632	Part D Exceptions Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation	9529923448				PPO - BBA		C	Kansas City
H3632	Part D Price File Contact (Back-up)			Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Farifield	OH	45014	11/17/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Part D Price File Contact (Optional)			Bourdages	Kathy		9529923653					PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Part D Price File Contact (Primary)			Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/17/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Part D Quality Assurance Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Part D Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Patient Safety Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Payment Contact			Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/11/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Pharmacy Director			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/10/2020	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Pharmacy Network Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Pharmacy Network Management Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	La Tasha							LaTasha_Monroe@expressscripts.com	13051 N. Telecom Pkwy		Temple Terrace	FL	33637	11/17/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation	8009221557				PPO - BBA		C	Kansas City
H3632	Pharmacy Technical Help Desk Contact (Secondary)			Bourdages	Kathy							PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/09/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation	8009221557				PPO - BBA		C	Kansas City
H3632	Plan Directory Contact for Public Website			Service	Customer		8002348755					AskGovtPrograms@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Plan to Plan Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Processor Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Quality Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Reconciliation Contact (Secondary)			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Recovery Audit Contact	Manager Claims Operations	Mr	Foley	Steve		9529924160					steven.foley@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	SNP Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	SNP State Contact			Zillhardt	John		9529922290					John.Zillhardt@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Surveillance Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	System Contact			Schwartz	Pamela		9529922584					pamela.schwartz@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Third Party Administrator (TPA) Liaison			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	User Access Contact			Sherman	Autumn		9529923483					autumn.sherman@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Utilization Management Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3632	Utilization Review Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/15/2019	2023	MEDICA COMMUNITY HEALTH PLAN	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Consolidation					PPO - BBA		C	Kansas City
H3653	Agent/Broker Compensation Data Contact	Sr. Sales Coordinator	Mr.	Hilfinger	George		4198872423				4198872017	george.hilfinger@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Automated TrOOP Balance Transfer Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Backup User Access Contact	Analyst III	Ms.	Stilwell	Denise		4198872711				4198872019	denise.stilwell@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Best Available Evidence Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872040	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Bid Audit Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Bid Audit Site Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Bid Primary Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	CAP Report Contact for Public Website	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	Nicole.Beadle@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	CEO - CMS Administrator Contact	President	Ms.	Johnston	Lori		4198872960				4198872030	Lori.Johnston@Promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	01/04/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	CEO - Senior Official for Contracting	President	Ms.	Johnston	Lori		4198872960				4198872030	Lori.Johnston@Promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Chief Financial Officer	Chief Financial Officer	Mr.	Martin	Jeff		4198872959				4198872031	jeff.martin@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Chief Operating Officer	Chief Operating Officer	Mr.	Wilson	Jered		4198872970				4198872030	Jered.Wilson@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Chief Information Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Chief Information Security Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	CMS Casework Communication Contact	Member Services Team Leader	Ms.	Harper	Leslie		4198872410				4198872047	leslie.harper@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Complaints Tracking Contact	Member Services Team Leader	Ms.	Harper	Leslie		4198872410				4198872047	leslie.harper@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Contact for Fraud Investigations	Senior Risk Analyst	Ms.	Bylow	Janet		4198872121				4198872036	janet.bylow@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Coordination of Benefits Contact	Director Risk Adjustment & Recoveries	Ms.	Curry	Deborah		4198872215				4198872398	Deborah.Curry@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	08/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Corporate Mailing						4198872500				4198872025	paramounthealthcare@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43597	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Coverage Gap Discount Program (CGDP) Payment Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Customer Service Operations Contact	Operations Manager, Member Services	Ms.	Trivedi	Kyle		4198872424				4198872047	kyle.trivedi@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	DIR Contact	Finance Supervisor	Mr.	DeHoff	Timothy		4198872947				5674024477	Timothy.DeHoff@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	05/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	DIR Contact (Secondary)	Director of Finance	Mr.	Potter	Rich		4198872006				5674024477	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Emergency Part D Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Emergency Part D Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	01/04/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Employer Waiver Contact	Sales Manager	Mr.	Hilfinger	George		4198872423				4198872017	George.Hilfinger@promedica.org	300 Madison Ave. Suite 270	P.O Box 928	Toledo	OH	43604	03/06/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Encounter Data & Risk Adjustment Operations Contact	Director Risk Adjustment & Recoveries	Ms.	Curry	Deborah		4198872215				4198872398	Deborah.Curry@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	08/25/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Enrollment Contact	Director, Operational Services	Mr.	Gottfried	Kevin		4198872937				4198872016	kevin.gottfried@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	EOB Transfer Contact	Analyst II	Ms.	Ballinger	Tracy		4198872902				4198872020	tracy.ballinger@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Financial Audit Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Financial Reporting Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Formulary Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Formulary Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	General Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Government Relations Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	HIPAA Privacy Officer	Director, System Privacy	Ms.	Winterhalter	Sandy		5675859132				5675859640	sandy.winterhalter@promedica.org	100 Madison Avenue		Toledo	OH	43604	02/14/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	HIPAA Security Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872036	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Hospice Contact	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Interoperability Contact	CIO, ProMedica Insurance Corp, PHS-Administration	Mr.	Brackett	David		4198872102					david.brackett@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	MA Appeals/Grievances Contact	Appeals/Grievance Team Lead	Ms.	Graham	Beth		4198872446				4198872047	beth.graham@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	MA Claims Processing Contact for Public Website	Claims Team Leader	Ms.	Castle	Tracy		4198872611					Tracy.Castle@ProMedica.Org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/27/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Marketing Contact	Sr. Medicare Project Coordinator	Ms.	King	Aleah		5027628341				4198872017	Aleah.King@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	03/06/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Medical Director	Chief Medical Officer	Dr.	Bialecki-Haase	Dee		4198872296				4198872032	Dee.Bialecki-HaaseMD@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Medicare Compliance Officer	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Medicare Coordinator	Regulatory Coordinator	Ms.	Borell	Grace	C	4198872844				4198872011	grace.borell@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Medicare Part D Opioid Overutilization Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Medication Therapy Management Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Online Enrollment Center Contact (Back-up)	Marketing Account Executive	Mr.	Rivera Jr.	Mike		4198872484				4198872017	mike.riverajr@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Online Enrollment Center Contact (Optional)	Federal Program Enrollment Service Coordinator	Ms.	Bettinger	Suzanne		4198872487				4198872039	Suzanne.Bettinger@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Online Enrollment Center Contact (Primary)	Account Executive	Mr.	Rivera Jr	Mike		4198872484				4198872017	mike.riverajr@promedica.org	300 Madison Avenue Suite 270	P.O Box 928	Toledo	OH	43604	03/06/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Part C Application Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Part C Reporting Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/03/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Appeals	Senior Pharmacist	Mr.	Bogner	Craig	M					5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active	8004623589				HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Appeals Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian						5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active	4198872204				HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Application Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/06/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Benefits Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Claims Submission Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Exceptions Contact	Senior Pharmacist	Mr.	Bogner	Craig	M					5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active	8004623589				HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Exceptions Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian						5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active	4198872204				HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Price File Contact (Back-up)	Senior Consultant, Finance Med D	Mr.	Loveland	Chet		4806064873					Chet.Loveland@cvshealth.com	9501 E. Shea Blvd MC121		Scottsdale	AZ	85260	08/14/2020	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Price File Contact (Optional)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Price File Contact (Primary)	Senior Manager, PBM Financial Operations	Ms.	Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	02/14/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Quality Assurance Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Part D Reporting Contact	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Patient Safety Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Payment Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/13/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Pharmacy Director	Director, Pharmacy	Ms.	Zuber	Amber		4198872248				5675859454	amber.zuber@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/13/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Pharmacy Network Management Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Pharmacy Network Management Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Pharmacy Technical Help Desk Contact	Manager, Vendor Management	Mr.	Palmieri	Mike							Mike.Palmieri@Caremark.com	2401 Cherahala Blvd		Knoxville	TN	37932	06/02/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H3653	Physician Incentive Contact	Manager, Value Based Programs	Mr.	Mickunas	Chris		4198872088					chris.mickunas@promedica.org	2545 Farmers Drive		Columbus	OH	43235	02/14/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Plan Directory Contact for Public Website	Member Services Dept.		Services	Member		8004623589				4198872047	paramounthealthcare@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/13/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Plan to Plan Reconciliation Contact	Sr. Analyst		Lumbrezer	Cathy		4198872907					Cathy.Lumbrezer@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	03/24/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Processor Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Quality Contact	Manager, Quality Improvement/Disease Management	Ms.	Anello	Terrie		4198872301				4198872396	terrie.anello@Promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/13/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Reconciliation Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872020	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/13/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Reconciliation Contact (Secondary)	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Recovery Audit Contact	Manager, Risk Adjustment	Ms.	Curry	Deb		4198872215				4198872398	Deborah.Curry@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/13/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Surveillance Contact	Director of Operations	Mr.	Carpenter	Chad	M	6147217406				4198872017	Chad.Carpenter@promedica.org	2545 Farmers Dr		Columbus	OH	43235	03/06/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	System Contact	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/13/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Third Party Administrator (TPA) Liaison	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	User Access Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/13/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Utilization Management Contact	Director, Utilization/Case Management	Ms.	Hass	Stephanie	N	4192812214				4198872028	stephanie.hass@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/13/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3653	Utilization Review Contact	Director, Utilization/Case Management	Ms.	Hass	Stephanie		4192812214				4198872028	stephanie.hass@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	06/13/2022	2023	PARAMOUNT CARE, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/14/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H3655	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H3655	PHR Beneficiary Contact																	11/05/2015	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H3655	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3655	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Agent/Broker Compensation Data Contact	Vice President, Sales		Titterington	Sue		3309968988	68988			3309968454	titteringtons@summacare.com	1200 East Market Street	Suite 400	Akron	OH	44305	09/07/2021	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Automated TrOOP Balance Transfer Contact			Zlotkus	Steve		8587905873				8587906052	PartDCAT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/29/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Backup User Access Contact	Interim Chief Compliance Officer		Jones	Tracy		3309968228				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Best Available Evidence Contact	Manager, Eligibility & Billing	Ms	Eberhart	Karla		3309968679				3309968726	medicareeligbill@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	07/13/2021	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Bid Audit Contact	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/16/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Bid Primary Contact	Manager, Financial Analysis		Werstler	Julie		3309968716					werstlerj@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	CAP Report Contact for Public Website	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active	4409152569				HMO - Health Maintenance Organization		C	Chicago
H3660	CEO - CMS Administrator Contact	President	Mr.	Epling	William	C	3309968808				3309968454	eplingw@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	CEO - Senior Official for Contracting	President	Mr.	Epling	William	C	3309968808				3309968454	eplingw@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Chief Financial Officer	CFO	Mr.	Fehlner	Alan		3309968565				3309968454	fehlnera@summacare.com	1200 East Market Stree	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Chief Operating Officer	VP, Operations and Administration	Ms.	Rusk	Melissa		3306976906					ruskm@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	02/02/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Chief Information Officer	Senior VP, IT&S/CIO	Mr.	Locklear	Elbridge		2343126200					lockleare@summahealth.org	1077 Gorge Blvd		Akron	OH	44310	02/02/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Chief Information Security Officer		Mr	Irungu	George		2487563771					irungug@summahealth.org	1077 Gorge Blvd		Akron	OH	44310	12/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	CMS Casework Communication Contact	Compliance Coordinator		Donnenwirth	Terry		3309965605				3309968726	donnenwirtht@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	02/02/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Complaints Tracking Contact	Compliance Coordinator		Donnenwirth	Terry		3309965605				3309968726	donnenwirtht@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Contact for Fraud Investigations	Interim Chief Compliance Officer	Ms	Jones	Tracy		3309965605				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Coordination of Benefits Contact	Manager,Medicare eligibility		Eberhart	Karla		3309968679				3309968726	eberhartk@summacare.com	1200 East Market Street, Ste 400	P.O. Box 3620	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Corporate Mailing						3309968410				3309968454	www@summacare.com	SummaCare Inc.	P.O. Box 3620	Akron	OH	443093620	04/12/2006	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant	Mr	Weals	Michael		3309965112					wealsm@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Customer Service Operations Contact	Director, Customer Services		Elerick	Christine		3309968419					elerickc@summacare.com	1077 Gorge Boulevard		Akron	OH	44310	01/24/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	DIR Contact		Mr.	O'Neill	Mike		3309968565				3309968454	o'neillm@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	12/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	DIR Contact (Secondary)	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Emergency Part D Contact	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Emergency Part D Contact (Secondary)	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Employer Waiver Contact	Vice President, Product Development		Armao	Anne		8009968411	62326			3309968454	armaoa@summacare.com	1200 East Market Street	Suite 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Encounter Data & Risk Adjustment Operations Contact	Director, Risk Adjustment	Mr	Alexsonshk	Rick		3309968676				3309968553	alexsonr@summacare.com	1200 East Main Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Enrollment Contact	Manager,Medicare eligibility		Eberhart	Karla		3309968679				3309968726	eberhartk@summacare.com	1200 East Market Street, Ste 400	P.O. Box 3620	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	EOB Transfer Contact	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Financial Audit Contact	Manager, Auditing Services	Ms	Smith	Kimberly		3309965138				3309968454	smithk@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Financial Reporting Contact	Financial Accounting Analyst		Coyne	Eric		3309968298					coynee@summacare.com	1200 East Market Street	Suite 400	Akron	OH	44305	07/12/2023	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Formulary Contact	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Formulary Contact (Secondary)	Manager, Formulary Administration & Maintenance		Nyawabila	Christina		8587906297				8583572410	Christina.Nyawabila@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	01/29/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	General Contact	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Government Relations Contact	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	HIPAA Privacy Officer	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	HIPAA Security Officer	Interim Chief Compliance Officer		Jones	Tracy		3309968228				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/26/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Hospice Contact	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Interoperability Contact	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	MA Appeals/Grievances Contact	Director, Appeals and Grievances		Beck	Robert		3309968299				3309968545	beckr@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	MA Claims Processing Contact for Public Website	Director of Claims		Rusk	Melissa		3309968970				3309968977	ruskm@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Marketing Contact	System Director, Marketing and Public Relations		Kinaitis	Tracie		3309965207				3309968454	kinaitist@summacare.com	1200 East Market Street	Suite 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Medical Director	Medical Director	Dr	Grow	James		3309968775				3309968605	growj@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Medicare Compliance Officer	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/16/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Medicare Coordinator	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Medication Therapy Management Contact	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Online Enrollment Center Contact (Back-up)	Compliance Coordinator		Donnenwirth	Terry		3309968828				3309968553	DonnewirthT@summacare.com	1200 East Market Street, Ste 400	P.O. Box 3620	Akron	OH	443093620	10/17/2018	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Online Enrollment Center Contact (Primary)	Manager,Medicare eligibility		Eberhart	Karla		3309968679				3309968726	eberhartk@summacare.com	1200 East Market Street, Ste 400	P.O. Box 3620	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Part C Application Contact	Vice President, Product Development		Armao	Anne		8009968411	62326			3309968454	armaoa@summacare.com	1200 East Market Street	Suite 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Part C Reporting Contact	Compliance Analyst		Pacheco	Shani		3309965605				3309968726	pachecos@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	02/02/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Appeals	Director, Appeals and Grievances		Beck	Robert						3309968545	beckr@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active	8009966250				HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Appeals Contact (Secondary)			Tarle	Alexis						3309968580	tarlea@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	01/11/2021	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active	8009966250				HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Application Contact	Vice President, Product Development		Armao	Anne		8009968411	62326			3309968454	armaoa@summacare.com	1200 East Market Street	Suite 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Benefits Contact	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Claims Submission Contact			Davis-Jones	DeLonga		8587907415				8587906529	MedicarePartDProjectManagers@medimpact.com	10680 Treena Street	Stop 5	San Diego	CA	92131	01/29/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Exceptions Contact	Director, PA Services		Grondin	Don						8587906529	Don.grondin@medimpact.com	10680 Treena Street	Stop 5	San Diego	CA	92131	01/17/2012	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active	8587906536				HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Exceptions Contact (Secondary)	Manager, PA Processing		Tjaden	Karen						8587906529	Karen.tjaden@medimpact.com	10680 Treena Street	Stop 5	San Diego	CA	92131	12/30/2011	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active	8587906163				HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Price File Contact (Back-up)			Niemi	Kristin		8587906159				8587906529	planfindercommunications@MedImpact.com	10680 Treena Street	Stop 5	San Diego	CA	92131	01/29/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Price File Contact (Optional)	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Price File Contact (Primary)			Niemi	Kristin		8587906159				8587906529	planfindercommunications@MedImpact.com	10680 Treena Street	Stop 5	San Diego	CA	92131	01/29/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Quality Assurance Contact	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Part D Reporting Contact	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Patient Safety Contact	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Payment Contact	President	Mr.	Epling	William	C	3309968808				3309968454	eplingw@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Personal Health Record Contact	Director, Clinical Management		Potelicki	Jacquie		3309968481				3309968611	potelickij@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Pharmacy Director	Pharmacy Director		Swartz	Tiffanie		3309965651				3309968580	swartzt@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Pharmacy Network Management Contact	Supervisor, Pharmacy Network Support		Burke	Sharon		8587907148				8587906011	Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/06/2013	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Pharmacy Network Management Contact (Secondary)	Pharmacy Relationship Manager		Tong	Glen		8587907486				8587906529	Glen.tong@medimpact.com	10680 Treena Street	Stop 5	San Diego	CA	92131	12/30/2011	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Pharmacy Technical Help Desk Contact	Director, Contact Center Services		Battle	Dorry						8587906075	Dorry.battle@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/06/2013	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active	8773911109				HMO - Health Maintenance Organization		C	Chicago
H3660	Pharmacy Technical Help Desk Contact (Secondary)	Supervisor, Contact Center Services		Brewer	Kathy						8587906529	Kathy.Brewer@medimpact.com	10680 Treena Street	Stop 5	San Diego	CA	92131	02/10/2012	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active	8773911109				HMO - Health Maintenance Organization		C	Chicago
H3660	PHR Beneficiary Contact																	03/01/2007	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS	SummaCare	Summa Health	675	Yes	Active	3309968775				HMO - Health Maintenance Organization		C	Chicago
H3660	Plan Directory Contact for Public Website	Provider Services		Rank	Donna		3309968400				3309968490	contactproviderservices@summacare.com	1077 Gorge Boulevard		Akron	OH	44310	10/17/2018	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Plan to Plan Reconciliation Contact	Financial Accounting Analyst		Coyne	Eric		3309968298					coynee@summacare.com	1200 East Market Street	Suite 400	Akron	OH	44305	07/12/2023	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Processor Contact			Davis-Jones	DeLonga		8587907415				8587906529	MedicarePartDProjectManagers@medimpact.com	10680 Treena Street	Stop 5	San Diego	CA	92131	01/29/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Quality Contact	Director, Quality		Sich	Julie		3309968779					sichj@summacare.com	1200 East Main Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Reconciliation Contact	Director, Risk Adjustment	Mr	Alexsonshk	Rick		3309968676				3309968553	alexsonr@summacare.com	1200 East Main Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Recovery Audit Contact	Director, Risk Adjustment	Mr	Alexsonshk	Rick		3309968676				3309968553	alexsonr@summacare.com	1200 East Main Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Surveillance Contact	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	System Contact	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Third Party Administrator (TPA) Liaison	Senior Accountant	Mr	Weals	Michael		3309965112					wealsm@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	User Access Contact	Interim Chief Compliance Officer	Ms	Jones	Tracy	L	4409152569				3309968726	jonestl@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/18/2022	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Utilization Management Contact	Director, Clinical Management		Potelicki	Jacquie		3309968481				3309968611	potelickij@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3660	Utilization Review Contact	Director, Clinical Management		Potelicki	Jacquie		3309968481				3309968611	potelickij@summacare.com	1200 East Market Street	Ste 400	Akron	OH	44305	08/03/2020	2023	SUMMACARE INC.	Local CCP	SummaCare Medicare Advantage Plans	HMO/HMOPOS		Summa Health	675	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Agent/Broker Compensation Data Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Automated TrOOP Balance Transfer Contact	Medicare Part D Supervisor		Schrock	Ranada		3303633132					rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Backup User Access Contact	Sr Compliance Specialist		Perrenoud	Terri		3303633369				3303633066	tperrenoud@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Best Available Evidence Contact	Enrollment Coordinator		Palmer	Laura		3303634149					lpalmer@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Bid Audit Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Bid Audit Site Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Bid Primary Contact	Medicare CEO		Scheetz	Michael		3302681983				3303637644	mscheetz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	02/21/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	CAP Report Contact for Public Website	Medicare CEO		Scheetz	Michael		3302681983					mscheetz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	02/21/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	CEO - CMS Administrator Contact	Medicare CEO	Mr.	Scheetz	Michael		3302681983					mscheetz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	02/21/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	CEO - Senior Official for Contracting	Medicare CEO	Mr.	Scheetz	Michael		3302681983					mscheetz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	02/21/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Chief Financial Officer	Sr Vice-President	Ms.	Reagan	Andrea		3303633325				3304382911	areagan@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/20/2021	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Chief Operating Officer	Chief Operating Officer	Mr	Hayden	Frank		3303633171					fhayden@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	03/02/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Chief Information Officer	VP Information Services	Mr	Fayyaz	Raza		3303634470					rfayyaz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Chief Information Security Officer	VP Information Services	Mr	Fayyaz	Raza		3303634470					rfayyaz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	CMS Casework Communication Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Complaints Tracking Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Contact for Fraud Investigations	FWA Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Coordination of Benefits Contact	Medicare Part D Supervisor		Schrock	Ranada		3303633132				3305806764	rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Corporate Mailing						3303637407				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Coverage Gap Discount Program (CGDP) Payment Contact	Accounts Payable		Maglott	Mark		3303634034					mmaglott@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	11/15/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Customer Service Operations Contact	Customer Service Supervisor		Bowling-Shaffer	Lisa		3303632206				3303637714	lbowling-shaffer@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	DIR Contact	Medicare Part D Supervisor		Schrock	Ranada		3303633132				3305806764	rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	DIR Contact (Secondary)	Sr Compliance Specialist		Sibley	Camille		3303632480				3303633066	csibley@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	10/14/2021	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Emergency Part D Contact	Medicare Part D Supervisor		Schrock	Ranada		3303633132					rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	01/03/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Emergency Part D Contact (Secondary)	Pharmacy Director		Harvey	Michael		3302125701					mharvey@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	10/14/2021	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Employer Waiver Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Encounter Data & Risk Adjustment Operations Contact	Medicare CEO		Scheetz	Michael		3302681983	34093				MScheetz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	02/21/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Enrollment Contact	Enrollment Coordinator		Palmer	Laura		3303634149				3305806764	lpalmer@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	EOB Transfer Contact	Medicare Part D Supervisor		Schrock	Ranada		3303633132				3305806764	rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Financial Audit Contact	Compliance Officer	Mrs	Lab	Kari		3303632022				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Financial Reporting Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Formulary Contact	Clinical Pharmacist		Schwartz	Laura		3303274646					lschwartz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	06/05/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Formulary Contact (Secondary)	Medicare Part D Supervisor		Schrock	Ranada		3303633132					rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	General Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Government Relations Contact	Compliance Officer		Lab	Kari		3303633199				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	HIPAA Privacy Officer	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	HIPAA Security Officer	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Hospice Contact	Medicare Part D Supervisor		Schrock	Ranada		3303633132				3305806764	rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Interoperability Contact	Medicare Compliance Officer		Lab	Kari		3309337662					klab@aultcare.com	2600 Sixth St. SW	Morrow House	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	MA Appeals/Grievances Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	MA Claims Processing Contact for Public Website	Claims Supervisor		Peters	Tara		3303637269					tpeters@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Marketing Contact	Compliance Specialist		Kellar	Amy		3304377169				3303633066	akellar@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	06/14/2021	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Medical Director	Medical Director	Dr.	Wymyslo	Edmund		3303634421					ewymyslo@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	06/05/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Medicare Compliance Officer	Compliance Officer	Mrs	Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Medicare Coordinator	Compliance Officer	Mrs	Lab	Kari		3309337662					klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Schwartz	Laura		3303274646				3303633284	lschwartz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	06/05/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Medication Therapy Management Contact	Director of Pharmacy		Harvey	Michael		3302125701					mharvey@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	10/14/2021	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Online Enrollment Center Contact (Back-up)	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Online Enrollment Center Contact (Optional)	Sr Compliance Specialist		Perrenoud	Terri		3303633369					tperrenoud@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Online Enrollment Center Contact (Primary)	Enrollment Supervisor		Palmer	Laura		3303634149					lpalmer@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Part C Application Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Part C Reporting Contact	Sr Compliance Specialist		Perrenoud	Terri		3303633369				3303633066	tperrenoud@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Appeals	Compliance Officer		Lab	Kari						3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active	8005775084				HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Appeals Contact (Secondary)	Medicare Part D Supervisor		Schrock	Ranada						3305806407	rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active	8005775084				HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Application Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Benefits Contact	Medicare Part D Supervisor		Schrock	Ranada		3303633132					rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Claims Submission Contact	Medicare Part D Supervisor		Schrock	Ranada		3303633132					rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Exceptions Contact	Medicare Part D Supervisor		Schrock	Ranada							rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active	8005775084	2248			HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Exceptions Contact (Secondary)	Medicare Part D Coordinator		Walter	Jean							jwalter@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active	8005775084				HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Price File Contact (Back-up)	Sr Compliance Specialist		Sibley	Camille		3303632480				3303633066	csibley@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	10/14/2021	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Price File Contact (Optional)			OptumRx	Optum Rx		6514955363					medops_planfinder@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	10/12/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Price File Contact (Primary)	Medicare Part D Supervisor		Schrock	Ranada		3303633132					rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Quality Assurance Contact	Director of Pharmacy		Harvey	Michael		3302125701					mharvey@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	10/14/2021	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Part D Reporting Contact	Sr Compliance Specialist		Sibley	Camille		3303632480					csibley@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	10/14/2021	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Patient Safety Contact	Clinical Pharmacist		Schwartz	Laura		3303274646					lschwartz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	06/05/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Payment Contact	Medicare CEO		Scheetz	Michael		3302681983				3303637644	mscheetz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	02/21/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Personal Health Record Contact	Compliance Officer		Lab	Kari		3309337662					klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Pharmacy Director	Director of Pharmacy		Harvey	Michael		3302125701					mharvey@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	10/14/2021	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Pharmacy Network Management Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Pharmacy Network Management Contact (Secondary)	Medicare Part D Supervisor		Schrock	Ranada		3303633132					rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Pharmacy Technical Help Desk Contact	Medicare Part D Supervisor		Schrock	Ranada							rschrock@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active	8668682373				HMO - Health Maintenance Organization		C	Chicago
H3664	Pharmacy Technical Help Desk Contact (Secondary)	Director of Pharmacy		Harvey	Michael							mharvey@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	07/01/2022	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active	8668682373				HMO - Health Maintenance Organization		C	Chicago
H3664	PHR Beneficiary Contact																	01/20/2011	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS	PrimeTime Health Plan	Aultman Health Foundation	446	Yes	Active	8005775084				HMO - Health Maintenance Organization		C	Chicago
H3664	Physician Incentive Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Plan Directory Contact for Public Website	Customer Service Supervisor		Bowling-Shaffer	Lisa		3303637407					lbowling-shaffer@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Plan to Plan Reconciliation Contact	Reconciliation Analyst		David	Darrin		3307057988					ddavid@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Processor Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Quality Contact	AVP, Clinical Quality and Accreditation		Vojtush	Lisa		3303637407					LVojtush@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Reconciliation Contact	Medicare CEO		Scheetz	Michael		3302681983				3303637644	mscheetz@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	02/21/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Reconciliation Contact (Secondary)	Reconciliation Analyst		David	Darrin		3307057988					ddavid@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Recovery Audit Contact	Compliance Officer	Mrs	Lab	Kari		3303632022				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Surveillance Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	System Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Third Party Administrator (TPA) Liaison	Reconciliation Analyst		David	Darrin		3307057988					ddavid@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	09/24/2020	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	User Access Contact	Compliance Officer		Lab	Kari		3309337662				3303633066	klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Utilization Management Contact	Compliance Officer		Lab	Kari		3309337662					klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3664	Utilization Review Contact	Compliance Officer		Lab	Kari		3309337662					klab@aultcare.com	Morrow House	2600 Sixth Street SW	Canton	OH	44710	05/24/2023	2023	AULTCARE HEALTH INSURING CORPORATION	Local CCP	PrimeTime Health Plan	HMO/HMOPOS		Aultman Health Foundation	446	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Agent/Broker Compensation Data Contact	Director of Sales		Dues	Travis		6145463157				6145463131	Travis.Dues@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Automated TrOOP Balance Transfer Contact	Part D Analyst		Houk	Kim		6145463183				6145463131	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Backup User Access Contact	Sr. Application Specialist		Crawford	Carl		6145463215				6145463144	ccrawford@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Best Available Evidence Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Bid Audit Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463211	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Bid Audit Site Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Bid Primary Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	CAP Report Contact for Public Website	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	CEO - CMS Administrator Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	Jack.Randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	CEO - Senior Official for Contracting	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Chief Financial Officer	Chief Financial Officer	Mr	Vis	David		6145463211				6145463131	david.vis@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Chief Operating Officer	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Chief Information Officer	VP Service Optimization	Mr.	Trimmer	Matt		3017547190					matt.trimmer@trinity-health.org	3100 Easton Square Place		Columbus	OH	43219	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Chief Information Security Officer	Sr Security Manager, Enterprise Information Securi	Mr.	Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	CMS Casework Communication Contact	Compliance Specialist	Mr.	Jordan	David	A	6147068474				6142348372	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Complaints Tracking Contact	Compliance Specialist	Mr	Jordan	David	A	6147068474					djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Contact for Fraud Investigations	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Coordination of Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Corporate Mailing						4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Customer Service Operations Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	DIR Contact	CEO		Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square  Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	DIR Contact (Secondary)	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Electronic Health Record Contact	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Emergency Part D Contact	Chief Compliance Officer		Suffern	Patricia		4124780244				6145463132	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	12/23/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Emergency Part D Contact (Secondary)	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Employer Waiver Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Reconciliation Analyst		Sloan	Mike		6145463134					mike.sloan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Enrollment Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	EOB Transfer Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Financial Audit Contact	Chief Administration Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Financial Reporting Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Formulary Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Formulary Contact (Secondary)	Director, Pharmacy		Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	General Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Government Relations Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	HIPAA Privacy Officer	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	HIPAA Security Officer	Sr Security Manager, Enterprise Information Securi		Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Hospice Contact	Senior Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Interoperability Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	MA Appeals/Grievances Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	MA Claims Processing Contact for Public Website	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Marketing Contact	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Medical Director	MD	Dr.	Wise	Greg		6145463151				6145463131	gwise@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Medicare Compliance Officer	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Medicare Coordinator	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Medicare Part D Opioid Overutilization Contact	Pharmacy Data Analyst	Ms.	Houk	Kimberly		6145463183					kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Medication Therapy Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	OffShore Subcontractor Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment	Ms	Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Online Enrollment Center Contact (Optional)	Director, Enrollment and Premium Billing		Caudle	Jeff		6145463224				6145463148	jcaudle@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Online Enrollment Center Contact (Primary)	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Part C Application Contact	Director, Product Management and Business Devlpt		Mauck	Brandon		6145955681					brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Part C Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Part D Appeals	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H3668	Part D Appeals Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H3668	Part D Application Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Part D Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Part D Claims Submission Contact	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Part D Exceptions Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H3668	Part D Exceptions Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H3668	Part D Price File Contact (Back-up)	Formulary Consultant		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea		Scottsdale	AZ	85260	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Part D Price File Contact (Primary)	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Part D Quality Assurance Contact	Director of Pharmacy, Health Plans		Turoff	Chris		6144030394				6142346481	chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Part D Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Patient Safety Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Payment Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Pharmacy Director	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Pharmacy Network Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Pharmacy Network Management Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Pharmacy Technical Help Desk Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H3668	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Data Analyst	Mrs	Miller	Kim							kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H3668	PHR Beneficiary Contact																	12/05/2016	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS	MediGold	Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H3668	Physician Incentive Contact	Interim VP, Health Services	Ms	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Plan Directory Contact for Public Website	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Plan to Plan Reconciliation Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Processor Contact	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Quality Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Reconciliation Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Reconciliation Contact (Secondary)	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Recovery Audit Contact	Chief Administrative Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Surveillance Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	System Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Third Party Administrator (TPA) Liaison	Sr Finance Analyst		Fountain	Lisa		6145463220					lfountain@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	User Access Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Utilization Management Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3668	Utilization Review Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3672	Agent/Broker Compensation Data Contact	Director, Medicare Sales		Christian	Cindy		3308342303					CChristian@healthplan.org	The Health Plan	100 Lillian Gish Blvd	Massillon	OH	44647	10/25/2018	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Automated TrOOP Balance Transfer Contact	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Backup User Access Contact	VP of Medicare		Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/07/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Best Available Evidence Contact	Manager Medicare Operations		Panas	Lori		7406996208				7406996164	lorip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	01/10/2018	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Bid Audit Contact	Gov't Compliance Officer		Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/07/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Bid Audit Site Contact	Gov't Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Bid Primary Contact	VP of Medicare		Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	04/26/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	CAP Report Contact for Public Website	Gov''t Compliance Officer		Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	CEO - CMS Administrator Contact	CEO	Mr	Knight	Jeff		7406957585					JeffK@healthplan.org	The Health Plan	1110 Main Streeet	Wheeling	WV	26003	01/04/2023	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	CEO - Senior Official for Contracting	CEO	Mr	Knight	Jeff		7406957585					JeffK@healthplan.org	The Health Plan	1110 Main Streeet	Wheeling	WV	26003	11/07/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Chief Financial Officer	Chief Financial Officer	Mr	Ralston	Ryan		7406996236				7406996161	rralston@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/13/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Chief Operating Officer	VP of Medicare	Ms.	Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	01/04/2023	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Chief Information Officer	CIO	Mr	Bryan	Ken		7406957877					kbyran@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Chief Information Security Officer	CIO	Mr	Bryan	Ken		7406957877					kbryan@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	CMS Casework Communication Contact	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Complaints Tracking Contact	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Contact for Fraud Investigations	Director SIU	Ms	Crowder	Trina		3042206390				7406996150	tcrowder@healthplan.org	The Health Plan	141 Summers St.	Charleston	WV	25301	10/07/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Coordination of Benefits Contact	Manager COB		Fetty	Jackie		7406957699				7406996163	jfetty@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Corporate Mailing						7406953585					info@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	01/10/2018	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Coverage Gap Discount Program (CGDP) Payment Contact	Assistant Controller	Mr	Blinco	David		7406996151				7406996161	dblinco@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/04/2018	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Customer Service Operations Contact	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	DIR Contact	Controller		Marsh	Jane		7406996121					jmarsh@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/10/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	DIR Contact (Secondary)	Chief Financial Officer		Ralston	Ryan		7406996236					rralston@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/10/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Emergency Part D Contact	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Emergency Part D Contact (Secondary)	Director Pharmacy		Kovalski	Amy		7402324320				3048857592	akovalski@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	12/27/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Employer Waiver Contact	Gov't Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Encounter Data & Risk Adjustment Operations Contact	Manager, Risk Adjustment		Davis	Matt		7406996283					mdavis@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/23/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Enrollment Contact	Manager Medicare Enrollment		Panas	Lori		7406996208				7406996164	LoriP@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	EOB Transfer Contact	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Financial Audit Contact	Gov't Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	07/29/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Financial Reporting Contact	Chief Financial Officer	Mr	Ralston	Ryan		7406996236				7406996161	rralston@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/07/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Formulary Contact	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Formulary Contact (Secondary)	Director Pharmacy		Kovalski	Amy		7402324320				3048857592	akovalski@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	04/27/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	General Contact	Gov't Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Government Relations Contact	Gov't Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	HIPAA Privacy Officer	Gov''t Compliance Officer		Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	HIPAA Security Officer	CIO	Mr	Bryan	Ken		7406957877					kbryan@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/02/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Hospice Contact	Manager, Pharmacy Compliance		Johnson	Chasity		7403598592				3048857592	ChasityJ@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	04/27/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Interoperability Contact	Gov''t Compliance Officer		Medley	Jill		7406957693					jmedley@healthplan.org	1110 Main Street		Wheeling	WV	26003	12/27/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	MA Appeals/Grievances Contact	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	MA Claims Processing Contact for Public Website	Manager Medicare Claims		Westfall	Vickie		7406957636				7406996163	VickieW@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Marketing Contact	Director, Medicare Sales		Christian	Cindy		3308342303					CChristian@healthplan.org	The Health Plan	100 Lillian Gish Blvd	Massillon	OH	44647	11/04/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Medical Director	Medical Director	Dr	Kairis	Ed		7406957686				7406955297	ekairis@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/03/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Medicare Compliance Officer	Gov't Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Medicare Coordinator	VP of Medicare	Ms.	Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Hill	Brendal	J	8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Medication Therapy Management Contact	Director, Clinical & Trend Solutions		Muralidharan	Adrienne		3143131932					AMuralidharan@express-scripts.com	One Express Way		St. Louis	MO	63121	12/22/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	OffShore Subcontractor Contact	Gov''t Compliance Officer		Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Online Enrollment Center Contact (Back-up)	Enrollment Service Representative		Knutsen	Megan		7406957890				7406996164	mknutsen@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	05/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Online Enrollment Center Contact (Primary)	Manager Medicare Operations		Panas	Lori		7406996208				7406996164	lorip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	01/10/2018	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part C Application Contact	VP of Medicare		Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	05/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part C Reporting Contact	VP of Medicare	Ms.	Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Appeals	Appeal & Grievance Supervisor		Devault	Paige						7406996163	appeals_grievances_department@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/30/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active	8778477907				HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Appeals Contact (Secondary)	Appeal & Grievance Manager		Trigg	Leisha						7406996163	appeals_grievances_department@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/30/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active	8778477907				HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Application Contact	VP of Medicare		Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	05/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Benefits Contact	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Claims Submission Contact	Director Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	10/14/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Exceptions Contact	Clinical Pharmacist		Hill	Brendal						3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active	8006246961	6627			HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Exceptions Contact (Secondary)	Director Pharmacy		Kovalski	Amy						3048857592	akovalski@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	04/27/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active	8006246961	6608			HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Price File Contact (Back-up)	Manager, Regulated Markets Product		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	Express Scripts	4865 Dixie Hwy	Fairfield	OH	45014	04/10/2023	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Price File Contact (Optional)	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Price File Contact (Primary)	Sr. Manager, Regulated Markets		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	Express Scripts	5151 Blazer Pkwy	Dublin	OH	43017	04/10/2023	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Quality Assurance Contact	VP Pharmacy Services		Cecil	Luke		7405791681				3048857592	lcecil@healthplan.org	The Health Plan	1110 Main Street	Wheeling WV	WV	26003	10/15/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Part D Reporting Contact	Manager, Pharmacy Compliance		Johnson	Chasity		7403598592				3048857592	ChasityJ@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	04/27/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Patient Safety Contact	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Payment Contact			Piergallini	Jeremy		7406996138				7406996161	jpiergallini@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	09/04/2018	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Pharmacy Director	VP Pharmacy Services		Cecil	Luke		7405791681				3048857592	lcecil@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/07/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Pharmacy Network Management Contact	Network Account Dir, Retail Strategy & Contracting		Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	01/12/2023	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	Express Scripts	13051 N. Telecom PKWY STE 150	Temple Terrace	FL	33637	11/18/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Philadelphia
H3672	Physician Incentive Contact	VP of Medicare	Ms.	Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Plan Directory Contact for Public Website	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Plan to Plan Reconciliation Contact	Controller		Marsh	Jane		7406996121				7406996161	jmarsh@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/30/2018	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Processor Contact	Sr Dir Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	Express Scripts	One Expressway	St. Louis	MO	63121	10/30/2018	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Quality Contact	Assistant VP Population Health		Cappellini	Brenda		3042856501					bcappellini@healthplan.org	The Health Plan	1110 Main Street	Wheeling WV	WV	26003	10/08/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Reconciliation Contact	Controller		Marsh	Jane		7406996121					jmarsh@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	02/21/2023	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Reconciliation Contact (Secondary)	Chief Financial Officer		Ralston	Ryan		7406996236					rralston@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	02/21/2023	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Recovery Audit Contact	Gov't Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	SNP Application Contact	VP of Medicare		Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	05/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	SNP State Contact	VP of Medicare	Ms.	Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Surveillance Contact	Gov't Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	System Contact	CIO	Mr	Bryan	Ken		7406957877					kbryan@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/02/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Third Party Administrator (TPA) Liaison	Assistant Controller		Blinco	David		7406996151					dblinco@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	07/11/2018	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	User Access Contact	Gov't Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Utilization Management Contact	Director, Utilization Management		Jones	Heather		7406996980					hjones@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3672	Utilization Review Contact	Director, Utilization Management		Jones	Heather		7406996980					hjones@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THE HEALTH PLAN OF WEST VIRGINIA, INC.	Local CCP	The Health Plan	HMO/HMOPOS		The Health Plan of West Virginia, Inc.	354	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3706	Agent/Broker Compensation Data Contact	VP, Government Business Strategy		Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Automated TrOOP Balance Transfer Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Backup User Access Contact	Compliance Manager		Vazquez	Cynthia		4052805680					cynthia.vazquez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/11/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Best Available Evidence Contact	Manager, Eligibility & Enrollment		Rhodes	Trent		4052805871					trent.rhodes@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Bid Audit Contact	VP, Government Business Strategy		Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Bid Audit Site Contact	VP, Government Business Strategy		Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Bid Primary Contact	VP, Government Business Strategy		Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	CAP Report Contact for Public Website	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	7877582500	2040			HMO - Health Maintenance Organization		C	New York
H3706	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	O'Drobinak	Jim		7879998771					jim.odrobinak@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	O'Drobinak	Jim		7879998771					jim.odrobinak@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Chief Financial Officer	Chief Financial Officer	Mr.	Aponte	Jose		7877582500	5022				joseap@medicalcardsystem.com	210 Park Ave	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Chief Operating Officer	Chief Executive Officer	Mr.	O'Drobinak	Jim		7879998771					jim.odrobinak@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Chief Information Officer	Chief Information Officer	Mr.	Adhia	Kevin		4052805765					kevin.adhia@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	09/20/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Chief Information Security Officer	Chief Information Officer	Mr.	Adhia	Kevin		4052805765					kevin.adhia@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	09/20/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	CMS Casework Communication Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Complaints Tracking Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Contact for Fraud Investigations	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Coordination of Benefits Contact	Manager, Eligibility & Enrollment		Rhodes	Trent		4052805871					trent.rhodes@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Corporate Mailing						7877582500	2424				CSolis@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/12/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Coverage Gap Discount Program (CGDP) Payment Contact	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Customer Service Operations Contact	Director, Customer Care		Thomas	Daniel		4055261126					Daniel.Thomas@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	DIR Contact	VP, Government Business Strategy		Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	DIR Contact (Secondary)	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Electronic Health Record Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Emergency Part D Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Emergency Part D Contact (Secondary)	Manager, Clinical Pharmacy Operations		Adkins	Rene		9188787331				4052805613	rene.adkins@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Employer Waiver Contact	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Encounter Data & Risk Adjustment Operations Contact	Director, Medicare Risk Adjustment		Mody	Harshil		6307811675					harshil.mody@globalhealth.com	6120 South Yale Avenue	Suite 925	Tulsa	OK	74136	06/19/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Enrollment Contact	Manager, Eligibility & Enrollment		Rhodes	Trent		4052805871					trent.rhodes@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	EOB Transfer Contact	VP, Adjudication and Configurations		Thakkar	Rahul		4052805716				4055523098	rahul.thakkar@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Financial Audit Contact	VP, Government Business Strategy	Mr.	Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Financial Reporting Contact	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Formulary Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Formulary Contact (Secondary)	Manager, Clinical Pharmacy Operations		Adkins	Rene		9188787331				4052805613	rene.adkins@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	General Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Government Relations Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	HIPAA Privacy Officer	Director Legal Services and Privacy		Ramirez	Alia		4052802988					alia.ramirez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	HIPAA Security Officer	Chief Information Officer		Adhia	Kevin		4052805765					kevin.adhia@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	09/20/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Hospice Contact	VP, Health Services		Stouffer	Kelly		4052805608					kelly.stouffer@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Interoperability Contact	Chief Information Officer	Mr.	Adhia	Kevin		4052805765					kevin.adhia@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	09/20/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	MA Appeals/Grievances Contact	VP, Health Services		Stouffer	Kelly		4052805608				4052805294	kelly.stouffer@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	MA Claims Processing Contact for Public Website	VP, Adjudication and Configurations		Thakkar	Rahul		4052805716				4055523098	rahul.thakkar@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Marketing Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Medical Director	Medical Director	Dr.	Agarwal	Pallavi		9187207689					pallavi.agarwal@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/10/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Medicare Compliance Officer	VP of Compliance and Medicare Compliance Officer	Mrs.	Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Medicare Coordinator	Manager, Medicare Compliance		Vazquez	Cynthia		4052805680					Cynthia.vazquez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Medicare Part D Opioid Overutilization Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Medication Therapy Management Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	OffShore Subcontractor Contact	Director Legal Services and Privacy		Ramirez	Alia		4052802988					alia.ramirez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Online Enrollment Center Contact (Primary)	Manager, Eligibility & Enrollment		Rhodes	Trent		4052805871					trent.rhodes@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Part C Application Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Part C Reporting Contact	Manager, Medicare Compliance		Vazquez	Cynthia		4052805680					Cynthia.vazquez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Part D Appeals	VP, Pharmacy		Patel	Monank							monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	8664943927				HMO - Health Maintenance Organization		C	New York
H3706	Part D Appeals Contact (Secondary)	Manager, Clinical Pharmacy Operations		Adkins	Rene						4052805613	rene.adkins@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	8664943927				HMO - Health Maintenance Organization		C	New York
H3706	Part D Application Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Part D Benefits Contact	Manager, Health Plan Benefits		Stavinoha	Rosalie		4052805637					rosalie.stavinoha@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025631	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Part D Claims Submission Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Part D Exceptions Contact	VP, Pharmacy		Patel	Monank							monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	8664943927				HMO - Health Maintenance Organization		C	New York
H3706	Part D Exceptions Contact (Secondary)	Manager, Clinical Pharmacy Operations		Adkins	Rene						4052805613	rene.adkins@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	8664943927				HMO - Health Maintenance Organization		C	New York
H3706	Part D Price File Contact (Back-up)	Manager, Clinical Pharmacy Operations		Adkins	Rene		9188787331					rene.adkins@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Part D Price File Contact (Primary)	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Part D Quality Assurance Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Part D Reporting Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Patient Safety Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Payment Contact	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Personal Health Record Contact	Director, Legal Services and Privacy		Ramirez	Alia		4052802988					alia.ramirez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Pharmacy Director	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Pharmacy Network Management Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Pharmacy Technical Help Desk Contact	VP, Pharmacy		Patel	Monank							monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H3706	PHR Beneficiary Contact																	06/19/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS	GlobalHealth	MHH Healthcare, L.P.	669	Yes	Active	8442805555				HMO - Health Maintenance Organization		C	New York
H3706	Physician Incentive Contact	VP Provider Contracting, Credentialing and Network		Echols	Patricia		2147636941					patricia.echols@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Plan Directory Contact for Public Website	Call Center Director		Thomas	Daniel		4055261126					daniel.thomas@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/17/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Plan to Plan Reconciliation Contact	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/05/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Processor Contact	Manager, Claims Processing		Schultz	Patricia		4052805338					patricia.schultz@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Quality Contact	VP, Health Services		Stouffer	Kelly		4052805608					kelly.stouffer@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Reconciliation Contact	VP, Finance		Harris	Tayla		4052805724					Tayla.Harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Reconciliation Contact (Secondary)	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Recovery Audit Contact	VP of Compliance and Medicare Compliance Officer	Mrs.	Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	SNP Application Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Surveillance Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	System Contact	Chief Information Officer	Mr.	Adhia	Kevin		4052805765					kevin.adhia@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	09/20/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Third Party Administrator (TPA) Liaison	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	User Access Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Utilization Management Contact	VP, Health Services		Stouffer	Kelly		4052805608					kelly.stouffer@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3706	Utilization Review Contact	VP, Health Services		Stouffer	Kelly		4052805608					kelly.stouffer@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3708	Agent/Broker Compensation Data Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Automated TrOOP Balance Transfer Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Backup User Access Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Best Available Evidence Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Bid Audit Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Bid Audit Site Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Bid Primary Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	CAP Report Contact for Public Website	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	CEO - CMS Administrator Contact	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	CEO - Senior Official for Contracting	CEO	Mr.	Bailey	Michael	D	6157518131				8442805360	mbailey@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Chief Financial Officer	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Chief Operating Officer	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Chief Information Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Chief Information Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	CMMI Model Point of Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	CMS Casework Communication Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Complaints Tracking Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Contact for Fraud Investigations	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Coordination of Benefits Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Corporate Mailing						6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Customer Service Operations Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	05/18/2020	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	DIR Contact	VP Formulary & Rebate Economics		Ellermeir	Nicole		9133875120					nellermeir@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	DIR Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Electronic Health Record Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Emergency Part D Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Emergency Part D Contact (Secondary)	Pharmacy Operations	Mrs.	Sanchez	Lynn		4056014429				8442805360	lsanchez@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Encounter Data & Risk Adjustment Operations Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Enrollment Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	EOB Transfer Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Financial Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Financial Reporting Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Formulary Contact	Clinical Formulary Pharmacist	Ms.	Quinn	Kelsey		3304864954					kquinn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Formulary Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	General Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Government Relations Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	HIPAA Privacy Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	HIPAA Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Hospice Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Interoperability Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	MA Appeals/Grievances Contact	A&G Team Lead	Mrs.	Henderson	Maya		6156268442				8442805360	mhenderson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	MA Claims Processing Contact for Public Website	Director, Health Plan Administration	Mrs.	Brimm	Angie		8665834649				8442805360	abrimm@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/09/2023	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Marketing Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Medical Director	Medical Director	Dr.	Misra	Sumathi		6156365478					SMisra@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/17/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Medicare Compliance Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Medicare Coordinator	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Medicare Part D Opioid Overutilization Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Medication Therapy Management Contact	Director of Clinical Product Development and Strat	Ms.	Miller	Holly		3304866457				3304058094	hrmiller@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	OffShore Subcontractor Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Online Enrollment Center Contact (Back-up)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Online Enrollment Center Contact (Primary)	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Part C Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Part C Reporting Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Appeals	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations	Mr	Binegar	Sam						3304058081	appeals@ElixirSolutions.com	2181 E Aurora Road	Building B, Suite 201	Twinsburg	OH	44087	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8003997524				HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Benefits Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Claims Submission Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Exceptions Contact	Associate VP of Clinical Operations	Ms.	Lavignette	Amanda						3304864801	alavignette@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Exceptions Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Price File Contact (Back-up)	Sr Financial Manager Reporting & Analytics	Mr	Campbell	Tim		3308886988					tcampbell@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Price File Contact (Optional)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Price File Contact (Primary)	Senior Director Rebates, Trade Relations	Mr.	Bonus	Jason		3304864841				3304864801	jbonus@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Quality Assurance Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Part D Reporting Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Patient Safety Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Pharmacy Director	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Pharmacy Network Management Contact	Director of Pharmacy Network Development and Ops	Ms	Profio	Lauren		3304864864				3304058094	lprofio@EnvisionRx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Pharmacy Network Management Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8446331063				HMO - Health Maintenance Organization		C	Dallas
H3708	Pharmacy Technical Help Desk Contact (Secondary)	R.Ph, Vice President, Health Services		Roper	Lisa						4056015627	lroper@amhealthplans.com	909 S Meridian Avenue	Ste 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8665834649				HMO - Health Maintenance Organization		C	Dallas
H3708	Plan Directory Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Plan to Plan Reconciliation Contact	Sr. Manager,  Financial Accounting	Ms.	Tilley	Stephanie		9312420499					stilley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	08/30/2023	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Processor Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Quality Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Reconciliation Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Reconciliation Contact (Secondary)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Recovery Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	SNP Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	SNP State Contact	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Surveillance Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	System Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Third Party Administrator (TPA) Liaison	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	User Access Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Utilization Management Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3708	Utilization Review Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	OKLAHOMA SUPERIOR SELECT, INC.	Local CCP	American Health Advantage of Oklahoma	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3727	Agent/Broker Compensation Data Contact	Mgr. Sales and Marketing	Mr	Beasley	Corey		5135698544				5136056845	cobeasley@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Automated TrOOP Balance Transfer Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/27/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Backup User Access Contact	Compliance Auditing & Monitoring Manager	Mrs.	McBratney	Kimberly		7852246063				5136056845	kmcbratney@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/08/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Best Available Evidence Contact	Enrollment Compliance Specialist	Mr	Nelson	Robert		5134698552				5136056845	robert.nelson@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	07/26/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Bid Audit Contact	CFO		Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/27/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Bid Audit Site Contact	CFO		Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/27/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Bid Primary Contact	Director of Product Growth & Development	Mrs	Muldowney	Jessica		5138355228				5136056845	jmuldowney@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/27/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	CAP Report Contact for Public Website	Chief Compliance Officer		Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/27/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	CEO - CMS Administrator Contact	CEO	Mr	Hager	Robert		5134699593				5136056845	rhager@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/27/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	CEO - Senior Official for Contracting	CEO	Mr	Hager	Robert		5134699593				5136056845	rhager@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/27/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Chief Financial Officer	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/27/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Chief Operating Officer	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Chief Information Officer	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Chief Information Security Officer	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	CMS Casework Communication Contact	VP Healthcare Services & Quality Operations		Gramlick	Stephanie		5134698547				5136056845	stgramlick@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Complaints Tracking Contact	Director Health Plan Operations	Ms	Torrey	Heather		5134698546				5136056830	htorrey@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/24/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Contact for Fraud Investigations	Chief Compliance Officer		Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/27/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Coordination of Benefits Contact	CFO		Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/27/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Corporate Mailing						8337992273				5136056845	rhager@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Coverage Gap Discount Program (CGDP) Payment Contact	CFO		Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Customer Service Operations Contact	Director Health Plan Operations	Ms	Torrey	Heather		5134698546				5136056845	htorrey@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/24/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	DIR Contact	Sr Director, Government Programs		Farmer	Jim		3308886098					jfarmer@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/08/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	DIR Contact (Secondary)	Mgr Fin. Report & Analytic Finance		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	8957 Canyon Falls Blvd.		Twinsburg	OH	44087	02/23/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Emergency Part D Contact	Pharmacist		McGhee	Anna	C	5137061309				5136056845	aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Emergency Part D Contact (Secondary)	Compliance Officer	Dr	Guzman	Fabian		5134698556				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	12/20/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Encounter Data & Risk Adjustment Operations Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Enrollment Contact	Chief Compliance Officer	Mr	Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	EOB Transfer Contact	Chief Financial Officer	Mr	Heimgartner	Jeremy		5132404810	4810			5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road, Suite 240		Blue Ash	OH	45242	12/21/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Financial Audit Contact	Director Medicare Compliance	Mrs.	McBratney	Kimberly	A	7852246063				5136056845	kmcbratney@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	09/21/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Financial Reporting Contact	CFO		Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Formulary Contact			Sagoo	Sukhjit		3304866311					ssagoo@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	07/21/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Formulary Contact (Secondary)	Director Formulary Operations		Rossi	David		3304866311					drossi@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	07/21/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	General Contact	Chief Compliance Officer		Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Government Relations Contact	COMPLIANCE OFFICER	Mr	Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	HIPAA Privacy Officer	Chief Compliance Officer		Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	HIPAA Security Officer	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Hospice Contact	CMO	Dr	Schlageck	Joe		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Interoperability Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	MA Appeals/Grievances Contact	Director Health Plan Operations	Ms	Torrey	Heather		5134698546				5136056830	htorrey@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/24/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	MA Claims Processing Contact for Public Website	Director Health Plan Operations	Ms	Torrey	Heather		5134698546				5136056830	htorrey@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Marketing Contact	Mgr. Sales and Marketing	Mr	Beasley	Corey		5135698544				5136056845	cobeasley@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Medical Director	Chief Medical Officer	Dr	Schlageck	Joe		5132404810					fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Medicare Compliance Officer	Chief Compliance Officer	Mr	Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Medicare Coordinator	Compliance Auditing & Monitoring Manager	Mrs.	McBratney	Kimberly		7852246063				5136056845	kmcbratney@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Medicare Part D Opioid Overutilization Contact	Pharmacist		McGhee	Anna	C	5137061309				5136056845	aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Medication Therapy Management Contact	VP Pharmacy Solutions		Miller	Holly		3302931916					hmiller@healthdialog.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/08/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Part C Application Contact	COMPLIANCE OFFICER	Mr	GUZMAN	Fabian		5132408410				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Part C Reporting Contact	Chief Compliance Officer	Mr	Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Part D Appeals	Director of Pharmacy		McGhee	Anna							acmcghee@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	12/08/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active	5137061309				HMO - Health Maintenance Organization		C	Chicago
H3727	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations		Binegar	Samantha						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/08/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Chicago
H3727	Part D Application Contact	Pharmacist		McGhee	Anna	C	5137061309				5136056845	aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Part D Benefits Contact	Pharmacist		McGhee	Anna	C	5137061309				5136056845	aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Part D Claims Submission Contact			Ehrenzeller	Vicki		3308886869					vehrenzeller@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/07/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Part D Exceptions Contact	AVP Clinical Operations	MS	Lavignette	Amanda						3304864801	alavignette@elixirsolutions.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	01/20/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Chicago
H3727	Part D Exceptions Contact (Secondary)	Pharmacist		McGhee	Anna	C						aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active	5134897100				HMO - Health Maintenance Organization		C	Chicago
H3727	Part D Price File Contact (Back-up)	Financial Analyst, Finance		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/08/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Part D Price File Contact (Primary)	Sr Financial Manager Reporting & Analytics		Campbell	Tim		3308886988					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/08/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Part D Quality Assurance Contact	Pharmacist		McGhee	Anna	C	5137061309				5136056845	aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Part D Reporting Contact	Compliance Auditing & Monitoring Manager	Mrs	McBratney	Kimberly		7852246063				5136056845	kmcbratney@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Patient Safety Contact	VP Healthcare Services & Quality Operations		Gramlick	Stephanie		5134698547				5136056845	stgramlick@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Payment Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Personal Health Record Contact	Director of Operations		Torrey	Heather		5134698546					htorrey@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/24/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Pharmacy Director	Pharmacist		McGhee	Anna	C	5137061309				5136056845	aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Pharmacy Network Management Contact	Director Pharmacy Network Development and Operatio		Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/08/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Pharmacy Technical Help Desk Contact	Elixir VP Operations		Conn	Todd							tconn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/20/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active	8336978516				HMO - Health Maintenance Organization		C	Chicago
H3727	Physician Incentive Contact			Acker	Amy		7037891929					aacker@communicare-advantage.com	10123 Alliance Drive		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Plan Directory Contact for Public Website	Enrollment Specialist		Piper	Carole		5136056845				5136056845	cpiper@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	04/28/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Plan to Plan Reconciliation Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Processor Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Quality Contact	VP Healthcare Services & Quality Operations		Gramlick	Stephanie		5134698547				5136056845	stgramlick@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Reconciliation Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Reconciliation Contact (Secondary)	Director of Pharmacy		McGhee	Anna		5137061309					acmcghee@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	02/27/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Recovery Audit Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	SNP Application Contact	Compliance Officer		Guzman	Fabian		5132404810					fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Surveillance Contact	Compliance Auditing & Monitoring Manager	Mrs.	McBratney	Kimberly		7852246063				5136056845	kmcbratney@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	01/30/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	System Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Third Party Administrator (TPA) Liaison	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	10/28/2022	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	User Access Contact	Chief Compliance Officer	Mr	Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	01/30/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Utilization Management Contact	VP Healthcare Services & Quality Operations		Gramlick	Stephanie		5134698547				5136056845	stgramlick@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3727	Utilization Review Contact	VP Healthcare Services & Quality Operations		Gramlick	Stephanie		5134698547				5136056845	stgramlick@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	OH CHS SNP INC.	Local CCP	Communicare Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H3748	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/10/2018	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/06/2019	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	12/10/2018	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H3748	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/10/2018	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	12/10/2018	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3748	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF WASHINGTON, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3749	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H3749	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H3749	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H3749	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H3749	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3749	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3755	Agent/Broker Compensation Data Contact	Manager Medicare Marketing		McEver	Kelly		9185945295	4122				kmcever@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	09/09/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/06/2017	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Backup User Access Contact	Manager, Grievance and Appeals	Ms.	Pugh	Nicole		9185945295	6315			9185945260	cpugh@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Best Available Evidence Contact	Supervisor, Medicare Enrollment		East	Shawn		9185945295	6903				seast@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/06/2017	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Bid Audit Contact	Manager Medicare Marketing		McEver	Kelly		9185945295	4122				kmcever@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	09/09/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Bid Primary Contact	Director Underwriting		Tull	Karla		9185945295	2009				ktull@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	03/10/2020	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	CAP Report Contact for Public Website	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	CEO - CMS Administrator Contact	President & CEO	Mr.	Bush	Robert		9185945295	4124				rbush@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	08/16/2021	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	CEO - Senior Official for Contracting	President & CEO	Mr.	Bush	Robert		9185945295	4124				rbush@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	08/16/2021	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Chief Financial Officer	CFO	Mr.	Sutton	Josiah		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	01/23/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Chief Operating Officer	SVP & Chief Operating Officer	Mr.	Sutton	Josian		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Chief Information Officer	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Chief Information Security Officer	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	CMS Casework Communication Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/27/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Complaints Tracking Contact	Manager, Senior Center		Lee	Laura		9185945295	6385				llee@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/06/2017	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Contact for Fraud Investigations	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Coordination of Benefits Contact	Supervisor, Claims		Higgins	Susan		9185945295	6401				coordinationofbenefits@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	09/21/2022	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Corporate Mailing						9185945295	5386				swhite@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/27/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant II		Wilson	Jamar		9185945295	6488				jwilson@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	03/10/2020	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Customer Service Operations Contact	Director of Customer Experience		Holt	John		9185945295	4128				jholt@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	02/27/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	DIR Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	04/19/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	DIR Contact (Secondary)	Sr. Manager, Financial Planning & Analysis		Brenner	Matt		9185945295	4119				mbrenner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	03/10/2020	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Emergency Part D Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/27/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Emergency Part D Contact (Secondary)	Manager, Pharmacy Services		Perez	Charles		9185945295	6479			9188794309	cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/27/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Encounter Data & Risk Adjustment Operations Contact	Director Health Data		Morningstar	Angela		9185945295	5205				amorningstar@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	10/18/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Enrollment Contact	Supervisor, Medicare Enrollment		East	Shawn		9185945295	6903				seast@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/06/2017	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	EOB Transfer Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/27/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Financial Audit Contact	VP Accounting and Treasury	Ms.	Scott	Cyd	G	9185945295	5325			9185945260	cscott@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	03/10/2020	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Financial Reporting Contact	CFO	Mr.	Sutton	Josiah		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	01/23/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Formulary Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	08/21/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Formulary Contact (Secondary)	Sr. Analyst		Loveland	Chet		4806064873					Chet.Loveland@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	General Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Government Relations Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	HIPAA Privacy Officer	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	HIPAA Security Officer	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Hospice Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/27/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Interoperability Contact	VP Chief CO, RO & General Counsel	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	MA Appeals/Grievances Contact	Manager, Grievance and Appeals		Pugh	Nicole		9185945295	6315			9185945260	npugh@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	03/10/2020	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	MA Claims Processing Contact for Public Website	Director, Operations		Lang	Michelle		9185945295	6326				mlang@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	02/27/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Marketing Contact	SVP & Chief Operating Officer		Sutton	Josiah		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Medical Director	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Medicare Compliance Officer	VP Chief Risk & Compliance Officer	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	08/16/2021	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Medicare Coordinator	Medicare Compliance Specialist		Kanner	Dee		9185945295	6268				dkanner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/20/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Abdo	Mike		9185945295	6395				mabdo@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	10/31/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Medication Therapy Management Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street	Suite 100	Tulsa	OK	74103	04/26/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Online Enrollment Center Contact (Back-up)	Enrollment Specialist		Baur	Amanda		9185945295	4503				abaur@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	04/25/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Online Enrollment Center Contact (Primary)	Supervisor, Medicare Enrollment		East	Shawn		9185945295	6903				seast@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/06/2017	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Part C Application Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Part C Reporting Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Appeals	Manager, Grievance and Appeals		Pugh	Nicole						9185945260	cpugh@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	03/10/2020	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	9185945295	6315			HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Appeals Contact (Secondary)	Supervisor, Grievances & Appeals		Mitchell	Damenica							dmitchell@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	03/10/2020	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	9185945295	6314			HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Application Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Benefits Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/06/2017	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Claims Submission Contact	Strategic Account Executive, CVS/Caremark		Tibus	Daniel		8475595726					daniel.tibus@CVSHealth.com	9501 E Shea Blvd MC042		Scottsdale	AZ	85260	01/21/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Exceptions Contact	Supervisor, Pharmacy Services		Burke	Amy						9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/27/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	8772938628	6808			HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Services		Perez	Charles						9188794309	cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	03/10/2020	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	8772938628	6479			HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Price File Contact (Back-up)	Senior Consultant, Finance Med D		Loveland	Chet		4806064873				4013357984	Chet.Loveland@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	11/26/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Price File Contact (Optional)	Medicare Part D Advisor		Schilcher	Sydney		4806064615				4013357984	Sydney.Schilcher@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	11/26/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Price File Contact (Primary)	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	11/26/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Quality Assurance Contact	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Part D Reporting Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/06/2017	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Patient Safety Contact	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Payment Contact	Accounts Receivable Supervisor		Fell	Jill		9185945295	6271				jfell@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/06/2017	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Pharmacy Director	Director of Pharmacy		Abdo	Mike		9185945295	6395				mabdo@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/27/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Pharmacy Network Management Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	04/24/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Pharmacy Network Management Contact (Secondary)	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Pharmacy Technical Help Desk Contact	Supervisor, Pharmacy Services		Burke	Amy						9187944309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/27/2018	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	8772938628	6808			HMO - Health Maintenance Organization		C	Dallas
H3755	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Help Desk		HelpDesk	Pharmacy								9501 E Shea Blvd		Scottsdale	AZ	85260	11/26/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Dallas
H3755	Plan Directory Contact for Public Website	Director of Customer Experience		Holt	John		9185945295	4128				jholt@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	02/27/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Plan to Plan Reconciliation Contact	Senior Financial Analyst		Mack	Lynda		9185945295	6320				lmack@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	03/10/2020	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Processor Contact	Strategic Account Executive, CVS/Caremark		Tibus	Daniel		8475595726					daniel.tibus@CVSHealth.com	9501 E Shea Blvd MC042		Scottsdale	AZ	85260	01/21/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Quality Contact	Sr Manager, Health Programs		Such	Becky		9185945295	6226			9185945260	bsuch@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	02/20/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Reconciliation Contact	VP Accounting & Treasury		Scott	Cyd		9185945295	5325				cscott@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	03/01/2021	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Reconciliation Contact (Secondary)	Manager Financial Planning & Analysis		Brenner	Matthew		9185945295	4119				mbrenner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	03/01/2021	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Recovery Audit Contact	VP Chief CO, RO & General Counsel	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Surveillance Contact	VP Chief CO, RO & General Counsel	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	System Contact	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Third Party Administrator (TPA) Liaison	Senior Financial Analyst		Mack	Lynda		9185945295	6320				lmack@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/06/2017	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	User Access Contact	Medicare Compliance Specialist		Kanner	Dee		9185945295	6862				dkanner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	09/10/2019	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Utilization Management Contact	Senior Manager, Medical Management		Gordon	Michelle		9185945295	6398				mgordon@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	12/06/2017	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3755	Utilization Review Contact	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	CommunityCare Senior Health Plan (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H3777	Agent/Broker Compensation Data Contact	Director, Financial Systems		Lazar	Lisa		9197653359					Lisa.Lazar@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/28/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Automated TrOOP Balance Transfer Contact			Therapeutics	Prime		6127776747					eobp2@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/03/2020	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Backup User Access Contact	EDI Analyst		Umstead	Kamala		9197654363					kamala.umstead@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27707	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Best Available Evidence Contact	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Bid Audit Contact	Director, Actuarial Services		Turner	Danica		9847775665					danica.turner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Bid Audit Site Contact	AVP, Head of Actuarial Services		Turner	Danica		9847775665					danica.turner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Bid Primary Contact	Director, Actuarial Services		Vander Berg	Lucas		9842193485					Lucas.VanderBerg@bcbsnc.com	PO Box 2291		Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	CAP Report Contact for Public Website	Sr Communications Advisor		Stinneford	Mark		9197653005					media.inquiry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	CEO - CMS Administrator Contact	SVP, Government Markets	Ms	Gary	Francesca		9849603788					fran.gary@bcbsnc.com	PO Box 2291		Durham	NC	27702	07/06/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	CEO - Senior Official for Contracting	SVP, Government Markets	Ms	Gary	Francesca		9849603788					fran.gary@bcbsnc.com	PO Box 2291		Durham	NC	27702	07/06/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Chief Financial Officer	SVP, Chief Financial Officer	Mr	Perry	Mitchell		9197653923					mitch.perry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/06/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Chief Operating Officer	VP, Engagement, Integration & Innovation	Mrs	Boykin	Angela		9197654684					angela.boykin@bcbsnc.com	PO Box 2291		Durham	NC	27702	07/06/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Chief Information Officer	Chief Information Officer	Ms.	Abernathy	Jo		9197652383					jo.abernathy@bcbsnc.com	PO Box 2291		Durham	NC	27702	06/01/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Chief Information Security Officer	Chief Information Security Officer	Mr	Chilton	Richard		9197652021					rick.chilton@bcbsnc.com	PO Box 2291		Durham	NC	27702	06/01/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	CMS Casework Communication Contact	Director, Stakeholder Escalations		Holder	Nicole		9197651320					Caseworker@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/28/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Complaints Tracking Contact	Director, Stakeholder Escalations		Holder	Nicole		9197651320					Nicole.Holder@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/28/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Contact for Fraud Investigations	VP, Audit		Bennett	Tracy		3362014290					tracyr.bennett@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Coordination of Benefits Contact	Team Lead, Operations		Pridgen	David		3362014141					David. Pridgen@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Corporate Mailing						3362014460				3366592969	deborah.washington-mcneill@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Coverage Gap Discount Program (CGDP) Payment Contact	Principal Financial Accounting & Reporting Analyst		Varshney	Monisha		3528705750					monisha.varshney@bcbsnc.com	PO Box 2291		Durham	NC	27702	11/24/2020	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Customer Service Operations Contact	Sr. Manager, Contact Center		Woods	Renita		9197657057					Renita.Woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	DIR Contact	Director, Actuarial Services		Pigg	Ryland		9196168313					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P. O. Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Emergency Part D Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Emergency Part D Contact (Secondary)	VP, Government Markets Ops		Perry	Endya		9197775504					endya.perry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/06/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Encounter Data & Risk Adjustment Operations Contact	Manager, Risk Adjustment		Kimbrell	Tammy		9844448393					Tammy.Kimbrell2@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Enrollment Contact	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	EOB Transfer Contact	Medicare Pharmacy Operations Admin		Edwards	Chrissie		9197653536				9197657291	Corporate.pharmacy@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Financial Audit Contact	Director, Audit	Ms.	Ferrell	Kim		3362014038					kim.ferrell@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Financial Reporting Contact	Director, Subsidiary Reporting		Hill	Adam		5044950050					Adam.Hill@bcbsnc.com	PO Box 2291		Durham	NC	27702	05/10/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Formulary Contact	Clinical Pharmacist		Hiller	Debra		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics Inc	2900 Ames Crossing Road	Eagan	MN	55121	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	General Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Government Relations Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	HIPAA Privacy Officer	Director, Privacy, Ethics & Corp Policies		Hamlet	Lynn		9197657416					lynn.hamlet@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	HIPAA Security Officer	Chief Information Security Official		Chilton	Rick		9197652021					rick.chilton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Hospice Contact	Pharmacy Services Coordinator		Leggett	Ursula		9197654599					Ursula.Leggett@bcbsnc.com	PO Box 2291		Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Interoperability Contact	Director, Corporate Compliance Official		Haith	Elenor		9842125897					Elenor.Haith@bcbsnc.com	PO Box 2291		Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	MA Appeals/Grievances Contact	Director, Comm. & Medicare Appeals & Grievances	Ms.	McFall	Adonna		9197654061					adonna.mcfall@bcbsnc.com	PO Boc 2291		Durham	NC	27702	03/03/2020	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	MA Claims Processing Contact for Public Website	Call Center Support		Woods	Renita		8882969790					Renita.Woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Marketing Contact	Manager, Medicare Plan Administration		Brown	Alison		9196728994					alison.brown@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Medical Director	Lead Medical Director	Dr.	Campbell	John		9197652718					john.campbell@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Medicare Compliance Officer	VP, Medicare Compliance & Chief Compliance Officer	Mrs.	Haith	Elenor		9842125897					Elenor.Haith@bcbsnc.com	PO Box 2291		Durham	NC	27702	06/15/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Medicare Coordinator	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Medicare Part D Opioid Overutilization Contact	Medicare Pharmacy Operations Admin	Ms.	Edwards	Chrissie		9197653536					chrissie.edwards@bcbsnc.com	PO Box 2291		Durham	NC	27702	03/02/2020	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Medication Therapy Management Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					Joseph.Geter@bcbsnc.com	PO Box 2291		Durham	NC	27702	06/29/2022	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	OffShore Subcontractor Contact	Director, Corporate Compliance		Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Online Enrollment Center Contact (Primary)	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Part C Application Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Part C Reporting Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Part D Appeals	Director, Commercial and Medicare Appeals & Griev		McFall	Adonna							Adonna.McFall@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882987520				HMO - Health Maintenance Organization		C	Atlanta
H3777	Part D Appeals Contact (Secondary)	Mgr, MA and PDP Appeals and Grievances		Lanier	Paige						8883758836	paige.lanier@bcbsnc.com	PO Box 17509	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8774947647				HMO - Health Maintenance Organization		C	Atlanta
H3777	Part D Application Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Part D Benefits Contact	Manager, Medicare Pharmacy Programs		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	08/13/2021	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Part D Claims Submission Contact	Functional Business Consultant - Govt Prgms		Brooke	Lance		4026862603					lbrooke@primetherapeutics.com	Prime Therapeutics LLC	2900  Ames Crossing Road	Eagan	MN	55121	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Part D Exceptions Contact	Manager		Swanson	Ryan							PartDExceptions@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882969790				HMO - Health Maintenance Organization		C	Atlanta
H3777	Part D Price File Contact (Back-up)	Team Leader, Clinical Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Part D Price File Contact (Optional)	Database Reporting Analyst		Thoung	Randy		6127776812					Randy.Thoung@PrimeTherapeutics.com	1440 Northland Drive		Mendota Heights	MN	55120	07/08/2019	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Part D Price File Contact (Primary)	Manager, Medicare Pharmacy Programs		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	08/13/2021	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Part D Quality Assurance Contact	AVP, Pharmacy  Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	08/01/2022	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Part D Reporting Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3362014460					deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Patient Safety Contact	VP, Pharmacy Government Programs	Mr.	Geter	Joseph		9197657733					Joseph.Geter@bcbsnc.com	PO Box 2291		Durham	NC	27702	06/29/2022	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Payment Contact	AVP, Head of Actuarial Services & Valuation		Pigg	Ryland		9847776107					Ryland.Pigg@bcbsnc.com	PO Box 2291		Durham	NC	27702	05/12/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Pharmacy Director	AVP, Pharmacy Government Prgrams		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	08/01/2022	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Pharmacy Network Management Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	08/01/2022	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Pharmacy Network Management Contact (Secondary)	Manager, Medicare Pharmacy Programs		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	PO Box 2291		Durham	NC	27702	08/13/2021	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Pharmacy Technical Help Desk Contact			Helpdesk	Pharmacy							PharmacyOps@primetherapeutics.com	Prime Therapeutics, LLC	1305 Corporate Center Drive	Eagan	MN	55121	01/28/2019	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8772777893				HMO - Health Maintenance Organization		C	Atlanta
H3777	Plan Directory Contact for Public Website	Call Center support		Services	Member		8882969790					renita.woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Plan to Plan Reconciliation Contact	Manager, Financial Accounting & Reporting		Hitchcock	Grace		9197657999					grace.hitchcock@bcbsnc.com	ATTN:  Sheila Adams or Yvonne Stancil (Medicare P2P)	P.O. Box 30060 Mailstop 700-1AP	Durham	NC	27702	12/29/2021	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Processor Contact	Director Government Programs & Ops		Zdelen	Daniel		6127776775					daniel.zelen@primetherapeutics.com	Prime Therapeutics, LLC	2655 Eagen Woods Drive	Eagen	MN	55122	03/02/2020	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Quality Contact	VP, Quality, Health Equity & Risk Adjustment	Ms.	Bartholomew	Charmaine		6789208681					Charmaine.Bartholomew@bcbsnc.com	PO Box 2291		Durham	NC	27702	06/28/2022	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Reconciliation Contact	Director Actuarial Services		Pigg	Ryland		9847776107					Ryland.Pigg@bcbsnc.com	PO Box 2291		Durham	NC	27702	02/15/2022	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Reconciliation Contact (Secondary)	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/10/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Recovery Audit Contact	Director, Corporate Compliance	Mrs	Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina,	PO Box 2291	Durham	NC	27702	06/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Surveillance Contact	Director, Corporate Compliance		Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	System Contact	Director, IT Solution Delivery	Ms.	Holbrook	Janice		3362014101					Janice.Holbrook@bcbsnc.com	PO Box 2291		Durham	NC	27702	02/15/2022	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Third Party Administrator (TPA) Liaison	AVP, Head of Actuarial Services & Valuation		Pigg	Ryland		9847776107					Ryland.Pigg@bcbsnc.com	PO Box 2291		Durham	NC	27702	05/12/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	User Access Contact	Electronic Data Interchange Analyst		Dunn	Lorrie		9197653669					lorrie.dunn@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27707	05/30/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Utilization Management Contact	Director, Clinical Teams		Perdue	Angela		3362014352					angela.perdue@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3777	Utilization Review Contact	Director, Clinical Teams		Perdue	Angela		3362014352					angela.perdue@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	EXPERIENCE HEALTH, INC.	Local CCP	Experience Health, Inc.	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H3794	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H3794	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H3794	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H3794	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H3794	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3794	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3800	Agent/Broker Compensation Data Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Automated TrOOP Balance Transfer Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Backup User Access Contact		Mr	Grindrod	Rick		4104240804					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	08/17/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Best Available Evidence Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Bid Audit Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Bid Audit Site Contact	President & CEO	Mr.	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Bid Primary Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	CAP Report Contact for Public Website	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	CEO - CMS Administrator Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	CEO - Senior Official for Contracting	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Chief Financial Officer	CFO	Mr	Persinger	Keith		4104563946					kpersinger@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	12/29/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Chief Operating Officer	Chief Operating Officer	Mr	Persinger	Keith		4104563946					kpersinger@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	12/29/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Chief Information Officer	Director of Information Technology	Mr	Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Chief Information Security Officer	Director of Information Technology	Mr.	Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	CMS Casework Communication Contact	Chief Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Complaints Tracking Contact		Mr.	Grindrod	Rick		4104240804					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite  300	Linthicum Heights	MD	21090	08/17/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Contact for Fraud Investigations	Director, Operations	Ms.	Winton	Linda		8173743812					lwinton@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/24/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Coordination of Benefits Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	10/23/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Corporate Mailing						4104240772					info@pphealthplan.com	785 Elkridge Landing Rd	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	10/23/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Customer Service Operations Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	DIR Contact	Financial Analyst	Mr	Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	02/21/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	DIR Contact (Secondary)	Sr Financial Manager Reporting & Analytics		Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	02/21/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Emergency Part D Contact	Director of Pharmacy	Dr	Ford	James	E	4433100351					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Emergency Part D Contact (Secondary)	Pharmacy Operations Manager	Dr	Brown	Latrese		4437621114					lbrown@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Encounter Data & Risk Adjustment Operations Contact	Software Engineer		Rifkin	Joshua		4108977578					jrifkin@pphealthplan.com	785 Elkridge Landing Road		Linthicum	MD	21090	10/23/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Enrollment Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	EOB Transfer Contact	Sr. Director of  Operations		Brain	Jay		2403672626				8448134544	JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Financial Audit Contact	Director of Finace	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	10/23/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Financial Reporting Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Formulary Contact	Assigned Formulary Pharmacist		Baggett	Renee		3308886243					rbaggett@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Formulary Contact (Secondary)	Director Formulary Operations		Singh	Roop		3304866482					rsingh@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	General Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Government Relations Contact			Grindrod	Rick		4104240804					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	08/17/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	HIPAA Privacy Officer		Mr.	Grindrod	Rick		4104240804					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	08/17/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	HIPAA Security Officer	Director of Information Technology		Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Hospice Contact	Account Manager	Ms.	Sousa	Ana		2158724933					asousa@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Interoperability Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	MA Appeals/Grievances Contact	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	MA Claims Processing Contact for Public Website	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Marketing Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623019	Sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Medical Director	Medical Director	Dr	Kimmel	Alan		4102183691					akimmel@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Medicare Compliance Officer	Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	11/10/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Medicare Coordinator		Mr.	Grindrod	Rick		4104240804					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	08/17/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Medicare Part D Opioid Overutilization Contact	Pharmacy Director	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/15/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Medication Therapy Management Contact	VP Pharmacy Solutions	Ms	Miller	Holly		3302931916					hmiller@healthdialog.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	OffShore Subcontractor Contact	Chief Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part C Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part C Reporting Contact	Medicare Advantage Reporting Process Manager	Ms	Butler	Christina		2403532930					cbutler@pphealthplan.com	785  Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/13/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Appeals	Pharmacy Director	Dr	Ford	James	E						jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/12/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	8448468007				HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Appeals Contact (Secondary)	Clinical Operations Appeals Supervisor	Ms.	Binegar	Samantha	J					3304058081	Appeals@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Benefits Contact	Director of Pharmacy	Dr	Ford	James	E	4432759810					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Claims Submission Contact	Elixir Account Manager	Ms	Brisson	Carly		9169392883					cbrisson@elixirsolutions.com	8957 Canyon Falls Blvd		Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Exceptions Contact	Associate Vice President	Ms	Lavignette	Amanda							alavignette@envsionrx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	11/10/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Exceptions Contact (Secondary)	Senior Director, Pharmacy Services	Dr	Ford	James							jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	11/10/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	4432759801				HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Price File Contact (Back-up)	Financial Analyst III		Wentz	Christophe		3304864910					cwentz@elixirsolutions.com	8957 Canyon Falls Blvd		Twinsburg	OH	44087	06/08/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Price File Contact (Optional)	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Price File Contact (Primary)	Director of Reporting & Analytics	Mr	Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	8957 Canyon Falls Blvd.		Twinsburg	OH	44087	06/08/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Quality Assurance Contact	Pharmacy Operations Manager	Dr	Brown	Latrese		4437621114					lbrown@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Part D Reporting Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Patient Safety Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Payment Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Pharmacy Director	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Pharmacy Network Management Contact	Director Pharmacy Network Development & Operations		Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Pharmacy Technical Help Desk Contact	Vice President of Operations	Mr	Conn	Todd							tconn@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	8448468007				HMO - Health Maintenance Organization		C	Philadelphia
H3800	Plan Directory Contact for Public Website	Director of Partner Development	Ms	Radice	Sue		4109913213					Sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Plan to Plan Reconciliation Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	10/23/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Processor Contact	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Rd	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Quality Contact	Dir. of Performance Improvement & Quality	Mr	Kirwan	Mark		4104240411					mkirwan@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Reconciliation Contact	Director of Finance	Ms	McIntyre	Marybeth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	10/23/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Reconciliation Contact (Secondary)	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Recovery Audit Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	SNP Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	SNP State Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Surveillance Contact	Chief Compliance Officer	Mr	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	System Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					jbrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Third Party Administrator (TPA) Liaison	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	User Access Contact	Chief Compliance Officer	Mr	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/24/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Utilization Management Contact	Director of Utilization Review	Mr	Derby	Thomas		4846823923					tderby@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3800	Utilization Review Contact	Director of Utilization Review	Mr	Derby	Thomas		4846823923					tderby@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF ILLINOIS	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3805	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H3805	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H3805	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H3805	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H3805	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3805	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3809	Automated TrOOP Balance Transfer Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Backup User Access Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153861				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Best Available Evidence Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	05/22/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Bid Primary Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	CAP Report Contact for Public Website	Health Plan Operations Manager		Wachsmuth	Rosalie		5032156556				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	CEO - CMS Administrator Contact	Chief Executive for PACE	Ms.	Tuller	Susan		2063205325					susan.tuller@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	06/17/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	CEO - Senior Official for Contracting	Chief Executive for PACE	Ms.	Tuller	Susan		2063205325					susan.tuller@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	06/17/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Chief Financial Officer	Health Plan & Finance Director	Ms.	Barr	Natalie		5032153859				5032150685	natalie.barr@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Chief Operating Officer		Ms.	Noordijk	Cindy		5032154124				5032150685	cynthia.noordijk@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Chief Information Officer		Ms.	Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Chief Information Security Officer		Ms.	Noordijk	Cindy		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	CMS Casework Communication Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Complaints Tracking Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Contact for Fraud Investigations			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Coordination of Benefits Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Corporate Mailing						5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Coverage Gap Discount Program (CGDP) Payment Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Customer Service Operations Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	DIR Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	DIR Contact (Secondary)			Chambers	Perry		5032153672					Perry.Chambers@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Emergency Part D Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	01/04/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Emergency Part D Contact (Secondary)			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Encounter Data & Risk Adjustment Operations Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	10/23/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Enrollment Contact			Chambers	Perry		5032153672					Perry.Chambers@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	EOB Transfer Contact			Chambers	Perry		5032153672				5032150685	Perry.Chambers@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Financial Audit Contact	Health Plan Operations Manager	Ms.	Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Ste 200		Portland	OR	97213	01/28/2021	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Financial Reporting Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Formulary Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Formulary Contact (Secondary)			Hart	Tish		5032153533					LaTisha.Hart@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	General Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Government Relations Contact			Noordijk	Cindy		5032154124				5032150685	cynthia.noordijk@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	HIPAA Privacy Officer	Compliance Officer		Noordijk	Cindy		5032154124				5032150685	cynthia.noordijk@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	HIPAA Security Officer	Compliance Officer		Noordijk	Cindy		5032154124				5032150685	cynthia.noordijk@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Interoperability Contact			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	MA Appeals/Grievances Contact			Chinn	Velaa		2063205325					velaa.chinn@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	MA Claims Processing Contact for Public Website			Chinn	Velaa		2063205325					velaa.chinn@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Marketing Contact			Frederick	Jeannie		5032153741					jeannie.frederick@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Medical Director	Medical Director	Dr.	Nash	Maureen		5032157880				5032150685	maureen.nash@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Medicare Compliance Officer	Compliance Officer	Ms.	Noordijk	Cindy		5032154124				5032150685	cynthia.noordijk@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Medicare Coordinator			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98108	08/09/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Medicare Part D Opioid Overutilization Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Medication Therapy Management Contact			Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Part C Application Contact	Compliance Officer		Noordijk	Cindy		5032154124				5032150685	cynthia.noordijk@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Part D Appeals	Health Plan Operations Manager		Wachsmuth	Rosalie						5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active	5032153681				PACE - Nat		C	Seattle
H3809	Part D Appeals Contact (Secondary)			Chinn	Velaa							velaa.chinn@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active	2063205325				PACE - Nat		C	Seattle
H3809	Part D Application Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Part D Benefits Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Part D Claims Submission Contact			Chambers	Perry		5032153672					Perry.Chambers@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Part D Exceptions Contact			Chambers	Perry							Perry.Chambers@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active	5032153672				PACE - Nat		C	Seattle
H3809	Part D Exceptions Contact (Secondary)			Wachsmuth	Rosalie							rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active	5032153681				PACE - Nat		C	Seattle
H3809	Part D Price File Contact (Back-up)			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Part D Price File Contact (Optional)			Chinn	Velaa		2063205325					velaa.chinn@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Part D Price File Contact (Primary)			Chambers	Perry		5032153672					velaa.chinn@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Part D Quality Assurance Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Part D Reporting Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Patient Safety Contact			Reed	Rebecca		5032153465					rebecca.reed@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Payment Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Personal Health Record Contact			Noordijk	Cindy		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Pharmacy Director			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Pharmacy Network Management Contact			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Pharmacy Network Management Contact (Secondary)			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Pharmacy Technical Help Desk Contact			Service	Customer							Rosalie.Wachsmuth@providence.org	4515 Martin Luther King Jr Way S, Ste. 100		Seattle	WA	98108	05/02/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active	8884455518				PACE - Nat		C	Seattle
H3809	Pharmacy Technical Help Desk Contact (Secondary)			Wachsmuth	Rosalie							rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	05/02/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active	5032153681				PACE - Nat		C	Seattle
H3809	Plan Directory Contact for Public Website			Bering	Rika		5032156556				5032150685	rika.bering@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Plan to Plan Reconciliation Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Processor Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Quality Contact			Reed	Rebecca		5032153465					rebecca.reed@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Reconciliation Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	44400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Reconciliation Contact (Secondary)			Chambers	Perry		5032153672					Perry.Chambers@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	02/22/2021	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Recovery Audit Contact	Health Plan & Finance Director	Ms.	Wachsmuth	Rosalie		5032154124					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/24/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Surveillance Contact	Compliance Officer	Ms.	Noordijk	Cindy		5032154124				5032150685	cynthia.noordijk@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	System Contact			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Third Party Administrator (TPA) Liaison			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	User Access Contact			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Utilization Management Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3809	Utilization Review Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	03/20/2019	2023	PROVIDENCE HEALTH & SERVICES - OREGON	National PACE	Providence ElderPlace Portland	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H3810	Agent/Broker Compensation Data Contact	Director of Marketing	Ms.	LaFond	Nicole		5414714106	8113			5414711524	nicole.lafond@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	04/28/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Automated TrOOP Balance Transfer Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106	8202				amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Backup User Access Contact	Lead Developer	Mr.	Eyman	John		5414714106					john.eyman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Best Available Evidence Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		9712226045					amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Bid Audit Contact	CEO	Mr.	Flow	Douglas	L	5414714106				5414711524	doug.flow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Bid Audit Site Contact	CEO	Mr.	Flow	Douglas	L	5414714106				5414711524	doug.flow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Bid Primary Contact	Chief Marketing & Innovation Officer	Mr.	Sennhauser	Freddy		5414714106				5414711524	freddy.sennhauser@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	04/28/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	CAP Report Contact for Public Website	CEO	Mr.	Flow	Douglas	L	5414714106				5414711524	doug.flow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	CEO - CMS Administrator Contact	Chief Compliance Officer	Ms.	Ackerman	Cynthia		5414714106					cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	01/31/2019	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	CEO - Senior Official for Contracting	CEO	Mr.	Flow	Douglas	L	5414714106				5414711524	doug.flow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Chief Financial Officer	CFO	Mr.	Woodin	Matthew	P	5414714106				5414711524	matthew.woodin@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/07/2022	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Chief Operating Officer	COO	Mr.	Flow	Douglas	L	5414714106				5414711524	doug.flow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Chief Information Officer	CIO	Mr.	Zesiger	Justin		5414714106					justin.zesiger@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	08/20/2018	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Chief Information Security Officer	CIO	Mr.	Zesiger	Justin		5414714106					justin.zesiger@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	08/20/2018	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	CMS Casework Communication Contact	VP Compliance	Ms.	Matola	Laura		5414714106				5414711524	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Complaints Tracking Contact	VP Compliance	Ms.	Matola	Laura		5414714106	3121			5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Contact for Fraud Investigations	Chief Compliance Officer	Ms.	Ackerman	Cynthia		5414714106				5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Coordination of Benefits Contact	Enrollment Director	Ms.	Anders	Sheila		5414714106	5111			5419561674	sheila.anders@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Corporate Mailing						5414714106				5414711524	doug.flow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	12/14/2016	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Coverage Gap Discount Program (CGDP) Payment Contact	CFO		Woodin	Matthew	P	5414714106				5414711524	matthew.woodin@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Customer Service Operations Contact	Chief Compliance Officer	Ms.	Ackerman	Cynthia		5414714106				5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	DIR Contact	CFO		Woodin	Matthew	P	5414714106				5414711524	matthew.woodin@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	DIR Contact (Secondary)	Chief Compliance Officer	Ms.	Ackerman	Cynthia		5414714106	8115			5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Electronic Health Record Contact	CIO	Mr.	Zesiger	Justin		5414714106					justin.zesiger@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	01/31/2019	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Emergency Part D Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		9712226045					amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Emergency Part D Contact (Secondary)	VP Compliance	Ms.	Matola	Laura		5417615291				5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Encounter Data & Risk Adjustment Operations Contact	VP, Claims Administration & Business Services	Ms.	Gillespie	Lori		5414714106				5414711524	Lori.Gillespie@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97520	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Enrollment Contact	Enrollment Director	Ms.	Anders	Sheila		5414714106				5414711524	sheila.anders@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	EOB Transfer Contact	VP, Claims Administration & Business Services	Ms.	Gillespie	Lori		5414714106				5414711524	lori.gillespie@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Financial Audit Contact	CFO	.	Woodin	Matthew	P	5414714106				5414711524	matthew.woodin@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Financial Reporting Contact	CFO		Woodin	Matthew	P	5414714106				5414711524	matthew.woodin@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Formulary Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106	8202				amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Formulary Contact (Secondary)			Nyawabila	Christina		8587906350				8586891799	FAS@medimpact.com	10181  Scripps Gateway Court		San Diego	CA	92131	02/26/2019	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	General Contact	CEO	Mr.	Flow	Douglas	L	5414714106				5414711524	doug.flow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Government Relations Contact	CEO	Mr.	Flow	Douglas	L	5414714106				5414711524	doug.flow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	HIPAA Privacy Officer	Chief Compliance Officer	Ms.	Ackerman	Cynthia		5414714106				5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	HIPAA Security Officer	Chief Compliance Officer	Ms.	Ackerman	Cynthia		5414714106				5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Hospice Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106					amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Interoperability Contact	CIO		Zesiger	Justin		5414714106					justin.zesiger@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	11/30/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	MA Appeals/Grievances Contact	VP Compliance	Ms.	Matola	Laura		5414714106	8145			5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	MA Claims Processing Contact for Public Website	VP, Claims Administration & Business Services	Ms.	Gillespie	Lori		5414714106				5414711524	lori.gillespie@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Marketing Contact	Director of Marketing	Ms.	LaFond	Nicole		5414714106	8113			5414711524	nicole.lafond@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	04/28/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Medical Director	Chief Medical Officer	Dr.	Burnett	Kelley		5414714106				5414711524	kelley.burnett@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Ackerman	Cynthia	A	5414714106	8115			5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	12/02/2020	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Medicare Coordinator	VP Compliance	Ms.	Matola	Laura		5414714106	8145			5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Medicare Part D Opioid Overutilization Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106				5414711524	Amy.Burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Medication Therapy Management Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106	8202				amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	OffShore Subcontractor Contact	Chief Compliance Officer	Ms.	Ackerman	Cynthia		5414714106				5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	01/31/2019	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Online Enrollment Center Contact (Back-up)	Chief Marketing & Innovation Officer	Mr.	Sennhauser	Freddy		5414714106				5414711524	freddy.sennhauser@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	04/28/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Online Enrollment Center Contact (Primary)	Director of Marketing	Ms.	LaFond	Nicole		5414714106	8113			5414711524	nicole.lafond@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	04/28/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Part C Application Contact	Director of Marketing	Ms.	LaFond	Nicole		5414714106	8113			5414711524	nicole.lafond@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	04/28/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Part C Reporting Contact	VP Compliance	Ms.	Matola	Laura		5414714106				5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Part D Appeals	VP Compliance	Ms.	Matola	Laura						5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active	8884600185				HMO - Health Maintenance Organization		C	Seattle
H3810	Part D Application Contact	Director of Marketing	Ms.	LaFond	Nicole		5414714106	8113			5414711524	nicole.lafond@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	04/28/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Part D Benefits Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106	8202				amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Part D Claims Submission Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106	8202				amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Part D Exceptions Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy							amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active	8884600185				HMO - Health Maintenance Organization		C	Seattle
H3810	Part D Price File Contact (Back-up)	Lead Developer	Mr.	Eyman	John		5414714106	8202				john.eyman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Part D Price File Contact (Optional)	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106				5414711524	amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Part D Price File Contact (Primary)			Niemi	Kirstin		8587906455					PlanFinderCommunications@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	09/17/2019	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Part D Quality Assurance Contact	VP Compliance	Ms.	Matola	Laura		5414714106				5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Part D Reporting Contact	VP Compliance	Ms.	Matola	Laura		5414714106				5414713789	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Patient Safety Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106					amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Payment Contact	CFO		Woodin	Matthew	P	5414714106				5414711524	matthew.woodin@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Pharmacy Director	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106	8202				amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Pharmacy Network Management Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106	8202				amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Pharmacy Technical Help Desk Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy							amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active	8884600185				HMO - Health Maintenance Organization		C	Seattle
H3810	Physician Incentive Contact	CEO	Mr.	Flow	Douglas	L	5414714106				5414711524	doug.flow@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Plan Directory Contact for Public Website	Director of Marketing	Ms.	LaFond	Nicole		8884600185	8113			5414711524	nicole.lafond@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	04/28/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Plan to Plan Reconciliation Contact	CFO		Woodin	Matthew	P	5414714106				5414711524	matthew.woodin@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Processor Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106				5414711524	amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Quality Contact	VP Compliance	Ms.	Matola	Laura		5414714106				5414711524	laura.matola@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Reconciliation Contact	CFO		Woodin	Matthew	P	5414714106				5414711524	matthew.woodin@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Recovery Audit Contact	CFO	Mr.	Woodin	Matthew	P	5414714106				5414711524	matthew.woodin@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	SNP Application Contact	Director of Marketing	Ms.	LaFond	Nicole		5414714106	8113				nicole.lafond@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	04/28/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	SNP State Contact	Chief Marketing & Innovation Officer		Sennhauser	Freddy		5414714106				5414711524	freddy.sennhauser@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	05/15/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Surveillance Contact	Chief Compliance Officer	Ms.	Ackerman	Cynthia		5414714106				5414711524	cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	System Contact	Developer	Mr.	Ridenour	Joseph		5414714106					joe.ridenour@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Third Party Administrator (TPA) Liaison	CFO		Woodin	Matthew	P	5414714106				5414711524	matthew.woodin@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	06/08/2023	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	User Access Contact	Chief Compliance Officer   EPOC	Ms.	Ackerman	Cynthia		5414714106					cynthia.ackerman@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Utilization Management Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106	8202				amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3810	Utilization Review Contact	VP, Benefit Management & Pharmacy Services	Ms.	Burns	Amy		5414714106	8202				amy.burns@allcarehealth.com	1701 NE 7th Street		Grants Pass	OR	97526	10/05/2021	2023	ALLCARE HEALTH PLAN, INC.	Local CCP	AllCare Advantage	HMO/HMOPOS		AllCare Health, Inc.	660	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Agent/Broker Compensation Data Contact	Director - SHPO Sales and Member Engagement		Quest	Bridgett		5417686738					bquest@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Automated TrOOP Balance Transfer Contact	Director of Medicare Programs	Ms.	Severson	Denise		5417686326				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Backup User Access Contact	Regulatory Compliance Coordinator	Ms.	Keyser	Staci	L	5417684670				5417689791	shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	12/13/2017	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Best Available Evidence Contact	Director of Financial Operations	Mr	Began	Trent		5417687993				5417684294	tbegan@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Bid Audit Contact	Director of Medicare Programs	Ms.	Severson	Denise		5417684278				5417684294	shpmedicareprograms@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	08/17/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Bid Audit Site Contact	Director of Medicare Programs	Ms.	Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Bid Primary Contact	Chief Executive Officer	Mr.	Butler	Bruce		5417685484				5417684294	bbutler@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	06/03/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	CAP Report Contact for Public Website	Director of Medicare Programs	Ms.	Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Butler	Bruce		5417685484				5417684294	bbutler@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	01/03/2023	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	CEO - Senior Official for Contracting	CEO	Mr.	Butler	Bruce		5417685484				5417684294	bbutler@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	09/26/2019	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Chief Financial Officer	Chief Executive Officer	Mr.	Butler	Bruce		5417685484				5417684294	bbutler@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	09/26/2019	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Chief Operating Officer	Chief Operations Officer	Ms.	Fowler	Annette		5417685484				5417684294	afowler@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	05/25/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Chief Information Officer	VP, Information Services	Mr.	Bernarding	Trevin		5417681681					Tbernardin@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	06/22/2023	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Chief Information Security Officer		Mr.	Kelly	James		5417684507					jkelly@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	08/31/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	CMS Casework Communication Contact	Program Manager II	Ms.	keyser	Stephani	L	5417685514					skeyser@samhealth.org	2300 nw walnut blvd		corvallis	OR	97330	09/20/2023	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Complaints Tracking Contact	Compliance Officer		Norman	Chris		5419054914					shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	07/27/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Contact for Fraud Investigations	Compliance Officer		Norman	Chris		5419054914					shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	07/27/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Coordination of Benefits Contact	Director of Medicare Programs		Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Corporate Mailing						5417686326				5417684294	shpocompliance@samhealth.org	PO Box M		Corvallis	OR	97339	03/18/2014	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance		Began	Trent		5417687993					tbegan@samhealth.org	2300 NW Walnut Boulevard		Corvallis	OR	97330	07/26/2019	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Customer Service Operations Contact	Manager of Customer Service	Mr	Taylor	Philip		5417686757				5417684294	ptaylor@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	06/03/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	DIR Contact	Director of Finance	Mr.	Began	Trent		5417687993					tbegan@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	12/20/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	DIR Contact (Secondary)		Ms.	Ligterink	Jamie		5417685352				5417684294	jligterink@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	03/27/2018	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Emergency Part D Contact	Director of Pharmacy Services		Kuffour	Nana Ama		5417684245					shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	01/03/2023	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Emergency Part D Contact (Secondary)	Director of Medicare Programs		Severson	Denise		5035082621				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	12/22/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Encounter Data & Risk Adjustment Operations Contact	Manager Risk & Revenue	Mr	Penner	Wade		5417687895					wpenner@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	03/11/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Enrollment Contact	Manager		Young	Carnetta		5417687988				5417684294	carnettay@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	03/02/2023	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	EOB Transfer Contact	Director of Medicare Programs	Ms.	Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Financial Audit Contact	Manager Financial Planning	Mr.	Boyer	Benjamin		5417684210				5417684294	Bboyer@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	08/31/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Financial Reporting Contact	Director of Finance	Mr.	Began	Trent		5417687993				5417684294	shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	12/20/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Formulary Contact	Manager of Pharmacy Programs		Molina	Katie		5417687145				5417684294	kmolina@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	02/03/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Formulary Contact (Secondary)	Optum Formulary Consultant		Chen	Christine		2242312709					Christine.Chen2@optum.com	1600 McConnor Parkway		Shaumburg	IL	60173	12/08/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	General Contact	Compliance Officer		Norman	Chris		5419054914				5417689791	chnorman@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	07/27/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Government Relations Contact	Director of Medicare Programs	Ms.	Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	HIPAA Privacy Officer	Compliance Officer		Norman	Chris		5419054914					chnorman@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	07/27/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	HIPAA Security Officer	Compliance Officer		Norman	Chris		5419054914					shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	07/27/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Hospice Contact	Manager Pharmacy Programs		Molina	Katie		5417687145					kmolina@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	02/03/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Interoperability Contact	Medicare Sustainment Program Manager	Ms.	Keyser	Stephani		5417685514				5417684294	skeyser@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	04/27/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	MA Appeals/Grievances Contact	Supervisor	Ms.	Ciolino	Christie		5417685514					cciolino@samhealth.org	2300 nw walnut blvd		corvallis	OR	97330	09/20/2023	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	MA Claims Processing Contact for Public Website	Director of Health Information	Ms.	Canning	Dotha		5417686433					shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	04/04/2016	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Marketing Contact	Medicare Sustainment Program Manager	Ms.	Keyser	Stephani		5417685514				5417684294	skeyser@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	04/27/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Medical Director	Medical Director	Dr.	Godek	Brent		5417684889				5417684518	shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	03/02/2023	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Medicare Compliance Officer	Compliance Officer	Mr.	Norman	Chris		5419054914				5417684294	chnorman@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	07/27/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Medicare Coordinator	Regulatory Compliance Coordinator	Ms.	Keyser	Staci		5417684670				5417689791	shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	05/26/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Medicare Part D Opioid Overutilization Contact	Manager of Pharmacy Programs		Molina	Katie		5417687145				5417684294	kmolina@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	02/03/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Medication Therapy Management Contact	Director of Pharmacy Services		Kuffour	Nana Ama		5417687145					nkuffour@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	02/03/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	OffShore Subcontractor Contact	Compliance Officer		Norman	Chris		5419054914					shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	07/27/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Online Enrollment Center Contact (Back-up)	Director of Medicare Programs		Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Online Enrollment Center Contact (Optional)	Manager		Young	Carnetta		5417687988				5417684294	carnettay@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	03/07/2023	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Online Enrollment Center Contact (Primary)	Director of Finance	Mr	Began	Trent		5417687993				5417684294	tbegan@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	07/06/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Part C Application Contact	Director of SHP Medicare Programs	Ms.	Severson	Denise	L	5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/08/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Part C Reporting Contact	Medicare Sustainment Program Manager	Ms.	Keyser	Stephani		5417685514				5417689791	skeyser@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	04/27/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Appeals	Supervisor		Ciolino	Christie	L						cciolino@samhealth.org	2300 nw walnut blvd		corvallis	OR	97330	09/20/2023	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active	5417685514				HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Appeals Contact (Secondary)	carnettay@samhealth.org		Young	Carnetta						5417689765	carnettay@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	06/06/2023	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active	5417686738				HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Application Contact	Director of Medicare Programs	Ms.	Severson	Denise	L	5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Benefits Contact	Director of Pharmacy Services		Kuffour	Nana Ama		5417684245					shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	01/20/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Claims Submission Contact	Manager Risk & Revenue	Mr.	Penner	Wade		5417687895				5417684294	shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	03/11/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Exceptions Contact	Director of Pharmacy Services		Kuffour	Nana Ama						5417684294	shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	01/20/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active	5417684245				HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Exceptions Contact (Secondary)	Director of Medicare Programs		Severson	Denise						5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active	5417684278				HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Price File Contact (Back-up)	Manager Medicare Operations		Nemes	Nancy		2162125218					nancy.nemes@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	03/07/2016	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Price File Contact (Optional)	Director of Operations		Blythe	Mike		5417686385				5417684294	shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	02/19/2019	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Price File Contact (Primary)	OptumRX		Lyman	Dorothy		5414955369					Dorothy.Lyman@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	07/06/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Quality Assurance Contact	Director of Quality and Population Health		Kuffour	Nana Ama		5417685555				5417684294	nkuffour@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	12/14/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Part D Reporting Contact	Medicare Sustainment Program Manager	Ms.	Keyser	Stephani		5417685514				5417689791	skeyser@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	04/27/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Patient Safety Contact	Director of Quality		Kuffour	Nana Ama		5417685555				5417684294	nkuffour@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	12/14/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Payment Contact	Director of Finance	Mr.	Began	Trent		5417687993				5417684294	tbegan@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	05/25/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Personal Health Record Contact	Director of Medicare Programs		Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Pharmacy Director	Director of Pharmacy Services		Kuffour	Nana Ama		5417684245					shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	01/20/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Pharmacy Network Management Contact	Director of Pharmacy Services		Kuffour	Nana Ama		5417687145				5417684294	nkuffour@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	02/03/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Pharmacy Network Management Contact (Secondary)	Manager Pharmacy Operations		Killgore	Danielle		5417684278				5417684294	Dkillgore@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	02/03/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Pharmacy Technical Help Desk Contact	Manager of Pharmacy Programs		Molina	Katie						5417686828	kmolina@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	02/03/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active	8884352396				HMO - Health Maintenance Organization		C	Seattle
H3811	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Compliance Coordinator		Killgore	Danielle						5417686283	dkillgore@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	09/26/2019	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active	8884352396				HMO - Health Maintenance Organization		C	Seattle
H3811	Physician Incentive Contact	Director of Finance	Mr.	Began	Trent		5417687993				5417684294	shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	03/26/2019	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Plan Directory Contact for Public Website	Director of Sales and Member Engagement		Quest	Bridgett		5417686738				5417684294	shpocompliance@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Plan to Plan Reconciliation Contact	Manager - Fin Plan-Analysis	Mr.	Boyer	Benjamin		5417684210				5417684294	bboyer@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	08/31/2021	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Processor Contact	Director of Medicare Programs		Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Quality Contact	Director of Quality	Ms.	Kuffour	Nana Ama		5417685555				5417685015	nkuffour@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	12/14/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Reconciliation Contact	Director of Finance	Mr.	Began	Trent		5417687993				5417684294	tbegan@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	08/08/2019	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Reconciliation Contact (Secondary)	Manager Reimbursement	Ms	Ligterink	Jamie		5417685352				5417684294	jligterink@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	03/27/2018	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Recovery Audit Contact	Director of Medicare Programs	Mrs.	Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	SNP Application Contact	Director of Medicare Programs		Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	SNP State Contact	Director of Medicare Programs		Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Surveillance Contact	Director of Medicare Programs		Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	System Contact	Director of Medicare Programs		Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Third Party Administrator (TPA) Liaison	Pharmacy Reimbursement Coordinator		Ligterink	Jamie		5417685352					jligterink@samhealth.org	2300 NW Walnut Boulevard		Corvallis	OR	97330	04/20/2016	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	User Access Contact	Medicare Sustainment Program Manager	Ms.	Keyser	Stephani		5417685514				5417689791	skeyser@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	04/27/2022	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Utilization Management Contact	Director of Medicare Programs		Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3811	Utilization Review Contact	Director of Medicare Programs		Severson	Denise		5417684278				5417684294	dseverson@samhealth.org	2300 NW Walnut Blvd		Corvallis	OR	97330	10/09/2020	2023	SAMARITAN HEALTH PLANS, INC.	Local CCP	Samaritan Advantage Health Plans	HMO/HMOPOS		Samaritan Health Services	201	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3813	Agent/Broker Compensation Data Contact	Senior Medicare Product Manager	Mrs.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	11/15/2019	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	Relay.Health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/04/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Backup User Access Contact	Medicare Compliance Auditor		Siegfried-Roads	Carey		5032654719				5032654790	carey.siegfriedroads@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	11/03/2014	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Best Available Evidence Contact	Supervisor Membership Accounting		Black	Colby		5032655606					colby.black@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Bid Audit Contact	Senior Medicare Product Manager	Ms.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/08/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Bid Audit Site Contact	Actuarial Pricing Manager	Mr.	Danburg-Wyld	Mark		5039525020					mark.danburgwyld@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	02/11/2019	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Bid Primary Contact	Senior Medicare Product Manager	Ms.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/08/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	CEO - CMS Administrator Contact	CEO	Mr.	Gootee	Robert		5032434491					robert.gootee@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/16/2023	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	CEO - Senior Official for Contracting	CEO	Mr.	Gootee	Robert		5032434491				5032654790	robert.gootee@modahealth.com	601 S.W. Second Ave Suite 900		Portland	OR	97204	01/07/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Chief Financial Officer	Sr VP CFO	Mr.	Evans	Dave		5032433952				5039485557	dave.evans@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	07/11/2018	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Chief Operating Officer	VP Claims, Customer Service and Configuration	Ms.	Thornburg	Margaret		5032654787					margaret.thornburg@modahealth.com	601 S.W. Second Ave Suite 900		Portland	OR	97204	11/10/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Chief Information Officer	Chief Information Officer	Ms.	Hansen	Sue		5032655705	5705				sue.hansen@modahealth.com	601 SW Second Ave.		Portland	OR	97204	01/25/2016	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Chief Information Security Officer	Director, Information Security	Mr	James	Dale		5039485597					dayle.james@modahealth.com	601 SW Second Ave.		Portland	OR	97204	06/24/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	CMS Casework Communication Contact	Lead Appeals Coordinator	Ms.	Shattuck	Mica		5034124021				8339491888	mica.shattuck@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/11/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Complaints Tracking Contact	Lead Appeals Coordinator	Ms.	Shattuck	Mica		5034124021				8339491888	mica.shattuck@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/11/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Contact for Fraud Investigations	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Coordination of Benefits Contact			Service	Customer		8772999062				5039485577	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	97240	04/19/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Corporate Mailing						8772999062				5039485577	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/25/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Coverage Gap Discount Program (CGDP) Payment Contact	Corporate Controller	Ms.	Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 SW Second Ave		Portland	OR	97204	08/17/2016	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Customer Service Operations Contact	Customer Service Manager	Ms.	Duncan	Colleen		5037653424					colleen.duncan@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	02/11/2019	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	DIR Contact	Manager, Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	DIR Contact (Secondary)	Rx Government Programs Analyst		Beebe	Colin		5034124175					colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	02/23/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Emergency Part D Contact	Manager Pharmacy Operations		Kraemer	Laura		5034688790					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/13/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Emergency Part D Contact (Secondary)	Pharmacy PAC Govt Programs II		Beebe	Colin		7276566998					colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/13/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Employer Waiver Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Encounter Data & Risk Adjustment Operations Contact	Manager Risk Adjustment		Echenrodt	Brianne		5032286554	1144				brianne.eckenrodt@modahealth.com	601 SW 2nd Ave		Portland	OR	97204	04/19/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Enrollment Contact	Membership Accounting Supervisor	=	Black	Colby		5032655606					colby.black@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	EOB Transfer Contact	Supervisor, Rx Quality and Compliance		Brokaw	Katie		5032654771				8339491891	katie.brokaw@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Financial Audit Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Financial Reporting Contact	Corporate Controller	Ms.	Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/11/2016	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Formulary Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					RXGovernmentPrograms@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Formulary Contact (Secondary)	Medicare team Lead, Formulary Services		Paddock	Deanna		6087291628				6087292628	deanna.paddock@navitus.com	2601 West Beltline Highway, Suite 600		Madison	WI	53713	01/21/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	General Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Government Relations Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	HIPAA Privacy Officer	Privacy Officer	Mr.	White	Scott		5039525044					scott.white@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	06/24/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	HIPAA Security Officer	Director, Information Security		James	Dayle		5039485597					dayle.james@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	06/24/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Hospice Contact	Rx Government Programs Analyst	Mr.	Beebe	Colin		5034124175	4175			8002078235	colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	06/04/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Interoperability Contact	Director Regulatory Affairs and Privacy Officer	Mr	White	Scott		5039525044					scott.white@modahealth.com	601 SW Second Ave		Portland	OR	97204	04/17/2023	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	MA Appeals/Grievances Contact	Manager Medical Claims		Craft	Jessica		5032193675					jessica.craft@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/30/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	MA Claims Processing Contact for Public Website	Customer Service		Service	Customer		8772999062				5039485577	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/25/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Marketing Contact	Manager Market Intelligence, Medicare	Mr.	Skyba	Richard		5034124215					richard.skyba@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	03/30/2018	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Medical Director	Medical Director	Dr.	Popowich	Yale		5039525022					Yale.Popowich@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/06/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Medicare Coordinator	Medicare Compliance Analyst	Ms.	Seon Hye	Jangmie		5039525245	5245				jangmie.seonhyemcinnes@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/08/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Medication Therapy Management Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Online Enrollment Center Contact (Back-up)	Membership Accounting Trainer	Mr.	Schamber	Jacob		5032286554	1518				jacob.schamber@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	01/22/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Online Enrollment Center Contact (Optional)	Membership Accounting Specialist II		Pahlka	Chelsea		5032654729					chelsea.pahlka@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Online Enrollment Center Contact (Primary)	Supervisor Membership Accounting		Black	Colby		5032655606					colby.black@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Part C Application Contact	Senior Medicare Product Manager	Mrs.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	11/08/2019	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Part C Reporting Contact	Medicare Compliance Analyst	Ms.	Seon Hye	Jangmie	T	5039525245	5245				jangmie.seonhyemcinnes@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	11/11/2019	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Part D Appeals	Manager Medical Claims		Craft	Jessica							jessica.craft@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/30/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active	5032193675				PPO - BBA		C	Seattle
H3813	Part D Appeals Contact (Secondary)	Lead Appeals Coordinator	Ms.	Shattuck	Mica						8339491888	mica.shattuck@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/11/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active	8772999062				PPO - BBA		C	Seattle
H3813	Part D Application Contact	Senior Medicare Product Manager	Mrs.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	11/08/2019	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Part D Benefits Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Part D Claims Submission Contact	Manager, Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/04/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Part D Exceptions Contact	Pharmacy, Customer Service		Service	Customer						8002078235	PharmacyMedicare@modahealth.com	601 S.W. Second Ave.		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active	8887867509				PPO - BBA		C	Seattle
H3813	Part D Exceptions Contact (Secondary)	Manager Pharmacy Operations		Kraemer	Laura							Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active	5032654759				PPO - BBA		C	Seattle
H3813	Part D Price File Contact (Back-up)	Supervisor Pharmacy Operations	Mr.	Beebe	Colin		5034124175	4175			8339491889	colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Pln.Finder@navitus.com	361 Integrity Drive		Madison	WI	53717	06/04/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Part D Quality Assurance Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Part D Reporting Contact	Medicare Compliance Analyst		Seon Hye	Jangmie	T	5039525245	5245				jangmie.seonhyemcinnes@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	11/15/2019	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Patient Safety Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Payment Contact	Corporate Controller		Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Pharmacy Director	Director, Pharmacy		Rodriguez	Carly		5039525011					carly.rodriguez@modahealth.com	601 SW Second Ave		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688				6087292688	Jan.Robinson@navitus.com	361 Integrity Drive		Madison	WI	53717	03/31/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Pharmacy Network Management Contact (Secondary)	Supervisor, Pharmacy Network Support		Burke	Sharon		8587907148				8587906011	Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/17/2013	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Pharmacy Technical Help Desk Contact	Sr. Manager, Customer Care Accounts		Nett	Danielle						9202214724	Danielle.Nett@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	04/22/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active	8662703877				PPO - BBA		C	Seattle
H3813	Plan Directory Contact for Public Website			Service	Customer		8772999062				5039485577	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/25/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Plan to Plan Reconciliation Contact	Lead Pharmacy Benefit Formulary Coordinator	Ms	Brokaw	Katie		5032654771	4771				katie.brokaw@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/22/2020	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Processor Contact	Manager, Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Quality Contact	Manager, Quality Metrics		Trenholme	Nathan		5032652935				5032654790	nathan.trenholme@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/29/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Reconciliation Contact	Supervisor, Rx Quality and Compliance		Brokaw	Katie		5032654771					katie.brokaw@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	02/23/2022	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Reconciliation Contact (Secondary)	Manager, Underwriting	Mr.	Danburg-Wyld	Mark		5039525020					mark.danburgwyld@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	07/12/2019	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Recovery Audit Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Surveillance Contact	Medicare Compliance Officer		McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	System Contact	Medicare Compliance Officer		McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Third Party Administrator (TPA) Liaison	Corporate Controller	Ms.	Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 SW Second Ave		Portland	OR	97204	08/18/2016	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	User Access Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Utilization Management Contact			Services	Healthcare		8005928283				8556372666	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/25/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3813	Utilization Review Contact			Services	Healthcare		8005928283				8556372666	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/25/2017	2023	MODA HEALTH PLAN, INC.	Local CCP	Moda Health Plan, Inc.	Local PPO		Moda Partners, Inc.	226	Yes	Active					PPO - BBA		C	Seattle
H3814	Agent/Broker Compensation Data Contact	VP Sales Operations		Hohenberg	Brandon		5058600441					brandon.hohenberg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Esp	Bryan		8587906445					PartDCAT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/04/2015	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Backup User Access Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Best Available Evidence Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Bid Audit Contact	Chief Compliance Officer	Mrs.	Flynn	Jordan		6026924381					jordan.flynn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Bid Audit Site Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Bid Primary Contact	VP of Product		Viveiros	Matt		9175826324					matt.viveiros@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	CAP Report Contact for Public Website	Chief Compliance Officer		Flynn	Jordan		9713040068				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	6026924381				HMO - Health Maintenance Organization		C	Seattle
H3814	CEO - CMS Administrator Contact	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	CEO - Senior Official for Contracting	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Chief Financial Officer	Chief Financial Officer	Mr.	Stewart	Mark		4012848679					mark.stewart@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Chief Operating Officer	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Chief Information Officer	Chief Information Officer	Mr.	Snyder	Dan		9712089848					dan.snyder@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Chief Information Security Officer	Information Security Officer	Mr.	Rohver	Eric		5414922164					eric.rohveri@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	CMS Casework Communication Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Complaints Tracking Contact	Director of Appeals and Grievances		Vaughn	Sara		9712094307				5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Contact for Fraud Investigations	HIPAA Privacy Officer/FWA Program Manager		Saunders Ricks	Rhonda		9713040043				5035841772	rhonda.saundersricks@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Coordination of Benefits Contact	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Corporate Mailing						8776728620				5035841772	compliance@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/20/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Controller		Kirkpatrick	James		5034285602					james.kirkpatrick@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/17/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Customer Service Operations Contact	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	DIR Contact	Vice President of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	DIR Contact (Secondary)	Director of Actuarial Services		Guest IV	William		5039677386					william.guestIV@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Emergency Part D Contact	VP Pharmacy Operations	Ms.	Liu	Helen		9707129377					helen.liu@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Emergency Part D Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Encounter Data & Risk Adjustment Operations Contact	CFO		Stewart	Mark		4012848679					mark.stewart@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Enrollment Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	EOB Transfer Contact	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441				9512067316	jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Financial Audit Contact	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Financial Reporting Contact	CFO		Stewart	Mark		4012848679				5416728670	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Formulary Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Formulary Contact (Secondary)	Supervisor, Formulary Services		Nyawabila	Christina		8587906297					FMT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/04/2015	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	General Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Government Relations Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	HIPAA Privacy Officer	HIPAA Privacy Officer/FWA Program Manager		Saunders Ricks	Rhonda		9713040043				5035841772	rhonda.saundersricks@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	HIPAA Security Officer	ISO	Mr.	Rohver	Eric		5414922164					eric.rohveri@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Hospice Contact	VP of Pharmacy Operations	Ms.	Liu	Helen		9707129377					helen.liu@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Interoperability Contact	Chief Technology Officer		Snyder	Dan		9712089848					dan.snyder@atriohp.com	1965 Ryan Dr. SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	MA Appeals/Grievances Contact	Director of Appeals and Grievances		Vaughn	Sara		9712094307				5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	MA Claims Processing Contact for Public Website	customer service		Service	Customer		8776728620				5416728670	customerservice@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	10/05/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Marketing Contact	Compliance Manager	Mr.	Allotta	Tony		8303090299					tony.allotta@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	06/09/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Medical Director	Chief Medical Director		Wethers	Darren		3143782525					darren.wethers@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Medicare Coordinator	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Medicare Part D Opioid Overutilization Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	01/19/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Medication Therapy Management Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	OffShore Subcontractor Contact	Chief Legal Officer, General Counsel		Wilson	Charles		5039677387				5035841772	charles.wilson@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	05/18/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Online Enrollment Center Contact (Optional)	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Online Enrollment Center Contact (Primary)	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Part C Application Contact	Chief Legal Officer		Wilson	Charles		5039677387				8662569002	charles.wilson@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	02/15/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Part C Reporting Contact	Compliance Manager	Mrs.	Luma	Yoleine		9172080084					yoleine.luma@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/09/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Appeals	Director of Appeals and Grievances		Vaughn	Sara						5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	8776728620	3			HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Appeals Contact (Secondary)	VP of Pharmacy Operationss		Liu	Helen						5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	9707129377				HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Application Contact	Chief Legal Officer		Wilson	Charles		5039677387				8662569002	charles.wilson@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	02/15/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Benefits Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Claims Submission Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Exceptions Contact	Director of Appeals and Grievances		Vaughn	Sara						5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	11/11/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	8776728620	3			HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Exceptions Contact (Secondary)	VP of Pharmacy Operations	Ms.	Liu	Helen						5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	9717129377				HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Price File Contact (Back-up)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Price File Contact (Optional)	Medicare Part D Project Manager		Maldonado	Cheryl		8587906397					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct,		San Diego	CA	92131	04/09/2014	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Price File Contact (Primary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Quality Assurance Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Part D Reporting Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Patient Safety Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Payment Contact	President & CEO		Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Personal Health Record Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Pharmacy Director	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Pharmacy Network Management Contact	Supervisor, Pharmacy Network Support		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	03/13/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Pharmacy Network Management Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Pharmacy Technical Help Desk Contact	Director, Contact Center Services		Brewer	Kathy							Customerservice@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/08/2018	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	8006819571				HMO - Health Maintenance Organization		C	Seattle
H3814	Pharmacy Technical Help Desk Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen							helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	9707129377				HMO - Health Maintenance Organization		C	Seattle
H3814	PHR Beneficiary Contact																	05/09/2018	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS	ATRIO Health Plans	ATRIO Health Plans	5	Yes	Active	8776728620				HMO - Health Maintenance Organization		C	Seattle
H3814	Plan Directory Contact for Public Website	Customer Service		Service	Customer		8776728620				5416728670	customerservice@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	10/05/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Plan to Plan Reconciliation Contact	Chief Financial Officer		Stewart	Mark		4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Processor Contact	Director, Medicare Programs		Scherlippens	Carine		8587907415					Carine.Scherlippens@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	04/09/2014	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Quality Contact	Chief Medical Director		Wethers	Darren		3143782525					darren.wethers@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Reconciliation Contact	Chief Financial Officer		Stewart	Mark		4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Reconciliation Contact (Secondary)	Director of Actuarial Services		Guest IV	William		5039677386					william.guestIV@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	02/17/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Recovery Audit Contact	CFO	Mr.	Stewart	Mark		4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	SNP Application Contact	Director of SNP Programs		Yaun	Caroline		9526886695					caroline.yaun@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	09/08/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	SNP State Contact	Director of SNP Programs		Yaun	Caroline		9526886695					caroline.yaun@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	09/08/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Surveillance Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	System Contact	Chief Technology Officer	Mr.	Snyder	Dan		9712089848					dan.snyder@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Third Party Administrator (TPA) Liaison	Chief Operating Officer		Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	User Access Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	jordan.flynn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/20/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Utilization Management Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3814	Utilization Review Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3815	Agent/Broker Compensation Data Contact	VP, Sales		Simonds	Kristina		6572187635					KSimonds@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Automated TrOOP Balance Transfer Contact	PBM - Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	10/01/2020	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Backup User Access Contact	Compliance Director		Spitzer	Chandra		6572745530					CSpitzer@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Best Available Evidence Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Bid Audit Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Bid Audit Site Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Bid Primary Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	CAP Report Contact for Public Website	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	CEO - CMS Administrator Contact	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	CEO - Senior Official for Contracting	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Chief Financial Officer	Chief Financial Officer	Mr.	Freeman	Thomas		6572187604					TFreeman@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Chief Operating Officer	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Kardes	Hakan		6572187772					hkardes@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	03/29/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Chief Information Security Officer	VP, Technology & CISO	Mr.	MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	CMMI Model Point of Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	CMS Casework Communication Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Complaints Tracking Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Contact for Fraud Investigations	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Coordination of Benefits Contact	AVP, Membership & Eligibility		Torres	Carrie		6572187409	2109				CArreola@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Corporate Mailing						6572187713				8443202247	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	07/14/2015	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Coverage Gap Discount Program (CGDP) Payment Contact	Manager Financial Operations		De La Torre	Angelo		8443102247	2122			5622074634	adelatorre@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Customer Service Operations Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	DIR Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	DIR Contact (Secondary)	AVP, Pharmacy		Liu	Ruby		3237287232	2316				RLiu@AHCUSA.com	1100 W. Town & Country Rd., Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Electronic Health Record Contact	AVP, Platform Product		Brown Hayes	Michael		7144979628					MBrown-Hayes@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	04/01/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Emergency Part D Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Emergency Part D Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		3108667966				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Employer Waiver Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Encounter Data & Risk Adjustment Operations Contact	VP Risk Adjustment		Bogdanov	Eyosef		5623666179					ebogdanov@ahcusa.com	1100 W. Town and Country Rd.	Suite 1600	Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Enrollment Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	EOB Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/19/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Financial Audit Contact	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Financial Reporting Contact	Sr. Director, Accounting & Reporting		Tran	Sue Anne		6572187673	7673				stran@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Formulary Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Formulary Contact (Secondary)	PBM - Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/19/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	General Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Government Relations Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	HIPAA Privacy Officer	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	HIPAA Security Officer	VP, Technology & CISO		MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Hospice Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Interoperability Contact	VP, Data Engineering & BI CTO Data and Al		Sam	Georgie		8188807212					gsam@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/01/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	MA Appeals/Grievances Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	MA Claims Processing Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Marketing Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Medical Director	SVP Market Management WCR	Dr.	Kim	John		6572187640				5622074617	JKim@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Medicare Compliance Officer	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy	B	6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Medicare Coordinator	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Medicare Part D Opioid Overutilization Contact	PBM - Supv Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	07/06/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Medication Therapy Management Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	OffShore Subcontractor Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	CLynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Online Enrollment Center Contact (Back-up)	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Online Enrollment Center Contact (Optional)	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Online Enrollment Center Contact (Primary)	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Part C Application Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Part C Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Appeals	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/19/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Appeals Contact (Secondary)	Sr. Manager, Appeals & Grievance		Jimenez	Gudelia							GJimenez@ahcusa.com	1100 W. Town and Country Road, Suite #300		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187488	2188			HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Application Contact	CEO		Maroney	Dawn		5623346192				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Benefits Contact	PBM - Director, Benefit Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/19/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Claims Submission Contact	PBM - Functional Business Consultant Govt Programs		Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	03/19/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Exceptions Contact	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/31/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Exceptions Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali							AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187709				HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Price File Contact (Back-up)	PBM - Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/19/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Price File Contact (Optional)	PBM - QA Analyst		Tastad	Emily		6127776931					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/21/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Price File Contact (Primary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Quality Assurance Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Part D Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Patient Safety Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Payment Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Personal Health Record Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Pharmacy Director	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Pharmacy Network Management Contact	PBM - AVP, Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	03/31/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Pharmacy Network Management Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/21/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H3815	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	07/09/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H3815	PHR Beneficiary Contact																	11/18/2015	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS	Alignment Health Plan	Alignment Healthcare USA, LLC	612	Yes	Active	8666342247				HMO - Health Maintenance Organization		C	San Francisco
H3815	Physician Incentive Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Plan Directory Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Plan to Plan Reconciliation Contact	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122			5622074266	adelatorre@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Processor Contact	Manager, PBM Operations		Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/31/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Quality Contact	Sr. Director, Quality Management/Credentialing		Lacock	Lisa		6572187638					LLacock@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Reconciliation Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Reconciliation Contact (Secondary)	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122				adelatorre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Recovery Audit Contact	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	SNP Application Contact	Director, Product Management		Torres	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	SNP State Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Surveillance Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	System Contact	VP, AVA Health Plan Systems & Operations		Bates	Patrick		6572187636	7636				PBates@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	03/25/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Third Party Administrator (TPA) Liaison	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122				adelatorre@ahcusa.com	1100 W. Town and Country Rd, Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	User Access Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Utilization Management Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3815	Utilization Review Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H3817	Agent/Broker Compensation Data Contact	VP Medicare Sales	Mr.	Hess	Brent		8013336143					Brent.Hess@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	07/06/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Automated TrOOP Balance Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Backup User Access Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St.	MS:E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Best Available Evidence Contact	Membership Ambassador	Ms.	Neufeld	Jeri		8006621470	2526			8883352988	ORMEMMEDAmbassador@regence.com	PO Box 1827		Medford	OR	97501	02/16/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Bid Audit Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Bid Audit Site Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Bid Primary Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	CAP Report Contact for Public Website	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	CEO - CMS Administrator Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/04/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	CEO - Senior Official for Contracting	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/09/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Chief Financial Officer	SVP & CFO	Mr.	Rains	Mike		2063326521					Mike.Rains@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Chief Operating Officer	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Chief Information Officer	SVP STRATEGIC TECH SOL & CIO	Mr	Rotival	Laurent		2063325034					Laurent.Rotival@cambiahealth.com	200 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Chief Information Security Officer	VP & CHIEF INFO SEC OFFICER	Mr	Anderson	Kirk		5037251608					Kirk.Anderson@cambiahealth.com	100 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	CMMI Model Point of Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	CMS Casework Communication Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Complaints Tracking Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Contact for Fraud Investigations	Senior Audit Investigator	Ms.	Grimes-Burke	Jennifer		5035873355					Jennifer.Grimes-Burke@regence.com	100 SW Market St	M/S E12B	Portland	OR	97201	06/16/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Coordination of Benefits Contact	Manager, Member Services	Ms	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	PO Box 1827	MS: B32M	Medford	OR	97501	07/09/2016	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Corporate Mailing						5032206237				5035884350	Jennifer.DelVillar@regence.com	100 SW Market Street		Portland	OR	97201	01/07/2013	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Sr I	Mr.	Gerken	Matthew		2063324809					Matthew.Gerken@cambiahealth.com	1800 9th Ave		Seattle	WA	98101	04/19/2016	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Customer Service Operations Contact	Manager Member Services	Ms	Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	DIR Contact	Manager Pharmacy Informatics		Kidd	Vicki		2083957739				2083337874	vicki.kidd@regence.com	1211 West Myrtle, Suite 110		Boise	ID	83702	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	DIR Contact (Secondary)	Dir. Gov. Pro Compliance / Medicare Compliance Off	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street E10C		Portland	OR	97201	07/22/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Emergency Part D Contact	VP Pharm Ops & Compliance	Mr.	Weiss	Justin		5032256677					Justin.Weiss@cambiahealth.com	200 SW Market St		Portland	OR	97201	12/20/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Emergency Part D Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Employer Waiver Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment, Manager	Mr.	Moore	Jason		2087982318					Jason.Moore@cambiahealth.com	1602 21st Ave		Lewiston	ID	83501	10/18/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Enrollment Contact	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	EOB Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Financial Audit Contact	Government Programs Audit Consultant	Mr.	Hutt	Brian		5032206160					Brian.Hutt@regence.com	200 SW Market Street	MS: E10C	Portland	OR	97201	05/09/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Financial Reporting Contact	Fin Acctg & Reporting, Assistant Director	Mr	Striplin	Daniel	W	5032256069					Dan.Striplin@regence.com	200 SW Market		Portland	OR	97201	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Formulary Contact	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Ave		Portland	OR	97201	01/18/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	General Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Government Relations Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St.	MS:E10C	Portland	OR	97201	04/18/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	HIPAA Privacy Officer	VP Chief Compliance & Privacy Officer	Ms.	Erbes	Kristen		5035256533					kristen.erbes@regence.com	200 SW Market St	M/S: E14A	Portland	OR	97201	02/25/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	HIPAA Security Officer	Chief Information Security Officer	Mr.	Person	Steve		5037251654					Steve.Person@regence.com	1621 SW First Ave.		Portland	OR	97201	02/25/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Hospice Contact	Pharmacy Ops Oversight Specialist	Ms.	Pickens	Spring		5032255240					Spring.Pickens@regence.com	100 SW Market St	MS: WW5-56	Portland	OR	97201	02/05/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Interoperability Contact	VP Chief Tech Officer		Anderson	Kirk		5037251608					kirk.anderson@cambiahealth.com	Cambia Health Solutions	200 SW Market Street	Portland	OR	97201	02/09/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	MA Appeals/Grievances Contact	Director, Clinical Services Operations	Ms.	Sikora	Joelle		2063325320					Joelle.Sikora@regence.com	1800 Ninth Avenue		Seattle	WA	98101	05/09/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	MA Claims Processing Contact for Public Website	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Marketing Contact	Compliance Analyst		Meirose	Robyn		5033918668					robyn.meirose@regence.com	200 SW Market St  MS: E10C		Portland	OR	97201	09/15/2015	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Medical Director	SVP Chief Medical Officer	Ms.	Milavetz	Donna		8013336740					Donna.Milavetz@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	12/05/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Medicare Compliance Officer	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	07/14/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Medicare Coordinator	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827		Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Medicare Part D Opioid Overutilization Contact	Drug Management Program	Ms.	Anderson	Ally		8557297221					partdoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Medication Therapy Management Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Online Enrollment Center Contact (Back-up)	Dir Medicare Planning & Performance	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Online Enrollment Center Contact (Optional)	Manager Member Services	Ms.	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	2057 Commerce Dr		Medford	OR	97504	11/06/2017	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Online Enrollment Center Contact (Primary)	Spv Membership, GP OR Medicare Ops & Billing	Ms.	Cromwell	Krista		5416181286					Krista.Cromwell@regence.com	PO Box 1827	M/S: B32M	Medford	OR	97501	03/07/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Part C Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Part C Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				PPO - BBA		C	Seattle
H3817	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossig Rd	Eagan	MN	55120	03/21/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8006936651				PPO - BBA		C	Seattle
H3817	Part D Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Part D Benefits Contact	Product Manager III	Ms.	Holliston	Danica		5032254871					Danica.Holliston@regence.com	200 SW Market St  M/S: E10M		Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Part D Claims Submission Contact	Functional Business Consultant - Government Prgrms	Mr.	Brook	Lance		4026862603					LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	08/05/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				PPO - BBA		C	Seattle
H3817	Part D Exceptions Contact (Secondary)	Asst Director Pharmacy Operations	Ms.	Yi	Edie							edie.yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	972071271	12/15/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	5032254801				PPO - BBA		C	Seattle
H3817	Part D Price File Contact (Back-up)	Database Reporting Analyst	Ms	Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Part D Price File Contact (Optional)	QA Analyst Sr	Ms.	Tastad	Emily		6127772557					emily.tastad@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/03/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Part D Price File Contact (Primary)	AD Pharmacy Informatics	Ms.	Kidd	Vicki		2083957739					Vicki.Kidd@regence.com	1211 West Myrtle		Boise	ID	83702	07/22/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Part D Quality Assurance Contact	Assistant Dir Pharmacy Operations	Ms.	Yi	Edie		5032254801				2083957744	Edie. Yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	97201	12/27/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Part D Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Patient Safety Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Payment Contact	Asst Director Fin Acctg & Reporting	Mr.	Striplin	Dan		5032256069					Dan.Striplin@cambiahealth.com	100 SW Market St	M/S: C2A	Portland	OR	97201	01/14/2014	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Pharmacy Director	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Avenue, M/S PDX - WW3-33		Portland	OR	97201	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Pharmacy Network Management Contact	AVP, Network Mangement	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/18/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Management Relations		Lenhart	Alicia		6127773969				8778236373	Alicia.Lenhart@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Pharmacy Technical Help Desk Contact	Director, Member Services Government Programs	Mr.	Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				PPO - BBA		C	Seattle
H3817	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jon							jonathan.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				PPO - BBA		C	Seattle
H3817	Plan Directory Contact for Public Website	Manager Member Services		Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Plan to Plan Reconciliation Contact	Pharmacy Operations Oversight Specialist, Sr.	Ms.	Manzer	Amy		5032255368					Amy.Manzer@regence.com	200 SW Market St	M/S: PDX-ZOF WW3-33	Portland	OR	97201	08/26/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing	Egan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Quality Contact	Director, Quality Management	Mr.	Mcclure	Andy		5032206189					Andrew.Mcclure@regence.com	1621 SW First Ave	M/S WW5-52	Portland	OR	97201	04/12/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Reconciliation Contact	VP Finance Controller		Vannoy	Anjie		5032761865					Anjie.Vannoy@cambiahealth.com	100 SW Market St.	MS:PDX-WW2-21	Portland	OR	97201	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Reconciliation Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS:E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Recovery Audit Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Surveillance Contact	Government Programs Compliance Officer		Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St  M/S: E10C		Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	System Contact	Medicare Business Operations, Product Owner	Ms.	Fredinburg	Deana		5033754426					Deana.Fredinburg@regence.com	PO BOX 1827	M/S: B32AG	Medford	OR	97501	06/24/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Third Party Administrator (TPA) Liaison	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St		Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	User Access Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Utilization Management Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3817	Utilization Review Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H3822	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Servce Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	11/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	12/04/2018	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	02/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/04/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	02/10/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3822	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3822	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	08/09/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3822	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3822	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	11/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/22/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8772777898				HMO - Health Maintenance Organization		C	Denver
H3822	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	0000000000				HMO - Health Maintenance Organization		C	Denver
H3822	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	09/21/2018	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	07/29/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	04/26/2016	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3822	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	04/26/2016	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3828	Agent/Broker Compensation Data Contact	Director of Sales		Dues	Travis		6145463157				6145463131	Travis.Dues@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Automated TrOOP Balance Transfer Contact	Part D Analyst		Houk	Kim		6145463183				6145463131	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Backup User Access Contact	Sr. Application Specialist		Crawford	Carl		6145463215				6145463144	ccrawford@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Best Available Evidence Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Bid Audit Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463211	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Bid Audit Site Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Bid Primary Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	CAP Report Contact for Public Website	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	CEO - CMS Administrator Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	Jack.Randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	CEO - Senior Official for Contracting	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Chief Financial Officer	Chief Financial Officer	Mr	Vis	David		6145463211				6145463131	david.vis@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Chief Operating Officer	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Chief Information Officer	VP Service Optimization	Mr.	Trimmer	Matt		3017547190					matt.trimmer@trinity-health.org	3100 Easton Square Place		Columbus	OH	43219	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Chief Information Security Officer	Sr Security Manager, Enterprise Information Securi	Mr.	Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	CMS Casework Communication Contact	Compliance Specialist	Mr.	Jordan	David	A	6147068474				6142348372	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Complaints Tracking Contact	Compliance Specialist	Mr	Jordan	David	A	6147068474					djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Contact for Fraud Investigations	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Coordination of Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Corporate Mailing						4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Customer Service Operations Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	DIR Contact	CEO		Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square  Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	DIR Contact (Secondary)	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Electronic Health Record Contact	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Emergency Part D Contact	Chief Compliance Officer		Suffern	Patricia		4124780244				6145463132	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	12/23/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Emergency Part D Contact (Secondary)	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Employer Waiver Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Reconciliation Analyst		Sloan	Mike		6145463134					mike.sloan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Enrollment Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	EOB Transfer Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Financial Audit Contact	Chief Administration Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Financial Reporting Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Formulary Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Formulary Contact (Secondary)	Director, Pharmacy		Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	General Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Government Relations Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	HIPAA Privacy Officer	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	HIPAA Security Officer	Sr Security Manager, Enterprise Information Securi		Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Hospice Contact	Senior Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Interoperability Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	MA Appeals/Grievances Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	MA Claims Processing Contact for Public Website	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Marketing Contact	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Medical Director	MD	Dr.	Wise	Greg		6145463151				6145463131	gwise@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Medicare Compliance Officer	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Medicare Coordinator	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Medicare Part D Opioid Overutilization Contact	Pharmacy Data Analyst	Ms.	Houk	Kimberly		6145463183					kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Medication Therapy Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	OffShore Subcontractor Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment	Ms	Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Online Enrollment Center Contact (Optional)	Director, Enrollment and Premium Billing		Caudle	Jeff		6145463224				6145463148	jcaudle@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Online Enrollment Center Contact (Primary)	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Part C Application Contact	Director, Product Management and Business Devlpt		Mauck	Brandon		6145955681					brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Part C Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Part D Appeals	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H3828	Part D Appeals Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H3828	Part D Application Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Part D Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Part D Claims Submission Contact	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Part D Exceptions Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H3828	Part D Exceptions Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H3828	Part D Price File Contact (Back-up)	Formulary Consultant		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea		Scottsdale	AZ	85260	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Part D Price File Contact (Primary)	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Part D Quality Assurance Contact	Director of Pharmacy, Health Plans		Turoff	Chris		6144030394				6142346481	chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Part D Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Patient Safety Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Payment Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Pharmacy Director	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Pharmacy Network Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Pharmacy Network Management Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Pharmacy Technical Help Desk Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active	8666934620				PPO - BBA		C	Chicago
H3828	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Data Analyst	Mrs	Miller	Kim							kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active	8666934620				PPO - BBA		C	Chicago
H3828	PHR Beneficiary Contact																	02/01/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO	MediGold	Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H3828	Physician Incentive Contact	Interim VP, Health Services	Ms	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Plan Directory Contact for Public Website	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Plan to Plan Reconciliation Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Processor Contact	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Quality Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Reconciliation Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Reconciliation Contact (Secondary)	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Recovery Audit Contact	Chief Administrative Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Surveillance Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	System Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Third Party Administrator (TPA) Liaison	Sr Finance Analyst		Fountain	Lisa		6145463220					lfountain@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	User Access Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Utilization Management Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3828	Utilization Review Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H3832	Agent/Broker Compensation Data Contact	Supervisor, Medicare Sales		Guzman	Tati		8089485463				8089486585	tati_guzman@hmsa.com	P.O. Box 860	8 AMS	Honolulu	HI	96808	12/29/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Automated TrOOP Balance Transfer Contact	Senior Business Analyst		Kalino	Karen		8089486262				8089486585	karen_apiki_kalino@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	11/27/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Backup User Access Contact	VP, Chief Compliance Officer		Nakamura	Carrie		8089485369					carrie_nakamura@hmsa.com	P.O. Box 860	10-CE	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Best Available Evidence Contact	Manager, Membership Services		Makio	Lani		8089486215				8089486285	lani_makio@hmsa.com	P.O. Box 860	7 - MS	Honolulu	HI	96808	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Bid Audit Contact	EVP, Chief Financial Officer		Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Bid Audit Site Contact	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Bid Primary Contact	President & Consulting Actuary		Swain	Gavin		8089527931					Gavin_Swain@hmsa.com	2333 Kapiolani Blvd	gXs Consulting, LLC	Honolulu	HI	96826	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Rivad	Maila		8089485767				8089486585	MCO@hmsa.com	P.O. Box 860	10-CE	Honolulu	HI	96808	01/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	CEO - CMS Administrator Contact	President and CEO	Mr.	Mugiishi	Mark		8089485021				8089485999	mark_mugiishi@hmsa.com	P.O. Box 860	11-EXEC	Honolulu	HI	96808	01/05/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	CEO - Senior Official for Contracting	President and CEO	Mr.	Mugiishi	Mark		8089485021				8089485999	mark_mugiishi@hmsa.com	P.O. Box 860	11-EXEC	Honolulu	HI	96808	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Chief Financial Officer	EVP, Chief Financial Officer	Ms.	Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Chief Operating Officer	EVP, Chief Business Operations Officer	Mr.	Herndon	David		8089485099					David_Herndon@hmsa.com	P.O. Box 860	11-EXEC	Honolulu	HI	96808	08/08/2019	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Chief Information Officer	SVP and Chief Information Officer	Mr.	Hopfer	Rick		8089486025				8089485999	rick_hopfer@hmsa.com	P.O. Box 860	11-EXEC	Honolulu	HI	96808	07/14/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Chief Information Security Officer	CISO and Privacy Officer	Mr.	Gummadi	Sudhakar		8089485737				8089527580	sudhakar_gummadi@hmsa.com	P.O. Box 860	10-IPP	Honolulu	HI	96808	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	CMS Casework Communication Contact	Medicare Grievance & Appeal Coordinator		Hartenstein	Renee		8089485347				8089527546	Renee_Hartenstein@hmsa.com	P.O. Box 860	KB-MAA	Honolulu	HI	96808	12/29/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Complaints Tracking Contact	Medicare Grievance & Appeal Coordinator		Hartenstein	Renee		8089485347				8089527546	renee_hartenstein@hmsa.com	P.O. Box 860	KB-MAA	Honolulu	HI	96808	11/24/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Contact for Fraud Investigations	Director, Special Investigations Unit		Aronson	Virginya		8089528548					virginya_aronson@hmsa.com	P.O. Box 860	10 SIU	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Coordination of Benefits Contact	Sr Mgr, Internal Operations		Shimamura	Ross		8089486294					ross_shimamura@hmsa.com	P.O. Box 860	7-CA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Corporate Mailing						8089486000					!MedicarePrograms@hmsa.com	P.O. Box 860	9 - MP	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Customer Service Operations Contact	Manager, Customer Relations Operations		Unger	Kevin		8089486186				8089485567	Customer-service@hmsa.com	P.O. Box 860	7 CR	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	DIR Contact	EVP, Chief Financial Officer		Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	DIR Contact (Secondary)	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Emergency Part D Contact	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Emergency Part D Contact (Secondary)	Health Management Operations Compliance Analyst		Iwaishi	Brandon		8089485618					brandon_iwaishi@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Encounter Data & Risk Adjustment Operations Contact	Manager		Nakashima	Mark	M	8089486594					Mark_Nakashima@hmsa.com	P.O. Box 860	6-HGRP	Honolulu	HI	968080860	11/08/2019	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Enrollment Contact	Manager, Membership Services		Makio	Lani		8089486215				8089486285	lani_makio@hmsa.com	P.O. Box 860	7 - MS	Honolulu	HI	96808	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	EOB Transfer Contact	Senior Business Analyst, Medicare Programs		Refuerzo	Marilou		8084970295				8089486585	marilou_refuerzo@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Financial Audit Contact	Director, Government Accounting and Reporting	Ms.	Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Financial Reporting Contact	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Formulary Contact	Health Management Operations Compliance Analyst		Iwaishi	Brandon		8089485618					brandon_iwaishi@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	05/10/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Formulary Contact (Secondary)	Manager, Clinical Pharmacy		Kuniyoshi	Derek		8089486723				8089488298	derek_kuniyoshi@hmsa.com	1601 Kapiolani Blvd.	10-KB-PM	Honolulu	HI	96814	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	General Contact	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Government Relations Contact	SVP, Government		Diesman	Jennifer		8085616397				8089486860	jennifer_diesman@hmsa.com	P.O. Box 860	11 EXEC	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	HIPAA Privacy Officer	CISO and Privacy Officer	Mr.	Gummadi	Sudhakar		8089485737				8089527580	sudhakar_gummadi@hmsa.com	P.O. Box 860	10-IPP	Honolulu	HI	96808	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	HIPAA Security Officer	CISO and Privacy Officer	Mr.	Gummadi	Sudhakar		8089485737				8089527580	sudhakar_gummadi@hmsa.com	P.O. Box 860	10-IPP	Honolulu	HI	96808	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Hospice Contact	Business Analyst - Medicare Part D		Pagura	Herch		8089486559				8089485611	herch_pagura@hmsa.com	PO Box 860	PM - Administration	Honolulu	HI	96808	11/03/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Interoperability Contact	VP, Health Data Integ & Analytic		Dobbs	David	C	8089486030					david_dobbs@hmsa.com	P.O. Box 860	6 CORP	Honolulu	HI	96808	04/08/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	MA Appeals/Grievances Contact	Senior Manager, Member Advocacy & Appeals		Dureg	Jeron		8089485180				8089527546	jeron_dureg@hmsa.com	P.O. Box 860	KB-MAA	Honolulu	HI	96808	11/27/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	MA Claims Processing Contact for Public Website	Director, Payment Integrity & Quality Assurance		Nagao	Traci		8089485599				8089486210	traci_nagao@hmsa.com	P.O. Box 860	7 - CA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Marketing Contact	Bus Analyst II - Medicare		England	Belle		8089481064					belle_england@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Medical Director	Medicare Medical Director		Percy	David		8089486252				8089486340	david_percy@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Rivad	Maila		8089485767				8089486585	MCO@hmsa.com	P.O. Box 860	10-CE	Honolulu	HI	96808	01/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Medicare Coordinator	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Medicare Part D Opioid Overutilization Contact	Manager, Clinical Pharmacy		Kuniyoshi	Derek		8089486723				8089488298	derek_kuniyoshi@hmsa.com	1601 Kapiolani Blvd.	10-KB-PM	Honolulu	HI	96814	07/02/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Medication Therapy Management Contact	BH Business Analyst		Francis	Teesha		8089527564					teesha_francis@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Online Enrollment Center Contact (Back-up)	Business Analyst, TIQI, Enrollment		Del Toro	Chris		8089527848					Chris_Del_Toro@hmsa.com	P.O. Box 860	7-CR	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Online Enrollment Center Contact (Optional)	Bus Analyst II - Medicare		England	Belle		8089481064					belle_england@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Online Enrollment Center Contact (Primary)	Manager, Membership Services		Makio	Lani		8089486215				8089486285	lani_makio@hmsa.com	P.O. Box 860	7 MS	Honolulu	HI	96808	10/19/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Part C Application Contact	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Rivad	Maila		8089485767				8089486585	MCO@hmsa.com	P.O. Box 860	10-CE	Honolulu	HI	96808	10/09/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Part D Appeals	Senior Manager, Member Advocacy & Appeals		Dureg	Jeron						8089527546	jeron_dureg@hmsa.com	P.O. Box 860	KB-MAA	Honolulu	HI	96808	11/27/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active	8089485180				PPO - BBA		C	San Francisco
H3832	Part D Appeals Contact (Secondary)	Senior Business Analyst		Kalino	Karen						8089486585	karen_apiki_kalino@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	11/27/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active	8089486262				PPO - BBA		C	San Francisco
H3832	Part D Application Contact	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Part D Benefits Contact	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Part D Claims Submission Contact	EVP, Chief Financial Officer		Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Part D Exceptions Contact	Manager, Clinical Pharmacy		Kuniyoshi	Derek						8089488298	derek_kuniyoshi@hmsa.com	1601 Kapiolani Blvd.	10-KB-PM	Honolulu	HI	96814	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active	8004622085				PPO - BBA		C	San Francisco
H3832	Part D Price File Contact (Back-up)	Manager		Loveland	Chet		4806064873				4013357984	chet.loveland@CVSHealth.com	9501 E Shea Blvd	CVS Caremark	Scottsdale	AZ	85260	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Part D Price File Contact (Optional)	Program Manager  PBM Finance Operations		Pertgen	Richard		8045258502					Richard.Pertgen@cvshealth.com	9501 E. Shea Blvd. MC080	CVS Caremark	Scottsdale	AZ	85260	12/29/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Part D Price File Contact (Primary)	Sr. Manager		Okrie	Courtney		4803181864				4013357984	courtney.okrie@cvshealth.com	9501 E. Shea Blvd. MC080	CVS Caremark	Scottsdale	AZ	85260	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Part D Quality Assurance Contact	Health Management Operations Compliance Analyst		Iwaishi	Brandon		8089485618					brandon_iwaishi@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Part D Reporting Contact	Medicare Compliance Officer	Ms.	Rivad	Maila		8089485767				8089486585	MCO@hmsa.com	P.O. Box 860	10-CE	Honolulu	HI	96808	10/09/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Patient Safety Contact	Manager, Clinical Pharmacy		Kuniyoshi	Derek		8089486723				8089488298	derek_kuniyoshi@hmsa.com	1601 Kapiolani Blvd.	10-KB-PM	Honolulu	HI	96814	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Payment Contact	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Pharmacy Director	VP, Chief Medical Officer		Park	Stefanie		8089486792					stefanie_park@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	05/03/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Pharmacy Network Management Contact	Director		Smith	Shawn		4803914844					shawn.smith@cvshealth.com	9501 E. Shea Blvd., MC080	CVS Caremark	Scottsdale	AZ	85260	12/20/2019	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Pharmacy Network Management Contact (Secondary)	VP, Chief Medical Officer		Park	Stefanie		8089486792					stefanie_park@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	05/03/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Pharmacy Technical Help Desk Contact	Lead Director, Client Operations Customer Care		Neiman	Beth							Beth.Neiman@CVSHealth.com	100 Mall Blvd	CVS Specialty	Monroeville	PA	15146	11/07/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active	8666934620				PPO - BBA		C	San Francisco
H3832	Pharmacy Technical Help Desk Contact (Secondary)	Health Management Operations Compliance Analyst		Iwaishi	Brandon							brandon_iwaishi@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	05/10/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active	8089485618				PPO - BBA		C	San Francisco
H3832	Plan Directory Contact for Public Website	Manager, Customer Relations Operations		Unger	Kevin		8089486186				8089485567	Customer-service@hmsa.com	P.O. Box 860	7 CR	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Plan to Plan Reconciliation Contact	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Processor Contact	Director, Payment Integrity & Quality Assurance		Nagao	Traci		8089485599				8089486210	traci_nagao@hmsa.com	P.O. Box 860	7 - CA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Quality Contact	Director, Medicare Stars		Loo	Trisha		8089486103					Trisha_Loo@hmsa.com	P.O. Box 860	6-QM	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Reconciliation Contact	EVP, Chief Financial Officer		Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Reconciliation Contact (Secondary)	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Recovery Audit Contact	EVP, Chief Financial Officer	Ms.	Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	SNP Application Contact	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8-MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	SNP State Contact	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Surveillance Contact	Supervisor, Medicare Sales		Guzman	Tati		8089485463				8089486585	tati_guzman@hmsa.com	P.O. Box 860	8 AMS	Honolulu	HI	96808	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	System Contact	Solution Delivery Advisor		Ng	Philip		8089486688				8089486799	philip_ng@hmsa.com	P.O. Box 860	5 - IS	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Third Party Administrator (TPA) Liaison	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	User Access Contact	Medicare Compliance Officer	Ms.	Rivad	Maila		8089485767				8089486585	MCO@hmsa.com	P.O. Box 860	10-CE	Honolulu	HI	96808	06/08/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Utilization Management Contact	Senior Manager, MM Operations		Yam	Marlene		8089485745				8089445611	marlene_yam@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	12/28/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3832	Utilization Review Contact	Senior Manager, MM Operations		Yam	Marlene		8089485745				8089445611	marlene_yam@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	12/28/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION	Local CCP	HMSA Akamai Advantage	Local PPO		Hawaii Medical Service Association	107	Yes	Active					PPO - BBA		C	San Francisco
H3864	Agent/Broker Compensation Data Contact	Regional Sales Manager - Medicare Sales		Westphal	Brad		5413304996				5413226423	Brad.Westphal@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Automated TrOOP Balance Transfer Contact	VP, Government Operations		Hannabach	Jane		5413302530					Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	12/17/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Backup User Access Contact	Compliance Manager	Mrs.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	11/12/2019	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Best Available Evidence Contact	VP, Government Operations		Hannabach	Jane		5413302530					Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	12/17/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Bid Audit Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Bid Audit Site Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Bid Primary Contact	VP, Medicare Programs		Moss-Lewis	Jennifer		5413304993					Jennifer.MossLewis@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	CAP Report Contact for Public Website	President and Chief Executive Officer (CEO)	Mr.	Espinola	John		5416845286					John.Espinola@pacificsource.com	555 International Way		Springfield	OR	97477	04/03/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	CEO - CMS Administrator Contact	President and Chief Executive Officer (CEO)	Mr.	Espinola	John		5416845286					John.Espinola@PacificSource.com	555 International Way		Springfield	OR	97477	04/03/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	CEO - Senior Official for Contracting	President and Chief Executive Officer (CEO)	Mr.	Espinola	John		5416845286					John.Espinola@pacificsource.com	555 International Way		Springfield	OR	97477	04/03/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Chief Financial Officer	Executive VP and Chief Financial Officer (CFO)	Mr.	Davidson	Peter		5416845212				5413853008	Peter.Davidson@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Chief Operating Officer	Executive VP and Chief Operating Officer (COO)	Mr.	Doolen	Erick		5416845596					Erick.Doolen@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Chief Information Officer	Executive VP and Chief Operating Officer (COO)	Mr.	Doolen	Erick		5416845596					Erick.Doolen@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Chief Information Security Officer	Executive VP and Chief Operating Officer (COO)	Mr.	Doolen	Erick		5416845596					Erick.Doolen@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	CMS Casework Communication Contact	Team Leader Appeals and Grievances		Downey	Reanna		5417065031					Reanna.Downey@pacificsource.com	PO Box 7469		Bend	OR	97708	07/20/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Complaints Tracking Contact	Team Leader Appeals and Grievances		Downey	Reanna		5417065031					Reanna.Downey@pacificsource.com	PO Box 7469		Bend	OR	97708	07/20/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Contact for Fraud Investigations	Director, Corporate Compliance - Commercial		Holliday	Gary		5416845251					Gary.Holliday@pacificsource.com	555 International Way		Springfield	OR	97475	02/23/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Coordination of Benefits Contact	Claims Manager COB-TPL		Keeler	Dena		5412253765					Dena.Keeler@pacificsource.com	555 International Way		Springfield	OR	97477	04/14/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Corporate Mailing						5413855315				5413853008	Jennifer.MossLewis@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accounts Receivable Accountant		Beaty	Charlene		5416845250					Charlene.Beaty@pacificsource.com	555 International Way		Springfield	OR	97477	08/08/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Customer Service Operations Contact	VP, Government Operations		Hannabach	Jane		5413302530				5413853008	Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	DIR Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999				8003664873	RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	DIR Contact (Secondary)	Manager of Pharmacy Administration, Govt		Riffle	Connie		5413304999				8003664873	connie.riffle@pacificsource.com	PO Box 7469		Bend	OR	97708	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Emergency Part D Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999				8003664873	RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Analytic Manager		Kellogg	Ariel		5412253719					Ariel.Kellogg@pacificsource.com	555 International Way		Springfield	OR	97477	12/20/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Enrollment Contact	VP, Government Operations		Hannabach	Jane		5413302530					Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	12/17/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	EOB Transfer Contact	VP, Government Operations	Mrs.	Hannabach	Jane		5413302530				5413853008	Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Financial Audit Contact	Vice President of Finance	Ms	Patterson	Kari		5416845594					Kari.Patterson@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		Boise	ID	83706	09/26/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Financial Reporting Contact	Executive VP and Chief Financial Officer (CFO)	Mr.	Davidson	Peter		5416845212				5413853008	Peter.Davidson@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Formulary Contact	Rx Clinical Services Team		Services	Pharmacy		5038025965				5413853008	rxclinical@pacificsource.com	PO Box 7469		Bend	OR	97708	12/05/2019	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Formulary Contact (Secondary)	Pharmacy Compliance Specialist		Ryan	Alyssa		5418023031					Alyssa.Ryan@pacificsource.com	1500 SW 1st Ave, Suite 100		Portland	OR	97201	08/29/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	General Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Government Relations Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	HIPAA Privacy Officer	HIPAA Privacy Specialist		Olson	Terrie		5416408765					Terrie.Olson@pacificsource.com	555 International Way		Springfield	OR	97477	08/08/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	HIPAA Security Officer	Executive VP and Chief Operating Officer (COO)	Mr.	Doolen	Erick		5416845596					Erick.Doolen@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Hospice Contact	Manager of Pharmacy Administration, Govt		Riffle	Connie		5413307309				8003664873	Connie.Riffle@pacificsource.com	PO Box 7469		Bend	OR	97708	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Interoperability Contact	IT Director of Technical Solutions		Stucky	David		5412252703					David.Stucky@pacificsource.com	555 International Way		Springfield	OR	97477	12/20/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	MA Appeals/Grievances Contact	Team Leader Appeals and Grievances		Downey	Reanna		5417065031					Reanna.Downey@pacificsource.com	PO Box 7469		Bend	OR	97708	07/20/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	MA Claims Processing Contact for Public Website	VP, Government Operations		Hannabach	Jane		5413302530				5413853008	Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Marketing Contact	VP Enterprise Marketing and Communications		McMaster	Susan		9712225961					Susan.McMaster@pacificsource.com	1500 SW First Avenue, Suite #100A		Portland	OR	97201	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Medical Director	Medical Director	Dr.	McEachern	Edward		5413304999					Rxleadership@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		Boise	ID	83706	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Medicare Compliance Officer	Compliance Manager	Mrs.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/07/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Medicare Coordinator	Compliance Project Coordinator	Mrs.	Ely	Shelley		5413304914					Shelley.Ely@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Medicare Part D Opioid Overutilization Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	12/17/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Medication Therapy Management Contact	Pharmacy Clinical Team		Clinical	Pharmacy		5413304999					RxClinical@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Online Enrollment Center Contact (Primary)	VP, Government Operations		Hannabach	Jane		5413302530				5413853008	Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Part C Application Contact	Compliance Project Coordinator	Mrs.	Ely	Shelley		5413304914					Shelley.Ely@pacificsource.com	PO Box 7469		Bend	OR	97708	10/03/2019	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Part C Reporting Contact	Compliance Manager	Mrs.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Part D Appeals	Team Leader Appeals and Grievances		Downey	Reanna							Reanna.Downey@pacificsource.com	PO Box 7469		Bend	OR	97708	07/20/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active	5417065031				HMO - Health Maintenance Organization		C	Seattle
H3864	Part D Appeals Contact (Secondary)	Manager of Appeals and Grievances		Waltman	Jessica						5413226424	Jessica.Waltman@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		Boise	ID	83706	11/12/2019	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active	2089085825				HMO - Health Maintenance Organization		C	Seattle
H3864	Part D Application Contact	Compliance Project Coordinator	Mrs.	Ely	Shelley		5413304914					Shelley.Ely@pacificsource.com	PO Box 7469		Bend	OR	97708	10/03/2019	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Part D Benefits Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Part D Claims Submission Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Part D Exceptions Contact	Pharmacy Services Leadership Team		Services	Pharmacy							RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active	5413304999				HMO - Health Maintenance Organization		C	Seattle
H3864	Part D Price File Contact (Back-up)			Loveland	Chet		4806064873				4013357984	Chet.Loveland@CVSHealth.com	CVS Caremark |Caremark	9501 E Shea Blvd	Scottsdale	AZ	85260	01/10/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Part D Price File Contact (Optional)	SR. Manager, PBM Financial Operations		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	CVS Caremark | Caremark	9501 E. Shea Blvd.	Scottsdale	AZ	85260	01/06/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Part D Price File Contact (Primary)	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	12/17/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Part D Quality Assurance Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Part D Reporting Contact	Compliance Manager	Mrs.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Patient Safety Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Payment Contact	Executive VP and Chief Financial Officer (CFO)	Mr.	Davidson	Peter		5416845212				5413853008	Peter.Davidson@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Pharmacy Director	Director of Clinical Pharmacy Services		Briones	Danielle		5413304999				8003664873	rxleadership@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		Boise	ID	83706	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Pharmacy Network Management Contact	SR. Manager, PBM Financial Operations		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea Blvd, MC080		Scottsdale	AZ	85620	01/06/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Pharmacy Network Management Contact (Secondary)	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Pharmacy Technical Help Desk Contact	Government Programs Pharmacy Services		Services	Pharmacy							pharmacy@pacificsource.com	PO Box 7469		Bend	OR	97708	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active	8884377728				HMO - Health Maintenance Organization		C	Seattle
H3864	Pharmacy Technical Help Desk Contact (Secondary)			Help Desk	Pharmacy								CVS Health	9501 E. Shea Blvd.	Scottsdale	AZ	85260	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active	8003646331				HMO - Health Maintenance Organization		C	Seattle
H3864	Physician Incentive Contact	VP of Provider Network		McGarry	Peter		5038025338					Peter.McGarry@pacificsource.com	13010 SW 68th Parkway, Suite 140		Tigard	OR	97223	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Plan Directory Contact for Public Website	Customer Service		Service	Customer		5413855315					MedicareCS@PacificSource.com	PO Box 7469		Bend	OR	97708	02/12/2019	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Plan to Plan Reconciliation Contact	Enrollment and Billing Representative		Yeakey	Paula		5417065172					P2Padmin@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Processor Contact	SR. Manager, PBM Financial Operations		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	CVS Caremark | Caremark	9501 E. Shea Blvd	Scottsdale	AZ	85260	01/06/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Quality Contact	Director of Clinical Quality Improvement		Randleman	Lizzy		5413307317					Lizzy.Randleman@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Reconciliation Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999				8003664873	RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Reconciliation Contact (Secondary)	Manager of Pharmacy Administration, Govt		Riffle	Connie		5413307309				8003664873	Connie.Riffle@pacificsource.com	PO Box 7469		Bend	OR	97708	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Recovery Audit Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	SNP Application Contact	Compliance Project Coordinator		Ely	Shelley		5413304914					Shelley.Ely@pacificsource.com	PO Box 7469		Bend	OR	97708	02/17/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	SNP State Contact	Medicaid Contract Manager		Joseph	Kristin		5417065030					Kristin.Joseph@pacificsource.com	PO Box 7469		Bend	OR	97708	07/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Surveillance Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	System Contact	VP, Government Operations		Hannabach	Jane		5413302530				5413853008	Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Third Party Administrator (TPA) Liaison	Administrative Programs Manager		Riffle	Connie		5413307309					Connie.Riffle@pacificsource.com	PO Box 7469		Bend	OR	97708	05/11/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	User Access Contact	Compliance Project Coordinator	Mrs.	Ely	Shelley		5413304914					Shelley.Ely@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Utilization Management Contact	Health Services Manager		Kaiser	Lisa		2087802007					Lisa.Kaiser@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		Boise	ID	83706	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3864	Utilization Review Contact	Health Services Manager		Kaiser	Lisa		2087802007					Lisa.Kaiser@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		Boise	ID	83706	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	HMO/HMOPOS		PacificSource	429	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H3890	Agent/Broker Compensation Data Contact	Sales Manager	Mr.	Markuson	Richard		4102410788					RMarkuson@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Automated TrOOP Balance Transfer Contact	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Backup User Access Contact	Sr. Director IT	Mr.	Reppas	Soterios		4104244620					sreppas@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Best Available Evidence Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Bid Audit Contact	Chief Actuary	Ms.	McAleer	Bethany		2026588702					BMcAleer@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Bid Primary Contact	Director Medicare Business Product Development	Mr.	Alsahlani	Hazem		4129521008					HAlsahlani@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/04/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	CEO - CMS Administrator Contact	President Medicare Advantage	Ms.	Wilson	Marja		3603061205					MWilson@jhhp.org	7231 Parkway Drive,	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	CEO - Senior Official for Contracting	President Medicare Advantage	Ms.	Wilson	Marja		3603061205					MWilson@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Chief Financial Officer	Chief Financial Officer	Mr.	Chojnowski	Daniel		2078072496					DChojnowski@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Chief Operating Officer	Chief Operating Officer	Mr.	O'Donnell	Ryan		7038876201					RODonnell@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Chief Information Officer	Sr. Director Information Systems	Mr.	Minale	Nick		3153825005					NMinale@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Chief Information Security Officer	Information Security Manager, IT/IS	Mr.	Ross	Willie		4104244642					wross@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	CMS Casework Communication Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4436180786					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Complaints Tracking Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Contact for Fraud Investigations	Director of Special Investigations	Mr.	Waugh	John		4106891079					JWaugh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Coordination of Benefits Contact	Sr. Director Medicare Plan Administration	Ms.	Riaz	Salma		8636341202					Sriaz@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Corporate Mailing						4104244955					PGillan@jhhp.org	Johns Hopkins Health Plans	Attn:Paul Gillan, Esq., 7231 Parkway Drive, Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Coverage Gap Discount Program (CGDP) Payment Contact	Assistant Vice President	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Customer Service Operations Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	DIR Contact	AVP Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	DIR Contact (Secondary)	AVP  Pharmacy	Mr.	Fatodu	Hugh		4104244671					FatoduH@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Emergency Part D Contact	Director, Pharmacy	Ms.	Gazy	Nahid		3017423395				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Emergency Part D Contact (Secondary)	AVP Pharmacy	Mr.	Fatodu	Hugh		4109256831				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Employer Waiver Contact	Director Medicare Business Product Development	Mr.	Alsahlani	Hazem		4129521008					HAlsahlani@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/04/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Encounter Data & Risk Adjustment Operations Contact	AVP of Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Enrollment Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	EOB Transfer Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679				4104242805	AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Financial Audit Contact	AVP of Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Financial Reporting Contact	AVP of Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Formulary Contact	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Formulary Contact (Secondary)	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	General Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					mdonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Government Relations Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Richardson	Carol	M	4106149900					crichar6@jhmi.edu	733 N. Broadway	MRB Suite 102B	Baltimore	MD	21205	08/04/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	HIPAA Security Officer	Chief Information Security Officer	Mr.	Lacey	Darren		4107354477					dll@jhu.edu	5801 Smith Avenue	Davis Building, 3110B	Baltimore	MD	21209	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Hospice Contact	Medicare Part D Pharmacy Manager	Ms.	Wexler	Mary Beth		4107625938					MBWexler@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Interoperability Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					Mdonnelly@jhhp.org	Johns Hopkins HealthCare LLC	7231 Parkway Drive, Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	MA Appeals/Grievances Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679				4104242805	AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	MA Claims Processing Contact for Public Website	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Marketing Contact	Director of Communications and External Affairs	Ms.	Dixon	Karen		4106891970					KDixon@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Medical Director	Associate Chief Medical Officer	Dr.	Gerry	Danielle		4437642190					DGerry@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Donnelly	Mary		4436180786					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Medicare Coordinator	Sr. Director Medicare Plan Administration	Ms.	Riaz	Salma		8636341202					SRiaz@jhhp.org	7231 Parkway Drive,	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Medication Therapy Management Contact	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Online Enrollment Center Contact (Back-up)	Chief Operating Officer	Mr.	O'Donnell	Ryan		7038876201					RODonnell@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Online Enrollment Center Contact (Primary)	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Part C Application Contact	Director Medicare Business Product Development	Mr.	Alsahlani	Hazem		4129521008					HAlsahlani@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/04/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Part C Reporting Contact	Sr. Director Medicare Plan Administration	Ms.	Riaz	Salma		8636341202					Sriaz@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Part D Appeals	Director, Pharmacy	Ms.	Gazy	Nahid						4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active	8002612396				PPO - BBA		C	Philadelphia
H3890	Part D Appeals Contact (Secondary)	AVP Pharmacy	Mr.	Fatodu	Hugh						4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active	8002612396				PPO - BBA		C	Philadelphia
H3890	Part D Application Contact	Director Medicare Business Product Development	Mr.	Alsahlani	Hazem		4129521008					HAlsahlani@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/04/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Part D Benefits Contact	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Part D Claims Submission Contact	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Part D Exceptions Contact	Director, Pharmacy	Ms.	Gazy	Nahid						4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active	8002612396				PPO - BBA		C	Philadelphia
H3890	Part D Exceptions Contact (Secondary)	AVP Pharmacy	Mr.	Fatodu	Hugh						4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active	8002612396				PPO - BBA		C	Philadelphia
H3890	Part D Price File Contact (Back-up)	Senior Manager	Ms.	Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	9501 E. Shea Blvd.	MC121	Scottsdale	AZ	85260	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Part D Price File Contact (Optional)	Senior Analyst	Mr.	Loeveland	Chet		4806064873					Chet.Loveland@cvshealth.com	9501 E. Shea Blvd.	MC121	Scottsdale	AZ	85260	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Part D Price File Contact (Primary)	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Part D Quality Assurance Contact	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	FatoduH@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Part D Reporting Contact	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Patient Safety Contact	AVP Pharmacy Services	Mr.	Fatodu	Hugh		4104244671				4104244671	Fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Payment Contact	Associate Vice President Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Pharmacy Director	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Pharmacy Network Management Contact	AVP Pharmacy	Mr.	Fatodu	Hugh		4104244671				4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy	Ms.	Gazy	Nahid		4107621521				4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Pharmacy Technical Help Desk Contact	Director, Pharmacy	Ms.	Gazy	Nahid						4107621521	ngazy@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active	8666934620				PPO - BBA		C	Philadelphia
H3890	Pharmacy Technical Help Desk Contact (Secondary)	AVP Pharmacy	Mr.	Fatodu	Hugh						4104244671	fatoduh@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active	8666934620				PPO - BBA		C	Philadelphia
H3890	Plan Directory Contact for Public Website	Sr. Director Medicare Plan Administration	Ms.	Riaz	Salma		4107625905					SRiaz@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/07/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Plan to Plan Reconciliation Contact	Associate Vice President Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Processor Contact	Director Medicare Operations	Mr.	Helquist	Andrew		8043148679					AHelquist@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Quality Contact	Sr. Director of Quality Improvement	Ms.	Norrie	Joellyn		8134407027					JNorrie@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Reconciliation Contact	AVP of Finance	Mr.	Magee	Ryan		4104244948					RMagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Recovery Audit Contact	AVP of Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	SNP Application Contact	Sr. Director Medicare Business Product Development	Mr.	Alsahlani	Hazem		4129521008					HAlsahlani@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Surveillance Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	System Contact	Sr. Director Medicare Plan Administration	Ms.	Riaz	Salma		8636341202					SRiaz@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Third Party Administrator (TPA) Liaison	Associate Vice President Finance	Mr.	Magee	Ryan		4104244948					rmagee@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	User Access Contact	Medicare Compliance Officer	Ms.	Donnelly	Mary		4104244855					MDonnelly@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Utilization Management Contact	AVP of Health Services	Ms.	Poth	Kristin		4105822700					KPoth@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3890	Utilization Review Contact	AVP of Health Services	Ms.	Poth	Kristin		4105822700					KPoth@jhhp.org	7231 Parkway Drive	Suite 100	Hanover	MD	21076	08/03/2023	2023	HOPKINS HEALTH ADVANTAGE, INC.	Local CCP	Johns Hopkins Advantage MD	Local PPO		Johns Hopkins Healthcare LLC	616	Yes	Active					PPO - BBA		C	Philadelphia
H3907	Agent/Broker Compensation Data Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Automated TrOOP Balance Transfer Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2021	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Backup User Access Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Best Available Evidence Contact	Customer Service		Health Plan	UPMC		8775393080					upmchp@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Bid Audit Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Bid Audit Site Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Bid Primary Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	CAP Report Contact for Public Website	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	CEO - CMS Administrator Contact	President	Ms.	Holder	Diane	P	4124547640				4124547750	holderd@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/04/2023	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	CEO - Senior Official for Contracting	President	Ms.	Holder	Diane	P	4124547640				4124547750	holderd@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/04/2023	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Chief Financial Officer	Chief Financial Officer	Mr.	Gebbens	Gordon		4124545559					gebbgx@UPMC.EDU	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	07/18/2016	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Chief Operating Officer	Chief Operating Officer	Ms.	Jenkins	Mary Beth	L	4124547764					jenkinsml@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	12/09/2015	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Chief Information Officer	Chief Information Officer	Mr.	McCallister	Ed		4124547711					mccallisterew@upmc.edu	USX Tower, 60th Floor	600 Grant Street	Pittsburgh	PA	15219	03/14/2016	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Chief Information Security Officer	Vice President, ISD	Mr	Haas	Scott		4124546162					haassm@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	03/14/2016	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	CMS Casework Communication Contact	Sr. Manager, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2022	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Complaints Tracking Contact	Sr. Manager, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2022	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Contact for Fraud Investigations	Sr. Director Fraud & Abuse		Workman	Craig		4124545524					workmanc@upmc.edu	USX Tower, 47th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Coordination of Benefits Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Corporate Mailing						4124547500					upmchp@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst		Kelly	Alexis		4124547856				4124542110	medicarereporting@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/05/2021	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Customer Service Operations Contact	Customer Service		Health Plan	UPMC		8775393080					upmchp@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	01/18/2012	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	DIR Contact	Director, Pharmacy Finance		Bovier	Jacqueline		4124547584					bovierjd@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	06/18/2015	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	DIR Contact (Secondary)	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Emergency Part D Contact	Vice President, Customer Engagement & Enrollment		Palmerine	Anne		4129777828					palmerineac3@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Operations		Kienzle	Paul		7242070388					kienzlepa@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Encounter Data & Risk Adjustment Operations Contact	Director, Government Revenue		Plank	Tim		4124547747					planktm@upmc.edu	USX Tower, 36th Floor	600 Grant Street	Pittsburgh	PA	15219	10/28/2019	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Enrollment Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	EOB Transfer Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Financial Audit Contact	AVP, Medicare Operations	Mr.	Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	08/14/2020	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Financial Reporting Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Formulary Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Formulary Contact (Secondary)	Specialist, Pharmacy Operations	Ms.	Lindemuth	Nicole		4124548589					lindemuthnl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	08/29/2012	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	General Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	02/16/2022	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Government Relations Contact	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Grumbine	Megan		7034021772					grumbinem@upmc.edu	USX Tower, 41st Floor	600 Grant St.	Pittsburgh	PA	15219	11/03/2020	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	HIPAA Security Officer	Chief Privacy Officer	Ms.	Grumbine	Megan		7034021772					grumbinem@upmc.edu	USX Tower, 41st Floor	600 Grant St.	Pittsburgh	PA	15219	11/03/2020	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Hospice Contact	Pharmacy Coordinator	Ms.	Lindemuth	Nicole		4124548589					lindemuthnl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	06/24/2020	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Interoperability Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	02/16/2022	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	MA Appeals/Grievances Contact	Sr. Administrator, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	MA Claims Processing Contact for Public Website	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Marketing Contact	Director, Medicare Marketing		McVey	Alicia		4124545525					mcveyal@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	08/03/2017	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Medical Director	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Medicare Coordinator	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Medicare Part D Opioid Overutilization Contact	Sr. Manager, Clinical Pharmacy		Zandier	Lauren		4124542950				4124545295	craigl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	10/23/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Medication Therapy Management Contact	Sr. Manager Clinical Pharmacy		Zandier	Lauren		4124542950				4124545295	craigl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	10/23/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Online Enrollment Center Contact (Back-up)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Online Enrollment Center Contact (Optional)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Online Enrollment Center Contact (Primary)	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part C Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	11/01/2017	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part C Reporting Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part D Appeals	Manager, C&G		Richards	Rebecca						4124547920	richardsr3@upmc.edu	600 Grant St., USX, 42nd Floor		Pittsburgh	PA	15219	02/25/2021	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active	4124540116				HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part D Appeals Contact (Secondary)	Manager, Pharmacy Compliance		Chaussinand	Matt							chaussinandm@upmc.edu	600 Grant St., USX, 12th Floor		Pittsburgh	PA	15219	02/25/2021	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active	4124545914				HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part D Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	11/01/2017	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part D Benefits Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions		Dovico	Rosario		2012696398					rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	04/23/2019	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part D Exceptions Contact			Services	Pharmacy							upmchp@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	08/29/2012	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active	8003964139				HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part D Price File Contact (Back-up)	Sr. Manager, Government Programs		Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part D Price File Contact (Optional)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part D Price File Contact (Primary)	Director, Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107 St. #11202		Overland Park	KS	66207	07/28/2020	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part D Quality Assurance Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Part D Reporting Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Patient Safety Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Payment Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Personal Health Record Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Pharmacy Director	Sr. Director, Pharmacy Operations		Kienzle	Paul		7242070388					kienzlepa@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Pharmacy Network Management Contact	Network Account Director		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	10/31/2016	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Pharmacy Technical Help Desk Contact	DIrector, Customer Service		Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	07/29/2021	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Philadelphia
H3907	PHR Beneficiary Contact																	05/04/2007	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS	MyHealth	UPMC Health System	249	Yes	Active	4128032065				HMO - Health Maintenance Organization		C	Philadelphia
H3907	Physician Incentive Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Plan Directory Contact for Public Website			Marketing	Medicare		8773813765					upmchp@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Plan to Plan Reconciliation Contact	Business Analyst		Michalski	Jeff		4124545715				4124542110	medicarereporting@upmc.edu	c/o UPMC Health Plan Attn: Dave Soltesz P2P	US Steel Tower, 600 Grant Street, 21st Floor	Pittsburgh	PA	15219	10/03/2022	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Processor Contact	Sr Director - Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Quality Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Reconciliation Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Reconciliation Contact (Secondary)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Recovery Audit Contact	Sr. Director, Medicare Operations	Mr.	Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	SNP Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	11/01/2017	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	SNP State Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Surveillance Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	System Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Third Party Administrator (TPA) Liaison	Business Analyst		Kelly	Alexis		4124547856				4124542110	kellya9@upmc.edu	c/o UPMC Health Plan Attn: Alexis Kelly P2P	US Steel Tower, 600 Grant Street, 9th Floor	Pittsburgh	PA	15219	04/23/2019	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	User Access Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Utilization Management Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3907	Utilization Review Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/12/2018	2023	UPMC HEALTH PLAN, INC.	Local CCP	UPMC for Life	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3908	Automated TrOOP Balance Transfer Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Backup User Access Contact	Executive Director	Ms	Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Best Available Evidence Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Bid Primary Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	CAP Report Contact for Public Website	Executive Director		Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	CEO - CMS Administrator Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	CEO - Senior Official for Contracting	Executive Director	Ms	Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	03/14/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Chief Financial Officer	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Chief Operating Officer	COO	Ms	Lewis	Anne		4066472980					Anne.Lewis@trinity-health.org	14508 Chestnut Street		Philadelphia	PA	19139	09/22/2020	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Chief Information Officer	Director Enterprise IT Operations	Mr	Gillespie	Jeff		6142348636					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Chief Information Security Officer	VP Information Security	Mr	Jennings	Preston		6105503083					Preston.Jennings@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	CMS Casework Communication Contact	Executive Director	Ms	Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Complaints Tracking Contact	Regional Director QI/Compliance	Ms	Russell	Mellisa		2677878225				4134932024	mellisa.russell@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Contact for Fraud Investigations	Regional Director QI/Compliance	Ms	Russell	Mellisa		2677878225				4134932024	mellisa.russell@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Coordination of Benefits Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Corporate Mailing						2677878300					Lisa.johnson001@trinity-health.org	Mercy LIFE West Philadelphia	4508 Chestnut Street	Philadelphia	PA	19139	09/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Customer Service Operations Contact	Executive Director	Ms	Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	DIR Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	DIR Contact (Secondary)			Fuhrmeister	Nicole		2677878300					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	03/20/2018	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Emergency Part D Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Emergency Part D Contact (Secondary)	Compliance Coordinator		Velianoff	Kathy		7343432349					velianok@trinity-health.org	2205 Victor Parkwasy		Livonia	MI	48152	12/20/2018	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Encounter Data & Risk Adjustment Operations Contact	Director of Coding and Documentation		Creaney	Emy		7343431939					creaneye@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Enrollment Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	EOB Transfer Contact	Regional Director Finance	Ms	Szymczyk	Dawn		4138274243				4134932024	Dawn.Szymczyk@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Financial Audit Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Financial Reporting Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Formulary Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	General Contact	Executive Director	Ms	Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Government Relations Contact	Executive Director	Ms	Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	03/14/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	HIPAA Privacy Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	HIPAA Security Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Interoperability Contact	Director Enterprise IT Operations		Gillespie	Jeff		7343433079					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	MA Appeals/Grievances Contact	Regional Director QI/Compliance	Ms	Russell	Mellisa		2677878225				4134932024	mellisa.russell@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	MA Claims Processing Contact for Public Website	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Marketing Contact	Director Marketing & Communications	Ms.	Lark	Azia		9735182754					azia.lark@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	02/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Medical Director	Medical Director	Dr.	May	Kim		2677878225					kim.may@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	09/22/2020	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Medicare Compliance Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Medicare Coordinator	Executive Director	Ms	Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Part C Application Contact	Executive Director	Ms	Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Part D Appeals	Manager Part D Compliance	Mr.	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad Street		Philadelphia	PA	19145	09/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H3908	Part D Appeals Contact (Secondary)	Director Quality & Compliance		Johnson	Lisa							LISA.JOHNSON001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	12/31/2020	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active	2677878292				PACE - Nat		C	Philadelphia
H3908	Part D Application Contact	Executive Director	Ms	Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Part D Benefits Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Part D Claims Submission Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Part D Exceptions Contact	Manager Part D Compliance		Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad Street		Philadelphia	PA	19145	09/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H3908	Part D Exceptions Contact (Secondary)	Director Quality & Compliance	Ms	Johnson	Lisa							LISA.JOHNSON001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	12/31/2020	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active	8887366236				PACE - Nat		C	Philadelphia
H3908	Part D Price File Contact (Back-up)	Executive Director	Ms	Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Part D Price File Contact (Optional)			Velianoff	Kathy		7343432349					velianok@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	07/26/2018	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Part D Price File Contact (Primary)	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Part D Quality Assurance Contact	Regional Director QI/Compliance	Ms	Russell	Mellisa		2677878225				4134932024	mellisa.russell@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Part D Reporting Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Patient Safety Contact	Regional Director QI/Compliance	Ms	Russell	Mellisa		2677878225				4134932024	mellisa.russell@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Payment Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Personal Health Record Contact	Chief Clinical & Compliance Officer	Ms	Hays Mcelroy	Carrie		7343432668					carrie.haysmcelroy@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	09/22/2020	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Pharmacy Director	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@mercyhealth.org	1930 South Broad Street		Philadelphia	PA	19145	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Pharmacy Network Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	1001 Baltimore Pike		Springfield	PA	19064	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Pharmacy Technical Help Desk Contact	Manager Part D Compliance		Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H3908	PHR Beneficiary Contact																	05/11/2016	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE	Mercy LIFE - West Philadelphia	Trinity Health Corporation	234	Yes	Active	6106902607				PACE - Nat		C	Philadelphia
H3908	Plan Directory Contact for Public Website	Executive Director	Ms	Johnson	Lisa		2677878150					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	03/14/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Plan to Plan Reconciliation Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Processor Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Quality Contact	Regional Director QI/Compliance	Ms	Russell	Mellisa		2677878225				4134932024	mellisa.russell@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Reconciliation Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Reconciliation Contact (Secondary)			Fuhrmeister	Nicole		2677878300					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	02/16/2022	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Recovery Audit Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Surveillance Contact	Executive Director	Ms	Johnson	Lisa		7343432668					lisa.johnson001@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	System Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Third Party Administrator (TPA) Liaison	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	User Access Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Utilization Management Contact	Medical Director	Dr.	May	Kim		2677878225					kim.may@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	09/22/2020	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3908	Utilization Review Contact	Medical Director	Dr.	May	Kim		2677878225					kim.may@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	09/22/2020	2023	TRINITY HEALTH LIFE PENNSYLVANIA, INC.	National PACE	Mercy LIFE - West Philadelphia	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3909	Agent/Broker Compensation Data Contact	Director Gov. Markets Sales & Marketing Enablement		Curcio	Chris		2676751808					chris.curcio@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	12/22/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Automated TrOOP Balance Transfer Contact	Lead Business Systems Support Admin		Jimenez	Barbara		2676751825					barbara.jimenez@ibx.com	1901 Market Street	16th Floor	Philadelphia	PA	19103	02/27/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Backup User Access Contact	Reg. Performance Mgmt. Analyst II		Smith	Janet		2152419308					janet.smith@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	02/27/2020	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Best Available Evidence Contact	Sr. Business Analyst		Caldwell	Geraldine		2676751809					Geraldine.Caldwell@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/16/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Bid Audit Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Bid Audit Site Contact	Actuarial Associate and Manager		Smith	William	R	2152412812					William.Smith@ibx.com	1901 Market Street	40th Floor	Philadelphia	PA	19103	01/02/2020	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Bid Primary Contact	Actuarial Associate and Manager		Smith	William	R	2152412812					William.Smith@ibx.com	1901 Market Street	40th Floor	Philadelphia	PA	19103	04/15/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	CAP Report Contact for Public Website	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	CEO - CMS Administrator Contact	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		6094050539					Juan.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/15/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	CEO - Senior Official for Contracting	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		2152414614	24614				Juan.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/15/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Chief Financial Officer	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		2152414614	24614				Juan.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/22/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Chief Operating Officer	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		2152414614	24614				Juan.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/15/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Chief Information Officer	EVP and Chief Strategy, Corp. Dev., & Info Officer	Mr.	Vennera	Michael		2152419525					Michael.Vennera@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	04/24/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Chief Information Security Officer	Chief Information Security Leader	Mr.	Abella	John		2676759865					john.abella@ibx.com	1901 Market Street	8th Floor	Philadelphia	PA	19103	02/15/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	CMS Casework Communication Contact	Manager, Medicare Operations		Zonies	Melissa		2676751633					Melissa.Zonies@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	01/26/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Complaints Tracking Contact	Manager, Medicare Operations		Zonies	Melissa		2676751633					Melissa.Zonies@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	01/26/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Contact for Fraud Investigations	Director, Financial Investigations		Deery	Christophe	E	2156407302	27302			2152382287	christopher.deery@ibx.com	1901 Market Street	42nd Floor	Philadelphia	PA	19103	12/30/2015	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Coordination of Benefits Contact	Manager, COB/OPL		Hawkins	Veronica		2156407507	27507				Veronica.Hawkins@ibx.com	1901 Market Street	17th Floor	Philadelphia	PA	19103	12/24/2020	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Corporate Mailing						2152412400				2155674542	mitchell.goldberg@ibx.com	1901 Market Street		Philadelphia	PA	19103	08/13/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Coverage Gap Discount Program (CGDP) Payment Contact	CPA		Murphy	Stacey		2152413522	23522				Stacey.Murphy@ibx.com	1901 Market Street, 36th Floor	Corporate Accounting Shared Services	Philadelphia	PA	19103	06/28/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Customer Service Operations Contact	Director, Contact Center		Lentz	Michael		2157933262	63262				michael.lentz@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	11/01/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	DIR Contact	Manager Gov. Markets - Commercial Risk Adjustment		Sanders	Sean		2152419420					Sean.Sanders@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	06/29/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	DIR Contact (Secondary)	Lead GM Data Audit & Sub Analyst		Wyher	Geoffrey		2152417265					Geoffrey.Wyher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	06/29/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Emergency Part D Contact	Vice President Operations		Gold	Nicole		2673193327					Nicole.Gold@ibx.com	1901 Market Street	7th Floor	Philadelphia	PA	19103	02/27/2020	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Emergency Part D Contact (Secondary)	Manager, Regulatory Peformance Management		Adams	Desiree		2153279829					Desiree.Adams@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	02/24/2020	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Employer Waiver Contact	SVP Government Markets, Sales & Marketing Leadersh		Cruz	Kortney		2152414762					Kortney.Cruz@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	12/16/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Encounter Data & Risk Adjustment Operations Contact	Manager Data, Delivery and Reporting	Ms.	Heifetz	Nata		2152410511					Nata.Heifetz@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	12/19/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Enrollment Contact	Sr. Business Analyst		Caldwell	Geraldine		2676751809					Geraldine.Caldwell@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/16/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	EOB Transfer Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy,Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Financial Audit Contact	Director of Audit, Regulatory Audit & Compliance	Ms.	Kovach	Lauren		2152412506				2155674542	Lauren.Kovach@ibx.com	1901 Market Street		Philadelphia	PA	19103	04/19/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Financial Reporting Contact	VP Tax		Robinson	Ken		2152414065					ken.robinson@ibx.com	1901 Market Street	39th Floor	Philadelphia	PA	19103	12/22/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Formulary Contact	Clinical Pharmacist		Urbanek	Michael		2152419003				2152413526	Michael.Urbanek@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	10/01/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Formulary Contact (Secondary)	Clinical Consultant OptumRx		Malhi	Paramveer		6124766526					paramveer.malhi@optum.com	1100 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	General Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Government Relations Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	HIPAA Privacy Officer	VP Corporate Compliance		Zipfel	Michael		2152414908					michael.zipfel@ibx.com	1901 Market Street		Philadelphia	PA	19013	04/19/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	HIPAA Security Officer	Chief Information Security Leader		Abella	John		2676759865					john.abella@ibx.com	1901 Market Street	8th Floor	Philadelphia	PA	19103	02/15/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Hospice Contact	Pharmacy Service Process & Governance Director		Erdman	Kathy		2152412654					kathy.erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	06/29/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Interoperability Contact	Director Information Governance		Denyer	James		2152410858					james.denyer@ibx.com	1901 Market Street	20th Floor	Philadelphia	PA	19103	11/29/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	MA Appeals/Grievances Contact	Manager, Medicare Member Appeals and Grievances		Tobias	Bobbi		2152410669					Bobbi.Tobias@ibx.com	1901 Market Street	Mailstop, 12TH floor	Philadelphia	PA	19103	04/19/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	MA Claims Processing Contact for Public Website	Director Claims Operations		Perfetto	Lisa		2152414126					lisa.perfetto@ibx.com	1901 Market Street, 15th Floor		Philadelphia	PA	19103	02/28/2018	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Marketing Contact	RPM Analyst II, NJMA Government		Dunn	Devonda		2152413837					devonda.dunn@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/26/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Medical Director	Medical Director, CCT Leadership	Dr.	Syropoulos	Heidi	J	2152414511					Heidi.Syropoulos@ibx.com	1901 Market Street		Philadelphia	PA	19103	04/25/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Medicare Compliance Officer	Dir, Corp. Compl, Privacy & Medicare Compl Officer	Mr.	Goldberg	Mitchell		2152419516				2155674542	Mitchell.Goldberg@ibx.com	1901 Market Street	42nd Floor	Philadelphia	PA	19103	04/29/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Medicare Coordinator	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Steffes	Michael		2156407557				2152413526	Michael.Steffes@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	12/22/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Medication Therapy Management Contact	Clinical Pharmacist		Steffes	Michael		2156407557				2152413526	Michael.Steffes@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	12/22/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Online Enrollment Center Contact (Back-up)	Manager, Enrollment Services		Kelley	Josh		2152414829	24829				Joshua.Kelley@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/19/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Online Enrollment Center Contact (Optional)	Regulatory Performance Mgmt. Analyst II		Smith	Janet		2152419308					janet.smith@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	12/19/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Online Enrollment Center Contact (Primary)	Sr. Business Analyst		Caldwell	Geraldine		2676751809					Geraldine.Caldwell@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/16/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Part C Application Contact	Sr Product & Capability Mgr  Product Management		Keenan	Kate		2152419495					kate.keenan@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	02/28/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Part C Reporting Contact	Manager, Government Markets Reporting		Pippett	Andrew		2152417416					Andrew.Pippett@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	06/29/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Part D Appeals	Manager, Medicare Member Appeals and Grievances		Tobias	Bobbi							Bobbi.Tobias@ibx.com	1901 Market Street	Mailstop, 12TH floor	Philadelphia	PA	19103	04/19/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active	8887183333				PPO - BBA		C	Philadelphia
H3909	Part D Appeals Contact (Secondary)	Supervisor, Medicare Member Appeals and Grievances		Byrd	Kelly							Kelly.Byrd@ibx.com	1901 Market Street	Mailstop, 12TH floor	Philadelphia	PA	19103	06/28/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active	8887183333				PPO - BBA		C	Philadelphia
H3909	Part D Application Contact	Senior Product and Capability Mgr.		Keenan	Kate		2152419495					kate.keenan@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	02/28/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Part D Benefits Contact	Pharmacy Service Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Part D Claims Submission Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Part D Exceptions Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy						2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active	8886787015				PPO - BBA		C	Philadelphia
H3909	Part D Exceptions Contact (Secondary)	Manager, Prior Authorization		Mourad	Hala							Hala.Mourad@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active	8886787015				PPO - BBA		C	Philadelphia
H3909	Part D Price File Contact (Back-up)	Senior Business Analyst, Plan Finder		Moore-Elliott	Shalandria		7637974305					Mshalandria.moore-elliott@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Part D Price File Contact (Optional)	Project Leader		Coursey	Yaminah		2152413955					yaminah.coursey@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	12/07/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Part D Price File Contact (Primary)	Senior Business Analyst, Plan Finder		Kim	Kevin		7633617996					Kevin.kim@optum.com	11000 Optum Circle		Eden Prairie Eden	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Part D Quality Assurance Contact	Director Quality Management		Donohue	Kathleen		2152413277					Kathleen.Donohue@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/27/2018	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Part D Reporting Contact	Manager, Government Markets Reporting		Pippett	Andrew		2152417416					Andrew.Pippett@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	06/29/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Patient Safety Contact	Clinical Pharmacist		Steffes	Michael		2156407557				2152413526	Michael.Steffes@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	12/22/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Payment Contact	Manager, Risk Analytics		Buscher	Harry		2152410806					harry.buscher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	06/17/2015	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Pharmacy Director	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Pharmacy Network Management Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/30/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations		Perez	Felix	M	7632833503					felix.perez@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Pharmacy Technical Help Desk Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy						2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active	8886787015				PPO - BBA		C	Philadelphia
H3909	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Help Desk		Summers	Todd							todd.summers@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active	8886787015				PPO - BBA		C	Philadelphia
H3909	Physician Incentive Contact	Deputy General Counsel		Dianno	Mark		2152412919					Mark.Dianno@ibx.com	1901 Market Street	43rd Floor	Philadelphia	PA	19103	01/26/2023	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Plan Directory Contact for Public Website			Service	Customer		8887183333					info@ibxmedicare.com	PO Box 7799		Philadelphia	PA	191017799	04/29/2015	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Plan to Plan Reconciliation Contact	Lead GM Data Audit & Sub Analyst		Wyher	Geoffrey		2156407265				2152412408	Geoffrey.Wyher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	02/18/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Processor Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Quality Contact	Director Quality Management		Donohue	Kathleen		2152413277					Kathleen.Donohue@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/27/2018	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Reconciliation Contact	Director Risk Adjustment & Data Delivery		Buscher	Harry		2152410806					harry.buscher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	03/27/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Reconciliation Contact (Secondary)	Mgr. Gov. Mkts. - Commercial Risk Analytics		Sanders	Sean		2152419420					Sean.Sanders@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	01/15/2021	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Recovery Audit Contact	Director of Regulatory Performance Management	Ms.	Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	SNP Application Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	SNP State Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Surveillance Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	System Contact	Director Enterprise Information Management		Varghese	John		2152414553					john.varghese@ibx.com	1901 Market Street	20th Floor	Philadelphia	PA	19103	10/26/2017	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Third Party Administrator (TPA) Liaison	CPA		Murphy	Stacey		2152413522	23522				Stacey.Murphy@ibx.com	1901 Market Street, 36th Floor	Corporate Accounting	Philadelphia	PA	19103	06/28/2022	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	User Access Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22ndFloor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Utilization Management Contact	Director Care Management		McGurk	Cheryl		2152414542					Cheryl.mcgurk@ibx.com	1901 Market Street	30th Floor	Philadelphia	PA	19103	12/29/2017	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3909	Utilization Review Contact	Director Care Management		McGurk	Cheryl		2152414542					Cheryl.mcgurk@ibx.com	1901 Market Street	30th Floor	Philadelphia	PA	19103	12/29/2017	2023	QCC INSURANCE COMPANY	Local CCP	Independence Blue Cross	Local PPO		Independence Health Group, Inc.	609	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Agent/Broker Compensation Data Contact	Manager, Sales Support & Operations	Mr.	Thompson	Seth		4128883167					Seth.Thompson@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Backup User Access Contact	Sr. Risk and Regulatory Intelligence Analyst	Ms.	Hegedus	Emily		6078219034					emily.hegedus@highmarkhealth.org	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Best Available Evidence Contact	Manager, Government Business Enrollment	Mr.	Stanhoff	David		4125445689					LISBAE@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Bid Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Bid Audit Site Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Bid Primary Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	01/13/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	11/10/2017	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	CEO - CMS Administrator Contact	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	CEO - Senior Official for Contracting	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Chief Financial Officer	CFO Highmark Health Plan	Mr.	Bridges	Ja'Ron		4125441452					JaRon.Bridges@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/27/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Chief Operating Officer	SVP, Government Business Segment President	Ms.	Miller	Alexis	A	4125447389					Alexis.Miller@Highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Chief Information Officer	Senior Vice President, Infrastructure & Architectu	Mr.	Krebs	Mark		7173026255					mark.krebs@goenGen.com	120 Fifth Avenue		Pittsbrugh	PA	15222	09/25/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Chief Information Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	CMMI Model Point of Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/15/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	CMS Casework Communication Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	01/06/2020	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Complaints Tracking Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne		4125444579				7176354209	Lynne.Walsh@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	01/06/2020	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Contact for Fraud Investigations	VP Financial Investigation & Provider Review	Mr.	Spear	Kurt		4125447069					Kurt.Spear@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	01/15/2016	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Coordination of Benefits Contact	Sr. Process Analyst	Ms.	Cassidy	Christina		4125444417					Christina.Cassidy@highmark.com	120 Fifth Avenue	PAP P5111	Pittsburgh	PA	15222	12/26/2019	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Corporate Mailing						4125447031					Thomas.Boettler@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant	Mr.	DeVan	Walter		7173026609					Walter.DeVanJr@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/05/2017	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Customer Service Operations Contact	Director, Member & Provider Services		Scarnati	Chris		8148716712					Chris.Scarnati@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/30/2020	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	DIR Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	DIR Contact (Secondary)	Senior Risk & Compliance Case Manager		Stetson	Kelsey		4125445816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	02/17/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Emergency Part D Contact	Director, Customer Experience		Scarnati	Chris		8148716712					Chris.Scarnati@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	01/06/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Emergency Part D Contact (Secondary)	Manager, Customer Service		Merritt	Meggan		3042992512					Meggan.Hostuttler@highmark.com	120 Fifth Avenue Place	Suite PKSB-2	Pittsburgh	PA	15222	01/06/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Employer Waiver Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/07/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Encounter Data & Risk Adjustment Operations Contact	Director, Actuarial Services	Mr.	DelPrince	Vincent	M	4125443939					Vincent.Delprince@highmark.com	501 Penn Avenue		Pittsburgh	PA	15222	08/04/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Enrollment Contact	Director, Enrollment and Billing	Mr.	Palmer	David		4125446384					David.Palmer@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/22/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	EOB Transfer Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	bob.opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/26/2019	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Financial Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Financial Reporting Contact	Vice President, Accounting & Reportin	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Formulary Contact	Senior Pharmacist, Clinical Pharmacy Services		DiTullio	Kelly		4128884336					Kelly.DiTullio@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/08/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Formulary Contact (Secondary)	Senior Pharmacist, Clinical Pharmacy Services		Humphries	Jessica		4128884890					jessica.humphries@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/08/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	General Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Government Relations Contact	SVP, Government Affiars	Mr.	Warfel	Michael	G	7173023979					michael.warfel@highmark.com	1800 Center St.		Camp Hill	PA	17011	03/18/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	HIPAA Privacy Officer	Chief Privacy and Data Ethics Officer	Ms.	Patrick	Justine		4125444643					justine.patrick@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	HIPAA Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Hospice Contact	Intake Coordinator		Welker	Jessica		7178883043					DrugHelp_Authorizations@highmark.com	120 5th Avenue Place		Pittsburgh	PA	15222	10/25/2019	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Interoperability Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	MA Appeals/Grievances Contact	Manager, Appeals & Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	01/06/2020	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	MA Claims Processing Contact for Public Website	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/22/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Marketing Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					Jillian.Pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	10/14/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Medical Director	VP, Executive Medical Director	Dr,	Law	Timothy		4125446445					timothy.law@highmark.com	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	11/10/2017	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Medicare Coordinator	Director, Government Compliance	Ms.	Carl	Kathleen	A	4125447156					Kathleen.Carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	06/03/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Medicare Part D Opioid Overutilization Contact	Pharmacist	Ms.	Ali	Dewaa		4129040214					Dewaa.ali@highmark.com	120 Fifth Avenue PAP P4207		Pittsburgh	PA	15222	07/31/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Medication Therapy Management Contact	Senior Pharmacist	Ms.	Adlesic	Meredith		4128883749					Meredith.Adlesic@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	10/14/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	OffShore Subcontractor Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Online Enrollment Center Contact (Back-up)	Manager Enrollment & Billing	Mr.	Stanhoff	David		4125445689					LISBAE@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Online Enrollment Center Contact (Optional)	Manager, Business Platform	Mr.	Hudson	Brian		7173025964					Brian.Hudson@highmark.com	1800 Center St.		Camp Hill	PA	17011	07/22/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Online Enrollment Center Contact (Primary)	Director, Enrollment and Billing	Mr.	Palmer	David		4125446384					David.Palmer@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/22/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Part C Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/07/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Part C Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Part D Appeals	Manager, Member Appeals & Grievances	Ms.	Walsh	Lynne	M					7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	12/31/2020	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	4125444579				PPO - BBA		C	Philadelphia
H3916	Part D Appeals Contact (Secondary)	Supervisor, Appeals & Grievances	Ms.	Miller	Rachel	M					7176354209	Rachel.Miller@highmark.com	Fifth Ave Place	120 Fifth Avenue, Ste 5322	Pittsburgh	PA	15222	09/06/2018	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	4125441596				PPO - BBA		C	Philadelphia
H3916	Part D Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/07/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Part D Benefits Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/07/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Part D Claims Submission Contact	Director Regulated Marketing Medicare Solutions		Dovico	Rosario		9145896300				8882822583	Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	11/08/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Part D Exceptions Contact			Affairs	Pharmacy							drughelp@highmark.com	120 Fifth Avenue	Suite SPECARE	Pittsburgh	PA	15222	08/04/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8006002227				PPO - BBA		C	Philadelphia
H3916	Part D Exceptions Contact (Secondary)	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	08/04/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8003443405	733326			PPO - BBA		C	Philadelphia
H3916	Part D Price File Contact (Back-up)	Pharmacy Analyst	Mr.	Nolder	Tim		4124398263					timothy.nolder@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	06/02/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Part D Price File Contact (Optional)	Director, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	02/14/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Part D Price File Contact (Primary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/07/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Part D Quality Assurance Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/07/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Part D Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Patient Safety Contact	Director, Clinical Pharmacy Operations	Mr.	Causer	Derek		4125445835					Derek.Causer@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Payment Contact	Vice President, Accounting and Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Pharmacy Director	Manager, Pharmacy Programs		Winterhalter	Christa		4128884108					Christa.Winterhalter@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	04/07/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Pharmacy Network Management Contact	Network Account Director, Retail Strat & Contract	Ms.	Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	01/12/2018	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/07/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	11/08/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8009221557				PPO - BBA		C	Philadelphia
H3916	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Government Operations	Ms	Lynn Schill	Jodie							Jodie.LynnSchill@highmark.com	120 Fifth Avenue Pittsburgh, PA 15222		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	5705783579				PPO - BBA		C	Philadelphia
H3916	PHR Beneficiary Contact																	07/23/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO	Highmark Inc	Highmark Health	123	Yes	Active	8665886967				PPO - BBA		C	Philadelphia
H3916	Physician Incentive Contact	VP Prov Reimbursement & Network	Mr.	McDonald	Brendan		4125446611					brendan.mcdonald@highmarkhealth.org	120 5th Avenue Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Plan Directory Contact for Public Website			Service	Provider		8665886967					resourcecenter@highmark.com	120 Fifth Ave		Pittsburgh	PA	15222	06/07/2017	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Plan to Plan Reconciliation Contact	Manager, Operational Accounting	Mr.	Stehr	Brett	J	7173022748					P2Precon@highmark.com	Highmark Inc. Attn: Cashier	PO Box 898820	Camp Hill	PA	170890407	06/28/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Processor Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Quality Contact	VP, Clinical Quality and Medical Policy	Dr.	Onuoha-Obilor	Stella		4125444335					Stella.Onuoha-Obilor@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/07/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Reconciliation Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Reconciliation Contact (Secondary)	Senior Risk * Compliance Case manager		Stetson	Kelsey		4125448816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	02/17/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Recovery Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Surveillance Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					jillian.pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	04/07/2022	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	System Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Third Party Administrator (TPA) Liaison	Accountant		Jurgiewicz	Kimberly		5707807969					kimberly.jurgiewicz@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	05/25/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	User Access Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Utilization Management Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3916	Utilization Review Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK SENIOR HEALTH COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H3917	Automated TrOOP Balance Transfer Contact			PATNAIK	PADDY		9529834787					ESITroopTransfer@express-scripts.com	PITTSBURGH CARE PARTNERSHIP, INC	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/05/2009	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Backup User Access Contact	FINANCE DIRECTOR	MRS	TRUMP	ANGIE	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	11/18/2010	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Best Available Evidence Contact	FINANCE DIRECTOR	MRS	TRUMP	ANGIE	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	11/18/2010	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Bid Primary Contact	FINANCE DIRECTOR	MRS	TRUMP	ANGIE	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	CAP Report Contact for Public Website	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA		4124361344				4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/13/2013	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	CEO - CMS Administrator Contact	PRESIDENT	MS	HASHTROUDI	FATEMEH		4124361341				4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	CEO - Senior Official for Contracting	PRESIDENT	MS	HASHTROUDI	FATEMEH		4124361341				4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Chief Financial Officer	FINANCE DIRECTOR	MRS	TRUMP	ANGIE	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	05/22/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Chief Operating Officer	PRESIDENT	MS	HASHTROUDI	FATEMEH		4124361341				4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Chief Information Officer	HEALTH INFORMATION MANAGER	MS	GAMBINO	ROBIN		4124361337				4122351340	gambinord@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/19/2016	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Chief Information Security Officer	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA		4124361344				4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/19/2016	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	CMS Casework Communication Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Complaints Tracking Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Contact for Fraud Investigations	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA		4124361344				4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/13/2013	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Coordination of Benefits Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Corporate Mailing						4124361320				4122351341	CPSCLDataReview@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	01/22/2019	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Coverage Gap Discount Program (CGDP) Payment Contact	FINANCE DIRECTOR	MRS	TRUMP	ANGIE	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	03/08/2016	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Customer Service Operations Contact	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA		4124361344				4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/13/2013	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	DIR Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	DIR Contact (Secondary)	HEALTH PLAN MANAGER		FRANKS	AARON		4124361321				4122351344	franksad@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/15/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Emergency Part D Contact	PRESIDENT	MS	HASHTROUDI	FATEMEH		4126641448				4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Emergency Part D Contact (Secondary)	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA		4126641448				4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	12/23/2014	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Encounter Data & Risk Adjustment Operations Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Enrollment Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	EOB Transfer Contact	ACCOUNTING MANAGER		PAVLIC	RENEE		4124361327				4122351344	pavlicrl2@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	12/24/2018	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Financial Audit Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Financial Reporting Contact	FINANCE DIRECTOR	MRS	TRUMP	ANGIE	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	11/18/2010	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Formulary Contact	MEDICAL DIRECTOR		HEBERT	RANDY		4122043424				4122351349	hebertrs3@upmc.edu	2400 ARDMORE BOULEVARD		PITTSBURGH	PA	15221	05/22/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	General Contact	PRESIDENT	MS	HASHTROUDI	FATEMEH		4124361341				4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Government Relations Contact	PRESIDENT	MS	HASHTROUDI	FATEMEH		4124361341				4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	HIPAA Privacy Officer	HEALTH INFORMATION MANAGER		GAMBINO	ROBIN		4124361337				4122351340	gambinord@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	05/04/2012	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	HIPAA Security Officer	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA		4124361344				4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/13/2013	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Interoperability Contact			Trump	Angie		4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/15/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	MA Appeals/Grievances Contact	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA		4124361344				4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	05/22/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	MA Claims Processing Contact for Public Website	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Marketing Contact	DIRECTOR OF MARKETING AND PUBLIC RELATIONS	MRS	KACZKOWSKI	STACI		4124361338				4122351347	kaczkowskiS@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	05/04/2012	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Medical Director	MEDICAL DIRECTOR		HEBERT	RANDY		4122043424				4122351349	hebertrs3@upmc.edu	2400 ARDMORE BOULEVARD		PITTSBURGH	PA	15221	05/22/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Medicare Compliance Officer	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA		4124361344				4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/13/2013	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Medicare Coordinator	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Medicare Part D Opioid Overutilization Contact	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA		4124361344				4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	12/24/2018	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Medication Therapy Management Contact	MEDICAL DIRECTOR		HEBERT	RANDY		4122043424				4122351349	hebertrs3@upmc.edu	2400 ARDMORE BOULEVARD		PITTSBURGH	PA	15221	05/22/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Online Enrollment Center Contact (Primary)	FINANCE DIRECTOR	MRS	TRUMP	ANGIE	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	03/10/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Part C Application Contact	PRESIDENT	MS	HASHTROUDI	FATEMEH		4124361341				4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Part D Appeals	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA						4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	03/10/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active	8664191693				PACE - Nat		C	Philadelphia
H3917	Part D Appeals Contact (Secondary)	PRESIDENT	MS	HASHTROUDI	FATEMEH						4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active	8664191693				PACE - Nat		C	Philadelphia
H3917	Part D Application Contact	FINANCE DIRECTOR	MRS	TRUMP	ANGIE	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Part D Benefits Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Part D Claims Submission Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Part D Exceptions Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M					4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active	4124361333				PACE - Nat		C	Philadelphia
H3917	Part D Price File Contact (Back-up)	INFORMATION SYSTEMS MANAGER	MRS	LENTZ	DEBORAH	L	4124361334				4122351344	lentzdl@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	03/10/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Part D Price File Contact (Primary)	FINANCE DIRECTOR	MRS	TRUMP	ANGIE	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	11/18/2010	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Part D Quality Assurance Contact	PRESIDENT	MS	HASHTROUDI	FATEMEH		4124361341				4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Part D Reporting Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Patient Safety Contact	MEDICAL DIRECTOR		HEBERT	RANDY		4122043424				4122351349	hebertrs3@upmc.edu	2400 ARDMORE BOULEVARD		PITTSBURGH	PA	15221	05/22/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Payment Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Personal Health Record Contact	HEALTH INFORMATION MANAGER		GAMBINO	ROBIN		4124361337				4122351340	gambinord@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	05/04/2012	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Pharmacy Director	MEDICAL DIRECTOR		HEBERT	RANDY		4122043424				4122351349	hebertrs3@upmc.edu	2400 ARDMORE BOULEVARD		PITTSBURGH	PA	15221	05/22/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Pharmacy Network Management Contact	PRESIDENT	MS	HASHTROUDI	FATEMEH		4124361341				4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Pharmacy Technical Help Desk Contact	Finance Director		Trump	Angie						4122351341	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active	4124361333				PACE - Nat		C	Philadelphia
H3917	PHR Beneficiary Contact																	03/10/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE	PITTSBURGH CARE PARTNERSHIP, INC.	UPMC Health System	249	Yes	Active	8664191693				PACE - Nat		C	Philadelphia
H3917	Plan Directory Contact for Public Website	DIRECTOR OF MARKETING AND PUBLIC RELATIONS	MRS	KACZKOWSKI	STACI		4124361338				4122351347	kaczkowskiS@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	05/04/2012	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Plan to Plan Reconciliation Contact	HEALTH PLAN MANAGER		FRANKS	AARON		4124361321				4122351344	franksad@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	01/09/2023	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Processor Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Quality Contact	QUALITY ANALYST & PROGRAM COORDINATOR	MRS	HASHTROUDI	FATEMEH		4124361336				4124361322	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	04/11/2014	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Reconciliation Contact	FINANCE DIRECTOR	MRS	Trump	Angie	M	4124361333				4122351344	trumpam@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Reconciliation Contact (Secondary)	HEALTH PLAN MANAGER		FRANKS	AARON		4124361321				4122351344	franksad@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/15/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Recovery Audit Contact	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA		4124361344				4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/13/2013	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Surveillance Contact	DIRECTOR OF COMPLIANCE AND RISK MANAGEMENT	MRS	STERN	PATRICIA		4124361344				4122351348	sternpa@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	02/13/2013	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	System Contact	MANAGER CLIENT SERVICES, IT	MR	ROGERS	PHILLIP	K	4127736844					rogerspk@upmc.edu	2310 JANE STREET		PITTSBURGH	PA	15203	11/18/2010	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Third Party Administrator (TPA) Liaison	HEALTH PLAN MANAGER		FRANKS	AARON		4124361321				4122351344	franksad@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	08/03/2021	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	User Access Contact	INFORMATION SYSTEMS MANAGER	MRS	LENTZ	DEBORAH	L	4124361334				4122351344	lentzdl@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	03/10/2020	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Utilization Management Contact	PRESIDENT	MS	HASHTROUDI	FATEMEH		4124361341				4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3917	Utilization Review Contact	PRESIDENT	MS	HASHTROUDI	FATEMEH		4124361341				4122351341	hashtroudif@upmc.edu	SUITE # 700	2400 ARDMORE BOULEVARD	PITTSBURGH	PA	15221	07/21/2022	2023	PITTSBURGH CARE PARTNERSHIP, INC.	National PACE	Community LIFE	National PACE		UPMC Health System	249	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Automated TrOOP Balance Transfer Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Backup User Access Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Best Available Evidence Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Bid Primary Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	CAP Report Contact for Public Website	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	CEO - CMS Administrator Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	CEO - Senior Official for Contracting	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Chief Financial Officer	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Chief Operating Officer	Director of Quality and Compliance	mrs	Hartnett	Bridget		4123888042				4123888055	bhartnett@LIFEPittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Chief Information Officer	Sr. Director of Operations	Mr.	Krchmar	Aaron		4123888042				4123888055	Akrchmar@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Chief Information Security Officer	Sr. Director of Operations	Mr.	Krchmar	Aaron		4123888042				4123888055	Akrchmar@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	CMS Casework Communication Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Complaints Tracking Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Contact for Fraud Investigations	Director of Quality and Compliance		Hartnett	Bridget		4123888042				4123888055	bhartnett@LIFEPittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Coordination of Benefits Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Corporate Mailing						4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Customer Service Operations Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	DIR Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	DIR Contact (Secondary)	Director of Health Plan Management		Ardeno	Brandie		4123888042					Bardeno@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Emergency Part D Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Emergency Part D Contact (Secondary)	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Encounter Data & Risk Adjustment Operations Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Enrollment Contact	Director of Eligibility		Collins	Lynn	C	4123888042				4123888055	lcollins@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	EOB Transfer Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Financial Audit Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Financial Reporting Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Formulary Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	General Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Government Relations Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	HIPAA Privacy Officer	Director of Quality and Compliance	Ms.	Hartnett	Bridget		4123888042				4123888055	bhartnett@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	HIPAA Security Officer	SR. Director of Operations	Mr.	Krchmar	Aaron		4123888042				4123888055	Akrchmar@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Interoperability Contact	CEO		Gago	Joann		4123254228					JGago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Ste 200	Pittsburgh	PA	15220	05/04/2022	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	MA Appeals/Grievances Contact	Director of Quality and Compliance		Hartnett	Bridget		4123888042				4123888055	bhartnett@LIFEPittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	MA Claims Processing Contact for Public Website	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Marketing Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Medical Director	Medical Director		Guilinger	Ruth	A	4123888042				4123888055	RGuilinger@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	11/16/2022	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Medicare Compliance Officer	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Medicare Coordinator	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Medicare Part D Opioid Overutilization Contact	Medical Director		Guilinger	Ruth Ann		4123888042				4123888055	RGuilinger@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	05/23/2019	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Medication Therapy Management Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Part C Application Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Part D Appeals	CEO	Ms.	Gago	Joann	F					4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active	4123888042				PACE - Nat		C	Philadelphia
H3918	Part D Appeals Contact (Secondary)	Director of Quality and Compliance		Hartnett	Bridget							bhartnett@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Ste 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active	4123254228				PACE - Nat		C	Philadelphia
H3918	Part D Application Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Part D Benefits Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Part D Claims Submission Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Part D Exceptions Contact	CFO	Ms.	Schmitt	Laura	B					4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active	4123888042				PACE - Nat		C	Philadelphia
H3918	Part D Price File Contact (Back-up)	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Part D Price File Contact (Optional)	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Part D Price File Contact (Primary)	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Part D Quality Assurance Contact	Director of Quality and Compliance		Hartnett	Bridget		4123888042				4123888055	bhartnett@LIFEPittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Part D Reporting Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Patient Safety Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Payment Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Pharmacy Director	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Pharmacy Network Management Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Pharmacy Network Management Contact (Secondary)	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Pharmacy Technical Help Desk Contact	Medical Director		Guilinger	Ruth	A					4123888055	Rguilinger@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	11/16/2022	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active	4123888055				PACE - Nat		C	Philadelphia
H3918	Plan Directory Contact for Public Website	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Plan to Plan Reconciliation Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Processor Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Quality Contact	Director of Quality and Compliance		Hartnett	Bridget		4123888042				4123888055	bhartnett@LIFEPittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Reconciliation Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Reconciliation Contact (Secondary)	Director of Health Plan Management		Ardeno	Brandie		4123888042					Bardeno@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Recovery Audit Contact	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Surveillance Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	System Contact	Senior Director of Operations		Krchmar	Aaron		4123888042				4123888055	AKrchmar@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	11/30/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Third Party Administrator (TPA) Liaison	CFO	Ms.	Schmitt	Laura	B	4123888042				4123888055	lschmitt@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	01/05/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	User Access Contact	Senior Director of Operations		Krchmar	Aaron		4123888042				4123888055	AKrchmar@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	11/30/2021	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Utilization Management Contact	CEO	Ms.	Gago	Joann	F	4123888042				4123888055	jgago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	12/13/2016	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3918	Utilization Review Contact	CEO		Gago	Joann		4123888042				4123888055	JGago@lifepittsburgh.org	875 Greentree Road	One Parkway Center, Suite 200	Pittsburgh	PA	15220	03/15/2022	2023	LIVING INDEPENDENCE FOR THE ELDERLY PITTSBURGH INC	National PACE	LIFE Pittsburgh	National PACE		Living Independence for the Elderly	142	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Automated TrOOP Balance Transfer Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Backup User Access Contact	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Best Available Evidence Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Bid Primary Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	CAP Report Contact for Public Website	Regional VP Operations	Mrs.	Januszeski	Suzanne		2153394449				6102719530	suzanne.januszeski@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	CEO - CMS Administrator Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	CEO - Senior Official for Contracting	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	07/25/2022	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Chief Financial Officer	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Chief Operating Officer	COO	Ms.	Lewis	Anne		4066472980					anne.lewis@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	04/28/2022	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Chief Information Officer	Director, Enterprise IT Operations	Mr.	Gillespie	Jeff		6142348636					gillespj@trinity-health.org	1930 S Broad Street	Suite 3	Philadelphia	PA	19145	09/15/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Chief Information Security Officer	VP Information Security	Ms	Jennings	Preston		6105503183					Preston.Jennings@trinity-health.org	3805 West Chester Pike	Ste. 100	Newtown Square	PA	19073	09/15/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	CMS Casework Communication Contact	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Complaints Tracking Contact	Director of Quality & Compliance	Mrs.	Yocum	Jennifer		2153394449					jennifer.yocum@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Contact for Fraud Investigations	Director of Quality & Compliance	Mrs.	Yocum	Jennifer		2153394449					jennifer.yocum@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Coordination of Benefits Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Corporate Mailing						6106902516				2153394523	Dan.Drake@trinity-health.org	1930 S. Broad Street	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Coverage Gap Discount Program (CGDP) Payment Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Customer Service Operations Contact	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	07/25/2022	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	DIR Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	DIR Contact (Secondary)	Finance Manager	Mr.	Urban	Edward		2153394531					edward.urban001@trinity-health.org	1930 South Broad Street Unit 3		Philadelphia	PA	19145	02/16/2022	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Emergency Part D Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Encounter Data & Risk Adjustment Operations Contact	Director of Coding and Documentation		Creaney	Emy		7343431939					creaneye@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Enrollment Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	EOB Transfer Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Financial Audit Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Financial Reporting Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Formulary Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	09/03/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	General Contact	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	07/25/2022	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Government Relations Contact	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	HIPAA Privacy Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	HIPAA Security Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Interoperability Contact	Director Enterprise IT Operations		Gillespie	Jeff		7343433079					gillespij@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	MA Appeals/Grievances Contact	Director of Quality & Compliance	Mrs.	Yocum	Jennifer		2153394449					jennifer.yocum@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	MA Claims Processing Contact for Public Website	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Marketing Contact	Director of Marketing & Communications		Lark	Azia		9735182754				2153394523	azia.lark@trinity-health.org	1001 Baltimore Pike		Springfield	PA	19064	02/03/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Medical Director	Medical Director	Dr	Johnson	Kristi		4848039722					kristi.johnson001@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	02/28/2022	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Medicare Compliance Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Medicare Coordinator	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/04/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	09/03/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	09/03/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Part C Application Contact	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Part D Appeals	Manager Part D Compliance		Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	09/03/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H3919	Part D Appeals Contact (Secondary)	Director Quality & Compliance		Hampton	Kim							kimberly.hampton@trinity-health.org	1930 South Broad Street	Unit 3	Philadelphia	PA	19145	09/03/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394449				PACE - Nat		C	Philadelphia
H3919	Part D Application Contact	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Part D Benefits Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Part D Claims Submission Contact	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	Mercy LIFE	1930 South Broad Street, Unit 3	Philadelphia	PA	19145	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Part D Exceptions Contact	Manager Part D Compliance		Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 S. Broad Street		Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H3919	Part D Exceptions Contact (Secondary)	Director Quality & Compliance		Hampton	Kim							kimberly.hampton@trinity-health.org	1930 South Broad Street	Unit 3	Philadelphia	PA	19145	09/24/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394449				PACE - Nat		C	Philadelphia
H3919	Part D Price File Contact (Back-up)	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Part D Price File Contact (Primary)	Regional Finance Director	Mr.	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Part D Quality Assurance Contact	Director of Quality & Compliance	Mrs.	Yocum	Jennifer		2153394449					jennifer.yocum@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Part D Reporting Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Patient Safety Contact	Director of Quality & Compliance	Mrs.	Yocum	Jennifer		2153394449					jennifer.yocum@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Payment Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Pharmacy Director	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	09/03/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Pharmacy Network Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	1001 Baltimore Pike		Springfield	PA	19064	09/03/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Pharmacy Technical Help Desk Contact	Manager Part D Compliance		Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H3919	Plan Directory Contact for Public Website	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Plan to Plan Reconciliation Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362				2153395650	Joseph.Garbarino@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	09/03/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Processor Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Quality Contact	Director of Quality & Compliance	Mrs.	Yocum	Jennifer		2153394449					jennifer.yocum@trinity-health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Reconciliation Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Reconciliation Contact (Secondary)	Finance Manager	Mr.	Urban	Edward		2153394531					edward.urban001@trinity-health.org	1930 South Broad Street Unit 3		Philadelphia	PA	19145	02/16/2022	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Recovery Audit Contact	Regional Finance Director	Mr.	Schmotzer	David		2153394533					David.Schmotzer@Trinity-Health.org	1930 S. Broad St.	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Surveillance Contact	Regional VP Operations	Ms	Januszeski	Suzanne		8569044632					suzanne.januszeski@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/02/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	System Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Third Party Administrator (TPA) Liaison	Regional Finance Director	Mr.	Schmotzer	David		2153394533				2153395650	David.Schmotzer@Trinity-Health.org	1930 S. Broad St,	Suite 3	Philadelphia	PA	19145	08/13/2021	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	User Access Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Utilization Management Contact	Medical Director	Dr	Johnson	Kristi		4848039722					kristi.johnson001@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	02/28/2022	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3919	Utilization Review Contact	Medical Director	Dr	Johnson	Kristi		4848039722					kristi.johnson001@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	02/28/2022	2023	Mercy LIFE	National PACE	Mercy LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H3923	Agent/Broker Compensation Data Contact	Vice President, Government Sales	Mr.	Biesecker	Gregory		7172520587					Gregory.Biesecker@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	03/24/2023	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Automated TrOOP Balance Transfer Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Backup User Access Contact	Medicare Compliance Analyst	Ms.	Tremmel	Selina		7175387981					selina.tremmel@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	05/18/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Best Available Evidence Contact	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465811	nicole.peterson@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	09/08/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Bid Audit Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	11/25/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Bid Audit Site Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	11/25/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Bid Primary Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	11/25/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	06/16/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	CEO - CMS Administrator Contact	President and CEO	Mr.	Shamash	Todd		7175417747				7176518913	todd.shamash@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	01/04/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	CEO - Senior Official for Contracting	President and CEO	Mr.	Shamash	Todd		7175417747				7176518913	todd.shamash@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	01/04/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Chief Financial Officer	Chief Financial Officer	Mr.	Woodard	Ralph		7175417181					ralph.woodard@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	09/24/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Chief Operating Officer	EVP & Chief Operating Officer	Mr.	Heisey	Glenn		7175417288				7176518497	glenn.heisey@capbluecross.com	2500 Elmenrton Avenue		Harrisburg	PA	17177	01/04/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Chief Information Officer	Chief Information Officer	Mr.	Frank	Scott		7175417341					scott.frank@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	02/17/2016	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Chief Information Security Officer	Chief Information Security Officer	Mr.	Burd	Aaron		7175416939					aaron.burd@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	CMS Casework Communication Contact		Ms.	Drawbaugh	Cindy		7175416257					cindy.drawbaugh@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	01/16/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Complaints Tracking Contact		Ms.	Drawbaugh	Cindy		7175416257					cindy.drawbaugh@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	01/16/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Contact for Fraud Investigations		Ms.	Livelsberger	Jennifer		7177753756					Jennifer.Livelsberger@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	01/16/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Coordination of Benefits Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Corporate Mailing						7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	171779799	02/15/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Coverage Gap Discount Program (CGDP) Payment Contact		Ms.	Beauduy	Tamara		7175416946					Tamara.Beauduy@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	05/18/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Customer Service Operations Contact	Director Medicare Operations	Mr.	Koch	Jonathan		7178292114				7176518873	jonathan.koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	06/17/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	DIR Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	DIR Contact (Secondary)	Actuarial Business Consultant, Actuarial and Under	Mr.	Shafer	Brian		7175416263				7176514214	Brian.Shafer@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	02/19/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Emergency Part D Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7175864604				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/30/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Emergency Part D Contact (Secondary)	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/09/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Employer Waiver Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	11/25/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Encounter Data & Risk Adjustment Operations Contact			Matos	Tamara		7175416275					tamara.matos@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/27/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Enrollment Contact	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465897	nicole.peterson@capbluecross.com	2500 Elmerton Ave.		Harrisburg	PA	17177	08/16/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	EOB Transfer Contact	Director Medicare Operations	Mr.	Koch	Jonathan		7178292114				7176518873	Jonathan.Koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Financial Audit Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/09/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Financial Reporting Contact	VP Finance and Controller	Mr.	Hershberger	Josh		7173710410					Josh.Hershberger@CapBlueCross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	09/13/2023	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Formulary Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	1305 Corporate Center Drive		Eagan	MN	55121	06/15/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	General Contact	Sr. VP Government Programs	Mr.	Fernandez	Frank		7175416062					Frank.Fernandez@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Government Relations Contact	Sr. VP & General Counsel	Mr.	Hopkins	Joel		7175416358				7176514445	Joel.Hopkins@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	07/19/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	HIPAA Privacy Officer	Privacy & Data Protection Officer	Mr.	Stambaugh	Alan		7175417077					Alan.Stambaugh@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	171779799	05/31/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	HIPAA Security Officer	Chief Information Security Officer	Mr.	Burd	Aaron		7175416939					aaron.burd@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Hospice Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Interoperability Contact	Senior Director, Information Technology		Blackwell	William		7175417246					William.Blackwell@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	11/24/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	MA Appeals/Grievances Contact	Director, Medicare Operations	Mr.	Koch	Jonathan		7178292114					Jonathan.Koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	05/30/2019	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	MA Claims Processing Contact for Public Website	Director Medicare Operations	Mr.	Koch	Jonathan		8666882242					Jonathan.Koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Marketing Contact	Director, Marketing	Mr.	Londre	Michael		7175416467				7175402499	Michael.Londre@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	11/24/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Medical Director	Chief Medical Director	Dr.	Wigginton	Jeremy	A	7175417152					jeremy.wigginton@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/09/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Medicare Coordinator			Wilbert	Tiffany		7175417606					tiffany.wilbert@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Medicare Part D Opioid Overutilization Contact	Senior Director, Medicare Pharmacy Operations and	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue	P.O. Box 779846	Harrisburg	PA	17177	01/02/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Medication Therapy Management Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	02/19/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	02/15/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Online Enrollment Center Contact (Back-up)	Director Medicare Operations	Mr.	Koch	Jonathan		7178292114				7176518873	Jonathan.Koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Online Enrollment Center Contact (Primary)	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465811	nicole.peterson@capbluecross.com	2500 Elmerton Ave.		Harrisburg	PA	17177	09/08/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Part C Application Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	11/25/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Part C Reporting Contact		Ms.	Dale	Rasheda		7175416444					rasheda.dale@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/29/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	09/08/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active	8006936651				PPO - BBA		C	Philadelphia
H3923	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/29/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active	8006936651				PPO - BBA		C	Philadelphia
H3923	Part D Application Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	11/25/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Part D Benefits Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Part D Claims Submission Contact	Manager, Medicare Pharmacy Operations	Ms,	Cook	Tammy	L	7177038749				7173466836	tammy.cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	01/29/2018	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Part D Exceptions Contact	Senior Director, Medicare Pharmacy Operations	Ms	Leedock	Melissa							Melissa.Leedock@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	01/02/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active	8669874213				PPO - BBA		C	Philadelphia
H3923	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist	Ms	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55120	03/30/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active	8006936651				PPO - BBA		C	Philadelphia
H3923	Part D Price File Contact (Back-up)	QA Analyst Sr		Nguyen	Kim		6127776931					kim.nguyen@PrimeTherapeutics.com	Prime Therapeutics, LLC	1305 Corporate Center Drive	Eagan	MN	55121	09/08/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Part D Price File Contact (Optional)	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Part D Price File Contact (Primary)	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Part D Quality Assurance Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Part D Reporting Contact		Ms.	Leonard	Kellie		7175417117					Kellie.Leonard@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	05/26/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Patient Safety Contact	Senior Director, Medicare Pharmacy Operations and	Ms.	Leedock	Melissa		7177541693				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	01/02/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Payment Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	02/15/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Pharmacy Director	Senior Director, Medicare Pharmacy Operations and	Ms.	Leedock	Melissa		7177541693				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	07/19/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Pharmacy Network Management Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	12/14/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Pharmacy Network Management Contact (Secondary)			Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	1305 Corporate Center Drive		Eagan	MN	55121	09/08/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Pharmacy Technical Help Desk Contact	Director, Member Services	Ms	Pretlow	Jennifer							jennifer.pretlow@primetherapeutics.com	Prime Therapeutics LLC 2655 Eagan Woods Drive		Eagan	MN	55122	09/08/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active	8888780151				PPO - BBA		C	Philadelphia
H3923	Plan Directory Contact for Public Website	Medicare Compliance Officer	Ms.	Yu	Gloria		8666882242					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	02/15/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Plan to Plan Reconciliation Contact	Accountant I	Ms.	Beauduy	Tamara		7175416946					FinanceP2P-CASH@CapBlueCross.com	2500 Elmerton Avenue	Mail Drop 3237	Harrisburg	PA	17177	08/16/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Processor Contact	Manager, PBM Operations	Ms.	Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC 2900 Ames Crossing Road		Eagan	MN	55121	09/08/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Quality Contact	Sr. Medical Director	Dr.	Harr	Denise		7177038497					Denise.Harr@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	06/16/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Reconciliation Contact	Director, Actuarial Services	Mr.	Baksi	David		7175417317					david.baksi@capbluecross.com	2500 Elmerton Ave.		Harrisburg	PA	17177	09/10/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Reconciliation Contact (Secondary)	Actuarial Business Consultant	Mr.	Shafer	Brian		7175416263					Brian.Shafer@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	09/10/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	02/15/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	SNP Application Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	11/25/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	SNP State Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	11/25/2020	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Surveillance Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	02/15/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	System Contact	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465897	nicole.peterson@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/16/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Third Party Administrator (TPA) Liaison		Ms.	Beauduy	Tamara		7175416946					Tamara.Beauduy@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	12/27/2022	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	User Access Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	02/15/2021	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Utilization Management Contact		Ms.	Yoder	Hollie		7177755884					Hollie.Yoder@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3923	Utilization Review Contact		Ms.	Yoder	Hollie		7177755884					Hollie.Yoder@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	CAPITAL ADVANTAGE INSURANCE COMPANY	Local CCP	Capital Blue Cross	Local PPO		CAPITAL BLUE CROSS	41	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Agent/Broker Compensation Data Contact	Manager, Sales Operations	Ms.	Martz	Andrea	L	5705094265					amartz3@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223910	12/21/2021	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Automated TrOOP Balance Transfer Contact	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	eobp2p@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	10/31/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Backup User Access Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Best Available Evidence Contact	Director, Health Plan Operations - Enrollment	Ms.	Kinney	Noelle	C	5702149270					nckinney@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	10/25/2021	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Bid Audit Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Bid Audit Site Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Bid Primary Contact	VP, Government Programs	Ms.	Mastrandrea	Mary		4103037972					mmastrandrea@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	10/30/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	CEO - CMS Administrator Contact	COO/CFO	Mr.	McCullough	Mark	A	5023861395					mmccullough1@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	12/21/2021	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	CEO - Senior Official for Contracting	CEO and President, Geisinger Health Plan	Mr.	Wrobel	Kurt	J	5702717212				5702715268	kjwrobel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	03/10/2021	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Chief Financial Officer	COO/CFO	Mr.	McCullough	Mark	A	5702140783					mmccullough1@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	12/28/2020	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Chief Operating Officer	COO/CFO	Mr.	McCullough	Mark	A	5702140783					mmccullough1@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	12/28/2020	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Chief Information Officer	Chief Information Officer	Mr.	Angelakos	Mike		5702140475					mangelakos@geisinger.edu	Geisinger Health System	100 N. Academy Avenue	Danville	PA	178223025	06/07/2023	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Chief Information Security Officer	Chief Information Security Officer	Mr.	Gable	Zachary	A	5702142452					zagable@geisinger.edu	Geisinger Information Security Office	100 N. Academy Avenue Mail Code 40-38	Danville	PA	178223003	07/25/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	CMS Casework Communication Contact	Customer Service Team Coordinator		Peters	Joanne		5702143285				5702715970	jpeters@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	12/31/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Complaints Tracking Contact	Customer Service Team Coordinator		Peters	Joanne		5702143285				5702715970	jpeters@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	12/31/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Contact for Fraud Investigations	Manager Program Integrity	Ms.	Coslett	Kathy	B	5702140639					kbcoslett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	06/01/2023	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Coordination of Benefits Contact	Supervisor, Health Plan COB	Ms.	Minium, CPC	Joanne		5708497572					COB@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223251	04/20/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Corporate Mailing						5702716836				5702145305	fkdavis@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	05/17/2023	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Coverage Gap Discount Program (CGDP) Payment Contact	PDE/Part D Analyst	Mr.	Baylor	Blaze	A	5702144692				5702144692	babaylor1@thehealthplan.com	Geisinger Health Plan, Federal Government Programs	100 North Academy Avenue	Danville	PA	17822	05/03/2023	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Customer Service Operations Contact	Director, Health Plan Operations, Customer Care	Mr.	Sanders	John	R	5702148046					jrsanders@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	10/31/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	DIR Contact	Pharmacy Data Analyst Lead	Ms.	Bertollo	Krista	L	5702145059				5702146768	klbertollo@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	DIR Contact (Secondary)	Manager, Pharmacy Data and Reporting	Ms.	Chesnick	Candy		5702715555	59687			5702146768	cjchesnick@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Emergency Part D Contact	Director, Pharmacy Services	Dr.	Miller	Jamie		5703366446				5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/26/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Emergency Part D Contact (Secondary)	CEO and President, Geisinger Health Plan	Mr.	Wrobel	Kurt	J	5027519147				5702715268	kjwrobel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	12/21/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Encounter Data & Risk Adjustment Operations Contact	Actuarial Director		Trafton	Kristina	L	5702145043					kltrafton@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223225	10/29/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Enrollment Contact	Director, Health Plan Operations - Enrollment	Ms.	Kinney	Noelle	C	5702149270					nckinney@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	10/25/2021	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	EOB Transfer Contact	Pharmacy Data Analyst Lead	Ms.	Bertollo	Krista		5702145059				5702146768	EOBP2P@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Financial Audit Contact	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Financial Reporting Contact	VP Financial Reporting and Operations	Mr.	Teska	Christophe	S	5702146766					csteska@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223251	04/17/2023	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Formulary Contact	Medicare pharmacist	Dr.	Sponenberg	Todd	L	5702146597				5702146768	tsponenberg@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Formulary Contact (Secondary)	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen		5702149379				5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	General Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Government Relations Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	HIPAA Privacy Officer	Chief Privacy Officer	Mr.	Friesen, JD	Jonathan	R	5702716525					jfriesen@geisinger.edu	Geisinger Privacy Office	100 North Academy Avenue Mail Code 40-38	Danville	PA	178223003	07/25/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	HIPAA Security Officer	Chief Privacy Officer	Mr.	Friesen, JD	Jonathan	R	5702716525					jfriesen@geisinger.edu	Geisinger Privacy Office	100 North Academy Avenue Mail Code 40-38	Danville	PA	178223003	07/25/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Hospice Contact	Claims and Benefits Auditor, GHP Pharmacy	Ms.	Seabrook	Naiki	A	5702147851				5703002122	naseabrook@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	11/01/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Interoperability Contact	Sr. Director Information Technology	Mr.	Niedjaco	Felix	C	5708088538					fcniedjaco@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223911	03/23/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	MA Appeals/Grievances Contact	Director, Member Resolution Team	Ms.	Piepszowski	BethAnn		5702717166				5702717225	bapiepszowski@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	10/31/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	MA Claims Processing Contact for Public Website	Manager GHP Customer Service Operations/Claims	Ms.	George	Karen	M	5702140876					kmgeorge@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	12/22/2021	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Marketing Contact	Director, Health Plan Marketing	Ms.	Kimberland	Kelly		4122983841				5702717218	kkimberland@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	07/21/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Medical Director	Chief Medical Officer	Dr.	Bulger, DO, MBA	John		5702147020				5702715268	jbulger@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223008	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Medicare Coordinator	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Medicare Part D Opioid Overutilization Contact	Health Plan Pharmacist	Dr.	Shumlas	Leslie		5702141230					lshumlas1@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	07/21/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Medication Therapy Management Contact	Health Plan Pharmacist	Dr.	Scheib	Kristen		5702149238					kmscheib@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	11/01/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	OffShore Subcontractor Contact	Associate Vice President Legal Counsel	Mr.	Davis	F. Kelly		5702716836				5702145305	fkdavis@thehealthplan.com	Geisinger Health Plan Legal Services	100 N. Academy Avenue	Danville	PA	178223220	05/17/2023	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Online Enrollment Center Contact (Back-up)	Supervisor Customer Service	Ms.	Biehl	Lori		5708082168					lbiehl@thehealthplan.com	Geisinger Health Plan Enrollment - GHP	100 N. Academy Avenue	Danville	PA	178222580	06/01/2023	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Online Enrollment Center Contact (Primary)	Manager Customer Service Operations	Mr.	D'Elia	Russell		5708085038					rdelia@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	06/01/2023	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Part C Application Contact	Medicare Contract Specialist	Ms.	Wartinger	Lynn	S	5702718776					lswartinger@thehealthplan.com	Geisinger Health Plan, Federal Government Programs	100 North Academy Avenue	Danville	PA	178223220	07/25/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Part C Reporting Contact	Operations Specialist	Ms.	Utt	Bobbi	J	5702146718				5702148921	bjutt@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Part D Appeals	Manager, Pharmacy Cust. Srvc.	Ms	Bitler	Jessie	M						jmbitler@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/30/2020	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active	8009884861				PPO - BBA		C	Philadelphia
H3924	Part D Application Contact	Operations Specialist, Government Programs	Ms.	Wartinger	Lynn	S	5702718776				5702148921	lswartinger@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Part D Benefits Contact	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen	K	5702149379				5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Part D Claims Submission Contact	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen	K	5702149379				5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223229	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Part D Exceptions Contact	Director, Pharmacy Services	Dr.	Miller	Jamie						5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/22/2017	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active	8009884861				PPO - BBA		C	Philadelphia
H3924	Part D Exceptions Contact (Secondary)	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen	K					5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active	8009884861				PPO - BBA		C	Philadelphia
H3924	Part D Price File Contact (Back-up)	Medicare Pharmacist	Dr.	Sponenberg	Todd		5702145059				5702146597	tsponenberg@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	10/29/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Part D Price File Contact (Primary)	Manager, Government Programs Pharmacy Operations	Dr.	Bender	Kristen		5702715555	59687			5702149379	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17821	07/10/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Part D Quality Assurance Contact	Chief Medical Officer	Dr.	Bulger, DO, MBA	John		5702147020				5702715268	jbulger@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223008	11/01/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Part D Reporting Contact	Operations Specialist	Ms.	Utt	Bobbi	J	5702146718				5702148921	bjutt@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Patient Safety Contact	Chief Medical Officer	Dr.	Bulger, DO, MBA	John		5702147020				5702715268	jbulger@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223008	11/01/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Payment Contact	Actuarial Director		Trafton	Kristina	L	5702145043					kltrafton@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223225	10/29/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Pharmacy Director	Director, Pharmacy Services	Dr.	Miller	Jamie		5702715730				5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/22/2017	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Pharmacy Network Management Contact	PerformRx Director, Service Operations	Ms.	Leal MBA CHIE	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/28/2020	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Services	Dr.	Miller	Jamie		5702715730				5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/22/2017	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Pharmacy Technical Help Desk Contact	PerformRx Director, Service Operations	Ms	Leal MBA CHIE	Avelina							aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/21/2021	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active	8555081715				PPO - BBA		C	Philadelphia
H3924	Physician Incentive Contact	Manager, Provider Management	Ms.	Ortiz	Massiel		5704920147					mortiz4@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	12/06/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Plan Directory Contact for Public Website	Geisinger Health Plan		Care	Customer		5704989731				5702715871	ghp_customer+service@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223229	11/13/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Plan to Plan Reconciliation Contact	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	eobp2p@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	10/31/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Processor Contact	PerformRx Director, Service Operations	Ms.	Leal MBA CHIE	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/28/2020	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Quality Contact	Sr. Director, Medical Management	Mr.	Hummel	Eric		5702146405					ehummel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	11/01/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Reconciliation Contact	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	pwmerkel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	02/22/2021	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Reconciliation Contact (Secondary)	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Recovery Audit Contact	Associate Vice President Legal Counsel	Mr.	Davis	F Kelly		5702716836				5702145305	fkdavis@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	05/17/2023	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	SNP Application Contact	Operations Specialist, Government Programs	Ms.	Wartinger	Lynn	S	5702718776				5702718921	lswartinger@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	SNP State Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Surveillance Contact	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	System Contact	Technical Analyst Lead	Mr.	Sholder	Richard	J	5702717895				5702715162	rjsholder@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	07/25/2022	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Third Party Administrator (TPA) Liaison	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	pwmerkel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	04/14/2020	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	User Access Contact	Operations Specialist, Government Programs	Ms.	Wartinger	Lynn	S	5702718776				5702148921	lswartinger@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Utilization Management Contact	Sr. Director, Medical Management	Mr.	Hummel	Eric		5702146405					ehummel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	11/01/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3924	Utilization Review Contact	Sr. Director, Medical Management	Mr.	Hummel	Eric		5702146405					ehummel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	11/01/2019	2023	GEISINGER INDEMNITY INSURANCE COMPANY	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H3925	Automated TrOOP Balance Transfer Contact	NA	Mr.	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Backup User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Best Available Evidence Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Bid Primary Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	CAP Report Contact for Public Website	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Chief Financial Officer	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Chief Operating Officer	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Chief Information Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Chief Information Security Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	CMS Casework Communication Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Complaints Tracking Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Contact for Fraud Investigations	Executive Director	Mr.	Voeghtly	Robert		8145356000	22139			8142487902	Rvoeghtly@seniorlifejohnstown.com	401 Broad Street		Johnstown	PA	15906	04/19/2023	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Coordination of Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Corporate Mailing						8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Coverage Gap Discount Program (CGDP) Payment Contact			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Customer Service Operations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	DIR Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Emergency Part D Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Encounter Data & Risk Adjustment Operations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	10/18/2019	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Enrollment Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	EOB Transfer Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Financial Audit Contact	CFO	Mr	Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Financial Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Formulary Contact			N/A	N/A		8145356000	22100				N/A@n/a.com	N/A		N/A	PA	15906	05/17/2013	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	General Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Government Relations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	HIPAA Privacy Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	HIPAA Security Officer	IT Director		Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Interoperability Contact	Chief Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	MIrwin@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	02/16/2022	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	MA Appeals/Grievances Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Marketing Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Medical Director	Medical Director		Ratchford	Donald		8145356000	26007				DRatchford@physiciansolutionsgrp.com	401 Broad Street		Johnstown	PA	15906	02/26/2018	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Medicare Compliance Officer	Executive Director	Mr	Voeghtly	Robert		8145356000	22110			8142487902	RVoeghtly@seniorlifejohnstown.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Medicare Coordinator	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Medicare Part D Opioid Overutilization Contact	Medical Director		Ratchford	Donald		8145356000	26007				DRatchford@physiciansolutionsgrp.com	401 Broad Street		Johnstown	PA	15906	11/27/2018	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Medication Therapy Management Contact	Chief Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	03/13/2019	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Part C Application Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Part D Appeals	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H3925	Part D Appeals Contact (Secondary)	Chief Executive Officer	Mr.	Irwin	Mark						8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	12/29/2020	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active	8145356000	22101			PACE - Nat		C	Philadelphia
H3925	Part D Application Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Part D Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Part D Claims Submission Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Part D Exceptions Contact	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H3925	Part D Price File Contact (Back-up)			N/A	N/A		8145356000	22100				N/A@N/A.com	N/A		N/A	PA	15906	05/17/2013	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Part D Price File Contact (Primary)			N/A	N/A		8145356000	22100				N/A@N/A.com	N/A		N/A	PA	15906	05/17/2013	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Part D Quality Assurance Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Part D Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Patient Safety Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Payment Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Pharmacy Director			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Pharmacy Network Management Contact			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Pharmacy Technical Help Desk Contact			Rowland	Bob							Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active	7242751203	219			PACE - Nat		C	Philadelphia
H3925	Plan Directory Contact for Public Website	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Processor Contact	Claims Manager		Best	Karen		8145356000	22104			8142487902	KBest@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Quality Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Reconciliation Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Recovery Audit Contact	CFO	Mr	Dodson	David	M	8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Surveillance Contact			Irwin	Mark		8145356000	22101				Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	System Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Third Party Administrator (TPA) Liaison			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Utilization Management Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3925	Utilization Review Contact	ChieExecutive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	PENNSYLVANIA PACE, INC.	National PACE	Senior LIFE Johnstown	National PACE		Pennsylvania PACE, Inc.	181	Yes	Active					PACE - Nat		C	Philadelphia
H3928	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8887369118				8885547668	BAE/LISMailbox@aetna.com	Attn:  BAE	P.O. Box 14088	Lexington	KY	405124088	12/03/2018	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/05/2017	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H3928	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Plan Directory Contact for Public Website			Customer Service	Aetna		8883606626					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	11/25/2014	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3928	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (LA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/06/2015	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H3931	PHR Beneficiary Contact																	02/28/2007	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				HMO - Health Maintenance Organization		C	Philadelphia
H3931	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/11/2015	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	02/08/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	02/08/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3931	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3942	Automated TrOOP Balance Transfer Contact	Business Analyst		Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Backup User Access Contact	Quality Assurance Coordinator		Forney	Harriet		9103438209	155			9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Best Available Evidence Contact	Quality Assurance Coordinator	Ms.	Forney	Harriet		9103438209	155			9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Bid Primary Contact	Sr. Director of HCBS	Mr.	Chang	Thomas	T	3367463519				3367463523	tchang@EveryAge.org	802 E. Center Street		Lexington	NC	27401	11/19/2021	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	CAP Report Contact for Public Website	Quality Assurance Coordinator		Forney	Harriet		9103438209	155			9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	CEO - CMS Administrator Contact	Executive Director	Ms	Finch	Ruth		9103438209	8000932			9103438836	rfinch@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	CEO - Senior Official for Contracting	Chief Operating Officer	Ms	Reimann	Aimee		8284658017				9103438836	areimann@EveryAge.org	100 Leonard Ave		Newton	NC	28658	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Chief Financial Officer	CFO	Ms.	Jones	Tammy		8284658007				9103438836	tjones@EveryAge.org	100 Leonard Ave		Newton	NC	28658	02/01/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Chief Operating Officer	Sr. Director of HCBS	Mr.	Chang	Thomas	T	3367463519				3367463523	tchang@EveryAge.org	802 E. Center Street		Lexington	NC	27401	11/02/2021	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Chief Information Officer	Director of Information Technology	Mr.	Larew	Brantley		8284658016				9103438836	Blarew@EveryAge.org	100 Leonard Ave		Newton	NC	28658	11/18/2021	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Chief Information Security Officer	Director of Information Technology	Mr.	Larew	Brantley		8284658016				9103438836	Blarew@EveryAge.org	100 Leonard Ave		Newton	NC	28658	11/18/2021	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	CMS Casework Communication Contact	Executive Director	Ms	Finch	Ruth		9103438209	8000932			9103438836	rfinch@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Complaints Tracking Contact	Quality Assurance Coordinator		Forney	Harriet		9103438209	155			9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Contact for Fraud Investigations	Quality Assurance Coordinator		Forney	Harriet		9103438209	155			9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Coordination of Benefits Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Corporate Mailing						9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Customer Service Operations Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	DIR Contact	Business Office Team Lead	Ms.	Stormer	Kristen		3367463547				3367463523	kstormer@EVERYAGE.org	1380 North College Road		Wilmington	NC	28405	02/01/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	DIR Contact (Secondary)	Sr. Director of HCBS	Mr.	Chang	Thomas	T	3367463519				3367463523	tchang@EveryAge.org	802 E. Center Street		Lexington	NC	27401	11/19/2021	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Emergency Part D Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Emergency Part D Contact (Secondary)	Sr. Director of HCBS	Mr.	Chang	Thomas	T	3367463519				3367463523	tchang@EveryAge.org	802 E. Center Street		Lexington	NC	27401	11/19/2021	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Encounter Data & Risk Adjustment Operations Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Enrollment Contact	Enrollmnet Coordinator	Ms.	Wilkins	Aysha		9105204347	8000922			9107630947	awilkins@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	EOB Transfer Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Financial Audit Contact	Sr. Director of HCBS	Mr.	Chang	Thomas	T	3367463519				3367463523	tchang@everyage.org	802 E. Center Street		Lexington	NC	27292	01/16/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Financial Reporting Contact	CFO	Ms.	Jones	Tammy		8284658007				9103438836	tjones@EveryAge.org	100 Leonard Ave		Newton	NC	28658	02/01/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Formulary Contact	Business Analyst		Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	General Contact	Business Analyst		Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Government Relations Contact	Executive Director		Finch	Ruth		9103438209	8000932			9103438836	rfinch@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	HIPAA Privacy Officer	Quality Assurance Coordinator		Forney	Harriet		9103438209	155			9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	HIPAA Security Officer	Quality Assurance Coordinator		Forney	Harriet		9103438209	155			9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Interoperability Contact	Executive Director	Ms	Finch	Ruth		9103438209	8000932			9103438836	rfinch@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	MA Appeals/Grievances Contact	Quality Assurance Coordinator		Forney	Harriet		9103438209	155			9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	MA Claims Processing Contact for Public Website	Business Office Team Lead		Stormer	Kristen		3367463547				3367463523	kstormer@EVERYAGE.org	1380 North College Road		802 E. Center Street	NC	27292	02/01/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Marketing Contact	Executive Director	Ms	Finch	Ruth		9103438209	8000932			9103438836	rfinch@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Medical Director	Medical Director	Dr.	Roddy	David		3367463500				3365283814	droddy@everyage.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Medicare Compliance Officer	Quality Coordinator	Ms	Forney	Harriet		9103438209				9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Medicare Coordinator	Business Analyst		Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Roddy	David		3367463500				3365283814	droddy@everyage.org	1380 North College Road		Wilmington	NC	28405	11/19/2021	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Medication Therapy Management Contact	Medical Director	Dr.	Roddy	David		3367463500	145			3365283814	droddy@everyage.org	1380 North College Road		Wilmington	NC	28405	11/19/2021	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Online Enrollment Center Contact (Back-up)	Executive Director		Finch	Ruth		9103438209	8000932			9103438836	rfinch@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Online Enrollment Center Contact (Optional)	Enrollment Coordinator	Mrs.	Wilkins	Alysha		9105204347	8000922			9107630947	awilkins@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Online Enrollment Center Contact (Primary)	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Part C Application Contact	Executive Director		Finch	Ruth		9103438209	8000932			9103438836	rfinch@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Part D Appeals	Quality Coordinator		Forney	Harriet						9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active	8883438209	161			PACE - Nat		C	Atlanta
H3942	Part D Appeals Contact (Secondary)	Medical Director	Dr.	Roddy	David						9103438836	droddy@everyage.org	1380 North College Road		Wilmington	NC	28405	11/19/2021	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active	8883438209	161			PACE - Nat		C	Atlanta
H3942	Part D Application Contact	Executive Director	Ms	Finch	Ruth		9103438209	8000932			9103438836	rfinch@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Part D Benefits Contact	Business Analyst		Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Part D Claims Submission Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Part D Exceptions Contact	Business Analyst		Chastain	Kelly						9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active	8883438209	8000930			PACE - Nat		C	Atlanta
H3942	Part D Exceptions Contact (Secondary)	Quality Coordinator		Forney	Harriet						9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active	8883438209	161			PACE - Nat		C	Atlanta
H3942	Part D Price File Contact (Back-up)	Executive Director	Ms	Finch	Ruth		9103438209	8000932			9103438836	rfinch@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Part D Price File Contact (Primary)	Business Analyst		Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Part D Quality Assurance Contact	Quality Coordinator	Ms.	Forney	Harriet		9103438209	155			9103438836	HForney@everyage.org	1380 North College Road		Wilmington	NC	28405	01/16/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Part D Reporting Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Patient Safety Contact	Quality Assurance Coordinator		Forney	Harriet		9103438209	155			9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Payment Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Personal Health Record Contact	Executive Director	Ms	Finch	Ruth		9103438209	164			9103438836	rfinch@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Pharmacy Director	Medical Director	Dr.	Roddy	David		3367463500	145			3365283814	droddy@everyage.org	1380 North College Road		Wilmington	NC	28405	11/19/2021	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Pharmacy Network Management Contact	Business Analyst		Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Pharmacy Technical Help Desk Contact	Business Analyst	Ms.	Chastain	Kelly						9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active	8883438209	8000930			PACE - Nat		C	Atlanta
H3942	PHR Beneficiary Contact																	09/13/2016	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE	Elderhaus, Inc.	EveryAge	797	Yes	Active	8883438209	161			PACE - Nat		C	Atlanta
H3942	Plan Directory Contact for Public Website	Business Analyst		Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Plan to Plan Reconciliation Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Processor Contact	Business Office Team Lead	Ms.	Stormer	Kristen		3367463547				3367463523	kstormer@EVERYAGE.org	1380 North College Road		Wilmington	NC	28405	02/01/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Quality Contact	Quality Assurance Coordinator		Forney	Harriet		9103438209	155			9103438836	hforney@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Reconciliation Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Reconciliation Contact (Secondary)	Sr. Director of HCBS	Mr.	Chang	Thomas	T	3367463519				3367463523	tchang@EveryAge.org	802 E. Center Street		Lexington	NC	27401	11/19/2021	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Recovery Audit Contact	Executive Director	Ms	Finch	Ruth		9103438209	164			9103438836	rfinch@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/09/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Surveillance Contact	Business Analyst		Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	System Contact	Business Analyst		Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Third Party Administrator (TPA) Liaison	Business Office Team Lead	Ms.	Stormer	Kristen		3367463547				3367463523	kstormer@EVERYAGE.org	1380 North College Road		Wilmington	NC	28405	02/01/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	User Access Contact	Business Analyst	Ms.	Chastain	Kelly		9103438209	8000930			9103438836	kchastain@EveryAge.org	1380 North College Road		Wilmington	NC	28405	01/17/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Utilization Management Contact	Business Office Team Lead	Ms.	Stormer	Kristen		3367463547				3367463523	kstormer@EVERYAGE.org	1380 North College Road		Wilmington	NC	28405	02/01/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3942	Utilization Review Contact	Business Office Team Lead	Ms.	Stormer	Kristen		3367463547				3367463523	kstormer@EVERYAGE.org	1380 North College Road		Wilmington	NC	28405	02/01/2023	2023	ELDERHAUS INC.	National PACE	Elderhaus PACE	National PACE		EveryAge	797	Yes	Active					PACE - Nat		C	Atlanta
H3949	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H3949	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H3949	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H3949	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H3949	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H3949	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H3949	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3949	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	BRAVO HEALTH PENNSYLVANIA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H3952	Agent/Broker Compensation Data Contact	Director Gov. Markets Sales & Marketing Enablement		Curcio	Chris		2676751808					chris.curcio@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	12/22/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Automated TrOOP Balance Transfer Contact	Lead Business Systems Support Admin		Jimenez	Barbara		2676751825					barbara.jimenez@ibx.com	1901 Market Street	16th Floor	Philadelphia	PA	19103	02/27/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Backup User Access Contact	Reg. Performance Mgmt. Analyst II		Smith	Janet		2152419308					janet.smith@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	02/27/2020	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Best Available Evidence Contact	Sr. Business Analyst		Caldwell	Geraldine		2676751809					Geraldine.Caldwell@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/16/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Bid Audit Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Bid Audit Site Contact	Actuarial Associate and Manager		Smith	William	R	2152412812					William.Smith@ibx.com	1901 Market Street	40th Floor	Philadelphia	PA	19103	01/02/2020	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Bid Primary Contact	Actuarial Associate and Manager		Smith	William	R	2152412812					William.Smith@ibx.com	1901 Market Street,	40th Floor	Philadelphia	PA	19103	04/27/2018	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	CAP Report Contact for Public Website	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	CEO - CMS Administrator Contact	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		6094050539					Juan.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/15/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	CEO - Senior Official for Contracting	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		2152414614	24614				Juan.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/15/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Chief Financial Officer	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		2152414614	24614				Juan.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/15/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Chief Operating Officer	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		2152414614	24614				Juan.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/15/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Chief Information Officer	EVP and Chief Strategy, Corp. Dev., & Info Officer	Mr.	Vennera	Michael		2152419525					Michael.Vennera@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	04/24/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Chief Information Security Officer	Chief Information Security Leader	Mr.	Abella	John		2676759865					John.Abella@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	04/21/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	CMS Casework Communication Contact	Manager, Medicare Operations		Zonies	Melissa		2676751633					Melissa.Zonies@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	01/26/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Complaints Tracking Contact	Manager, Medicare Operations		Zonies	Melissa		2676751633					Melissa.Zonies@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	01/26/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Contact for Fraud Investigations	Director, Financial Investigations		Deery	Christophe	E	2156407302	27302			2152382287	christopher.deery@ibx.com	1901 Market Street	42nd Floor	Philadelphia	PA	19103	12/30/2015	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Coordination of Benefits Contact	Manager, COB/OPL		Hawkins	Veronica		2156407507	27507				Veronica.Hawkins@ibx.com	1901 Market Street	17th Floor	Philadelphia	PA	19103	12/24/2020	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Corporate Mailing						2152412400					mitchell.goldberg@ibx.com	1901 Market Street		Philadelphia	PA	19103	02/27/2012	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Coverage Gap Discount Program (CGDP) Payment Contact	CPA		Murphy	Stacey		2152413522	23522				Stacey.Murphy@ibx.com	1901 Market Street, 36th Floor	Corporate Accounting	Philadelphia	PA	19103	06/28/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Customer Service Operations Contact	Director, Contact Center		Lentz	Michael		2157933262	63262				michael.lentz@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	11/01/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	DIR Contact	Manager Gov. Markets - Commercial Risk Adjustment		Sanders	Sean		2152419420					Sean.Sanders@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	06/29/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	DIR Contact (Secondary)	Lead GM Data Audit & Sub Analyst		Wyher	Geoffrey		2152417265					Geoffrey.Wyher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	06/29/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Emergency Part D Contact	Vice President, Operations		Gold	Nicole		2673193327					Nicole.Gold@ibx.com	1901 Market Street	7th Floor	Philadelphia	PA	19103	02/27/2020	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Emergency Part D Contact (Secondary)	Manager Regulatory Performance Management		Adams	Desiree		2153279829					Desiree.Adams@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	02/24/2020	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Employer Waiver Contact	SVP Government Markets, Sales & Marketing Leadersh		Cruz	Kortney		2152414762					Kortney.Cruz@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	12/16/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Encounter Data & Risk Adjustment Operations Contact	Manager Data Delivery and Reporting	Ms.	Heifetz	Nata		2152410511					Nata.Heifetz@ibx.com	1901 Market Street	37th Floor	Phialdelphia	PA	19103	12/19/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Enrollment Contact	Sr. Business Analyst		Caldwell	Geraldine		2676751809					Geraldine.Caldwell@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/16/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	EOB Transfer Contact	Pharmacy Service Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Financial Audit Contact	Director of Audit, Regulatory Audit & Complaince	Ms.	Kovach	Lauren		2152412506				2155674542	Lauren.Kovach@ibx.com	1901 Market Street		Philadelphia	PA	19103	04/19/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Financial Reporting Contact	VP Tax		Robinson	Ken		2152414065					ken.robinson@ibx.com	1901 Market Street	39th Floor	Philadelphia	PA	19103	12/22/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Formulary Contact	Clinical Pharmacist		Urbanek	Michael		2152419003				2152413526	Michael.Urbanek@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	10/01/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Formulary Contact (Secondary)	Clinical Consultant OptumRx		Malhi	Paramveer		6124766526					paramveer.malhi@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/16/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	General Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Government Relations Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	HIPAA Privacy Officer	VP Corporate Compliance		Zipfel	Michael		2152414908					michael.zipfel@ibx.com	1901 Market Street		Philadelphia	PA	19013	04/19/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	HIPAA Security Officer	Chief Information Security Leader		Abella	John		2676759865					john.abella@ibx.com	1901 Market Street	8th Floor	Philadelphia	PA	19103	02/15/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Hospice Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654					kathy.erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	06/29/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Interoperability Contact	Director Information Governance		Denyer	James		2152410858					james.denyer@ibx.com	1901 Market Street	20th Floor	Philadelphia	PA	19103	11/29/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	MA Appeals/Grievances Contact	Manager, Medicare Member Appeals and Grievances		Tobias	Bobbi		2152410669					Bobbi.Tobias@ibx.com	1901 Market Street	Mailstop, 12TH floor	Philadelphia	PA	19103	04/19/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	MA Claims Processing Contact for Public Website	Director Claims Operations		Perfetto	Lisa		2152414126					lisa.perfetto@ibx.com	1901 Market Street, 15th Floor		Philadelphia	PA	19103	02/28/2018	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Marketing Contact	RPM Analyst II, NJMA Government		Dunn	Devonda		2152413837					devonda.dunn@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/26/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Medical Director	Medical Director	Dr.	Syropoulos	Heidi	J	2152414511					Heidi.Syropoulos@ibx.com	1901 Market Street		Philadelphia	PA	19103	04/25/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Medicare Compliance Officer	Dir, Corp. Compl, Privacy & Medicare Compl Officer	Mr.	Goldberg	Mitchell		2152419516				2155674542	mitchell.goldberg@ibx.com	1901 Market Street	42nd Floor	Philadelphia	PA	19103	04/29/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Medicare Coordinator	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Steffes	Michael		2156407557				2152413526	Michael.Steffes@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	12/16/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Medication Therapy Management Contact	Clinical Pharmacist		Steffes	Michael		2156407557				2152413526	Michael.Steffes@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	12/16/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Online Enrollment Center Contact (Back-up)	Manager, Enrollment Services		Kelley	Josh		2152414829					Joshua.Kelley@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/19/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Online Enrollment Center Contact (Optional)	Regulatory Performance Mgmt. Analyst II		Smith	Janet		2152419308					janet.smith@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	12/19/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Online Enrollment Center Contact (Primary)	Sr. Business Analyst		Caldwell	Geraldine		2676751809					Geraldine.Caldwell@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/16/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part C Application Contact	Senior Product and Capability Mgr.		Keenan	Kate		2152419495					kate.keenan@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	02/28/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part C Reporting Contact	Manager, Government Markets Reporting		Pippett	Andrew		2152417416					Andrew.Pippett@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	06/29/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Appeals	Manager Medicare Member Appeals and Grievances		Tobias	Bobbi							Bobbi.Tobias@ibx.com	1901 Market Street	Mailstop, 12TH floor	Philadelphia	PA	19103	04/19/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8887183333				HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Appeals Contact (Secondary)	Supervisor, Medicare Member Appeals and Grievances		Byrd	Kelly							Kelly.Byrd@ibx.com	1901 Market Street	Mailstop, 12TH floor	Philadelphia	PA	19103	06/28/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8887183333				HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Application Contact	Senior Product and Capability Mgr.		Keenan	Kate		2152419495					kate.keenan@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	02/28/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Benefits Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Claims Submission Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Exceptions Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy						2152412654	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8886787015				HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Exceptions Contact (Secondary)	Manager, Prior Authorization		Mourad	Hala							Hala.Mourad@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8886787015				HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Price File Contact (Back-up)	Senior Business Analyst, Plan Finder		Moore-Elliott	Shalandria		7637974305					Mshalandria.moore-elliott@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/16/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Price File Contact (Optional)	Project Leader		Coursey	Yaminah		2152413955					yaminah.coursey@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	12/07/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Price File Contact (Primary)	Senior Business Analyst, Plan Finder		Kim	Kevin		7693617996					kevin.kim@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/16/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Quality Assurance Contact	Director Quality Management		Donohue	Kathleen		2152413277					Kathleen.Donohue@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/27/2018	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Part D Reporting Contact	Manager Government Markets Reporting		Pippett	Andrew		2152417416					Andrew.Pippett@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	06/29/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Patient Safety Contact	Clinical Pharmacist		Steffes	Michael		2156407557				2152413526	Michael.Steffes@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	12/16/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Payment Contact	Director Risk Adjustment & Data Delivery		Buscher	Harry		2152410806					Harry.Buscher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	06/08/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Pharmacy Director	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Pharmacy Network Management Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations		Perez	Felix	M	7632833503					felix.perez@optum.com	11000 Optum Circle	Office # 937	Eden Prairie	MN	55344	05/16/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Pharmacy Technical Help Desk Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy						2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8886787015				HMO - Health Maintenance Organization		C	Philadelphia
H3952	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Help Desk		Summers	Todd							todd.summers@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8886787015				HMO - Health Maintenance Organization		C	Philadelphia
H3952	Physician Incentive Contact	Deputy General Counsel		Dianno	Mark		2152412919					Mark.Dianno@ibx.com	1901 Market Street	43rd Floor	Philadelphia	PA	19103	01/26/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Plan Directory Contact for Public Website			Service	Customer		8006453965					info@ibxmedicare.com	PO Box 7799		Philadelphia	PA	191017799	04/29/2015	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Plan to Plan Reconciliation Contact	Lead GM Data Audit & Sub Analyst		Wyher	Geoffrey		2156407265				2152412408	geoffrey.wyher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	02/18/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Processor Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/30/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Quality Contact	Director Quality Management		Donohue	Kathleen		2152413277					Kathleen.Donohue@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/27/2018	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Reconciliation Contact	Director Risk Adjustment & Data Delivery		Buscher	Harry		2152410806					harry.buscher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	03/27/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Reconciliation Contact (Secondary)	Mgr. Gov. Mkts. - Commercial Risk Analytics		Sanders	Sean		2152419420					Sean.Sanders@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	01/15/2021	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Recovery Audit Contact	Director of Regulatory Performance Management	Ms.	Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	SNP Application Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	SNP State Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Surveillance Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	System Contact	Director Enterprise Information Management		Varghese	John		2152414553					john.varghese@ibx.com	1901 Market Street	20th Floor	Philadelphia	PA	19103	10/26/2017	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Third Party Administrator (TPA) Liaison	CPA		Murphy	Stacey		2152413522	23522				Stacey.Murphy@ibx.com	1901 Market Street, 36th Floor	Corporate Accounting	Philadelphia	PA	19103	06/28/2022	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	User Access Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Utilization Management Contact	Director Medical Management & Utilization Review		McGurk	Cheryl		2152414542					Cheryl.mcgurk@ibx.com	1901 Market Street	30th Floor	Philadelphia	PA	19103	08/29/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3952	Utilization Review Contact	Director Medical Management & Utilization Review		McGurk	Cheryl		2152414542					Cheryl.mcgurk@ibx.com	1901 Market Street	30th Floor	Philadelphia	PA	19103	08/29/2023	2023	KEYSTONE HEALTH PLAN EAST, INC.	Local CCP	Independence Blue Cross	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Agent/Broker Compensation Data Contact	Manager, Sales Operations	Ms.	Martz	Andrea	L	5705094265					amartz3@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223910	12/21/2021	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Automated TrOOP Balance Transfer Contact	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	eobp2p@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	10/31/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Backup User Access Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Best Available Evidence Contact	Director, Health Plan Operations - Enrollment	Ms.	Kinney	Noelle	C	5702149270					nckinney@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	10/25/2021	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Bid Audit Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Bid Audit Site Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Bid Primary Contact	VP, Government Programs	Ms.	Mastrandrea	Mary		4103037972					mmastrandrea@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	10/31/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	CEO - CMS Administrator Contact	COO / CFO	Mr.	McCullough	Mark	A	5023861395					mmccullough1@thehealthplan.com	100 North Academy Avenue		Danville	PA	17822	12/21/2021	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	CEO - Senior Official for Contracting	CEO and President, Geisinger Health Plan	Mr.	Wrobel	Kurt	J	5702717212				5702715268	kjwrobel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	03/10/2021	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Chief Financial Officer	COO / CFO	Mr.	McCullough	Mark	A	5702140783					mmccullough1@thehealthplan.com	100 North Academy Avenue		Danville	PA	17822	11/18/2020	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Chief Operating Officer	COO / CFO	Mr.	McCullough	Mark	A	5702140783					mmccullough1@thehealthplan.com	100 North Academy Avenue		Danville	PA	17822	11/18/2020	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Chief Information Officer	Chief Information Officer	Mr.	Angelakos	Mike		5702140475					mangelakos@geisinger.edu	Geisinger Health System	100 N. Academy Avenue	Danville	PA	178223025	06/07/2023	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Chief Information Security Officer	Chief Information Security Officer	Mr.	Gable	Zachary	A	5702142452					zagable@geisinger.edu	Geisinger Information Security Office	100 N. Academy Avenue Mail Code 40-38	Danville	PA	178223003	07/25/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	CMS Casework Communication Contact	Customer Service Team Coordinator		Peters	Joanne		5702143285				5702715970	jpeters@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	12/31/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Complaints Tracking Contact	Customer Service Team Coordinator		Peters	Joanne		5702143285				5702715970	jpeters@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	12/31/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Contact for Fraud Investigations	Manager Program Integrity	Ms.	Coslett	Kathy	B	5702140639					kbcoslett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	06/01/2023	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Coordination of Benefits Contact	Supervisor, Health Plan COB	Ms.	Minium, CPC	Joanne		5708497572					COB@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223251	04/20/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Corporate Mailing						5702716836				5702145305	fkdavis@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	05/17/2023	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Coverage Gap Discount Program (CGDP) Payment Contact	PDE/Part D Analyst	Mr.	Baylor	Blaze	A	5702144692				5702144692	babaylor1@thehealthplan.com	Geisinger Health Plan, Federal Government Programs	100 North Academy Avenue	Danville	PA	17822	05/03/2023	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Customer Service Operations Contact	Director, Health Plan Operations, Customer Care	Mr.	Sanders	John	R	5702148046					jrsanders@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	11/01/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	DIR Contact	Pharmacy Data Analyst Lead	Ms.	Bertollo	Krista	L	5702145059				5702146768	klbertollo@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	DIR Contact (Secondary)	Manager, Pharmacy Data and Reporting	Ms.	Chesnick	Candy		5702715555	59687			5702146768	cjchesnick@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Emergency Part D Contact	Director, Pharmacy Services	Dr.	Miller	Jamie		5703366446				5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/26/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Emergency Part D Contact (Secondary)	CEO and President, Geisinger Health Plan	Mr.	Wrobel	Kurt	J	5027519147				5702715268	kjwrobel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	12/21/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Encounter Data & Risk Adjustment Operations Contact	Actuarial Director		Trafton	Kristina	L	5702145043					kltrafton@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223225	10/29/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Enrollment Contact	Director, Health Plan Operations - Enrollment	Ms.	Kinney	Noelle	C	5702149270					nckinney@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	10/25/2021	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	EOB Transfer Contact	Pharmacy Data Analyst Lead	Ms.	Bertollo	Krista		5702145059				5702146768	EOBP2P@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Financial Audit Contact	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Financial Reporting Contact	VP Financial Reporting and Operations	Mr.	Teska	Christophe	S	5702146766					csteska@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223251	04/17/2023	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Formulary Contact	Medicare pharmacist	Dr.	Sponenberg	Todd	L	5702146597				5702146768	tsponenberg@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Formulary Contact (Secondary)	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen		5702149379				5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	General Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Government Relations Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	HIPAA Privacy Officer	Chief Privacy Officer	Mr.	Friesen, JD	Jonathan	R	5702716525					jfriesen@geisinger.edu	Geisinger Privacy Office	100 North Academy Avenue Mail Code 40-38	Danville	PA	178223003	07/25/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	HIPAA Security Officer	Chief Privacy Officer	Mr.	Friesen, JD	Jonathan	R	5702716525					jfriesen@geisinger.edu	Geisinger Privacy Office	100 North Academy Avenue Mail Code 40-38	Danville	PA	178223003	07/25/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Hospice Contact	Claims and Benefits Auditor, GHP Pharmacy	Ms.	Seabrook	Naiki	A	5702147851				5703002122	naseabrook@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	11/01/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Interoperability Contact	Sr. Director Information Technology	Mr.	Niedjaco	Felix	C	5708088538					fcniedjaco@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223911	03/23/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	MA Appeals/Grievances Contact	Director, Member Resolution Team	Ms.	Piepszowski	BethAnn		5702717166				5702717225	bapiepszowski@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	10/31/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	MA Claims Processing Contact for Public Website	Manager GHP Customer Service Operations/Claims	Ms.	George	Karen	M	5702140876					kmgeorge@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	12/22/2021	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Marketing Contact	Director, Health Plan Marketing	Ms.	Kimberland	Kelly		4122983841				5702717218	kkimberland@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	07/21/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Medical Director	Chief Medical Officer	Dr.	Bulger, DO, MBA	John		5702147020				5702715268	jbulger@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223008	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Medicare Coordinator	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Medicare Part D Opioid Overutilization Contact	Health Plan Pharmacist	Dr.	Shumlas	Leslie		5702141230					lshumlas1@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	07/21/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Medication Therapy Management Contact	Health Plan Pharmacist	Dr.	Scheib	Kristen		5702149238					kmscheib@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	11/01/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	OffShore Subcontractor Contact	Associate Vice President Legal Counsel	Mr.	Davis	F. Kelly		5702716836				5702145305	fkdavis@thehealthplan.com	Geisinger Health Plan Legal Services	100 N. Academy Avenue	Danville	PA	178223220	05/17/2023	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Online Enrollment Center Contact (Back-up)	Supervisor Customer Service	Ms.	Biehl	Lori		5708082168					lbiehl@thehealthplan.com	Geisinger Health Plan Enrollment - GHP	100 N. Academy Avenue	Danville	PA	178222580	06/01/2023	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Online Enrollment Center Contact (Optional)	Manager, Customer Service Operations	Ms.	Hess	Becky	J	5702144421					bhess@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	10/31/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Online Enrollment Center Contact (Primary)	Manager Customer Service Operations	Mr.	D'Elia	Russell		5708085038					rdelia@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	06/01/2023	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part C Application Contact	Medicare Contract Specialist	Ms.	Wartinger	Lynn	S	5702718776					lswartinger@thehealthplan.com	Geisinger Health Plan, Federal Government Programs	100 North Academy Avenue	Danville	PA	178223220	07/25/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part C Reporting Contact	Operations Specialist	Ms.	Utt	Bobbi	J	5702146718				5702148921	bjutt@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part D Appeals	Manager, Pharmacy Cust. Srvc.	Ms	Bitler	Jessie	M						jmbitler@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/30/2020	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active	8009884861				HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part D Application Contact	Operations Specialist, Government Programs	Ms.	Wartinger	Lynn	S	5702718776				5702148921	lswartinger@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part D Benefits Contact	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen	K	5702149379				5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part D Claims Submission Contact	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen	K	5702149379				5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223229	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part D Exceptions Contact	Director, Pharmacy Services	Dr.	Miller	Jamie						5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/22/2017	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active	8009884861				HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part D Exceptions Contact (Secondary)	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen	K					5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active	8009884861				HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part D Price File Contact (Back-up)	Medicare Pharmacist	Dr.	Sponenberg	Todd		5702145059				5702146597	tsponenberg@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	10/29/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part D Price File Contact (Primary)	Manager, Government Programs Pharmacy Operations	Dr.	Bender	Kristen		5702715555	59687			5702149379	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17821	07/10/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part D Quality Assurance Contact	Chief Medical Officer	Dr.	Bulger, DO, MBA	John		5702147020				5702715268	jbulger@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223008	11/01/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Part D Reporting Contact	Operations Specialist	Ms.	Utt	Bobbi	J	5702146718				5702148921	bjutt@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Patient Safety Contact	Chief Medical Officer	Dr.	Bulger, DO, MBA	John		5702147020				5702715268	jbulger@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223008	11/01/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Payment Contact	Actuarial Director		Trafton	Kristina	L	5702145043					kltrafton@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223225	10/29/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Pharmacy Director	Director, Pharmacy Services	Dr.	Miller	Jamie		5702715730				5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/22/2017	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Pharmacy Network Management Contact	PerformRx Director, Service Operations	Ms.	Leal MBA CHIE	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/28/2020	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Services	Dr.	Miller	Jamie		5702715730				5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/22/2017	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Pharmacy Technical Help Desk Contact	PerformRx Director, Service Operations	Ms	Leal MBA CHIE	Avelina							aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/21/2021	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active	8555081715				HMO - Health Maintenance Organization		C	Philadelphia
H3954	Physician Incentive Contact	Manager, Provider Management	Ms.	Ortiz	Massiel		5704920147					mortiz4@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	12/06/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Plan Directory Contact for Public Website	Geisinger Health Plan		Care	Customer		5704989731				5702715871	ghp_customer+service@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223229	11/13/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Plan to Plan Reconciliation Contact	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	eobp2p@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	10/31/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Processor Contact	PerformRx Director, Service Operations	Ms.	Leal MBA CHIE	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/28/2020	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Quality Contact	Sr. Director, Medical Management	Mr.	Hummel	Eric		5702146405					ehummel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	11/01/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Reconciliation Contact	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	pwmerkel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	02/22/2021	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Reconciliation Contact (Secondary)	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Recovery Audit Contact	Associate Vice President Legal Counsel	Mr.	Davis	F Kelly		5702716836				5702145305	fkdavis@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	05/17/2023	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	SNP Application Contact	Operations Specialist, Government Programs	Ms.	Wartinger	Lynn	S	5702718776				5702718921	lswartinger@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	SNP State Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Surveillance Contact	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	System Contact	Technical Analyst Lead		Sholder	Richard	J	5702717895				5702715162	rjsholder@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	07/25/2022	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Third Party Administrator (TPA) Liaison	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	pwmerkel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	04/14/2020	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	User Access Contact	Operations Specialist, Government Programs	Ms.	Wartinger	Lynn	S	5702718776				5702148921	lswartinger@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Utilization Management Contact	Sr. Director, Medical Management	Mr.	Hummel	Eric		5702146405					ehummel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	11/01/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3954	Utilization Review Contact	Sr. Director, Medical Management	Mr.	Hummel	Eric		5702146405					ehummel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	11/01/2019	2023	GEISINGER HEALTH PLAN	Local CCP	Geisinger Gold	HMO/HMOPOS		Geisinger Health	96	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Agent/Broker Compensation Data Contact	Manager, Sales Support & Operations	Mr.	Thompson	Seth		4128883167					Seth.Thompson@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Backup User Access Contact	Sr. Risk and Regulatory Intelligence Analyst	Ms.	Hegedus	Emily		6078219034					emily.hegedus@highmarkhealth.org	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Best Available Evidence Contact	Manager, Government Business Enrollment	Mr.	Stanhoff	David		4125445689					LISBAE@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Bid Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Bid Audit Site Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Bid Primary Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	01/13/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	12/05/2017	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	CEO - CMS Administrator Contact	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	CEO - Senior Official for Contracting	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Chief Financial Officer	CFO Highmark Health Plan	Mr.	Bridges	Ja'Ron		4125441452					JaRon.Bridges@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/27/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Chief Operating Officer	SVP, Government Business Segment President	Ms.	Miller	Alexis	A	4125447389					Alexis.Miller@Highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Chief Information Officer	Senior Vice President, Infrastructure & Architectu	Mr.	Krebs	Mark		7173026255					mark.krebs@goenGen.com	120 Fifth Avenue		Pittsbrugh	PA	15222	09/25/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Chief Information Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	CMMI Model Point of Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/15/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	CMS Casework Communication Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	01/06/2020	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Complaints Tracking Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne		4125444579				7176354209	Lynne.Walsh@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	01/06/2020	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Contact for Fraud Investigations	VP Financial Investigation & Provider Review	Mr.	Spear	Kurt		4125447069					Kurt.Spear@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	01/15/2016	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Coordination of Benefits Contact	Sr. Process Analyst	Ms.	Cassidy	Christina		4125444417					Christina.Cassidy@highmark.com	120 Fifth Avenue	PAP P5111	Pittsburgh	PA	15222	12/26/2019	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Corporate Mailing						4125447031					Thomas.Boettler@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant	Mr.	DeVan	Walter		7173026609					Walter.DeVanJr@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/05/2017	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Customer Service Operations Contact	Director, Member & Provider Services		Scarnati	Chris		8148716712					Chris.Scarnati@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/09/2020	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	DIR Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	DIR Contact (Secondary)	Senior Risk & Compliance Case Manager		Stetson	Kelsey		4125445816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Emergency Part D Contact	Director, Customer Experience		Scarnati	Chris		8148716712					Chris.Scarnati@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Emergency Part D Contact (Secondary)	Manager, Customer Service		Merritt	Meggan		3042992512					Meggan.Hostuttler@highmark.com	120 Fifth Avenue Place	Suite PKSB-2	Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Employer Waiver Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Encounter Data & Risk Adjustment Operations Contact	Director, Actuarial Services	Mr.	DelPrince	Vincent	M	4125443939					Vincent.Delprince@highmark.com	501 Penn Avenue		Pittsburgh	PA	15222	08/04/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Enrollment Contact	Director, Enrollment and Billing	Mr.	Palmer	David		4125446384					David.Palmer@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/22/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	EOB Transfer Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	bob.opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/26/2019	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Financial Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Financial Reporting Contact	Vice President, Accounting & Reportin	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Formulary Contact	Senior Pharmacist, Clinical Pharmacy Services		DiTullio	Kelly		4128884336					Kelly.DiTullio@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/08/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Formulary Contact (Secondary)	Senior Pharmacist, Clinical Pharmacy Services		Humphries	Jessica		4128884890					jessica.humphries@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/08/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	General Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Government Relations Contact	SVP, Government Affiars	Mr.	Warfel	Michael	G	7173023979					michael.warfel@highmark.com	1800 Center St.		Camp Hill	PA	17011	03/18/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	HIPAA Privacy Officer	Chief Privacy and Data Ethics Officer	Ms.	Patrick	Justine		4125444643					Justine.Patrick@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	HIPAA Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Hospice Contact	Intake Coordinator		Welker	Jessica		7178883043					DrugHelp_Authorizations@highmark.com	120 5th Avenue Place		Pittsburgh	PA	15222	10/25/2019	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Interoperability Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	MA Appeals/Grievances Contact	Manager, Appeals & Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	01/06/2020	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	MA Claims Processing Contact for Public Website	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/22/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Marketing Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					Jillian.Pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	10/14/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Medical Director	VP, Executive Medical Director	Dr,	Law	Timothy		4125446445					timothy.law@highmark.com	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	12/05/2017	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Medicare Coordinator	Director, Government Compliance	Ms.	Carl	Kathleen	A	4125447156					Kathleen.Carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Medicare Part D Opioid Overutilization Contact	Pharmacist	Ms.	Ali	Dewaa		4129040214					Dewaa.ali@highmark.com	120 Fifth Avenue PAP P4207		Pittsburgh	PA	15222	07/31/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Medication Therapy Management Contact	Senior Pharmacist	Ms.	Adlesic	Meredith		4128883749					Meredith.Adlesic@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	OffShore Subcontractor Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Online Enrollment Center Contact (Back-up)	Manager Enrollment & Billing	Mr.	Stanhoff	David		4125445689					LISBAE@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Online Enrollment Center Contact (Optional)	Manager, Business Platform	Mr.	Hudson	Brian		7173025964					Brian.Hudson@highmark.com	1800 Center St.		Camp Hill	PA	17011	07/22/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Online Enrollment Center Contact (Primary)	Director, Enrollment and Billing	Mr.	Palmer	David		4125446384					David.Palmer@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/22/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part C Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part C Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Appeals	Manager, Member Appeals & Grievances	Ms.	Walsh	Lynne	M					7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	12/31/2020	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	4125444579				HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Appeals Contact (Secondary)	Supervisor, Appeals & Grievances	Ms.	Miller	Rachel	M					7176354209	Rachel.Miller@highmark.com	Fifth Ave Place	120 Fifth Avenue, Ste 5322	Pittsburgh	PA	15222	09/06/2018	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	4125441596				HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Benefits Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Claims Submission Contact	Director Regulated Marketing Medicare Solutions		Dovico	Rosario		9145896300				8882822583	Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	11/08/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Exceptions Contact			Affairs	Pharmacy							drughelp@highmark.com	120 Fifth Avenue	Suite SPECARE	Pittsburgh	PA	15222	08/04/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	8006002227				HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Exceptions Contact (Secondary)	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	08/04/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Price File Contact (Back-up)	Pharmacy Analyst	Mr.	Nolder	Tim		4124398263					timothy.nolder@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Price File Contact (Optional)	Director, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	02/14/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Price File Contact (Primary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Quality Assurance Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Part D Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Patient Safety Contact	Director, Clinical Pharmacy Operations	Mr.	Causer	Derek		4125445835					Derek.Causer@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Payment Contact	Vice President, Accounting and Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Pharmacy Director	Manager, Pharmacy Programs		Winterhalter	Christa		4128884108					Christa.Winterhalter@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Pharmacy Network Management Contact	Network Account Director, Retail Strat & Contract	Ms.	Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	01/12/2018	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	11/08/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Philadelphia
H3957	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Government Operations	Ms	Lynn Schill	Jodie							Jodie.LynnSchill@highmark.com	120 Fifth Avenue Pittsburgh, PA 15222		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active	5705783579				HMO - Health Maintenance Organization		C	Philadelphia
H3957	PHR Beneficiary Contact																	07/23/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS	Highmark Inc	Highmark Health	123	Yes	Active	8665886967				HMO - Health Maintenance Organization		C	Philadelphia
H3957	Physician Incentive Contact	VP Prov Reimbursement & Network	Mr.	McDonald	Brendan		4125446611					brendan.mcdonald@highmarkhealth.org	120 5th Avenue Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Plan Directory Contact for Public Website			Service	Provider		8665886967					resourcecenter@highmark.com	120 Fifth Ave		Pittsburgh	PA	15222	12/05/2017	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Plan to Plan Reconciliation Contact	Manager, Operational Accounting	Mr.	Stehr	Brett	J	7173022748					P2Precon@highmark.com	Highmark Inc. Attn: Cashier	PO Box 898820	Camp Hill	PA	170890407	06/28/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Processor Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Quality Contact	VP, Clinical Quality and Medical Policy	Dr.	Onuoha-Obilor	Stella		4125444335					Stella.Onuoha-Obilor@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Reconciliation Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Reconciliation Contact (Secondary)	Senior Risk * Compliance Case manager		Stetson	Kelsey		4125448816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Recovery Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Surveillance Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					jillian.pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	System Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Third Party Administrator (TPA) Liaison	Accountant		Jurgiewicz	Kimberly		5707807969					kimberly.jurgiewicz@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	User Access Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Utilization Management Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3957	Utilization Review Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK CHOICE COMPANY	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8887369118				8885547668	BAE/LISMailbox@aetna.com	Attn:  BAE	P.O. Box 14088	Lexington	KY	405124088	12/03/2018	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/05/2017	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H3959	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Plan Directory Contact for Public Website			Customer Service	Aetna		8002900190					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	11/26/2014	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	11/26/2018	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3959	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Agent/Broker Compensation Data Contact	Vice President, Government Sales	Mr.	Biesecker	Gregory		7172520587					Gregory.Biesecker@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	03/21/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Automated TrOOP Balance Transfer Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Backup User Access Contact	Medicare Compliance Analyst	Ms.	Tremmel	Selina		7175387981					selina.tremmel@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Best Available Evidence Contact	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465811	nicole.peterson@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Bid Audit Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Bid Audit Site Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Bid Primary Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	CEO - CMS Administrator Contact	President and CEO	Mr.	Shamash	Todd		7175417747				7176518913	todd.shamash@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	CEO - Senior Official for Contracting	President and CEO	Mr.	Shamash	Todd		7175417747				7176518913	todd.shamash@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Chief Financial Officer	Chief Financial Officer	Mr.	Woodard	Ralph		7175417181					ralph.woodard@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Chief Operating Officer	EVP & Chief Operating Officer	Mr.	Heisey	Glenn		7175417288				7176518497	glenn.heisey@capbluecross.com	2500 Elmenrton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Chief Information Officer	Chief Information Officer	Mr.	Frank	Scott		7175417341					scott.frank@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Chief Information Security Officer	Chief Information Security Officer	Mr.	Burd	Aaron		7175416939					aaron.burd@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	CMS Casework Communication Contact		Ms.	Drawbaugh	Cindy		7175416257					cindy.drawbaugh@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Complaints Tracking Contact		Ms.	Drawbaugh	Cindy		7175416257					cindy.drawbaugh@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Contact for Fraud Investigations		Ms.	Livelsberger	Jennifer		7177753756					Jennifer.Livelsberger@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Coordination of Benefits Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Corporate Mailing						7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	171779799	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Coverage Gap Discount Program (CGDP) Payment Contact		Ms.	Beauduy	Tamara		7175416946					Tamara.Beauduy@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Customer Service Operations Contact	Director Medicare Operations	Mr.	Koch	Jonathan		7178292114				7176518873	jonathan.koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	DIR Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	DIR Contact (Secondary)	Actuarial Business Consultant, Actuarial and Under	Mr.	Shafer	Brian		7175416263				7176514214	Brian.Shafer@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Emergency Part D Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7175864604				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Emergency Part D Contact (Secondary)	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Employer Waiver Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Encounter Data & Risk Adjustment Operations Contact			Matos	Tamara		7175416275					tamara.matos@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Enrollment Contact	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465897	nicole.peterson@capbluecross.com	2500 Elmerton Ave.		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	EOB Transfer Contact	Director Medicare Operations	Mr.	Koch	Jonathan		7178292114				7176518873	Jonathan.Koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Financial Audit Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Financial Reporting Contact	VP Finance and Controller	Mr.	Hershberger	Josh		7173710410					Josh.Hershberger@CapBlueCross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	09/13/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Formulary Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	1305 Corporate Center Drive		Eagan	MN	55121	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	General Contact	Sr. VP Government Programs	Mr.	Fernandez	Frank		7175416062					Frank.Fernandez@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Government Relations Contact	Sr. VP & General Counsel	Mr.	Hopkins	Joel		7175416358				7176514445	Joel.Hopkins@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	HIPAA Privacy Officer	Privacy & Data Protection Officer	Mr.	Stambaugh	Alan		7175417077					Alan.Stambaugh@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	171779799	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	HIPAA Security Officer	Chief Information Security Officer	Mr.	Burd	Aaron		7175416939					aaron.burd@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Hospice Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Interoperability Contact	Senior Director, Information Technology		Blackwell	William		7175417246					William.Blackwell@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	MA Appeals/Grievances Contact	Director, Medicare Operations	Mr.	Koch	Jonathan		7178292114					Jonathan.Koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	MA Claims Processing Contact for Public Website	Director Medicare Operations	Mr.	Koch	Jonathan		8666882242					Jonathan.Koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Marketing Contact	Director, Marketing	Mr.	Londre	Michael		7175416467				7175402499	Michael.Londre@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Medical Director	Chief Medical Director	Dr.	Wigginton	Jeremy	A	7175417152					jeremy.wigginton@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Medicare Coordinator			Wilbert	Tiffany		7175417606					tiffany.wilbert@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Medicare Part D Opioid Overutilization Contact	Senior Director, Medicare Pharmacy Operations and	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue	P.O. Box 779846	Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Medication Therapy Management Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Online Enrollment Center Contact (Back-up)	Director Medicare Operations	Mr.	Koch	Jonathan		7178292114				7176518873	Jonathan.Koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Online Enrollment Center Contact (Primary)	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465811	nicole.peterson@capbluecross.com	2500 Elmerton Ave.		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part C Application Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part C Reporting Contact		Ms.	Dale	Rasheda		7175416444					rasheda.dale@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Application Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Benefits Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Claims Submission Contact	Manager, Medicare Pharmacy Operations	Ms,	Cook	Tammy	L	7177038749				7173466836	tammy.cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Exceptions Contact	Senior Director, Medicare Pharmacy Operations	Ms	Leedock	Melissa							Melissa.Leedock@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active	8669874213				HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist	Ms	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55120	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Price File Contact (Back-up)	QA Analyst Sr		Nguyen	Kim		6127776931					kim.nguyen@PrimeTherapeutics.com	Prime Therapeutics, LLC	1305 Corporate Center Drive	Eagan	MN	55121	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Price File Contact (Optional)	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Price File Contact (Primary)	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Quality Assurance Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Part D Reporting Contact		Ms.	Leonard	Kellie		7175417117					Kellie.Leonard@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Patient Safety Contact	Senior Director, Medicare Pharmacy Operations and	Ms.	Leedock	Melissa		7177541693				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Payment Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Pharmacy Director	Senior Director, Medicare Pharmacy Operations and	Ms.	Leedock	Melissa		7177541693				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Pharmacy Network Management Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Pharmacy Network Management Contact (Secondary)			Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	1305 Corporate Center Drive		Eagan	MN	55121	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Pharmacy Technical Help Desk Contact	Director, Member Services	Ms	Pretlow	Jennifer							jennifer.pretlow@primetherapeutics.com	Prime Therapeutics LLC 2655 Eagan Woods Drive		Eagan	MN	55122	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active	8888780151				HMO - Health Maintenance Organization		C	Philadelphia
H3962	Plan Directory Contact for Public Website	Medicare Compliance Officer	Ms.	Yu	Gloria		8666882242					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Plan to Plan Reconciliation Contact	Accountant I	Ms.	Beauduy	Tamara		7175416946					FinanceP2P-CASH@CapBlueCross.com	2500 Elmerton Avenue	Mail Drop 3237	Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Processor Contact	Manager, PBM Operations	Ms.	Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC 2900 Ames Crossing Road		Eagan	MN	55121	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Quality Contact	Sr. Medical Director	Dr.	Harr	Denise		7177038497					Denise.Harr@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Reconciliation Contact	Director, Actuarial Services	Mr.	Baksi	David		7175417317					david.baksi@capbluecross.com	2500 Elmerton Ave.		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Reconciliation Contact (Secondary)	Actuarial Business Consultant	Mr.	Shafer	Brian		7175416263					Brian.Shafer@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	SNP Application Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	SNP State Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Surveillance Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	System Contact	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465897	nicole.peterson@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Third Party Administrator (TPA) Liaison		Ms.	Beauduy	Tamara		7175416946					Tamara.Beauduy@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	User Access Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Utilization Management Contact		Ms.	Yoder	Hollie		7177755884					Hollie.Yoder@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	03/21/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3962	Utilization Review Contact		Ms.	Yoder	Hollie		7177755884					Hollie.Yoder@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	KEYSTONE HEALTH PLAN CENTRAL, INC.	Local CCP	Capital Blue Cross	HMO/HMOPOS		CAPITAL BLUE CROSS	41	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H3975	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Backup User Access Contact	Manager, Regulatory Compliance		Wilson	Ashley		3145056491					Ashley.L.Wilson@centene.com	7676 Forsyth Blvd.		St. Louis	MO	63105	06/24/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/24/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H3975	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H3975	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H3975	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H3975	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road Tampa,FL 33634		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H3975	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H3975	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H3975	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road, Ren 1, 3rd Floor		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	09/21/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3975	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H3977	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Backup User Access Contact	Chief Information Officer	Mrs.	Bennett	Kathleen		3038694664				3039961600	kbennett@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Best Available Evidence Contact	Director of PACE Finance	Mr.	Ewing	Mark		3038694664				3039961600	mewing@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Bid Primary Contact	Director of PACE Finance	Mr	Ewing	Mark		3038694664				3039961600	mewing@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	CAP Report Contact for Public Website	Chief Operating Officer Central Regional Operation	Ms.	Lozzano	Maria		7209746758				3039961600	mlozzano@myinnovage.com	8950 East Lowry Blvd.		Denver	CO	80230	09/10/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	CEO - CMS Administrator Contact	CEO	Ms.	Hewitt	Maureen		3038694664				3039961600	mhewitt@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	CEO - Senior Official for Contracting	President & CEO	Ms.	Hewitt	Maureen		3038694664				3039961600	mhewitt@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Chief Financial Officer	CFO	Mrs.	Gutierrez	Barbara		3038694664				3039961600	bgutierrez@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Chief Operating Officer	COO	Ms.	Lozzano	Maria		3038694664				3039961600	mlozzano@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/10/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Chief Information Officer	Chief Information Officer	Mrs.	Bennett	Kathy		3038694664				3039961600	kbennett@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Chief Information Security Officer	Chief Information Security Officer	Mr	Smith	Alvin		7207896084				3039961600	ASmith2@myinnovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	CMS Casework Communication Contact	Corporate Compliance Officer	Mrs.	Erwin	Dana		3038694664				3039961600	derwin@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Complaints Tracking Contact	Chief Compliance Officer	Mrs.	Erwin	Dana	G	3034831088				3039961600	derwin@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Contact for Fraud Investigations	Corporate Compliance Officer	Mrs.	Erwin	Dana		3038694664				3039961600	derwin@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Coordination of Benefits Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		3038694664				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Corporate Mailing						3038694664				3039961600	bgutierrez@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Coverage Gap Discount Program (CGDP) Payment Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		3038694664				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Customer Service Operations Contact	Director of Quality	Ms.	Curry	Jill		3038694664				3039961600	jcurry@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/10/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	DIR Contact	VP of Pharmacy Services	Ms.	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	DIR Contact (Secondary)	Director of PACE Finance	Mr.	Ewing	Mark		3038694664				3039961600	mewing@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Emergency Part D Contact	VP of Pharmacy Services	Mrs.	Chase	Darla		7209746785				3039961600	DChase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Emergency Part D Contact (Secondary)	Finance Director	Mr.	Ewing	Mark		3038694664				3039961600	mewing@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Encounter Data & Risk Adjustment Operations Contact			Ewing	Mark		7209746746					mewing@myinnovage.com	8950 E Lowry Blvd		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Enrollment Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		3038694664				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	EOB Transfer Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		3038694664				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Financial Audit Contact	VP PACE Finance	Mr.	Ewing	Mark		3038694664				3039961600	mewing@myinnovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Financial Reporting Contact	CFO	Mrs.	Gutierrez	Barbara		3038694664				3039961600	bgutierrez@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Formulary Contact	VP of Pharmacy Services	Mrs.	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Formulary Contact (Secondary)	Director of PACE Finance	Mr.	Ewing	Mark		3038694664				3039961600	mewing@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	General Contact	Chief Operating Officer	Ms.	Lozzano	Maria		3038694664				3039961600	mlozzano@myinnovage.com	8950 East Lowry Blvd.		Denver	CO	80230	09/10/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Government Relations Contact	Vice President Regulatory Affairs	Mrs.	Dahan	Beverley		3038694664				3039961600	bdahan@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	HIPAA Privacy Officer	Corporate Counsel	Mr.	Robertson	Cody		3038694664				3039961600	crobertson@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	HIPAA Security Officer	Chief Information Officer	Ms.	Bennett	Kathleen		3038694664				3039961600	kbennett@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	MA Appeals/Grievances Contact	Chief Medical Officer	Dr.	Welch	Melissa		3038694664				3039961600	mwelch@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	MA Claims Processing Contact for Public Website	Medicare Compliance Manager	Ms.	Brown	Lauren		3038694664				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Marketing Contact	EVP President of Sales and Marketing	Ms.	Doerr	Robin		3038694664				3039961600	rdoerr@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Medical Director	Medical Director	Dr.	Strange	Lynn		3038694664				3039961600	lstrange@myinnovage.com	8950 East Lowry Blvd.		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Medicare Compliance Officer	VP of Pharmacy Services	Mrs.	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Medicare Coordinator	VP Finance	Mr.	Ewing	Mark		3038694664				3039961600	mewing@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Medicare Part D Opioid Overutilization Contact	VP of Pharmacy Services	Mrs.	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 E. Lowry Blvd		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Medication Therapy Management Contact	VP of Pharmacy Services	Mrs.	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Online Enrollment Center Contact (Back-up)	Director of PACE Finance	Mr.	Ewing	Mark		3038694664				3039961600	mewing@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Online Enrollment Center Contact (Primary)	Medicare Compliance Manager	Ms.	Brown	Lauren		3038694664				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Part C Application Contact	VP, Government and Legislative Affairs	Ms.	Dahan	Beverley		3035483246				3039961600	bdahan@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Part D Appeals	Chief Legal Counsel, General & Admin	Mrs.	Walton	Vanessa						3039961600	VWalton2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending	7209742459				PACE - Nat		C	Atlanta
H3977	Part D Appeals Contact (Secondary)	VP of Pharmacy Services	Mrs.	Chase	Darla						3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending	7209746785				PACE - Nat		C	Atlanta
H3977	Part D Application Contact	Director of PACE Finance	Mr.	Ewing	Mark		3038694664				3039961600	mewing@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Part D Benefits Contact	VP of Pharmacy Services	Mrs.	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Part D Claims Submission Contact	VP of Pharmacy Services	Mrs.	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Part D Exceptions Contact	VP of Pharmacy Services	Mrs.	Chase	Darla						3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending	7209746785				PACE - Nat		C	Atlanta
H3977	Part D Exceptions Contact (Secondary)	Director of PACE Finance	Mr.	Ewing	Mark						3039961600	mewing@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending	3038694664				PACE - Nat		C	Atlanta
H3977	Part D Price File Contact (Back-up)	Director of PACE Finance	Mr.	Ewing	Mark		3038694664				3039961600	mewing@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Part D Price File Contact (Primary)	VP of Pharmacy Services	Mrs.	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Part D Quality Assurance Contact	Corporate Chief Medical Officer	Dr.	Welch	Melissa		7209746014				3039961600	MWelch@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Part D Reporting Contact	VP of Pharmacy Services	Mrs.	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Patient Safety Contact	VP of Pharmacy Services	Ms	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Payment Contact	CFO	Ms.	Gutierrez	Barbara		3038694664				3039961600	bgutierrez@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Personal Health Record Contact	Corporate Counsel, Legal	Mr	Robertson	Cody		3033006930				3039961600	CRobertson@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Pharmacy Director	VP of Pharmacy Services	Ms.	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Pharmacy Network Management Contact	VP of Pharmacy Services	Mrs.	Chase	Darla		7209746785				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Pharmacy Technical Help Desk Contact	VP of Pharmacy Services	Mrs.	Chase	Darla						3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending	7209746785				PACE - Nat		C	Atlanta
H3977	PHR Beneficiary Contact																	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE	Total Longterm Care, Inc.			Yes	Pending	8772776163	732			PACE - Nat		C	Atlanta
H3977	Plan Directory Contact for Public Website	Director of Communication	Ms.	Rasmussen	Sarah		3038694664				3039961600	srasmussen@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/10/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Plan to Plan Reconciliation Contact	Medicare Compliance Manager		Brown	Lauren		3038694664				7209173390	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Processor Contact	CFO	Ms.	Gutierrez	Barbara		3038694664				3039961600	bgutierrez@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Quality Contact	Corporate Chief Medical Officer	Dr.	Welch	Melissa		7209746014				3039961600	MWelch@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Reconciliation Contact	Director of PACE Finance	Mr.	Ewing	Mark		7209746746				3039961600	mewing@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Reconciliation Contact (Secondary)	VP of PHarmacy Services	Mrs	Chase	Darla		3038694664				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Recovery Audit Contact	Director of PACE Finance	Mr.	Ewing	Mark		3038694664					mewing@myinnovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Surveillance Contact	Chief Marketing Officer	Ms.	Doerr	Robin		7209726015				3039961600	rdoerr@myinnovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	System Contact	Chief Information Officer	Mrs.	Bennett	Kathleen		3038694664				3039961600	kbennett@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Third Party Administrator (TPA) Liaison	Medicare Compliance Manager		Brown	Lauren		3038694664				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	User Access Contact	Chief Information Officer	Ms.	Bennett	Kathleen		3038694664				3039961600	Kbennett@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Utilization Management Contact	Corporate Chief Medical Officer	Dr.	Welch	Melissa		7209746014				3039961600	MWelch@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3977	Utilization Review Contact	Corporate Chief Medical Officer	Dr.	Welch	Melissa		7209746014				3039961600	MWelch@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/17/2020	2023	INNOVAGE KENTUCKY PACE, LLC	National PACE	InnovAge Kentucky PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H3979	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	01/30/2020	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	1001 E. Lookout Drive	Chicago	IL	60601	03/11/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	11/27/2019	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	12/04/2018	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	02/27/2019	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/04/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	02/10/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3979	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3979	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	08/09/2019	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3979	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H3979	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	11/27/2019	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/22/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8772777898				HMO - Health Maintenance Organization		C	Denver
H3979	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/23/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	0000000000				HMO - Health Maintenance Organization		C	Denver
H3979	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	09/21/2018	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	07/29/2020	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	04/26/2016	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3979	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	09/21/2018	2023	GHS HEALTH MAINTENANCE ORGANIZATION, INC.	Local CCP	Blue Cross and Blue Shield of Oklahoma	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H3991	Automated TrOOP Balance Transfer Contact	VP Quality Finance		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Backup User Access Contact	Regional Director, Virginia Operations	Mr.	Hess	Ronald		6198852533					ronald.hess@cherryblossompace.com	1901 North Beauregard Street	Suite 110	Alexandria	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Best Available Evidence Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Bid Primary Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	CAP Report Contact for Public Website	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active	8144565433				PACE - Nat		C	Philadelphia
H3991	CEO - CMS Administrator Contact	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	CEO - Senior Official for Contracting	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Chief Financial Officer	CFO	Mr.	Phillips	Jeffery		8144565433					jphillips@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	11/14/2022	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Chief Operating Officer	Regional Director, Virgina Operations	Mr.	Hess	Ronald		6198852533					ronald.hess@cherryblossompace.com	1901 North Beauregard St	Suite 110	Alexandria	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Chief Information Officer	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Chief Information Security Officer	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	CMS Casework Communication Contact	Director of Quality		Sheeder	Shelby		8144565433					ssheeder@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Complaints Tracking Contact	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Contact for Fraud Investigations	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Coordination of Benefits Contact	VP Quality Finance		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Corporate Mailing						6198852533					ronald.hess@cherryblossompace.com	1901 North Beauregard Street	Suite 110	Alexandria	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Coverage Gap Discount Program (CGDP) Payment Contact	VP Quality Finance		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Customer Service Operations Contact	Regional Director, Virgina Operations	Mr.	Hess	Ronald		6198852533					ronald.hess@cherryblossompace.com	1901 North Beauregard Street	Suite 110	Alexandria	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	DIR Contact	VP Quality Finance		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	DIR Contact (Secondary)	Regional Director, Virgina Operations	Mr.	Hess	Ronald		6198852533					ronald.hess@cherryblossompace.com	1901 North Beauregard Street	Suite 110	Alexandria	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Emergency Part D Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Emergency Part D Contact (Secondary)	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Encounter Data & Risk Adjustment Operations Contact	Regional Director, Virgina Operations	Mr.	Hess	Ronald		6198852533					ronald.hess@cherryblossompace.com	1901 North Beauregard Street	Suite 110	Alexandria	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Enrollment Contact	VP Quality Finance		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	EOB Transfer Contact	VP Quality Finance		Kachersky	Jennifer		8144565433				8144542500	jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Financial Audit Contact	VP Quality Finance	Mrs.	Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Financial Reporting Contact	VP Quality Finance		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Formulary Contact	Medical Director	Dr.	Schoenburg	Racheli		5717890770					racheli.schoenburg@cherryblossompace.com	1901 N Beauregard St	Ste 110	Alexandria	VA	22311	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Formulary Contact (Secondary)	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	General Contact	Regional Director, Virgina Operations	Mr.	Hess	Ronald		6198852533					ronald.hess@cherryblossompace.com	1901 North Beauregard Street	Suite 110	Alexandria	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Government Relations Contact	CEO		Fish	Richard		8144565433					rfish@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	HIPAA Privacy Officer	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	HIPAA Security Officer	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Interoperability Contact	VP Quality Finance		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	MA Appeals/Grievances Contact	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	MA Claims Processing Contact for Public Website	VP Quality Finance		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Marketing Contact	Director, Marketing and Intake		Campbell	Marcie		8144565433					mcampbell@lifenwpa.org	100 State ST	Suite 201	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Medical Director	Medical Director	Dr.	Schoenburg	Racheli		5717890770					racheli.schoenburg@cherryblossompace.com	1901 N Beauregard St	Ste 110	Alexandria	VA	22311	08/30/2021	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Medicare Compliance Officer	Director of Quality Improvement	Mrs.	Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Ste 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Medicare Coordinator	Regional Director, Virgina Operations	Mr.	Hess	Ronald		6198852533					ronald.hess@cherryblossompace.com	1901 North Beauregard Street	Suite 110	Alexandria	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Medicare Part D Opioid Overutilization Contact	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Medication Therapy Management Contact	Medical Director	Dr.	Schoenburg	Racheli		5717890770					racheli.schoenburg@cherryblossompace.com	1901 N Beauregard St	Ste 110	Alexandria	VA	22311	08/30/2021	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Part C Application Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Part D Appeals	VP, Finance and Quality		Kachersky	Jennifer							jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active	8144565433				PACE - Nat		C	Philadelphia
H3991	Part D Appeals Contact (Secondary)	Regional Director, Virgina Operations	Mr.	Hess	Ronald							ronald.hess@cherryblossompace.com	1901 North Beauregard Street	Suite 110	Alexandria	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active	6198852533				PACE - Nat		C	Philadelphia
H3991	Part D Application Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Part D Benefits Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Part D Claims Submission Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Part D Exceptions Contact	Medical Director	Dr.	Schoenburg	Rachel							racheli.schoenburg@cherryblossompace.com	1901 N. Beauregard St	Ste 201	ALEXANDRIA	VA	22311	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active	7032582273				PACE - Nat		C	Philadelphia
H3991	Part D Exceptions Contact (Secondary)	Regional Director, Virgina Operations	Mr.	Hess	Ronald							ronald.hess@cherryblossompace.com	1901 North Beauregard Street	Suite 110	ALEXANDRIA	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active	6198852533				PACE - Nat		C	Philadelphia
H3991	Part D Price File Contact (Back-up)	CFO		Phillips	Jeff		8144565433					jphillips@oneseniorcare.com	100 State Street	Ste 201	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Part D Price File Contact (Optional)	Executive Director	Ms	Cunningham	Kate		5717890770					kate.cunningham@cherryblossompace.com	1901 N Beauregard St	Ste 110	Alexandria	VA	22311	08/18/2022	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Part D Price File Contact (Primary)	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Part D Quality Assurance Contact	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Part D Reporting Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Patient Safety Contact	Medical Director	Dr.	Schoenburg	Racheli		5717890770					racheli.schoenburg@cherryblossompace.com	1901 N Beauregard St	Ste 110	Alexandria	VA	22311	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Payment Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Personal Health Record Contact	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Pharmacy Director	Medical Director	Dr.	Schoenburg	Racheli		5717890770					racheli.schoenburg@cherryblossompace.com	1901 N Beauregard St	Ste 110	Alexandria	VA	22311	11/17/2021	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Pharmacy Network Management Contact	Director, Contracts		Feldmann	William		8144565433					wfeldmann@oneseniorcare.com	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Pharmacy Network Management Contact (Secondary)	Regional Director, Virgina Operations	Mr.	Hess	Ronald		6198852533					ronald.hess@cherryblossompace.com	1901 North Beauregard Street	Suite 110	ALEXANDRIA	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Pharmacy Technical Help Desk Contact	VP, Finance and Quality		Kachersky	Jennifer							jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active	8144565433				PACE - Nat		C	Philadelphia
H3991	Pharmacy Technical Help Desk Contact (Secondary)	Regional Director, Virgina Operations	Mr.	Hess	Ronald							ronald.hess@cherryblossompace.com	1901 North Beauregard Street	Suite 110	ALEXANDRIA	VA	22311	09/08/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active	6198852533				PACE - Nat		C	Philadelphia
H3991	Plan Directory Contact for Public Website	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Plan to Plan Reconciliation Contact	VP Quality Finance		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Processor Contact	VP Quality Finance		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Quality Contact	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Reconciliation Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Reconciliation Contact (Secondary)	CFO		Phillips	Jeff		8144565433					jphillips@oneseniorcare.com	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Recovery Audit Contact	VP Quality Finance	Mrs.	Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/30/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Surveillance Contact	Director, Marketing and Intake		Campbell	Marcie		8144565433					mcampbell@lifenwpa.org	100 State Street	Ste 201	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	System Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Third Party Administrator (TPA) Liaison	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	User Access Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Utilization Management Contact	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H3991	Utilization Review Contact	Director of Quality Improvement		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	103 N. Front Street, Suite 1	Suite 1	Clearfield	PA	16830	01/26/2023	2023	CONCERTOHEALTH OF NORTHERN VIRGINIA, LLC	National PACE	Cherry Blossom PACE	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4003	Agent/Broker Compensation Data Contact	CFO	Mr.	Vivaldi	Carlos		7873069135				7873004886	carlos.vivaldi@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Automated TrOOP Balance Transfer Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Backup User Access Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Best Available Evidence Contact	AVP Enrollment and Membership Accounting	Ms.	Suarez	Yamile		7874069767				7879992199	Yamile.Suarez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Bid Audit Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Bid Audit Site Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Bid Primary Contact	Product Development Manager	Ms	Martinez	Viviana		7874849559				7876253356	viviana.martinez-lanza@mmmhc.com	PO Box 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	CAP Report Contact for Public Website	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	52259			HMO - Health Maintenance Organization		C	Chicago
H4003	CEO - CMS Administrator Contact	President of MMM	Mr.	Rivera Cardona	Ricardo		7876330707				7873004886	ricardo.rivera-cardona@mmmhc.com	350 Avenida Chardon	Torre Chardon Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	CEO - Senior Official for Contracting	President Medicare Programs	Mr.	Gonzalez Rivera	Orlando		7872070700				7873004886	Orlando.Gonzalez@mmmhc.com	350 Avenida Chardon	Torre Chardon Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Chief Financial Officer	Chief Financial Officer	Mr.	Vivaldi	Carlos		7873069135				7873004886	Carlos.Vivaldi@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Chief Operating Officer	COO	Ms	Garcia	Vilmari		7874478131				7873004886	vilmari.garcia@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Chief Information Officer	CIO	Mr.	Molinary	Rachid		7872496365				9395451239	rachid.molinary@mmmhc.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Chief Information Security Officer	Vice President IT Department	Mr.	Arill	Juan		7875016127				7879991726	juan.arill@mmmhc.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	12/09/2021	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	CMMI Model Point of Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	CMS Casework Communication Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Complaints Tracking Contact	A&G Director	Ms.	Rodriguez	Janice		9397173509	2537			7876202390	janice.rodriguez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Contact for Fraud Investigations	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Coordination of Benefits Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Corporate Mailing						7876223000	52259			7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Coverage Gap Discount Program (CGDP) Payment Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Customer Service Operations Contact	Vice President of Operations	Ms.	Iglesias	Morayma		7876002047					morayma.iglesias-sustache@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	DIR Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	DIR Contact (Secondary)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Electronic Health Record Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	52259			HMO - Health Maintenance Organization		C	Chicago
H4003	Emergency Part D Contact	Pharmacy VP	Ms	Morant	Iris		7873797592				7873005503	iris.morant-rodriguez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	12/22/2022	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Emergency Part D Contact (Secondary)	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Employer Waiver Contact	Chief Sales and Marketing Officer	Ms.	Montilla	Lara		7875065320					lara.montilla-byrne@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	12/09/2021	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Encounter Data & Risk Adjustment Operations Contact	Director Risk and Quality Data Analytics	Mr	Kaplun	Alex		2015663591					akaplun@mmmhc.com	350 Avenida Chardon Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Enrollment Contact	AVP Enrollment and Membership Accounting	Ms.	Suarez	Yamile		7874069767				7879992199	Yamile.Suarez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	EOB Transfer Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Financial Audit Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Financial Reporting Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Formulary Contact	Director of Formulary and Utilization Management	Dr.	Lazaro	Maria	I	7876756858	8617			7873005503	maria.lazaro@mmmhc.com	PO BOX 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Formulary Contact (Secondary)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	General Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Government Relations Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	HIPAA Privacy Officer	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	HIPAA Security Officer	Vice President IT Department	Mr.	Arill	Juan		7875016127				7879991726	juan.arill@mmmhc.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	12/09/2021	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Hospice Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Interoperability Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	MA Appeals/Grievances Contact	A&G Director	Ms.	Rodriguez	Janice		9397173509	2537			7876202390	janice.rodriguez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	MA Claims Processing Contact for Public Website	Chief of Clinical Operations	Mr	Salinas	Gonzalo		7873832706	2033			7879992177	Gonzalo.Salinas@mso-pr.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Marketing Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Medical Director	Chief Medical Officer	Dr.	Rosso	Diego		7874478148				7873005523	diego.rosso@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Medicare Compliance Officer	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Medicare Coordinator	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Medicare Part D Opioid Overutilization Contact	Pharmacy AVP	Ms	Ramos	Sara		7874132083				7873005503	sara.ramos-gonzalez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Medication Therapy Management Contact	Pharmacy AVP	Ms	Ramos	Sara		7874132083				7873005503	sara.ramos-gonzalez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	OffShore Subcontractor Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Online Enrollment Center Contact (Back-up)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Online Enrollment Center Contact (Optional)	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Online Enrollment Center Contact (Primary)	AVP Enrollment and Membership Accounting	Ms.	Suarez	Yamile		7874069767				7879992199	Yamile.Suarez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Part C Application Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Part C Reporting Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Appeals	A&G Director	Ms.	Rodriguez	Janice						7876202390	janice.rodriguez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	12/09/2021	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	2537			HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Appeals Contact (Secondary)	Chief Medical Officer	Dr.	Rosso	Diego						7873005523	Diego.Rosso@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	58722			HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Application Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Benefits Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Claims Submission Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Exceptions Contact	Pharmacy Operation Director	Ms	Rivera	Erika						7873005503	erika.rivera@mmmhc.com	PO BOX 71114		San Juan	PR	009368014	03/10/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	58633			HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Exceptions Contact (Secondary)	Pharmacy VP	Ms.	Morant	Iris						7873005503	iris.morant-rodriguez@mso-pr.com	PO BOX 71114		San Juan	PR	009368014	03/10/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	58660			HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Price File Contact (Back-up)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Price File Contact (Optional)		Ms	Forty	Mario		4806064865					Mario.Forty@cvshealth.com	9501 E. Shea Blvd,		Scorrsdale	AZ	85260	02/27/2018	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Price File Contact (Primary)	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Quality Assurance Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Part D Reporting Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Patient Safety Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Payment Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Personal Health Record Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Pharmacy Director	Pharmacy VP	Ms	Morant	Iris		7873797592				7873005503	iris.morant-rodriguez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	12/27/2022	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Pharmacy Network Management Contact	Pharmacy Services Manager	Ms	Rodriguez	Isis		7876532814				7872866032	irodriguezp@mc-21.com	MC-21 Corporation	Call Box 4908	Caguas	PR	00726	11/11/2016	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Pharmacy Network Management Contact (Secondary)	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Pharmacy Technical Help Desk Contact	Pharmacy VP	Ms.	Morant	Iris						7873005503	iris.morant-rodriguez@mso-pr.com	PO BOX 71114		San Juan	PR	009368014	03/10/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8777767706	58660			HMO - Health Maintenance Organization		C	Chicago
H4003	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Operation Director	Ms	Rivera	Erika						7873005503	erika.rivera@mmmhc.com	PO BOX 71114		San Juan	PR	009368014	03/10/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	58633			HMO - Health Maintenance Organization		C	Chicago
H4003	PHR Beneficiary Contact																	12/27/2013	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS	MMM Healthcare, Inc.	Elevance Health, Inc.	1	Yes	Active	8663335470				HMO - Health Maintenance Organization		C	Chicago
H4003	Physician Incentive Contact	Finance Director	Ms.	Perez	Mireya		7874484061				7873005502	Mireya.perez@mso-pr.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Plan Directory Contact for Public Website	AVP Member Services	Ms.	Quinones	Janice		8666766060					janice.quinones@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	01/25/2022	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Plan to Plan Reconciliation Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Processor Contact	CVS VP Medicare Program Services	Ms.	Merlino	Melanie		4802152151				4803146881	Melanie.Merlino@caremark.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	12/30/2013	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Quality Contact	AVP of Quality Management	Ms.	Miranda	Ana	B	7872218738				7873005510	ana.miranda-mercado@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Reconciliation Contact	AVP Finance	Mr.	Gonzalez Cuadrado	Agustin		7876089270				7873004886	agustin.gonzalez-cuadrado@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Reconciliation Contact (Secondary)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Recovery Audit Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	SNP Application Contact	Chief Sales and Marketing Officer	Ms.	Montilla	Lara		7875065320					lara.montilla-byrne@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	12/09/2021	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	SNP State Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Surveillance Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	System Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Third Party Administrator (TPA) Liaison	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	User Access Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Utilization Management Contact	Chief of Clinical Operations	Mr	Salinas	Gonzalo		7873832706	2033			7879992177	Gonzalo.Salinas@mso-pr.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4003	Utilization Review Contact	Chief Medical Officer	Dr.	Rosso	Diego		7874478148				7873005523	diego.rosso@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Agent/Broker Compensation Data Contact	CFO	Mr.	Vivaldi	Carlos		7873069135				7873004886	carlos.vivaldi@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Automated TrOOP Balance Transfer Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Backup User Access Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Best Available Evidence Contact	AVP Enrollment and Membership Accounting	Ms.	Suarez	Yamile		7874069767				7879992199	Yamile.Suarez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Bid Audit Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Bid Audit Site Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Bid Primary Contact	Product Development Manager	Ms	Martinez	Viviana		7874849559				7876253356	viviana.martinez-lanza@mmmhc.com	PO Box 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	CAP Report Contact for Public Website	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	52259			HMO - Health Maintenance Organization		C	Chicago
H4004	CEO - CMS Administrator Contact	President of MMM	Mr.	Rivera Cardona	Ricardo		7876330707				7873004886	ricardo.rivera-cardona@mmmhc.com	350 Avenida Chardon	Torre Chardon Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	CEO - Senior Official for Contracting	President Medicare Programs	Mr.	Gonzalez Rivera	Orlando		7872070700				7873004886	Orlando.Gonzalez@mmmhc.com	350 Avenida Chardon	Torre Chardon Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Chief Financial Officer	Chief Financial Officer	Mr.	Vivaldi	Carlos		7873069135				7873004886	Carlos.Vivaldi@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Chief Operating Officer	COO	Ms	Garcia	Vilmari		7874478131				7873004886	vilmari.garcia@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Chief Information Officer	CIO	Mr.	Molinary	Rachid		7872496365				9395451239	rachid.molinary@mmmhc.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Chief Information Security Officer	Vice President IT Department	Mr.	Arill	Juan		7875016127				7879991726	juan.arill@mmmhc.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	CMMI Model Point of Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	CMS Casework Communication Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Complaints Tracking Contact	A&G Director	Ms.	Rodriguez	Janice		9397173509	2537			7876202390	janice.rodriguez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Contact for Fraud Investigations	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Coordination of Benefits Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Corporate Mailing						7876223000	52259			7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Coverage Gap Discount Program (CGDP) Payment Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Customer Service Operations Contact	Vice President of Operations	Ms.	Iglesias	Morayma		7876002047					morayma.iglesias-sustache@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	DIR Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	DIR Contact (Secondary)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Electronic Health Record Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	52259			HMO - Health Maintenance Organization		C	Chicago
H4004	Emergency Part D Contact	Pharmacy VP	Ms	Morant	Iris		7873797592				7873005503	iris.morant-rodriguez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Emergency Part D Contact (Secondary)	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Employer Waiver Contact	Chief Sales and Marketing Officer	Ms.	Montilla	Lara		7875065320					lara.montilla-byrne@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Encounter Data & Risk Adjustment Operations Contact	Director Risk and Quality Data Analytics	Mr	Kaplun	Alex		2015663591					akaplun@mmmhc.com	350 Avenida Chardon Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Enrollment Contact	AVP Enrollment and Membership Accounting	Ms.	Suarez	Yamile		7874069767				7879992199	Yamile.Suarez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	EOB Transfer Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Financial Audit Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Financial Reporting Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Formulary Contact	Director of Formulary and Utilization Management	Dr.	Lazaro	Maria	I	7876756858	8617			7873005503	maria.lazaro@mmmhc.com	PO BOX 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Formulary Contact (Secondary)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	General Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Government Relations Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	HIPAA Privacy Officer	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	HIPAA Security Officer	Vice President IT Department	Mr.	Arill	Juan		7875016127				7879991726	juan.arill@mmmhc.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Hospice Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Interoperability Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	MA Appeals/Grievances Contact	A&G Director	Ms.	Rodriguez	Janice		9397173509	2537			7876202390	janice.rodriguez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	MA Claims Processing Contact for Public Website	Chief of Clinical Operations	Mr	Salinas	Gonzalo		7873832706	2033			7879992177	Gonzalo.Salinas@mso-pr.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Marketing Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Medical Director	Chief Medical Officer	Dr.	Rosso	Diego		7874478148				7873005523	diego.rosso@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Medicare Compliance Officer	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Medicare Coordinator	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Medicare Part D Opioid Overutilization Contact	Pharmacy AVP	Ms	Ramos	Sara		7874132083				7873005503	sara.ramos-gonzalez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	07/03/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Medication Therapy Management Contact	Pharmacy AVP	Ms	Ramos	Sara		7874132083				7873005503	sara.ramos-gonzalez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	OffShore Subcontractor Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Online Enrollment Center Contact (Back-up)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Online Enrollment Center Contact (Optional)	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Online Enrollment Center Contact (Primary)	AVP Enrollment and Membership Accounting	Ms.	Suarez	Yamile		7874069767				7879992199	Yamile.Suarez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Part C Application Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Part C Reporting Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Appeals	A&G Director	Ms.	Rodriguez	Janice						7876202390	janice.rodriguez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	2537			HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Appeals Contact (Secondary)	Chief Medical Officer	Dr.	Rosso	Diego						7873005523	Diego.Rosso@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	58722			HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Application Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Benefits Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Claims Submission Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Exceptions Contact	Pharmacy Operation Director	Ms	Rivera	Erika						7873005503	erika.rivera@mmmhc.com	PO BOX 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	58633			HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Exceptions Contact (Secondary)	Pharmacy VP	Ms.	Morant	Iris						7873005503	iris.morant-rodriguez@mso-pr.com	PO BOX 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	58660			HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Price File Contact (Back-up)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Price File Contact (Optional)		Ms	Forty	Mario		4806064865					Mario.Forty@cvshealth.com	9501 E. Shea Blvd,		Scorrsdale	AZ	85260	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Price File Contact (Primary)	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Quality Assurance Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Part D Reporting Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Patient Safety Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Payment Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Personal Health Record Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Pharmacy Director	Pharmacy VP	Ms	Morant	Iris		7873797592				7873005503	iris.morant-rodriguez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Pharmacy Network Management Contact	Pharmacy Services Manager	Ms	Rodriguez	Isis		7876532814				7872866032	irodriguezp@mc-21.com	MC-21 Corporation	Call Box 4908	Caguas	PR	00726	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Pharmacy Network Management Contact (Secondary)	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Pharmacy Technical Help Desk Contact	Pharmacy VP	Ms.	Morant	Iris						7873005503	iris.morant-rodriguez@mso-pr.com	PO BOX 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8777767706	58660			HMO - Health Maintenance Organization		C	Chicago
H4004	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Operation Director	Ms	Rivera	Erika						7873005503	erika.rivera@mmmhc.com	PO BOX 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8663335470	58633			HMO - Health Maintenance Organization		C	Chicago
H4004	PHR Beneficiary Contact																	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS	MMM Healthcare, Inc.	Elevance Health, Inc.	1	Yes	Active	8663335470				HMO - Health Maintenance Organization		C	Chicago
H4004	Physician Incentive Contact	Finance Director	Ms.	Perez	Mireya		7874484061				7873005502	Mireya.perez@mso-pr.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Plan Directory Contact for Public Website	AVP Member Services	Ms.	Quinones	Janice		8666766060					janice.quinones@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Plan to Plan Reconciliation Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Processor Contact	CVS VP Medicare Program Services	Ms.	Merlino	Melanie		4802152151				4803146881	Melanie.Merlino@caremark.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Quality Contact	AVP of Quality Management	Ms.	Miranda	Ana	B	7872218738				7873005510	ana.miranda-mercado@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Reconciliation Contact	AVP Finance	Mr.	Gonzalez Cuadrado	Agustin		7876089270				7873004886	agustin.gonzalez-cuadrado@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Reconciliation Contact (Secondary)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Recovery Audit Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	SNP Application Contact	Chief Sales and Marketing Officer	Ms.	Montilla	Lara		7875065320					lara.montilla-byrne@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	SNP State Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Surveillance Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	System Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Third Party Administrator (TPA) Liaison	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	User Access Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Utilization Management Contact	Chief of Clinical Operations	Mr	Salinas	Gonzalo		7873832706	2033			7879992177	Gonzalo.Salinas@mso-pr.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4004	Utilization Review Contact	Chief Medical Officer	Dr.	Rosso	Diego		7874478148				7873005523	diego.rosso@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	PMC Medicare Choice	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4005	Agent/Broker Compensation Data Contact	Sales & Accounts Management Senior VP		Perez Fernandez	Gustavo	A	7877494949	8325026			7876258721	gustavo.perez@ssspr.com	PO Box 363628		San Juan	PR	00936	01/10/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Automated TrOOP Balance Transfer Contact	MA Revenue Management Director	Mr	Rosich	Luis		7879751365	8321176			7879933257	lrosich@sssadvantage.com	PO Box 11320		San Juan	PR	00922	11/01/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Backup User Access Contact	Privacy Analyst	Ms	Lopez	Stephanie	L	7877494949	8322688			7879933260	stephanie.lopez2@ssspr.com	PO Box 11320		San Juan	PR	00922	11/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Best Available Evidence Contact	MA Enrollment & Reconciliation Director		Toste	Maria		7877494949	8322541			7875224307	mtoste@sssadvantage.com	PO Box 11320		San Juan	PR	00922	06/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Bid Audit Contact	Product Development  VP	Mrs	Rojas Sola	Marie	E	7877494949	8321325				marie.rojas@ssspr.com	PO Box 0363628		San Juan	PR	00936	10/17/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Bid Audit Site Contact	Chief Growth & Customer Exp. Officer	Ms	Fernandez	Ivelisse	M	7877494949	8321074			7876200939	ivelisse.fernandez@ssspr.com	P.O. Box 11320		San Juan	PR	00922	02/11/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Bid Primary Contact	Product Development VP	Mrs	Rojas Sola	Marie	E	7877494949	8321325				marie.rojas@ssspr.com	P.O. Box 363628		San Juan	PR	00936	10/17/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	CAP Report Contact for Public Website	Digital Marketing Manager	Mrs.	Ruiz Martinez	Norma	J	7487494949	8321083				nruiz@ssspr.com	PO Box 363628		San Juan	PR	00936	02/11/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	CEO - CMS Administrator Contact	President Triple-S Salud and President Triple-S Ad	Mr.	Justice	Thurman	R	8605971073				7877494097	thurman.justice@bcbsfl.com	1820 Ocean Front		Neptune Beach	FL	32266	04/10/2023	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	CEO - Senior Official for Contracting	President Triple-S Salud and President Triple-S Ad	Mr	Justice	Thurman	R	8605971073				7877494097	thurman.justice@bcbsfl.com	1820 Ocean Front		Neptune Beach	FL	32266	04/10/2023	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Chief Financial Officer	Chief Financial Officer	Mr.	Veach	Daryl		7877494949					daryl.veach@ssspr.com	P.O. Box 363628		San Juan	PR	009363628	09/29/2023	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Chief Operating Officer	President Triple-S Salud and President Triple-S Ad	Mr	Justice	Thurman	R	8605971073				7877494019	thurman.justice@bcbsfl.com	1820 Ocean Front		Neptune Beach	FL	32266	04/10/2023	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Chief Information Officer	Business Operations Monitoring Senior VP	Mrs	Gonzalez Lassalle	Carmen	M	7877494949	8324113				cgonzalezl@ssspr.com	PO Box 363628		San Juan	PR	00936	05/24/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Chief Information Security Officer	Information and Cyber Security Director	Mr.	Vidal Yordan	Carlos	R	7877494949	8326004			7877744820	carlos.vidal@ssspr.com	PO Box 363628		San Juan	PR	00936	03/02/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	CMS Casework Communication Contact	Appeals and Grievances Manager	Mrs	Martinez	Aixa		7877494949	8322307			7879933261	aixam@sssadvantage.com	PO Box 11320		San Juan	PR	00922	08/12/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Complaints Tracking Contact	Appeals and Grievances Manager	Mrs.	Martinez	Aixa		7877494949	8322307			7879933261	aixam@sssadvantage.com	PO Box 11320		San Juan	PR	00922	08/12/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Contact for Fraud Investigations	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Coordination of Benefits Contact	MA Enrollment & Reconcilliation Director	Mrs.	Toste	Maria		7877494949	8322541			7875224307	mtoste@sssadvantage.com	PO Box 11320		San Juan	PR	00922	04/26/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Corporate Mailing						7877494949	8322438				jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Coverage Gap Discount Program (CGDP) Payment Contact	Part D Reporting Analyst	Mrs	Cortes	Johannie		7877494949	832248			7876258717	johannie@sssadvantage.com	PO Box 11320		San Juan	PR	009229905	08/12/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Customer Service Operations Contact	Customer Service Manager	Mr.	Jaxon	Harold		7876649288				7876200931	harold.jaxon@ssspr.com	PO Box 363628		San Juan	PR	00922	12/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	DIR Contact	Part D Reporting Analyst	Ms	Cortes	Johannie		7877494949	8322448			7879933257	johannie@ssspr.com	PO Box 11320		San Juan	PR	00922	12/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	DIR Contact (Secondary)	MA Premium Management Manager	Mrs	Ruiz Sanchez	Alexsandra		7877494949	8322185				alexsandra.ruiz@ssspr.com	PO Box 11320		San Juan	PR	00922	12/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Electronic Health Record Contact	Health Plan Information Technology VP	Mr.	Abrams Guzman	Jose	L	7877494949	8320040			7879933256	jose.abrams@ssspr.com	PO Box 11320		San Juan	PR	00922	03/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Emergency Part D Contact	Pharmacy Vice-president	Mrs	Muniz	Omarys		7877494949	8324535			7875224004	omaris.muniz@ssspr.com	PO Box 11320		San Juan	PR	00922	12/20/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Emergency Part D Contact (Secondary)	Pharmacy Regulatory & Compliance Manager	Mrs.	Cordero Miranda	Cindy	N	7877494949	8321797			7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Employer Waiver Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Encounter Data & Risk Adjustment Operations Contact	MA Revenue Management Director	Mr.	Rosich	Luis		7879751365	8321176			7879933257	lrosich@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Enrollment Contact	Enrollment Director	Mrs.	Cruz	Nayda	G	7877494949	8320212			7875224307	ngcruz@ssspr.com	PO Box 11320		San Juan	PR	00922	02/09/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	EOB Transfer Contact	Pharmacy Regulatory & Compliance Manager	Mrs.	Cordero Miranda	Cindy	N	7877494949	8321797			7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Financial Audit Contact	Compliance Audit and Monitoring Director	Mrs	Marrero	Monica		7877494949	8322303				monica.marrero@ssspr.com	PO Box 11320		San Juan	PR	00922	12/21/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Financial Reporting Contact	Corporate Financial Reporting Director	Ms	Montes Santiago	Loyda	I	7877494949	8321967			7877494019	loyda.montes@ssspr.com	PO Box 363628		San Juan	PR	00936	03/18/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Formulary Contact	Pharmacy Senior Manager		Santos	Zoraida		7877494949	8324181			7875224004	zsantos@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/30/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Formulary Contact (Secondary)	Clinical Pharmacist	Ms	Vargas	Viviana		7875231212	1171				viviana.vargas@abarcahealth.com	650 Avenida Muoz Rivera	Suite 701	San Juan	PR	00918	01/19/2017	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	General Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Government Relations Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	HIPAA Privacy Officer	Privacy Officer	Ms	Padilla	Lucy		7877494949	8322502			7879933260	lpadilla@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	HIPAA Security Officer	Cyber Security Director/CISO	Mr	Vidal Yordan	Carlos	R	7877494949	8326004				carlos.vidal@ssspr.com	PO Box 363628		San Juan	PR	00936	05/24/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Hospice Contact	Medical Director	Mrs.	Rivas	Jadeyra		7877494949	8322358			7875224004	jadeyra.rivas@ssspr.com	PO Box 11320		San Juan	PR	00922	03/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Interoperability Contact	Innov. & Integration Sr Director	Mr.	Mora Silva	Fernando		7877494949	8322073			7879933256	fmoras@sssadvantage.com	PO Box 11320		San Juan	PR	00922	07/08/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	MA Appeals/Grievances Contact	Appeals and Grievances Manager	Mrs	Martinez	Aixa		7877494949	8322307			7879933261	aixam@sssadvantage.com	PO Box 11320		San Juan	PR	00922	08/12/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	MA Claims Processing Contact for Public Website	Claims Director	Mrs	Roldan-Marin	Francheska	M	7877494949	8324942				froldan@ssspr.com	PO Box 11320		San Juan	PR	00922	10/17/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Marketing Contact	Marketing & Content Department Manager	Mrs	Martin	Gabriela		7877494949	8321073			7877494060	gmartinb@ssspr.com	PO Box 363628		San Juan	PR	00936	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Medical Director	Chief Medical Officer	Dr	Novoa	Jose		7877494949	8325171			0000000000	jnovoa@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Medicare Compliance Officer	Compliance Officer & VP	Mrs	Cardenas	Jenny	D	7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	009229905	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Medicare Coordinator	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Medicare Part D Opioid Overutilization Contact	Pharmacy Senior Manager	Mrs	Santos	Zoraida		7877494949	8324181			7875224004	zsantos@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/30/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Medication Therapy Management Contact	Pharmacy Senior Manager		Santos	Zoraida		7877494949	8324181			7875224004	zsantos@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/30/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	OffShore Subcontractor Contact	Privacy Officer		Padilla	Lucy		7877494949	8322502			7879933260	lpadilla@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Online Enrollment Center Contact (Back-up)	MA Enrollment Manager	Mrs	Marcano	Zoe		7877494949	8322628			7875224307	zoem@sssadvantage.com	PO Box 11320		San Juan	PR	00922	06/23/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Online Enrollment Center Contact (Optional)	Enrollment Manager	Ms	Marcano	Zoe	C	7877494949	8322628			7875224307	zoem@sssadvantage.com	PO Box 11320		San Juan	PR	009209905	04/27/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Online Enrollment Center Contact (Primary)	Enrollment Director	Mrs	Cruz	Nayda	G	7877494949	8320212			7875224307	ngcruz@ssspr.com	PO Box 11320		San Juan	PR	00922	02/09/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Part C Application Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Part C Reporting Contact	Compliance Audit and Monitoring Director	Ms	Marrero	Monica		7877494949	8322303				monica.marrero@ssspr.com	PO Box 11320		San Juan	PR	009229905	03/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Part D Appeals	Appeals and Grievances Manager	Mrs	Martinez	Aixa						7879933261	aixam@sssadvantage.com	PO Box 11320		San Juan	PR	00922	08/12/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	7877494949	8322307			PPO - BBA		C	Atlanta
H4005	Part D Appeals Contact (Secondary)	Reg Strategy, Grievances & Appeals Director	Mrs.	Cuprill	Diana						7879933261	dcuprill@sssadvantage.com	PO Box 11320		San Juan	PR	00922	12/29/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	7877494949	8322350			PPO - BBA		C	Atlanta
H4005	Part D Application Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Part D Benefits Contact	Pharmacy Vice-president	Mrs	Muniz	Omarys		7877494949	8324535			7875224004	omaris.muniz@ssspr.com	PO Box 11320		San Juan	PR	00922	12/20/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Part D Claims Submission Contact	Pharmacy Regulatory & Compliance Manager	Mrs.	Cordero Miranda	Cindy	N	7877494949	8321797			7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Part D Exceptions Contact	Pharmacy Senior Manager	Mrs	Graxirena	Dalia						7875224004	dgraxire@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	7877494949	8321812			PPO - BBA		C	Atlanta
H4005	Part D Exceptions Contact (Secondary)	Pharmacy Regulatory & Compliance Manager	Mrs.	Cordero Miranda	Cindy	N					7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	009363828	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	7877494949	8321797			PPO - BBA		C	Atlanta
H4005	Part D Price File Contact (Back-up)	Data Analyst II		De Jess	Cesar		7875231212	1169				cesar.dejesus@abarcahealth.com	650 Avenida Muoz Rivera	Suite 701	San Juan	PR	00918	08/23/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Part D Price File Contact (Optional)	Pharmacy Regulatory & Compliance Manager	Mrs.	Cordero Miranda	Cindy	N	7877494949	8321797			7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Part D Price File Contact (Primary)	Data Analyst II		Reed	Lindsay		9396428582	1125				lindsay.reed@abarcahealth.com	650 Avenida Muoz Rivera	Suite 701	San Juan	PR	00918	08/23/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Part D Quality Assurance Contact	Pharmacy Regulatory & Compliance Manager	Mrs.	Cordero Miranda	Cindy	N	7877494949	8321797			7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Part D Reporting Contact	Compliance Audit and Monitoring Director	Ms	Marrero	Monica		7877494949	8322303				monica.marrero@ssspr.com	PO Box 11320		San Juan	PR	009229905	03/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Patient Safety Contact	Pharmacy Senior Manager		Santos	Zoraida		7877494949	8324181			7875224004	zsantos@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/30/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Payment Contact	Revenue and Members Operation  Senior VP	Mrs	Reyes	Ivette		7877494949	8322419				ireyes@sssadvantage.com	PO Box 11320		San Juan	PR	00922	08/18/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Personal Health Record Contact	Privacy Officer	Ms	Padilla	Lucy		7877494949	8322502			7879933260	lpadilla@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Pharmacy Director	Pharmacy Vice-president	Mrs	Muniz	Omarys		7877494949	8324535			7875224004	omaris.muniz@ssspr.com	PO Box 11320		San Juan	PR	00922	12/20/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Pharmacy Network Management Contact	Director of Service Operations		Hernandez	Hector		7875231212	1123				hector.hernandez@abarcahealth.com	650 Avenida Muoz Rivera	Suite 701	San Juan	PR	00918	01/04/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Pharmacy Network Management Contact (Secondary)	Pharmacy Vice-president	Mrs	Muniz	Omarys		7877494949	8324535			7875224004	omaris.muniz@ssspr.com	PO Box 363628		San Juan	PR	00939	12/20/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Pharmacy Technical Help Desk Contact	Director of Service Operations		Hernandez	Hector						7875231240	hector.hernandez@abarcahealth.com	650 Avenida Muoz Rivera	Suite 701	San Juan	PR	00918	01/04/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	8559222722				PPO - BBA		C	Atlanta
H4005	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Vice-president	Mrs	Muniz	Omarys						7875224004	omaris.muniz@ssspr.com	PO Box 11320		San Juan	PR	00922	12/20/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	7877494949	8324535			PPO - BBA		C	Atlanta
H4005	PHR Beneficiary Contact																	06/12/2015	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO	Triple-S Advantage	Guidewell Mutual Holding Corporation	594	Yes	Active	8886201919				PPO - BBA		C	Atlanta
H4005	Physician Incentive Contact	Medical Groups Performance Management VP	Mr.	Mendez	Francisco	J	7877494949	8322385			7876200939	francisco.j.mendez@ssspr.com	PO Box 11320		San Juan	PR	00922	02/11/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Plan Directory Contact for Public Website	PCP Perform and Engagement Vice-president	Ms	Mendez	Zoraida		7877494949	8322629			7876200939	zoraida.mendez@ssspr.com	PO Box 11320		San Juan	PR	00922	02/11/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Plan to Plan Reconciliation Contact	MA Revenue Management Director	Ms	Rosich	Luis		7879751365	8321176			7879933257	lrosich@sssadvantage.com	PO Box 11320		San Juan	PR	00922	11/01/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Processor Contact	Claims Director	Ms	Aponte	Iris		7877494949	4316			7877494143	imaponte@ssspr.com	POBox 363628		San Juan	PR	009363628	11/02/2017	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Quality Contact	Quality and Stars Director	Ms	Hernandez	Patricia		7877494949	8322554			7879933256	patriciah@sssadvantage.com	P.O. Box 11320		San Juan	PR	00922	09/03/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Reconciliation Contact	MA Revenue Management Director	Ms	Rosich	Luis		7879751365	8321176			7879933257	lrosich@sssadvantage.com	PO Box 11320		San Juan	PR	00922	11/06/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Reconciliation Contact (Secondary)	Revenue and Members Operation  Senior VP	Mrs	Reyes	Ivette		7877494949	8322419				ireyes@sssadvantage.com	P.O. Box 11320		San Juan	PR	00922	08/18/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Recovery Audit Contact	Compliance and Audit and Monitoring Director	Ms	Marrero	Monica		7877494494	8322303				monica.marrero@ssspr.com	PO Box 11320		San Juan	PR	00922	03/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	SNP Application Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	SNP State Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Surveillance Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	System Contact	Privacy Officer	Ms.	Padilla	Lucy		7877494949	8322502			7879933260	lpadilla@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Third Party Administrator (TPA) Liaison	Part D Reporting Analyst	Mrs.	Cortes	Johannie		7877494949	8322448			7876258717	johannie@sssadvantage.com	PO Box 11320		San Juan	PR	009229905	08/12/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	User Access Contact	Privacy Officer	Ms.	Padilla	Lucy		7877494949	8322502			7879933260	lpadilla@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Utilization Management Contact	Senior VP of Clinical Management Strategic & Opera	Ms	Phillips	Tammie		7877494949	8324859			7877494097	tammie.phillips@ssspr.com	PO Box 363628		San Juan	PR	009363628	09/03/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4005	Utilization Review Contact	Senior VP of Clinical Management Strategic & Opera	Ms	Phillips	Tammie		7877494949	8324859			7877494097	tammie.phillips@ssspr.com	PO Box 363628		San Juan	PR	009363628	09/03/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple-S Advantage	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H4007	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	MA Appeals/Grievances Contact	Senior Compliance Professional		Rodriguez Casillas	Lymari		7873061621					crodriguez2@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Appeals			Cardona	Solcire							G_APuertoRicoTeam@humana.com	PO Box 195560		San Jaun	PR	00919	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8005950462				HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Appeals Contact (Secondary)			Torres	Frank							FTorres6@humana.com	11430 N W 20th Street	Suite 200	Miami	FL	33172	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024763947				HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H4007	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H4007	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4007	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLANS OF PUERTO RICO, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4036	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H4036	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				PPO - BBA		C	Chicago
H4036	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H4036	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				PPO - BBA		C	Chicago
H4036	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				PPO - BBA		C	Chicago
H4036	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				PPO - BBA		C	Chicago
H4036	PHR Beneficiary Contact																	11/05/2015	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				PPO - BBA		C	Chicago
H4036	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4036	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4045	Agent/Broker Compensation Data Contact	Manager, Medicare Outreach	Mr.	Ly	Thien		4088741941					tly@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Automated TrOOP Balance Transfer Contact	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Backup User Access Contact	Interim Compliance Officer	Mr.	Haskell	Tyler		4085021587				4088741970	TylerH@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Best Available Evidence Contact	Manager, Medicare Oureach	Mr.	Ly	Thien		4088741941					tly@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Bid Audit Contact	Medicare Compliance Manager	Mr.	Quan	Daniel		4085323349					dquan@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Bid Primary Contact	Medicare Compliance Manager	Mr.	Quan	Daniel		4085323349					dquan@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	CAP Report Contact for Public Website	Interim Compliance Officer	Mr.	Haskell	Tyler		4088741749				4088741970	TylerH@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Tomcala	Christine	M	4086126914					ctomcala@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Tomcala	Christine	M	4088741701					ctomcala@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Chief Financial Officer	Chief Financial Officer	Mr.	Jarecki	Neal		4088741892					NJarecki@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Chief Operating Officer	Chief Operating Officer	Ms.	Turner	Christine		4088741834					cturner@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Chief Information Officer	Chief Information Officer	Mr.	Tamayo	Jonathan		4088741768					jtamayo@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Chief Information Security Officer	Chief Information Officer	Mr.	Tamayo	Jonathan		4088741768					jtamayo@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	CMS Casework Communication Contact	Manager, Grievance & Appeals	Mr.	Oliveira	Mauro		4088741966				4088741962	MOliveira@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Complaints Tracking Contact	Manager, Grievance & Appeals	Mr.	Oliveira	Mauro		4088741966				4088741962	MOliveira@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Contact for Fraud Investigations	Medicare Compliance Manager	Mr.	Quan	Daniel		4085323349					dquan@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Coordination of Benefits Contact			email	COB		4088741866					COB@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	04/20/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Corporate Mailing						4083762000					mainoffice@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mr.	Jarecki	Neal		4088741892					njarecki@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Customer Service Operations Contact	Director, Customer Services	Ms.	Nguyen	Tanya		4088741851					tnguyen@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	DIR Contact	Vice President, Strategies and Analytics	Ms	Bui-Tong	Ngoc		4088741881					nbuitong@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	DIR Contact (Secondary)	Chief Financial Officer	Mr.	Jarecki	Neal		4088741892					njarecki@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Emergency Part D Contact	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Emergency Part D Contact (Secondary)	Chief Medical Officer	Dr.	Nakahira	Laurie		4084388768					lnakahira@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Encounter Data & Risk Adjustment Operations Contact	Vice President, Strategies and Analytics	Ms	Bui-Tong	Ngoc		4088741881					nbuitong@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Enrollment Contact	Manager, Medicare Outreach	Mr.	Ly	Thien		4088741941					tly@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	EOB Transfer Contact	Director, Claims	Ms.	Bell	Arlene		4088741795				4088741925	abell@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Financial Audit Contact	Chief Financial Officer	Mr.	Jarecki	Neal		4088741892					njarecki@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Financial Reporting Contact	Chief Financial Officer	Mr.	Jarecki	Neal		4088741892					njarecki@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Formulary Contact	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Formulary Contact (Secondary)	Clinical Pharmacist	Ms.	Otomo	Tami		4088741909					totomo@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	General Contact	Interim Compliance Officer	Mr.	Haskell	Tyler		4085021587				4088741970	TylerH@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Government Relations Contact	Director, Government Relations	Mr.	Haskell	Tyler		4088741749					thaskell@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	HIPAA Privacy Officer	Interim Compliance Officer	Mr.	Haskell	Tyler		4088741749				4088741970	TylerH@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	HIPAA Security Officer	Chief Information Officer	Mr.	Tamayo	Jonathan		4088741768					jtamayo@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Hospice Contact	Chief Medical Officer	Dr.	Nakahira	Laurie		4088741990					lnakahira@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Interoperability Contact	Director, Application and Product Development		Chang	Linda		4088741958					LChang@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	MA Appeals/Grievances Contact	Manager, Grievance & Appeals	Mr.	Oliveira	Mauro		4088741966				4088741962	MOliveira@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	MA Claims Processing Contact for Public Website	Director, Claims	Ms.	Bell	Arlene		4088741795				4088741925	abell@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Marketing Contact	Director, Marketing & Communications	Ms.	Byom	Chelsea		4086803175					cbyom@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Medical Director	Chief Medical Officer	Dr.	Nakahira	Laurie		4088741990					lnakahira@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Medicare Compliance Officer	Director, Compliance	Mr.	Quan	Daniel		4085323349					dquan@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	09/28/2023	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Medicare Coordinator	Interim Compliance Officer	Mr.	Haskell	Tyler		4085021587				4088741970	TylerH@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/15/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Medication Therapy Management Contact	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Part C Application Contact	Medicare Compliance Manager	Mr.	Quan	Daniel		4085323349					dquan@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Part C Reporting Contact	Medicare Compliance Manager	Mr.	Quan	Daniel		4085323349					dquan@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Part D Appeals	Manager, Grievance & Appeals	Mr.	Oliveira	Mauro						4088741962	MOliveira@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active	8777234795	1966			HMO - Health Maintenance Organization		C	San Francisco
H4045	Part D Appeals Contact (Secondary)	QA Program Manager	Mr.	Hernandez	Victor							VHernandez@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active	4088741415				HMO - Health Maintenance Organization		C	San Francisco
H4045	Part D Application Contact	Medicare Compliance Manager	Mr.	Quan	Daniel		4085323349					dquan@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Part D Benefits Contact	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Part D Claims Submission Contact	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Part D Exceptions Contact	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang							Dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active	4088741901				HMO - Health Maintenance Organization		C	San Francisco
H4045	Part D Exceptions Contact (Secondary)	Clinical Pharmacist	Ms.	Otomo	Tami							totomo@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active	4088741909				HMO - Health Maintenance Organization		C	San Francisco
H4045	Part D Price File Contact (Back-up)	Clinical Pharmacist	Ms.	Otomo	Tami		4088741909					totomo@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Part D Price File Contact (Primary)	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Part D Quality Assurance Contact	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Part D Reporting Contact	Medicare Compliance Manager	Mr.	Quan	Daniel		4085323349					dquan@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Patient Safety Contact	Chief Medical Officer	Dr.	Nakahira	Laurie		4088741990					lnakahira@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Payment Contact	Controller		Granieri	Barbara		4084021711					bgranieri@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Pharmacy Director	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Pharmacy Network Management Contact	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist	Ms.	Otomo	Tami		4088741909					totomo@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services	Ms.	Brewer	Kathy							customerservice@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active	8888078666				HMO - Health Maintenance Organization		C	San Francisco
H4045	Plan Directory Contact for Public Website			Services	Customer		8777234795					callcentermanagement@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Plan to Plan Reconciliation Contact	Controller		Granieri	Barbara		4084021711					bgranieri@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Processor Contact	Director, Claims	Ms.	Bell	Arlene		4088741795				4088741925	abell@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Quality Contact	Director, Quality & Process Improvement		Chang	Mai		6692164917					mchang@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	03/23/2023	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Reconciliation Contact	Vice President, Strategies and Analytics	Ms	Bui-Tong	Ngoc		4088741881					nbuitong@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Reconciliation Contact (Secondary)	Chief Financial Officer	Mr.	Jarecki	Neal		4088741892					NJarecki@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Recovery Audit Contact	Chief Financial Officer	Mr.	Jarecki	Neal		4088741892					NJarecki@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	SNP Application Contact	Medicare Compliance Manager	Mr.	Quan	Daniel		4085323349					dquan@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	SNP State Contact	Medicare Compliance Manager	Mr.	Quan	Daniel		4085323349					dquan@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Surveillance Contact	Interim Compliance Officer	Mr.	Haskell	Tyler		4088741749				4088741970	TylerH@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	System Contact	Chief Information Officer	Mr.	Tamayo	Jonathan		4088741768					jtamayo@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Third Party Administrator (TPA) Liaison	Vice President, Strategies and Analytics	Ms	Bui-Tong	Ngoc		4088741881					nbuitong@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	User Access Contact	Medicare Compliance Manager	Mr.	Quan	Daniel		4085323349					dquan@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Utilization Management Contact	Director, Pharmacy and Utilization Management	Dr.	Huynh	Dang		4088741901					dhuynh@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4045	Utilization Review Contact	Chief Medical Officer	Dr.	Nakahira	Laurie		4088741990					lnakahira@scfhp.com	6201 San Ignacio Ave		San Jose	CA	95119	02/09/2022	2023	SANTA CLARA COUNTY HEALTH AUTHORITY	Local CCP	Santa Clara Family Health Plan	HMO/HMOPOS		SANTA CLARA COUNTY HEALTH AUTHORITY	303	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4053	Automated TrOOP Balance Transfer Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Backup User Access Contact	Director	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Best Available Evidence Contact	Director	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Bid Primary Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	CAP Report Contact for Public Website	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext.	Suite 203	Columbia	SC	29203	03/03/2022	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	CEO - CMS Administrator Contact	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/03/2022	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	CEO - Senior Official for Contracting	Director	Ms	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Chief Financial Officer	Director-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Chief Operating Officer	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/03/2022	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Chief Information Officer	Director-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Chief Information Security Officer	Director-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	CMS Casework Communication Contact	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/03/2022	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Complaints Tracking Contact	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/06/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Contact for Fraud Investigations	Director	Ms.	Burnette	Alison		8034344421					Alison.Burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Coordination of Benefits Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Corporate Mailing						8647977851				8647977880	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	04/08/2019	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Coverage Gap Discount Program (CGDP) Payment Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Customer Service Operations Contact	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/03/2022	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	DIR Contact	Director-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Emergency Part D Contact	Manager, Ambulatory Pharmacy	Mr.	Sanders	Chuck		8645221705				8645221724	Chuck.Sanders@prismahealth.org	845B S. Buncombe Road		Greer	SC	29650	12/22/2021	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Emergency Part D Contact (Secondary)	Manager- PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	03/24/2020	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Encounter Data & Risk Adjustment Operations Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Enrollment Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	EOB Transfer Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Financial Audit Contact	Director-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Financial Reporting Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Formulary Contact	Pharmacy Manager		Marsh	David		8039318123					David.Marsh@prismahealth.org	1308 Laurel Street		Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	General Contact	Director	Ms.	Burnette	Alison		8034344421					alison.burnette2@prismahealth.org	15 Richland Medical Park	Suite 203	Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Government Relations Contact	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/03/2022	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	HIPAA Privacy Officer	Corporate Compliance Officer	Mr.	Pietras	Scott		8647977712					scott.pietras@prismahealth.org	300 East McBee Avenue	Suite 302	Greenville	SC	29601	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	HIPAA Security Officer	Corporate Compliance Officer	Mr.	Pietras	Scott		8647977712					scott.pietras@prismahealth.org	300 East McBee Avenue	Suite 302	Greenville	SC	29601	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Interoperability Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	MA Appeals/Grievances Contact	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/03/2022	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	MA Claims Processing Contact for Public Website	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Marketing Contact	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/03/2022	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Medical Director	Medical Director	Mrs.	Theriot Roley	Laurie		8645221950				8645221955	laurie.theriot@prismahealth.org	32 Centennial Drive		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Medicare Compliance Officer	Corporate Compliance Officer	Mr.	Pietras	Scott		8647977712					scott.pietras@prismahealth.org	300 E. McBee Ave	Suite 302	Greenville	SC	29601	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Medicare Coordinator	Manager-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Medicare Part D Opioid Overutilization Contact	Medical Director	Mrs.	Theriot Roley	Laurie		8645221950				8645221955	laurie.theriot@prismahealth.org	32 Centennial Drive		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Medication Therapy Management Contact	Medical Director	Mrs.	Theriot Roley	Laurie		8645221950				8645221955	laurie.theriot@prismahealth.org	32 Centennial Drive		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Part C Application Contact	Manager, PACE Health Plan Operations		Siler	Sarah		8645221966					sarh.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Part D Appeals	Manager, PACE Health Plan Operations		Siler	Sarah						8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active	8645221966				PACE - Nat		C	Atlanta
H4053	Part D Application Contact	Manager-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Part D Benefits Contact	Manager - PACE Health Plan Operations		Siler	Sarah		8645221966					sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Part D Claims Submission Contact	Manager-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Part D Exceptions Contact	Pharmacy Manager		Marsh	David							david.marsh@prismahealth.org	1308 Laurel Street		Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active	8039318123				PACE - Nat		C	Atlanta
H4053	Part D Price File Contact (Back-up)	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Part D Price File Contact (Primary)	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Part D Quality Assurance Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Part D Reporting Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Patient Safety Contact	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/03/2022	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Payment Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Pharmacy Director	Director, Pharmacy Services	Mr	Ranck	Steve		8645221708				8645221720	steve.ranck@prismahealth.org	845 S. Buncombe Rd., Suite B		Greer	SC	29650	04/08/2019	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Pharmacy Network Management Contact	Manager, Pharmacy	Mr.	Sanders	Chuck		8645221962				8645221955	chuck.sanders@prismahealth.org	32 Centennial Way		Greenville	SC	29605	04/08/2019	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Pharmacy Technical Help Desk Contact	Manager, Pharmacy	Mr.	Sanders	Chuck						8645221955	chuck.sanders@prismahealth.org	32 Centennial Way		Greenville	SC	29605	04/08/2019	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active	8009988995				PACE - Nat		C	Atlanta
H4053	Plan Directory Contact for Public Website	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Plan to Plan Reconciliation Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Processor Contact	Pharmacy Manager		Marsh	David		8039318123					david.marsh@prismahealth.org	1308 Laurel Street		Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Quality Contact	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/06/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Reconciliation Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Recovery Audit Contact	Director	Ms.	Burnette	Alison		8034344421					alison.burnette@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Surveillance Contact	Director of Operations	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/03/2022	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	System Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Third Party Administrator (TPA) Liaison	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	User Access Contact	Corporate Compliance Officer	Mr	Pietras	Scott		8647977712					scott.pietras@prismahealth.org	300 E. Mcbee Ave.	Suite 302	Greenville	SC	29601	04/08/2019	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Utilization Management Contact	Director	Ms.	Burnette	Alison		8034344421					alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4053	Utilization Review Contact	Director	Ms.	Burnette	Alison		8034344421					alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-UPSTATE	National PACE	Prisma Health SeniorCare PACE-Upstate	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4054	Agent/Broker Compensation Data Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Automated TrOOP Balance Transfer Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Backup User Access Contact		Mr	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Best Available Evidence Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Bid Audit Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Bid Audit Site Contact	President & CEO	Mr.	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Bid Primary Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	CAP Report Contact for Public Website	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	CEO - CMS Administrator Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	CEO - Senior Official for Contracting	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Chief Financial Officer	CFO	Mr	Persinger	Keith		4104563946					kpersinger@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Chief Operating Officer	Chief Operating Officer	Mr	Persinger	Keith		4104563946					kpersinger@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Chief Information Officer	Director of Information Technology	Mr	Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Chief Information Security Officer	Director of Information Technology	Mr.	Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	CMS Casework Communication Contact	Chief Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Complaints Tracking Contact		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite  300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Contact for Fraud Investigations		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Coordination of Benefits Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Corporate Mailing						4104240772					info@pphealthplan.com	785 Elkridge Landing Rd	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Customer Service Operations Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	DIR Contact	Financial Analyst	Mr	Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Avenue NW	Suite 100	North Canton	OH	44720	02/21/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	DIR Contact (Secondary)	Sr Financial Manager Reporting & Analytics		Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW	Suite 100	North Canton	OH	44720	02/21/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Emergency Part D Contact	Director of Pharmacy	Dr	Ford	James	E	4433100351					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Emergency Part D Contact (Secondary)	Pharmacy Operations Manager	Dr	Brown	Latrese		4437621114					lbrown@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Encounter Data & Risk Adjustment Operations Contact	Software Engineer		Rifkin	Joshua		4108977578					jrifkin@pphealthplan.com	785 Elkridge Landing Road		Linthicum	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Enrollment Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	EOB Transfer Contact	Sr. Director of  Operations		Brain	Jay		2403672626				8448134544	JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Financial Audit Contact	Director of Finace	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Financial Reporting Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Formulary Contact	Formulary Pharmacist	MS	Baggett	Renee		3308886243					rbaggett@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Formulary Contact (Secondary)	Director Formulary Operations		Singh	Roop		3304866482					rsingh@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	General Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Government Relations Contact			Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	HIPAA Privacy Officer		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	HIPAA Security Officer	Director of Information Technology		Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Hospice Contact	Account Manager	Ms.	Sousa	Ana		2158724933					asousa@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Interoperability Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	MA Appeals/Grievances Contact	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	MA Claims Processing Contact for Public Website	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Marketing Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623019	Sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Medical Director	Medical Director	Dr	Kimmel	Alan		4102183691					akimmel@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Medicare Compliance Officer	Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	11/10/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Medicare Coordinator		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Medicare Part D Opioid Overutilization Contact	Pharmacy Director	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/15/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Medication Therapy Management Contact	VP Pharmacy Solutions		Miller	Holly		3302931916					hmiller@healthdialog.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	OffShore Subcontractor Contact	Chief Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part C Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part C Reporting Contact	Medicare Advantage Reporting Process Manager	Ms	Butler	Christina		2403532930					cbutler@pphealthplan.com	785  Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Appeals	Pharmacy Director	Dr	Ford	James	E						jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	8448468007				HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Appeals Contact (Secondary)	Clinical Operations Appeals Supervisor	Ms.	Binegar	Samantha						3304058081	Appeals@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Benefits Contact	Director of Pharmacy	Dr	Ford	James	E	4432759810					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Claims Submission Contact	Elixir Account Manager	Ms	Brisson	Carly		9169392883					cbrisson@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Exceptions Contact	Associate Vice President	Ms	Lavignette	Amanda							alavignette@envsionrx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Exceptions Contact (Secondary)	Senior Director, Pharmacy Services	Dr	Ford	James							jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	4432759801				HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Price File Contact (Back-up)	Financial Analyst III	Mr.	Wentz	Christophe		3304864910					cwentz@elixirsolutions.com	8957 Canyon Falls Blvd		Twinsburg	OH	44087	06/08/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Price File Contact (Optional)	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Price File Contact (Primary)	Director of Reporting & Analytics	Mr	Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	8957 Canyon Falls Blvd.		Twinsburg	OH	44087	06/08/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Quality Assurance Contact	Pharmacy Operations Manager	Dr	Brown	Latrese		4437621114					lbrown@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Part D Reporting Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Patient Safety Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Payment Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Pharmacy Director	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Pharmacy Network Management Contact	Director Pharmacy Network Development & Operations	Ms	Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Pharmacy Technical Help Desk Contact	Vice President of Operations	Mr	Conn	Todd							tconn@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	8448468007				HMO - Health Maintenance Organization		C	Philadelphia
H4054	Plan Directory Contact for Public Website	Director of Partner Development	Ms	Radice	Sue		4109913213					Sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Plan to Plan Reconciliation Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Processor Contact	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Rd	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Quality Contact	Dir. of Performance Improvement & Quality	Mr	Kirwan	Mark		4104240411					mkirwan@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Reconciliation Contact	Director of Finance	Ms	McIntyre	Marybeth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Reconciliation Contact (Secondary)	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Recovery Audit Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	SNP Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	SNP State Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Surveillance Contact	Chief Compliance Officer	Mr	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	System Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					jbrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Third Party Administrator (TPA) Liaison	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	User Access Contact			Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Utilization Management Contact	Director of Utilization Review	Mr	Derby	Thomas		4846823923					tderby@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4054	Utilization Review Contact	Director of Utilization Review	Mr	Derby	Thomas		4846823923					tderby@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/04/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF TEXAS, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4073	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/24/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H4073	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H4073	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H4073	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4073	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4074	Automated TrOOP Balance Transfer Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Backup User Access Contact	Executive Director	Ms	Overton	Kathryn		2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/24/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Best Available Evidence Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Bid Primary Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	CAP Report Contact for Public Website	Executive Director	Ms	Overton	Kathryn		2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/24/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	CEO - CMS Administrator Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	CEO - Senior Official for Contracting	Executive Director	Ms	Overton	Kathryn		2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/24/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Chief Financial Officer	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	07/27/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Chief Operating Officer	COO	Ms	Lewis	Anne		4066472980					anne.lewis@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	04/28/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Chief Information Officer	Director Enterprise IT Operations	Mr	Gillespie	Jeff		6142348636					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Chief Information Security Officer	VP Information Security	Mr	Jennings	Preston		6105503083					Preston.Jennings@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	CMS Casework Communication Contact	Executive Director	Ms	Overton	Kathryn		2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/24/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Complaints Tracking Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Contact for Fraud Investigations	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Coordination of Benefits Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Corporate Mailing						2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	09/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Coverage Gap Discount Program (CGDP) Payment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Customer Service Operations Contact	Executive Director	Ms	Overton	Kathryn		2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/24/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	DIR Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	DIR Contact (Secondary)	Business Office Manager		Keyser	Denise		2512878420					Denisek@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	04/20/2021	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Emergency Part D Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Encounter Data & Risk Adjustment Operations Contact	Director of Coding and Documentation		Creaney	Emy		7343431939					creaneye@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Enrollment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	EOB Transfer Contact	Regional director Finance	Ms.	Fuhrmeister	Nicole		2157788707				9104834930	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Financial Audit Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Financial Reporting Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Formulary Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	General Contact	Executive Director	Ms	Overton	Kathryn		2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/24/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Government Relations Contact	Executive Director	Ms	Overton	Kathryn		2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	HIPAA Privacy Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	HIPAA Security Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Interoperability Contact	Director Enterprise IT Operations		Gillespie	Jeff		7343433079					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	MA Appeals/Grievances Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	MA Claims Processing Contact for Public Website	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Marketing Contact	Director Marketing & Communications	Ms	Lark	Azia		9735182754					azia.lark@trinity-health.org	2900 Spring Hill Ave		Mobile	AL	36607	02/03/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Medical Director	CMO	Dr.	Nichols	Karen		2512878420				9104834930	karen.nichols001@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Medicare Compliance Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Medicare Coordinator	Executive Director	Ms	Overton	Kathryn		2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	07/27/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Part C Application Contact	Executive Director	Ms	Overton	Kathryn		2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/24/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Part D Appeals	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@mercyhealth.org	1930 South Broad St	Unit 3	Philadelphia	PA	19145	01/04/2021	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Atlanta
H4074	Part D Application Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Part D Benefits Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Part D Claims Submission Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Part D Exceptions Contact	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad St	Unit 3	Philadelphia	PA	19145	09/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Atlanta
H4074	Part D Price File Contact (Back-up)	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Part D Price File Contact (Primary)	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Part D Quality Assurance Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Part D Reporting Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Patient Safety Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Payment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Pharmacy Director	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Pharmacy Network Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	1001 Baltimore Pike		Springfield	PA	19064	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Pharmacy Technical Help Desk Contact	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad St	Unit 3	Philadelphia	PA	19145	09/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Atlanta
H4074	Plan Directory Contact for Public Website	Executive Director	Ms	Overton	Kathryn		2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/24/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Plan to Plan Reconciliation Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Processor Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Quality Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Reconciliation Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Reconciliation Contact (Secondary)			Keyser	Denise		2512878420					Denisek@mercylifeal.com	2900 springhill		Mobile	AL	36607	02/16/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Recovery Audit Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	10/03/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Surveillance Contact	Executive Director	Ms	Overton	Kathryn		2512878420				2512878478	kathryn.overton@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/24/2022	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	System Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Third Party Administrator (TPA) Liaison	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	User Access Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Utilization Management Contact	CMO	Dr.	Nichols	Karen		9104297226				9104834930	karen.nichols001@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4074	Utilization Review Contact	CMO	Dr.	Nichols	Karen		9104297226				9104834930	karen.nichols001@trinity-health.org	4900 Raeford Road		Fayetteville	NC	28304	08/04/2023	2023	MERCY LIFE OF ALABAMA	National PACE	Mercy LIFE of Alabama	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Atlanta
H4091	Agent/Broker Compensation Data Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility	Ms.	Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Backup User Access Contact	Chief Compliance Officer	Ms.	Panaro	Celeste		8322783988					Celeste.Panaro@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Best Available Evidence Contact	COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Bid Audit Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Bid Audit Site Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Bid Primary Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	CAP Report Contact for Public Website	Chief Compliance Officer	Ms.	Panaro	Celeste		8322783988					Celeste.Panaro@ACVCorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	CEO - CMS Administrator Contact	CEO	Mr.	Chaffin	Ron		4848888941					ron.chaffin@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	CEO - Senior Official for Contracting	CEO	Mr.	Chaffin	Ron		2053207527					ron.chaffin@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Chief Financial Officer	CFO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 Seventh Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Chief Operating Officer	Chief Operating Officer	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 Seventh Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Chief Information Officer	VP, PMO & IT	Ms.	Watts	Tammy		2056037958					tammy.watts@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	01/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Chief Information Security Officer	VP, PMO & IT	Ms.	Watts	Tammy		2056037958					tammy.watts@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	01/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	CMS Casework Communication Contact	Chief Compliance Officer	Ms.	Panaro	Celeste		8322783988					Celeste.Panaro@ACVCorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Complaints Tracking Contact	Chief Compliance Officer	Ms.	Panaro	Celeste		8322783988					Celeste.Panaro@ACVCorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Contact for Fraud Investigations	Chief Compliance Officer	Ms.	Panaro	Celeste		8322783988					Celeste.Panaro@ACVCorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Coordination of Benefits Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Corporate Mailing						2057579107				2059947028	Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	12/02/2022	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Customer Service Operations Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	DIR Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	DIR Contact (Secondary)	Controller	Mr.	Caton	Grady		2057579107					Grady.Caton@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Emergency Part D Contact	Director Pharmacy Operations	Ms.	Jacobi	Jackie		2057579007					jackie.jacobi@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Mr.	Hayes	Jacob		2057900260					Jacob.hayes@acvcorp.com	3008 7th Avenue South	Suite 110	Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Encounter Data & Risk Adjustment Operations Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Enrollment Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	EOB Transfer Contact	CFO/COO	Ms.	Brenier	Holly		2057579107				8003756496	Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Financial Audit Contact	CFO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Financial Reporting Contact	CFO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Formulary Contact	Director Pharmacy Operations	Ms.	Jacobi	Jackie		2057579007					jackie.jacobi@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Formulary Contact (Secondary)	Formulary Team Lead	Ms.	Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	General Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Government Relations Contact	Chief Compliance Officer	Ms.	Panaro	Celeste		8322783988					Celeste.Panaro@ACVCorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	HIPAA Privacy Officer	Chief Compliance Officer	Ms.	Panaro	Celeste		8322783988					Celeste.Panaro@ACVCorp.com	3008 Seventh Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	HIPAA Security Officer	VP, PMO & IT	Ms.	Watts	Tammy		2056037958					Tammy.Watts@acvcorp.com	3008 Seventh Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Hospice Contact	Director Pharmacy Operations	Ms.	Jacobi	Jackie		2057579007					jackie.jacobi@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Interoperability Contact	VP, PMO & IT	Ms.	Watts	Tammy		2056037958					tammy.watts@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	01/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	MA Appeals/Grievances Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	MA Claims Processing Contact for Public Website			Provider Services	Simpra Prv		8446374770					Providerinquiry@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	07/10/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Marketing Contact	Chief Compliance Officer	Ms.	Panaro	Celeste		8322783988					Celeste.Panaro@ACVCorp.com	3008 7th Avenue South	Suite 110	Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Medical Director	Chief Medical Director	Dr.	Hays	Clare		2058629595					clare.hays@acvcorp.com	3008 Seventh Avenue South		Birmingham	AL	35233	02/24/2022	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Panaro	Celeste		8322783988					Celeste.Panaro@ACVCorp.com	3008 Seventh Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Medicare Coordinator	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Medicare Part D Opioid Overutilization Contact	Director Pharmacy Operations	Ms.	Jacobi	Jackie		2057579007					jackie.jacobi@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Medication Therapy Management Contact	Director Pharmacy Operations	Ms.	Jacobi	Jackie		2057579007					jackie.jacobi@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	OffShore Subcontractor Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Part C Application Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Part C Reporting Contact	Chief Compliance Officer	Ms.	Panaro	Celeste		8322783988					Celeste.Panaro@ACVCorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Part D Appeals	Supervisor, Grievance and Appeals	Mr.	LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active	9202214149				PPO - BBA		C	Atlanta
H4091	Part D Appeals Contact (Secondary)	Supervisor, Grievances and Appeals	Ms.	Fritsche	Jacki						6082985881	Jacki.Fritsche@Navitus.com	361 Integrity Drive		Madison	WI	53717	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active	6082985781				PPO - BBA		C	Atlanta
H4091	Part D Application Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Part D Benefits Contact	Director Pharmacy Operations	Ms.	Jacobi	Jackie		2057579007					jackie.jacobi@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Part D Claims Submission Contact	Manager,Technical Operations	Mr.	Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Part D Exceptions Contact	Sr. Manager, Clinical Prior Authorization	Mr.	LeClair	Christophe						9202214676	Christopher.LeClair@Navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active	9202214176				PPO - BBA		C	Atlanta
H4091	Part D Exceptions Contact (Secondary)	Director Pharmacy Operations	Ms.	Jacobi	Jackie							jackie.jacobi@acvcorp.com	3008 7th Avenue South	S	Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active	2057579007				PPO - BBA		C	Atlanta
H4091	Part D Price File Contact (Back-up)		Ms.	Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	361 Integrity Drive	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	Madison	WI	53717	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Part D Price File Contact (Optional)	Director Pharmacy Operations	Ms.	Jacobi	Jackie		2057579007					jackie.jacobi@acvcorp.com	3008 7th Avenue South	S	Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	12/31/2019	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Part D Quality Assurance Contact	Director, Pharmacy	Ms.	Jacobi	Jackie		2057579007					Jackie.Jacobi@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Part D Reporting Contact	Director, Pharmacy	Ms.	Jacobi	Jackie		2057579007					Jackie.Jacobi@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Patient Safety Contact	Director Pharmacy Operations	Ms.	Jacobi	Jackie		2057579007					jackie.jacobi@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Payment Contact	CFO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Pharmacy Director	Director Pharmacy Operations	Ms.	Jacobi	Jackie		2057579007					jackie.jacobi@acvcorp.com	3008 7th Avenue South	Suite 110	Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Pharmacy Network Management Contact	Director, Pharmacy Performance	Ms.	Robinson	Jan		6087291688					Jan.Robinson@navitus.com	361 Integrity Drive		Madison	WI	53717	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Pharmacy Network Management Contact (Secondary)	Director Pharmacy Operations	Ms.	Jacobi	Jackie		2057579007					jackie.jacobi@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Pharmacy Technical Help Desk Contact	Sr. Manager, Customer Care Accounts	Ms.	Nett	Danielle						9202214724	Danielle.Nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active	8662703877	4224			PPO - BBA		C	Atlanta
H4091	Pharmacy Technical Help Desk Contact (Secondary)	Director Pharmacy Operations	Ms.	Jacobi	Jackie							jackie.jacobi@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active	2057579007				PPO - BBA		C	Atlanta
H4091	Physician Incentive Contact	Chief Medical Officer	Dr.	Hays	Clare		2058629595					Clare.Hays@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	02/24/2022	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Plan Directory Contact for Public Website	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Plan to Plan Reconciliation Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Processor Contact	Sr. Medicare Services Executive	Ms.	Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Quality Contact	Director, Quality	Ms.	Lumpkin	Karen		2057578993					Karen.Lumpkin@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Reconciliation Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Reconciliation Contact (Secondary)	Controller	Mr.	Caton	Grady		2057579107					Grady.Caton@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Recovery Audit Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	SNP Application Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	SNP State Contact	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Surveillance Contact	Chief Business Development Officer	Ms.	Hord	Stacey		2564906404					Stacey.Hord@ACVCorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	System Contact	VP, PMO & IT	Ms.	Watts	Tammy		2056037958					tammy.watts@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Third Party Administrator (TPA) Liaison	CFO/COO	Ms.	Brenier	Holly		2057579107					Holly.Brenier@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	User Access Contact	Chief Compliance Officer	Ms.	Panaro	Celeste		8322783988					Celeste.Panaro@ACVCorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Utilization Management Contact	Director, Utilization Management	Ms.	Mitchell	Koby		2057579031					Koby.Mitchell@ACVCorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4091	Utilization Review Contact	Director, Utilization Management	Ms.	Mitchell	Koby		2057579031					Koby.Mitchell@acvcorp.com	3008 7th Avenue South		Birmingham	AL	35233	06/12/2023	2023	SIMPRA ADVANTAGE, INC.	Local CCP	Simpra Advantage	Local PPO		Associated Care Ventures, Inc.	674	Yes	Active					PPO - BBA		C	Atlanta
H4093	Agent/Broker Compensation Data Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Automated TrOOP Balance Transfer Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Backup User Access Contact		Mr	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Best Available Evidence Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Bid Audit Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Bid Audit Site Contact	President & CEO	Mr.	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Bid Primary Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	CAP Report Contact for Public Website	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	CEO - CMS Administrator Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	CEO - Senior Official for Contracting	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Chief Financial Officer	CFO	Mr	Persinger	Keith		4104563946					kpersinger@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	12/29/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Chief Operating Officer	Chief Operating Officer	Mr	Persinger	Keith		4104563946					kpersinger@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	12/29/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Chief Information Officer	Director of Information Technology	Mr	Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Chief Information Security Officer	Director of Information Technology	Mr.	Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	CMS Casework Communication Contact	Chief Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Complaints Tracking Contact		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite  300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Contact for Fraud Investigations	Director, Operations	Ms.	Winton	Linda		8173743812					lwinton@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/24/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Coordination of Benefits Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/30/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Corporate Mailing						4104240772					info@pphealthplan.com	785 Elkridge Landing Rd	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/30/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Customer Service Operations Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	DIR Contact	Financial Analyst	Mr	Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Avenue NW	Suite 100	North Canton	OH	44720	02/21/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	DIR Contact (Secondary)	Sr Financial Manager Reporting & Analytics		Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW	Suite 100	North Canton	OH	44720	02/21/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Emergency Part D Contact	Director of Pharmacy	Dr	Ford	James	E	4433100351					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Emergency Part D Contact (Secondary)	Pharmacy Operations Manager	Dr	Brown	Latrese		4437621114					lbrown@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Encounter Data & Risk Adjustment Operations Contact	Software Engineer		Rifkin	Joshua		4108977578					jrifkin@pphealthplan.com	785 Elkridge Landing Road		Linthicum	MD	21090	10/18/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Enrollment Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	EOB Transfer Contact	Sr. Director of  Operations		Brain	Jay		2403672626				8448134544	JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Financial Audit Contact	Director of Finace	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/30/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Financial Reporting Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Formulary Contact	Formulary Pharmacist	MS	Baggett	Renee		3308886243					rbaggett@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Formulary Contact (Secondary)	Director Formulary Operations		Singh	Roop		3304866482					rsingh@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	General Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Government Relations Contact			Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	HIPAA Privacy Officer		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	HIPAA Security Officer	Director of Information Technology		Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Hospice Contact	Account Manager	Ms.	Sousa	Ana		2158724933					asousa@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Interoperability Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	MA Appeals/Grievances Contact	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	MA Claims Processing Contact for Public Website	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Marketing Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623019	Sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Medical Director	Medical Director	Dr	Kimmel	Alan		4102183691					akimmel@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Medicare Compliance Officer	Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	11/10/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Medicare Coordinator		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Medicare Part D Opioid Overutilization Contact	Pharmacy Director	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/15/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Medication Therapy Management Contact	VP Pharmacy Solutions	Ms	Miller	Holly		3302931916					hmiller@healthdialog.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	OffShore Subcontractor Contact	Chief Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part C Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part C Reporting Contact	Medicare Advantage Reporting Process Manager	Ms	Butler	Christina		2403532930					cbutler@pphealthplan.com	785  Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/13/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Appeals	Pharmacy Director	Dr	Ford	James	E						jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/12/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	8448468007				HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Appeals Contact (Secondary)	Clinical Operations Supervisor	Ms.	Binegar	Samantha	J					3304058081	Appeals@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Benefits Contact	Director of Pharmacy	Dr	Ford	James	E	4432759810					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Claims Submission Contact	Elixir Account Manager	Ms	Brisson	Carly		9169392883					cbrisson@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Exceptions Contact	Associate Vice President	Ms	Lavignette	Amanda							alavignette@envsionrx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	11/10/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Exceptions Contact (Secondary)	Senior Director, Pharmacy Services	Dr	Ford	James							jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	11/10/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	4432759801				HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Price File Contact (Back-up)	Financial Analyst III		Wentz	Christophe		3304864910					cwentz@elixirsolutions.com	8957 Canyon Falls Blvd		Twinsburg	OH	44087	06/08/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Price File Contact (Optional)	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Price File Contact (Primary)	Director of Reporting & Analytics	Mr	Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	8957 Canyon Falls Blvd.		Twinsburg	OH	44087	06/08/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Quality Assurance Contact	Pharmacy Operations Manager	Dr	Brown	Latrese		4437621114					lbrown@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Part D Reporting Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Patient Safety Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Payment Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Pharmacy Director	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Pharmacy Network Management Contact	Director Pharmacy Network Development & Operations	Ms	Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Pharmacy Technical Help Desk Contact	Vice President of Operations	Mr	Conn	Todd							tconn@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	8448468007				HMO - Health Maintenance Organization		C	Philadelphia
H4093	Plan Directory Contact for Public Website	Director of Partner Development	Ms	Radice	Sue		4109913213					Sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Plan to Plan Reconciliation Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/30/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Processor Contact	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Rd	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Quality Contact	Dir. of Performance Improvement & Quality	Mr	Kirwan	Mark		4104240411					mkirwan@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Reconciliation Contact	Director of Finance	Ms	McIntyre	Marybeth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/30/2019	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Reconciliation Contact (Secondary)	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Recovery Audit Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	SNP Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	SNP State Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Surveillance Contact	Chief Compliance Officer	Mr	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	System Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					jbrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Third Party Administrator (TPA) Liaison	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	User Access Contact	Chief Compliance Officer	Mr	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/25/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Utilization Management Contact	Director of Utilization Review	Mr	Derby	Thomas		4846823923					tderby@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4093	Utilization Review Contact	Director of Utilization Review	Mr	Derby	Thomas		4846823923					tderby@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF PENNSYLVANIA, INC	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4094	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H4094	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H4094	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H4094	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H4094	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4094	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4105	Automated TrOOP Balance Transfer Contact	Health Plan Manager		Loiselle	Amanda		4016544071				4016544660	aloiselle@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Backup User Access Contact	CEO		Kwiatkowski	Joan	L	4016544564				4016544660	jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Best Available Evidence Contact	CEO		Kwiatkowski	Joan	L	4016544564				4016544660	jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Bid Primary Contact	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	CAP Report Contact for Public Website	CEO		Kwiatkowski	Joan	L	4016544564				4016544660	jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	CEO - CMS Administrator Contact	CEO	Mrs.	Kwiatkowski	Joan	L	4016545465				4016544660	jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	12/27/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	CEO - Senior Official for Contracting	CEO	Mrs.	Kwiatkowski	Joan	L	4016545465				4016544660	jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	12/27/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Chief Financial Officer	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Chief Operating Officer	CEO	Mrs.	Kwiatkowski	Joan	L	4016544564				4016544660	jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Chief Information Officer	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Chief Information Security Officer	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	CMS Casework Communication Contact	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Complaints Tracking Contact	CEO	Mrs.	Kwiatkowski	Joan	L	4016544564				4016544660	jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Contact for Fraud Investigations	CEO	Mrs.	Kwiatkowski	Joan	L	4016544564				4016544660	jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Coordination of Benefits Contact	Senior Accountant		Swierk	Doreen		4017683035				4016544660	dswierk@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Corporate Mailing						4014906566				4016544660	jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Coverage Gap Discount Program (CGDP) Payment Contact	Reporting and Compliance Specialist		Loiselle	Amanda		4016544071				4016544660	aloiselle@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Customer Service Operations Contact	Chief Marketing & Development Officer	Mr.	Boucher	Tom		4016544644				4016544660	tboucher@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	DIR Contact	CEO	Ms.	Kwiatkowski	Joan		4016544564				4016544660	JKwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	02/17/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	DIR Contact (Secondary)	Reporting and Compliance Specialist		Loiselle	Amanda		4016544071				4016544660	aloiselle@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Emergency Part D Contact	CEO		Kwiatkowski	Joan		4016545465					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Emergency Part D Contact (Secondary)	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Encounter Data & Risk Adjustment Operations Contact	Reporting and Compliance Specialist		Loiselle	Amanda		4016544071				4016544660	aloiselle@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Enrollment Contact	Senior Accountant		Swierk	Doreen		4017683035				4014906537	dswierk@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	EOB Transfer Contact	Reporting and Compliance Specialist		Loiselle	Amanda		4016544071				4016544660	aloiselle@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Financial Audit Contact	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Financial Reporting Contact	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Formulary Contact	Pharmacist		Dyer	Curtis		4016545254					cdyer@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	01/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	General Contact	CEO		Kwiatkowski	Joan		4016545465					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Government Relations Contact	CEO	Mrs.	Kwiatkowski	Joan	L	4016544564				4016544660	jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	HIPAA Privacy Officer	Compliance & Quality Manager	Mr.	Walker	Mike		4016544075				4016544660	mwalker@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	HIPAA Security Officer	CEO	Mrs.	Kwiatkowski	Joan	L	4016544564				4016544660	jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Interoperability Contact	CEO	Ms.	Kwiatkowski	Joan		4016544564					Jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	02/24/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	MA Appeals/Grievances Contact	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	MA Claims Processing Contact for Public Website	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Marketing Contact	Chief Marketing & Development Officer	Mr.	Boucher	Tom		4016544644				4016544660	tboucher@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Medical Director	Chief Medical Officer	Dr.	Nikolopoulos	Nicholas		4013189616				4014906537	nnikolopoulos@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	02/21/2023	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Medicare Compliance Officer	Chief of Organizational Performance	Mrs.	Boucher	Liz		4016545255				4016544660	lboucher@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Medicare Coordinator	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Medicare Part D Opioid Overutilization Contact	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	02/17/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Medication Therapy Management Contact	Pharmacist		Dyer	Curtis		4016545254					cdyer@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	01/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	OffShore Subcontractor Contact	CEO		Kwiatkowski	Joan	L	4014906566				4014906537	jkwiatkowski@carelink-ri.com	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Online Enrollment Center Contact (Back-up)	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Online Enrollment Center Contact (Primary)	Senior Accountant		Swierk	Doreen		4017683035				4014906537	dswierk@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Part C Application Contact	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Part D Appeals	Pharmacist		Dyer	Curtis							cdyer@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	01/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active	4016545254				PACE - Nat		C	Boston
H4105	Part D Application Contact	Pharmacist		Dyer	Curtis		4016545254					cdyer@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	01/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Part D Benefits Contact	Pharmacist		Dyer	Curtis		4016545254					cdyer@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	01/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Part D Claims Submission Contact	Data Management Specialist		Loiselle	Amanda		4016544071				4014906537	aloiselle@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Part D Exceptions Contact	Reporting and Compliance Specialist		Loiselle	Amanda						4016544660	aloiselle@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active	8777817223				PACE - Nat		C	Boston
H4105	Part D Exceptions Contact (Secondary)	CEO		Kwiatkowski	Joan							jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active	4016544564				PACE - Nat		C	Boston
H4105	Part D Price File Contact (Back-up)	Health Plan Manager		Loiselle	Amanda		4016544071					aloiselle@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Part D Price File Contact (Primary)	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Part D Quality Assurance Contact	Pharmacist		Dyer	Curtis		4016545254				4016544660	cdyer@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	01/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Part D Reporting Contact	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Patient Safety Contact	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Payment Contact	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Personal Health Record Contact	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Pharmacy Director	Pharmacist		Dyer	Curtis		4016545254					cdyer@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	01/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Pharmacy Network Management Contact	Pharmacist		Dyer	Curtis		4016545254					cdyer@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	01/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Pharmacy Technical Help Desk Contact	Pharmacist		Dyer	Curtis	L					4016544660	cdyer@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	01/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active	4016545254				PACE - Nat		C	Boston
H4105	Pharmacy Technical Help Desk Contact (Secondary)	Reporting and Compliance Specialist		Loiselle	Amanda						4016544660	aloiselle@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active	8777817223				PACE - Nat		C	Boston
H4105	PHR Beneficiary Contact																	11/23/2009	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE	Pace Organization of Rhode Island	PACE Organization of Rhode Island	177	Yes	Active	8777817223				PACE - Nat		C	Boston
H4105	Plan Directory Contact for Public Website	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Plan to Plan Reconciliation Contact	Health Plan Manager		Loiselle	Amanda		4016544071				4016544660	aloiselle@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Processor Contact	CFO	Mr.	McAnaugh	Craig		4016544074				4014906537	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Quality Contact	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Reconciliation Contact	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Reconciliation Contact (Secondary)	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Recovery Audit Contact	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Surveillance Contact	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	System Contact	CFO	Mr.	McAnaugh	Craig		4016544074					cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Third Party Administrator (TPA) Liaison	CFO	Mr.	McAnaugh	Craig		4016544074				4016544660	cmcanaugh@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	05/25/2022	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	User Access Contact	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Utilization Management Contact	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4105	Utilization Review Contact	CEO		Kwiatkowski	Joan		4016544564					jkwiatkowski@pace-ri.org	10 Tripps Lane		Riverside	RI	02915	11/08/2021	2023	PACE ORGANIZATION OF RHODE ISLAND	National PACE	PACE Organization Of Rhode Island	National PACE		PACE Organization of Rhode Island	177	Yes	Active					PACE - Nat		C	Boston
H4118	Automated TrOOP Balance Transfer Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Backup User Access Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Best Available Evidence Contact	Executive Director	Mrs	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	11/09/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Bid Primary Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	CAP Report Contact for Public Website	Executive Director		Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	CEO - CMS Administrator Contact	Executive Director	Mrs	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	CEO - Senior Official for Contracting	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Chief Financial Officer	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Chief Operating Officer	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Chief Information Officer	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Chief Information Security Officer	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	CMS Casework Communication Contact	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Complaints Tracking Contact	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Contact for Fraud Investigations	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Coordination of Benefits Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Corporate Mailing						7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Mrs.	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Customer Service Operations Contact	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	DIR Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	DIR Contact (Secondary)	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Emergency Part D Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Emergency Part D Contact (Secondary)	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Encounter Data & Risk Adjustment Operations Contact	Director of Finance		Dukes	Jaclyn		7348790325					jdukes@hvpace.org	2940 Ellsworth Road		Ypsilanti	MI	48197	10/21/2019	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Enrollment Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	EOB Transfer Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224			7342215124	jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	08/28/2017	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Financial Audit Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Financial Reporting Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Formulary Contact	Quality Director	MRS	Gearhart	Felicia		7345725777					fgearhart@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/10/2020	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Formulary Contact (Secondary)	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	General Contact	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Government Relations Contact	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	HIPAA Privacy Officer	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	HIPAA Security Officer	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Interoperability Contact			Love-Felton	Sonja		7345725777					sfelton@hvpace.org	2940 Ellsworth Road		Ypsilanti	MI	48197	04/18/2022	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	MA Appeals/Grievances Contact	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	MA Claims Processing Contact for Public Website	Director of Finance	MRS	Dukes	Jaclyn		7345725777					jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Marketing Contact	Marketing Manager	MRS	Mann-Shanahan	Lindsay		7345725777					lmann-shanahan@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/10/2020	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Medical Director	Medical Director	MRS	Almeda	Marjorie		7345725777					malmeda@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	01/05/2021	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Medicare Compliance Officer	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	02/11/2019	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Medicare Coordinator	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Medicare Part D Opioid Overutilization Contact	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	03/10/2020	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Medication Therapy Management Contact	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	03/10/2020	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	OffShore Subcontractor Contact	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Online Enrollment Center Contact (Back-up)	Marketing Manager	MRS	Mann-Shanahan	Lindsay		7345725777					lmann-shanahan@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/10/2020	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Online Enrollment Center Contact (Optional)	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Online Enrollment Center Contact (Primary)	Executive Director	MRS	Berry	Tina		7345725777					cberry@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/01/2019	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Part C Application Contact	Executive Director		Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth Road		Ypsilanti	MI	48197	03/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Part D Appeals	Quality Director	Mrs	Gearhart	Felicia							fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active	8554837223				PACE - Nat		C	Chicago
H4118	Part D Appeals Contact (Secondary)	Finance Director	Mrs	Dukes	Jaclyn						7342215124	jdukes@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	01/05/2021	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active	8554837223				PACE - Nat		C	Chicago
H4118	Part D Application Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Part D Benefits Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Part D Claims Submission Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Part D Exceptions Contact	Director of Finance	Mrs	Dukes	Jaclyn							jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active	8554837223				PACE - Nat		C	Chicago
H4118	Part D Exceptions Contact (Secondary)	Executive Director	MRS	Love-Felton	Sonja							SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active	7345725777				PACE - Nat		C	Chicago
H4118	Part D Price File Contact (Back-up)	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Part D Price File Contact (Optional)	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Part D Price File Contact (Primary)	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Part D Quality Assurance Contact	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Part D Reporting Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Patient Safety Contact	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Payment Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Personal Health Record Contact	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Pharmacy Director	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	03/10/2020	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Pharmacy Network Management Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Pharmacy Network Management Contact (Secondary)	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Pharmacy Technical Help Desk Contact	Quality Director	Mrs	Gearhart	Felicia							fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active	8554837223				PACE - Nat		C	Chicago
H4118	Pharmacy Technical Help Desk Contact (Secondary)	Executive Director	MRS	Love-Felton	Sonja							SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active	7345725777				PACE - Nat		C	Chicago
H4118	PHR Beneficiary Contact																	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE	Huron Valley PACE	Utd Methodist Retirement Communities of SE MI	558	Yes	Active	8554837223				PACE - Nat		C	Chicago
H4118	Plan Directory Contact for Public Website	Marketing Manager	MRS	Mann-Shanahan	Lindsay		7345725777					lmann-shanahan@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	03/10/2020	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Plan to Plan Reconciliation Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Processor Contact	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Quality Contact	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Reconciliation Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	05/02/2016	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Reconciliation Contact (Secondary)	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Recovery Audit Contact	Director of Finance	Mrs	Dukes	Jaclyn		7345725777	224				jdukes@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	08/28/2017	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Surveillance Contact	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	System Contact	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Third Party Administrator (TPA) Liaison	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	User Access Contact	Executive Director	MRS	Love-Felton	Sonja		7345725777					SFelton@hvpace.org	2940 Ellsworth		Ypsilanti	MI	48197	06/27/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Utilization Management Contact	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4118	Utilization Review Contact	Quality Director	Mrs	Gearhart	Felicia		7348790324					fgearhart@hvpace.org	2940 Ellsworth Rd		Ypsilanti	MI	48197	11/05/2018	2023	THE WASHTENAW PACE	National PACE	Huron Valley PACE	National PACE		Utd Methodist Retirement Communities of SE MI	558	Yes	Active					PACE - Nat		C	Chicago
H4140	Agent/Broker Compensation Data Contact	VP, Compliance Officer		Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/22/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Automated TrOOP Balance Transfer Contact	Medicare Part D Program Manager		Rivera Aquino	Denisse		8582915269					partDCAT@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/07/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Backup User Access Contact	CFO		Garrote Torra	Ivonne		7865780954					i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH1	Coral Gables	FL	33134	05/11/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Best Available Evidence Contact	Director of Enrollment		Hernandez	Gloria		7865780959				7865780964	ghernandez@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/22/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Bid Audit Contact	CFO		Garrote Torra	Ivonne		7865780954				7865780281	i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH1	Coral Gables	FL	33134	10/07/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Bid Primary Contact	CFO		Garrote Torra	Ivonne		7865780954				7865780281	i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH1	Coral Gables	FL	33134	10/07/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	CAP Report Contact for Public Website	VP, Compliance Officer		Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/22/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	CEO - CMS Administrator Contact	CEO	Mr.	Perez	Rafael	P	7865780945				7865780281	rperez@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	12/10/2020	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	CEO - Senior Official for Contracting	CEO	Mr.	Perez	Rafael	P	7865780945				7865780281	rperez@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	12/10/2020	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Chief Financial Officer	CFO	Ms.	Garrote Torra	Ivonne		7865780954				7865780282	i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	10/07/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Chief Operating Officer	President	Mr.	Perez	Martiniano	J	7865780946				7865780282	mperez@doctorshcp.com	2020 Ponce De Leon Bvd	PH 1	Coral Gables	FL	33134	12/10/2020	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Chief Information Officer	Director of IT	Mr.	Miranda	Lazaro		7865780952				7865760298	lmiranda@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Chief Information Security Officer	Director of IT	Mr.	Miranda	Lazaro		7865780952				7865760298	lmiranda@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	CMMI Model Point of Contact	Director of IT		Miranda	Lazaro		7865780952				7865760298	lmiranda@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/22/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	CMS Casework Communication Contact	VP, Administration		Griffin	Susan		7865780947					jcurbelo@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/22/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Complaints Tracking Contact	Administration		Griffin	Susan		7865780947				7865780285	sgriffin@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Contact for Fraud Investigations	Administration		Griffin	Susan		7865780947				7865780285	sgriffin@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Coordination of Benefits Contact	CFO		Garrote- Torra	Ivonne		7865780954				7865780289	i.gtor03@doctorshcp.com	2020 Ponce De Leon Bvd	PH 1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Corporate Mailing						7865780965				7865780290	receptionist@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Coverage Gap Discount Program (CGDP) Payment Contact	CFO		Garrote Torra	Ivonne		7865780954					i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	10/07/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Customer Service Operations Contact	Director Member Services		Curbelo	Jenny		7865780956				7865780283	jcurbelo@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/22/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	DIR Contact	CFO		Garrote Torra	Ivonne		7865780954					i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	10/07/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	DIR Contact (Secondary)	Chief Medical Officer	Dr.	Cabrera	Jorge		7865848349					j.cabr14@doctorshcp.com	2020 Ponce De Leon Blvd	PH1	Coral Gables	FL	33134	03/02/2023	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Emergency Part D Contact	Chief Medical Officer	Dr.	Cabrera	Jorge		7865848349					j.cabr14@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	03/02/2023	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Emergency Part D Contact (Secondary)	Chief Medical Officer		Cabrera	Jorge		7865780962					j.cabr14@doctorshcp.com	2020 Ponce De Leon	PH 1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Encounter Data & Risk Adjustment Operations Contact	Senior Director, IT		Miranda	Lazaro		7865780952					lmiranda@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	10/18/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Enrollment Contact	Director of Enrollment		Hernandez	Gloria		7865780959				7865780964	ghernandez@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	EOB Transfer Contact	Claims		Perez	Martiniano		7865780946				7865780289	mperez@doctorshcp.com	2020 Ponce De Leon Bvd	PH 1	Coral Gables	FL	33134	07/13/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Financial Audit Contact	CFO	Ms.	Garrote Torra	Ivonne		7865780954					i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH1	Coral Gables	FL	33134	10/07/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Financial Reporting Contact	CFO		Garrote Torra	Ivonne		7865780954				7865780282	i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	10/07/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Formulary Contact	Clinical Pharmacist Consultant		Silveira	Silvia		7868663471					ssilveira@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/22/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Formulary Contact (Secondary)	Chief Medical Officer	Dr.	Cabrera	Jorge		7865780962					j.cabr14@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	03/02/2023	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	General Contact	CEO		Perez	Rafael	P	7865780945				7865780281	rperez@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	12/10/2020	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Government Relations Contact	Compliance Officer		Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	HIPAA Privacy Officer	Compliance Officer		Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	HIPAA Security Officer	Senior Director, IT		Miranda	Lazaro		7865780952					lmiranda@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Hospice Contact	Chief Medical Officer	Dr.	Cabrera	Jorge		7865780962					j.cabr14@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Interoperability Contact	Director, IT		Miranda	Lazaro		7865780952					lmiranda@doctorshcp.com	2020 Ponce De Leon Blvd	PH-1	Coral Gables	FL	33134	12/21/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	MA Appeals/Grievances Contact	Director Member Services		Curbelo	Jenny		7865780956				7865780283	jcurbelo@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	MA Claims Processing Contact for Public Website	President		Perez	Martiniano		7865780946				7865780289	mperez@doctorshcp.com	2020 Ponce De Leon Bvd	PH 1	Coral Gables	FL	33134	04/21/2023	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Marketing Contact	Director Marketing and Sales		Delgado	Arlen		7865780957					adelgado@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Medical Director	Chief Medical Officer	Dr.	Cabrera	Jorge		7865780962					j.cabr14@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Medicare Compliance Officer	VP, Compliance Officer	Ms.	Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/22/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Medicare Coordinator	VP, Compliance Officer		Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Torres	Gerrado		7868663472					g.torr28@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Medication Therapy Management Contact	Senior Director, Quality and Stars		Valencia-Villa	Rosaelena		7864253711					rvalencia@doctorshcp.com	2020 Ponce de Leon Blvd	Suite PH-1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Online Enrollment Center Contact (Primary)	Director of Enrollment		Hernandez	Gloria		7865780959				7865780964	ghernandez@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/22/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Part C Application Contact	VP, Compliance Officer		Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Part C Reporting Contact	VP, Compliance Officer		Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Part D Appeals	Grievance & Appeals		Xart	Jennifer						7865780293	jxart@doctorshcp.com	2020 Ponce De Leon Blvd.	PH 1	Coral Gables	FL	33134	01/04/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active	7865848594				HMO - Health Maintenance Organization		C	Atlanta
H4140	Part D Appeals Contact (Secondary)	Grievance & Appeals		Curbelo	Jenny						7865780293	jcurbelo@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/19/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active	7865780956				HMO - Health Maintenance Organization		C	Atlanta
H4140	Part D Application Contact	VP, Compliance Officer		Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Part D Benefits Contact	Chief Medical Officer	Dr.	Cabrera	Jorge		7865780962					j.cabr14@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	03/02/2023	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Part D Claims Submission Contact	Sub Medicare Operations		Rivera-Aquino	Denissee		8582915269					pde@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/30/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Part D Exceptions Contact	Chief Medical Officer	Dr.	Cabrera	Jorge							j.cabr14@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	03/02/2023	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active	7865780962				HMO - Health Maintenance Organization		C	Atlanta
H4140	Part D Exceptions Contact (Secondary)	Clinical Pharmacist		Torres	Gerardo							g.torr28@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active	7868663472				HMO - Health Maintenance Organization		C	Atlanta
H4140	Part D Price File Contact (Back-up)	Chief Medical Officer	Dr.	Cabrera	Jorge		7865780962					j.cabr14@doctorshcp.com	2020 Ponce De Leon	PH1	Coral Gables	FL	33134	03/02/2023	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Part D Price File Contact (Primary)	Medicare Part D Program Manager		Keller	Shanon		8587907104					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/30/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Part D Quality Assurance Contact	Senior Director Quality and STARS		Valencia-Villa	Rosaelena		7864253711					rvalencia@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	12/21/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Part D Reporting Contact	VP, Compliance Officer		Campuzano	Mayra		7865848349				7864724448	mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/25/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Patient Safety Contact	Senior Director Quality and STARS		Valencia-Villa	Rosaelena		7864253711					rvalencia@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	12/21/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Payment Contact	Chief Financial Officer	Ms	Garrote Torra	Ivonne		7865780954					i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	10/07/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Pharmacy Director	Chief Medical Officer	Dr.	Cabrera	Jorge		7865780962					j.cabr14@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Pharmacy Network Management Contact	Director, Pharmacy Network Administration		Hunt	Brian		8587907092					brian.hunt@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/07/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services		Brewer	Kathy							customerservice@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/07/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active	8009104730				HMO - Health Maintenance Organization		C	Atlanta
H4140	Plan Directory Contact for Public Website	VP Network Development		Duran	Maria		7865780940					m.dur.5@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	06/30/2020	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Plan to Plan Reconciliation Contact	CFO		Garrote Torra	Ivonne		7865780954					i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH1	Coral Gables	FL	33134	10/07/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Processor Contact	VP, Compliance Officer		Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Quality Contact	Senior Director Quality and STARS		Valencia-Villa	Rosaelena		7864253711					rvalencia@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	12/21/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Reconciliation Contact	CFO		Garrote Torra	Ivonne		7865780954					i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH1	Coral Gables	FL	33134	10/14/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Recovery Audit Contact	CFO	Ms.	Garrote Torra	Ivonne		7865780954				7865780282	i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	10/07/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	SNP Application Contact	Senior Director, Quality and Stars		Valencia	Rosaelena		7864253711					rvalencia@doctorshcp.com	2020 Ponce De Leon	PH 1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	SNP State Contact	Vice President, Compliance Officer		Campuzano	Mayra		7865848349				7864724448	mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/22/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Surveillance Contact	VP, Compliance Officer		Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	System Contact	Director of IT		Miranda	Lazaro		7865780952				7865780298	lmiranda@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	02/22/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Third Party Administrator (TPA) Liaison	CFO		Garrote Torra	Ivonne		7865780954					i.gtor03@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	10/07/2021	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	User Access Contact	VP, Compliance Officer		Campuzano	Mayra		7865848349					mcampuzano@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	08/15/2019	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Utilization Management Contact	Senior Director, Utilization Management	Dr.	Tano	Raul		7864253709					r.tano16@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4140	Utilization Review Contact	Senior Director, Utilization Management	Dr.	Tano	Raul		7864253709					r.tano16@doctorshcp.com	2020 Ponce De Leon Blvd	PH 1	Coral Gables	FL	33134	07/22/2022	2023	DOCTORS HEALTHCARE PLANS, INC.	Local CCP	Doctors HealthCare Plans, Inc.	HMO/HMOPOS		DOCTORS HEALTHCARE PLANS, INC.	691	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4141	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H4141	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H4141	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4141	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA EMPLOYERS HEALTH PLAN OF GEORGIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4142	Automated TrOOP Balance Transfer Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Backup User Access Contact	Executive Program Director	Mrs.	Davis	Connie		9184535554	5599			9182070141	connie-davis@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/01/2023	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Best Available Evidence Contact	QI/Compliance Manager	Ms.	Losing	Laura		9182074979				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Bid Primary Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	CAP Report Contact for Public Website	QI/Compliance Manager	Ms.	Losing	Laura		9184535554				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	CEO - CMS Administrator Contact	Executive Program Director	Mrs.	Davis	Connie		9184535554	5599			9182070141	connie-davis@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/01/2023	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	CEO - Senior Official for Contracting	Executive Program Director	Mrs.	Davis	Connie		9184535554	5599			9182070141	connie-davis@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/01/2023	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Chief Financial Officer	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Chief Operating Officer	Center Manager	Ms.	Jackson	Rachel		9184535554	4979			9184314112	rachel-jackson@cheokee.org	1387 W. 4th		Tahlequah	OK	74464	09/27/2021	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Chief Information Officer	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Chief Information Security Officer	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	CMS Casework Communication Contact	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Complaints Tracking Contact	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Contact for Fraud Investigations	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Coordination of Benefits Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Corporate Mailing						9184535554				9184314112	eldercare@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/03/2008	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	10/28/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Customer Service Operations Contact	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	DIR Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	DIR Contact (Secondary)	Payment Coordinator	Ms.	Yochum	Diana		9184586946				9182070141	diana-yochum@cherokee.org	1387 W. 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Emergency Part D Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Emergency Part D Contact (Secondary)	Payment Coordinator		Yochum	Diana		9184535554	5614			9184314112	daniel-stout@cherokee.org	1387 W. 4th		Tahlequah	OK	74464	02/19/2021	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Encounter Data & Risk Adjustment Operations Contact	Payment Coordinator		Yochum	Diana		9184586946				9182070141	diana-yochum@cherokee.org	1387 W. 4th Street		Tahlequah	OK	74464	10/28/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Enrollment Contact	Payment Coordinator	Ms.	Yochum	Diana		9184586946				9182070141	diana-yochum@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	EOB Transfer Contact	Payment Coordinator	Ms.	Yochum	Diana		9184586946				9182070141	diana-yochum@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Financial Audit Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Financial Reporting Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Formulary Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	General Contact	Executive Program Director	Mrs.	Davis	Connie		9184535554	5599			9182070141	connie-davis@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/01/2023	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Government Relations Contact	Executive Program Director	Mrs	Davis	Connie		9184535554	5599			9182070141	connie-davis@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/01/2023	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	HIPAA Privacy Officer	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	HIPAA Security Officer	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Interoperability Contact	Executive Program Director	Ms.	Davis	Connie		9184585554	5599			9182070141	connie-davis@cherokee.org	1387 W. 4th Street		Tahlequah	OK	74464	03/01/2023	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	MA Appeals/Grievances Contact	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	MA Claims Processing Contact for Public Website	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Marketing Contact	Intake/Marketing Director	Ms.	Nix	Erin		9184535554	4226			9182070141	erin-nix@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	09/27/2021	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Medical Director	Medical Director	Dr.	Galdamez	John		9184535554				9184314112	john-galdamez@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	09/19/2014	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Medicare Compliance Officer	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Medicare Coordinator	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Medicare Part D Opioid Overutilization Contact	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Medication Therapy Management Contact	Medical Director	Dr.	Galdamez	John		9184535554				9184314112	john-galdamez@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	09/19/2014	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Part C Application Contact	Executive Program Director	Mrs.	Davis	Connie		9184535554	5599			9182070141	connie-davis@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/01/2023	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Part D Appeals	Chief Financial Officer	Ms.	Pittman	Thelma						9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active	9182074936				PACE - Nat		C	Dallas
H4142	Part D Appeals Contact (Secondary)	QI/Compliance Manager		Losing	Laura	A					9182070141	laura-losing@cherokee.org	1387 W. 4th Street		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active	9184535554	4970			PACE - Nat		C	Dallas
H4142	Part D Application Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Part D Benefits Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Part D Claims Submission Contact	Payment Coordinator	Ms.	Yochum	Diana		9184586946				9182070141	diana-yochum@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Part D Exceptions Contact	Medical Director	Dr.	Galdamez	John						9184314112	john-galdamez@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	09/19/2014	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active	8002560671	5554			PACE - Nat		C	Dallas
H4142	Part D Price File Contact (Back-up)	Payment Coordinator	Ms.	Yochum	Diana		9184586946				9182070141	diana-yochum@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Part D Price File Contact (Primary)	Chief Financial Officer	Mrs.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Part D Quality Assurance Contact	QI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Part D Reporting Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Patient Safety Contact	Center Manager	Ms.	Jackson	Rachel		9184535554	4979			9182070141	rachel-jackson@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	09/27/2021	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Payment Contact	Payment Coordinator	Ms.	Yochum	Diana		9184586946				9182070141	diana-yochum@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Pharmacy Director	Chief Operating Officer		Greenhalgh	Michael		8889742763	6211				MGreenhalgh@CareKinesis.com	CareKinesis, Inc.	704 E. Main St, Suite K	Moorestown	NJ	08057	01/03/2014	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Pharmacy Network Management Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Pharmacy Network Management Contact (Secondary)	QI/Compliance Manager		Losing	Laura		9184535554				9184314112	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Pharmacy Technical Help Desk Contact	Director of Technology Operations		Nyzio	Jason								CareKinesis, Inc.	110 Marter Avenue, Suite 309	Moorestown	NJ	08057	01/03/2014	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active	8889742763				PACE - Nat		C	Dallas
H4142	Plan Directory Contact for Public Website	Marketing/Intake Manager	Ms	Walls	Kendra		9184535554	4226			9182070141	erin-nix@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	02/24/2023	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Plan to Plan Reconciliation Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Processor Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Quality Contact	QAPI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Reconciliation Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Recovery Audit Contact	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	03/13/2019	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Surveillance Contact	QAPI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	System Contact	Executive Program Director	Mrs.	Davis	Connie		9184535554	5599			9182070141	connie-davis@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/01/2023	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Ms.	Pittman	Thelma		9182074936				9182070141	thelma-pittman@cherokee.org	1387 W 4th Street		Tahlequah	OK	74464	09/27/2021	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	User Access Contact	QAPI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Utilization Management Contact	Executive Program Director	Mrs.	Davis	Connie		9184535554	5599			9182070141	connie-davis@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	03/01/2023	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4142	Utilization Review Contact	QAPI/Compliance Manager	Ms.	Losing	Laura		9182074970				9182070141	laura-losing@cherokee.org	1387 W 4th St.		Tahlequah	OK	74464	08/10/2022	2023	CHEROKEE NATION COMPREHENSIVE CARE AGENCY	National PACE	Cherokee Elder Care	National PACE		Cherokee Nation Comprehensive Care Agency	358	Yes	Active					PACE - Nat		C	Dallas
H4152	Agent/Broker Compensation Data Contact	Director, Sales		Mallette	Rebecca		4014591343					rebecca.mallette@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Automated TrOOP Balance Transfer Contact	Director PBM Operations		Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Backup User Access Contact	Senior Compliance Analyst		Giacomini	Elizabeth		4017490690				4014591598	elizabeth.giacomini@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Best Available Evidence Contact	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721				4014595649	ivona.wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Bid Audit Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Bid Audit Site Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Bid Primary Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Pennypacker	Regan		4017430003				4014591598	mco@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8006373718	2100			HMO - Health Maintenance Organization		C	Boston
H4152	CEO - CMS Administrator Contact	CEO	Ms	Wofford	Martha		4014591200					martha.wofford@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	CEO - Senior Official for Contracting	CEO	Ms	Wofford	Martha		4014591200					martha.wofford@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Chief Financial Officer	CFO	Mr.	Marrone	Michael		2077522829					michael.marrone@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Chief Operating Officer	EVP, Chief Administrative Ofcr & Chief Legal Ofcr	Ms.	Lederberg	Michele		4014591202					michele.lederberg@bcbsri.org	500 Exchange Street		Providance	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Chief Information Officer	Chief Information Officer	Mr.	Comella	David		4014591687					david.comella@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Chief Information Security Officer	VP and Chief Risk Officer	Mr	Fredrickson	Jon		4014591522					jon.fredrickson@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	CMMI Model Point of Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	CMS Casework Communication Contact	Director, GAU		Antunes	Kathy		4014595136				4014595668	kathy.antunes@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Complaints Tracking Contact	Director, GAU		Antunes	Kathy		4014595136				4014595668	kathy.antunes@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Contact for Fraud Investigations	Director, Special Investigations Unit		Casilli	Brian		4014591727				4014591648	brian.casilli@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Coordination of Benefits Contact	Director PBM Operations		Allie	Cindy		6127776722				6127776706	COBMedD@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Corporate Mailing						4014592100				4014591598	medicarecompliance@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Treasury Analyst		Gulino	Samuel		4014595968					samuel.gulino@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Customer Service Operations Contact	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721				4014595089	Ivona.Wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	DIR Contact	Sr. Health Data Analyst		Simas	Heather		4014595286				4014591754	heather.simas@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	DIR Contact (Secondary)	Director, Actuarial Services		Eynatian	Chris		4014591741					chris.eynatian@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Emergency Part D Contact	Director Pharmacy Operations		Sifakis	Gina		4017418686					gina.sifakis@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Emergency Part D Contact (Secondary)	Medicare Part D Auditor		Higgins	Aimee		4016168583				4014591754	aimee.higgins@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Encounter Data & Risk Adjustment Operations Contact	Chief Government Programs Revenue Officer		Rangarajan	Kiran		4014595247					kiran.rangarajan@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Enrollment Contact	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721					Ivona.Wisniewski@bcbsri.org	500 Exchange St		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	EOB Transfer Contact	Director PBM Operations		Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Financial Audit Contact	CFO	Mr.	Marrone	Michael		2077522829					michael.marrone@bcbsri.org	500 Exchange Street		Providence	RI	02903	09/21/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Financial Reporting Contact	Manager, Financial Operations		Bettencourt	Mike		4014595932				4014591875	mike.bettencourt@BCBSRI.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Formulary Contact	Director, Pharmacy Performance		Dunn	David		4014591409				4014591754	david.dunn@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Formulary Contact (Secondary)	Supervisor Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	General Contact	Medicare Compliance Officer	Ms.	Pennypacker	Regan		4017430003				4014591598	mco@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Government Relations Contact	SVP Government Programs		Pitney	Christina		4014591103					christina.pitney@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	HIPAA Privacy Officer	VP and Chief Risk Officer		Fredrickson	Jon		4014591522					jon.fredrickson@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	HIPAA Security Officer	VP and Chief Risk Officer		Fredrickson	Jon		4014591522					jon.fredrickson@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Hospice Contact	Lead, Outsourced Medicare Operations		Storti	Jane		4018378818					jane.storti@bcbsri.org	500 Exchange St.		Providence	RI	02903	07/28/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Interoperability Contact	Director, Enterprise Analytics		Pant	Lokesh		6123003095					lokesh.pant@bcbsri.org	500 Exchange St.		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	MA Appeals/Grievances Contact	Director, GAU		Antunes	Kathy		4014595136				4014595668	kathy.antunes@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	MA Claims Processing Contact for Public Website	Managing Director, Claims Operations		McCaughey	Tracy		4014592400					tracy.mccaughey@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Marketing Contact	Director, Marketing & Communications		Blustein	Amy		4014592595					amy.blustein@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Medical Director	EVP and CMO	Dr.	Shafi	Farah		6178515725					farah.shafi@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Pennypacker	Regan		4017430003				4014591598	mco@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Medicare Coordinator	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721				4014591813	ivona.wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists		Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Medication Therapy Management Contact	Director		Dunn	David		4014591409				4014591754	David.Dunn@bcbsri.org	500 Exchange St		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	OffShore Subcontractor Contact	Senior Compliance Analyst		Giacomini	Elizabeth		4017490690				4014591598	elizabeth.giacomini@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Online Enrollment Center Contact (Back-up)	Team Leader		Storti	Jane		4014595588				4014595649	jane.storti@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Online Enrollment Center Contact (Primary)	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721				4014595649	Ivona.Wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Part C Application Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Part C Reporting Contact	Sr. Compliance Analyst		Brennan	Jonathan		4014595741				4014591598	jonathan.brennan@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Part D Appeals	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Boston
H4152	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Boston
H4152	Part D Application Contact	Medicare Part D Auditor		Higgins	Aimee		4014595555				4014591754	aimee.higgins@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Part D Benefits Contact	Director Benefits Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	Prime Therapeutics	1440 Northland Drive	Mendota Heights	MN	55120	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Part D Claims Submission Contact	Functional Business Consultant- Government Program		Brooke	Lance		4026862603					lbrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Part D Exceptions Contact	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Boston
H4152	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Boston
H4152	Part D Price File Contact (Back-up)	Price File Analyst Sr.		Trudeau	Ashley		6127771338					ashley.trudeau@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Part D Price File Contact (Optional)	Network Pricing Data Analyst		Tastad	Emily		6518085779					emily.tastad@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Rd	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Part D Price File Contact (Primary)	Director Pharmacy Performance		Dunn	David		4014591409					david.dunn@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Part D Quality Assurance Contact	Medicare Part D Auditor		Higgins	Aimee		4014595555					aimee.higgins@bcbsri.org	500 Exchange St		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Part D Reporting Contact	Sr. Compliance Analyst		Brennan	Jonathan		4014595741					jonathan.brennan@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Patient Safety Contact	Director of Pharmacy, Pharmacy Performance		Dunn	David		4014591409				4014591754	david.dunn@bcbsri.org	500 Exchange St		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Payment Contact	Sr. Financial Analyst		Souza	Cheryl		4014591860					cheryl.souza@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Pharmacy Director	Director Pharmacy Operations		Sifakis	Gina		4014595704					gina.sifakis@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Pharmacy Network Management Contact	VP, Network Management		Conlin	Marci		6127772842				8778236373	Marci.Conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Pharmacy Network Management Contact (Secondary)	Senior Director Network Client Services		Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8554571207				HMO - Health Maintenance Organization		C	Boston
H4152	Pharmacy Technical Help Desk Contact (Secondary)	Director, Member Services		Bunch	Jon							jonathon.bunch@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active	8554571207				HMO - Health Maintenance Organization		C	Boston
H4152	Plan Directory Contact for Public Website	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721					Ivona.Wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Plan to Plan Reconciliation Contact	Sr. Health Data Analyst		Simas	Heather		4014595286				4014591198	heather.simas@bcbsri.org	PO Box 1057		Providence	RI	02901	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Processor Contact	Director PBM Operations		Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Quality Contact	Director, Quality and Stars		Mitchell	Catherine		4014592644					Catherine.Mitchell@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Reconciliation Contact	Sr. Health Data Analyst		Simas	Heather		4014595286				4014591754	heather.simas@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Reconciliation Contact (Secondary)	Director, Actuarial Services		Eynatian	Chris		4014591741					chris.eynatian@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Recovery Audit Contact	SVP Government Programs	Ms.	Pitney	Christina		4014591103				4014591598	christina.pitney@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	SNP Application Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	SNP State Contact	Managing Director Duals		Moran	Leanna		4014591331					leanna.moran@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Surveillance Contact	VP, Medicare		Menard	Michael		4014591979					michael.menard@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	System Contact	Mng Dir Operations - Medicare Segment		Wisniewski	Ivona		4014591721				4014595649	Ivona.Wisniewski@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Third Party Administrator (TPA) Liaison	Sr. Health Data Analyst		Simas	Heather		4014595286					heather.simas@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	User Access Contact	Associate Compliance Officer		Martin	Jordan		4014592845				4014591598	jordan.martin@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Utilization Management Contact	Director Utilization Review		Labbe	Karen		4014591796				4014595072	Karen.Labbe@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4152	Utilization Review Contact	Director Utilization Review		Labbe	Karen		4014591796				4014595072	Karen.Labbe@bcbsri.org	500 Exchange Street		Providence	RI	02903	07/25/2023	2023	BLUE CROSS & BLUE SHIELD OF RHODE ISLAND	Local CCP	Blue Cross & Blue Shield of Rhode Island	HMO/HMOPOS		Blue Cross & Blue Shield of Rhode Island	24	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H4161	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Bid Primary Contact	Product Management Director		Gray	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/03/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H4161	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H4161	PHR Beneficiary Contact																	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H4161	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4161	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/10/2022	2023	BLUE CROSS OF CALIFORNIA PARTNERSHIP PLAN	Local CCP	Anthem Blue Cross Partnership Plan	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4172	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	12/31/2019	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Backup User Access Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/01/2019	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	CAP Report Contact for Public Website	Compliance Officer		Locke	Kitty		6158902020	1664				compliance@nhcadvantageplan.com	100 East Vine Street		Murfreesboro	TN	37130	09/28/2023	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	CEO - CMS Administrator Contact		Mr.	Ussery	Michael		6158902020					mussery@nhccare.com	100 E. Vine St.		Murfreesboro	TN	37130	02/04/2019	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	CEO - Senior Official for Contracting	CEO	Mr.	Ussery	Michael		6158902020					mussery@nhccare.com	100 E. Vine St.		Murfreesboro	TN	37130	04/02/2018	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Chief Financial Officer	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Chief Operating Officer	Chief Operating Officer	Mr.	McIntosh	Bubba		6158902020					bmcintosh@nhccare.com	100 East Vine Street		Murfreesboro	TN	37130	08/10/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	06/21/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	06/21/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Contact for Fraud Investigations	Compliance Officer		Locke	Kitty		6158902020	1664				compliance@nhcadvantageplan.com	100 East Vine Street		Murfreesboro	TN	37130	09/28/2023	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/01/2019	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Corporate Mailing						8448546886				8336102390	customerservice@nhcadvantageplan.com	P.O. Box 5849		Glen Allen	VA	230585849	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Encounter Data & Risk Adjustment Operations Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/02/2019	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	EOB Transfer Contact			Lowry	Kristy		8448546886				8336102390	customerservice@nhcadvantageplan.com	P.O. Box 5849		Glen Allen	VA	23058	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Financial Audit Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Financial Reporting Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	12/31/2019	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	General Contact			Hopkins	Robyn		9136535921					robyn.hopkins@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	07/02/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	HIPAA Privacy Officer	Chief Compliance Officer and HIPAA Privacy Officer	Ms.	Crowe	Melanie		4049330409					melanie.crowe@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	HIPAA Security Officer	Sr. Director Cybersecurity	Mr	Brogdon	Clevelen		6158094476					Clevelen.Brogdon@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	06/21/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Medical Director	VP Medical Affairs		Dahlgren	Andrew		8042968288					Andrew.Dahlgren@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	06/14/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Medicare Compliance Officer	Compliance Officer	Ms.	Locke	Kitty		6158902020	1664				compliance@nhcadvantageplan.com	100 East Vine Street		Murfreesboro	TN	37130	09/28/2023	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Medicare Coordinator	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Part C Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Part C Reporting Contact			Rennie	Lynda		8043966383					Lynda.Rennie@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	03/01/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	12/31/2019	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Payment Contact	CFO	Mr.	Ragland	Robert		8042663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Kansas City
H4172	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Kansas City
H4172	Physician Incentive Contact			Hopkins	Robyn		9136535921					robyn.hopkins@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Plan Directory Contact for Public Website			Locke	Kitty		6158902020	1664				compliance@nhcadvantageplan.com	100 East Vine Street		Murfreesboro	TN	37130	09/28/2023	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Plan to Plan Reconciliation Contact	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/06/2017	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Quality Contact			Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/02/2019	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Reconciliation Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/15/2020	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Reconciliation Contact (Secondary)	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Recovery Audit Contact	Compliance Officer	Mrs.	Locke	Kitty		6158902020	1664				compliance@nhcadvantageplan.com	100 East Vine Street		Murfreesboro	TN	37130	09/28/2023	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Third Party Administrator (TPA) Liaison	Manager of Regulatory Accounting	Ms.	Weis	Katelyn		6073294042					kate.weis@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	User Access Contact	Compliance Officer		Locke	Kitty		6158902020	1664				compliance@nhcadvantageplan.com	10900 Nuckols Rd.		Glen Allen	TN	37130	09/28/2023	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4172	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	NHC ADVANTAGE, LLC	Local CCP	NHC Advantage	HMO/HMOPOS		Missouri Healthcare Advisors, LLC	638	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4185	Automated TrOOP Balance Transfer Contact	Controller		Irving	Jennifer		4422572190					jennifer.irving@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Backup User Access Contact	Director of IT		Lomeli	Marina		4422867820					marinal@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Best Available Evidence Contact	Chief Medical Officer	Dr.	Schultz	James		4422868409					jims@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Bid Primary Contact	Controller		Irving	Jennifer		4422572190					jennifer.irving@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	CAP Report Contact for Public Website	PACE Compliance Officer		Godisan	Healery		9515439038					healery.godisan@nhcare.org	4371 Latham St		Riverside	CA	92501	04/26/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active	8446427223				PACE - Nat		C	San Francisco
H4185	CEO - CMS Administrator Contact	Chief Executive Officer	Dr.	Patel	Rakesh		7605208375					rakeshp@nhcare.org	425 N Date St		Escondido	CA	92025	05/03/2021	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	CEO - Senior Official for Contracting	Chief Executive Officer	Dr	Patel	Rakesh		7605208375					rakeshp@nhcare.org	425 N Date St		Escondido	CA	92025	09/28/2021	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Chief Financial Officer	Chief Financial Officer	Ms	Daigle	Lisa		4422868196					lisad@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Chief Operating Officer	Chief Operating Officer	Mr.	Glenn	Jeffrey		4422868532					jeffrey.glenn@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Chief Information Officer	Director of IT	Ms	Lomeli	Marina		4422867820					marinal@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Chief Information Security Officer	Director of IT	Ms	Lomeli	Marina		4422867820					marinal@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	CMS Casework Communication Contact	PACE Program Director		Forbito	Astrid		9515303341					astrid.forbito@nhcare.org	4371 Latham St		Riverside	CA	92501	02/23/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Complaints Tracking Contact	PACE Compliance Officer	Ms	Godisan	Healery		9515439038					healery.godisan@nhcare.org	4371 Latham Street		Riverside	CA	92501	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Contact for Fraud Investigations	PACE Compliance Officer	Ms	Godisan	Healery		9515439038					healery.godisan@nhcare.org	4371 Latham Street		Riverside	CA	92501	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Coordination of Benefits Contact	Revenue Cycle Director		Garcia	Belinda		4422868985					belinda.garcia@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Corporate Mailing						7605208200					healery.godisan@nhcare.org	425 N Date St		Escondido	CA	92025	05/26/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Coverage Gap Discount Program (CGDP) Payment Contact	Revenue Cycle Director		Garcia	Belinda		4422868985					belinda.garcia@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Customer Service Operations Contact	PACE Program Director		Forbito	Astrid		9515303341					astrid.forbito@nhcare.org	4371 Latham St.		Riverside	CA	92501	02/23/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	DIR Contact	PACE Finance Manager		Grant	Christa		4422572082					christa.grant@nhcare.org	425 N Date St		Escondido	CA	92025	08/01/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Emergency Part D Contact	Clinical Pharmacist		Maynard	Brittany		4422868535					brittany.maynard@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Emergency Part D Contact (Secondary)	Clinical Pharmacist		Hughes	Michelle		4422868542					Michelle.Hughes@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Encounter Data & Risk Adjustment Operations Contact	Director of Reporting & Analytics	Ms	Nguyen	Julie		7607376905					julie.nguyen@nhcare.org	425 Date Street		Escondido	CA	92025	09/28/2021	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Enrollment Contact	PACE Program Director		Forbito	Astrid		9515303341					astrid.forbito@nhcare.org	4371 Latham St.		Riverside	CA	92501	02/23/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	EOB Transfer Contact	Revenue Cycle Director		Garcia	Belinda		4422868985				7607412782	belinda.garcia@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Financial Audit Contact	Controller	Ms	Irving	Jennifer		4422572190					jennifer.irving@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Financial Reporting Contact	PACE Finance Manager		Grant	Christa		4422572082					christa.grant@nhcare.org	425 N Date St		Escondido	CA	92025	08/01/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Formulary Contact	Director of Pharmacy Operations	Ms	Maynard	Brittany		4422868535					brittany.maynard@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Formulary Contact (Secondary)	Clinical Pharmacist		Maynard	Brittany		4422868535					brittany.maynard@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	General Contact	Chief Operating Officer		Glenn	Jeffrey		7605005641					Jeffrey.Glenn@nhcare.org	150 La Terraza Blvd		Escondido	CA	92025	05/26/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Government Relations Contact	PACE Compliance Officer		Godisan	Healery		9515439038					healery.godisan@nhcare.org	4371 Latham St		Riverside	CA	92501	04/26/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	HIPAA Privacy Officer	PACE Compliance Officer	Ms	Godisan	Healery		9515439038					healery.godisan@nhcare.org	4371 Latham Street		Riverside	CA	92501	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	HIPAA Security Officer	PACE Compliance Officer	Ms	Godisan	Healery		9515439038					healery.godisan@nhcare.org	4371 Latham Street		Riverside	CA	92501	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Interoperability Contact	COO	Mr.	Glenn	Jeffrey		4422868532					jeffrey.glenn@nhcare.org	425 N Date Street		Escondido	CA	92025	02/23/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	MA Appeals/Grievances Contact	PACE Compliance Officer		Godisan	Healery		9515439038					Healery.Godisan@nhcare.org	4371 Latham St.		Riverside	CA	92501	02/18/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	MA Claims Processing Contact for Public Website	Revenue Cycle Director		Garcia	Belinda		4422868985					belinda.garcia@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Marketing Contact	Senior Director of Marketing & Community Engagemen		Zavala	Adrian		9512637296					adrian.zavala@nhcare.org	4371 Latham Street		Riverside	CA	92501	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Medical Director	Chief Medical Officer	Dr.	Schultz	James		8338674642					jims@nhcare.org	460 Elm St		Escondido	CA	92025	02/23/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Medicare Compliance Officer	PACE Compliance Officer	Ms	Godisan	Healery		9515439038					healery.godisan@nhcare.org	4371 Latham St		Riverside	CA	92501	04/26/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Medicare Coordinator	Revenue Cycle Director	Ms	Garcia	Belinda		4422868985					Belinda.Garcia@nhcare.org	425 N. Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Medicare Part D Opioid Overutilization Contact	Director of Operations Behavioral Health		Vierra	Wendi		4422868342					Wendi.Vierra@nhcare.org	425 N Date St		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Medication Therapy Management Contact	Clinical Pharmacist		Hughes	Michelle		4422868542					Michelle.Hughes@nhcare.org	425 N Date St		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Online Enrollment Center Contact (Back-up)	Outreach & Enrollment Supervisor		Tejeda	Susana		8446427223					susana.tejeda@nhcare.org	4371 Latham St		Riverside	CA	92501	02/23/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Online Enrollment Center Contact (Primary)	PACE Program Director		Forbito	Astrid		9515303341					astrid.forbito@nhcare.org	4371 Latham Street		Riverside	CA	92501	02/23/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Part C Application Contact	Chief Operating Officer		Glenn	Jeffrey		7605005641					Jeffrey.Glenn@nhcare.org	150 La Terraza Blvd		Escondido	CA	92025	05/26/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Part D Appeals	Clinical Pharmacist		Maynard	Brittany							brittany.maynard@nhcare.org	425 N Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active	4422868535				PACE - Nat		C	San Francisco
H4185	Part D Appeals Contact (Secondary)	Clinical Pharmacist		Hughes	Michelle							Michelle.Hughes@nhcare.org	425 N Date St		Escondido	CA	92025	05/03/2021	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active	8338674642				PACE - Nat		C	San Francisco
H4185	Part D Application Contact	PACE Finance Manager		Grant	Christa		4422572082					christa.grant@nhcare.org	425 N Date St		Escondido	CA	92025	08/01/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Part D Benefits Contact	PACE Finance Manager		Grant	Christa		4422572082					christa.grant@nhcare.org	425 N Date St		Escondido	CA	92025	08/01/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Part D Claims Submission Contact	PACE Finance Manager		Grant	Christa		4422572082					christa.grant@nhcare.org	425 N Date St		Escondido	CA	92025	08/01/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Part D Exceptions Contact	PACE Finance Manager		Grant	Christa							christa.grant@nhcare.org	425 N Date St		Escondido	CA	92025	08/01/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active	4422572082				PACE - Nat		C	San Francisco
H4185	Part D Price File Contact (Back-up)	PACE Finance Manager		Grant	Christa		4422572082					christa.grant@nhcare.org	425 N Date St		Escondido	CA	92025	08/01/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Part D Price File Contact (Primary)	PACE Finance Manager		Grant	Christa		4422572082					christa.grant@nhcare.org	425 N Date St		Escondido	CA	92025	08/01/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Part D Quality Assurance Contact	PACE Finance Manager		Grant	Christa		4422572082					christa.grant@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	08/01/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Part D Reporting Contact	PACE Finance Manager		Grant	Christa		4422572082					christa.grant@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	08/01/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Patient Safety Contact	PACE Compliance Officer		Godisan	Healery		9515439038					healery.godisan@nhcare.org	4371 Latham St		Riverside	CA	92501	05/26/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Payment Contact	Revenue Cycle Director		Garcia	Belinda		4422868985					belinda.garcia@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Personal Health Record Contact	PACE Compliance Officer		Godisan	Healery		9515439038					healery.godisan@nhcare.org	4371 Latham St		Riverside	CA	92501	05/26/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Pharmacy Director	Director of Pharmacy Services	Ms	Maynard	Brittany		4422868535					brittany.maynard@nhcare.org	425 N. Date St		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Pharmacy Network Management Contact	PACE Finance Manager		Grant	Christa		4422572082					christa.grant@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	08/01/2023	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Pharmacy Technical Help Desk Contact	Clinical Pharmacist		Hughes	Michelle							Michelle.Hughes@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active	4422868542				PACE - Nat		C	San Francisco
H4185	Pharmacy Technical Help Desk Contact (Secondary)	Clinical Pharmacist		Maynard	Brittany							brittany.maynard@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active	4422868535				PACE - Nat		C	San Francisco
H4185	Plan Directory Contact for Public Website	Revenue Cycle Director		Garcia	Belinda		4422868985					belinda.garcia@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Plan to Plan Reconciliation Contact	Revenue Cycle Director		Garcia	Belinda		4422868985					belinda.garcia@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Processor Contact	Revenue Cycle Director		Garcia	Belinda		4422868985					belinda.garcia@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Quality Contact	Director Quality and Population Health	Ms	Hughes	Michelle		4422868542					michelle.hughes@nhcare.org	425 N. Date St		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Reconciliation Contact	Director of Reporting & Analytics		Nguyen	Julie		4422774421					Julie.Nguyen@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Recovery Audit Contact	Revenue Cycle Director	Ms	Garcia	Belinda		4422868985					belinda.garcia@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Surveillance Contact	Director of Facilities		DeLeon	Mike		4422572959					mike.deleon@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	System Contact	Director of IT		Lomeli	Marina		4422867820					marinal@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Third Party Administrator (TPA) Liaison	Revenue Cycle Director		Garcia	Belinda		4422868985					belinda.garcia@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/24/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	User Access Contact	Director of IT		Lomeli	Marina		4422867820					marinal@nhcare.org	1540 E. Valley Parkway		Escondido	CA	92025	02/21/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Utilization Management Contact	PACE Compliance Officer		Godisan	Healery		9515439038				9514293595	healery.godisan@nhcare.org	4371 Latham St		Riverside	CA	92501	04/26/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4185	Utilization Review Contact	PACE Compliance Officer		Godisan	Healery		9515439038				9514293595	healery.godisan@nhcare.org	4371 Latham St		Riverside	CA	92501	04/26/2022	2023	NEIGHBORHOOD HEALTHCARE	National PACE	Neighborhood Healthcare PACE	National PACE		Neighborhood HealthCare	777	Yes	Active					PACE - Nat		C	San Francisco
H4198	Agent/Broker Compensation Data Contact	Manager Medicare Marketing		McEver	Kelly		9185945295	4122				kmcever@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Backup User Access Contact	Manager, Grievance and Appeals	Ms.	Pugh	Nicole		9185945295	6315			9185945260	cpugh@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Best Available Evidence Contact	Supervisor, Medicare Enrollment		East	Shawn		9185945295	6903				seast@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Bid Audit Contact	Manager Medicare Marketing		McEver	Kelly		9185945295	4122				kmcever@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Bid Primary Contact	Director Underwriting		Tull	Karla		9185945295	2009				ktull@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	CAP Report Contact for Public Website	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	CEO - CMS Administrator Contact	President & CEO	Mr.	Bush	Robert		9185945295	4124				rbush@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	CEO - Senior Official for Contracting	President & CEO	Mr.	Bush	Robert		9185945295	4124				rbush@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Chief Financial Officer	CFO	Mr.	Sutton	Josiah		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Chief Operating Officer	SVP & Chief Operating Officer	Mr.	Sutton	Josian		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Chief Information Officer	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Chief Information Security Officer	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	CMS Casework Communication Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Complaints Tracking Contact	Manager, Senior Center		Lee	Laura		9185945295	6385				llee@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Contact for Fraud Investigations	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Coordination of Benefits Contact	Supervisor, Claims		Higgins	Susan		9185945295	6401				coordinationofbenefits@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Corporate Mailing						9185945295	5386				swhite@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant II		Wilson	Jamar		9185945295	6488				jwilson@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Customer Service Operations Contact	Director of Customer Experience		Holt	John		9185945295	4128				jholt@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	DIR Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	DIR Contact (Secondary)	Sr. Manager, Financial Planning & Analysis		Brenner	Matt		9185945295	4119				mbrenner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Emergency Part D Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Emergency Part D Contact (Secondary)	Manager, Pharmacy Services		Perez	Charles		9185945295	6479			9188794309	cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Encounter Data & Risk Adjustment Operations Contact	Director Health Data		Morningstar	Angela		9185945295	5205				amorningstar@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Enrollment Contact	Supervisor, Medicare Enrollment		East	Shawn		9185945295	6903				seast@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	EOB Transfer Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Financial Audit Contact	VP Accounting and Treasury	Ms.	Scott	Cyd	G	9185945295	5325			9185945260	cscott@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Financial Reporting Contact	CFO	Mr.	Sutton	Josiah		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Formulary Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Formulary Contact (Secondary)	Sr. Analyst		Loveland	Chet		4806064873					Chet.Loveland@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	General Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Government Relations Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	HIPAA Privacy Officer	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	HIPAA Security Officer	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Hospice Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Interoperability Contact	VP Chief CO, RO & General Counsel	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	MA Appeals/Grievances Contact	Manager, Grievance and Appeals		Pugh	Nicole		9185945295	6315			9185945260	npugh@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	MA Claims Processing Contact for Public Website	Director, Operations		Lang	Michelle		9185945295	6326				mlang@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Marketing Contact	SVP & Chief Operating Officer		Sutton	Josiah		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Medical Director	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Medicare Compliance Officer	VP Chief Risk & Compliance Officer	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Medicare Coordinator	Medicare Compliance Specialist		Kanner	Dee		9185945295	6268				dkanner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Abdo	Mike		9185945295	6395				mabdo@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Medication Therapy Management Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street	Suite 100	Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Online Enrollment Center Contact (Back-up)	Enrollment Specialist		Baur	Amanda		9185945295	4503				abaur@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Online Enrollment Center Contact (Primary)	Supervisor, Medicare Enrollment		East	Shawn		9185945295	6903				seast@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Part C Application Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Part C Reporting Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Appeals	Manager, Grievance and Appeals		Pugh	Nicole						9185945260	cpugh@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	9185945295	6315			HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Appeals Contact (Secondary)	Supervisor, Grievances & Appeals		Mitchell	Damenica							dmitchell@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	9185945295	6314			HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Application Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Benefits Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Claims Submission Contact	Strategic Account Executive, CVS/Caremark		Tibus	Daniel		8475595726					daniel.tibus@CVSHealth.com	9501 E Shea Blvd MC042		Scottsdale	AZ	85260	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Exceptions Contact	Supervisor, Pharmacy Services		Burke	Amy						9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	8772938628	6808			HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Services		Perez	Charles						9188794309	cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	8772938628	6479			HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Price File Contact (Back-up)	Senior Consultant, Finance Med D		Loveland	Chet		4806064873				4013357984	Chet.Loveland@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Price File Contact (Optional)	Medicare Part D Advisor		Schilcher	Sydney		4806064615				4013357984	Sydney.Schilcher@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Price File Contact (Primary)	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Quality Assurance Contact	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Part D Reporting Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Patient Safety Contact	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Payment Contact	Accounts Receivable Supervisor		Fell	Jill		9185945295	6271				jfell@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Pharmacy Director	Director of Pharmacy		Abdo	Mike		9185945295	6395				mabdo@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Pharmacy Network Management Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Pharmacy Network Management Contact (Secondary)	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Pharmacy Technical Help Desk Contact	Supervisor, Pharmacy Services		Burke	Amy						9187944309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	8772938628	6808			HMO - Health Maintenance Organization		C	Dallas
H4198	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Help Desk		HelpDesk	Pharmacy								9501 E Shea Blvd		Scottsdale	AZ	85260	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Dallas
H4198	Plan Directory Contact for Public Website	Director of Customer Experience		Holt	John		9185945295	4128				jholt@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Plan to Plan Reconciliation Contact	Senior Financial Analyst		Mack	Lynda		9185945295	6320				lmack@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Processor Contact	Strategic Account Executive, CVS/Caremark		Tibus	Daniel		8475595726					daniel.tibus@CVSHealth.com	9501 E Shea Blvd MC042		Scottsdale	AZ	85260	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Quality Contact	Sr Manager, Health Programs		Such	Becky		9185945295	6226			9185945260	bsuch@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Reconciliation Contact	VP Accounting & Treasury		Scott	Cyd		9185945295	5325				cscott@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Reconciliation Contact (Secondary)	Manager Financial Planning & Analysis		Brenner	Matthew		9185945295	4119				mbrenner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Recovery Audit Contact	VP Chief CO, RO & General Counsel	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Surveillance Contact	VP Chief CO, RO & General Counsel	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	System Contact	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Third Party Administrator (TPA) Liaison	Senior Financial Analyst		Mack	Lynda		9185945295	6320				lmack@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	User Access Contact	Medicare Compliance Specialist		Kanner	Dee		9185945295	6862				dkanner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Utilization Management Contact	Senior Manager, Medical Management		Gordon	Michelle		9185945295	6398				mgordon@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4198	Utilization Review Contact	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	COMMUNITYCARE GOVERNMENT PROGRAMS, INC.	Local CCP	Integris Health Partners+ (HMO)	HMO/HMOPOS		St Francis Health System & St John Health System	621	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4203	Automated TrOOP Balance Transfer Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Backup User Access Contact	Director	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Best Available Evidence Contact	Director	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Bid Primary Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	CAP Report Contact for Public Website	Director	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	CEO - CMS Administrator Contact	Director	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	CEO - Senior Official for Contracting	Director	Ms	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	02/04/2022	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Chief Financial Officer	Director-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Chief Operating Officer	Director	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Chief Information Officer	Director-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Chief Information Security Officer	Director-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	CMS Casework Communication Contact	Director	Ms.	Burnette	Alison		8034344421					Alison.Burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Complaints Tracking Contact	Director	Ms.	Burnette	Alison		8034344421					Alison.Burnette2@prismahealth.org	15 Richland Medical Park Drive	Suite 203	Columbia	SC	29203	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Contact for Fraud Investigations	Director	Ms.	Burnette	Alison		8034344421					Alison.Burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Coordination of Benefits Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Corporate Mailing						8034344421				8034343773	Alison.Burnette2@prismahealth.org	3555 Harden Street Est	Suite 203	Columbia	SC	29203	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Coverage Gap Discount Program (CGDP) Payment Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Customer Service Operations Contact	Director-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	DIR Contact	Director-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	DIR Contact (Secondary)	Senior Business Analyst	Mr.	Nygard	Joseph		8645221968					joseph.nygard2@prismahealth.org	32 Centennial Way		Greenville	SC	29605	08/20/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Emergency Part D Contact	Pharmacy Manager		Marsh	David		8039318123					david.marsh@prismahealth.org	1308 Laurel Street		Columbia	SC	29203	11/26/2019	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Encounter Data & Risk Adjustment Operations Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Enrollment Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	EOB Transfer Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Financial Audit Contact	Director-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Financial Reporting Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Formulary Contact	Pharmacy Manager		Marsh	David		8039318123					David.Marsh@prismahealth.org	1308 Laurel Street		Columbia	SC	29203	11/26/2019	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	General Contact	Director	Ms.	Burnette	Alison		8034344421					alison.burnette2@prismahealth.org	15 Richland Medical Park	Suite 203	Columbia	SC	29203	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Government Relations Contact	Director	Ms.	Burnette	Alison		8034344421				8034343773	Alison Burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	HIPAA Privacy Officer	Corporate Compliance Officer	Mr.	Pietras	Scott		8647977712					scott.pietras@prismahealth.org	300 East McBee Avenue	Suite 302	Greenville	SC	29601	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	HIPAA Security Officer	Corporate Compliance Officer	Mr.	Pietras	Scott		8647977712					scott.pietras@prismahealth.org	300 East McBee Avenue	Suite 302	Greenville	SC	29601	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Interoperability Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	MA Appeals/Grievances Contact	Director	Ms.	Burnette	Alison		8034344421				8034343773	Alison.Burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	MA Claims Processing Contact for Public Website	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Marketing Contact	Outreach/Intake Manager	Mr.	Kitchens	Dan		8645221960				8645221955	dan.kitchens@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Medical Director	Medical Director	Mrs.	Theriot Roley	Laurie		8645221950				8645221955	laurie.theriot@prismahealth.org	32 Centennial Drive		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Medicare Compliance Officer	Corporate Compliance Officer	Mr.	Pietras	Scott		8647977712					scott.pietras@prismahealth.org	300 E. McBee Ave	Suite 302	Greenville	SC	29601	08/13/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Medicare Coordinator	Manager-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	01/11/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Medicare Part D Opioid Overutilization Contact	Medical Director	Mrs.	Theriot Roley	Laurie		8645221950				8645221955	laurie.theriot@prismahealth.org	32 Centennial Drive		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Medication Therapy Management Contact	Medical Director	Mrs.	Theriot Roley	Laurie		8645221950				8645221955	laurie.theriot@prismahealth.org	32 Centennial Drive		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Part C Application Contact	Manager, PACE Health Plan Operations		Siler	Sarah		8645221966					sarh.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	08/20/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Part D Appeals	Manager, PACE Health Plan Operations		Siler	Sarah						8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	01/11/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active	8645221966				PACE - Nat		C	Atlanta
H4203	Part D Appeals Contact (Secondary)	Director	Ms.	Burnette	Alison							alison.burnette2@prismahealth.org	3555 Harden Street Ext.	Suite 203	Columbia	SC	29203	08/14/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active	8034343770				PACE - Nat		C	Atlanta
H4203	Part D Application Contact	Manager-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	01/11/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Part D Benefits Contact	Manager - PACE Health Plan Operations		Siler	Sarah		8645221966					sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	08/20/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Part D Claims Submission Contact	Manager-PACE Health Plan Operations	Mrs	Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	01/11/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Part D Exceptions Contact	Pharmacy Manager		Marsh	David							david.marsh@prismahealth.org	1308 Laurel Street		Columbia	SC	29203	11/26/2019	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active	8039318123				PACE - Nat		C	Atlanta
H4203	Part D Price File Contact (Back-up)	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Part D Price File Contact (Optional)	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Part D Price File Contact (Primary)	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Part D Quality Assurance Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Part D Reporting Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Patient Safety Contact	Medical Director	Mrs.	Theriot Roley	Laurie		8645221950				8645221955	laurie.theriot@prismahealth.org	32 Centennial Drive		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Payment Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Pharmacy Director	Pharmacy Manager		Marsh	David		8039318123					David.Marsh@Prismahealth.org	1308 Laurel Street		Columbia	SC	29203	11/26/2019	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Pharmacy Network Management Contact	Pharmacy Manager		Marsh	David		8039318123					david.marsh@prismahealth.org	1308 Laurel Street		Columbia	SC	29203	11/26/2019	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Pharmacy Technical Help Desk Contact	Pharmacy Manager		Marsh	David							david.marsh@prismahealth.org	1308 Laurel Street		Columbia	SC	29203	11/26/2019	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active	8039318123				PACE - Nat		C	Atlanta
H4203	Plan Directory Contact for Public Website	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Plan to Plan Reconciliation Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Processor Contact	Pharmacy Manager		Marsh	David		8039318123					david.marsh@prismahealth.org	1308 Laurel Street		Columbia	SC	29203	11/26/2019	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Quality Contact	Director	Ms.	Burnette	Alison		8034344421				8034343773	alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	03/06/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Reconciliation Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Recovery Audit Contact	Director	Ms.	Burnette	Alison		8034344421					alison.burnette@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/14/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Surveillance Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	System Contact	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Third Party Administrator (TPA) Liaison	Director-PACE Health Plan Operations		Siler	Sarah		8645221966				8645221955	sarah.siler@prismahealth.org	32 Centennial Way		Greenville	SC	29605	09/21/2023	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	User Access Contact	Director	Ms.	Burnette	Alison		8034344421					alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/14/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Utilization Management Contact	Director	Ms.	Burnette	Alison		8034344421					alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/14/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4203	Utilization Review Contact	Director	Ms.	Burnette	Alison		8034344421					alison.burnette2@prismahealth.org	3555 Harden Street Ext	Suite 203	Columbia	SC	29203	08/14/2021	2023	PRISMA HEALTH-MIDLANDS	National PACE	Prisma Health SeniorCare PACE-Midlands	National PACE		Prisma Health	739	Yes	Active					PACE - Nat		C	Atlanta
H4213	Agent/Broker Compensation Data Contact	Manager, Individual Sales Agent		Creasman	Matthew		5013993923					mdcreasman@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Automated TrOOP Balance Transfer Contact	Eligibility Supervisor		White	William		6127776736					eobp2p@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Backup User Access Contact	Regulatory Compliance System Administrator		Coffman	Clay		5013782559					crcoffman@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Best Available Evidence Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Bid Audit Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 S Gaines St		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Bid Audit Site Contact	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Bid Primary Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	CAP Report Contact for Public Website	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	CEO - CMS Administrator Contact	Lead Executive, Senior Products	Ms.	Dixon	Laurin	E	9016063429					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	CEO - Senior Official for Contracting	CEO	Mr.	Barnett	Curtis		5013782007					cebarnett@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Chief Financial Officer	CFO	Mr.	Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Chief Operating Officer	Executive VP, Chief Operating Officer	Mr.	Dillard	Gray		5013782436					gddillard@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Chief Information Officer	Chief Information Officer	Ms.	Ryan	Kathy		5013782017					koryan@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Chief Information Security Officer	Chief Information Officer	Ms.	Ryan	Kathy		5013782017					koryan@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	CMS Casework Communication Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Complaints Tracking Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Contact for Fraud Investigations	Director, Performance Mgt. & Investigations		Gunter	Debbie		5013786610					dsgunter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Coordination of Benefits Contact	Eligibility Supervisor		White	William		6127776736					cobmedd@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Corporate Mailing						5013785635					mdvannatta@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Customer Service Operations Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	DIR Contact	Lead Executive, Senior Products		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	DIR Contact (Secondary)	CFO		Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Emergency Part D Contact	Lead Executive, Senior Products		Dixon	Laurin	E	9016063429					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Emergency Part D Contact (Secondary)	Manager, Senior Products		Sherer	Michael		5013786341					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Encounter Data & Risk Adjustment Operations Contact	Director Medicare Risk Adjustment		Serrano	Kacey		5013714238					klserrano@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Enrollment Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	EOB Transfer Contact	Eligibility Supervisor		White	William		6127776736				8776772730	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Financial Audit Contact	Medicare Compliance Officer	Mr	Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Financial Reporting Contact	Financial Reporting Accountant		Russell	Holly		5013993954					hkrussell@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Formulary Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Formulary Contact (Secondary)			Wahl	Dan		6127776815					dwahl@primetherapeutics.com	Prime Therapeutics 1305 Corporate Drive		Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	General Contact	Led Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Government Relations Contact	Sr Counsel Gov't Relation		Fenton	Janie		5013782103					jwfenton@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	HIPAA Privacy Officer	Sr Counsel Litigation		Roberts	Chet		5013782375					cxroberts@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	HIPAA Security Officer	Physical Security/Chief Security Officer		Shirley	Devin		5016880747					DMShirley@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	09/11/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Hospice Contact	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Interoperability Contact			Ritchey	Heather		5013782000					hrritchey@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	MA Appeals/Grievances Contact	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	MA Claims Processing Contact for Public Website	Supervisor, Medicare Claims		Pilkington Ross	Amanda		5013013452					ampilkington@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Marketing Contact	VP Consumer and Retail Markets	Mr.	Vannatta	Matthew		5013785635					mdvannatta@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Medical Director	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Kirch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Medicare Coordinator	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Medicare Part D Opioid Overutilization Contact	Associate Medical Director	Dr.	Becker	Thomas		5013783100					tebecker@arkbluecross.com	601 S Gaines St.		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Medication Therapy Management Contact	Manager, Stars Pharmacy Lead		Walsh	Tyler		5013993975					trwalsh@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	OffShore Subcontractor Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Online Enrollment Center Contact (Back-up)	Supervisor, Medicare Operations		Sherer	Michael		5013786341					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/06/2020	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Online Enrollment Center Contact (Optional)	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 S Gaines		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Online Enrollment Center Contact (Primary)	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Part C Application Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Part C Reporting Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Part D Appeals			Review Dept.	Clinical						8006936703	CRUMed@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active	8006936651				PFFS - Private Fee for Service		C	Dallas
H4213	Part D Appeals Contact (Secondary)	Senior Counsel, Appeals		Phillips	Ashleigh						5013783366	adphillips@arkbluecross.com	PO Box 2181	Attn: Legal Appeals	Little Rock	AR	72203	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active	5013782025				PFFS - Private Fee for Service		C	Dallas
H4213	Part D Application Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Part D Benefits Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Part D Claims Submission Contact			Brooke	Lance		4026862603				4029702545	lbrooke@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Part D Exceptions Contact			Review Audit & Regul	Clinical						8006936703	clinicalreviewclientinquiries@primetherapeutics.co	Centennial Crossings - Clinical Review 4401 West 76th S		Edina	MN	55435	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active	8006936651				PFFS - Private Fee for Service		C	Dallas
H4213	Part D Exceptions Contact (Secondary)			Review Dept Med D Au	Clinical						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Edina	MN	55435	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active	8006936651				PFFS - Private Fee for Service		C	Dallas
H4213	Part D Price File Contact (Back-up)	Price File Analyst Sr.		Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Part D Price File Contact (Optional)	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Part D Price File Contact (Primary)	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Part D Quality Assurance Contact	Manager Metrics and Reporting		Luukkonen	Lynette		6127775574					lynette.luukkonen@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Part D Reporting Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Patient Safety Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Payment Contact	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	PFFS Terms and Conditions of Payment Contact for Public Website	Manager, Medicare Networks		Hatfield	Amanda		5013013447					akhatfield@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Pharmacy Director	Associate Medical Director	Dr.	Becker	Thomas		5013783100					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Pharmacy Network Management Contact	Senior Director Network Provider Relations		Grindsteinner	Bretta		6127774021					bgrinsteinner@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Pharmacy Network Management Contact (Secondary)	Sr. Manager Pharmacy Provider Relations		Ecklund	Elisa		6127774308					eecklund@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Pharmacy Technical Help Desk Contact			Pharmacy Help Desk	Prime						8882852242	MGarzarodriguez@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active	8006933815				PFFS - Private Fee for Service		C	Dallas
H4213	Plan Directory Contact for Public Website			Service	Customer		8442014934					MediPakAdvRx@arkbluecross.com	P O Box 3648		Little Rock	AR	72203	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Plan to Plan Reconciliation Contact	Financial Analyst		Holt	Susan		5013993958				5013783258	sbholt@arkbluecross.com	P O Box 8084		Little Rock	AR	72203	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Processor Contact	Director Business Service Ops - Govt Programs		Allie	Cindy		6127776772				6127776705	callie@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Quality Contact	Director Quality Programs		Griffin	Brandon		5013782208					jbgriffin@arkbluecross.com	320 W Capitol		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Reconciliation Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Reconciliation Contact (Secondary)	CFO		Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Recovery Audit Contact	Financial Analyst	Ms.	Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Surveillance Contact	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	System Contact	Manager, Configuration		Spicer	Derek		5013013425					bdspicer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Third Party Administrator (TPA) Liaison	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	User Access Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387				5013017306	wlbradford@arkbluecross.com	601 Gaines Street	10-South	Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Utilization Management Contact	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4213	Utilization Review Contact	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PFFS	Arkansas Blue Medicare	PFFS		USAble Mutual Insurance Company	421	Yes	Active					PFFS - Private Fee for Service		C	Dallas
H4227	Agent/Broker Compensation Data Contact	Vice President, Medicare Pennsylvania	Ms.	Moody	Tonya	R	2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	08/08/2018	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Automated TrOOP Balance Transfer Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	12/30/2020	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Backup User Access Contact	Medicare Compliance Sr Operations Analyst	Ms	Morris	Gail		2158635141					gpmorris@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	300 Stevens Drive, Suite 201	Philadelphia	PA	19113	11/22/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Best Available Evidence Contact	Medicare Enrollment Manager	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	12/26/2018	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Bid Audit Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Dr	Philadelphia	PA	19113	07/04/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Bid Audit Site Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Bid Primary Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Solomon	Mary		2673004846					mlsolomon@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	09/02/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	CEO - CMS Administrator Contact	Executive VP, Public Affairs & Government Markets	Mr.	Fera	Stephen		2152413207					Stephen.Fera@ibx.com	1901 Market Street, 45th floor		Philadelphia	PA	19103	09/08/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	CEO - Senior Official for Contracting	Executive VP, Public Affairs & Government Markets	Mr.	Fera	Stephen		2152413207					Stephen.Fera@ibx.com	1901 Market Street, 45th floor		Philadelphia	PA	19103	09/08/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Chief Financial Officer	EVP, CFO & Treasurer	Mr.	Lopez	Juan		6094050539					Juan.Lopez@ibx.com	1901 Market Street, 39th floor		Philadelphia	PA	19103	11/04/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Chief Operating Officer	Executive Vice President, Health Markets	Mr.	Bohner	Steve	H	2159378276					sbohner@amerihealthcaritas.com	AmeriHealth Caritas Families of Companies	100 Stevens Drive, 3rd Floor	Philadelphia	PA	19113	07/26/2019	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Chief Information Officer	Exec. Vice President, Chief Information Officer	Mr.	Dickson	Fred		2158636570					fdickson@amerihealthcaritas.com	Amerihealth Caritas	2 International Plaza, Suite 440	Philadelphia	PA	19113	11/20/2019	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Chief Information Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	Amerihealth Caritas	2 International Plaza, Suite 440	Philadelphia, PA	PA	19113	11/20/2019	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	CMMI Model Point of Contact	Director Medical Management Medicare	Ms.	Becker	Nancy		4844971265					nbecker1@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	08/16/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	CMS Casework Communication Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/07/2023	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Complaints Tracking Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/07/2023	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Contact for Fraud Investigations	Director, SIU	Mr.	McCall	Trevor		4844971241					tmccall2@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr	Philadelphia	PA	19113	08/04/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Coordination of Benefits Contact	Manager, Provider Network Oversight	Ms.	Williams	Kathy		8437467499					kwilliams@firstchoicevipcareplus.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/09/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Corporate Mailing						2159378725					KGrimmett@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	08/16/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager	Ms.	Maheepathi	Geetha		4435279822					gmaheepathi@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	3875 West Chester Pike	Newtown Square	PA	19073	03/15/2023	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Customer Service Operations Contact	Director, Medicare Customer Service	Ms.	Veras	Helen		2672981794					hveras@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	08/08/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	DIR Contact	Director, Medicare Risk Adjustment and Performance	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/09/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	DIR Contact (Secondary)	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2824045991					AKindred@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Electronic Health Record Contact	Manager Information Services	Ms.	Drumming	Terri		2159378578					tdrumming@amerihealthcaritas.com	200 Stevens Drive Philadelphia, PA 19113		Philadelphia	PA	19113	08/16/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Emergency Part D Contact	Director, Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	11/19/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Emergency Part D Contact (Secondary)	Director, Corporate Pharmacy		Cherian	Sheena		2158635768					scherian@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	12/28/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Employer Waiver Contact	Director Medical Management Medicare	Ms.	Becker	Nancy		4844971265					nbecker1@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	08/16/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Encounter Data & Risk Adjustment Operations Contact	Director, Medicare ACA and Risk Adjustment	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	08/09/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Enrollment Contact	Manager, Enrollment Operations	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/21/2019	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	EOB Transfer Contact	Director, Medicare Claims	Mr.	Boyer	Joseph		2158636668				2159375321	jboyer@Amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/27/2015	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Financial Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					ak16850@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/09/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Financial Reporting Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Formulary Contact	Director of Clinical Services, Formulary/DUR	Ms.	Megargell	Lauren		2159374135					Lauren.megargell@performrx.com	PerformRx	200 Stevens Dr. 4th Floor	Philadelphia	PA	19113	02/10/2020	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Formulary Contact (Secondary)	Director, Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadephia	PA	19113	11/19/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	General Contact	Vice President, Medicare Pennsylvania	Ms.	Moody	Tonya	R	2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	08/08/2018	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Government Relations Contact	Director, Public Policy	Mr.	Cozzo	Steven		2159378236					scozzo@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr.	Philadelphia	PA	19113	10/14/2020	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	HIPAA Privacy Officer	Director of Privacy	Ms.	Gustafson	Rebecca		2158636634					rgustafson@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr	Philadelphia	PA	19113	08/04/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	HIPAA Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr.	Philadelphia	PA	19113	12/29/2017	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Hospice Contact	Pharmacist II	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	09/02/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Interoperability Contact	Director, Medicare Performance Management		Kindred	Amanda		2484045991					akindred@amerihealthcaritas.com	4000 Town Center	Suite 1300	Southfield	MI	48075	03/10/2023	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	MA Appeals/Grievances Contact	Director, Corporate Appeals	Ms.	Garber	Brenda		2158635585					bgarber@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	12/03/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	MA Claims Processing Contact for Public Website			Services	Provider		8005216007					VIPProviderComm@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	01/17/2017	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Marketing Contact	Medicare Compliance Sr Operations Analyst	Ms.	Morris	Gail	P	2158635141					gpmorris@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	300 Stevens Dr, Suite 201	Philadelphia	PA	19113	11/22/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Medical Director	Chief Medical Director	Dr.	Busch	Gregory		8562174603					gbusch@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	08/16/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Solomon	Mary		2673004846					mlsolomon@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	09/02/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Medicare Coordinator	Vice President, Medicare Pennsylvania	Ms.	Moody	Tonya	R	2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	08/08/2018	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	11/22/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Medication Therapy Management Contact	Director,Clin Outcomes &Therapy Optimization	Ms.	Patel	Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	12/29/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	OffShore Subcontractor Contact	Performance Program Oversight Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	3785 Chester Pike	Newtown Square	PA	19073	01/05/2023	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Online Enrollment Center Contact (Back-up)	Sr Medicare Enrollment Processor	Ms.	Price	Jamilla		2158636355					jprice@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	04/09/2020	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Online Enrollment Center Contact (Primary)	Medicare Enrollment Manager	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	12/27/2017	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part C Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	07/04/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part C Reporting Contact	Manager, Medicare Performance Management	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Appeals	Supv Quality Auditing	Ms.	Clark	Janine							jclark2@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	12/29/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	4844985214				HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Appeals Contact (Secondary)	Appeals & Grievance Administrator	Ms	Christian	Yolanda							ychristian@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	11/22/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8552210045				HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	07/04/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Benefits Contact	Director of Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	11/22/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Claims Submission Contact	Manager, Pharmacy Benefits Clinical Operations	Mr.	Montgomery	Sean		2159378049					smontgomery@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	06/19/2019	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Bonko	Gerald						2158635100	gbonko@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	12/22/2016	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636483				HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Prior Auth	Mr.	McHale	Shawn						2158635100	smchale@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	12/22/2016	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636370				HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Price File Contact (Back-up)	Claims Processor Associate	MS	Reed	Lindsay		8473466370					lindsay.reed@abarcahealth.com	650 Avenue Munoz Rivera	Suite 701,	San Juan	PR	00918	11/22/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Price File Contact (Optional)	Claims Processor Associate	Ms	Canales	Desiree		7875231212	1107				desiree.canales@abarcahealth.com	Abarca Health	650 Ave Munoz Rivera	San Juan	PR	00918	11/22/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Price File Contact (Primary)	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	12/30/2020	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Quality Assurance Contact	Director, Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	11/19/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Part D Reporting Contact	Quality Assurance Contract Account Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@keystonefirstpa.com	AmeriHealth Caritas Family of Companies	300 Stevens Dr. Suite 201	Philadelphia	PA	19113	03/07/2023	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Patient Safety Contact	Director,Clinical Outcomes &Therap Optimization	Ms	Patel	Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	11/22/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Payment Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Personal Health Record Contact	Manager Information Services	Ms.	Drumming	Terri		2159378578					tdrumming@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	08/16/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Pharmacy Director	Director, Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadephia	PA	19113	11/19/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Pharmacy Network Management Contact	Director	Ms.	Leal	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Dr. 4th Floor	Philadelphia	PA	19113	12/30/2020	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Pharmacy Network Management Contact (Secondary)	Network Operations Analyst	Mr.	Kramerov	Allen		2159374120					akramerov@performrx.com	PerformRx	200 Stevens Dr. 4th Floor	Philadelphia	PA	19113	11/22/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Pharmacy Technical Help Desk Contact	Director, Service Operations	Ms.	Leal	Avelina							aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/15/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8668280023				HMO - Health Maintenance Organization		C	Philadelphia
H4227	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Care Center	Ms.	Lee	Pamela							plee@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	11/05/2019	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8664298918				HMO - Health Maintenance Organization		C	Philadelphia
H4227	PHR Beneficiary Contact																	08/16/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS	AmeriHealth Caritas	Independence Health Group, Inc.	609	Yes	Active	2672985710				HMO - Health Maintenance Organization		C	Philadelphia
H4227	Physician Incentive Contact	Manager Provider Relations	Ms.	Williams	Kathy		8437467499					kwilliams@firstchoicevipcareplus.com	4390 Belle Oaks Drive Suite 400		North Charleston	SC	29405	08/16/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Plan Directory Contact for Public Website			Services	Provider		8005216007					VIPProviderComm@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	01/12/2017	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Plan to Plan Reconciliation Contact	Director, Finance	Ms	Sow	Oumou		4102584587					osow@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	P.O. 7137	London	KY	40742	06/15/2023	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Processor Contact	Director of Clincal Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerFormrx	200 Stevens drive	Philadelphia	PA	19113	07/23/2020	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Quality Contact	Director, Quality Management	Ms.	Barnett	Kathy		3173583705					kbarnett@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	04/25/2016	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Reconciliation Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Reconciliation Contact (Secondary)	Business Analyst	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	08/10/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Recovery Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	SNP Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	07/04/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	SNP State Contact	Vice President, Medicare Pennsylvania	Ms.	Moody	Tonya	R	2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	08/08/2018	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Surveillance Contact	Business Development Manager	Ms.	Kumagai	Naoko		2157563724					nkumagai@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/08/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	System Contact	Manager, Medicare IS	Ms.	Drumming	Terri		2159378578					tdrumming@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	11/22/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Third Party Administrator (TPA) Liaison	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	User Access Contact	Medicare Compliance Officer	Ms.	Solomon	Mary		2673004846					mlsolomon@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	09/02/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Utilization Management Contact	Vice President Utilization Management, Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/16/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4227	Utilization Review Contact	Vice President Utilization Management, Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/16/2021	2023	VISTA HEALTH PLAN, INC.	Local CCP	VISTA Health Plan Inc.	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4232	Agent/Broker Compensation Data Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Automated TrOOP Balance Transfer Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Backup User Access Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Best Available Evidence Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Bid Audit Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Bid Audit Site Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Bid Primary Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	CAP Report Contact for Public Website	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	CEO - CMS Administrator Contact	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	CEO - Senior Official for Contracting	CEO	Mr.	Bailey	Michael	D	6157518131				8442805360	mbailey@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Chief Financial Officer	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Chief Operating Officer	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Chief Information Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Chief Information Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	CMMI Model Point of Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	CMS Casework Communication Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Complaints Tracking Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Contact for Fraud Investigations	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Coordination of Benefits Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Corporate Mailing						6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Customer Service Operations Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	05/18/2020	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	DIR Contact	VP Formulary & Rebate Economics		Ellermeir	Nicole		9133875120					nellermeir@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	DIR Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Electronic Health Record Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Emergency Part D Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Emergency Part D Contact (Secondary)	Pharmacy Operations	Mrs.	Sanchez	Lynn		4056014429				8442805360	lsanchez@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Encounter Data & Risk Adjustment Operations Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Enrollment Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	EOB Transfer Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Financial Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Financial Reporting Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Formulary Contact	Clinical Formulary Pharmacist	Ms.	Quinn	Kelsey		3304864954					kquinn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Formulary Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	General Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Government Relations Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	HIPAA Privacy Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	HIPAA Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Hospice Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Interoperability Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	MA Appeals/Grievances Contact	A&G Team Lead	Mrs.	Henderson	Maya		6156268442				8442805360	mhenderson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	MA Claims Processing Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		8003997524				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Marketing Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Medical Director	Medical Director	Dr.	Misra	Sumathi		6156365478					SMisra@AmHealthPlans.com	201 Jordan Road	Ste 200	Franklin	TN	37067	02/17/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Medicare Compliance Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Medicare Coordinator	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Medicare Part D Opioid Overutilization Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Medication Therapy Management Contact	Director of Clinical Product Development and Strat	Ms.	Miller	Holly		3304866457				3304058094	hrmiller@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	OffShore Subcontractor Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Online Enrollment Center Contact (Back-up)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Online Enrollment Center Contact (Primary)	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Part C Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Part C Reporting Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Appeals	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations	Mr	Binegar	Sam						3304058081	appeals@ElixirSolutions.com	2181 E Aurora Road	Building B, Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8003997524				HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Benefits Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Claims Submission Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Exceptions Contact	Associate VP of Clinical Operations	Ms.	Lavignette	Amanda						3304864801	alavignette@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Exceptions Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Price File Contact (Back-up)	Sr Financial Manager Reporting & Analytics	Mr	Campbell	Tim		3308886988					tcampbell@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Price File Contact (Optional)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Price File Contact (Primary)	Senior Director Rebates, Trade Relations	Mr.	Bonus	Jason		3304864841				3304864801	jbonus@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Quality Assurance Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Part D Reporting Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Patient Safety Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Pharmacy Director	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Pharmacy Network Management Contact	Director of Pharmacy Network Development and Ops	Ms	Profio	Lauren		3304864864				3304058094	lprofio@EnvisionRx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Pharmacy Network Management Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8336746196				HMO - Health Maintenance Organization		C	Dallas
H4232	Pharmacy Technical Help Desk Contact (Secondary)			Sanchez	Lynn						4056015627	lsanchez@amhealthplans.com	909 S. Meridian Ave. Ste 425		Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8555210627				HMO - Health Maintenance Organization		C	Dallas
H4232	Plan Directory Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Plan to Plan Reconciliation Contact	Sr. Manager,  Financial Accounting	Ms.	Tilley	Stephanie		9312420499					stilley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	08/30/2023	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Processor Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Quality Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Reconciliation Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Reconciliation Contact (Secondary)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Recovery Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	SNP Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	SNP State Contact	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Surveillance Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	System Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Third Party Administrator (TPA) Liaison	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	User Access Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Utilization Management Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4232	Utilization Review Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF UT, INC.	Local CCP	American Health Advantage of Utah	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4235	Automated TrOOP Balance Transfer Contact	Director of Finance and Administration	CFO	Witt	Anne		7048740604				7048341998	awitt@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	03/01/2022	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Backup User Access Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Best Available Evidence Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Bid Primary Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	CAP Report Contact for Public Website	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	CEO - CMS Administrator Contact	Executive Director	Ms	Kenzig	Cathy		7048740600					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/23/2020	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	CEO - Senior Official for Contracting	Executive Director	CEO	Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Chief Financial Officer	Director of Finance and Administration	CFO	Witt	Anne		7048740604					awitt@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	03/25/2019	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Chief Operating Officer	Executive Director	COO	Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Chief Information Officer	Director of Quality & Corporate Compliance	Ms	Alexander	Lydia		7048740600				7048654385	lyalexander@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	06/18/2020	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Chief Information Security Officer	Compliance & Quality Director	CIO	Alexander	Lydia		7048740639					lyalexander@seniortlc.org	1875 Remount Road		Gastonia	NC	28054	01/07/2021	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	CMS Casework Communication Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Complaints Tracking Contact	Director of Finance and Administration	CFO	Witt	Anne		7048740604					awitt@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	03/25/2019	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Contact for Fraud Investigations	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Coordination of Benefits Contact	Finance Director		Witt	Anne		7048740604					awitt@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	03/22/2018	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Corporate Mailing						7048740600				7048743307	ckenzig@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	09/16/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Coverage Gap Discount Program (CGDP) Payment Contact	Director fo Administration and Finance	CIO	Witt	Anne		7048740600				7048654785	awitt@seniortlc.org	1875 Remount Raod		Gastonia	NC	28054	06/03/2016	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Customer Service Operations Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	DIR Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	DIR Contact (Secondary)	Finance Director		Witt	Anne		7048740604					awitt@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	03/22/2018	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Emergency Part D Contact	Executive Director		Kenzig	Cathy		7048740600					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/23/2020	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Emergency Part D Contact (Secondary)	Director of Finance and Administration	Dr.	Clark	Alan		7048740621					aclark@seniortlc.org	1875 Remount Rd.		Gastonia	NC	28054	01/07/2021	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Encounter Data & Risk Adjustment Operations Contact	Compliance & Quality Director		Alexander	Lydia		7048740639					lyalexander@seniortlc.org	1875 Remount Road		Gastonia	NC	28054	01/07/2021	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Enrollment Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	EOB Transfer Contact	Executive Director		Kenzig	Cathy		7048740603				7048667732	ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Financial Audit Contact	Executive Director	CEO	Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Financial Reporting Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Formulary Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	General Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Government Relations Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	HIPAA Privacy Officer	Director Corporate Compliance		Alexander	Lydia		7048740600					lyalexander@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/23/2020	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	HIPAA Security Officer	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Interoperability Contact			Kenzig	Catherine		7048740603					ckenzig@seniortlc.org	1875 Remount Road		Gastonia	NC	28054	06/02/2022	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	MA Appeals/Grievances Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	MA Claims Processing Contact for Public Website	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Marketing Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Medical Director	Medical Director	Dr	Clark	Alan		7048740619				7048743307	aclark@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	10/03/2013	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Medicare Compliance Officer	Compliance & Quality Director	CIO	Alexander	Lydia		7048740639					lyalexander@seniortlc.org	1875 Remount Road		Gastonia	NC	28054	01/07/2021	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Medicare Coordinator	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr	Clark	Alan		7048740619				7048743307	aclark@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	03/25/2019	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Medication Therapy Management Contact	Medical Director	Dr	Clark	Alan		7048740619				7048743307	aclark@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	10/03/2013	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Part C Application Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Part D Appeals	Quality Coordinator	Ms	Alexander	Lydia						7048740600	lyalexander@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	03/22/2018	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active	8553277852				PACE - Nat		C	Atlanta
H4235	Part D Appeals Contact (Secondary)			Alexander	Lydia						7048341998	lyalexander@seniortlc.org	1875 Remount Road		Gastonia	NC	28054	01/07/2021	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active	8553277852				PACE - Nat		C	Atlanta
H4235	Part D Application Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Part D Benefits Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Part D Claims Submission Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Part D Exceptions Contact	Executive Director		Kenzig	Cathy							ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active	8553277852				PACE - Nat		C	Atlanta
H4235	Part D Price File Contact (Back-up)	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Part D Price File Contact (Primary)	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Part D Quality Assurance Contact	Quality Coordinator	Ms	Alexander	Lydia		7048740600				7048654385	lyalexander@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	03/27/2018	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Part D Reporting Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Patient Safety Contact	Medical Director	Dr	Clark	Alan		7048740619				7048743307	aclark@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Payment Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Personal Health Record Contact	Finance Director		Alexander	Lydia		7048740639					lyalexander@seniortlc.org	1875 Remount Rd.		Gastonia	NC	28054	01/07/2021	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Pharmacy Director	Medical Director	Dr	Clark	Alan		7048740619				7048743307	aclark@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Pharmacy Network Management Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Pharmacy Technical Help Desk Contact	Executive Director		Kenzig	Cathy							ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active	8882987770				PACE - Nat		C	Atlanta
H4235	Plan Directory Contact for Public Website	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Plan to Plan Reconciliation Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Processor Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Quality Contact	Quality Coordinator	Ms	Alexander	Lydia		7048740600				7048654385	lyalexander@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	03/22/2018	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Reconciliation Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Reconciliation Contact (Secondary)	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	01/26/2015	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Recovery Audit Contact	Finance Director	MS	Witt	Anne		7048740600				7048743307	awitt@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	11/08/2017	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Surveillance Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	System Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Third Party Administrator (TPA) Liaison	Director fo Administration and Finance	CIO	Witt	Anne		7048740600				7048654785	awitt@seniortlc.org	1875 Remount Raod		Gastonia	NC	28054	06/03/2016	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	User Access Contact	Executive Director		Kenzig	Cathy		7048740603					ckenzig@seniorTLC.org	1875 Remount Rd.		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Utilization Management Contact	Medical Director	Dr	Clark	Alan		7048740619				7048743307	aclark@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4235	Utilization Review Contact	Medical Director	Dr	Clark	Alan		7048740619				7048743307	aclark@seniorTLC.org	1875 Remount Rd		Gastonia	NC	28054	12/29/2014	2023	SENIOR TOTAL LIFE CARE, INC.	National PACE	Senior Total Life Care	National PACE		CaroMont Health, Inc.	556	Yes	Active					PACE - Nat		C	Atlanta
H4256	Automated TrOOP Balance Transfer Contact	FinanceDirector	Mr.	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	03/15/2021	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Backup User Access Contact	Interim Executive Director		Farkas	Nicole		2312523801				2312523750	nfarkas@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	10/18/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Best Available Evidence Contact	Interim Executive Director	Ms	Farkas	Nicole		2312523801				2312523750	nfarkas@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	10/18/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Bid Primary Contact	Interim Executive Director	Ms	Farkas	Nicole		2312523801				2312523750	nfarkas@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	10/18/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	CAP Report Contact for Public Website	Community Outreach and Advocacy	Ms	Wells	Lori		2312523821				2312523750	lwells@pacenorth.org	2325 Garfield Rd., N.		Traverse City	MI	49686	12/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active	2312523821				PACE - Nat		C	Chicago
H4256	CEO - CMS Administrator Contact	Interim Executive Director	ms	Farkas	Nicole		2312523801				2312523750	nfarkas@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	10/18/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	CEO - Senior Official for Contracting	Interim Executive Director	Ms	Farkas	Nicole		2312523801					nfarkas@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	10/18/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Chief Financial Officer	Financial Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Chief Operating Officer	Executive Director	Ms	Farkas	Nicole		2312523814				2312523750	nfarkas@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Chief Information Officer	Executive Director	Ms	Reardon	Michelle		2312523814				2312523750	mreardon@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Chief Information Security Officer	Executive Director	Ms	Reardon	Michelle		2312523814				2312523750	mreardon@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	CMS Casework Communication Contact	LMSW	Ms	Goble	Erica		2312523808				2312523750	egoble@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	03/15/2021	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Complaints Tracking Contact	Quality Director	Ms	Reardon	Michelle		2312523821				2312523750	mreardon@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	09/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Contact for Fraud Investigations	Quality and Compliance	Ms	Reardon	Michelle		2312523814				2312523750	mreardon@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Coordination of Benefits Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Corporate Mailing						2312523814					nfarkas@pacenorth.org	2325 Garfield Rd. N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Customer Service Operations Contact	Executive Director	Ms	Farkas	Nicole		2312522767				2312523750	nfarkas@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	DIR Contact	Executive Director	Ms	JACOBS	John Jacob		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield Rd		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	DIR Contact (Secondary)			JACOBS	JOHN		2312523816					jjacobs@pacenorth.org	2325 N Garfield Rd		Traverse City	MI	49686	02/17/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Emergency Part D Contact	Executive Director	Ms	Reardon	Michelle		2312523814				2312523750	mreardon@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Emergency Part D Contact (Secondary)	Finance Director	Mr.	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 Garfield Rd. N.		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Encounter Data & Risk Adjustment Operations Contact	Finance Director	Mr.	Jacobs	John		2312523816					jjacobs@pacenorth.org	2325 Garfield Road North		Traverse City	MI	49686	04/15/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Enrollment Contact	Community Outreach Director	Ms	WELLS	LORI		2312523821				2312523750	lwells@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	02/17/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	EOB Transfer Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Financial Audit Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Financial Reporting Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Formulary Contact	Medical Director	Dr.	Byland	Mark		2312523815				2312523750	mbyland@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	03/15/2021	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	General Contact	Interim Executive Director	Ms	Farkas	Nicole		2312523801				2312523750	nfarkas@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	10/18/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Government Relations Contact	Executive Director	Ms	Farkas	Nicole		2312523814				2312523750	nfarkas@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	HIPAA Privacy Officer	Quality Director	Ms	Reardon	Michelle		2312523821				2312523750	mreardon@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	09/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	HIPAA Security Officer	Quality Director	Ms	Reardon	Michelle		2312523821				2312523750	mreardon@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	09/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Interoperability Contact			JACOBS	JOHN	A	2312523816					JJACOBS@PACENORTH.ORG	2325 N GARFILED RD		TRAVERSE CITY	MI	49686	05/06/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	MA Appeals/Grievances Contact	Quality Director	Ms	Reardon	Michelle		2312523821				2312523750	mreardon@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	09/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	MA Claims Processing Contact for Public Website	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Marketing Contact	Community Outreach and Advocacy	Ms	Wells	Lori		2312523821				2312523750	lwells@pacenorth.org	2325 Garfield Rd., N.		Traverse City	MI	49686	12/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Medical Director	Medical Director	Dr	Byland	Mark		2312523815					mbyland@pacenorth.org	2325 Garfield Rd. N.		Traverse City	MI	49686	08/13/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Medicare Compliance Officer	Quality Director	Ms.	Reardon	Michelle		2312523821				2312523750	mreardon@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	09/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Medicare Coordinator	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr	Byland	Mark		2312523815				2312523750	mbyland@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	08/13/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Medication Therapy Management Contact	Medical Director	Dr	Byland	Mark		2312523815				2312523750	mbyland@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	08/13/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Online Enrollment Center Contact (Primary)	Community Outreach and Advocacy	Ms.	Wells	Lori		2312523821				2312523750	lwells@pacenorth.org	2325 Garfield Rd., N.		Traverse City	MI	49686	12/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Part C Application Contact	Finance Director	Mr	Jacobs	John		2312523816					jjacobs@pacenorth.org	2325 Garfield Rd. N.		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Part D Appeals	Quality Director	Ms	Reardon	Michelle						2312523750	mreardon@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	12/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active	2312523819				PACE - Nat		C	Chicago
H4256	Part D Appeals Contact (Secondary)	Finance Director	Mr.	Jacobs	John						2312523750	jjacobs@pacenorth.org	2325 Garfield Road North		Traverse City	MI	49686	12/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active	2312523816				PACE - Nat		C	Chicago
H4256	Part D Application Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Part D Benefits Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Part D Claims Submission Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Part D Exceptions Contact	Finance Director	Mr	Jacobs	John						2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active	2312523816				PACE - Nat		C	Chicago
H4256	Part D Price File Contact (Back-up)	Finance Director	Mr	Jacobs	John		2312523816					jjacobs@pacenorth.org	2325 Garfield Rd. N.		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Part D Price File Contact (Primary)	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Part D Quality Assurance Contact	Quality Director	Ms.	Reardon	Michelle		2312523821				2312523750	mreardon@pacenorth.org	2325 N Garfield rd		Traverse City	MI	49686	09/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Part D Reporting Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Patient Safety Contact	Medical Director	Dr.	Byland	Mark		2312523815				2312523750	mbyland@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	12/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Payment Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Personal Health Record Contact	Medical Records	Ms.	Robinson	Kristin		2312523822				2312523750	krobinson@pacenorth.org	2325 Garfield Road North		Traverse City	MI	49686	04/15/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Pharmacy Director	Medical Director	Dr.	Byland	Mark		2312523815				2312523750	mbyland@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	12/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Pharmacy Network Management Contact	Executive Director	Ms	JACOBS	John Jacob		2312523816				2312523750	jjacobs@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Pharmacy Technical Help Desk Contact	Executive Director	Ms	JACOBS	John Jacob						2312523750	jjacobs@pacenorth.org	2325 N Garfield Rd		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active	2312523816				PACE - Nat		C	Chicago
H4256	PHR Beneficiary Contact																	04/15/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE	PACE North	PACE North	721	Yes	Active	8334102086				PACE - Nat		C	Chicago
H4256	Plan Directory Contact for Public Website	Community Outreach Director	Ms	WELLS	LORI		2312523814				2312523750	lwells@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Plan to Plan Reconciliation Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Processor Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Quality Contact	Quality Director	Ms	Reardon	Michelle		2312523821				2312523750	mreardon@pacenorth.org	2325 N Garfield rd		Traverse City	MI	49686	09/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Reconciliation Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Recovery Audit Contact	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Surveillance Contact	Executive Director	Ms	Reardon	Michelle		2312523814				2312523750	mreardon@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	System Contact	Executive Director	Ms	Reardon	Michelle		2312523814				2312523750	mreardon@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Third Party Administrator (TPA) Liaison	Finance Director	Mr	Jacobs	John		2312523816				2312523750	jjacobs@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	05/21/2019	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	User Access Contact	Executive Director	Ms	Reardon	Michelle		2312523814				2312523750	mreardon@pacenorth.org	2325 Garfield Road, N.		Traverse City	MI	49686	12/20/2022	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Utilization Management Contact	Quality Director	Ms	Reardon	Michelle		2312523821				2312523750	mreardon@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	09/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4256	Utilization Review Contact	Quality Director	Ms	Reardon	Michelle		2312523821				2312523750	mreardon@pacenorth.org	2325 N Garfield RD		Traverse City	MI	49686	09/30/2020	2023	PACE NORTH, INC.	National PACE	PACE North	National PACE		PACE North	721	Yes	Active					PACE - Nat		C	Chicago
H4277	Agent/Broker Compensation Data Contact	Manager Medicare Marketing		McEver	Kelly		9185945295	4122				kmcever@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Backup User Access Contact	Manager, Grievance and Appeals	Ms.	Pugh	Nicole		9185945295	6315			9185945260	cpugh@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Best Available Evidence Contact	Supervisor, Medicare Enrollment		East	Shawn		9185945295	6903				seast@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Bid Audit Contact	Manager Medicare Marketing		McEver	Kelly		9185945295	4122				kmcever@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Bid Primary Contact	Director Underwriting		Tull	Karla		9185945295	2009				ktull@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	CAP Report Contact for Public Website	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	CEO - CMS Administrator Contact	President & CEO	Mr.	Bush	Robert		9185945295	4124				rbush@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	CEO - Senior Official for Contracting	President & CEO	Mr.	Bush	Robert		9185945295	4124				rbush@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Chief Financial Officer	CFO	Mr.	Sutton	Josiah		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Chief Operating Officer	SVP & Chief Operating Officer	Mr.	Sutton	Josian		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Chief Information Officer	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Chief Information Security Officer	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	CMS Casework Communication Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Complaints Tracking Contact	Manager, Senior Center		Lee	Laura		9185945295	6385				llee@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Contact for Fraud Investigations	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Coordination of Benefits Contact	Supervisor, Claims		Higgins	Susan		9185945295	6401				coordinationofbenefits@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Corporate Mailing						9185945295	5386				swhite@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant II		Wilson	Jamar		9185945295	6488				jwilson@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Customer Service Operations Contact	Director of Customer Experience		Holt	John		9185945295	4128				jholt@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	DIR Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	DIR Contact (Secondary)	Sr. Manager, Financial Planning & Analysis		Brenner	Matt		9185945295	4119				mbrenner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Emergency Part D Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Emergency Part D Contact (Secondary)	Manager, Pharmacy Services		Perez	Charles		9185945295	6479			9188794309	cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Encounter Data & Risk Adjustment Operations Contact	Director Health Data		Morningstar	Angela		9185945295	5205				amorningstar@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Enrollment Contact	Supervisor, Medicare Enrollment		East	Shawn		9185945295	6903				seast@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	EOB Transfer Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Financial Audit Contact	VP Accounting and Treasury	Ms.	Scott	Cyd	G	9185945295	5325			9185945260	cscott@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Financial Reporting Contact	CFO	Mr.	Sutton	Josiah		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Formulary Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Formulary Contact (Secondary)	Sr. Analyst		Loveland	Chet		4806064873					Chet.Loveland@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	General Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Government Relations Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	HIPAA Privacy Officer	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	HIPAA Security Officer	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Hospice Contact	Supervisor, Pharmacy Services		Burke	Amy		9185945295	6808			9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Interoperability Contact	VP Chief CO, RO & General Counsel	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	MA Appeals/Grievances Contact	Manager, Grievance and Appeals		Pugh	Nicole		9185945295	6315			9185945260	npugh@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	MA Claims Processing Contact for Public Website	Director, Operations		Lang	Michelle		9185945295	6326				mlang@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Marketing Contact	SVP & Chief Operating Officer		Sutton	Josiah		9185945295	5375				jsutton@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Medical Director	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Medicare Compliance Officer	VP Chief Risk & Compliance Officer	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Medicare Coordinator	Medicare Compliance Specialist		Kanner	Dee		9185945295	6268				dkanner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Abdo	Mike		9185945295	6395				mabdo@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Medication Therapy Management Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street	Suite 100	Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Online Enrollment Center Contact (Back-up)	Enrollment Specialist		Baur	Amanda		9185945295	4503				abaur@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Online Enrollment Center Contact (Primary)	Supervisor, Medicare Enrollment		East	Shawn		9185945295	6903				seast@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Part C Application Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Part C Reporting Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Part D Appeals	Manager, Grievance and Appeals		Pugh	Nicole						9185945260	cpugh@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active	9185945295	6315			PPO - BBA		C	Dallas
H4277	Part D Appeals Contact (Secondary)	Supervisor, Grievances & Appeals		Mitchell	Damenica							dmitchell@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active	9185945295	6314			PPO - BBA		C	Dallas
H4277	Part D Application Contact	VP Chief CO, RO & General Counsel		Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Part D Benefits Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Part D Claims Submission Contact	Strategic Account Executive, CVS/Caremark		Tibus	Daniel		8475595726					daniel.tibus@CVSHealth.com	9501 E Shea Blvd MC042		Scottsdale	AZ	85260	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Part D Exceptions Contact	Supervisor, Pharmacy Services		Burke	Amy						9188794309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active	8772938628	6808			PPO - BBA		C	Dallas
H4277	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Services		Perez	Charles						9188794309	cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active	8772938628	6479			PPO - BBA		C	Dallas
H4277	Part D Price File Contact (Back-up)	Senior Consultant, Finance Med D		Loveland	Chet		4806064873				4013357984	Chet.Loveland@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Part D Price File Contact (Optional)	Medicare Part D Advisor		Schilcher	Sydney		4806064615				4013357984	Sydney.Schilcher@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Part D Price File Contact (Primary)	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Part D Quality Assurance Contact	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Part D Reporting Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Patient Safety Contact	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Payment Contact	Accounts Receivable Supervisor		Fell	Jill		9185945295	6271				jfell@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Pharmacy Director	Director of Pharmacy		Abdo	Mike		9185945295	6395				mabdo@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Pharmacy Network Management Contact	Manager, Pharmacy Services		Perez	Charles		9185945295	6479				cperez@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Pharmacy Network Management Contact (Secondary)	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Pharmacy Technical Help Desk Contact	Supervisor, Pharmacy Services		Burke	Amy						9187944309	aburke@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active	8772938628	6808			PPO - BBA		C	Dallas
H4277	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Help Desk		HelpDesk	Pharmacy								9501 E Shea Blvd		Scottsdale	AZ	85260	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active	8666934620				PPO - BBA		C	Dallas
H4277	Plan Directory Contact for Public Website	Director of Customer Experience		Holt	John		9185945295	4128				jholt@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Plan to Plan Reconciliation Contact	Senior Financial Analyst		Mack	Lynda		9185945295	6320				lmack@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Processor Contact	Strategic Account Executive, CVS/Caremark		Tibus	Daniel		8475595726					daniel.tibus@CVSHealth.com	9501 E Shea Blvd MC042		Scottsdale	AZ	85260	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Quality Contact	Sr Manager, Health Programs		Such	Becky		9185945295	6226			9185945260	bsuch@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Reconciliation Contact	VP Accounting & Treasury		Scott	Cyd		9185945295	5325				cscott@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Reconciliation Contact (Secondary)	Manager Financial Planning & Analysis		Brenner	Matthew		9185945295	4119				mbrenner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Recovery Audit Contact	VP Chief CO, RO & General Counsel	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Surveillance Contact	VP Chief CO, RO & General Counsel	Mr.	Hill	Andrew		9185945295	4055				ahill@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	System Contact	SVP Chief Information Officer	Mr.	Wyrick	Rusty		9185945295	5233				rwyrick@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Third Party Administrator (TPA) Liaison	Senior Financial Analyst		Mack	Lynda		9185945295	6320				lmack@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	User Access Contact	Medicare Compliance Specialist		Kanner	Dee		9185945295	6862				dkanner@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Utilization Management Contact	Senior Manager, Medical Management		Gordon	Michelle		9185945295	6398				mgordon@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4277	Utilization Review Contact	SVP, Chief Medical Officer	Dr.	Mills	Lee		9185945295	5253				tlmills@ccok.com	Two West Second Street, Suite 100		Tulsa	OK	74103	07/19/2023	2023	CommunityCare Life & Health Insurance Co.	Local CCP	CommunityCare Options (PPO)	Local PPO		CommunityCare Managed Healthcare Plans of OK, Inc.	94	Yes	Active					PPO - BBA		C	Dallas
H4279	Agent/Broker Compensation Data Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Automated TrOOP Balance Transfer Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2021	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Backup User Access Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Best Available Evidence Contact	Customer Service		Health Plan	UPMC		8006068648					upmchp@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	03/17/2023	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Bid Audit Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Bid Audit Site Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Bid Primary Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	CAP Report Contact for Public Website	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	CEO - CMS Administrator Contact	President	Ms.	Holder	Diane	P	4124547640				4124547750	holderd@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/04/2023	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	CEO - Senior Official for Contracting	President	Ms.	Holder	Diane	P	4124547640				4124547750	holderd@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/04/2023	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Chief Financial Officer	Chief Financial Officer	Mr.	Gebbens	Gordon		4124545559					gebbgx@UPMC.EDU	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	07/18/2016	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Chief Operating Officer	Chief Operating Officer	Ms.	Jenkins	Mary Beth	L	4124547764					jenkinsml@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	12/09/2015	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Chief Information Officer	Chief Information Officer	Mr.	McCallister	Ed		4124547711					mccallisterew@upmc.edu	USX Tower, 60th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Chief Information Security Officer	Vice President, ISD	Mr	Haas	Scott		4124546162					haassm@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	CMS Casework Communication Contact	Sr. Administrator, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Complaints Tracking Contact	Sr. Manager, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	03/17/2023	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Contact for Fraud Investigations	Sr. Director Fraud & Abuse		Workman	Craig		4124545524					workmanc@upmc.edu	USX Tower, 47th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Coordination of Benefits Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Corporate Mailing						4124547500					upmchp@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst		Kelly	Alexis		4124547856				4124542110	medicarereporting@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/05/2021	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Customer Service Operations Contact	Customer Service		Health Plan	UPMC		8006068648					upmchp@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	03/17/2023	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	DIR Contact	Director, Pharmacy Finance		Bovier	Jacqueline		4124547584					bovierjd@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	06/18/2015	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	DIR Contact (Secondary)	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Emergency Part D Contact	Vice President, Customer Engagement & Enrollment		Palmerine	Anne		4129777828					palmerineac3@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Operations		Kienzle	Paul		7242070388					kienzlepa@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Encounter Data & Risk Adjustment Operations Contact	Director, Government Revenue		Plank	Tim		4124547747					planktm@upmc.edu	USX Tower, 36th Floor	600 Grant Street	Pittsburgh	PA	15219	10/28/2019	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Enrollment Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	EOB Transfer Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Financial Audit Contact	AVP, Medicare Operations	Mr.	Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	08/14/2020	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Financial Reporting Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Formulary Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Formulary Contact (Secondary)	Specialist, Pharmacy Operations	Ms.	Lindemuth	Nicole		4124548589					lindemuthnl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	08/29/2012	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	General Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Government Relations Contact	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Grumbine	Megan		7034021772					grumbinem@upmc.edu	USX Tower, 41st Floor	600 Grant St.	Pittsburgh	PA	15219	11/03/2020	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	HIPAA Security Officer	Chief Privacy Officer	Ms.	Grumbine	Megan		7034021772					grumbinem@upmc.edu	USX Tower, 41st Floor	600 Grant St.	Pittsburgh	PA	15219	11/03/2020	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Hospice Contact	Pharmacy Coordinator	Ms.	Lindemuth	Nicole		4124548589					lindemuthnl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	06/24/2020	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Interoperability Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	02/16/2022	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	MA Appeals/Grievances Contact	Sr. Administrator, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	MA Claims Processing Contact for Public Website	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Marketing Contact	Director, Medicare Marketing		McVey	Alicia		4124545525					mcveyal@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	08/03/2017	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Medical Director	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Medicare Coordinator	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Medicare Part D Opioid Overutilization Contact	Sr. Manager, Clinical Pharmacy		Zandier	Lauren		4124542950				4124545295	craigl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	10/23/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Medication Therapy Management Contact	Sr. Manager Clinical Pharmacy		Zandier	Lauren		4124542950				4124545295	craigl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	10/23/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Online Enrollment Center Contact (Back-up)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Online Enrollment Center Contact (Optional)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Online Enrollment Center Contact (Primary)	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part C Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part C Reporting Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part D Appeals	Manager, C&G		Richards	Rebecca						4124547920	richardsr3@upmc.edu	USX Tower, 42nd Floor	600 Grant Street	Pittsburgh	PA	15219	02/25/2021	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active	4124540116				HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part D Appeals Contact (Secondary)	Manager, Pharmacy Compliance		Chaussinand	Matt							chaussinandm@upmc.edu	600 Grant St., USX, 12th Floor		Pittsburgh	PA	15219	02/25/2021	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active	4124545914				HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part D Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	11/01/2017	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part D Benefits Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions		Dovico	Rosario		2012696398					rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	04/23/2019	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part D Exceptions Contact			Services	Pharmacy							upmchp@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	08/29/2012	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active	8003964139				HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part D Price File Contact (Back-up)	Sr. Manager, Government Programs		Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	03/12/2019	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part D Price File Contact (Optional)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part D Price File Contact (Primary)	Director, Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St. #11202		Overland Park	KS	66207	07/28/2020	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part D Quality Assurance Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Part D Reporting Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Patient Safety Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Payment Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Personal Health Record Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Pharmacy Director	Sr. Director, Pharmacy Operations		Kienzle	Paul		7242070388					kienzlepa@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Pharmacy Network Management Contact	Network Account Director		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	10/31/2016	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Pharmacy Technical Help Desk Contact	DIrector, Customer Service		Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	07/29/2021	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Philadelphia
H4279	PHR Beneficiary Contact																	05/17/2011	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS	MyHealth	UPMC Health System	249	Yes	Active	4128032065				HMO - Health Maintenance Organization		C	Philadelphia
H4279	Physician Incentive Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Plan Directory Contact for Public Website			Marketing	Medicare		8773813765					upmchp@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Plan to Plan Reconciliation Contact	Business Analyst		Michalski	Jeff		4124545715				4124542110	medicarereporting@upmc.edu	c/o UPMC Health Plan Attn: Dave Soltesz P2P	US Steel Tower, 600 Grant Street, 21st Floor	Pittsburgh	PA	15219	10/03/2022	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Processor Contact	Sr Director - Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	01/12/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Quality Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Reconciliation Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Reconciliation Contact (Secondary)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Recovery Audit Contact	Sr. Director, Medicare Operations	Mr.	Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	SNP Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	11/01/2017	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	SNP State Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Surveillance Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	System Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Third Party Administrator (TPA) Liaison	Business Analyst		Kelly	Alexis		4124547856				4124542110	kellya9@upmc.edu	c/o UPMC Health Plan Attn: Alexis Kelly P2P	US Steel Tower, 600 Grant Street, 9th Floor	Pittsburgh	PA	15219	04/16/2019	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	User Access Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Utilization Management Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4279	Utilization Review Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC FOR YOU, INC	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4286	Agent/Broker Compensation Data Contact	COO		Hernandez	Henry		3056315855				3056463226	henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Automated TrOOP Balance Transfer Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Backup User Access Contact	COO		Hernandez	Henry		3056315855				3056463326	henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Best Available Evidence Contact	COO		Hernandez	Henry		3056315855				3057182860	henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	09/10/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Bid Audit Contact	SVP & CFO		Pardo	Ann Mary		3056315064					annmary.pardo@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	01/26/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Bid Audit Site Contact	SVP & CFO		Pardo	Ann Mary		3056315064					annmary.pardo@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	01/26/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Bid Primary Contact	SVP & CFO		Pardo	Ann Mary		3056315064					annmary.pardo@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	01/26/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	CAP Report Contact for Public Website	VP & CIO		Gomez	Marcus		3056442156					marcus.gomez@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	CEO - CMS Administrator Contact	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St	Suite 210	Miami	FL	33166	09/22/2023	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	CEO - Senior Official for Contracting	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Chief Financial Officer	SVP & CFO	Ms.	Pardo	Ann Mary		3056315064					annmary.pardo@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	01/26/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Chief Operating Officer	COO	Mr.	Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Chief Information Officer	VP & CIO	Mr.	Gomez	Marcus		3056442156					marcus.gomez@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Chief Information Security Officer	VP & CIO	Mr.	Gomez	Marcus		3056442156					marcus.gomez@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	CMMI Model Point of Contact	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	CMS Casework Communication Contact	Chief Compliance Officer	Ms.	Yzquierdo	Milagros		3056315855					milagros.yzquierdo@leonhealth.com	8600 NW 41 St		Miami	FL	33166	06/16/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Complaints Tracking Contact	Chief Compliance Officer	Ms.	Yzquierdo	Milagros		3056315855					milagros.yzquierdo@leonhealth.com	8600 NW 41 St		Miami	FL	33166	06/16/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Contact for Fraud Investigations	SVP & CLO		Junco	Carlos		3056317475					carlos.junco@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Coordination of Benefits Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Corporate Mailing						3055415366					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	08/28/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Coverage Gap Discount Program (CGDP) Payment Contact	SVP & CFO		Pardo	Ann Mary		3056315064					annmary.pardo@leonhealth.com	8600 NW 41 St	Suite 210	Doral	FL	33166	03/01/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Customer Service Operations Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	DIR Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	DIR Contact (Secondary)	SVP & CFO		Pardo	Ann Mary		3056315064					annmary.pardo@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	01/26/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Electronic Health Record Contact	VP & CIO		Gomez	Marcus		3056442156					marcus.gomez@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Emergency Part D Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Emergency Part D Contact (Secondary)	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Employer Waiver Contact	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Encounter Data & Risk Adjustment Operations Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Enrollment Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	EOB Transfer Contact	COO		Hernandez	Henry		3056315855				3056463226	henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Financial Audit Contact	SVP & CFO	Ms.	Pardo	Ann Mary		3056315064					annmary.pardo@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	01/26/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Financial Reporting Contact	SVP & CFO		Pardo	Ann Mary		3056315064					annmary.pardo@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	01/26/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Formulary Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Formulary Contact (Secondary)	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	General Contact	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Government Relations Contact	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	HIPAA Privacy Officer	Chief Compliance Officer	Ms.	Yzquierdo	Milagros		3056315855					milagros.yzquierdo@leonhealth.com	8600 NW 41 St		Miami	FL	33166	06/16/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	HIPAA Security Officer	VP & CIO		Gomez	Marcus		3056442156					marcus.gomez@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Hospice Contact	SVP & CMO		Mas	Rafael		3056425366					rafael.mas@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Interoperability Contact	COO		Hernandez	Henry		3059860290					Henry.Hernandez@leonhealth.com	8600 NW 41st St Ste 210		Doral	FL	33166	05/02/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	MA Appeals/Grievances Contact	Chief Compliance Officer	Ms.	Yzquierdo	Milagros		3056315855					milagros.yzquierdo@leonhealth.com	8600 NW 41 St		Miami	FL	33166	06/16/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	MA Claims Processing Contact for Public Website	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Marketing Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Medical Director	SVP & CMO		Mas	Rafael		3056425366					rafael.mas@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Medicare Compliance Officer	Chief Compliance Officer	Mr.	Yzquierdo	Milagros		3054963156					milagros.yzquierdo@leonhealth.com	8600 NW 41 Street		Miami	FL	33166	04/20/2023	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Medicare Coordinator	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Medicare Part D Opioid Overutilization Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Medication Therapy Management Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	OffShore Subcontractor Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Online Enrollment Center Contact (Back-up)	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Online Enrollment Center Contact (Optional)	SVP & CLO		Junco	Carlos		3056317475					carlos.junco@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Online Enrollment Center Contact (Primary)	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Part C Application Contact	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Part C Reporting Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Part D Appeals	COO		Hernandez	Henry						3056463226	henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active	8333765366				HMO - Health Maintenance Organization		C	Atlanta
H4286	Part D Application Contact	President		Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 Street		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Part D Benefits Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Part D Claims Submission Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Part D Exceptions Contact	COO		Hernandez	Henry						3056463226	henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active	8333765366				HMO - Health Maintenance Organization		C	Atlanta
H4286	Part D Price File Contact (Back-up)	Compliance Officer	Mrs.	Yzquierdo	Milagros		3054963156					milagros.yzquierdo@leonhealth.com	8600 NW 41 St		Miami	FL	33166	10/11/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Part D Price File Contact (Optional)	PBM		Medimpact	Medimpact		8007882949					PlanFinderCommunications@medimpact.com	10181 Scripps Gateway Ct.		San Diego,	CA	92131	10/11/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Part D Price File Contact (Primary)	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Part D Quality Assurance Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Part D Reporting Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Patient Safety Contact	SVP & CMO		Mas	Rafael		3056425366					rafael.mas@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Payment Contact	SVP & CFO		Pardo	Ann Mary		3056315064					annmary.pardo@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	01/26/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Personal Health Record Contact	VP & CIO	Mr.	Gomez	Marcus		3056442156					marcus.gomez@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Pharmacy Director	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Pharmacy Network Management Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Pharmacy Network Management Contact (Secondary)	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Pharmacy Technical Help Desk Contact	COO		Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway CT		San Diego	CA	92131	11/14/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active	8006817504				HMO - Health Maintenance Organization		C	Atlanta
H4286	Pharmacy Technical Help Desk Contact (Secondary)	COO		Hernandez	Henry						3056463226	henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	04/25/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active	8006817504				HMO - Health Maintenance Organization		C	Atlanta
H4286	PHR Beneficiary Contact																	02/12/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS	Leon Health Plans	Leon Health Holdings, LLC	771	Yes	Active	8333765366				HMO - Health Maintenance Organization		C	Atlanta
H4286	Physician Incentive Contact	SVP & CMO		Mas	Rafael		3056425366					rafael.mas@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Plan Directory Contact for Public Website	VP & CIO	Mr.	Gomez	Marcus		3056442156					marcus.gomez@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Plan to Plan Reconciliation Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Processor Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Quality Contact	SVP & CMO		Mas	Rafael		3056425366					rafael.mas@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Reconciliation Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Reconciliation Contact (Secondary)	CFO &SVP		Pardo	Ann Mary		3056315064					annmary.pardo@leonhealth.com	8600 NW 41 Street		Miami	FL	33166	03/07/2023	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Recovery Audit Contact	SVP & CFO	Ms.	Pardo	Ann Mary		3056315064					annmary.pardo@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	01/26/2022	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	SNP Application Contact	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	SNP State Contact	President	Mr.	Maury	Albert		3056442135					albert.maury@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Surveillance Contact	Chief Compliance Officer	Ms.	Yzquierdo	Milagros		3056315855					milagros.yzquierdo@leonhealth.com	8600 NW 41 St		Miami	FL	33166	06/16/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	System Contact	VP & CIO	Mr.	Gomez	Marcus		3056442156					marcus.gomez@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Third Party Administrator (TPA) Liaison	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St,		Miami	FL	33166	05/17/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	User Access Contact	COO		Hernandez	Henry		3056315855					henry.hernandez@leonhealth.com	8600 NW 41 St		Miami	FL	33166	05/26/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Utilization Management Contact	SVP & CMO		Mas	Rafael		3056425366					rafael.mas@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4286	Utilization Review Contact	SVP & CMO		Mas	Rafael		3056425366					rafael.mas@leonmedicalcenters.com	8600 NW 41 St		Miami	FL	33166	02/05/2021	2023	LEON HEALTH, INC.	Local CCP	Leon Health Plans	HMO/HMOPOS		Leon Health Holdings, LLC	771	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4304	Agent/Broker Compensation Data Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Automated TrOOP Balance Transfer Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Backup User Access Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Best Available Evidence Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Bid Audit Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Bid Audit Site Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Bid Primary Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	CAP Report Contact for Public Website	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Westover	Chad		8015872636					Chad.Westover@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	CEO - Senior Official for Contracting	Chief Operating Officer	Ms	Fallert	Lisa		8015872636					lisa.fallert@utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Chief Financial Officer	Director Finance	Mr	Finlinson	Doug		8015872675					DOUG.FINLINSON@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Chief Operating Officer	Chief Operating Officer	Ms	Fallert	Lisa		8015872636					lisa.fallert@utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Chief Information Officer	Manager, Information Technology	Mr	Wilcox	Dave		8015872650					Dave.Wilcox@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Chief Information Security Officer	Manager, Information Technology	Mr	Wilcox	Dave		8015872650					Dave.Wilcox@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	CMS Casework Communication Contact	Appeals Manager	Ms.	Willey	Katie		8012130291					Katie.Willey@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Complaints Tracking Contact	Grievance & Appeals Supervisor	Ms.	Willey	Katie		8012130291					Katie.Willey@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Contact for Fraud Investigations	SIU Manager	Ms	Petrogeorge	Sophie		8015870682					Sophie.Petrogeorge@utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Coordination of Benefits Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Corporate Mailing						8015876480					uuhp@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Coverage Gap Discount Program (CGDP) Payment Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Customer Service Operations Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	DIR Contact	Director Finance	Mr	Finlinson	Doug		8015872675					DOUG.FINLINSON@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	DIR Contact (Secondary)	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8019716612				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Emergency Part D Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Emergency Part D Contact (Secondary)	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Employer Waiver Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Encounter Data & Risk Adjustment Operations Contact	Manager, Medicare Advantage Operations	Mr	Wilson	Mike		8016464833					Mike.Wilson@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Enrollment Contact	Medicare Adv Delegated Operations Supervisor	Mr	Beck	Michael		8016464834					Michael.Beck@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	EOB Transfer Contact	Medicare Advantage Delegated Operations Supervisor	Mr	Beck	Michael		8016464834				8012131547	Michael.Beck@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Financial Audit Contact	Director Finance	Mr	Finlinson	Doug		8015872675					DOUG.FINLINSON@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Financial Reporting Contact	Director Finance	Mr	Finlinson	Doug		8015872675					DOUG.FINLINSON@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Formulary Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Formulary Contact (Secondary)	Director Pharmacy Services	Ms	Britton	Laura		8015872829					Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	General Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Government Relations Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	HIPAA Privacy Officer	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	HIPAA Security Officer	Manager, Information Technology	Mr	Wilcox	Dave		8015872650					Dave.Wilcox@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Hospice Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Interoperability Contact	Director, Information Technology	Mr	Wilcox	Dave		8015872650					Dave.Wilcox@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	MA Appeals/Grievances Contact	Appeals Manager	Ms.	Willey	Katie		8012130291					Katie.Willey@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	MA Claims Processing Contact for Public Website	Manager, Medicare Advantage Operations	Mr	Wilson	Mike		8016464833					Mike.Wilson@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Marketing Contact	Compliance Specialist	Ms.	Lofton	Ashley		8012130382					Ashley.Lofton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Medical Director	Interim Chief Medical Officer	Dr	Schaecher	Kenneth		8015872053					Ken.Schaecher@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Medicare Compliance Officer	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Medicare Coordinator	Director Medicare Advantage		Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 Fashion Square Dr, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Medicare Part D Opioid Overutilization Contact	Director Pharmacy Services	Ms	Britton	Laura		8015872829					Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Medication Therapy Management Contact	Director Pharmacy Services	Ms	Britton	Laura		8015872829					Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	OffShore Subcontractor Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Online Enrollment Center Contact (Primary)	Medicare Adv Delegated Operations Supervisor	Mr	Beck	Michael		8016464834					Michael.Beck@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Part C Application Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Part C Reporting Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Part D Appeals	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David							David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract	8012130099				PPO - BBA		C	Dallas
H4304	Part D Appeals Contact (Secondary)	Compliance Manager	Mr.	Christensen	Eric							eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract	8012130292				PPO - BBA		C	Dallas
H4304	Part D Application Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Part D Benefits Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Part D Claims Submission Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Part D Exceptions Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David							David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract	8012130099				PPO - BBA		C	Dallas
H4304	Part D Exceptions Contact (Secondary)	Director Pharmacy Services	Ms	Britton	Laura							Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract	8015872829				PPO - BBA		C	Dallas
H4304	Part D Price File Contact (Back-up)	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Part D Price File Contact (Optional)	Director Pharmacy Services	Ms	Britton	Laura		8015892829					Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Part D Price File Contact (Primary)	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Part D Quality Assurance Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Part D Reporting Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Patient Safety Contact	Director Pharmacy Services	Ms	Britton	Laura		8015892829					Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Payment Contact	Director Finance	Mr	Finlinson	Doug		8015872675					DOUG.FINLINSON@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Pharmacy Director	Director Pharmacy Services	Ms	Britton	Laura		8015872829					Laura.Britton@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Pharmacy Network Management Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Pharmacy Network Management Contact (Secondary)	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Pharmacy Technical Help Desk Contact	CVS Pharmacy Technical Help Desk		Help Desk	CVS								6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract	8666934620				PPO - BBA		C	Dallas
H4304	Plan Directory Contact for Public Website	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Plan to Plan Reconciliation Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110	Attn: Finance Department (P2P)	Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Processor Contact	Medicare Adv Delegated Operations Supervisor	Mr	Beck	Michael		8016464834					Michael.Beck@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Quality Contact	Director Quality and Stars	Mr	Harding	Geoff		8012130565					Geoff.Harding@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Reconciliation Contact	Director Finance	Mr	Finlinson	Doug		8015872675					DOUG.FINLINSON@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Recovery Audit Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Surveillance Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	System Contact	Manager, Information Technology	Mr	Wilcox	Dave		8015872650					Dave.Wilcox@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Third Party Administrator (TPA) Liaison	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	User Access Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Utilization Management Contact	Director Care Management	Ms	Armour-Roth	Elizabeth		8015872789					Elizabeth.Armour-Roth@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4304	Utilization Review Contact	Director Care Management	Ms	Armour-Roth	Elizabeth		8015872789					Elizabeth.Armour-Roth@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	UNIVERSITY OF UTAH HEALTH INSURANCE PLANS	Local CCP	University of Utah Health Insurance Plans	Local PPO		University of Utah	762	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H4305	Automated TrOOP Balance Transfer Contact	Part D Manager		Summitt	Lori		8702077502				8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Backup User Access Contact	Program Integrity Manager		Rowe	Shellei		8702077485				8702070550	srowe@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/22/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Best Available Evidence Contact	Executive Director	CEO	Whitehead	Chad		8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews		Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Bid Primary Contact	CFO		Domino	DeAnna		8702077526				8702070527	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/06/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	CAP Report Contact for Public Website	Executive Director	CEO	Whitehead	Chad	R	8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	CEO - CMS Administrator Contact	Executive Director	CEO	Whitehead	Chad	R	8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	CEO - Senior Official for Contracting	Executive Director	CEO	Whitehead	Chad	R	8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Chief Financial Officer	Accountant	CFO	Domino	DeAnna	J	8702077526				8702070571	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/01/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Chief Operating Officer	Operations Manager	COO	Combs	Terry		8702077530				8702070527	tcombs@sbrmc.org	505  E Matthews Avenue	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Chief Information Officer	Executive Director	Mr.	Whitehead	Chad		8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Chief Information Security Officer	IT Security Mgr - SB	Ms	Stoneman	Marta		8702077181				8702076503	mwstoneman@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	01/10/2020	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	CMS Casework Communication Contact	Program Integrity Manager		Rowe	Shellei		8702077485				8702070550	srowe@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/22/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Complaints Tracking Contact	Operations Manager	COO	Combs	Terry		8702077530				8702070527	tcombs@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Contact for Fraud Investigations	VP Corp Compliance/Audit - SB		Shipman	Daya		8702074422				8709302854	dshipman@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	01/10/2020	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Coordination of Benefits Contact	Medicare Part D Manager		Summitt	Lori		8702077502				8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Corporate Mailing						8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Coverage Gap Discount Program (CGDP) Payment Contact	CFO		Domino	DeAnna		8702077526				8702070527	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/06/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Customer Service Operations Contact	Center Manager		Hayes	Tina		8702077503				8702070527	trhayes@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	06/13/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	DIR Contact	Accountant		Domino	DeAnna	J	8702077526				8702070571	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	02/22/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Emergency Part D Contact	Medicare Part D Manager		Summitt	Lori		8702077502				8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Encounter Data & Risk Adjustment Operations Contact	Accountant		Domino	DeAnna		8702077526				8702070571	ddomino@sbrmc.org	505 E Matthews		Jonesboro	AR	72401	02/20/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Enrollment Contact	Part D Manager		Summitt	Lori		8702077502				8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/11/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	EOB Transfer Contact	Part D Manager		Summitt	Lori		8702077502				8702070527	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	06/13/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Financial Audit Contact	Accountant	Mrs	Domino	DeAnna		8702077526				8702070571	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Financial Reporting Contact	Accountant		Domino	DeAnna		8702077526				8702070571	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Formulary Contact	Medicare Part D Manager	Mrs	Summitt	Lori		8702077502				8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	General Contact	Executive Director	CEO	Whitehead	Chad		8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Government Relations Contact	Executive Director	CEO	Whitehead	Chad		8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	HIPAA Privacy Officer	VP Corp Compliance/Audit - SB		Shipman	Daya		8702074422				8709302854	dshipman@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	01/10/2020	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	HIPAA Security Officer	IT Security Mgr - SB	Ms	Stoneman	Marta		8702077181				8702076503	mwstoneman@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	01/10/2020	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Interoperability Contact	Operations Manager		Combs	Terry		8702077530				8702070527	tcombs@sbrmc.org	505 E. Matthews		Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	MA Appeals/Grievances Contact	Program Integrity Manager		Rowe	Shellei		8702077485				8702070550	srowe@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/22/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	MA Claims Processing Contact for Public Website	CFO		Domino	DeAnna		8702077526				8702070527	lsummitt@sbrmc.org	505 E Mattews	505 E Matthews Avenue	Jonesboro	AR	72401	04/06/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Marketing Contact	Executive Director		Whitehead	Chad		8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Medical Director	Medical Director		Murrey	James		8702077511				8702070530	jmurrey2@sbrmc.org	505 E Matthews Avenue	505 E Matthews Avenue	Jonesboro	AR	72401	01/10/2020	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Medicare Compliance Officer	Program Integrity Manager	Mrs.	Rowe	Shellei		8702077485				8702070550	srowe@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/22/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Medicare Coordinator	Medicare Part D Manager		Summitt	Lori		8702077502				8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Medicare Part D Opioid Overutilization Contact	Center Manager		Hayes	Tina		8702077503				8702070527	trhayes@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	07/28/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Medication Therapy Management Contact	Center Manager		Hayes	Tina		8702077503				8702070527	trhayes@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	01/10/2020	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Online Enrollment Center Contact (Primary)	CFO		Domino	DeAnna		8702077526				8702070527	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/07/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Part C Application Contact	COO		Combs	Terry		8702077530				8702070527	tcombs@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Part D Appeals	Part D Manager		Summitt	Lori						8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active	8552077502				PACE - Nat		C	Denver
H4305	Part D Application Contact	Part D Manager		Summitt	Lori		8702077502				8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Part D Benefits Contact	Medicare Part D Manager		Summitt	Lori		8702077502				8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Part D Claims Submission Contact	CFO		Domino	DeAnna		8702077526				8702070527	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/07/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Part D Exceptions Contact	Medicare Part D Manager		Summitt	Lori						8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active	8552077502				PACE - Nat		C	Denver
H4305	Part D Exceptions Contact (Secondary)	Part D Manager		Summitt	Lori						8702070571	lsummitt@sbrmc.org	505 E. Matthews Avenue		Jonesboro	AR	72450	02/20/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active	8702077502				PACE - Nat		C	Denver
H4305	Part D Price File Contact (Back-up)	Accountant		Domino	DeAnna		8702077526				8702070571	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Part D Price File Contact (Primary)	Medicare Part D Manager		Summitt	Lori		8702077502				8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Part D Quality Assurance Contact	Part D Manager		Summitt	Lori		8702077502				8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	08/23/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Part D Reporting Contact	Part D Manager		Summitt	Lori		8702077502				8702070571	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	02/20/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Patient Safety Contact	Program Integrity Manager		Rowe	Shellei		8702077485				8702070550	srowe@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/22/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Payment Contact	Accountant		Domino	DeAnna	J	8702077526				8702070571	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	02/22/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Pharmacy Director	Medical Director	Dr	Murrey	James		8702077505				8702070527	bmcdaniel@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	01/10/2020	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Pharmacy Network Management Contact	Center Manager		Hayes	Tina		8702077503				8702070571	trhayes@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	07/28/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Pharmacy Network Management Contact (Secondary)	Executive Director	CEO	Whitehead	Chad		8702077530				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/11/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Pharmacy Technical Help Desk Contact	Part D Manager		Summitt	Lori						8702070502	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	02/20/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active	8552077526				PACE - Nat		C	Denver
H4305	Plan Directory Contact for Public Website	Executive Director		Whitehead	Chad		8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Plan to Plan Reconciliation Contact	CFO		Domino	DeAnna		8702077526				8702070527	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/07/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Processor Contact	CFO		Domino	DeAnna		8702077526				8702070527	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/07/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Quality Contact	Program Integrity Manager		Rowe	Shellei		8702077485				8702070550	srowe@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/22/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Reconciliation Contact	CFO		Domino	DeAnna		8702077526				8702070571	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/07/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Reconciliation Contact (Secondary)	Finance Manager		Summitt	Lori		8702077502				8702070527	lsummitt@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	07/28/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Recovery Audit Contact	Asst Controller Corporate - SB	Mrs.	Domino	DeAnna		8702074969				8709721749	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	01/10/2020	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Surveillance Contact	Executive Director		Whitehead	Chad	R	8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72450	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	System Contact	Executive Director		Whitehead	Chad	R	8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Third Party Administrator (TPA) Liaison	CFO		Domino	DeAnna		8702077526				8702070527	ddomino@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/07/2022	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	User Access Contact	Executive Director		Whitehead	Chad		8702077505				8702070527	crwhitehead@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	05/02/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Utilization Management Contact	Center Manager		Hayes	Tina		8702077503				8702070527	trhayes@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/18/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4305	Utilization Review Contact	Center Manager		Hayes	Tina		8702077503				8702070527	trhayes@sbrmc.org	505 E Matthews	505 E Matthews Avenue	Jonesboro	AR	72401	04/18/2023	2023	TOTAL LIFE HEALTHCARE	National PACE	Total Life Healthcare	National PACE		St. Bernard's Healthcare	353	Yes	Active					PACE - Nat		C	Denver
H4326	Automated TrOOP Balance Transfer Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Backup User Access Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Best Available Evidence Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Bid Primary Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8284642845	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	CAP Report Contact for Public Website	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active	8284683980	5335			PACE - Nat		C	Atlanta
H4326	CEO - CMS Administrator Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	CEO - Senior Official for Contracting	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Chief Financial Officer	Finance Manager	Mrs.	Balint	Nadine		8284683980	5304			8289944298	nbalint@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Chief Operating Officer	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	09/27/2022	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Chief Information Officer	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Chief Information Security Officer	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	CMS Casework Communication Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Complaints Tracking Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Contact for Fraud Investigations	Quality and Compliance Coordinator	Mrs.	Morgan	Deborah		8284683980	5319			8284642845	dmorgan@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Coordination of Benefits Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Corporate Mailing						8284683980				8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	03/12/2015	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Coverage Gap Discount Program (CGDP) Payment Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Customer Service Operations Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	DIR Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Emergency Part D Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Encounter Data & Risk Adjustment Operations Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Enrollment Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	EOB Transfer Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Financial Audit Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Financial Reporting Contact	Finance Manager	Mrs.	Balint	Nadine		8284683980	5304			8289944298	nbalint@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Formulary Contact		Ms.	Hladilek	Kayla		7158525717					ahladilek@pharmastarpbm.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	04/20/2016	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	General Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Government Relations Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	HIPAA Privacy Officer	Quality and Compliance Coordinator	Mrs.	Morgan	Deborah		8284683980	5319			8284642845	dmorgan@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	HIPAA Security Officer	Quality and Compliance Coordinator	Mrs.	Morgan	Deborah		8284683980	5319			8284642845	dmorgan@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Interoperability Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	12/14/2021	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	MA Appeals/Grievances Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	MA Claims Processing Contact for Public Website	Finance Manager	Mrs.	Balint	Nadine		8284683980	5304			8284642845	nbalint@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Marketing Contact	Director of Professional Relations	Mrs.	Kerley	Adriah		8284683980	5340			8289944298	akerley@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Medical Director	Medical Director	Dr.	Uche	John	O	8284683980	5324			8284642845	juche@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	06/02/2023	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Medicare Compliance Officer	Quality and Compliance Coordinator	Mrs.	Morgan	Deborah		8284683980	5319			8284642845	dmorgan@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Medicare Coordinator	Finance Specialist	Mrs.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Medicare Part D Opioid Overutilization Contact	Quality and Compliance Coordinator	Mrs.	Morgan	Deborah		8284683980	5319			8284642845	dmorgan@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Medication Therapy Management Contact	Medical Director	Dr.	Uche	John	O	8284683980	5324			8284683980	juche@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	06/02/2023	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Part C Application Contact	Executive Director	Mrs.	Jones	Emily		8284683980	53335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	12/14/2021	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Part D Appeals	Executive Director	Mrs.	Jones	Emily						8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active	8284683980	5335			PACE - Nat		C	Atlanta
H4326	Part D Appeals Contact (Secondary)	Finance Specialist	Ms.	Martin	Ambra						8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active	8284683980	5313			PACE - Nat		C	Atlanta
H4326	Part D Application Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	12/14/2021	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Part D Benefits Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Part D Claims Submission Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Part D Exceptions Contact	Finance Specialist	Ms.	Martin	Ambra						8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active	8284683980	5313			PACE - Nat		C	Atlanta
H4326	Part D Price File Contact (Back-up)	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Part D Price File Contact (Primary)		Ms.	Hladilek	Kayla		7158525717					ahladilek@pharmastarpbm.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	04/20/2016	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Part D Quality Assurance Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Part D Reporting Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Patient Safety Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Payment Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Personal Health Record Contact	Medical Records	Mrs.	Bowman	Elizabeth		8284683980	5310			8284642845	ebowman@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Pharmacy Director	Clinical Pharmacist	Ms.	Canduci	Kimberly		8889742763	6567				KCanduci@carekinesis.com	228 Strawbridge Drive		Moorestown	NJ	08057	03/04/2019	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Pharmacy Network Management Contact		Ms.	Slowiak	Andrea		7158522983					aslowiak@pharmastarpbm.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	03/07/2016	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Pharmacy Technical Help Desk Contact		Ms.	Brasberger	Lindsey							LBrasberger@carekinesis.com	228 Strawbridge Drive		Moorestown	NJ	08057	03/04/2019	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active	6096701034				PACE - Nat		C	Atlanta
H4326	PHR Beneficiary Contact																	02/18/2021	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE	PACE at Home	PACE @ Home	459	Yes	Active	8284683980				PACE - Nat		C	Atlanta
H4326	Plan Directory Contact for Public Website	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Plan to Plan Reconciliation Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Processor Contact	Executive Director	Mrs.	Jones	Emily		8284642845	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Quality Contact	Quality and Compliance Coordinator	Mrs.	Morgan	Deborah		8284683980	5319			8284642845	dmorgan@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Reconciliation Contact	Finance Specialist	Ms.	Martin	Ambra		8284683980	5313			8289944298	amartin@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Recovery Audit Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Surveillance Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	System Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335				ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Third Party Administrator (TPA) Liaison	Executive Director	Mrs.	Jones	Emily		8284683980	5335				ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	User Access Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Utilization Management Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4326	Utilization Review Contact	Executive Director	Mrs.	Jones	Emily		8284683980	5335			8284642845	ejones@pace-at-home.org	1915 Fairgrove Church Rd. SE		Newton	NC	28658	08/13/2020	2023	PACE @ HOME, INC.	National PACE	PACE@Home	National PACE		PACE @ Home	459	Yes	Active					PACE - Nat		C	Atlanta
H4343	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H4343	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	01/31/2020	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	01/31/2020	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	01/31/2020	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Medical Director	Medical Director	Mr	Haake	Karl		9132951245					karl.haake@sunflowerhealthplan.com	77 West Wacker Drive, 14th Floor		Chicago	IL	60601	03/30/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H4343	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H4343	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8336230771				HMO - Health Maintenance Organization		C	Dallas
H4343	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Plan Directory Contact for Public Website			Services	Provider		8555659519					CorporateMedicareComplianceDept@CENTENE.COM	8325 Lenexa Drive	Suite 200	Lenexa	KS	66214	03/31/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4343	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4346	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	02/07/2019	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H4346	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H4346	PHR Beneficiary Contact																	12/28/2017	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H4346	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4346	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	HMO COLORADO, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4393	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Services		Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Backup User Access Contact	Chief Information Officer	Ms.	Amoroso	Mitze		6465053860					mamoroso@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Best Available Evidence Contact	Asst. VP PACE		Adam Menard	Jackie		6462897763				6462195975	jadam@archcare.org	1432 5th Ave		New York	NY	10035	04/30/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Bid Primary Contact	Chief Financial Officer	Ms.	Covone	Annmarie		6466334702					acovone@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	03/31/2011	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	CAP Report Contact for Public Website	Executive Director	Ms.	Rosado	Elizabeth		6462897772					erosado@archcare.org	1432 5th Avenue		New York	NY	10035	10/12/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	LaRue	Scott		6462856858					slarue@archcare.org	205 Lexington Ave.	3rd Floor	New York	NY	10016	12/23/2014	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	LaRue	Scott		6464754868					slarue@chcsnet.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	11/04/2016	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Chief Financial Officer	Chief Financial Officer	Ms.	Covone	Annmarie		6466334702					acovone@chcsnet.org	205 Lexington Avenue	2nd Floor	New York	NY	10016	11/04/2016	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Chief Operating Officer	Vice President PACE	Ms.	Rosado	Elizabeth		6462897700					erosado@archcare.org	1432 5th Ave		New York	NY	10032	10/12/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Chief Information Officer	VP Information Technology	Ms.	Amoroso	Mitze		6465053860				6463695679	mamoroso@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Chief Information Security Officer	VP Information Technology	Ms.	Amoroso	Mitze		6465053860				6463695679	mamoroso@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	CMS Casework Communication Contact	Vice President PACE		Rosado	Elizabeth		6462897772					erosado@archcare.org	1432 Fifth Avenue		New York	NY	10035	10/05/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Complaints Tracking Contact	Compliance Manager	Ms.	McCosker	Elizabeth		9174845041				6462335745	emccosker@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	04/05/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Contact for Fraud Investigations	SVP, Compliance and Legal	Ms.	Strum	Sarah		6466334401					sstrum@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	04/05/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Coordination of Benefits Contact	Asst. VP PACE	Mr.	Adam Menard	Jackie		6462897763				6462195975	jadam@archcare.org	1432 5th Ave		New York	NY	10035	04/30/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Corporate Mailing						6462897772					erosado@archcare.org	Elizabeth Rosado	1432 Fifth Avenue	New York	NY	10035	10/12/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Director, Finance		Traina	Marc		6466334732					mtraina@archcare.org	205 Lexington Avenue	2nd Floor	New York	NY	10016	03/20/2020	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Customer Service Operations Contact	Advisor/Project Manager, Medicare D		Swanger	Rachel		4405424056					rachelswanger@caremark.com	CVS Caremark Part D Services, LCC.	29100 Aurora Road	Solon	OH	44139	08/20/2020	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	DIR Contact	Financial Analyst		Chan	Carol		6466334761				6462335745	cchan@archcare.org	205 Lexington Avenue, 2nd Floor	Archcare Advantage - Finance	New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	DIR Contact (Secondary)	CFO	Ms	Covone	Annmarie		6466334702				6466334701	acovone@chcsnet.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	04/03/2013	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Emergency Part D Contact	Vice President PACE	Ms.	Rosado	Elizabeth		6462897772					erosado@archcare.org	1432 Fifth Avenue		New York	NY	10035	10/05/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Emergency Part D Contact (Secondary)	Director, Pharmacy Services		Krupar	Roman		9175244812				6467941400	rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Encounter Data & Risk Adjustment Operations Contact	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Ave	8th Floor	New York	NY	10016	10/24/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Enrollment Contact	Asst. VP PACE		Adam Menard	Jackie		6462897763				6462195975	jadam@archcare.org	1432 5th Ave		New York	NY	10035	04/30/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	EOB Transfer Contact	Asst. VP PACE		Adam Menard	Jackie		6462897763				6462195975	jadam@archcare.org	1432 5th Ave		New York	NY	10035	04/30/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Financial Audit Contact	Chief Financial Officer	Ms.	Covone	Annmarie		6466334702					acovone@archcare.org	205 Lexington Avenue	2nd Floor	New York	NY	10016	03/25/2011	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Financial Reporting Contact	Chief Financial Officer	Ms.	Covone	Annmarie		6466334702					acovone@chcsnet.org	205 Lexington Avenue	2nd Floor	New York	NY	10016	11/04/2016	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Formulary Contact	Director, Pharmacy Services	Mr.	Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	General Contact	Vice President PACE	Ms.	Rosado	Elizabeth		6462897772					erosado@archcare.org	1432 5th Avenue		New York	NY	10035	10/05/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Government Relations Contact	Vice President PACE	Ms.	Rosado	Elizabeth		6462897700					erosado@archcare.org	1432 5th Ave		New York	NY	10032	04/05/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	HIPAA Privacy Officer	SVP, Compliance and Legal	Ms.	Strum	Sarah		6466334401					sstrum@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	04/05/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	HIPAA Security Officer	Chief Information Officer		Amoroso	Mitze		6465053860					mamoroso@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Interoperability Contact	Director of Non-Clinical Applications		Brown	Antonette		6462535650					atbrown@archcare.org	205 Lexington Avenue, 8th Floor	8th Floor	New York	NY	10016	09/21/2023	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	MA Appeals/Grievances Contact	Vice President PACE	Ms.	Rosado	Elizabeth		6462897700					erosado@archcare.org	1432 5th Ave		New York	NY	10032	04/05/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	MA Claims Processing Contact for Public Website	Director of Claims Management	Ms.	Boglia	Quiana		6463568442					qboglia@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	10/12/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Marketing Contact	Director of Marketing & Communications		Matta	Christine		6466334744					cmatta@archcare.org	205 Lexington Avenue	8th Floor	New York	NY	10016	09/21/2023	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Medical Director	Medical Director	Dr.	Davenport	Claire		6462897700					cdavenport@archcare.org	1432 Fifth Avenue		New York	NY	10035	06/17/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Medicare Compliance Officer	SVP, Compliance and Legal	Ms.	Strum	Sarah		6466334401					sstrum@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	04/05/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Medicare Coordinator	Vice President PACE	Ms.	Rosado	Elizabeth		6462897772					erosado@archcare.org	1432 5th Avenue		New York	NY	10035	10/05/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy Services		Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Medication Therapy Management Contact	Medical Director	Dr.	Davenport	Claire		6462897700					cdavenport@archcare.org	1432 Fifth Avenue		New York	NY	10035	06/17/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Online Enrollment Center Contact (Primary)	Asst. VP PACE		Adam Menard	Jackie		6462897763				6462195975	jadam@archcare.org	1432 5th Ave		New York	NY	10035	04/30/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Part C Application Contact	Vice President PACE	Ms.	Rosado	Elizabeth		6462897772					erosado@archcare.org	1432 Fifth Avenue		New York	NY	10035	10/05/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Part D Appeals	Director Pharmacy Services		Krupar	Roman	S						rkrupar@archcare.org	205 Lexington Avenue		New York	NY	10016	01/09/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active	9174845060				PACE - Nat		C	New York
H4393	Part D Appeals Contact (Secondary)	Vice President PACE		Rosado	Elizabeth							erosado@archcare.org	1432 5th Avenue		New York	NY	10035	01/09/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active	6462897772				PACE - Nat		C	New York
H4393	Part D Application Contact	Chief Financial Officer	Ms.	Covone	Annmarie		6466334702					acovone@archcare.org	205 Lexington Avenue	2nd Floor	New York	NY	10016	02/27/2013	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Part D Benefits Contact	Director, Pharmacy Services		Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Part D Claims Submission Contact	Director, Pharmacy Services	Mr.	Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Part D Exceptions Contact	Director, Medicare Clinical Operations		Patel	Nimesh							NimeshC.Patel@CVSCaremark.com	CVS Caremark Part D Services, LCC.	29100 Aurora Road	Solon	OH	44139	01/19/2016	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active	4405425770				PACE - Nat		C	New York
H4393	Part D Exceptions Contact (Secondary)	Director, Pharmacy Services		Krupar	Roman							rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active	9174845060				PACE - Nat		C	New York
H4393	Part D Price File Contact (Back-up)	Senior Analyst, Medicare Operations		Nichols	Kristy		4806147768					kristy.nichols@caremark.com	CVS Caremark Part D Services, LCC.	9501 E Shea Boulevard	Scottsdale	AZ	85260	07/03/2013	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Part D Price File Contact (Primary)	Chief Financial Officer	Ms.	Covone	Annmarie		6466334702					acovone@chcsnet.org	205 Lexington Avenue	2nd Floor	New York	NY	10016	11/04/2016	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Part D Quality Assurance Contact	Director, Pharmacy Services	Mr.	Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Part D Reporting Contact	CFO	Ms	Covone	Annmarie		6466334702					acovone@archcare.org	205 Lexington Avenue		New York	NY	10016	11/09/2011	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Patient Safety Contact	Medical Director	Dr.	Davenport	Claire		6462897700					cdavenport@archcare.org	1432 Fifth Avenue		New York	NY	10035	06/17/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Payment Contact	Chief Financial Officer	Ms.	Covone	Annmarie		6466334702					acovone@chcsnet.org	205 Lexington Avenue	2nd Floor	New York	NY	10016	11/04/2016	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Personal Health Record Contact	Asst. VP PACE		Adam Menard	Jackie		6462897763				6462195975	jadam@archcare.org	1432 5th Ave		New York	NY	10035	04/05/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Pharmacy Director	Director, Pharmacy Services	Mr.	Krupar	Roman		9174845060					rkrupar@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	02/06/2019	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Pharmacy Network Management Contact	Director, Network Systems & Standards		Tressler	Damon		4803914702				4803146023	damon.tressler@caremark.com	CVS Caremark Part D Services, LCC.	9501 E Shea Blvd., MC080	Scottsdale	AZ	85260	01/19/2016	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Pharmacy Network Management Contact (Secondary)	Medical Director	MD	Davenport	Claire		6462897700					cdavenport@archcare.org	1432 5th Avenue		New York	NY	10035	06/17/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Pharmacy Technical Help Desk Contact	Manager, Vendor Management		Palmieri	Mike						8666934620	Mike.Palmieri@caremark.com	CVS Caremark Part D Services, LCC.	2401 Cherahala Blvd., MC650	Knoxville	TN	37932	11/23/2021	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active	8666934620				PACE - Nat		C	New York
H4393	Plan Directory Contact for Public Website	Compliance Manager	Ms.	McCosker	Elizabeth		9174845041				6462335745	emccosker@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	04/05/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Plan to Plan Reconciliation Contact	Chief Financial Officer	Ms.	Covone	Annmarie		6466334702					acovone@archcare.org	205 Lexington Ave.	2nd Floor	New York	NY	10016	11/04/2016	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Processor Contact	Vice President, Medicare Program Services		Merlino	Melanie		4802152151				4803146881	Melanie.Merlino@caremark.com	CVS Caremark Part D Services, LCC.	9501 E Shea Blvd.	Scottsdale	AZ	85260	01/19/2016	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Quality Contact	Vice President PACE	Ms.	Rosado	Elizabeth		6462897700					erosado@archcare.org	1432 5th Ave		New York	NY	10032	04/05/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Reconciliation Contact	CFO	Ms.	Covone	Annmarie		6466334702					acovone@archcare.org	205 Lexington Avenue		New York	NY	10016	10/18/2010	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Reconciliation Contact (Secondary)	Senior Director, Finance		Johnson	Timothy		6466334737					tjohnson1@archcare.org	205 Lexington Avenue, 2nd Fl	Archcare Advantage - Finance	New York	NY	10016	04/26/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Recovery Audit Contact	Financial Analyst	Ms.	Chan	Carol		6466334761				6462335745	cchan@archcare.org	205 Lexington Avenue, 2nd Floor	Archcare Advantage - Finance	New York	NY	10016	11/04/2016	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Surveillance Contact	Vice President PACE	Ms.	Rosado	Elizabeth		6462897700					erosado@archcare.org	1432 5th Ave		New York	NY	10032	04/05/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	System Contact			Brown	Antonette		6462535650					atbrown@archcare.org	205 Lexington Avenue, 8th Floor	8th Floor	New York	NY	10016	09/21/2023	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Third Party Administrator (TPA) Liaison	VP, Managed Care Organization		Fama	Victor		9174845055					vfama@archcare.org	205 Lexington Avenue, 8th Floor		New York	NY	10016	03/13/2020	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	User Access Contact	Director of Non-Clinical Applications		Brown	Antonette		6462535650					atbrown@archcare.org	205 Lexington Avenue, 8th Floor	8th Floor	New York	NY	10016	09/21/2023	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Utilization Management Contact	Medical Director	Dr.	Davenport	Claire		6462897700					cdavenport@archcare.org	1432 Fifth Avenue		New York	NY	10035	06/17/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4393	Utilization Review Contact	Medical Director	Dr.	Davenport	Claire		6462897700					cdavenport@archcare.org	1432 Fifth Avenue		New York	NY	10035	06/17/2022	2023	CATHOLIC MANAGED LONG TERM CARE, INC.	National PACE	ArchCare Senior Life	National PACE		Catholic Health Care System	317	Yes	Active					PACE - Nat		C	New York
H4402	Automated TrOOP Balance Transfer Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Backup User Access Contact	Executive Director	Ms.	Guertin	Vicki		4234959118					vguertin@ascension.org	425 Cumberland Street		Chattanooga	TN	37404	03/05/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Best Available Evidence Contact	Medical Director	Dr.	Birch	Lorna		4236980802	1080188			4236226048	lbirch@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	09/04/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Bid Primary Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	CAP Report Contact for Public Website	Director of Compliance		Brown	Judith		4234959119				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	09/16/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	CEO - CMS Administrator Contact	Executive Director	Ms.	Guertin	Vicki		4236980802				4236226048	vguertin@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	02/27/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	CEO - Senior Official for Contracting	Executive Director	Ms.	Guertin	Vicki		4236980802				4236226048	vguertin@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	03/05/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Chief Financial Officer	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Chief Operating Officer	Vice President PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Chief Information Officer	Director of PACE Informatics	Mr.	Rice	Brandon		6202222766					brandon.rice@ascension.org	2622 W Central #100		Wichita	KS	67203	04/04/2022	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Chief Information Security Officer	Director of PACE Informatics	Mr.	Rice	Brandon		6202222766					brandon.rice@ascension.org	2622 W Central #100		Wichita	KS	67203	04/04/2022	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	CMS Casework Communication Contact	Compliance director	Ms	Brown	Judith		4234959119				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	09/16/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Complaints Tracking Contact	QI Director		Brown	Judith		4234959119				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	08/12/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Contact for Fraud Investigations	Compliance Director	Mr.	Johnson	Jeff		3147293562					jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Coordination of Benefits Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Corporate Mailing						4236980802				4236226048	vguertin@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	09/04/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Coverage Gap Discount Program (CGDP) Payment Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Customer Service Operations Contact	Site Director	Ms	Herring	Beth		4234959104				4234959145	bherring@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	02/22/2022	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	DIR Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	DIR Contact (Secondary)	Senior Director of Clinical Services PACE	Ms.	Goetzinger	Jill		7725215733				4236226048	jill.goetzinger@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Emergency Part D Contact	Director of Pharmacy		McDonough	Leah		4234959203				4236226048	lmcdonough@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	04/02/2018	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Emergency Part D Contact (Secondary)	Compliance Director	Mr.	Johnson	Jeff		3147293562					jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Encounter Data & Risk Adjustment Operations Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Enrollment Contact	Accounting	Ms.	Sanders	Rebecca		8016880282					rebecca.sanders2@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/11/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	EOB Transfer Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Financial Audit Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Financial Reporting Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/14/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Formulary Contact	Medical Director	Dr.	Birch	Lorna		4236980802	1080188			4236226048	lbirch@ascension.org	425 Cumberland Street	Suite 110	Chattanoga	TN	37404	09/04/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Formulary Contact (Secondary)	Pharmacy Director	Ms.	McDonough	Leah		4234953203					lmcdonough@ascension.org	425 Cumberland Street #110		Chattanooga	TN	37404	05/12/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	General Contact	Executive Director	Ms	Guertin	Vicki		4234959118				4236226048	vguertin@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	06/22/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Government Relations Contact	QI Director	Ms	Brown	Judith		4234959119				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	08/12/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	HIPAA Privacy Officer	Dir.Clinical Services	Ms	Brown	Judith		4234951991				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	09/16/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	HIPAA Security Officer	Dir.Quality	Ms	Brown	Judith		4234959119				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	09/16/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Interoperability Contact	Executive Director		Guertin	Vicki		4234949119				4236226048	vguertin@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	05/31/2022	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	MA Appeals/Grievances Contact	QI Director		Brown	Judith		4234959119				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	08/12/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	MA Claims Processing Contact for Public Website	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Marketing Contact	Marketing Director	Ms.	Thompson	Sierra		4236980802					sierra.thompson@ascension.org	425 Cumberland Street		Chattanooga	TN	37404	01/24/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Medical Director	Medical Director	Dr.	Birch	Lorna		4236980802	1080188			4236226048	lbirch@ascension.org	425 Cumberland Street	Suite 110	Chattanoga	TN	37404	09/04/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Medicare Compliance Officer	Compliance Director	Ms	Brown	Judith		4234959119				4236971752	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	04/27/2022	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Medicare Coordinator	Dir Compliance	Ms	Brown	Judith		4234959119				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	09/16/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Birch	Lorna		4236980802	1080188			4236226048	lbirch@ascension.org	425 Cumberland Street	Suite 110	Chattanoga	TN	37404	09/04/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Medication Therapy Management Contact	Medical Director	Dr.	Birch	Lorna		4236980802	1080188			4236226048	lbirch@ascension.org	425 Cumberland Street	Suite 110	Chattanoga	TN	37404	09/04/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Part C Application Contact	Executive Director	Ms.	Guertin	Vicki		4236980802				4236226048	vguertin@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	02/27/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Part D Appeals	Pharmacy Director		McDonough	Leah						4234959213	lmcdonough@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	02/18/2022	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active	4234959203				PACE - Nat		C	Atlanta
H4402	Part D Application Contact	Administrator	Ms.	Guertin	Vicki		4234959118					vguertin@ascension.org	425 Cumberland Street		Chattanooga	TN	37404	04/02/2018	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Part D Benefits Contact	Pharmacy Director		McDonough	Leah		4234959203				4236226048	lmcdonough@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	06/22/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Part D Claims Submission Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Part D Exceptions Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty						4236226048	ty.webster@ascension.org	250 East 10th Street		Chattanooga	TN	37402	09/22/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active	8004418883				PACE - Nat		C	Atlanta
H4402	Part D Exceptions Contact (Secondary)	Compliance Director	Mr.	Johnson	Jeff							jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active	8008814443				PACE - Nat		C	Atlanta
H4402	Part D Price File Contact (Back-up)	Director of Pharmacy		McDonough	Leah		4234959203				4236226048	lmcdonough@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	04/02/2018	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Part D Price File Contact (Primary)	Executive Director	Ms.	Guertin	Vicki		4236980802				4236226048	vguertin@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	03/05/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Part D Quality Assurance Contact	QI Director		Brown	Judith		4234959119				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	08/12/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Part D Reporting Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Patient Safety Contact	QI Director		Brown	Judith		4234959119				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	08/12/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Payment Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/14/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Personal Health Record Contact	Director of Health Information		April	Marr	M	4236980802	117				mmarr@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	08/12/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Pharmacy Director	Director of Pharmacy		McDonough	Leah		4234959203				4236226048	lmcdonough@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	04/02/2018	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Pharmacy Network Management Contact	Medical Director	Dr.	Birch	Lorna		4236980802	1080188			4236226048	lbirch@ascension.org	425 Cumberland Street	Suite 110	Chattanoga	TN	37404	09/04/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Pharmacy Technical Help Desk Contact	Director of Pharmacy		McDonough	Leah						4236226048	lmcdonough@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	04/02/2018	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active	8004418883				PACE - Nat		C	Atlanta
H4402	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacist-PharmD		Hankins	Sherry						4236226048	shankins@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	04/02/2018	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active	4236980802	203			PACE - Nat		C	Atlanta
H4402	PHR Beneficiary Contact																	06/07/2011	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE	Alexian Brothers Community Services	Ascension Health Alliance	708	Yes	Active	8004418883				PACE - Nat		C	Atlanta
H4402	Plan Directory Contact for Public Website	Marketing Director	Ms.	Thompson	Sierra		4236980802					sierra.thompson@ascension.org	425 Cumberland Street		Chattanooga	TN	37404	01/24/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Plan to Plan Reconciliation Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	03/14/2022	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Processor Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Quality Contact	QI Director		Brown	judith		4234959119				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	08/12/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Reconciliation Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Reconciliation Contact (Secondary)	Vice President PACE Operations	Mr.	Cooper	Brian		3143849724					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/14/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Recovery Audit Contact	Vice President PACE Operations	Mr.	Cooper	Brian	D	3143849724					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/14/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Surveillance Contact	Compliance Director	Mr.	Johnson	Jeff		3147293562					jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	System Contact	Vice President PACE Operations	Mr.	Cooper	Brian	D	3147293592					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Third Party Administrator (TPA) Liaison	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	User Access Contact	Quality Director	Ms	brown	judith		4234959119				4236226048	judith.brown2@ascension.org	425 Cumberland Street	Suite 110	Chattanooga	TN	37404	08/12/2021	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Utilization Management Contact	Medical Director	Dr.	Birch	Lorna		4236980802	1080188			4236226048	lbirch@ascension.org	425 Cumberland Street	Suite 110	Chattanoga	TN	37404	09/04/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4402	Utilization Review Contact	Medical Director	Dr.	Birch	Lorna		4236980802	1080188			4236226048	lbirch@ascension.org	425 Cumberland Street	Suite 110	Chattanoga	TN	37404	09/04/2020	2023	ALEXIAN BROTHERS COMMUNITY SERVICES	National PACE	Ascension Living Alexian PACE	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Atlanta
H4407	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/14/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H4407	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H4407	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H4407	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H4407	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H4407	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H4407	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4407	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4461	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H4461	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H4461	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4461	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	CARITEN HEALTH PLAN INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4490	Agent/Broker Compensation Data Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Automated TrOOP Balance Transfer Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Backup User Access Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Best Available Evidence Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Bid Audit Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Bid Audit Site Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Bid Primary Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	CAP Report Contact for Public Website	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	CEO - CMS Administrator Contact	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	CEO - Senior Official for Contracting	CEO	Mr.	Bailey	Michael	D	6157518131				8442805360	mbailey@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Chief Financial Officer	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Chief Operating Officer	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Chief Information Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Chief Information Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	CMMI Model Point of Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	CMS Casework Communication Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Complaints Tracking Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Contact for Fraud Investigations	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Coordination of Benefits Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Corporate Mailing						6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Customer Service Operations Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	05/18/2020	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	DIR Contact	VP Formulary & Rebate Economics		Ellermeir	Nicole		9133875120					nellermeir@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	DIR Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Electronic Health Record Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Emergency Part D Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Emergency Part D Contact (Secondary)	Pharmacy Operations	Mrs.	Sanchez	Lynn		4056014429				8442805360	lsanchez@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Encounter Data & Risk Adjustment Operations Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Enrollment Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	EOB Transfer Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Financial Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Financial Reporting Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Formulary Contact	Clinical Formulary Pharmacist	Ms.	Quinn	Kelsey		3304864954					kquinn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Formulary Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	General Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Government Relations Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	HIPAA Privacy Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	HIPAA Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Hospice Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Interoperability Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	MA Appeals/Grievances Contact	A&G Team Lead	Mrs.	Henderson	Maya		6156268442				8442805360	mhenderson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	MA Claims Processing Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		8003997524				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Marketing Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Medical Director	Medical Director	Dr.	Misra	Sumathi		6156365478					SMisra@AmHealthPlans.com	201 Jordan Road	Ste 200	Franklin	TN	37067	02/17/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Medicare Compliance Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Medicare Coordinator	Executive Director	Ms.	Kukuljan	Shiloh		3143549940				8442805360	skukuljan@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Medicare Part D Opioid Overutilization Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Medication Therapy Management Contact	Director of Clinical Product Development and Strat	Ms.	Miller	Holly		3304866457				3304058094	hrmiller@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	OffShore Subcontractor Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Online Enrollment Center Contact (Back-up)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Online Enrollment Center Contact (Primary)	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Part C Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Part C Reporting Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Appeals	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations	Mr	Binegar	Sam						3304058081	appeals@ElixirSolutions.com	2181 E Aurora Road	Building B, Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8003997524				HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Benefits Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Claims Submission Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Exceptions Contact	Associate VP of Clinical Operations	Ms.	Lavignette	Amanda						3304864801	alavignette@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Exceptions Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Price File Contact (Back-up)	Sr Financial Manager Reporting & Analytics	Mr	Campbell	Tim		3308886988					tcampbell@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Price File Contact (Optional)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Price File Contact (Primary)	Senior Director Rebates, Trade Relations	Mr.	Bonus	Jason		3304864841				3304864801	jbonus@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Quality Assurance Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Part D Reporting Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Patient Safety Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Pharmacy Director	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Pharmacy Network Management Contact	Director of Pharmacy Network Development and Ops	Ms	Profio	Lauren		3304864864				3304058094	lprofio@EnvisionRx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Pharmacy Network Management Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8335026757				HMO - Health Maintenance Organization		C	Dallas
H4490	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Technician		Sanchez	Lynn						6157610920	lsanchez@amhealthplans.com	909 S Meridian Avenue	Ste 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8442287934				HMO - Health Maintenance Organization		C	Dallas
H4490	Plan Directory Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Plan to Plan Reconciliation Contact	Sr. Manager,  Financial Accounting	Ms.	Tilley	Stephanie		9312420499					stilley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	08/30/2023	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Processor Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Quality Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Reconciliation Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Reconciliation Contact (Secondary)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Recovery Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	SNP Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	SNP State Contact	Executive Director	Ms.	Kukuljan	Shiloh		3143549940				8442805360	skukuljan@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Surveillance Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	System Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Third Party Administrator (TPA) Liaison	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	User Access Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Utilization Management Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4490	Utilization Review Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MISSOURI, INC.	Local CCP	American Health Advantage of Missouri	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4497	Agent/Broker Compensation Data Contact	Director, Broker Administration		Chilia	Tony		2166871948					tony.chilia@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Automated TrOOP Balance Transfer Contact	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Backup User Access Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Best Available Evidence Contact	Medicare Operations Analyst II		Crowley	Lauren		2166876585					BAEdocs@medmutual.com	100 American Road		Cleveland	OH	44144	04/03/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Bid Audit Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Bid Audit Site Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Bid Primary Contact	Lead Medicare Products Analyst		Kotecki	Bradley		2166872762					bradley.kotecki@medmutual.com	100 American Road		Cleveland	OH	44144	06/09/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	CAP Report Contact for Public Website	Medicare Compliance Officer		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	CEO - CMS Administrator Contact	President and CEO	Mr.	Glass	Steve		2166876223					steve.glass@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	CEO - Senior Official for Contracting	President and CEO	Mr.	Glass	Steve		2166876223					steve.glass@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Chief Financial Officer	Chief Financial Officer	Mr.	Helton	Tony		2166877409					Anthony.Helton@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Chief Operating Officer	Director, Medicare Compliance	Ms.	Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Chief Information Officer	Chief Information Officer	Mr.	Donovan	Chris		4408786450					chris.donovan@medmutual.com	100 American Road		Cleveland	OH	44144	04/03/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Chief Information Security Officer	Chief Data & Information Officer	Mr.	Donovan	Chris		4408786450					chris.donovan@medmutual.com	100 American Road		Cleveland	OH	44144	04/03/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	CMS Casework Communication Contact	Director, Customer Care		Glaspie	Anissa		2166877059					anissa.glaspie@medmutual.com	100 American Road		Cleveland	OH	44144	04/03/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Complaints Tracking Contact	Director, Customer Care		Glaspie	Anissa		2166877059					anissa.glaspie@medmutual.com	100 American Road		Cleveland	OH	44144	04/03/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Contact for Fraud Investigations	Director, Financial Investigations		Shoemaker	John		2166877245					john.shoemaker@medmutual.com	100 American Road		Cleveland	OH	44144	04/03/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Coordination of Benefits Contact	Manager, COB and Workers Comp		Njaim	Stephanie		4194737733					Stephanie.Njaim@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Corporate Mailing						2166877000					Victoria.Kressler@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Reporting and Data Analytics		Stepic	Michelle		2166877151					michelle.stepic@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Customer Service Operations Contact	Director, Customer Care		Glaspie	Anissa		2166877059					Anissa.Glaspie@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	DIR Contact	Manager, Financial Reporting and Data Analytics		Stepic	Michelle		2166877151					Michelle.Stepic@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	DIR Contact (Secondary)	Director, Corporate Financial Reporting		Fallon	Pembroke		2166877181					pembroke.fallon@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Electronic Health Record Contact	Director, HIPAA and Vendor Contract Compliance		Mayock	Julie		2166877769					Julie.Mayock@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Emergency Part D Contact	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Emergency Part D Contact (Secondary)	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Employer Waiver Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Encounter Data & Risk Adjustment Operations Contact	Manager, Risk Adjustment Information Services		Shaner	Donald		2166877159					Donald.Shaner@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Enrollment Contact	Director, Membership Services		Miller	Sue		2166877454					sue.miller@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	EOB Transfer Contact	Sr. Project Manager		Rush	Jamie		5132347613	617613			2166877675	ESITrOOPTransfer@express-scripts.com	8990 Duke Drive		Mason	OH	45040	12/14/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Financial Audit Contact	Lead Financial Analyst	Mr.	Long	David		2166876309					david.long@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Financial Reporting Contact	VP, Corporate Controller		Hanawalt	Cory		2166872790					corey.hanawalt@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Formulary Contact	Director, Pharmacy		Blagojevic	Marko		2166876239					Marko.Blagojevic@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Formulary Contact (Secondary)	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	General Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Government Relations Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	HIPAA Privacy Officer	VP, Corporate Compliance Officer		Mancino	Paul		2166872675					paul.mancino@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	HIPAA Security Officer	EVP, Chief Data and Information Officer		Donovan	Chris		4408786450					Chris.Donovan@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Hospice Contact	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Interoperability Contact	Director, HIPAA and Vendor Contracts		Mayock	Julie		2166877769					julie.mayock@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	MA Appeals/Grievances Contact	Director, Customer Care		Glaspie	Anissa		2166877059					Anissa.Glaspie@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	MA Claims Processing Contact for Public Website	Director, Claims Operations		Rittner	Kim		2166874377					kim.rittner@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Marketing Contact	Manager, Acquisition Marketing		Schultz	Melissa		2166877000					Melissa.Schultz@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Medical Director	Sr. Medical Officer	Dr.	Muzina	David		2166876480					david.muzina@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Medicare Compliance Officer	Director, Medicare Compliance	Ms.	Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Medicare Coordinator	Manager, Medicare Compliance		Trost	Lisa		2166877830					MACompliance@medmutual.com	2060 E. Ninth Street		Cleveland	OH	44115	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Ivec	Carl		2166876017					carl.ivec@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Medication Therapy Management Contact	Clinical Pharmacist		Ivec	Carl		2166876017					carl.ivec@medmutual.com	100 American Road		Cleveland	OH	44144	04/03/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	OffShore Subcontractor Contact	Manager, Medicare Compliance		Trost	Lisa		2166877830					MACompliance@medmutual.com	2060 E. Ninth Street		Cleveland	OH	44115	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Online Enrollment Center Contact (Back-up)	Manager, Member Services & System Administration		Bartholomai	Diane		2166877357					Diane.Bartholomai@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Online Enrollment Center Contact (Optional)	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Online Enrollment Center Contact (Primary)	Director, Membership Services		Miller	Sue		2166877454					sue.miller@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Part C Application Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Part C Reporting Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Part D Appeals	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/14/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active	8003443405	733326			PPO - BBA		C	Chicago
H4497	Part D Appeals Contact (Secondary)	Director, Pharmacy - Medicare and Information		Goff	Katherine							Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active	2166877344				PPO - BBA		C	Chicago
H4497	Part D Application Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Part D Benefits Contact	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive.		Franklin Lakes	NJ	07417	05/19/2021	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Part D Exceptions Contact	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/14/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active	6143363326				PPO - BBA		C	Chicago
H4497	Part D Exceptions Contact (Secondary)	Director, Pharmacy - Medicare and Information		Goff	Katherine							Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active	2166877344				PPO - BBA		C	Chicago
H4497	Part D Price File Contact (Back-up)	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Part D Price File Contact (Optional)	Sr. Manager Government Programs		Dolfi	Amanda		6147613606				2166872623	amanda_dolfi@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/14/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Part D Price File Contact (Primary)			Westrum	Joshua		4807363132	433132				Medicarewebsitefiles@express-scripts.com	7909 S. Hardy Dr.	#106	Tempe	AZ	85284	12/14/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Part D Quality Assurance Contact	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Part D Reporting Contact	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Patient Safety Contact	Director, Pharmacy		Blagojevic	Marko		2166876239					Marko.Blagojevic@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Payment Contact	VP, Corporate Controller		Hanawalt	Cory		2166872790					Cory.Hanawalt@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Personal Health Record Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Pharmacy Director	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Pharmacy Network Management Contact			Kelly	Heather		3146921866					hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	02/02/2015	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	4700 North Hanley		St. Louis	MO	63134	12/23/2021	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active	8009221557				PPO - BBA		C	Chicago
H4497	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy - Medicare and Information		Goff	Katherine							Katherine.Goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active	2166877344				PPO - BBA		C	Chicago
H4497	Physician Incentive Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Plan Directory Contact for Public Website	Director, Provider Experience		Subsinsky	Shirra		8003621279					ProviderInformation@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Plan to Plan Reconciliation Contact	Manager, Financial Reporting and Data Analytics		Stepic	Michelle		2166877151					Michelle.Stepic@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Processor Contact	Sr. Director, Government Programs Medicare		Gibson	Sharon		8057779130					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	11/28/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Quality Contact	Director, Clinical Quality Improvement		Sullivan	Suzanne		4408786481					suzanne.sullivan@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Reconciliation Contact	Manager, Financial Reporting and Data Analytics		Stepic	Michelle		2166877151					Michelle.Stepic@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Reconciliation Contact (Secondary)	Director, Corporate Financial Reporting		Fallon	Pembroke		2166877181					pembroke.fallon@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Recovery Audit Contact	Director, Financial Payment and Review	Mr.	Palace	Ted		2166872807					Ted.Palace@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	SNP Application Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	SNP State Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Surveillance Contact	Director, Individual Sales and Compliance		Coyne	Jaime		2166872676					MASalesCompliance@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	System Contact	VP, Chief Technology Officer		Stein	Matt		4408786460					matt.stein@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Third Party Administrator (TPA) Liaison	Manager, Financial Reporting and Data Analytics		Stepic	Michelle		2166877151					Michelle.Stepic@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	User Access Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Utilization Management Contact	VP, Clinical Care Management		Nadzam	Victoria		2166877824					victoria.nadzam@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4497	Utilization Review Contact	VP, Clinical Care Management		Nadzam	Victoria		2166877824					victoria.nadzam@medmutual.com	100 American Road		Cleveland	OH	44144	05/12/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	Local PPO		MEDICAL MUTUAL OF OHIO	289	Yes	Active					PPO - BBA		C	Chicago
H4506	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Corporate Mailing						8132063477					crysten.troutman@wellcare.com	P. O. Box 31386		Tampa	FL	33631	10/02/2020	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/15/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/24/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/15/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/15/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	09/21/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/15/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H4506	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/15/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H4506	PHR Beneficiary Contact																	09/27/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H4506	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/15/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4506	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	SELECTCARE OF TEXAS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4513	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/14/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H4513	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H4513	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H4513	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H4513	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H4513	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H4513	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4513	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H4514	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H4514	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H4514	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H4514	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H4514	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4514	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4517	Automated TrOOP Balance Transfer Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Backup User Access Contact	Executive Director		Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Best Available Evidence Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Bid Primary Contact	Executive Director		Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	CAP Report Contact for Public Website	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	CEO - CMS Administrator Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	CEO - Senior Official for Contracting	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Chief Financial Officer	Director of Finance	Mrs	Houck	Jamie		8063745516				8063739446	jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	11/05/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Chief Operating Officer	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Chief Information Officer	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Chief Information Security Officer	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	CMS Casework Communication Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Complaints Tracking Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Contact for Fraud Investigations	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Coordination of Benefits Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Corporate Mailing						8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Customer Service Operations Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	DIR Contact	Director of Finance	Mrs	Houck	Jamie		8063745516				8063739446	jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	02/24/2021	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	DIR Contact (Secondary)	Executive Director	Mrs	Hurt	Kristen	R	8063745516					krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	02/24/2021	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Emergency Part D Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Emergency Part D Contact (Secondary)	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Encounter Data & Risk Adjustment Operations Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Enrollment Contact	Master Social Worker		Gaitan	Ruby		8063745516				8063739446	ruby@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	05/06/2015	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	EOB Transfer Contact	Director of Finance		Houck	Jamie		8063745516				8063739446	jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Financial Audit Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Financial Reporting Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Formulary Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	General Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Government Relations Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	HIPAA Privacy Officer	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	HIPAA Security Officer	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Interoperability Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	04/26/2022	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	MA Appeals/Grievances Contact	Compliance Coordinator	Ms	Gross	Stephanie		8063745516				8063739446	stephanie@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	07/22/2021	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	MA Claims Processing Contact for Public Website	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Marketing Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Medical Director	Medical Director		Rankin	Ron		8063745516				8063734769	ron@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	05/05/2010	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Medicare Compliance Officer	Compliance Coordinator	Ms	Gross	Stephanie		8063745516				8063739446	stephanie@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	07/22/2021	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Medicare Coordinator	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Medicare Part D Opioid Overutilization Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	04/26/2022	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Medication Therapy Management Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Part C Application Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Part D Appeals	Executive Director		Hurt	Kristen	R					8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active	8882996401				PACE - Nat		C	Dallas
H4517	Part D Appeals Contact (Secondary)	Director of Finance		Houck	Jamie						8063739446	jamieh@janwerneradultdaycare.org	3108 S. Fillmore		Amarillo	TX	79110	01/04/2021	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active	8882996401				PACE - Nat		C	Dallas
H4517	Part D Application Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Part D Benefits Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Part D Claims Submission Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Part D Exceptions Contact	Finance Director	Ms	Houck	Jamie						8063739446	jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active	8883748400				PACE - Nat		C	Dallas
H4517	Part D Price File Contact (Back-up)	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Part D Price File Contact (Primary)	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Part D Quality Assurance Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Part D Reporting Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Patient Safety Contact	Director of Clinical Services		Skarke	Lana		8063745516				8063734769	lskarke@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	07/22/2021	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Payment Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Pharmacy Director	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Pharmacy Network Management Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Pharmacy Technical Help Desk Contact	Director of Finance	Ms	Houck	Jamie						8063739446	jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active	8882996401				PACE - Nat		C	Dallas
H4517	Plan Directory Contact for Public Website	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Plan to Plan Reconciliation Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Processor Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Quality Contact	Executive Director		Hurt	Kristen		8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Reconciliation Contact	Director of Finance	Mrs	Houck	Jamie		8063745516				8063739446	jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	02/24/2021	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Reconciliation Contact (Secondary)	Executive Director	Mrs	Hurt	Kristen	R	8063745516					krissy@janwerneradultdaycare.org	3108 S. Fillmore		Amarillo	TX	79110	02/24/2021	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Recovery Audit Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Surveillance Contact	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	System Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Third Party Administrator (TPA) Liaison	Executive Director	Mrs	Hurt	Kristen	R	8063745516				8063739446	krissy@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	79110	09/08/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	User Access Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Utilization Management Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4517	Utilization Review Contact	Director of Finance		Houck	Jamie		8063745516					jamieh@janwerneradultdaycare.org	3108 S Fillmore		Amarillo	TX	791101026	03/20/2020	2023	AMARILLO MULTISVC CTR FR THE AGING INC	National PACE	The Basics at Jan Werner	National PACE		Amarillo Multisvc Ctr Fr the Aging Inc	12	Yes	Active					PACE - Nat		C	Dallas
H4518	Automated TrOOP Balance Transfer Contact	Accounts Payable Manager		Garcia	Irene		9155623444	2370				Irene.Garcia@bienvivir.org	2300 McKinley		El Paso	TX	79930	12/17/2019	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Backup User Access Contact	EHR Project Manager		Caracosa	Luis		9155623444	2410				lcaracosa@bienvivir.org	2300 McKinley		El Paso	TX	79930	04/24/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Best Available Evidence Contact	Accounting Supervisor		Garcia	Irene		9155623444	2370				igarcia@bienvivir.org	2300 McKinley		El Paso	TX	79930	05/23/2016	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Bid Primary Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luisortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	02/22/2022	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	CAP Report Contact for Public Website	Director of Process Improvement	Mr	Alvarado	Efren	A	9155623444	1606			9158758851	efren.alvarado@bienvivir.org	2300 McKinley		El Paso	TX	79930	07/15/2022	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	CEO - CMS Administrator Contact	Chief Executive Officer	Ms	Castillo	Rosemary		9155623444	2800				CEO@bienvivir.org	2300 McKinley		El Paso	TX	79930	09/18/2017	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	CEO - Senior Official for Contracting	Chief Executive Officer	Ms	Castillo	Rosemary		9155623444	2800				CEO@bienvivir.org	2300 McKinley		El Paso	TX	79930	09/18/2017	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Chief Financial Officer	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luis.ortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	08/13/2021	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Chief Operating Officer	VP of Center Operations	MR	Baca	James		9155623444	2240				jbaca@bienvivir.org	2300 McKinley		El Paso	TX	79930	10/30/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Chief Information Officer	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luis.ortiz@bienvivir.org	2300 McKinley		El Paso	TX	79930	08/13/2021	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Chief Information Security Officer		Mr	Caracosa	Luis		9155623444	2410				lcaracosa@bienvivir.org	2300 McKinley		El Paso	TX	79930	02/12/2016	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	CMS Casework Communication Contact	QI Manager	Ms.	Alvarado	Karla	L	9155623444	1603				karla.alvarado@bienvivir.org	2300 McKinley		El Paso	TX	79930	07/15/2022	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Complaints Tracking Contact	QI Manager	Ms.	Alvarado	Karla	L	9155623444	1603			9158758851	karla.alvarado@bienvivir.org	2300 McKinley		El Paso	TX	79930	07/15/2022	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Contact for Fraud Investigations	Compliance Officer	Mr	Barrera	Antonio		9155623444	1703				antonio.barrera@bienvivir.org	2300 McKinley		El Paso	TX	79930	02/23/2021	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Coordination of Benefits Contact	Accounts Payable Manager		Garcia	Irene		9155623444	2370				Irene.Garcia@bienvivir.org	2300 McKinley		El Paso	TX	79930	12/17/2019	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Corporate Mailing						9155623444	2800				sgalindo@bienvivir.org	2300 McKinley		El Paso	TX	79930	10/30/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Coverage Gap Discount Program (CGDP) Payment Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	05/23/2016	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Customer Service Operations Contact	VP of Center Operations	MR	Baca	James		9155623444	2240				jbaca@bienvivir.org	2300 McKinley		El Paso	TX	79930	10/30/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	DIR Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luis.ortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	03/21/2018	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	DIR Contact (Secondary)	Accounts Payable Manager		Garcia	Irene		9155623444	2370				Irene.Garcia@bienvivir.org	2300 McKinley Ave		El Paso	TX	79930	12/17/2019	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Emergency Part D Contact	Director of Pharmacy		Orona	Robert		9155623444	1801				rorona@bienvivir.org	2300 McKinley		El Paso	TX	79930	04/24/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Emergency Part D Contact (Secondary)	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	12/17/2019	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Encounter Data & Risk Adjustment Operations Contact	Accounts Payable Manager		Garcia	Irene		9155623444	2370				Irene.Garcia@bienvivir.org	2300 McKinley		El Paso	TX	79930	12/17/2019	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Enrollment Contact	Accounting Supervisor		Garcia	Irene		9155623444	2370				igarcia@bienvivir.org	2300 McKinley		El Paso	TX	79930	05/23/2016	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	EOB Transfer Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101			9158758850	luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Financial Audit Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luis.ortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	08/13/2021	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Financial Reporting Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luis.ortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	08/13/2021	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Formulary Contact	Director of Pharmacy		Orona	Robert		9155623444	1801				rorona@bienvivir.org	2300 McKinley		El Paso	TX	79930	04/24/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	General Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Government Relations Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	HIPAA Privacy Officer	Compliance Officer	Mr	Barrera	Antonio		9155623444	1703				antonio.barrera@bienvivir.org	2300 McKinley		El Paso	TX	79930	02/23/2021	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	HIPAA Security Officer	EHR Project Manager		Caracosa	Luis		9155623444	2410				lcaracosa@bienvivir.org	2300 McKinley		El Paso	TX	79930	04/24/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Interoperability Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luis.ortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	03/16/2022	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	MA Appeals/Grievances Contact	QI Manager	Ms.	Alvarado	Karla	L	9155623444	1603			9158758851	karla.alvarado@bienvivir.org	2300 McKinley		El Paso	TX	79930	07/15/2022	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	MA Claims Processing Contact for Public Website	Accounts Payable Manager		Garcia	Irene		9155623444	2370				Irene.Garcia@bienvivir.org	2300 McKinley		El Paso	TX	79930	12/17/2019	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Marketing Contact	Marketing Supervisor		Salinas	Michelle		9155623444	1315				msalinas@bienvivir.org	2300 McKinley		El Paso	TX	79930	10/30/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Medical Director	Medical Director	Dr.	Hurtado	Cuauhtemoc		9155623444	2800				Cuauhtemoc.Hurtado@bienvivir.org	2300 McKinley		El Paso	TX	79930	09/04/2020	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Medicare Compliance Officer	Compliance Officer	Mr	Barrera	Antonio		9155623444	1703				antonio.barrera@bienvivir.org	2300 McKinley		El Paso	TX	79930	02/23/2021	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Medicare Coordinator	Accounting Supervisor		Garcia	Irene		9155623444	2370				irene.payan@bienvivir.org	2300 McKinley		El Paso	TX	79930	08/13/2021	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Orona	Robert		9155623444	1801				rorona@bienvivir.org	2300 McKinley		El Paso	TX	79930	11/20/2018	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Medication Therapy Management Contact	Chief Executive Officer	Ms	Castillo	Rosemary		9155623444	2800				CEO@bienvivir.org	2300 McKinley		El Paso	TX	79930	12/17/2019	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Part C Application Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Part D Appeals	VP of Finance	Mr	Ortiz	Luis							luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active	9155623444	2101			PACE - Nat		C	Dallas
H4518	Part D Appeals Contact (Secondary)	PACE Center Director		Olivas	Naomi							naomi.olivas@bienvivir.org	2300 McKinley Ave		El Paso	TX	79930	01/06/2021	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active	9155623444	2470			PACE - Nat		C	Dallas
H4518	Part D Application Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Part D Benefits Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Part D Claims Submission Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Part D Exceptions Contact	Director of Pharmacy		Orona	Robert							rorona@bienvivir.org	2300 McKinley		El Paso	TX	79930	10/30/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active	9155623444	1801			PACE - Nat		C	Dallas
H4518	Part D Price File Contact (Back-up)	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Part D Price File Contact (Primary)	Accounting Supervisor		Garcia	Irene		9155623444	2370				ipayan@bienvivir.org	2300 McKinley		El Paso	TX	79930	06/17/2005	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Part D Quality Assurance Contact	QI Manager	Ms.	Alvarado	Karla	L	9155623444	1603			9158758851	karla.alvarado@bienvivir.org	2300 McKinley		El Paso	TX	79930	07/15/2022	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Part D Reporting Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luis.ortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	02/25/2021	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Patient Safety Contact	Chief Executive Officer	Ms	Castillo	Rosemary		9155623444	2800				CEO@bienvivir.org	2300 McKinley		El Paso	TX	79930	12/17/2019	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Payment Contact	Accounting Supervisor		Garcia	Irene		9155623444	2370				ipayan@bienvivir.org	2300 McKinley		El Paso	TX	79930	05/13/2005	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Pharmacy Director	Director of Pharmacy		Orona	Robert		9155623444	1801				rorona@bienvivir.org	2300 McKinley		El Paso	TX	79930	04/24/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Pharmacy Network Management Contact	Director of Pharmacy		Orona	Robert		9155623444	1801				rorona@bienvivir.org	2300 McKinley		El Paso	TX	79930	04/24/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Pharmacy Technical Help Desk Contact	Director of Pharmacy		Orona	Robert							rorona@bienvivir.org	2300 McKinley		El Paso	TX	79930	04/24/2012	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active	9155623444	1801			PACE - Nat		C	Dallas
H4518	Pharmacy Technical Help Desk Contact (Secondary)	Chief Executive Officer	Ms	Castillo	Rosemary							CEO@bienvivir.org	2300 McKinley		El Paso	TX	79930	12/17/2019	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active	9155623444				PACE - Nat		C	Dallas
H4518	Plan Directory Contact for Public Website	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Plan to Plan Reconciliation Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Processor Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Quality Contact	QI Manager	Ms.	Alvarado	Karla	L	9155623444	1603			9158758851	karla.alvarado@bienvivir.org	2300 McKinley		El Paso	TX	79930	07/15/2022	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Reconciliation Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luis.ortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	03/21/2018	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Recovery Audit Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Surveillance Contact	VP of Center Operations	Mr	Baca	James		9155623444	2240			9158758841	jbaca@bienvivir.org	2300 McKinley		El Paso	TX	79930	09/18/2017	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	System Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Third Party Administrator (TPA) Liaison	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	05/23/2016	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	User Access Contact	VP of Finance	Mr	Ortiz	Luis		9155623444	2101				luiortiz@bienvivir.org	2300 Mckinley		El Paso	TX	79930	10/28/2015	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Utilization Management Contact	Utilization Management Nurse	Ms	Acevedo	Imelda		9155623444	2216				iacevedo@bienvivir.org	2300 McKinley street		El Paso	TX	79930	04/11/2011	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4518	Utilization Review Contact	Utilization Management Nurse	Ms	Acevedo	Imelda		9155623444	2216				iacevedo@bienvivir.org	2300 McKinley street		El Paso	TX	79930	04/11/2011	2023	BIENVIVIR SENIOR HEALTH SERVICES	National PACE	Bienvivir Senior Health Services	National PACE		Bienvivir Senior Health Services	23	Yes	Active					PACE - Nat		C	Dallas
H4523	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/09/2015	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H4523	PHR Beneficiary Contact																	11/15/2012	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				HMO - Health Maintenance Organization		C	Philadelphia
H4523	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/11/2015	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4523	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (TX)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4527	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H4527	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H4527	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H4527	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H4527	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4527	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	PHYSICIANS HEALTH CHOICE OF TEXAS, LLC	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4537	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/24/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/30/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H4537	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H4537	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H4537	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H4537	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H4537	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H4537	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8338530865				PPO - BBA		C	Dallas
H4537	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4537	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF OKLAHOMA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4544	Agent/Broker Compensation Data Contact			Robert	Michael		5048494500	8550				michael.robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Backup User Access Contact			Hulin	Colin		5048494500	8900				colin.hulin@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Best Available Evidence Contact			Shirer	Rachael		5046818545					rachael.shirer@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Bid Audit Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	CEO - CMS Administrator Contact		Mrs.	O'Brien	Suzanne	S	5048494510	8510				Suzi.Swoop@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	CEO - Senior Official for Contracting		Mrs.	O'Brien	Suzanne	S	5048494500	8510				Suzi.Swoop@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Chief Operating Officer		Mrs.	Swoop O'Brien	Suzanne		5046818543	8510				suzi.swoop@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Chief Information Officer		Mr.	Hulin	Colin		5048494500	8900				colin.hulin@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	CMS Casework Communication Contact			Culotta	Dianne		5048494500	8672				dianne.culotta@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Complaints Tracking Contact			Culotta	Dianne		5048494500	8672				dianne.culotta@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Contact for Fraud Investigations			Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Corporate Mailing						5046818550					michael.robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Blvd, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Customer Service Operations Contact	Director of Customer Service		Miller	Cheryl		5048494500	8175				cheryl.miller@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	DIR Contact (Secondary)			Robert	Michael	J	5046818550					phn-pbmteam@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/13/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Enrollment Contact			Shirer	Rachael		5046818545					rachael.shirer@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Financial Audit Contact	Senior Vice President Audit and Compliance	Mr.	Robert	Michael		5048494500	8550				michael.robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Financial Reporting Contact			Geary	Emmet		5048494500	8604				emmet.geary@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Formulary Contact (Secondary)			Smith	Shannon		5046818887					shannon.smith@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	General Contact			Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	MA Appeals/Grievances Contact			Culotta	Dianne		5048494500	8672				dianne.culotta@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	MA Claims Processing Contact for Public Website			Shirer	Rachael		5046818545					rachael.shirer@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Marketing Contact			Yarbrough	Natalie		5048494500	1263				Natalie.Yarbrough@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2500	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Medical Director			Wallis, MD	Brent		5048494500	1155				brent.wallis@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Medicare Coordinator			Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Medication Therapy Management Contact			Smith	Shannon		5048494500	8887				phn-pbmteam@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	OffShore Subcontractor Contact			Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Online Enrollment Center Contact (Back-up)			Korndorffer	Gretchen		5048494500	8963				gretchen.korndorffer@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Online Enrollment Center Contact (Primary)	Vice President of Operations		Shirer	Rachael		5046818545					rachael.shirer@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2500	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Part C Application Contact			Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Part D Appeals			Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H4544	Part D Appeals Contact (Secondary)			Culotta	Dianne							dianne.culotta@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	5048494500	8672			PPO - BBA		C	San Francisco
H4544	Part D Application Contact			Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Part D Claims Submission Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H4544	Part D Exceptions Contact (Secondary)			Robert	Michael	j						phn-pbmteam@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard Suite 2200	Metairie	LA	70002	04/13/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8006318443	8550			PPO - BBA		C	San Francisco
H4544	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Payment Contact			Geary	Emmet		5048494500	8604				emmet.geary@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Pharmacy Network Management Contact			Fernandez	Marilyn		7633615037					marilyn_fernandez1@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Pharmacy Network Management Contact (Secondary)			Robert	Michael	j	5048494500	8550				phn-pbmteam@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/13/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H4544	Pharmacy Technical Help Desk Contact (Secondary)			Robert	Michael	j						phn-pbmteam@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/13/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8883465701				PPO - BBA		C	San Francisco
H4544	Plan Directory Contact for Public Website			Courtney	Meghan		5048494500	8812				meghan.courtney@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Processor Contact			Duss	Denise		7158582203					denise_duss@uhc.com	PO Box 9472		Minneapolis	MN	554409472	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Quality Contact	Director of Quality Improvement HEDIS/Stars		Lester	Elizabeth		5048491339					elizabeth.lester@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2500	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Recovery Audit Contact	Sr. VP Audit and Compliance	Mr.	Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	SNP Application Contact	Compliance Officer		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	System Contact			Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	User Access Contact		Mr.	Robert	Michael	J	5048494500	8550				Michael.Robert@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2200	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Utilization Management Contact			Ross	Kelli	A	5046818156					kelli.ross@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2500	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4544	Utilization Review Contact			Ross	Kelli	A	5046818156					kelli.ross@peopleshealth.com	Three Lakeway Center	3838 North Causeway Boulevard, Suite 2500	Metairie	LA	70002	04/05/2023	2023	PEOPLES HEALTH, INC.	Local CCP	Peoples Health	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H4556	Backup User Access Contact	CFO	Mr.	Latimer	Larry		2547731330	307			2547748029	larryl@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	CAP Report Contact for Public Website	Medicare Coordinator	Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	CEO - CMS Administrator Contact	CEO/Administrator	Ms.	Cumby	Shelly		2547731330	306			2547748029	shellyc@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	CEO - Senior Official for Contracting	CEO/Administrator	Ms.	Cumby	Shelly		2547731330	306			2547748029	shellyc@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Chief Financial Officer	CFO	Mrs.	Ross	Tracy		2547731330	307			2547748029	tracyr@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	01/30/2019	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	CMS Casework Communication Contact	Medicare Coordinator	Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Complaints Tracking Contact	Medicare Coordinator	Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Contact for Fraud Investigations		Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Corporate Mailing						2547731330				2547748029	shellyc@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Cost Report Contact	CFO	Mrs.	Ross	Tracy		2547731330	307			2547748029	tracyr@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	01/30/2019	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Customer Service Operations Contact	Medicare Coordinator	Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Encounter Data & Risk Adjustment Operations Contact	CFO		Ross	Tracy		2547731330	307			2547748029	tracyr@carehealthplan.com	PO Box 6130		Temple	TX	76502	10/18/2019	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Enrollment Contact			Hensley	Berenice		2547731330	310				bereniceh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	General Contact	Medicare Coordinator	Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Government Relations Contact	Medicare Coordinator	Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	MA Appeals/Grievances Contact		Mrs.	McCoy	Debbie		2547731330	407			2547748029	debbiem@carehealthplan.com	P O Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	MA Claims Processing Contact for Public Website		Mrs.	McCoy	Debbie		2547731330	407			2547748029	debbiem@carehealthplan.com	P O Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Marketing Contact		Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P O Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Medical Director		Mrs.	McCoy	Debbie		2547731330	407			2547748029	debbiem@carehealthplan.com	P O Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Medicare Compliance Officer	Medicare Coordinator	Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Medicare Coordinator	Medicare Coordinator	Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Part C Application Contact		Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P O Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Payment Contact	CFO	Ms.	Ross	Tracy		2547731330	307			2547748029	tracyr@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	01/30/2019	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Plan Directory Contact for Public Website	Medicare Coordinator	Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Quality Contact	Medicare Coordinator	Mrs	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Surveillance Contact		Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	System Contact			Paramore	Edward		2547731330	317				edp@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	User Access Contact	Medicare Coordinator	Mrs.	Hampton	Kathy		2547731330	268			2547748029	kathyh@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Utilization Management Contact	CEO/Administrator	Ms.	Cumby	Shelly		2547731330	306			2547748029	shellyc@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4556	Utilization Review Contact	CEO/Administrator	Ms.	Cumby	Shelly		2547731330	306			2547748029	shellyc@carehealthplan.com	P.O. Box 6130		Temple	TX	765036130	08/16/2016	2023	CONSOLIDATED ASSOC OF RAILROAD EMPLOYEES HC	HCPP - 1833 Cost	Consolidated Assoc Of Railroad Employees Hc	HCPP - 1833 Cost		Consolidated Assoc of Railroad Employees HC	67	No	Active					HCPP		1	Dallas
H4590	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H4590	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H4590	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H4590	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H4590	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4590	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE BENEFITS OF TEXAS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H4604	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H4604	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H4604	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H4604	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H4604	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4604	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE ROCKIES, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4605	Agent/Broker Compensation Data Contact	VP Medicare Sales	Mr.	Hess	Brent		8013336143					Brent.Hess@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	07/06/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Automated TrOOP Balance Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Backup User Access Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St.	MS:E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Best Available Evidence Contact	Membership Ambassador	Ms.	Neufeld	Jeri		8006621470	2526			8883352988	ORMEMMEDAmbassador@regence.com	PO Box 1827		Medford	OR	97501	02/16/2018	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Bid Audit Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Bid Audit Site Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Bid Primary Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	CAP Report Contact for Public Website	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	CEO - CMS Administrator Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/04/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	CEO - Senior Official for Contracting	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/09/2022	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Chief Financial Officer	SVP & CFO	Mr.	Rains	Mike		2063326521					Mike.Rains@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Chief Operating Officer	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Chief Information Officer	SVP STRATEGIC TECH SOL & CIO	Mr	Rotival	Laurent		2063325034					Laurent.Rotival@cambiahealth.com	200 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Chief Information Security Officer	VP & CHIEF INFO SEC OFFICER	Mr	Anderson	Kirk		5037251608					Kirk.Anderson@cambiahealth.com	100 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	CMMI Model Point of Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	CMS Casework Communication Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Complaints Tracking Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Contact for Fraud Investigations	Senior Audit Investigator	Ms.	Grimes-Burke	Jennifer		5035873355					Jennifer.Grimes-Burke@regence.com	100 SW Market St	M/S E12B	Portland	OR	97201	06/16/2022	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Coordination of Benefits Contact	Manager, Member Services	Ms	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	PO Box 1827	MS: B32M	Medford	OR	97501	07/09/2016	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Corporate Mailing						5032206237				5035884350	Jennifer.DelVillar@regence.com	100 SW Market Street		Portland	OR	97201	01/07/2013	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Sr I	Mr.	Gerken	Matthew		2063324809					Matthew.Gerken@cambiahealth.com	1800 9th Ave		Seattle	WA	98101	04/19/2016	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Customer Service Operations Contact	Manager Member Services	Ms	Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	DIR Contact	Manager Pharmacy Informatics		Kidd	Vicki		2083957739				2083337874	vicki.kidd@regence.com	1211 West Myrtle, Suite 110		Boise	ID	83702	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	DIR Contact (Secondary)	Dir. Gov. Pro Compliance / Medicare Compliance Off	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street E10C		Portland	OR	97201	07/22/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Emergency Part D Contact	VP Pharm Ops & Compliance	Mr.	Weiss	Justin		5032256677					Justin.Weiss@cambiahealth.com	200 SW Market St		Portland	OR	97201	12/20/2022	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Emergency Part D Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Employer Waiver Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment, Manager	Mr.	Moore	Jason		2087982318					Jason.Moore@cambiahealth.com	1602 21st Ave		Lewiston	ID	83501	10/18/2019	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Enrollment Contact	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	EOB Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Financial Audit Contact	Government Programs Audit Consultant	Mr.	Hutt	Brian		5032206160					Brian.Hutt@regence.com	200 SW Market Street	MS: E10C	Portland	OR	97201	05/09/2019	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Financial Reporting Contact	Fin Acctg & Reporting, Assistant Director	Mr	Striplin	Daniel	W	5032256069					Dan.Striplin@regence.com	200 SW Market		Portland	OR	97201	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Formulary Contact	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Ave		Portland	OR	97201	01/18/2018	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	General Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Government Relations Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St.	MS:E10C	Portland	OR	97201	04/18/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	HIPAA Privacy Officer	VP Chief Compliance & Privacy Officer	Ms.	Erbes	Kristen		5035256533					kristen.erbes@regence.com	200 SW Market St	M/S: E14A	Portland	OR	97201	02/25/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	HIPAA Security Officer	Chief Information Security Officer	Mr.	Person	Steve		5037251654					Steve.Person@regence.com	1621 SW First Ave.		Portland	OR	97201	02/25/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Hospice Contact	Pharmacy Ops Oversight Specialist	Ms.	Pickens	Spring		5032255240					Spring.Pickens@regence.com	100 SW Market St	MS: WW5-56	Portland	OR	97201	02/05/2018	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Interoperability Contact	VP Chief Tech Officer		Anderson	Kirk		5037251608					kirk.anderson@cambiahealth.com	Cambia Health Solutions	200 SW Market Street	Portland	OR	97201	02/09/2022	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	MA Appeals/Grievances Contact	Director, Clinical Services Operations	Ms.	Sikora	Joelle		2063325320					Joelle.Sikora@regence.com	1800 Ninth Avenue		Seattle	WA	98101	05/09/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	MA Claims Processing Contact for Public Website	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Marketing Contact	Compliance Analyst		Meirose	Robyn		5033918668					robyn.meirose@regence.com	200 SW Market St  MS: E10C		Portland	OR	97201	09/15/2015	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Medical Director	SVP Chief Medical Officer	Ms.	Milavetz	Donna		8013336740					Donna.Milavetz@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	12/05/2022	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Medicare Compliance Officer	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	07/14/2022	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Medicare Coordinator	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827		Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Medicare Part D Opioid Overutilization Contact	Drug Management Program	Ms.	Anderson	Ally		8557297221					partdoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Medication Therapy Management Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Online Enrollment Center Contact (Back-up)	Dir Medicare Planning & Performance	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Online Enrollment Center Contact (Optional)	Manager Member Services	Ms.	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	2057 Commerce Dr		Medford	OR	97504	11/06/2017	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Online Enrollment Center Contact (Primary)	Spv Membership, GP OR Medicare Ops & Billing	Ms.	Cromwell	Krista		5416181286					Krista.Cromwell@regence.com	PO Box 1827	M/S: B32M	Medford	OR	97501	03/07/2018	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Part C Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Part C Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				PPO - BBA		C	Seattle
H4605	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossig Rd	Eagan	MN	55120	03/21/2022	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8006936651				PPO - BBA		C	Seattle
H4605	Part D Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Part D Benefits Contact	Product Manager II	Ms.	Holliston	Danica		5032254871					Danica.Holliston@regence.com	200 SW Market St  M/S: E10M		Portland	OR	97201	07/19/2017	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Part D Claims Submission Contact	Functional Business Consultant - Government Prgrms	Mr.	Brook	Lance		4026862603					LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	08/05/2019	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				PPO - BBA		C	Seattle
H4605	Part D Exceptions Contact (Secondary)	Asst Director Pharmacy Operations	Ms.	Yi	Edie							edie.yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	972071271	12/15/2022	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	5032254801				PPO - BBA		C	Seattle
H4605	Part D Price File Contact (Back-up)	Database Reporting Analyst	Ms	Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2020	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Part D Price File Contact (Optional)	QA Analyst Sr	Ms.	Tastad	Emily		6127772557					emily.tastad@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/03/2022	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Part D Price File Contact (Primary)	AD Pharmacy Informatics	Ms.	Kidd	Vicki		2083957739					Vicki.Kidd@regence.com	1211 West Myrtle		Boise	ID	83702	07/22/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Part D Quality Assurance Contact	Assistant Dir Pharmacy Operations	Ms.	Yi	Edie		5032254801				2083957744	Edie. Yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	97201	12/27/2022	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Part D Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Patient Safety Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Payment Contact	Asst Director Fin Acctg & Reporting	Mr.	Striplin	Dan		5032256069					Dan.Striplin@cambiahealth.com	100 SW Market St	M/S: C2A	Portland	OR	97201	01/14/2014	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Pharmacy Director	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Avenue, M/S PDX - WW3-33		Portland	OR	97201	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Pharmacy Network Management Contact	AVP, Network Mangement	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/18/2020	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Management Relations		Lenhart	Alicia		6127773969				8778236373	Alicia.Lenhart@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Pharmacy Technical Help Desk Contact	Director, Member Services Government Programs	Mr.	Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				PPO - BBA		C	Seattle
H4605	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jon							jonathan.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				PPO - BBA		C	Seattle
H4605	Plan Directory Contact for Public Website	Manager Member Services		Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Plan to Plan Reconciliation Contact	Pharmacy Operations Oversight Specialist, Sr.	Ms.	Manzer	Amy		5032255368					Amy.Manzer@regence.com	200 SW Market St	M/S: PDX-ZOF WW3-33	Portland	OR	97201	08/26/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing	Egan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Quality Contact	Director, Quality Management	Mr.	Mcclure	Andy		5032206189					Andrew.Mcclure@regence.com	1621 SW First Ave	M/S WW5-52	Portland	OR	97201	04/12/2019	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Reconciliation Contact	VP Finance Controller		Vannoy	Anjie		5032761865					Anjie.Vannoy@cambiahealth.com	100 SW Market St.	MS:PDX-WW2-21	Portland	OR	97201	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Reconciliation Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS:E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Recovery Audit Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Surveillance Contact	Government Programs Compliance Officer		Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St  M/S: E10C		Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	System Contact	Medicare Business Operations, Product Owner	Ms.	Fredinburg	Deana		5033754426					Deana.Fredinburg@regence.com	PO BOX 1827	M/S: B32AG	Medford	OR	97501	06/24/2022	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Third Party Administrator (TPA) Liaison	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St		Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	User Access Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Utilization Management Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4605	Utilization Review Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUECROSS BLUESHIELD OF UTAH	Local CCP	Regence BlueCross BlueShield of Utah	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H4620	Agent/Broker Compensation Data Contact	SVP Health Plan Operations		Cochran	Rick		4026306924					rcochran@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/18/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Automated TrOOP Balance Transfer Contact	Director Enrollment, Eligibility &B OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/05/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Backup User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Best Available Evidence Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Bid Audit Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Bid Audit Site Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Bid Primary Contact	ACTUARY	Mr.	Copeland	Joe		3142095834					jcopeland@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/24/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	CAP Report Contact for Public Website	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	CEO - CMS Administrator Contact	COO	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	CEO - Senior Official for Contracting	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Chief Financial Officer	Chief Financial Officer	Mr.	Grabski	Ben		7633007611					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Chief Operating Officer	Chief Operating Officer	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Chief Information Officer	Chief Information Officer	Mr.	Saghabini	JeanClaude		6173124659					jsaghbini@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Chief Information Security Officer	Chief Information Security Officer	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	CMMI Model Point of Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	CMS Casework Communication Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Complaints Tracking Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Contact for Fraud Investigations	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Coordination of Benefits Contact			Inquiries	COB		8665979560					COBInquiry@lumeris.com	P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Corporate Mailing						8665979560					customerservice@essencehealthcare.com	CUSTOMER SERIVCE	P O BOX 5907	TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Coverage Gap Discount Program (CGDP) Payment Contact	Sr Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Customer Service Operations Contact	Vice President, Health Plan Operations	Ms.	Meyerhoffer	Linda		6366869682					rmeyerhoffer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	DIR Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	DIR Contact (Secondary)	Sr Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly	M	3142092795					pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Emergency Part D Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		6307425966					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Emergency Part D Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Encounter Data & Risk Adjustment Operations Contact	VP - Risk Adjustment Services	Mr.	Eschbach	Jason		6144397608					jeschbach@lumeris.com	13900 Riverport Drive		St. Louis	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Enrollment Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	EOB Transfer Contact	Director, Claims	Ms.	Wasserman	Rachelle		3147703520				3147706096	rwasserman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Financial Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Financial Reporting Contact	Corporate Accounting Director	Ms.	Pinkerton	Amanda		3145183519					apinkerton@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Formulary Contact		Ms	Nyawabila	Christina		8447906297					FAS@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Formulary Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	General Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Government Relations Contact	Chief Legal Officer	Ms.	Halterman	Gail		3142092717					ghalterman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Davis	Amy		3142093945					adavis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	HIPAA Security Officer	CISO	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Hospice Contact	Vice President, Clinical Operations		Cruz	Jennifer		3147703556					pharmacy@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Interoperability Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Darnell	Erika		3144382410					ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/09/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	MA Claims Processing Contact for Public Website			Service	Customer		8665979560				8884802577	customerservice@essencehealthcare.com	P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Marketing Contact	Manager, Compliance Marketing	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Medical Director	Senior Medical Officer, UM	Dr.	Fusco	Michael		3147703770					mfusco@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Medicare Compliance Officer	VP Compliance, Medicare Compliance Officer	Mr,	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Medicare Coordinator	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Medicare Part D Opioid Overutilization Contact	Snr. Clinical Pharmacist	Ms.	Pasagic	Melita		3147703775					mpasagic@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Medication Therapy Management Contact	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	OffShore Subcontractor Contact	SVP Corporate Accounting & Chief Compliance Office	Ms.	Venable	Erin		3142093957					evenable@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Online Enrollment Center Contact (Back-up)	Manager, Compliance	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Online Enrollment Center Contact (Optional)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Online Enrollment Center Contact (Primary)	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Part C Application Contact	Sr. Director CMS Applications & PBP submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Part C Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Part D Appeals	Director, Appeals & Grievances	Ms.	Darnell	Erika							ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/09/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	3144382410				PPO - BBA		C	Kansas City
H4620	Part D Appeals Contact (Secondary)	Sr. Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly	M						pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	3147209279				PPO - BBA		C	Kansas City
H4620	Part D Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Part D Benefits Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Part D Claims Submission Contact		Ms.	Scherlippens	Carine		8587907415					Carine.Scherlippens@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Part D Exceptions Contact		Ms.	Byers	June							June.Byers@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				PPO - BBA		C	Kansas City
H4620	Part D Exceptions Contact (Secondary)		Mr	Elias	Jason							Jason.Elias@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				PPO - BBA		C	Kansas City
H4620	Part D Price File Contact (Back-up)	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Part D Price File Contact (Optional)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Part D Price File Contact (Primary)		Ms.	Finder	Plan		8445136003					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Part D Quality Assurance Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Part D Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Patient Safety Contact	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Payment Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Pharmacy Director	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Pharmacy Network Management Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Pharmacy Network Management Contact (Secondary)			Pharmacy Operations	MedImpact		8445136003					PharmacyOperationsSups@MedImpact.com	10182 Scripps Gateway Court		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services	Ms.	Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				PPO - BBA		C	Kansas City
H4620	Pharmacy Technical Help Desk Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly							ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	3147703788				PPO - BBA		C	Kansas City
H4620	Physician Incentive Contact	Sr. Manager, Health Plan Finance	Mr.	Privott	David		3147703732					dprivott@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Plan Directory Contact for Public Website			Service	Customer		8665979560					customerservice@essencehealthcare.com	1P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Plan to Plan Reconciliation Contact	Sr Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Processor Contact		Ms.	Scott	Susan		8447906565					Susan.Scott@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Quality Contact	Snr. Director, Quality Improvement		Pattison	Lisa		5082728692					lpattison@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Reconciliation Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Reconciliation Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Recovery Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	SNP Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	SNP State Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Surveillance Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	System Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Third Party Administrator (TPA) Liaison	Client AP Specialist	Ms.	Brock	Letecea		3142548778					lbrock@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Utilization Management Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4620	Utilization Review Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE OF OHIO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H4623	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H4623	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H4623	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4623	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA REGIONAL HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H4624	Agent/Broker Compensation Data Contact	Chief Growth Officer	Mr.	Miller	Benjamin		3124297117	111				ben.miller@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Automated TrOOP Balance Transfer Contact			Montgomery	Nakisha		5124579422					nmontgomery@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	02/13/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Backup User Access Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Best Available Evidence Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Bid Audit Contact	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Bid Primary Contact	V.P. Product Development	Ms.	Pamanian	Lily		3127763356	325				lily.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	CAP Report Contact for Public Website	Chief Information Officer	Mr.	Shah	Vrajesh		3122057948	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	CEO - CMS Administrator Contact	CEO	Mr.	Clifton	Andrew		3128588400					andrew.clifton@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	12/15/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	CEO - Senior Official for Contracting	CEO	Mr.	Clifton	Andrew		3128588400					andrew.clifton@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	12/15/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Chief Financial Officer	CFO	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Chief Operating Officer	COO	Mr.	Collins	GARFIELD		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Chief Information Officer	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Chief Information Security Officer	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	CMS Casework Communication Contact	Director, Compliance Audit and Monitoring		Gordon	Reneatha		3128097947					reneatha.gordon@myzinghealth.com	225 W. Washington Street	Suite 450	Chicago	IL	60606	05/22/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Complaints Tracking Contact	Director, Compliance Audit and Monitoring	Ms.	Gordon	Reneatha		3128097947					compliance@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Contact for Fraud Investigations	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Coordination of Benefits Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Corporate Mailing						6126077433					reneatha.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Customer Service Operations Contact	COO	Mr.	Collins	Garfield		3123195468	101				garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	DIR Contact	CMO	Dr.	Fessenden	Michael		3123003495	196				michael.fessenden@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	DIR Contact (Secondary)	Pharmacy Project Manager	Mr.	Santaya	Carlos		3124770778					carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450	Suite 450	Chicago	IL	60606	05/19/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Emergency Part D Contact	Chief Medical Officer	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Employer Waiver Contact	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Encounter Data & Risk Adjustment Operations Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Enrollment Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	EOB Transfer Contact	CFO	Mr.	Sahin	Mete		7032825955				3122398304	mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Financial Audit Contact	CFO	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Financial Reporting Contact	CFO	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Formulary Contact	Formulary Operations Clinical Pharmacist, Elixir		Shick	Ryan		2342123614					rshick@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Formulary Contact (Secondary)	CMO	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	General Contact	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Government Relations Contact	Communication	Mr.	Martin	Stephen		3122057948	138				stephen.martin@myzing.com	225 West Washington Street	Suite 450	Chicago	IL	60606	02/15/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	HIPAA Privacy Officer	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	HIPAA Security Officer	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Hospice Contact	V.P. Clinical Operations		Wohkittel	Karen		3128585770					karen.wohkittel@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	05/22/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Interoperability Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	02/15/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	MA Appeals/Grievances Contact	V.P. Health Plan Operations	Mr.	Smith	Mark		3125858846	165				mark.smith@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	MA Claims Processing Contact for Public Website	COO	Mr.	Collins	Garfield		3122057948					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	02/15/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Marketing Contact	Chief Growth Officer	Ms.	Miller	Benjamin		3124297117					ben.miller@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Medical Director	Interim CMO	Dr	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	05/31/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Medicare Compliance Officer	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Medicare Coordinator	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Medicare Part D Opioid Overutilization Contact	Pharmacy Project Manager	Mr.	Santaya	Carlos		3124770778					carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450	Suite 450	Chicago	IL	60606	05/19/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Medication Therapy Management Contact	Pharmacy Project Manager	Mr.	Santaya	Carlos		3124770778					carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	05/19/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	OffShore Subcontractor Contact	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Part C Application Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Part C Reporting Contact	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Appeals	Pharmacy Project Manager	Mr.	Santaya	Carlos							carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	02/15/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	3124770778				HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations		Binegar	Sam						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Application Contact	COO	Mr.	Collins	Garfield		3123195468				3123195468	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Benefits Contact	CMO	Dr.	Fessenden	Michael		3123003495	186			3127762135	michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Claims Submission Contact	CMO	Dr.	Fessenden	Michael		3123003495				3127575109	michael.fessenden@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Exceptions Contact	Pharmacy Project Manager	Mr.	Santaya	Carlos							carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	02/15/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	3124770778				HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Exceptions Contact (Secondary)	Appeals Supervisor, Clinical Operations		Binegar	Sam						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	3303449571				HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Price File Contact (Back-up)	CMO	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Price File Contact (Optional)			Santaya	Carlos		3124770778					carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	05/22/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Price File Contact (Primary)	Sr Financial Manager Reporting & Analytics		Campbell	Tim		3308886988					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Quality Assurance Contact	CMO	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Part D Reporting Contact	CMO	Dr.	Fessenden	Michael		3123003495	186			3127762135	michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Patient Safety Contact	CMO	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 W. Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Payment Contact	CFO	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Pharmacy Director	CMO	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Pharmacy Network Management Contact	Director Pharmacy Network Development and Operatio		Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Pharmacy Network Management Contact (Secondary)	Pharmacy Project Manager	Mr.	Santaya	Carlos		3124770778					carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	02/15/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Pharmacy Technical Help Desk Contact	V.P. Operations		Conn	Todd							tconn@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	8554766993				HMO - Health Maintenance Organization		C	Chicago
H4624	Pharmacy Technical Help Desk Contact (Secondary)	CMO	Dr.	Fessenden	Michael							michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	3123003495				HMO - Health Maintenance Organization		C	Chicago
H4624	Plan Directory Contact for Public Website	COO	Mr.	Collins	Garfield		8669464458					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	02/15/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Plan to Plan Reconciliation Contact	Comptroller	Ms.	Jackson	Amy		3128833465					accountspayable@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	05/31/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Processor Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Quality Contact	Sr. V.P.  Stars & Quality	Mr.	Weaver	Daniel		3126615667					daniel.weaver@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Reconciliation Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Reconciliation Contact (Secondary)	Manager, Medicare Operations	Ms.	Wright	Wanda		3122057948	126				wanda.wright@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Recovery Audit Contact	Director, Compliance Audit and Monitoring	Ms.	Gordon	Reneatha		3128097947					reneatha.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	SNP Application Contact	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	SNP State Contact	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Surveillance Contact	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	System Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Third Party Administrator (TPA) Liaison	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	User Access Contact	Director of Compliance Audit and Monitoring	Ms.	Gordon	Reneatha		3122057948	121				reneatha.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Utilization Management Contact	V.P. Clinical Operations		Wohkittel	Karen		3128585770					karen.wohkittel@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	05/22/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4624	Utilization Review Contact	V.P. Clinical Operations		Wohkittel	Karen		3128585770					karen.wohkittel@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	05/22/2023	2023	ZING HEALTH OF MICHIGAN, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H4626	Automated TrOOP Balance Transfer Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Backup User Access Contact	Sr. Manager - Care Delivery Services	Ms.	Mateo	Rosely	A	3478823598					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Best Available Evidence Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Bid Primary Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	CAP Report Contact for Public Website	Sr. Manager - Care Delivery Services	Ms.	Mateo	Rosely	A	3478823598					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Pottharst	Robert		9292692222					rpottharst@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Pottharst	Robert		9292692222					rpottharst@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Chief Financial Officer	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Chief Operating Officer	Sr. Vice President  - Care Delivery Services	Mr.	D'Sa	Samir		7345462580					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Chief Information Officer	VP & Head of Product	Mrs.	Gobalan	Anupama		7148584942					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Chief Information Security Officer	VP & Head of Product	Mrs.	Gobalan	Anupama		7148584942					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	CMS Casework Communication Contact	Sr. Manager - Care Delivery Services	Ms.	Mateo	Rosely	A	3478823598					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Complaints Tracking Contact	Sr. Manager - Care Delivery Services	Ms.	Mateo	Rosely	A	3478823598					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Contact for Fraud Investigations	Sr. Vice President  - Care Delivery Services	Mr.	D'Sa	Samir		7345462580					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Coordination of Benefits Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Corporate Mailing						8338832889					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Customer Service Operations Contact	Sr. Manager - Care Delivery Services	Ms.	Mateo	Rosely	A	3478823598					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	DIR Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Emergency Part D Contact	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Emergency Part D Contact (Secondary)	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Encounter Data & Risk Adjustment Operations Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Enrollment Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	EOB Transfer Contact	Director, Accounting	Mr.	Menchaca	Rafael		2138865843				9295672060	HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Financial Audit Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Financial Reporting Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Formulary Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Formulary Contact (Secondary)	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	General Contact	Sr. Manager - Care Delivery Services	Ms.	Mateo	Rosely	A	3478823598					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Government Relations Contact	Chief Executive Officer	Mr.	Pottharst	Robert		9292692222					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	HIPAA Privacy Officer	VP & Head of Product	Mrs.	Gobalan	Anupama		7148584942					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	HIPAA Security Officer	VP & Head of Product	Mrs.	Gobalan	Anupama		7148584942					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Interoperability Contact	VP & Head of Product	Mrs.	Gobalan	Anupama		7148584942					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	MA Appeals/Grievances Contact	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	MA Claims Processing Contact for Public Website	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Marketing Contact	Director - Marketing & Growth	Mrs.	Tran	Phoi		6266796221					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Medical Director	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Medicare Compliance Officer	Sr. Vice President  - Care Delivery Services	Mr.	D'Sa	Samir		7345462580					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Medicare Coordinator	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Medicare Part D Opioid Overutilization Contact	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Medication Therapy Management Contact	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Part C Application Contact	Sr. Manager - Care Delivery Services	Ms.	Mateo	Rosely	A	3478823598					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Part D Appeals	Director, Accounting	Mr.	Menchaca	Rafael							HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending	2133796438				PACE - Nat		C	San Francisco
H4626	Part D Appeals Contact (Secondary)	VP and National Medical Director	Dr.	Schreiber	Robert							HPMS@myplacehealth.com	121 S Mountain View Ave	#100	Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending	6172247969				PACE - Nat		C	San Francisco
H4626	Part D Application Contact	Sr. Manager - Care Delivery Services	Ms.	Mateo	Rosely	A	3478823598					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Part D Benefits Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Part D Claims Submission Contact	VP & Head of Product	Mrs.	Gobalan	Anupama		7148584942					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Part D Exceptions Contact	Director, Accounting	Mr.	Menchaca	Rafael							HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending	2133796438				PACE - Nat		C	San Francisco
H4626	Part D Exceptions Contact (Secondary)	VP & Head of Product	Mrs.	Gobalan	Anupama							HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending	7148584942				PACE - Nat		C	San Francisco
H4626	Part D Price File Contact (Back-up)	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Part D Price File Contact (Primary)	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Part D Quality Assurance Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Part D Reporting Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Patient Safety Contact	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Payment Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Personal Health Record Contact	VP & Head of Product	Mrs.	Gobalan	Anupama		7148584942					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Pharmacy Director	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Pharmacy Network Management Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Pharmacy Network Management Contact (Secondary)	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Pharmacy Technical Help Desk Contact	VP & Head of Product	Mrs.	Gobalan	Anupama							HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending	7148584942				PACE - Nat		C	San Francisco
H4626	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Vice President - Care Delivery Services	Mr.	D'Sa	Samir							HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending	7345462580				PACE - Nat		C	San Francisco
H4626	PHR Beneficiary Contact																	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE	myPlace Greater LA PACE Inc	Prosper Services LLC	815	Yes	Pending	8338832889				PACE - Nat		C	San Francisco
H4626	Plan Directory Contact for Public Website	Sr. Manager - Care Delivery Services	Ms.	Mateo	Rosely	A	3478823598					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Plan to Plan Reconciliation Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Processor Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Quality Contact	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Reconciliation Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Recovery Audit Contact	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Surveillance Contact	VP & Head of Product	Mrs.	Gobalan	Anupama		7148584942					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	System Contact	VP & Head of Product	Mrs.	Gobalan	Anupama		7148584942					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Third Party Administrator (TPA) Liaison	Director, Accounting	Mr.	Menchaca	Rafael		2133796438					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	User Access Contact	VP & Head of Product	Mrs.	Gobalan	Anupama		7148584942					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Utilization Management Contact	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4626	Utilization Review Contact	VP and National Medical Director	Dr.	Schreiber	Robert		6172247969					HPMS@myplacehealth.com	121 S Mountain View Ave		Los Angeles	CA	90057	09/07/2023	2023	myPlace Greater LA PACE Inc.	National PACE	myPlace PACE	National PACE		Prosper Services LLC	815	Yes	Pending					PACE - Nat		C	San Francisco
H4652	Backup User Access Contact	Information Technology Manager		Porter	Brad		8015954302					bporter@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	CAP Report Contact for Public Website	CMS Compliance Officer		Puff-Newberry	Andrea		8015954337				8015952037	apnewberry@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	CEO - CMS Administrator Contact	President & CEO	Mr.	Egan	Rich		8015954300				8015952087	regan@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	CEO - Senior Official for Contracting	President & CEO	Mr.	Egan	Rich		8015954300				8015952009	regan@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Chief Financial Officer	CFO	Mr.	Barnett	Greg		8015954372				8015952037	gbarnett@ironroad.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Chief Operating Officer	COO	Mr.	Hatch	Michael		8015954388				8015952088	mhatch@uphealth.com	1040 North 2200 West  Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Chief Information Officer	Information Technology Officer	Mr.	Porter	Brad		8015954302					bporter@uphealth.com	1040 North 2200 West  Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Chief Information Security Officer	Information Officer Chief	Mr.	Porter	Brad		8015954302					bporter@uphealth.com	1040 North 2200 West  Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	CMS Casework Communication Contact	Director Care Management		Newman	Curtis		8015954470				8015952070	cneuman@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Complaints Tracking Contact	Membership Specialist	Mrs.	Ashley	Michelle		8015954403				8015952003	mashley@ironroadhealthcare.com	1040 N 2200 W Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Contact for Fraud Investigations	CMS Compliance Officer		Puff-Newberry	Andrea		8015954337				8015952037	apnewberry@uphealth.com	1040 N 2200 W Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Corporate Mailing						8015954300				8015954399	help@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Cost Report Contact	COO		Hatch	Michael		8015954388				8015952088	mhatch@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Customer Service Operations Contact	Manager of Customer Services		Hayes	Tonya		8015954300				8015952087	thayes@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Encounter Data & Risk Adjustment Operations Contact	Systems Analyst	Mrs.	Birkette	Johanna		8015954344				8015952044	jbirkett@uphealth.com	1040 N 2200 W Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Enrollment Contact	Manager of Membership & Customer Services		Armstrong	Darin		8015954365				8015952065	darmstrong@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	General Contact	CMS Compliance Officer		Puff-Newberry	Andrea		8005470421				8013368520	apnewberry@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Government Relations Contact	CMS Compliance Officer		Puff-Newberry	Andrea		8015954337				8015952037	apnewberry@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Interoperability Contact	Compliance	Mrs.	Puff-Newberry	Andrea	J	8015954337					andrea@ironroad.com	1040 N 2200 W		SLC	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	MA Appeals/Grievances Contact	Director Care Management		Newman	Curtis		8015954470				8015952070	cnewman@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	MA Claims Processing Contact for Public Website	Manager of Claims Processing		Smart	Julie		8015954385				8015952085	jsmart@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Marketing Contact	CMS Compliance Officer		Puff-Newberry	Andrea		8015954367				8015952037	apnewberry@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Medical Director	Director Care Management		Newman	Curtis		8015954470				8015952070	cnewman@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Medicare Compliance Officer	Corporate Compliance Officer	Ms.	Puff-Newberry	Andrea		8015954337				8015952037	apnewberry@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Medicare Coordinator	CMS Compliance Officer		Puff-Newberry	Andrea		8015954337				8015952037	apnewberry@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Part C Application Contact	President & CEO		Egan	Rich		8015954300				8015952087	regan@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Payment Contact	COO		Hatch	Michael		8015954388				8015952088	mhatch@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	PHR Beneficiary Contact																	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract	8005470421				HCPP		1	Denver
H4652	Plan Directory Contact for Public Website	Manager Network		Reed	Mindi		8015954300				8015952008	mreed@ironroadhealthcare.com	1040 N 2200 W Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Quality Contact	Director Care Management		Newman	Curtis		8015954470				8015952070	cnewman@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Surveillance Contact	CMS Compliance Officer		Puff-Newberry	Andrea		8015954337				8015952037	apnewberry@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	System Contact	Information Technology Manager		Porter	Brad		8015954302					bporter@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	User Access Contact	CMS Compliance Officer		Puff-Newberry	Andrea		8015954337				8015952037	apnewberry@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Utilization Management Contact	Director Care Management		Newman	Curtis		8015954470				8015952070	cnewman@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4652	Utilization Review Contact	Manager of Medical Services		Newman	Curtis		8015954470				8015952070	cnewman@uphealth.com	1040 North 2200 West Suite 200		Salt Lake City	UT	84116	06/02/2023	2023	UNION PACIFIC RAILROAD EMPLOYES HEALTH SYSTEMS	HCPP - 1833 Cost	Union Pacific Railroad Employes Health Systems	HCPP - 1833 Cost		Union Pacific Railroad Employes Health Systems	243	No	Withdrawn Contract					HCPP		1	Denver
H4675	Agent/Broker Compensation Data Contact	Medicare Program Analyst		Wilbanks	Dasha		9734665601					dasha_wilbanks@horizonblue.com	3 Penn Plaza	16-C	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Automated TrOOP Balance Transfer Contact	Manager, PBM Ops.	Ms.	Hanson	Michelle		6127776755					EOBP2P@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Backup User Access Contact	Medicare Program Analyst		Vargas	Mario		9734666379					mario_vargas@horizonblue.com	3 Penn Plaza East	16-C	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Best Available Evidence Contact	Supervisor, Govt. Programs		Achoe	Kisha		9734667328					Kisha_Achoe@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	07/27/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Bid Audit Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319				7322565428	jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Bid Audit Site Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319				7322565428	jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Bid Primary Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319				7322565428	jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	CAP Report Contact for Public Website	VP, Regulatory Compliance	Mr	McGrady	Daniel		6095373066					scott_johnson@horizonblue.com	3 Penn Plaza	PP-16F	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract	6095372317				HMO - Health Maintenance Organization		C	New York
H4675	CEO - CMS Administrator Contact	CEO - Chief Executive Officer	Ms.	Charbonneau	Luisa		8627630015					Luisa.Charbonneau@bravenhealth.com	3 Penn Plaza	PP-14	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	CEO - Senior Official for Contracting	CEO - Chief Executive Officer	Ms.	Charbonneau	Luisa		8627630015					Luisa.Charbonneau@bravenhealth.com	3 Penn Plaza	PP-14	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Chief Financial Officer	CFO	Mr.	Meaney	Frank		2035256777					Frank.Meaney@BravenHealth.com	3 Penn Plaza East		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Chief Operating Officer	Chief Operating Officer	Ms.	Mahoney	Audrey		7329957148					Audrey.Mahoney@Bravenhealth.com	3 Penn Plaza	PP-16	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Chief Information Officer	Chief Information Officer	Ms.	Machemer	Michelle		9734664188					Michelle_Machemer@horizonblue.com	3 Penn Plaza East	PP-10	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Chief Information Security Officer	Chief Information Security Officer	Mr.	Becknel	Damon		9734667753					Damon_Becknel@horizonblue.com	3 Penn Plaza East	PP-16	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	CMS Casework Communication Contact	Director, GP Operations		Maramraju	Venkata		6095372113					venkata.maramraju@horizonblue.com	1700 American Boulevard		Pennington	NJ	08534	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Complaints Tracking Contact	Mgr, Exec DOBI Compl & Appls		Mestres	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Contact for Fraud Investigations	Director, Special Investigations		Dineen	Timothy		9734668723					timothy_dineen@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Coordination of Benefits Contact	Manager, PBM Ops	Ms.	Hanson	Michelle		6127776755				6127776705	COBMedD@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Corporate Mailing						6095373066					scott_johnson@horizonblue.com	1700 American Blvd. HL-03	Hopewell Campus	Pennington	NJ	08534	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Reporting		Griffin	Kevin		6095372464					kevin_griffin@horizonblue.com	1700 American Blvd	HL-03Q	Pennington	NJ	08534	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Customer Service Operations Contact	Director, Operations - GP		Yanek	John		5182208000					john_yanek@horizonblue.com	3 Penn Plaza	PP-12	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	DIR Contact	Director, Clinical Pharm. Programs		Patrikios	Athena		9734666542					Athena_Patrikios@horizonblue.com	3 Penn Plaza	PP-12Q	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	DIR Contact (Secondary)	Pharmacy Analyst II		Farber	Keri	A	9734668995					keri_farber@horizonblue.com	3 Penn Plaza East	PP-12	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Emergency Part D Contact	Pharmacy Analyst II		Farber	Keri	A	9734668995					keri_farber@horizonblue.com	3 Penn Plaza	PP -12	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Emergency Part D Contact (Secondary)	Manager, Clinical Pharmacy		Sun	Jane		9734665044					jane_sun@horizonblue.com	3 Penn Plaza	PP 12-Q	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Encounter Data & Risk Adjustment Operations Contact	Mgr, Medicare & Medicaid Risk Assessment		Goryachkovsky	Jenny		9734665956					jenny_goryachkovsky@horizonblue.com	3 Penn Plaza	PP-12	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Enrollment Contact	Director, G. P. Operations		Maramraju	Venkata		6095372113					venkata_maramraju@horizonblue.com	1700 American Blvd. HL-03		Pennington	NJ	08534	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	EOB Transfer Contact	Manager, PBM Ops.	Ms.	Hanson	Michelle		6127776755				6127776705	EOBP2P@primetherapeutics.com	2990 Ames Crossing Rd		Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Financial Audit Contact	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					Lisa.keehn@bravenhealth.com	3 Penn Plaza		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Financial Reporting Contact	Corporate Controller		Concepcion	Ivan		9734664188					Ivan_Concepcion@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Formulary Contact	Director, Clinical Pharm Prg & Op - Medicare		Patrikios	Athena		9734666542					athena_patrikios@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Formulary Contact (Secondary)	Supervisor, Formulary Ops.	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	General Contact	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					lisa.keehn@bravenhealth.com	3 Penn Plaza		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Government Relations Contact	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					lisa.keehn@bravenhealth.com	3 Penn Plaza		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	HIPAA Privacy Officer	Director, Privacy Official		Dates	Chris		9734667669					Chris_Dates@horizonblue.com	3 Penn Plaza East	PP-16	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	HIPAA Security Officer	Chief Information Security Officer		Becknel	Damon		9734667753					Damon_Becknel@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Hospice Contact	Manager, Clinical Pharmacy		Sun	Jane		9734665044					Jane_Sun@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Interoperability Contact	Manager, Mandate Implementation		Victory	Jacqueline		9734668759					Jacqueline_Victory@horizonblue.com	3 Penn Plaza	PP-09	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	MA Appeals/Grievances Contact	Manager, MA DOBI Appeals & Grievances		Mestres	Suze		9734665503					Suze_Mestres@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	MA Claims Processing Contact for Public Website	Mgr, Exec DOBI Compl & Appls		Mestress	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Marketing Contact	Sales Manager II		Cennamo	Steven		9084160480					Steven_Cennamo@horizonblue.com	3 Penn Plaza	PP-12F	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Medical Director	Medical Director III, Govt. Programs	Dr.	Johnson	Terry		6095372097					terry_johnson@horizonblue.com	1700 American Blvd	HL-02	Pennington	NJ	08534	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					lisa.keehn@bravenhealth.com	3 Penn Plaza		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Medicare Coordinator	VP, Regulatory Compliance	Mr	McGrady	Daniel		6095372317					daniel_mcgrady@horizonblue.com	3 Penn Plaza	PP-16F	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Medicare Part D Opioid Overutilization Contact	Supv Pharmacists		Schons	Allison		8554570763				8557297221	PartDoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Medication Therapy Management Contact	Supervisor, MTM and Case/Care Management		Heibling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55120	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	OffShore Subcontractor Contact	Manager, Medicaid Regulatory Reqs/MCO		McGrady	Daniel		7325393680					daniel_mcgrady@horizonblue.com	1700 American Blvd	HL-03P	Pennington	NJ	08534	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Online Enrollment Center Contact (Back-up)	Supervisor		Johnson	Cheryl		9734666931					cheryl_johnson@horizonblue.com	3 Penn Plaza East, PP-12L		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Online Enrollment Center Contact (Optional)	Team Leader		Johnson	Cheryl		9734666931					Cheryl_Johnson@horizonblue.com	3 Penn Plaza - PP12L		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Online Enrollment Center Contact (Primary)	Manager, Medicare Operations		Santiago-Mercado	Nitza		9734667346					Nitza_Santiago-mercado@horizonblue.com	3 Penn Plaza East, PP-12L		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Part C Application Contact	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					Lisa.keehn@bravenhealth.com	3 Penn Plaza East	PP-14A	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Part C Reporting Contact	Medicare Program Analyst		Wilbanks	Dasha	N	9734665601					dasha_wilbanks@horizonblue.com	3 Penn Plaza	16-C	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd	PRIME Therapeutics	Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract	6127775393				HMO - Health Maintenance Organization		C	New York
H4675	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Kimberly	Emerson						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd	Clinical Review	Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract	8006936651				HMO - Health Maintenance Organization		C	New York
H4675	Part D Application Contact	Medicare Compliance Officer	Ms.	Keehn	Lisa		6462214210					Lisa.keehn@bravenhealth.com	3 Penn Plaza East	PP-14A	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Part D Benefits Contact	Director, Benefits Ops.	Ms.	Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Part D Claims Submission Contact	Functional Business Consultant - Govt. Programs	Mr.	Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	PRIME Therapeutics, LLC	2655 Eagan Woods Drive	Eagan	MN	55122	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Part D Exceptions Contact	Director, Reg/Audit Response	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd		Eagan,	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract	8006936651				HMO - Health Maintenance Organization		C	New York
H4675	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Kimberly	Emerson						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagen	MN	55120	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract	8006936651				HMO - Health Maintenance Organization		C	New York
H4675	Part D Price File Contact (Back-up)	Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Part D Price File Contact (Optional)	QA Analyst		Tastad	Emily		6127772557					emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Part D Price File Contact (Primary)	Manager, Pharmacy Operations	Ms.	Farber	Keri	A	9734668995					Keri_Farber@horizonblue.com	3 Penn Plaza East	PP-12	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Part D Quality Assurance Contact	Director, Pharmacy-Medicare		Patrikios	Athena		9734666542					Athena_Patrikios@horizonblue.com	3 Penn Plaza	PP-12Q	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Part D Reporting Contact	Medicare Program Analyst		Wilbanks	Dasha	N	9734665601					dasha_wilbanks@horizonblue.com	3 Penn Plaza	16-C	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Patient Safety Contact	Director, Pharmacy-Medicare		Patrikios	Athena		9734666542					Athena_Patrikios@horizonblue.com	3 Penn Plaza	PP-12Q	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Payment Contact	Manager, Financial Reporting		Griffin	Kevin		6095372464					kevin_griffin@horizonblue.com	1700 American Blvd	HL-03Q	Pennington	NJ	08534	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Pharmacy Director	Director, Clinical Pharmacy Programs		Patrikios	Athena		9734664654					athena_patrikios@horizonblue.com	3 Penn Plaza	PP-12Q	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Pharmacy Network Management Contact	AVP, Network Mgmt	Ms	Conlin	Marci		6127772842					Marci.Conlin@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Pharmacy Network Management Contact (Secondary)	Sr. Director Network Client Svcs.	Ms	Hanley	Megan		6127773969				8778236373	Megan.Hanley@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55122	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Pharmacy Technical Help Desk Contact	Director, Member Services		Shultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract	8003911926				HMO - Health Maintenance Organization		C	New York
H4675	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Exp. & Member Ops		Bunch	Jonathan							jonathan.bunch@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract	8003911926				HMO - Health Maintenance Organization		C	New York
H4675	Plan Directory Contact for Public Website	Mgr, Exec DOBI Compl & Appls		Mestres	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Plan to Plan Reconciliation Contact	Pharmacy Business Admin		Cunningham	Theresa		9734667886				9734664665	theresa_cunningham@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Processor Contact	Manager, PBM Ops	Ms.	Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Rd	PRIME Therapeutics	Eagan	MN	55121	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Quality Contact	Director, Quality Improvement Operations		Harris	Andrea		6095373027					andrea_harris@horizonblue.com	1700 American Blvd	HL-02	Pennington	NJ	08534	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Reconciliation Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319				7322565428	jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Reconciliation Contact (Secondary)	Manager, Actuarial		Muellers	Barbara		7322565313				7322565428	barbara_muellers@horizonblue.com	1427 Wyckoff Road	WL-03R	Wall	NJ	07727	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Recovery Audit Contact	Director, Special Investigations	Mr.	Dineen	Timothy		9734668723					timothy_dineen@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	SNP Application Contact			CONTACT	NO		9734664015					NOEMAIL@HORIZONBLUE.COM	3 Penn Plaza	12-H	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	SNP State Contact			CONTACT	NO		9734664015					NOEMAIL@HORIZONBLUE.COM	3 Penn Plaza	12-H	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Surveillance Contact	Manager, Medicare Requirements	Mr.	Johnson	Scott		6095373066					scott_johnson@horizonblue.com	1700 American Blvd. HL-03	Hopewell Campus	Pennington	NJ	08534	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	System Contact	Manager, Information Security Risk Management		Andreano	Matthew		9734664124					matthew_andreano@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Third Party Administrator (TPA) Liaison	Director, Pharmacy (Medicare)		Patrikios	Athena		9734666542					athena_patrikios@horizonblue.com	3 Penn Plaza	PP-12Q	Newark	NJ	07105	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	User Access Contact	Medicare Program Analyst		Wilbanks	Dasha	N	6095372613					Dasha_Wilbanks@horizonblue.com	1700 American Blvd. HL-01	Hopewell Campus	Pennington	NJ	08534	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Utilization Management Contact	Dir, Clin Ops & Delegate Vendor Oversight		Rush	Lisa		7322565016					Lisa_Rush@horizonblue.com	250 Century Parkway	3-D	Mount Laurel	NJ	08054	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4675	Utilization Review Contact	Dir, Clin Ops & Delegate Vendor Oversight		Rush	Lisa		7322565016					Lisa_Rush@horizonblue.com	250 Century Parkway	3-D	Mount Laurel	NJ	08054	05/31/2023	2023	HEALTHIER NEW JERSEY INSURANCE COMPANY	Local CCP	Braven Health	HMO/HMOPOS		NJ Collaborative Care, LLC	755	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H4676	Agent/Broker Compensation Data Contact	VP, Finance	Mr.	Shandley	Joey		7042758900	116				joey@troymedicare.com	615 S College Street	9 Fl	Charlotte	NC	28202	10/29/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Automated TrOOP Balance Transfer Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Backup User Access Contact	Sr Compliance Analyst		Young	Elisa		5408414151					elisa@troymedicare.com	615 S. College St	9F	Charlotte	NC	28202	03/05/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Best Available Evidence Contact	Director, Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S College Street	9 Fl	Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Bid Audit Contact	Consulting Actuary		Krentzman	Mike		7272597471	571				michaelk@wakely.com	7650 W. Courtney Campbell Causeway	Suite 1250	Tampa	FL	33607	06/03/2020	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Bid Primary Contact	Consulting Actuary		Krentzman	Mike		7272597471	571				michaelk@wakely.com	7650 W. Courtney Campbell Causeway	Suite 1250	Tampa	FL	33607	06/03/2020	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	CAP Report Contact for Public Website	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	CEO - CMS Administrator Contact	CEO	Mr.	Lipkind	Ethan		8474942677					ethan@troymedicare.com	615 S. College St	9 Fl	Charlotte	NC	28202	12/22/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	CEO - Senior Official for Contracting	CEO	Mr.	Lipkind	Ethan		8474942677					ethan@troymedicare.com	615 S. College St	9 FL	Charlotte	NC	28202	03/05/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Chief Financial Officer	Chief Financial Officer	Mr.	Mohawk	Russ		7046096422					joey@troymedicare.com	615 S College Street	9 Fl	Charlotte	NC	28202	09/27/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Chief Operating Officer	Chief Operating Officer	Ms	Za	Christina		9103701115	222				christina.za@troymedicare.com	615 S. College St	9F	Charlotte	NC	28202	06/13/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Chief Information Officer		Mr.	Simihaian	Flaviu		7042758900	111				flaviu@troymedicare.com	615 S College Street	9FL	Charlotte	NC	28202	03/07/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Chief Information Security Officer		Mr.	Simihaian	Flaviu		7042758900	111				flaviu@troymedicare.com	615 S. College St	10F	Charlotte	NC	28202	03/07/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	CMMI Model Point of Contact	Chief Development Officer	Mrs.	Eisenberg	Elyse		7042758900	112				elyse@troymedicare.com	615 S. College St	10F	Charlotte	NC	28202	06/13/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	CMS Casework Communication Contact	Chief Compliance Officer		Scott	Sally		5026453161					sally@troymedicare.com	615 S. College St	9F	Charlotte	NC	28202	03/05/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Complaints Tracking Contact	Chief Compliance Officer	Ms.	Scott	Sally		5026453161					sally@troymedicare.com	615 S. College St	9F	Charlotte	NC	28202	03/05/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Contact for Fraud Investigations	Chief Compliance Officer	Ms.	Scott	Sally		5026453161					sally@troymedicare.com	615 S. College St	9F	Charlotte	NC	28202	03/05/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Coordination of Benefits Contact	Director, Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S College Street	9 Fl	Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Corporate Mailing						7042758900	128				keith@troymedicare.com	615 S. College St.	FL 9	Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Coverage Gap Discount Program (CGDP) Payment Contact	VP, Finance	Mr.	Shandley	Joey		7042758900	116				joey@troymedicare.com	615 S College Street	9 Fl	Charlotte	NC	28202	10/05/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Customer Service Operations Contact	Chief Operating Officer		Za	Christina		9103701115	222				christina.za@troymedicare.com	615 S. College St	9FL	Charlotte	NC	28202	06/13/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	DIR Contact	VP, Finance		Shandley	Joey		7046096422					joey@troymedicare.com	615 S. College St.	FL 9	Charlotte	NC	28202	03/05/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	DIR Contact (Secondary)	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Emergency Part D Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Emergency Part D Contact (Secondary)	Chief Compliance Officer		Scott	Sally		5026453161					sally@troymedicare.com	615 S. College St.	FL 9	Charlotte	NC	28202	12/22/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Encounter Data & Risk Adjustment Operations Contact	Chief Development Officer		Eisenberg	Elyse		7042758900	112				elyse@troymedicare.com	615 S College Street	9 Fl	Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Enrollment Contact	Chief Operating Officer		Za	Christina		9103701115	222				christina.za@troymedicare.com	615 S. College St	9FL	Charlotte	NC	28202	06/13/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	EOB Transfer Contact	Chief Operating Officer		Za	Christina		9103701115	222			9193753533	christina.za@troymedicare.com	615 S. College St	9F	Charlotte	NC	28202	09/27/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Financial Audit Contact	VP, Finance	Mr	Shandley	Joey		7042758900	116				joey@troymedicare.com	615 S College Street	9 Fl	Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Financial Reporting Contact	VP, Finance		Shandley	Joey		7042758900	116				joey@troymedicare.com	615 S College Street	9 Fl	Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Formulary Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Formulary Contact (Secondary)	Clinical Pharmacist		Jackson	Deven		7042758900	136				deven@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	General Contact	Chief Compliance Officer	Ms.	Scott	Sally		7042758900	168				sally@troymedicare.com	615 S. College St	10F	Charlotte	NC	28202	05/04/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Government Relations Contact			Harrison	Scott		7036970339					srharrison@srhlaw.us	1200 G St., NW	Suite 800	Washington	DC	20005	02/10/2019	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	HIPAA Privacy Officer	Chief Compliance Officer	Ms.	Scott	Sally		5026453161					sally@troymedicare.com	615 S. College St	10F	Charlotte	NC	28202	02/27/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	HIPAA Security Officer		Mr.	Simihaian	Flaviu		7042758900	111				flaviu@troymedicare.com	615 South College Street Floor 9		Charlotte	NC	28202	03/07/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Hospice Contact	Director, Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S College St Fl 9		Charlotte	NC	28202	06/01/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Interoperability Contact		Mr.	Simihaian	Flaviu		7042758900	111				flaviu@troymedicare.com	615 S College Street		Charlotte	NC	28202	03/07/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	MA Appeals/Grievances Contact	Chief Operations Officer		Za	Christina		9103701115	222				christina.za@troymedicare.com	615 S. College St	9FL	Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	MA Claims Processing Contact for Public Website	Chief Operating Officer		Za	Christina		9103701115	222				christina.za@troymedicare.com	615 S. College St	9F	Charlotte	NC	28202	06/13/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Marketing Contact	Chief Compliance Officer		Scott	Sally		5026453161					sally@troymedicare.com	615 S College St FL 9	10F	Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Medical Director	Chief Medical Officer	Dr	Fitzgerald	Mike		8434691459					jennifer.murphy@troymedicare.com	615 S College St FL 9		Charlotte	NC	28202	09/27/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Scott	Sally		5026453161					sally@troymedicare.com	615 S. College St	9F	Charlotte	NC	28202	02/17/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Medicare Coordinator	Chief Operating Officer		Za	Christina		9103701115	222				christina.za@troymedicare.com	615 S. College St	9F	Charlotte	NC	28202	06/13/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Medication Therapy Management Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Part C Application Contact	Chief Development Officer	Mrs.	Eisenberg	Elyse		7042758900	112				elyse@troymedicare.com	615 S. College St	10F	Charlotte	NC	28202	06/13/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Part C Reporting Contact	Chief Compliance Officer	Ms.	Scott	Sally		7042758900	168				sally@troymedicare.com	615 S. College St	10F	Charlotte	NC	28202	05/04/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Appeals	Director of Pharmacy		Yon	Keith							keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active	7042758900	128			HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Appeals Contact (Secondary)	Clinical Pharmacist		Jackson	Deven							deven@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active	7042758900	136			HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Application Contact	Chief Development Officer	Mrs.	Eisenberg	Elyse		7042758900	112				elyse@troymedicare.com	615 S. College St	10F	Charlotte	NC	28202	06/13/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Benefits Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Claims Submission Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Exceptions Contact	Director of Pharmacy		Yon	Keith							keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active	7042758900	128			HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Exceptions Contact (Secondary)	Clinical Pharmacist		Jackson	Deven							deven@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active	7042758900	136			HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Price File Contact (Back-up)	Clinical Pharmacist		Jackson	Deven		7042758900	136				deven@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Price File Contact (Optional)	Clinical Pharmacist		Jackson	Deven		7042758900	136				deven@troymedicare.com	615 S College St FL 9		Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Price File Contact (Primary)	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Quality Assurance Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Part D Reporting Contact	Chief Compliance Officer	Ms.	Scott	Sally		7042758900	168				sally@troymedicare.com	615 S. College St	10F	Charlotte	NC	28202	05/04/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Patient Safety Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Payment Contact	VP, Finance		Shandley	Joey		7042758900	116				joey@troymedicare.com	615 S College Street	9 Fl	Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Pharmacy Director	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Pharmacy Network Management Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist		Jackson	Deven		7042758900	136				deven@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Pharmacy Technical Help Desk Contact			Pharmacy Services	PerformRx								200 Stevens Dr.		Philadelphia	PA	19113	06/02/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active	8665606052				HMO - Health Maintenance Organization		C	Atlanta
H4676	Pharmacy Technical Help Desk Contact (Secondary)	Clinical Pharmacist		Jackson	Deven							deven@troymedicare.com	615 S College St FL 9		Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active	7042758900	136			HMO - Health Maintenance Organization		C	Atlanta
H4676	Plan Directory Contact for Public Website		Mr.	Simihaian	Flaviu		7042758900	111				flaviu@troymedicare.com	615 S. College St	10F	Charlotte	NC	28202	03/07/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Plan to Plan Reconciliation Contact	Vice President of Finance	Mr.	Shandley	Joey		7042758900	116				joey@troymedicare.com	615 S College Street	10 Fl	Charlotte	NC	28202	05/04/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Processor Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Quality Contact	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Reconciliation Contact	VP, Finance		Shandley	Joey		7042758900	116				joey@troymedicare.com	615 S College Street	9 Fl	Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Reconciliation Contact (Secondary)	Director of Pharmacy		Yon	Keith		7042758900	128				keith@troymedicare.com	615 S. College St.	FL 10	Charlotte	NC	28202	03/07/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Recovery Audit Contact	Chief Compliance Officer	Ms.	Scott	Sally		5026453161					sally@troymedicare.com	615 S College St FL 9		Charlotte	NC	28202	08/25/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	SNP Application Contact	Chief Development Officer	Mrs.	Eisenberg	Elyse		7042758900	112				elyse@troymedicare.com	615 S. College Street		Charlotte	NC	28202	06/13/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Surveillance Contact	Chief Compliance Officer		Scott	Sally		7042758900	168				sally@troymedicare.com	615 S. College St	10F	Charlotte	NC	28202	02/27/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	System Contact		Mr.	Simihaian	Flaviu		7042758900	111				flaviu@troymedicare.com	615 S. College St	10F	Charlotte	NC	28202	03/07/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Third Party Administrator (TPA) Liaison	Chief Operating Officer		Za	Christina		9103701115	222				christina.za@troymedicare.com	615 S. College St	9F	Charlotte	NC	28202	06/13/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	User Access Contact	Chief Compliance Officer		Scott	Sally		7042758900	168				sally@troymedicare.com	615 S. College St	9 FL	Charlotte	NC	28202	10/13/2022	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Utilization Management Contact			Murphy	Jennifer		7045340045	175				jennifer.murphy@troymedicare.com	615 S College St Fl 9		Charlotte	NC	28202	01/30/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4676	Utilization Review Contact			Murphy	Jennifer		7045340045	175				jennifer.murphy@troymedicare.com	615 S College St Fl 9		Charlotte	NC	28202	01/30/2023	2023	TROY HEALTH, INC.	Local CCP	Troy Medicare	HMO/HMOPOS		Troy Holdings, Inc.	734	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4682	Automated TrOOP Balance Transfer Contact	Director of Finance		Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Backup User Access Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Best Available Evidence Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Bid Primary Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	CAP Report Contact for Public Website	Executive Director		Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	07/25/2022	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	CEO - CMS Administrator Contact		Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		los Angles	CA	90018	07/25/2022	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	CEO - Senior Official for Contracting		Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		los Angles	CA	90018	07/25/2022	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Chief Financial Officer		Mr	Cordeau	Bryan		2026039602					Bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Chief Operating Officer	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Chief Information Officer	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Chief Information Security Officer	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	CMS Casework Communication Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Complaints Tracking Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Contact for Fraud Investigations	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Coordination of Benefits Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Corporate Mailing						2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	07/25/2022	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Customer Service Operations Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	DIR Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Emergency Part D Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Encounter Data & Risk Adjustment Operations Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Enrollment Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	EOB Transfer Contact	Director of Finance	Mr	Cordeau	Bryan		2026039602				9495356405	bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Financial Audit Contact	Director of Finance	Mr	Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Financial Reporting Contact	Director of Finance		Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Formulary Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	General Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Government Relations Contact		Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		los Angles	CA	90018	07/25/2022	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	HIPAA Privacy Officer	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	HIPAA Security Officer	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	MA Appeals/Grievances Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	MA Claims Processing Contact for Public Website	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Marketing Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Medical Director	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Medicare Compliance Officer		Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		los Angles	CA	90018	07/25/2022	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Medicare Coordinator	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Medicare Part D Opioid Overutilization Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	4540 California Ave		Bakersfield	CA	93309	06/25/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Medication Therapy Management Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Part C Application Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Part D Appeals	Director of Finance		Cordeau	Bryan							bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending	2026039602				PACE - Nat		C	San Francisco
H4682	Part D Application Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Part D Benefits Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Part D Claims Submission Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Part D Exceptions Contact	Director of Finance		Cordeau	Bryan							bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending	2026039602				PACE - Nat		C	San Francisco
H4682	Part D Price File Contact (Back-up)	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Part D Price File Contact (Primary)	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Part D Quality Assurance Contact	Director of Finance		Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Part D Reporting Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Patient Safety Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Payment Contact	Director of Finance		Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Pharmacy Director	Executive Director		Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Pharmacy Network Management Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Pharmacy Technical Help Desk Contact	Director of Finance		Cordeau	Bryan							bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending	2026039602				PACE - Nat		C	San Francisco
H4682	Plan Directory Contact for Public Website	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Plan to Plan Reconciliation Contact	Director of Finance		Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Processor Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Quality Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Reconciliation Contact	Director of Finance	Mr	Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Recovery Audit Contact	Director of Finance	Mr	Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Surveillance Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	System Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Third Party Administrator (TPA) Liaison	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	User Access Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Utilization Management Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4682	Utilization Review Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOCARE PACE OF BAKERSFIELD, LLC	National PACE	Concertocare PACE of Bakersfield	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H4699	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/24/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/27/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H4699	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H4699	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H4699	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H4699	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H4699	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H4699	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H4699	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4699	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H4711	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/11/2018	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	12/11/2018	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	06/13/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H4711	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/11/2018	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4711	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF NEBRASKA, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4714	Automated TrOOP Balance Transfer Contact	CFO		Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Backup User Access Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Best Available Evidence Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Bid Primary Contact	Health Data Specialist	Mr.	Powell	Greg		7048873857					greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	02/27/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	CAP Report Contact for Public Website	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	CEO - CMS Administrator Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	CEO - Senior Official for Contracting	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Chief Financial Officer	Chief Financial Officer	Mr.	Nickerson	Kirby		7047548228				7046372950	knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	09/14/2020	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Chief Operating Officer	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Chief Information Officer	IT Director	Ms.	Glidewell	Mary		7047548226					MGlidewell@lscarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	09/14/2020	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Chief Information Security Officer	Director Corporate Compliance	Mrs.	Alexander	Lydia		7048873840					lyalexander@seniortlc.org	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	CMS Casework Communication Contact	Program Director	Ms.	Kenzig	Cathy		7048873840	3857			7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Complaints Tracking Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Contact for Fraud Investigations	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Coordination of Benefits Contact	CFO	Mr.	Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Corporate Mailing						7048873840	3857			7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Customer Service Operations Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	DIR Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	DIR Contact (Secondary)	Health Data Specialist		Powell	Greg		7048873857					greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Emergency Part D Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Emergency Part D Contact (Secondary)	Health Data Specialist		Powell	Greg		7048873857					greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Encounter Data & Risk Adjustment Operations Contact	CFO	Mr.	Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Enrollment Contact	CFO	Mr.	Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	EOB Transfer Contact	CFO	Mr.	Nickerson	Kirby		7047548228				7046372950	knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Financial Audit Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Financial Reporting Contact	CFO	Mr.	Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Formulary Contact	Health Data Specialist	Mr.	Powell	Greg		7048873857					greg.powell@pacesp.com	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Formulary Contact (Secondary)	Health Data Specialist	Mr.	Powell	Greg		7048873857					greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	General Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Government Relations Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	HIPAA Privacy Officer	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	HIPAA Security Officer	Director Corporate Compliance	Ms.	Alexander	Lydia		7048873857				7048873844	lyalexander@seniortlc.org	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Interoperability Contact	Director Corporate Compliance		Alexander	Lydia		7048873851					lyalexander@seniortlc.org	6613 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	MA Appeals/Grievances Contact	Director Corporate Compliance	Ms.	Alexander	Lydia		7048873840	3851			7048873844	lyalexander@seniortlc.org	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	MA Claims Processing Contact for Public Website	Health Data Specialist	Mr.	Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Marketing Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Medical Director	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Medicare Compliance Officer	Compliance Officer/Health Data Special	Mr.	Powell	Greg		3367456346					greg.powell@pacetriad.org	6133 The Plaza		Charlotte	NC	28215	02/27/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Medicare Coordinator	Health Data Specialist	Mr.	Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Medicare Part D Opioid Overutilization Contact	Health Data Specialist	Mr.	Powell	Greg		7048873857					greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Medication Therapy Management Contact	Health Data Specialist	Mr.	Powell	Greg		7048873857					greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Part C Application Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Part D Appeals	Health Data Specialist		Powell	Greg							Greg.Powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active	7048873857				PACE - Nat		C	Atlanta
H4714	Part D Appeals Contact (Secondary)	Health Data Specialist		Powell	Greg							Greg.Powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	09/14/2020	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active	7048873857				PACE - Nat		C	Atlanta
H4714	Part D Application Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Part D Benefits Contact	Health Data Specialist	Mr.	Powell	Greg		7048873857					greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Part D Claims Submission Contact	Health Data Specialist	Mr.	Powell	Greg		7048873857					greg.powell@LSCarolinas.net	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Part D Exceptions Contact	Health Data Specialist	Mr.	Powell	Greg							greg.powell@LSCarolinas.net	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active	7048873857				PACE - Nat		C	Atlanta
H4714	Part D Exceptions Contact (Secondary)	Health Data Specialist		Powell	Greg							Greg.Powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active	7048873857				PACE - Nat		C	Atlanta
H4714	Part D Price File Contact (Back-up)	Health Data Specialist	Mr.	Powell	Greg		7048873857					greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Part D Price File Contact (Primary)	Health Data Specialist	Mr.	Powell	Greg		7048873857					greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Part D Quality Assurance Contact	Health Data Specialist		Powell	Greg		3367456346					Greg.Powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	09/14/2020	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Part D Reporting Contact	Health Data Specialist	Mr.	Powell	Greg		7048873857					greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Patient Safety Contact	Health Data Specialist		Powell	Greg		3367456346					Greg.Powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	09/14/2020	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Payment Contact	CFO	Mr.	Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Pharmacy Director	Health Data Specialist		Powell	Greg		7048873857					Greg.Powell@pacesp.com	6133 The Plaza		Charlotte	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Pharmacy Network Management Contact	Health Data Specialist		Powell	Greg		7048873857					Greg.Powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Pharmacy Network Management Contact (Secondary)	Program Director	Ms.	Kenzig	Cathy		7048873869				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Pharmacy Technical Help Desk Contact	Health Data Specialist	Ms.	Powell	Greg						7048873844	greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	09/14/2020	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active	7048873840	3846			PACE - Nat		C	Atlanta
H4714	Plan Directory Contact for Public Website	CFO	Mr.	Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Plan to Plan Reconciliation Contact	Health Data Specialist	Mr.	Powell	Greg		7048873857					greg.powell@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Processor Contact	CFO	Mr.	Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Quality Contact	Quality Director	Ms.	Alexander	Lydia		7048873840	3851			7048873844	lyalexander@seniortlc.org	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Reconciliation Contact	CFO	Mr.	Nickerson	Kirby		7047548228					knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave.		Salisbury	NC	28145	01/11/2021	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Reconciliation Contact (Secondary)	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Recovery Audit Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Surveillance Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/19/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	System Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Third Party Administrator (TPA) Liaison	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	User Access Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Utilization Management Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4714	Utilization Review Contact	Program Director	Ms.	Kenzig	Cathy		7048873857				7048873844	cathy.kenzig@pacesp.com	6133 The Plaza		Charlotte	NC	28215	01/22/2023	2023	PACE OF THE SOUTHERN PIEDMONT, INC.	National PACE	PACE of the Southern Piedmont	National PACE		PACE of the Southern Piedmont, Inc.	509	Yes	Active					PACE - Nat		C	Atlanta
H4733	Agent/Broker Compensation Data Contact	Chief Operating Officer		Garcia	Joseph		6194986557					jgarcia@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Esp	Bryan		8587905873					PartDCAT@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Backup User Access Contact	Compliance Analyst		Padilla	Cecilia		6192713618					cepadilla@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	09/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Best Available Evidence Contact	Enrollment Manager		Fernandez	Judith		6194986418				6194269437	jferna@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Bid Audit Contact	Compliance Officer		Martinez	Elizabeth		6194986490					emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Bid Audit Site Contact	Compliance Officer		Martinez	Elizabeth		6194986490					emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Bid Primary Contact	Senior Director of Operations		Chavez	Francisca		6194986578					fchave@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	CAP Report Contact for Public Website	Compliance Officer		Martinez	Elizabeth		6194986490					emarti@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	03/21/2023	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active	8882444430				HMO - Health Maintenance Organization		C	San Francisco
H4733	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Diaz	Norma		6194986416				6194225930	ndiaz@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/02/2023	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Diaz	Norma		6194986416				6194225930	ndiaz@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Chief Financial Officer	Chief Financial Officer	Mr.	Carroll	Scott		6194986591				6194257803	scarro@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Chief Operating Officer	Chief Operating Officer	Mr.	Garcia	Joseph		6194986557					jgarcia@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Chief Information Officer	Chief Information Officer	Mr.	Sombillo	Allan		6194986413					asombi@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Chief Information Security Officer	Chief Information Officer	Mr.	Sombillo	Allan		6194986413					asombi@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	CMS Casework Communication Contact	Senior Director of Operations		Chavez	Francisca		6194986578					fchave@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	05/25/2023	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Complaints Tracking Contact	Director of Corporate Quality		Koizumi	Noreen		6194986476					nkoizu@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Contact for Fraud Investigations	Compliance Officer	Ms.	Martinez	Elizabeth		6194986490				6194225930	emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Coordination of Benefits Contact	Pharmacist		Chung	Tammy		6192408888				6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Corporate Mailing						6194220422				6194225930	info@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer		Carroll	Scott		6194986591				6194257803	scarro@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Customer Service Operations Contact	Senior Director of Operations		Chavez	Francisca		6194986578					fchave@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	05/25/2023	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	DIR Contact	Chief Financial Officer		Carroll	Scott		6194986591				6194257803	scarro@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	DIR Contact (Secondary)	Pharmacist		Chung	Tammy		6192408888				6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Emergency Part D Contact	Pharmacist		Chung	Tammy		6192408888				6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Emergency Part D Contact (Secondary)	Director of Corporate Quality		Koizumi	Noreen		6194986476				6194074652	nkoizu@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Encounter Data & Risk Adjustment Operations Contact	Director of Information Systems		Flora	Tatsani	I	6194986439					tinkha@chgsd.com	2420 Fenton Street	S-100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Enrollment Contact	Enrollment Manager		Fernandez	Judith		6194986418				6194269437	jferna@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	EOB Transfer Contact	Claims Administration Director		Arce	Adrian		6194986456				6194258726	aarce@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Financial Audit Contact	Chief Financial Officer	Mr.	Carroll	Scott		6194986591				6194257803	scarro@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Financial Reporting Contact	Chief Financial Officer		Carroll	Scott		6194986591				6194257803	scarro@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Formulary Contact	Pharmacist		Chung	Tammy		6192408888				6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Formulary Contact (Secondary)	Supervisor, Formulary Services		Nyawabila	Christina		8587906297					FMT@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	General Contact	Compliance Officer	Ms	Martinez	Elizabeth		6194986490				6194225930	emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Government Relations Contact	Associate CEO		Warren	Ann		6194986516				6194225930	awarre@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	HIPAA Privacy Officer	Compliance Officer		Martinez	Elizabeth		6194986490				6194225930	emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	HIPAA Security Officer	Chief Information Officer		Sombillo	Allan		6194986413					asombi@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Hospice Contact	Senior Director of Healthcare Services		Farook	Yousaf		6194986540					yfaroo@chgsd.com	2420 Fenton Street		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Interoperability Contact	Director of Information Systems		Flora	Tatsani	I	6194986439					tinkha@chgsd.com	2420 Fenton Street		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	MA Appeals/Grievances Contact	Corporate Quality Director		Koizumi	Noreen		6194986470					nkoizu@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	MA Claims Processing Contact for Public Website	Claims Administration Director		Arce	Adrian		6194986456				6194258726	aarce@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Marketing Contact	Compliance Officer		Martinez	Elizabeth		6194986490				6194225930	emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Medical Director	Interim Chief Medical Officer		Conrad, MD	Alan		6192714769					aconrad@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	09/26/2023	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Medicare Compliance Officer	Compliance Officer	Ms.	Martinez	Elizabeth		6194986490				6194225930	emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Medicare Coordinator	Chief Operating Officer		Garcia	Joseph		6194986557				6194225930	jgarcia@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Medicare Part D Opioid Overutilization Contact	Pharmacist		Chung	Tammy		6192408888				6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Medication Therapy Management Contact	Pharmacist		Chung	Tammy		6192408888				6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Part C Application Contact	Compliance Officer		Martinez	Elizabeth		6194986490				6194225930	emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Part C Reporting Contact	Compliance Officer		Martinez	Elizabeth		6194986490				6194225930	emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Appeals	Director of Corporate Quality		Koizumi	Noreen							nkoizu@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active	8882444430				HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Appeals Contact (Secondary)	Grievance and Appeals Supervisor		Herrera	Yessenia							yesseniaherrera@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	03/24/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active	8882444430				HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Application Contact	Compliance Officer	Ms.	Martinez	Elizabeth		6194986490				6194225930	emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Benefits Contact	Pharmacist		Chung	Tammy		6192408888				6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Claims Submission Contact	Pharmacist		Chung	Tammy		6192408888				6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Exceptions Contact	Pharmacist		Chung	Tammy						6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active	8882444430				HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Exceptions Contact (Secondary)	Director of Corporate Quality		Koizumi	Noreen						6194074652	nkoizu@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active	8882444430				HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Price File Contact (Back-up)	Pharmacist		Chung	Tammy		6192408888				6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Price File Contact (Optional)	Medicare Part D Project Manager		Maldonado	Cheryl		8587905849				8587906052	PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Price File Contact (Primary)	Director of Corporate Quality		Koizumi	Noreen		6194986476				6194074652	nkoizu@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	06/06/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Quality Assurance Contact	Director of Corporate Quality		Koizumi	Noreen		6194986476				6194074652	nkoizu@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	06/06/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Part D Reporting Contact	Compliance Officer		Martinez	Elizabeth		6194986490				6194225930	emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Patient Safety Contact	Director of Corporate Quality		Koizumi	Noreen		6194986476				6194074652	nkoizu@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	06/06/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Payment Contact	Chief Financial Officer		Carroll	Scott		6194986591				6194257803	scarro@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Pharmacy Director	Pharmacist		Chung	Tammy		6192408888				6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Pharmacy Network Management Contact	Pharmacist		Chung	Tammy		6192408888				6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Administration		Robertson	Jeanine		8587906108				8587906011	Jeanine.Robertson@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Pharmacy Technical Help Desk Contact	VP, Customer Contact Services		Battle	Dorry						8587906075	Customerservice@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active	8886486758				HMO - Health Maintenance Organization		C	San Francisco
H4733	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacist		Chung	Tammy						6193821217	ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active	8882444430				HMO - Health Maintenance Organization		C	San Francisco
H4733	Plan Directory Contact for Public Website	Senior Director of Operations		Chavez	Francisca		6194986578					fchave@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	05/25/2023	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Plan to Plan Reconciliation Contact	Pharmacist		Chung	Tammy		6192408888					ttran@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	11/30/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Processor Contact	Claims Administration Director		Arce	Adrian		6194986456				6194258726	aarce@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Quality Contact	Corporate Quality Director		Koizumi	Noreen		6194986476					nkoizu@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Reconciliation Contact	Chief Financial Officer		Carroll	Scott		6194986591				6194257803	scarro@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Reconciliation Contact (Secondary)	Finance Manager		Goux	Jon		6192408823					jgoux@chgsd.com	2420 Fenton Street Suite 100		Chula Vista	CA	91914	03/28/2023	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Recovery Audit Contact	Compliance Officer	Ms.	Martinez	Elizabeth		6194986490				6194225930	emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	SNP Application Contact			Martinez	Elizabeth		6194986490					emarti@chgsd.com	2420 Fenton Street		Chula Vista	CA	91914	02/15/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Surveillance Contact	Chief Operating Officer		Garcia	Joseph		6194986557					jgarcia@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	System Contact	Chief Information Officer		Sombillo	Allan		6194986413				6194763818	asombi@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Third Party Administrator (TPA) Liaison	Chief Financial Officer		Carroll	Scott		6194986591				6194257803	scarro@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	User Access Contact	Compliance Officer		Martinez	Elizabeth		6194986490				6194225930	emarti@chgsd.com	2420 Fenton Street	Suite 100	Chula Vista	CA	91914	01/03/2022	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Utilization Management Contact	Senior Director of Health Care Services		Farook	Yousaf		6194986540					YFaroo@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	09/26/2023	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4733	Utilization Review Contact	Senior Director of Health Care Services		Farook	Yousaf		6194986540					YFaroo@chgsd.com	2420 Fenton Street   Suite 100		Chula Vista	CA	91914	09/26/2023	2023	COMMUNITY HEALTH GROUP	Local CCP	Community Health Group	HMO/HMOPOS		Community Health Group	320	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4739	Agent/Broker Compensation Data Contact	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	06/24/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Automated TrOOP Balance Transfer Contact	Manager, Technical Delivery & Oversight	Mr.	Gajarajan	Nivi		2678258648					ngajarajan2@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	07/29/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Backup User Access Contact	Medicare Compliance Sr Operations Analyst		Morris	Ms. Gail		2158178922					gpmorris@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	300 Stevens Drive, Suite 201	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Best Available Evidence Contact	Medicare Enrollment Manager	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Bid Audit Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Bid Audit Site Contact	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	06/24/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Bid Primary Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Lovin	Dan		2672985617					dlovin@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive, 2nd flr.	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	CEO - CMS Administrator Contact	President - Medicare Pennsylvania	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	04/07/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	CEO - Senior Official for Contracting	President, Medicare Pennsylvania	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	04/07/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Chief Financial Officer	Chief Financial Officer	Mr.	Burgoyne	Michael		2159378875					mburgoyne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Chief Operating Officer	VP Medicare Integrated Health Plans	Mr.	McDade	Chris		4844971892					cmcdade@ameriHealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	07/26/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Chief Information Officer	Chief Information Officer	Mr.	Dickson	Fred		2158636570					fdickson@amerihealthcaritas.com	Amerihealth Caritas, Inc.	1 International Plaza IP2-4009	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Chief Information Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive	Philadelphia, PA	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	CMMI Model Point of Contact	Director, Medical Management Medicare	Ms.	Becker	Nancy		4844971265					nbecker1@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	12/29/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	CMS Casework Communication Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Complaints Tracking Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Contact for Fraud Investigations	Director, SIU	Mr.	McCall	Trevor		4844971241					tmccall2@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr	Philadelphia	PA	19113	08/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Coordination of Benefits Contact	Manager, Provider Network Oversight	Ms.	Williams	Kathy		8437467499					kwilliams@firstchoicevipcareplus.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Corporate Mailing						8434143130					tmoody@amerihealthcaritas.com	Select Health of South Carolina	4390 Belle Oaks Drive	Charleston	SC	29405	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager	Ms.	Maheepathi	Geetha		4435279822					gmaheepathi@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	3875 West Chester Pike	Newtown Square	PA	19073	03/15/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Customer Service Operations Contact	Director, Medicare Customer Service	Ms.	Veras	Helen		2672981794					hveras@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	08/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	DIR Contact	Director, Medicare Risk Adjustment and Performance	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	DIR Contact (Secondary)	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2824045991					AKindred@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Electronic Health Record Contact	Manager, Information Services		Drumming	Ms. Terri		2159378578					tdrumming@amerihealthcaritas.com	200 Stevens Drive Philadelphia		Philadephia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Emergency Part D Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	12/29/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Emergency Part D Contact (Secondary)	Director, Corporate Pharmacy		Cherian	Sheena		2158635768					scherian@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	12/28/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Employer Waiver Contact	Director, Medicare Medical Management	Ms	Becker	Nancy		4844971265					nbecker1@amerihealthcaritas.com	200 Stevens Drive Philadelphia		Philadephia	PA	19113	11/22/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Encounter Data & Risk Adjustment Operations Contact	Director, Medicare ACA and Risk Adjustment	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Enrollment Contact	Manager Enrollment Operations,	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealtharitas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	EOB Transfer Contact	Director, Medicare Claims	Mr.	Boyer	Joseph		2158636668				2159375321	Jboyer@Amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Financial Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	10/06/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Financial Reporting Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Formulary Contact	Director of Clinical Services, Formulary/DUR	Ms.	Megargell	Lauren		2159374135					Lauren.megargell@performrx.com	PerformRx	200 Stevens Dr.	Philadelphia	PA	19113	07/28/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Formulary Contact (Secondary)	DIrector of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family	200 Stevens Drive	Philadephia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	General Contact	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philidelphia	PA	19113	06/24/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Government Relations Contact	VP, Government Relations		Cozzo	Mr.Steven		2159378236					scozzo@Amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	HIPAA Privacy Officer	Director of Privacy	Ms.	Gustafson	Rebecca		2158636634					rgustafson@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr	Philadelphia	PA	19113	08/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	HIPAA Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr.	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Hospice Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadephia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Interoperability Contact	Director, Medicare Performance Management		Kindred	Amanda		2484045991					akindred@amerihealthcaritas.com	4000 Town Center	Suite 1300	Southfield	MI	48075	03/10/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	MA Appeals/Grievances Contact	Director, Corporate Appeals	Ms.	Garber	Brenda		2158635585					bgarber@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	12/03/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	MA Claims Processing Contact for Public Website			Services	Provider		8889780862					VIPProviderComm@amerihealthcaritas.com	The AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Marketing Contact	Medicare Compliance Sr Operations Analyst	Ms.	Morris	Gail	P	2158635141					gpmorris@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	300 Stevens Dr, Suite 201	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Medical Director	Medicare Medical Director	Dr.	Busch	Gregory		8562174603					gbusch@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	07/29/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Medicare Compliance Officer	Medicare Compliance Officer	Ms	Solomon	Mary		2673004846					mlsolomon@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Drive, 2flr.	Philadelphia	PA	19113	01/14/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Medicare Coordinator	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philidelphia	PA	19113	06/24/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Medication Therapy Management Contact	Director, Clinical Outcomes		Patel	Ms. Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	OffShore Subcontractor Contact	Performance Program Oversight Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	3785 Chester Pike	Newtown Square	PA	19073	01/05/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Online Enrollment Center Contact (Back-up)	Sr Medicare Enrollment Processor	Ms.	Price	Jamilla		2158636355					jprice@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Online Enrollment Center Contact (Primary)	Medicare Enrollment Specialist	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part C Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part C Reporting Contact	Manager, Medicare Performance Management	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Appeals	Supvr, Quality Auditing	Ms.	Clark	Janine							jclark2@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	12/29/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	4844985214				HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Appeals Contact (Secondary)	Appeals & Grievance Admin		Christian	Ms.Yolanda							ychristian@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8552210045				HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Benefits Contact	Pharmacist II	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	09/02/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Claims Submission Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	07/28/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Bonko	Gerald						2158635100	gbonko@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636483				HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Utilization Management	Mr.	McHale	Shawn						2158635100	smchale@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636370				HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Price File Contact (Back-up)	Claims Processor Associate		Reed	Ms.Lindsay		8473466370					lindsay.reed@abarcahealth.com	Abarca Health	650 Ave Munoz Rivera, Suite 701	San Juan	PR	00918	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Price File Contact (Optional)	Medicare Financial Operations Analyst III	Ms	Weihe	Heather		7875231212	1444				heather.weihe@abarcahealth.com	650 Ave Munoz Rivera	Suite 701	San Juan	PR	00918	11/22/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Price File Contact (Primary)	Manager, Pharmacy Network Operations	Mr.	King	James		8435694845					jking@performrx.com	PerformRx	200 Stevens Drive,	Philadelphia	PA	19113	07/28/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Quality Assurance Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	12/29/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Part D Reporting Contact	Quality Assurance Contract Account Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@keystonefirstpa.com	AmeriHealth Caritas Family of Companies	300 Stevens Dr. Suite 201	Philadelphia	PA	19113	03/10/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Patient Safety Contact	Director, Clinical Outcomes		Patel	Ms. Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Payment Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Personal Health Record Contact	Manager, Information Services		Drumming	Ms. Terri		2159378578					tdrumming@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Pharmacy Director	Director of Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	12/29/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Pharmacy Network Management Contact	Manager, Pharmacy Network Operations	Mr.	King	James		8435694845					jking@performrx.com	PerformRx	200 Stevens Dr.	Philadelphia	PA	19113	07/28/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Pharmacy Network Management Contact (Secondary)	Director, Service Operations		Leal	Ms.Avelina		2158636540					aleal@peformrx.com	PerformRx	200 Stevens Dr.	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Pharmacy Technical Help Desk Contact	Director, Service Operations	Ms.	Leal	Avelina							aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8553270511				HMO - Health Maintenance Organization		C	Philadelphia
H4739	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Care Center	Ms.	Lee	Pamela								PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8553270511				HMO - Health Maintenance Organization		C	Philadelphia
H4739	Physician Incentive Contact	Manager, Provider Relations	Ms.	Williams	Kathy		8437467499					kwilliams@firstchoicevipcareplus.com	4390 Belle Oak Drive,	Suite 400	Charletston	SC	29405	12/29/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Plan Directory Contact for Public Website			Services	Provider		8889780862					VIPProviderComm@amerihealthcaritas.com	The AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Plan to Plan Reconciliation Contact	Director, Finance	Ms	Sow	Oumou		4102584587					osow@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	P.O. 7137	London	KY	40742	06/15/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Processor Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Quality Contact	Director Quality Management	Ms.	Trimble	Dorothea		6162507322					dtrimble@amerihealthcaritas.com	Amerihealth Michigan	4000 Town Center, Suite 1300	Southfield	MI	48075	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Reconciliation Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Reconciliation Contact (Secondary)	Business Analyst	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Recovery Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	SNP Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	07/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	SNP State Contact	Plan Lead		Moody	Ms. Tonya		2158635700					tmoody@amerihealthcaritas.com	200 Stevens Dr.		Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Surveillance Contact	Business Development Manager	Ms.	Kumagai	Naoko		2157563724					nkumagai@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/08/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	System Contact	Business Systems Analyst Lead	Ms.	Drumming	Terri		2159378578					tdrumming@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Third Party Administrator (TPA) Liaison	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	User Access Contact	Medicare Compliance Officer	Mr.	Lovin	Dan		2676085073					dlovin@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive, 2nd flr	Philadelphia	PA	19113	02/12/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Utilization Management Contact	VP, Utilization Management Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	07/29/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4739	Utilization Review Contact	VP, Utilization Management Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	07/29/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Local CCP	First Choice VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4754	Agent/Broker Compensation Data Contact	Regional Sales Manager - Medicare Sales		Westphal	Brad		5413304996				5413226423	Brad.Westphal@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Automated TrOOP Balance Transfer Contact	VP, Government Operations		Hannabach	Jane		5413302530					Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	12/17/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Backup User Access Contact	Compliance Manager	Mrs.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	11/12/2019	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Best Available Evidence Contact	VP, Government Operations		Hannabach	Jane		5413302530					Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	12/17/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Bid Audit Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Bid Audit Site Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Bid Primary Contact	VP, Medicare Programs		Moss-Lewis	Jennifer		5413304993					Jennifer.MossLewis@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	CAP Report Contact for Public Website	President and Chief Executive Officer (CEO)	Mr.	Espinola	John		5416845286					John.Espinola@pacificsource.com	555 International Way		Springfield	OR	97477	04/03/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	CEO - CMS Administrator Contact	President and Chief Executive Officer (CEO)	Mr.	Espinola	John		5416845286					John.Espinola@PacificSource.com	555 International Way		Springfield	OR	97477	04/03/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	CEO - Senior Official for Contracting	President and Chief Executive Officer (CEO)	Mr.	Espinola	John		5416845286					John.Espinola@pacificsource.com	555 International Way		Springfield	OR	97477	04/03/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Chief Financial Officer	Executive VP and Chief Financial Officer (CFO)	Mr.	Davidson	Peter		5416845212				5413853008	Peter.Davidson@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Chief Operating Officer	Executive VP and Chief Operating Officer (COO)	Mr.	Doolen	Erick		5416845596					Erick.Doolen@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Chief Information Officer	Executive VP and Chief Operating Officer (COO)	Mr.	Doolen	Erick		5416845596					Erick.Doolen@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Chief Information Security Officer	Executive VP and Chief Operating Officer (COO)	Mr.	Doolen	Erick		5416845596					Erick.Doolen@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	CMS Casework Communication Contact	Team Leader Appeals and Grievances		Downey	Reanna		5417065031					Reanna.Downey@pacificsource.com	PO Box 7469		Bend	OR	97708	07/20/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Complaints Tracking Contact	Team Leader Appeals and Grievances		Downey	Reanna		5417065031					Reanna.Downey@pacificsource.com	PO Box 7469		Bend	OR	97708	07/20/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Contact for Fraud Investigations	Director, Corporate Compliance - Commercial		Holliday	Gary		5416845251					Gary.Holliday@pacificsource.com	555 International Way		Springfield	OR	97475	02/23/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Coordination of Benefits Contact	Claims Manager COB-TPL		Keeler	Dena		5412253765					Dena.Keeler@pacificsource.com	555 International Way		Springfield	OR	97477	04/14/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Corporate Mailing						5413855315				5413853008	Jennifer.MossLewis@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accounts Receivable Accountant		Beaty	Charlene		5416845250					Charlene.Beaty@pacificsource.com	555 International Way		Springfield	OR	97477	08/08/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Customer Service Operations Contact	VP, Government Operations		Hannabach	Jane		5413302530				5413853008	Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	DIR Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999				8003664873	RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	DIR Contact (Secondary)	Manager of Pharmacy Administration, Govt		Riffle	Connie		5413304999					connie.riffle@pacificsource.com	PO Box 7469		Bend	OR	97708	12/01/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Emergency Part D Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999				8003664873	RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Analytic Manager		Kellogg	Ariel		5412253719					Ariel.Kellogg@pacificsource.com	555 International Way		Springfield	OR	97477	12/20/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Enrollment Contact	VP, Government Operations		Hannabach	Jane		5413302530					Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	12/17/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	EOB Transfer Contact	VP, Government Operations	Mrs.	Hannabach	Jane		5413302530				5413853008	Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Financial Audit Contact	Vice President of Finance	Ms	Patterson	Kari		5416845594					Kari.Patterson@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		Boise	ID	83706	09/26/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Financial Reporting Contact	Executive VP and Chief Financial Officer (CFO)	Mr.	Davidson	Peter		5416845212				5413853008	Peter.Davidson@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Formulary Contact	Rx Clinical Services Team		Services	Pharmacy		5038025965				5413853008	rxclinical@pacificsource.com	PO Box 7469		Bend	OR	97708	12/05/2019	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Formulary Contact (Secondary)	Pharmacy Compliance Specialist		Ryan	Alyssa		5418023031					Alyssa.Ryan@pacificsource.com	1500 SW 1st Ave, Suite 100		Portland	OR	97201	08/29/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	General Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Government Relations Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	HIPAA Privacy Officer	HIPAA Privacy Specialist		Olson	Terrie		5416408765					Terrie.Olson@pacificsource.com	555 International Way		Springfield	OR	97477	08/08/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	HIPAA Security Officer	Executive VP and Chief Operating Officer (COO)	Mr.	Doolen	Erick		5416845596					Erick.Doolen@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Hospice Contact	Manager of Pharmacy Administration, Govt		Riffle	Connie		5413304999				8003664873	Connie.Riffle@pacificsource.com	PO Box 7469		Bend	OR	97708	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Interoperability Contact	IT Director of Technical Solutions		Stucky	David		5412252703					David.Stucky@pacificsource.com	555 International Way		Springfield	OR	97477	12/20/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	MA Appeals/Grievances Contact	Team Leader Appeals and Grievances		Downey	Reanna		5417065031					Reanna.Downey@pacificsource.com	PO Box 7469		Bend	OR	97708	07/20/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	MA Claims Processing Contact for Public Website	VP, Government Operations		Hannabach	Jane		5413302530				5413853008	Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Marketing Contact	VP Enterprise Marketing and Communications		McMaster	Susan		9712225961					Susan.McMaster@pacificsource.com	1500 SW First Avenue, Suite #100A		Portland	OR	97201	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Medical Director	Medical Director	Dr.	McEachern	Edward		5413304999					rxleadership@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		boise	ID	83706	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Medicare Compliance Officer	Compliance Manager	Mrs.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/07/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Medicare Coordinator	Compliance Project Coordinator	Mrs.	Ely	Shelley		5413304914					Shelley.Ely@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Medicare Part D Opioid Overutilization Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	12/17/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Medication Therapy Management Contact	Pharmacy Clinical Team		Clinical	Pharmacy		5413304999					RxClinical@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Online Enrollment Center Contact (Primary)	VP, Government Operations		Hannabach	Jane		5413302530				5413853008	Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Part C Application Contact	Compliance Coordinator	Mrs.	Ely	Shelley		5413304914					Shelley.Ely@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Part C Reporting Contact	Compliance Manager	Mrs.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Part D Appeals	Team Leader Appeals and Grievances		Downey	Reanna							Reanna.Downey@pacificsource.com	PO Box 7469		Bend	OR	97708	07/20/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active	5417065031				PPO - BBA		C	Seattle
H4754	Part D Appeals Contact (Secondary)	Manager of Appeals and Grievances		Waltman	Jessica						5413226424	Jessica.Waltman@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		Boise	ID	83706	11/12/2019	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active	2089085825				PPO - BBA		C	Seattle
H4754	Part D Application Contact	Compliance Coordinator	Mrs.	Ely	Shelley		5413304914					Shelley.Ely@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Part D Benefits Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Part D Claims Submission Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Part D Exceptions Contact	Pharmacy Services Leadership Team		Services	Pharmacy							RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active	5413304999				PPO - BBA		C	Seattle
H4754	Part D Price File Contact (Back-up)			Loveland	Chet		4806064873				4013357984	Chet.Loveland@CVSHealth.com	CVS Caremark | Caremark	9501 E Shea Blvd	Scottsdale	AZ	85260	01/10/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Part D Price File Contact (Optional)	SR. Manager, PBM Financial Operations		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	CVS Caremark | Caremark	9501 E. Shea Blvd.	Scottsdale	AZ	85260	01/06/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Part D Price File Contact (Primary)	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	12/17/2021	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Part D Quality Assurance Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Part D Reporting Contact	Compliance Manager	Mrs.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Patient Safety Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Payment Contact	Executive VP and Chief Financial Officer (CFO)	Mr.	Davidson	Peter		5416845212				5413853008	Peter.Davidson@pacificsource.com	555 International Way		Springfield	OR	97477	09/16/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Pharmacy Director	Director of Clinical Pharmacy Services		Briones	Danielle		5413304999				8003664873	rxleadership@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		Boise	ID	83706	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Pharmacy Network Management Contact	SR. Manager, PBM Financial Operations		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea Blvd, MC080		Scottsdale	AZ	85620	01/06/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Pharmacy Network Management Contact (Secondary)	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999					RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Pharmacy Technical Help Desk Contact	Government Programs Pharmacy Services		Services	Pharmacy							pharmacy@pacificsource.com	PO Box 7469		Bend	OR	97708	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active	8884377728				PPO - BBA		C	Seattle
H4754	Pharmacy Technical Help Desk Contact (Secondary)			Helpdesk	Pharmacy								CVS Caremark | Caremark	9501 E. Shea Blvd.	Scottsdale	AZ	85260	12/01/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active	8666934620				PPO - BBA		C	Seattle
H4754	Physician Incentive Contact	VP of Provider Network		McGarry	Peter		5038025338					Peter.McGarry@pacificsource.com	13010 SW 68th Parkway, Suite 140		Tigard	OR	97223	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Plan Directory Contact for Public Website	Customer Service		Service	Customer		5413855315					MedicareCS@PacificSource.com	PO Box 7469		Bend	OR	97708	03/11/2019	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Plan to Plan Reconciliation Contact	Enrollment and Billing Representative		Yeakey	Paula		5417065172					P2Padmin@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Processor Contact	SR. Manager, PBM Financial Operations		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	CVS Caremark | Caremark	9501 E. Shea Blvd	Scottsdale	AZ	85260	01/06/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Quality Contact	Director of Clinical Quality Improvement		Randleman	Lizzy		5413307317					Lizzy.Randleman@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Reconciliation Contact	Pharmacy Services Leadership Team		Services	Pharmacy		5413304999				8003664873	RxLeadership@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Reconciliation Contact (Secondary)	Manager of Pharmacy Administration, Govt		Riffle	Connie		5413304999				8003664873	Connie.Riffle@pacificsource.com	PO Box 7469		Bend	OR	97708	02/24/2023	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Recovery Audit Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Surveillance Contact	Director, Government Compliance	Ms.	Brown	Jennifer		5413308115				5413853008	Jennifer.Brown@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	System Contact	VP, Government Operations		Hannabach	Jane		5413302530				5413853008	Jane.Hannabach@pacificsource.com	PO Box 7469		Bend	OR	97708	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Third Party Administrator (TPA) Liaison	Administrative Programs Manager		Riffle	Connie		5413307309					Connie.Riffle@pacificsource.com	PO Box 7469		Bend	OR	97708	05/11/2022	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	User Access Contact	Compliance Project Coordinator	Mrs.	Ely	Shelley		5413304914					Shelley.Ely@pacificsource.com	PO Box 7469		Bend	OR	97708	10/08/2020	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Utilization Management Contact	Health Services Manager		Kaiser	Lisa		2087802007					Lisa.Kaiser@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		Boise	ID	83706	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4754	Utilization Review Contact	Health Services Manager		Kaiser	Lisa		2087802007					Lisa.Kaiser@pacificsource.com	408 E Parkcenter Boulevard, Suite 100		Boise	ID	83706	10/17/2018	2023	PACIFICSOURCE COMMUNITY HEALTH PLANS	Local CCP	PacificSource Medicare	Local PPO		PacificSource	429	Yes	Active					PPO - BBA		C	Seattle
H4801	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/20/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	02/16/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	02/16/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/20/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	02/10/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H4801	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H4801	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H4801	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H4801	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/22/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	8772777898				PPO - BBA		C	Denver
H4801	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/23/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active	0000000000				PPO - BBA		C	Denver
H4801	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/16/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4801	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	02/15/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H4808	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H4808	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H4808	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H4808	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H4808	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H4808	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H4808	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H4808	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4808	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF COLORADO INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H4829	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	6126562187				PPO - BBA		C	San Francisco
H4829	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	7632832653				PPO - BBA		C	San Francisco
H4829	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	8005959532				PPO - BBA		C	San Francisco
H4829	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	8007887871				PPO - BBA		C	San Francisco
H4829	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4829	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UHC OF CALIFORNIA	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H4835	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/11/2018	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/06/2019	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	12/11/2018	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H4835	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/11/2018	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4835	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF OKLAHOMA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4847	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/24/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H4847	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H4847	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8668928340				HMO - Health Maintenance Organization		C	Dallas
H4847	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4847	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4863	Agent/Broker Compensation Data Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Automated TrOOP Balance Transfer Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Backup User Access Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Best Available Evidence Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Bid Audit Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Bid Primary Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	CAP Report Contact for Public Website	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Kimbrough	Anthony		9315600041	2817				akimbrough@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Kimbrough	Anthony		9315600041	2817				akimbrough@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Chief Financial Officer	Chief Financial Officer	Mrs.	Adams	Renee		9315600041	3108				radams@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Chief Operating Officer	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206				mgraham@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Chief Information Officer	Chief Information Officer	Mr.	Alberd	Scott		9315600041	3130				salberd@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Chief Information Security Officer	Chief Information Officer	Mr.	Alberd	Scott		9315600041	3130				salberd@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	CMS Casework Communication Contact	Assistant General Counsel & VP of Compliance	Mr.	Beard	Jason		9315600041	3125				jbeard@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Complaints Tracking Contact	Assistant General Counsel & VP of Compliance	Mr.	Beard	Jason		9315600041	3125				jbeard@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Contact for Fraud Investigations	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Coordination of Benefits Contact	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206				mgraham@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Corporate Mailing						9315600041	3125				jbeard@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mrs.	Adams	Renee		9315600041	3108				radams@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Customer Service Operations Contact	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206				mgraham@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	DIR Contact	Chief Financial Officer	Ms.	Adams	Renee		9315600041	3108				RAdams@fbhp.com	P.O. Box 313		Columbia	TN	38402	03/06/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	DIR Contact (Secondary)	Medicare Compliance Officer	Mr.	Tutaj	Thomas		9315600041	6461				ttutaj@fbhp.com	P.O. Box 313		Columbia	TN	38402	03/06/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Emergency Part D Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Emergency Part D Contact (Secondary)	Assistant General Counsel & VP of Compliance	Mr.	Beard	Jason		9315600041	3125				jbeard@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Encounter Data & Risk Adjustment Operations Contact	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206				mgraham@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Enrollment Contact	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206				mgraham@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	EOB Transfer Contact	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206			9313888326	mgraham@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Financial Audit Contact	Manager of Internal Audit	Ms.	King	Lea		9315600041	2261				LKing@fbhp.com	P.O. Box 313		Columbia	TN	38402	08/11/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Financial Reporting Contact	Chief Financial Officer	Mrs.	Adams	Renee		9315600041	3108				radams@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Formulary Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	General Contact	Assistant General Counsel & VP of Compliance	Mr.	Beard	Jason		9315600041	3125				jbeard@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Government Relations Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	HIPAA Privacy Officer	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	HIPAA Security Officer	Chief Information Officer	Mr.	Alberd	Scott	D	9315600041	3130				salberd@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Hospice Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Interoperability Contact	Chief Information Officer	Mr.	Alberd	Scott		9315600041	3130				salberd@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	MA Appeals/Grievances Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206				mgraham@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Marketing Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Medical Director	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Tutaj	Thomas		9315600041	6461				ttutaj@fbhp.com	P.O. Box 313		Columbia	TN	38402	05/04/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Medicare Coordinator	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Medicare Part D Opioid Overutilization Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Medication Therapy Management Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Online Enrollment Center Contact (Optional)	Chief Information Officer	Mr.	Alberd	Scott		9315600041	3130				salberd@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Part C Application Contact	Assistant General Counsel & VP of Compliance	Mr.	Beard	Jason		9315600041	3125				jbeard@fbhp.com	P.O. Box 313		Columbia	TN	38401	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Part C Reporting Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Part D Appeals	Chief Medical Officer	Dr.	Stallworth	Catherine							CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active	6159732923				HMO - Health Maintenance Organization		C	Atlanta
H4863	Part D Application Contact	Assistant General Counsel & VP of Compliance	Mr.	Beard	Jason		9014128259	3125				jbeard@fbhp.com	P.O. Box 313		Columbia	TN	38401	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Part D Benefits Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Part D Claims Submission Contact	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206				mgraham@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Part D Exceptions Contact	Chief Medical Officer	Dr.	Stallworth	Catherine							CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active	6159732923				HMO - Health Maintenance Organization		C	Atlanta
H4863	Part D Price File Contact (Back-up)	Business Analyst		Vargas	Danielle		4437101262					medops-planfinder_dl@ds.uhc.com	1600 McConnor Pkwy		Schaumburg	IL	60173	10/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Part D Price File Contact (Optional)	Medicare Operations Manager	Ms.	Ballard	Amy		9014128259					aballard@fbhp.com	147 Bear Creek Pike		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Part D Price File Contact (Primary)	Business Analyst	Ms.	Moore-Elliott	Shalandria		7637974305					shalandria.moore-elliott@optum.com	1600 McConnor Pkwy		Schaumburg	IL	60173	10/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Part D Quality Assurance Contact	Assistant General Counsel & VP of Compliance	Mr.	Beard	Jason		9315600041	3125				jbeard@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Part D Reporting Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Patient Safety Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Payment Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Pharmacy Director	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk	Mr.	Summer	Todd							todd.summers@optum.com	755 Research Parkway Suite 300		Oklahoma City	OK	73104	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active	8666436924				HMO - Health Maintenance Organization		C	Atlanta
H4863	Physician Incentive Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Plan Directory Contact for Public Website	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Plan to Plan Reconciliation Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Processor Contact	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206				mgraham@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/10/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Quality Contact	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206				mgraham@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Reconciliation Contact	Chief Financial Officer	Ms.	Adams	Renee		9315600041	3108				RAdams@fbhp.com	P.O. Box 313		Columbia	TN	38402	03/06/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Reconciliation Contact (Secondary)	Medicare Compliance Officer	Mr.	Tutaj	Thomas		9315600041	6461				ttutaj@fbhp.com	P.O. Box 313		Columbia	TN	38402	03/06/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Recovery Audit Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Surveillance Contact	General Counsel/SVP of Health Plan Administration	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	System Contact	Chief Information Officer	Mr.	Alberd	Scott		9014128259	3130				salberd@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/09/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mrs.	Adams	Renee		9315600041	3108				radams@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	User Access Contact	Assistant General Counsel & VP of Compliance	Mr.	Beard	Jason		9315600041	3125				jbeard@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/08/2022	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Utilization Management Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4863	Utilization Review Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	TRH HEALTH INSURANCE COMPANY	Local CCP	Farm Bureau Health Plans	HMO/HMOPOS		Tennessee Rural Health Improvement Association	651	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H4868	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/24/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H4868	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H4868	PHR Beneficiary Contact																	09/27/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H4868	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4868	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H4869	Agent/Broker Compensation Data Contact	Audit and Compliance Officer		Leon	Francisco		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	09/23/2022	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Automated TrOOP Balance Transfer Contact	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	09/23/2022	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Backup User Access Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	09/23/2022	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Best Available Evidence Contact	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	09/23/2022	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Bid Audit Contact	Audit and Compliance Officer		Leon	Francisco		8138475561					francisco.leon@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	09/23/2022	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Bid Primary Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	CAP Report Contact for Public Website	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	CEO - CMS Administrator Contact	CEO	Mr,	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	CEO - Senior Official for Contracting	CEO	Mr,	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Chief Financial Officer	CEO	Mr,	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Chief Operating Officer	COO	Mr,	Kunemund	Gregg		3522627410					Gregg.kunemund@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	06/29/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Chief Information Officer	CEO	Mr.	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Chief Information Security Officer	VP Audit and Compliance	Mr,	Leon	Francisco		8138475561					francisco.leon@goldkidney.com	8502 Princess Dr, #260		Scottsdale	AZ	85255	01/11/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	CMMI Model Point of Contact	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	CMS Casework Communication Contact	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Complaints Tracking Contact	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Contact for Fraud Investigations	Audit and Compliance Officer		Leon	Francisco		8138475561					francisco.leon@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Coordination of Benefits Contact	CEO	Mr,	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Corporate Mailing						9175455439					dave@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Coordinator		Nguyen	Dayna		7143343052					dayna.nguyen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	06/06/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Customer Service Operations Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	DIR Contact	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	DIR Contact (Secondary)	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Electronic Health Record Contact	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Emergency Part D Contact	Director of Pharmacy		Haggit	Brian		6026961796					Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Emergency Part D Contact (Secondary)	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Employer Waiver Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Encounter Data & Risk Adjustment Operations Contact	VP Clinical Affairs	Mr,	Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Enrollment Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	EOB Transfer Contact	CEO		Firdaus	Dave		9175455439				8559156513	dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Financial Audit Contact	President, CEO, and Treasurer	Mr.	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Financial Reporting Contact	CEO	Mr,	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Formulary Contact	Director of Pharmacy		Haggit	Brian		6026961796					Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Formulary Contact (Secondary)	VP of Clinical Affairs		Sorensen	Kirsten		6026961796					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	General Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Government Relations Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	HIPAA Privacy Officer	Audit and Compliance Officer		Leon	Francisco		8138475561					francisco.leon@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	HIPAA Security Officer	Audit and Compliance Officer		Leon	Francisco		8138475561					francisco.leon@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Hospice Contact	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Interoperability Contact	CEO	Mr,	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 Princess Dr, #260		Scottsdale	AZ	85255	01/11/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	MA Appeals/Grievances Contact	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	MA Claims Processing Contact for Public Website	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Marketing Contact	Audit and Compliance Officer		Leon	Francisco		8138475561					francisco.leon@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Medical Director	CMO		Sahani	Mandeep		6023202916					mandeep.sahani@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Medicare Compliance Officer	Audit and Compliance Officer	Mr.	Leon	Francisco		8138475561					francisco.leon@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Medicare Coordinator	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Haggit	Brian		6026961796					Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Medication Therapy Management Contact	Director of Pharmacy		Haggit	Brian		6026961796					Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	OffShore Subcontractor Contact	Audit and Compliance Officer		Leon	Francisco		8138475561					francisco.leon@goldkidney.com	8502 Princess Dr, #260		Scottsdale	AZ	85255	01/11/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Online Enrollment Center Contact (Back-up)	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Online Enrollment Center Contact (Primary)	CIO	Mr.	Shankar	Ravi		9900262055	91				ravi@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85260	10/17/2022	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Part C Application Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Part C Reporting Contact	Audit and Compliance Officer		Leon	Francisco		8138475561					francisco.leon@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Appeals	Director of Pharmacy		Haggit	Brian							Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active	6026961796				HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Appeals Contact (Secondary)	VP of Clinical Affairs		Sorensen	Kirsten							kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active	5125853376				HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Application Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Benefits Contact	Director of Pharmacy		Haggit	Brian		6026961796					Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Claims Submission Contact	Director of Pharmacy		Haggit	Brian		6026961796					Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Exceptions Contact	Director of Pharmacy		Haggit	Brian							Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active	6026961796				HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Exceptions Contact (Secondary)	VP of Clinical Affairs		Sorensen	Kirsten							kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active	5125853376				HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Price File Contact (Back-up)	VP of Clinical Services		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Price File Contact (Optional)			Niemi	Kirstin		8587906455					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/29/2022	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Price File Contact (Primary)	Director of Pharmacy		Haggit	Brian		6026961796					Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Quality Assurance Contact	VP of Clinical Services		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Part D Reporting Contact	Director of Pharmacy		Haggit	Brian		6026961796					Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Patient Safety Contact	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Payment Contact	Finance Coordinator		Nguyen	Dayna		7143343052					dayna.nguyen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	08/30/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Personal Health Record Contact	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Pharmacy Director	Director of Pharmacy		Haggit	Brian		6026961796					Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Pharmacy Network Management Contact	Director of Pharmacy		Haggit	Brian		6026961796					Brian.Haggit@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Pharmacy Network Management Contact (Secondary)	VP of Clinical Affairs		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services		Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2022	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active	8886727206				HMO - Health Maintenance Organization		C	Seattle
H4869	Pharmacy Technical Help Desk Contact (Secondary)	Director of Pharmacy		Haggit	Brian							brian.haggit@goldkidney.com	8502 E. Princess Dr	#260	Scottsdale	AZ	85255	12/30/2022	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active	4809038502	238			HMO - Health Maintenance Organization		C	Seattle
H4869	Physician Incentive Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Plan Directory Contact for Public Website	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Plan to Plan Reconciliation Contact	CEO	Mr,	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Processor Contact	CEO	Mr,	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Quality Contact	CMO		Sahani	Mandeep		6023202916					mandeep.sahani@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Reconciliation Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Reconciliation Contact (Secondary)	Finance Coordinator		Nguyen	Dayna		7143343052					dayna.nguyen@goldkidney.com	8502 Princess Dr, #260		Scottsdale	AZ	85255	08/30/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Recovery Audit Contact	CEO	Mr.	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 Princess Dr, #260		Scottsdale	AZ	85255	04/25/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	SNP Application Contact	CEO	Mr,	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	SNP State Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Surveillance Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	System Contact	CEO	Mr.	Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Third Party Administrator (TPA) Liaison	Finance Coordinator		Nguyen	Dayna		7143343052					dayna.nguyen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	06/07/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	User Access Contact	CEO		Firdaus	Dave		9175455439					dave.firdaus@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Utilization Management Contact	VP of Clinical Services		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4869	Utilization Review Contact	VP of Clinical Services		Sorensen	Kirsten		5125853376					kirsten.sorensen@goldkidney.com	8502 E Princess Dr, #260		Scottsdale	AZ	85255	04/27/2023	2023	GOLD KIDNEY OF ARIZONA	Local CCP	Gold Kidney Health Plan	HMO/HMOPOS		Gold Kidney Health Plan	788	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H4875	Agent/Broker Compensation Data Contact	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Automated TrOOP Balance Transfer Contact	Enrollment Coordinator		Rice	Lori		6164648667					PH-MedicareTrOOPContact@PriorityHealth.com	1231 East Beltline Ave NE	MS 1175	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Backup User Access Contact	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Best Available Evidence Contact	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Bid Audit Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Bid Audit Site Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Bid Primary Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	CAP Report Contact for Public Website	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648824					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active	6164648424				PPO - BBA		C	Chicago
H4875	CEO - CMS Administrator Contact	CEO	Mr	Thandani	Praveen		6164949365				6169421150	CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	CEO - Senior Official for Contracting	Vice President Medicare	Mr	Norman	Scott		2488803191					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Chief Financial Officer	Chief Financial Officer	Mr	Gates	Nick	P	6164648144					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Chief Operating Officer	CEO	Mr	Thandani	Praveen		6164649365					CEOMedicare@priorityhealth.com	1231 East Beltine NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Chief Information Officer	Chief Information Officer	Mr	Crook	Chris		6164649939					CEOMedicare@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Chief Information Security Officer	SVP, IS Technology Services	Mr	Dresen	Scott		6164864277					CEOMedicare@priorityhealth.com	100 Michigan Street NE	MC 843	Grand Rapids	MI	49503	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	CMMI Model Point of Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	CMS Casework Communication Contact	Manager for Business Monitoring - G & A		LaBelle	Julie		9178417869					Radha.LaBelle@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Complaints Tracking Contact	Manager for Business Monitoring - G & A		LaBelle	Julie		9178417869					Radha.LaBelle@priorityhealth.com	1231 East Beltline Ave NE	MS 1115	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Contact for Fraud Investigations	Manager, Special Investigations Unit		Gross	Brenda		6164648152					Brenda.Gross@PriorityHealth.com	1231 E Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Coordination of Benefits Contact	Claims Manager		Ball	Jill		8883896648					CEOMedicare@priorityhealth.com	1239 East Beltline Ave NE	MS2205	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Corporate Mailing						6169420954				6164640145	PH-DistributionSE@PriorityHealth.com	1231 East Beltline Ave, NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Coverage Gap Discount Program (CGDP) Payment Contact	Operations Supervisor		Johnston	Adam		6164648915					adam.johnston@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Customer Service Operations Contact	Customer Care Center Manager, Medicare		Storment	Joe		5033309550					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	DIR Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	DIR Contact (Secondary)	Senior Financial Analyst		McZee	Nikki		6164648205					nikki.mczee@corewellhealth.org	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Electronic Health Record Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648824					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active	6164648424				PPO - BBA		C	Chicago
H4875	Emergency Part D Contact	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Emergency Part D Contact (Secondary)	Manager, Medicare Pharmacy Operations		VanLoenen	Amanda		6164648750					Amanda.VanLoenen@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Employer Waiver Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Encounter Data & Risk Adjustment Operations Contact			Florn	Cathy		7348902858					cathy.florn@priorityhealth.com	1239 E Beltline Ave Ne		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Enrollment Contact	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	EOB Transfer Contact	Claims Manager		Ball	Jill		6164648044				6169750247	CEOMedicare@priorityhealth.com	1239 East Beltline Ave NE	MS 2205	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Financial Audit Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Financial Reporting Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Formulary Contact	Medicare Part D Operations Manager		Van Loenen	Amanda		6164648750					PH-MedicareFormularyContact@PriorityHealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	General Contact	Vice President Medicare	Mr	Norman	Scott		2488803191					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Government Relations Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	HIPAA Privacy Officer	VP, Compliance & Privacy Officer		Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS1155	Grand Rapids	MI	49525	08/24/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	HIPAA Security Officer			Dresen	Scott		6164864277					CEOMedicare@priorityhealth.com	100 Michigan Street NE		Grand Rapids	MI	49503	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Hospice Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Interoperability Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	MA Appeals/Grievances Contact	Manager Grievance & Appeal		Macdonald	Amanda		6164648264					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1115	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	MA Claims Processing Contact for Public Website	Claims Manager		Ball	Jill		6164648044					CEOMedicare@priorityhealth.com	1239 East Beltline Ave NE	MS 2205	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Marketing Contact	Sr. Markets & Product Development Director		Brown	Samia		6164648002					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Medical Director	Medicare Director		Forshee	James		6164644873					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Medicare Compliance Officer	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					cindy.rollenhagen@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Medicare Coordinator	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Medicare Part D Opioid Overutilization Contact	Medicare Quality Manager		Gutierrez	Salvador		6165757622					salvador.gutierrez@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Medication Therapy Management Contact	Director of Pharmacy Operations		Chaffee	Jacob		6168261329					jacob.chaffee@priorityhealth.com	1231 East Beltline Dr Ne		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	OffShore Subcontractor Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Online Enrollment Center Contact (Optional)	Government Programs Enrollment Coordinator		Rice	Lori		6164648667					lori.rice@priorityhealth.com	1231 East Beltline Ave NE	MS 1180	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Online Enrollment Center Contact (Primary)	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Part C Application Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Part C Reporting Contact	Sr. Compliance Analyst		Eizinger	Eric		2178400871					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Part D Appeals	Supervisor, Medicare Part D Appeals		Anderson	Melissa							PHMedicarePartDAPPLS@spectrumhealth.org	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active	6164648547				PPO - BBA		C	Chicago
H4875	Part D Appeals Contact (Secondary)	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy							CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active	6164648424				PPO - BBA		C	Chicago
H4875	Part D Application Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Part D Benefits Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Part D Claims Submission Contact	Manager, Medicare Part D Operations		Van Loenen	Amanda		6164648750					part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Part D Exceptions Contact			Help Desk	Pharmacy							part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active	8004666642				PPO - BBA		C	Chicago
H4875	Part D Exceptions Contact (Secondary)	Mgr, Medicare Part D Operations	Ms.	Van Loenen	Amanda							amanda.vanloenen@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active	6164648750				PPO - BBA		C	Chicago
H4875	Part D Price File Contact (Back-up)	Product Manager Advisor		Williams	Stephanie		5135091549					Medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Part D Price File Contact (Optional)	Manager, Medicare Part D Operations		Van Loenen	Amanda		6164648750					part.d.ops@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Part D Quality Assurance Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Part D Reporting Contact	Sr. Compliance Analyst		Eizinger	Eric		2178400871					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Patient Safety Contact	Clinical Pharmacy Program Manager	Mr	Chaffee	Jacob		6165756149					CEOMedicare@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Payment Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Personal Health Record Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Pharmacy Director	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Pharmacy Network Management Contact	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Pharmacy Network Management Contact (Secondary)	Manager, Medicare Pharmacy Operations		Van Loenen	Amanda		6164648750					amanda.vanloenen@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Pharmacy Technical Help Desk Contact			Help Desk	Pharmacy							part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active	8004666642				PPO - BBA		C	Chicago
H4875	Pharmacy Technical Help Desk Contact (Secondary)	Mgr, Medicare Part D Ops	Ms.	Van Loenen	Amanda							amanda.vanloenen@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active	6164648750				PPO - BBA		C	Chicago
H4875	Physician Incentive Contact	Director, Provider Strategy & Solutions		Ryan	Susan		3137010444					CEOMedicare@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Plan Directory Contact for Public Website			Service	Customer		8883896648					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Plan to Plan Reconciliation Contact	Reconciliation & Billing Specialist		Bentley-Brown	Linda		6164648582				6169573420	linda.bentley-brown@priorityhealth.com	1231 East Beltline Ave NE	MS 1190	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Processor Contact	ESI Sr Dir - Product Management Medicare		Mahon	Snezana		3146846361					SMahon@express-scripts.com	ESI	One Express Way	St. Louis	MO	63121	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Quality Contact	Manager, Quality	Mr	Straayer	Ian		6165752782					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Reconciliation Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Reconciliation Contact (Secondary)	Manager, Finance Reporting		Hendricks	Rachel		6164648205					rachel.hendricks@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Recovery Audit Contact	Manager Cost Recovery	Ms	Gross	Brenda		6164648152					brenda.gross@priorityhealth.com	1231 East Beltline NE	Mail Stop 2305	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	SNP Application Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					janine.bishop@priorityhealth.com	1231 E Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	SNP State Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					janine.bishop@priorityhealth.com	1231 E Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Surveillance Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	System Contact	Data Analytics Analyst-Senior, Sr Markets		Johnson	Joshua		6165755760					PH-MedicareSystemsContact@PriorityHealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Third Party Administrator (TPA) Liaison	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					cindy.rollenhagen@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/06/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	User Access Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Utilization Management Contact	Director, Utilization Mgmt PH Pre-Service		Mahoney	Diana		8439068561					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4875	Utilization Review Contact	Director, Medicare Care Management		Scovel	Janet		6164648656					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH	Local CCP	Priority Health Medicare	Local PPO		Corewell Health	190	Yes	Active					PPO - BBA		C	Chicago
H4882	Agent/Broker Compensation Data Contact	VP Government Programs		Clelland	Jennifer	J	9529675119					jennifer.j.clelland@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	11/04/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Automated TrOOP Balance Transfer Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Backup User Access Contact	Coordinator Government Programs		Yu	Chao		9528837240					Chao.X.Yu@HealthPartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	04/20/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Best Available Evidence Contact	Manager Membership Accounting		Marty	Amanda	E	9529677685					amanda.e.marty@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/05/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Bid Audit Contact	VP Internal Audit Comp Officer		Bunde	Steven	D	9528836541				9528835522	steven.d.bunde@healthpartners.com	8170 33rd Avenue South		Bloomington	MN	55425	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Bid Audit Site Contact	Director Monitoring and Compliance		Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS:  21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Bid Primary Contact	Corporate Actuary		Stewart	Sara	M	9528835049					sara.m.stewart@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21105H	Minneapolis	MN	554401309	07/24/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	CAP Report Contact for Public Website	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	CEO - CMS Administrator Contact	President and CEO	Ms.	Walsh	Andrea	M	9528835343				9528835350	wendy.r.kobe@healthpartners.com	8170 33rd Avenue South	MS: 21110A	Minneapolis	MN	55425	01/05/2023	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	CEO - Senior Official for Contracting	President and CEO	Ms.	Walsh	Andrea	M	9528835343				9528835350	wendy.r.kobe@healthpartners.com	8170 33rd Avenue South	MS: 21110A	Minneapolis	MN	55425	01/04/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Chief Financial Officer	SVP & Chief Financial Officer	Ms.	Johnson	Kathleen	A	9528836531					kathy.a.johnson1@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110T	Minneapolis	MN	554401309	03/29/2023	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Chief Operating Officer	EVP and Chief Health Plan Officer	Ms.	Danielson	Jennifer	B	9528835573					victoria.j.slates@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110A	Minneapolis	MN	554401309	07/06/2023	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Chief Information Officer	Senior Vice President and CTO	Mr.	Zuzek	Dennis	M	9528837045					dennis.m.zuzek@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Chief Information Security Officer	VP Technology Infrastructure & Security	Mr.	Muller	Frank	J	9529676070					frank.j.muller@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	CMS Casework Communication Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Complaints Tracking Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Contact for Fraud Investigations	Senior Manager Claims Cost Management		Hove	Ryan	M	6512651573					ryan.m.hove@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  25510F	Minneapolis	MN	55101	07/24/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Coordination of Benefits Contact	Manager, Claims Production		Prine	Chantelle	M	9529677335					RVSCCOBTECHS@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	04/20/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Corporate Mailing						9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	01/24/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant		Knights	Michelle	M	9528836532					michelle.m.knights@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21109A	Minneapolis	MN	554401309	12/03/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Customer Service Operations Contact	Director Member Services		Renneke	Alison		9529677668					alison.m.renneke@healthpartners.com	8170 33rd Avenue South, PO Box 9463	MS:  21103R	Minneapolis	MN	554409463	01/29/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	DIR Contact	Pharmacy Plan Contract Manager		Reinhardt	Sandra	L	9528836739					sandra.l.reinhardt@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/29/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	DIR Contact (Secondary)	Health Informatics Analyst Pcp		Binsfeld	David	T	9529675950					david.t.binsfeld@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS 21108Q	Minneapolis	MN	554401309	01/24/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Emergency Part D Contact	Sr. Director Pharmacy Services		Strahl	Christine	L	9528835022				9529676667	christine.l.strahl@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/04/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Emergency Part D Contact (Secondary)	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9529675826				9529676667	dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/29/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Employer Waiver Contact	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Encounter Data & Risk Adjustment Operations Contact	Senior Director Operational Integrity		Anderson	Larin	D	9528835796					larin.d.anderson@healthpartners.com	8170 33rd Avenue South	MS: 21103J	Minneapolis	MN	55425	10/22/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Enrollment Contact	Director Membership Accounting		McWell	Carrie	J	9529675487					carrie.j.mcwell@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	11/30/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	EOB Transfer Contact	Sr. Manager Claims Production		Huseby	Pam	J	9529675530				9528837666	pam.j.huseby@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	08/30/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Financial Audit Contact	Director Monitoring and Compliance	Ms	Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Financial Reporting Contact	Director Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21109A	Minneapolis	MN	554401309	01/24/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Formulary Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Formulary Contact (Secondary)	Formulary Administration Pharmacist		Savage	Robert		8587906426					robert.savage@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	07/24/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	General Contact	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Government Relations Contact	VP Government Programs		Clelland	Jennifer	J	9529675119					jennifer.j.clelland@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	08/30/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	HIPAA Privacy Officer	Sr. Director Integrity Compliance Privacy Officer		Wells	Prasanta	K	9528837325					prasanta.k.wells@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103K	Minneapolis	MN	554401309	01/24/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	HIPAA Security Officer	VP Technology Infrastructure & Security	Mr.	Muller	Frank	J	9529676070					frank.j.muller@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Hospice Contact	Pharmacy Compliance Specialist		Riggs	Ben	H	9528518421					benjamin.h.riggs@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Interoperability Contact	Program Manager		Geisler	Chris	J	6122479067					Chris.J.Geisler@HealthPartners.Com	8170 33rd Avenue South		Bloomington	MN	55425	06/20/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	MA Appeals/Grievances Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	MA Claims Processing Contact for Public Website	Manager Claims Production		Huseby	Pam	J	9529675530					RVSCProviderInquiry@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	03/14/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Marketing Contact	Mgr Govt Prog Materials & Regulatory Comm		Her-Vang	Xong		9529675061					xong.x.hervang@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	11/16/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Medical Director	Health Plan Chief Medical Officer	Dr.	Kakacek	Virginia	L	9528837120					virginia.l.kakacek@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110Q	Minneapolis	MN	554401309	09/21/2023	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Medicare Compliance Officer	VP Internal Audit Comp Officer	Mr.	Bunde	Steven	D	9528836541				9528835522	steven.d.bunde@healthpartners.com	8170 33rd Avenue South		Bloomington	MN	55425	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Medicare Coordinator	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Medicare Part D Opioid Overutilization Contact	Pharmacy Compliance Specialist		Riggs	Ben		9528518421					Benjamin.H.Riggs@HealthPartners.Com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/29/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Medication Therapy Management Contact	Senior Manager Med Therapy Management Program		Rehrauer	Daniel	J	9529675133					daniel.j.rehrauer@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/11/2018	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Online Enrollment Center Contact (Back-up)	Director Membership Accounting		McWell	Carrie	J	9529675487					carrie.j.mcwell@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/30/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Online Enrollment Center Contact (Optional)	Admin Product Implementation Manager		Wessel	Sara	C	9529677623					sara.c.wessel@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/29/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Online Enrollment Center Contact (Primary)	Manager Membership Accounting		Marty	Amanda	E	9529677685					amanda.e.marty@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	01/09/2018	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Part C Application Contact	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Part C Reporting Contact	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Part D Appeals	Manager Member Rights and Benefits		Kruse	Morgan	L						Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS:  21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active	8007963806				PPO - BBA		C	Chicago
H4882	Part D Appeals Contact (Secondary)	Senior Rights & Benefits Project Lead		Schneider	Crystal	L						crystal.l.schneider@healthpartners.com	8170 33rd Avenue South	MS: 21103R	Bloomington	MN	55425	01/05/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active	8007963806				PPO - BBA		C	Chicago
H4882	Part D Application Contact	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Part D Benefits Contact	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Part D Claims Submission Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Part D Exceptions Contact	Supervisor, Clinical Review		Whelan	Hillary	A					8888835434	hillary.a.whelan@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active	8004927259				PPO - BBA		C	Chicago
H4882	Part D Price File Contact (Back-up)			Communications	Planfinder		8587905849				8587906052	PlanFinderCommunications@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	01/24/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Part D Price File Contact (Primary)	Pharmacy Compliance Specialist		Riggs	Ben	H	9528518421					benjamin.h.riggs@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Part D Quality Assurance Contact	Senior Manager Quality and Compliance		Book	Anne	M	9528835128					anne.m.book@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21108T	Minneapolis	MN	554401309	01/09/2018	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Part D Reporting Contact	Director of Medicare and Shared Services		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	11/29/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Patient Safety Contact	Senior Manager Med Therapy Management Program		Rehrauer	Daniel	J	9529675133					daniel.j.rehrauer@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/14/2018	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Payment Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21109A	Minneapolis	MN	554401309	01/24/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Pharmacy Director	VP Pharmacy		Busch	David	L	9529675049					david.l.busch@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	06/25/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Pharmacy Network Management Contact	Director Pharmacy Sales & Product Support		Friday	Ken	R	9529675826				9529676667	kenneth.r.friday@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Administration		Hunt	Brian		8587907092					Brian.Hunt@MedImpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/29/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Pharmacy Technical Help Desk Contact	Manager Health Plan Pharmacy Customer Service		Whelan	Hillary	A					8888835434	Hillary.A.Whelan@HealthPartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/19/2022	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active	8004927259				PPO - BBA		C	Chicago
H4882	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Contact Services		Brewer	Kathy							Customerservice@Medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/15/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active	8887831779				PPO - BBA		C	Chicago
H4882	Plan Directory Contact for Public Website			Services	Provider		9528837699					RVSCProviderInquiry@HealthPartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	01/24/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Plan to Plan Reconciliation Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584				9528836500	kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21109A	Minneapolis	MN	554401309	01/24/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Processor Contact	Director Pharmacy Sales & Product Support		Friday	Ken	R	9529675826				9529676667	kenneth.r.friday@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Quality Contact	Senior Manager Quality and Compliance		Book	Anne	M	9528835128					anne.m.book@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	01/09/2018	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Reconciliation Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	01/24/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Reconciliation Contact (Secondary)	Senior Accountant		Knights	Michelle	M	9528833532					michelle.m.knights@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/19/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Recovery Audit Contact	Director Monitoring and Compliance	Ms.	Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	SNP Application Contact	Manager State Public Programs		McGeehan	Susan	K	9529675182					susan.k.mcgeehan@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	55440	03/14/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	SNP State Contact	Manager State Public Programs		McGeehan	Susan	K	9529675182					susan.k.mcgeehan@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	55440	03/14/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Surveillance Contact	Director Monitoring and Compliance		Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	System Contact	Senior Director Operational Integrity		Anderson	Larin	D	9528835796					larin.d.anderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21193J	Minneapolis	MN	554401309	01/24/2017	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Third Party Administrator (TPA) Liaison	Senior Accountant		Knights	Michelle	M	9528833532					michelle.m.knights@healthpartners.com	8170 33rd Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/19/2020	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	User Access Contact	Mgr Govt Prog Materials & Regulatory Comm		Her-Vang	Xong		9529675061					xong.x.hervang@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	11/16/2021	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Utilization Management Contact	Director Utilization Management		Gunderson	Susan	C	9528835576					susan.c.gunderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	12/10/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4882	Utilization Review Contact	Director Utilization Management		Gunderson	Susan	C	9528835576					susan.c.gunderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21108T	Minneapolis	MN	554401309	12/10/2019	2023	HEALTHPARTNERS, INC.	Local CCP	HealthPartners	Local PPO		HealthPartners, Inc.	117	Yes	Active					PPO - BBA		C	Chicago
H4906	Backup User Access Contact	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	CAP Report Contact for Public Website	Controller		Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	CEO - CMS Administrator Contact	Administrator	Ms	Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	CEO - Senior Official for Contracting	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Chief Financial Officer	Administrator	Ms	Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Chief Operating Officer	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Chief Information Officer	Administrator	Ms	Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Chief Information Security Officer	Administrator	Ms	Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	CMS Casework Communication Contact	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Complaints Tracking Contact	Administrator	Ms	Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Contact for Fraud Investigations	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Corporate Mailing						5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Cost Report Contact	Administrator	Ms	Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Customer Service Operations Contact	Medicare Dues Clerk		Nicely	Rodney		8006799135				5408624958	Rodney@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Encounter Data & Risk Adjustment Operations Contact	Administrator	Ms	Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Enrollment Contact	Administrator	Ms	Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	General Contact	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Government Relations Contact	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Interoperability Contact	Administrator		Hoke	Michelle		5408625728					michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	09/05/2023	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	MA Appeals/Grievances Contact	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	MA Claims Processing Contact for Public Website	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Marketing Contact	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Medical Director	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Medicare Compliance Officer	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Medicare Coordinator	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Part C Application Contact	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Payment Contact	Administrator	Ms	Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Plan Directory Contact for Public Website	Medicare Dues Clerk		Nicely	Rodney		8006799135				5408624958	Rodney@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Quality Contact	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Surveillance Contact	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	System Contact	Administrator	Ms	Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	User Access Contact	Administrator	Ms	Hoke	Michelle	M	5408625728				5408624958	michellehoke@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Utilization Management Contact	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4906	Utilization Review Contact	Benefits Manager	Mrs	Via	Brandi		5408625728				5408624958	brandivia@coeha.com	427 E Ridgeway Street		Clifton Forge	VA	24422	11/07/2022	2023	C AND O EMPLOYEES' HOSPITAL ASSOCIATION	HCPP - 1833 Cost	C and O Employees' Hospital Association	HCPP - 1833 Cost		C & O Employees' Hospital Association	37	No	Active					HCPP		1	Philadelphia
H4909	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	02/07/2019	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Bid Primary Contact	Product Management Director		Gray	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	02/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H4909	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				PPO - BBA		C	Chicago
H4909	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H4909	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				PPO - BBA		C	Chicago
H4909	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				PPO - BBA		C	Chicago
H4909	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				PPO - BBA		C	Chicago
H4909	PHR Beneficiary Contact																	11/05/2015	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				PPO - BBA		C	Chicago
H4909	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4909	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H4919	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	01/28/2021	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Backup User Access Contact	Chief Information Officer		Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/25/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Best Available Evidence Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/25/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Bid Primary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/25/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	CAP Report Contact for Public Website	VP of Clinical Compliance		Teter	Lezlie		7203929719				3039961600	lteter@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/25/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	CEO - CMS Administrator Contact	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/25/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	CEO - Senior Official for Contracting	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/25/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Chief Financial Officer	CFO	Mr	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/25/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Chief Operating Officer	Senior Advisor	Ms.	Lozzano	Maria		9098902854				3039961600	mlozzano@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/25/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Chief Information Officer	Chief Information Officer	Ms.	Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/25/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Chief Information Security Officer	SVP of Information Technology	Mr.	Naus	Cole		7209210443				3039961600	MNaus@innovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	07/25/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	CMS Casework Communication Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Complaints Tracking Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Contact for Fraud Investigations	Chief Legal Officer		D'Amato	Nicole		6154732250				3039961600	NDAmato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/25/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Coordination of Benefits Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Corporate Mailing						3038694664				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Customer Service Operations Contact	Senior Advisor		Lozanno	Maria		9098902854				3039961600	mlozanno@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	DIR Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	DIR Contact (Secondary)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Emergency Part D Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Emergency Part D Contact (Secondary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Encounter Data & Risk Adjustment Operations Contact	Director of PACE Finance		Hewitt	Jessica		7209746767					jhewitt@innovage.com	8950 E Lowry Blvd		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Enrollment Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	EOB Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Financial Audit Contact	Director of PACE Finance	Ms	Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Financial Reporting Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Formulary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Formulary Contact (Secondary)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	General Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Government Relations Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	HIPAA Privacy Officer	Corporate Counsel		Moxon	Jeff		3038694664				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	HIPAA Security Officer	SVP of Information Technology		Naus	Cole		7209210443				3039961600	MNaus@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Interoperability Contact	SVP of Applications		Zierolf	Kris		7209742380					kzierolf@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	MA Appeals/Grievances Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	MA Claims Processing Contact for Public Website	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Marketing Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Medical Director	Medical Director		Ferrance	Randy		2159514586				3039961600	rferrance@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Medicare Compliance Officer	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Medicare Coordinator	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Medicare Part D Opioid Overutilization Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 E. Lowry Blvd		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Medication Therapy Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Online Enrollment Center Contact (Back-up)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Online Enrollment Center Contact (Primary)	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Part C Application Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Part D Appeals	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending	7207444048				PACE - Nat		C	Atlanta
H4919	Part D Appeals Contact (Secondary)	VP of Pharmacy Services	Mrs.	Chase	Darla						3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	01/28/2021	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending	7209746785				PACE - Nat		C	Atlanta
H4919	Part D Application Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Part D Benefits Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Part D Claims Submission Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Part D Exceptions Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending	7207444048				PACE - Nat		C	Atlanta
H4919	Part D Exceptions Contact (Secondary)	Director of PACE Finance	Mr.	Ewing	Mark						3039961600	mewing@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	01/28/2021	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending	3038694664				PACE - Nat		C	Atlanta
H4919	Part D Price File Contact (Back-up)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Part D Price File Contact (Primary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Part D Quality Assurance Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Part D Reporting Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Patient Safety Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Personal Health Record Contact	VP Associate of General Counsel		Moxon	Jeff		3033006930				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Pharmacy Director	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Pharmacy Network Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Pharmacy Technical Help Desk Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending	7207444048				PACE - Nat		C	Atlanta
H4919	PHR Beneficiary Contact																	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE	Total Longterm Care Inc	Total Community Options, Inc	813	Yes	Pending	8772776163	732			PACE - Nat		C	Atlanta
H4919	Plan Directory Contact for Public Website	Director of Marketing		Stavros	Sarah		3033006904				3039961600	sstavros@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Plan to Plan Reconciliation Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				7209173390	akizewski@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Processor Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Quality Contact	VP of Quality		Curry	Jill		2153782123				3039961600	jcurry@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Reconciliation Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Reconciliation Contact (Secondary)	VP of PHarmacy Services	Mrs	Chase	Darla		3038694664				3039961600	dchase@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	01/28/2021	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Recovery Audit Contact	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444404					mcinque@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Surveillance Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	System Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Third Party Administrator (TPA) Liaison	Medicare Compliance Manager		Brown	Lauren		7209746767				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	User Access Contact	Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Utilization Management Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4919	Utilization Review Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	INNOVAGE FLORIDA PACE, LLC	National PACE	InnovAge Florida  PACE - Tampa	National PACE		Total Community Options, Inc	813	Yes	Pending					PACE - Nat		C	Atlanta
H4922	Agent/Broker Compensation Data Contact	Director of Business Development		Vavrinec	Lori Ann		7184845008					lvavrinec@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Automated TrOOP Balance Transfer Contact	MANAGING DIRECTOR  FINANCE, ANALYTICS AND OPERATI		Giarraputo	Marybeth		7184845028					mgiarraputo@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Backup User Access Contact	Network Manager		DeCady	Jean		7184845048					Jdecady@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Best Available Evidence Contact	MANAGING DIRECTOR  FINANCE, ANALYTICS AND OPERATI		Giarraputo	Marybeth		7184845028					mgiarraputo@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Bid Audit Contact	MANAGING DIRECTOR  FINANCE, ANALYTICS AND OPERATI		Giarraputo	Marybeth		7184845028					mgiarraputo@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Bid Audit Site Contact	Executive Director		Connelly	Patricia		7184845007					pconnelly@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	12/28/2020	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Bid Primary Contact	MANAGING DIRECTOR  FINANCE, ANALYTICS AND OPERATI		Giarraputo	Marybeth		7184845028					mgiarraputo@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	CAP Report Contact for Public Website	Corporate Compliance Officer	Ms.	Mukuka	Barbra	I	7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	CEO - CMS Administrator Contact	Executive Director	Mr.	Shutman	Samuel		7184845007					sshutman@agewellnewyork.com	1991 Marcus Ave	Suite M107	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	CEO - Senior Official for Contracting	Executive Director	Mr.	Shutman	Samuel		7184845007					sshutman@agewellnewyork.com	1991 Marcus Ave	Suite M107	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Chief Financial Officer	Chief Financial Officer	Ms.	Murphy	Joseph		7184845011					mgiarraputo@agewellnewyork.com	1991 Marcus Avenue	Suite M107	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Chief Operating Officer	Executive Director	Mr.	Shutman	Samuel		7184845007					jmurphy@agewellnewyork.com	1991 Marcus Ave	Suite M107	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Chief Information Officer	IT Manager	Mr.	Decady	Jean		7184845048					jdecady@agewellnewyork.com	1991 Marcus Avenue	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Chief Information Security Officer	Network Manager	Mr.	DeCady	Jean		7184845048					jdecady@agewellnewyork.com	1991 Marcus Avenue	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	CMS Casework Communication Contact	Corporate Compliance Officer	Ms.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Complaints Tracking Contact	Corporate Compliance Officer	Ms.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Contact for Fraud Investigations	Corporate Compliance Officer		Mukuka	Barbra	I	7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Coordination of Benefits Contact	MANAGING DIRECTOR  FINANCE, ANALYTICS AND OPERATI		Giarraputo	Marybeth		7184845028					mgiarraputo@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Corporate Mailing						7184845001					tbuonocore@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Coverage Gap Discount Program (CGDP) Payment Contact	Director Financial Analysis		Giarraputo	Marybeth		7184845000	5141				mGiarraputo@agewellnewyork.com	1991 Marcus Avenue	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Customer Service Operations Contact	Director, Enrollment and Clinical Assessment		Komsic	Linda		7184845040					lkosmic@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	DIR Contact	Director Rebates, EnvisionRx		Ellermeier	Nicole		9133875120					nellermeier@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	DIR Contact (Secondary)	AgeWell New York		Giarraputo	Marybeth		7184845028					MGiarraputo@agewellnewyork.com	1991 Marcus Avenue	Suite M200	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Electronic Health Record Contact	Network Manager		DeCady	Jean		7184845048					Jdecady@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Emergency Part D Contact	Executive Director	Ms.	Connelly	Patricia		7184845007					pconnelly@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Emergency Part D Contact (Secondary)	Corporate Compliance Officer	Ms.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Encounter Data & Risk Adjustment Operations Contact			Romano	Carole		7184845000	5034				CRomano@agewellnewyork.com	1991 Marcus Avenue	Suite: M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Enrollment Contact			Romano	Carole		7184845000	5034				CRomano@agewellnewyork.com	1991 Marcus Avenue	Suite: M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	EOB Transfer Contact	Director of Medicare and Risk Adjustment		Romano	Carole		7184845034				8555859286	cromero@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Financial Audit Contact	Chief Compliance Officer	Mrs.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Avenue	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Financial Reporting Contact	Chief Financial Officer		Murphy	Joseph		7184845011					jmurphy@agewellnewyork.com	1991 Marcus Avenue	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Formulary Contact	Pharmacy Manager		Sagoo	Sukhjit		2342123137					ssgoo@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Formulary Contact (Secondary)	Director, Pharmacy		Zhang	Cecilia		7184845005					czhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	General Contact	Corporate Compliance Officer		Mukuka	Barbra	I	7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Government Relations Contact	Corporate Compliance Officer		Mukuka	Barbra	I	7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	HIPAA Privacy Officer	Corporate Compliance Officer		Mukuka	Barbra	I	7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	HIPAA Security Officer	Corporate Compliance Officer		Mukuka	Barbra	I	7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Hospice Contact	Director, Pharmacy		Zhang	Cecilia		7184845000	5178				czhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Interoperability Contact	MANAGING DIRECTOR  FINANCE, ANALYTICS AND OPERATI		Giarraputo	Marybeth		7184845028					mgiarraputo@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	MA Appeals/Grievances Contact			Kanhai	Veronica		7184845000	5298				dsingh@agewellnewyork.com	1991 Marcus Ave	Suite 201	LAke Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	MA Claims Processing Contact for Public Website	MANAGING DIRECTOR  FINANCE, ANALYTICS AND OPERATI		Giarraputo	Marybeth		7184845028					mgiarraputo@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Marketing Contact	Director of Business Development		Vavrinec	Lori Ann		7184845008					lvavrinec@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Medical Director	Medical Director		Lichtenstein	David		7184845006					Dlichtenstein@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Medicare Compliance Officer	Corporate Compliance Officer	Ms.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Medicare Coordinator			Romano	Carole		7184845000	5034				CRomano@agewellnewyork.com	1991 Marcus Avenue	Suite: M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Zhang	Cecilia		7184845005					czhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Medication Therapy Management Contact	Director, Pharmacy		Zhang	Cecilia		7184845005					czhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	OffShore Subcontractor Contact	Chief Compliance Officer	Ms.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Online Enrollment Center Contact (Primary)			Romano	Carole		7184845000	5034				CRomano@agewellnewyork.com	1991 Marcus Avenue	Suite: M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Part C Application Contact	Corporate Compliance Officer	Ms.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Part C Reporting Contact	Corporate Compliance Officer	Ms.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Part D Appeals	Appeals and Grievances Manager		Kanhai	Veronica							vkanhai@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated	8665868044				HMO - Health Maintenance Organization		C	New York
H4922	Part D Appeals Contact (Secondary)	Director, Pharmacy		Zhang	Cecilia							CZhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated	8665868044				HMO - Health Maintenance Organization		C	New York
H4922	Part D Application Contact	MANAGING DIRECTOR  FINANCE, ANALYTICS AND OPERATI		Giarraputo	Marybeth		7184845028					mgiarraputo@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Part D Benefits Contact	MANAGING DIRECTOR  FINANCE, ANALYTICS AND OPERATI		Giarraputo	Marybeth		7184845028					mgiarraputo@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Part D Claims Submission Contact	Account Manager		Durant	Olivia		9547672924					odurant@envisionrx.com	1301 East Broward Boulevard	Suite 300	Fort Lauderdale	FL	33301	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Part D Exceptions Contact	Director, Pharmacy		Zhang	Cecilia							CZhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated	1866586804				HMO - Health Maintenance Organization		C	New York
H4922	Part D Exceptions Contact (Secondary)	Manager, Appeal and Grievances		Kanhai	Veronica							dsingh@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated	8665868044				HMO - Health Maintenance Organization		C	New York
H4922	Part D Price File Contact (Back-up)	Manager Rebates, EnvisionRx		Campbell	Tim		3304866375				3304864801	tcampbell@elixirsolutions.com	8957 Canyon Falls		Twinsburg	OH	44087	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Part D Price File Contact (Optional)	Director, Pharmacy		Zhang	Cecilia		7184845005					CZhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Part D Price File Contact (Primary)	Financial Analyst, Finance		Kessler	Cameron		2342123110				3304864801	ckessler@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Part D Quality Assurance Contact	Senior Manager Quality Assurance		McLeish	Melicia	M	7184845000	5217				mmcLeish@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Part D Reporting Contact	Corporate Compliance Officer	Ms.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Patient Safety Contact	Director of Pharmacy		Zhang	Cecilia		7184845005					CZhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Payment Contact	Chief Financial Officer		Murphy	Joseph		7184845011					jmurphy@agewellnewyork.com	1991 Marcus Avenue	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Personal Health Record Contact	Network Manager		DeCady	Jean		7184845048					Jdecady@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Pharmacy Director	Director, Pharmacy		Zhang	Cecilia		7184845005					CZhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Pharmacy Network Management Contact	Director Pharmacy Network Contracting		Profio	Lauren		3304058094					lprofio@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy		Zhang	Cecilia		7184845005					CZhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Pharmacy Technical Help Desk Contact	Vice President Operations		Conn	Todd							tconn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated	8447827670				HMO - Health Maintenance Organization		C	New York
H4922	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy		Zhang	Cecilia							CZhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated	8662373210				HMO - Health Maintenance Organization		C	New York
H4922	PHR Beneficiary Contact																	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS	AgeWell New York	ParkerCare New York, LLC	534	Yes	Terminated	8665868044				HMO - Health Maintenance Organization		C	New York
H4922	Plan Directory Contact for Public Website	Corporate Compliance Officer	Ms.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Plan to Plan Reconciliation Contact	Chief Financial Officer		Murphy	Joseph		7184845011					APAgeWellNY@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Processor Contact	Director of Medicare and Risk Adjustment		Romano	Carole		7184845034				8555859286	cromano@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Quality Contact	Senior Manager Quality Assurance		McLeish	Melicia		7184845000	5217				mMcLeish@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Reconciliation Contact	MANAGING DIRECTOR  FINANCE, ANALYTICS AND OPERATI		Giarraputo	Marybeth		7184845028					mgiarraputo@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Reconciliation Contact (Secondary)	Director of Financial Analysis		Giarraputo	Marybeth		7184845028					MGiarraputo@agewellnewyork.com	1991 Marcus Avenue		Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Recovery Audit Contact	Chief Financial Officer	Mr.	Murphy	Joseph		7184845011					jmurphy@agewellnewyork.com	1991 Marcus Avenue	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	SNP Application Contact	Corporate Compliance Officer	Ms.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	SNP State Contact	Chief Compliance Officer		Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Surveillance Contact	Corporate Compliance Officer		Mukuka	Barbra	I	7184845032					bmukuka@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	System Contact	Network Manager		DeCady	Jean		7184845048					Jdecady@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Third Party Administrator (TPA) Liaison	Director, Pharmacy		Zhang	Cecilia		7184845005					CZhang@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	User Access Contact	Chief Compliance Officer	Mrs.	Mukuka	Barbra		7184845032					bmukuka@agewellnewyork.com	1991 Marcus Avenue	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Utilization Management Contact	Director of Utilization  Management		Esmero	Rhea		7184845081					resmero@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4922	Utilization Review Contact	Director of Utilization Management		Esmero	Rhea		7184845081					resmero@agewellnewyork.com	1991 Marcus Ave	Suite M201	Lake Success	NY	11042	08/16/2023	2023	AGEWELL NEW YORK, LLC	Local CCP	AgeWell New York	HMO/HMOPOS		ParkerCare New York, LLC	534	Yes	Terminated					HMO - Health Maintenance Organization		C	New York
H4931	Agent/Broker Compensation Data Contact	Medicare Sales Operations Director	Ms	Perry	Danielle		6024004768					Danielle.Perry@bannerhealth.com	2901 N Central Ave	Ste. 160	Phoenix	AZ	85012	03/29/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Automated TrOOP Balance Transfer Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N. Central Ave Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Backup User Access Contact	Compliance Senior Director	Ms	Corlette	Kristina		6027472431					BMAComplianceOfficer@BannerHealth.com	2901 N Central Ave., Ste 160		Phoenix	AZ	85012	12/05/2022	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Best Available Evidence Contact	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Bid Audit Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Bid Audit Site Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Bid Primary Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	CAP Report Contact for Public Website	Chief Operations Officer	Mrs	Spiekermeier	Sarah		5208745520				5208747083	Sarah.Spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Stringham	James		6025684179				5208747083	James.Stringham2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Stringham	James		6025684179				5208747083	James.Stringham2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Chief Financial Officer	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Chief Operating Officer	Chief Operations Officer	Mrs	Spiekermeier	Sarah		5208745520				5208747083	Sarah.Spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Chief Information Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Chief Information Security Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	CMS Casework Communication Contact	Director, Grievance and Appeals	Mr	Maccioli	James		6027476021				5208747083	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/31/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Complaints Tracking Contact	Director, Grievance and Appeals	Mr	Maccioli	James		6027476021				5208747083	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/31/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Contact for Fraud Investigations	Director of Compliance	Ms	Dorazio	Terri		5208742847				5208747072	Theresa.Dorazio@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Coordination of Benefits Contact	Director Reimbursement Services		Groves	Lori		6024692249					Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Corporate Mailing						5208745550				5208747083	silvia.parra@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Coverage Gap Discount Program (CGDP) Payment Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Customer Service Operations Contact	Customer Care Director	Mrs	Carrillo	Veronica		5208745349				5208747083	Veronica.Carrillo@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	DIR Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	DIR Contact (Secondary)	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave. Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Electronic Health Record Contact	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Emergency Part D Contact	Pharmacy On Call Cell Phone		On Call	Pharmacy		5202601860				5208747083	BUHPgovernmentprograms@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Emergency Part D Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Encounter Data & Risk Adjustment Operations Contact	Sr. Director Payment Integrity & Reimbursement	Mr.	Horton	Tanner		4806845016					Tanner.Horton2@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	03/09/2022	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Enrollment Contact	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	EOB Transfer Contact	Director Reimbursement Services		Groves	Lori		6024692254				5208747083	Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Financial Audit Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Financial Reporting Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Formulary Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Formulary Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	General Contact	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	03/22/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Government Relations Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	HIPAA Privacy Officer	Director of Compliance	Ms	Dorazio	Terri		5208742847				5208747072	Theresa.Dorazio@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	HIPAA Security Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Hospice Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Interoperability Contact	Interoperability Healthcare Leader	Mr	Mathew	Rakesh		6027277420					Rakesh.Mathew@bannerhealth.com	2901 N Central Ave. Ste 160		Phoenix	AZ	85012	01/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	MA Appeals/Grievances Contact	Director, Grievance and Appeals	Mr	Maccioli	James		6027476021				5208747083	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/31/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	MA Claims Processing Contact for Public Website	Director Reimbursement Services		Groves	Lori		6024692249					Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Marketing Contact	Marketing Manager	Ms	Medina	AnaMaria		5208745082				5208747083	AnaMaria.Medina@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Medical Director	Chief Medical Officer	Dr	Stein	Sandra		5209040346					Sandra.Stein@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	09/05/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Medicare Compliance Officer	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	03/22/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Medicare Coordinator	Senior Manager Government Programs	Ms	Flores	Vanessa		5208745781				5208747083	buhpgovernmentprograms@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Medicare Part D Opioid Overutilization Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave.	Ste. 160	Phoenix	AZ	85012	09/19/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Medication Therapy Management Contact	Director (Clinical & Trend Solutions)		Muralidharan	Adrienne		3143131932				8587906052	amuralidharan@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	12/21/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	OffShore Subcontractor Contact	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	03/22/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Online Enrollment Center Contact (Back-up)	Medicare Sales Operations Director	Ms	Perry	Danielle		6024004768					Danielle.Perry@bannerhealth.com	2901 N Central Ave	Ste. 160	Phoenix	AZ	85012	01/26/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Online Enrollment Center Contact (Optional)	Enrollment Supervisor	Ms	Espinoza	Brianna		5208744192				5205855252	Brianna.Espinoza@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Online Enrollment Center Contact (Primary)	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Part C Application Contact	Sr Director, Medicare Administrator	Ms	Chaydez	Myrna		6024355378					Myrna.Chaydez@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Part C Reporting Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Appeals	Director, Grievance and Appeals	Mr	Maccioli	James						8664658340	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8778743930				HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Appeals Contact (Secondary)	Associate Director, Grievance & Appeals	Mrs	Garcia	Renee						5208743462	Renee.Garcia2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8778743930				HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Application Contact	Sr Director, Medicare Administrator	Ms	Chaydez	Myrna		6024355378					Myrna.Chaydez@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Benefits Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Claims Submission Contact	Director Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	Express Scripts	One Express Way	St Louis	MO	63121	01/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Exceptions Contact	Express Scripts Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	Express Scripts	5151 Blazer Pkwy	Dublin	OH	43017	12/21/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Exceptions Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael							Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8888075695				HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Price File Contact (Back-up)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Price File Contact (Optional)	Express Scripts Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	Express Scripts	4865 Dixie Hwy	Fairfield	OH	45014	02/01/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Price File Contact (Primary)	Express Scripts Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	Express Scripts	5151 Blazer Pkwy	Dublin	OH	43017	02/01/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Quality Assurance Contact	Sr. Director Quality Management	Mrs	Robles Caraveo	Sandra		6233266425					sandra.roblescaraveo@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	07/30/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Part D Reporting Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Patient Safety Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Payment Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Personal Health Record Contact	Sr. Director Quality Management	Mrs	Robles Caraveo	Sandra		6233266425					sandra.roblescaraveo@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	07/30/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Pharmacy Director	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Pharmacy Network Management Contact	Express Scripts Network Accountant Director		Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	01/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Pharmacy Network Management Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 360		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Pharmacy Technical Help Desk Contact	Express Scripts (Director, Customer Services)		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	Express Scripts	13051 N Telecom PKWY STE 150	Temple Terrace	FL	33637	08/02/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8008641406				HMO - Health Maintenance Organization		C	San Francisco
H4931	Pharmacy Technical Help Desk Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael							Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8888075695				HMO - Health Maintenance Organization		C	San Francisco
H4931	PHR Beneficiary Contact																	06/14/2022	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS	Express Scripts	Banner Health	389	Yes	Active	3143131932				HMO - Health Maintenance Organization		C	San Francisco
H4931	Physician Incentive Contact	Payer Account Program Sr. Manager	Ms	Ruiz	Marcela		5208745215				5208747083	Marcela.Ruiz@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Plan Directory Contact for Public Website	BMA Customer Care		Care	Customer		5208743930				5208743434	memberservicesinquiries@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Plan to Plan Reconciliation Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Processor Contact	Director Reimbursement Services		Groves	Lori		6024692249					Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Quality Contact	Sr. Director Quality Management	Mrs	Robles Caraveo	Sandra		6233266425					sandra.roblescaraveo@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	07/30/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Reconciliation Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Reconciliation Contact (Secondary)	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave. Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Recovery Audit Contact	Finance CRU Director	Mr	Schreiber	Thomas		5208745240				5208747083	thomas.schreiber@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	SNP Application Contact	Chief Operations Officer	Mrs	Spiekermeier	Sarah		6237554652					sarah.spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	SNP State Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Surveillance Contact	Marketing Associate Director	Ms.	Medina	AnaMaria		5208745082					AnaMaria.Medina@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	System Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Third Party Administrator (TPA) Liaison	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	User Access Contact	Chief Operations Officer	Mrs	Spiekermeier	Sarah		6237554652					sarah.spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Utilization Management Contact	RN Director Utilization Management	Ms	Messing	Carla		6026171632					carla.messing@bannerhealth.com	525 W Brown Rd		Mesa	AZ	85201	09/14/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4931	Utilization Review Contact	Medical Management Associate Director	Ms	Wilson	Traci	R	4802702342					Traci.Wilson@bannerhealth.com	525 W Brown Rd		Mesa	AZ	85201	09/14/2021	2023	BANNER - UNIVERSITY CARE ADVANTAGE	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H4937	Agent/Broker Compensation Data Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Automated TrOOP Balance Transfer Contact	Senior Manager, Medicare Operations		Halley	Derek		8182286374					Derek.Halley@blueshieldca.com	6300 Canoga Ave,		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Backup User Access Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Best Available Evidence Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Bid Audit Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Bid Audit Site Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Bid Primary Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	CAP Report Contact for Public Website	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	CEO - CMS Administrator Contact	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	CEO - Senior Official for Contracting	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Chief Financial Officer	Senior Director, Medicare Finance	Mr.	Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Chief Operating Officer	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Chief Information Officer	Chief Information Officer	Ms.	Davis	Lisa		5106073600					Lisa.Davis@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Chief Information Security Officer	Chief Information Officer	Ms.	Davis	Lisa		5106073600					Lisa.Davis@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	CMS Casework Communication Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Complaints Tracking Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Contact for Fraud Investigations	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					marcos.mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Coordination of Benefits Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					alfonso.loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/02/2019	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Corporate Mailing						5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Customer Service Operations Contact	Director		Mathews	Carolyn		5626135004					Carolyn.Mathews@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	09/07/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	DIR Contact	VP Pharmacy Services		Lum	Alison		5106073697					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	03/02/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	DIR Contact (Secondary)	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/02/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Emergency Part D Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Emergency Part D Contact (Secondary)	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Employer Waiver Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland HIlls	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Encounter Data & Risk Adjustment Operations Contact	Senior Director, Actuary		Rodgers	John		3107442643					John.Rodgers@blueshieldca.com	100 N. Sepulveda Boulevard		El Segundo	CA	90245	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Enrollment Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	EOB Transfer Contact	Medicare Project & Program Manager		Zuehlke	Erica		2093713036				8558953519	zuehlke@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/07/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Financial Audit Contact	Senior Manager, Medicare Compliance	Mr.	Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Ave		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Financial Reporting Contact	Senior Director, Medicare Finance		Ballou	Taylor		5625806311					Taylor.ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Formulary Contact	Director, Formulary Strategy and P&T		Nguyen	Nhi		9168410342					Nhi.Nguyen@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Formulary Contact (Secondary)	Principal Pharmacist, Formulary Management		Trinh	Andy		3238276322					Andy.Trinh@blueshieldca.com	601 Potrero Grande Drive		Monterey Park	CA	91755	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	General Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Ave		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Government Relations Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	HIPAA Privacy Officer	Chief Privacy Officer		Keystone	David		5103013363					david.keystone@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/27/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	HIPAA Security Officer	Chief Privacy Officer		Keystone	David		5103013363					david.keystone@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/27/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Hospice Contact	Senior Program Manager		Fields	Torrie		4152295839					Torrie.Fields@blueshieldca.com	50 Beale St.		San Francisco	CA	94105	01/02/2019	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Interoperability Contact	VP Enterprise Digital Growth		Grimm	David		6196864233					david.grimm@blueshieldca.com	2275 Rio Bonito Way	Suite 250	San Diego	CA	92108	02/15/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	MA Appeals/Grievances Contact	Supervisor, Medicare Appeals and Grievances		Lopez	Celina		8182286183				9163506593	celina.lopez@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/02/2019	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	MA Claims Processing Contact for Public Website	Senior Manager, Medicare Operations		Halley	Derek		8182286374					Derek.Halley@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Marketing Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Medical Director	Medicare Medical Director	Dr.	Siddiq	Khaliq		5627137953					Khaliq.Siddiq@blueshieldca.com	555 Anton Boulevard	Suite 800	Costa Mesa	CA	92626	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Medicare Compliance Officer	Senior Director, Medicare Compliance	Mr.	Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Medicare Coordinator	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Medicare Part D Opioid Overutilization Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					OpioidDUR@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/13/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Medication Therapy Management Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					Dawn.Becker-Ellison@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	OffShore Subcontractor Contact	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Online Enrollment Center Contact (Back-up)	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					marcos.mata@blueshieldca.com	6300 Canoga Ave		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Online Enrollment Center Contact (Optional)	WH Application Development and Support		Miller	Terri		8182282155					terri.miller@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/02/2019	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Online Enrollment Center Contact (Primary)	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Part C Application Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Part C Reporting Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Part D Appeals	Supervisor, Medicare Appeals and Grievances		Lopez	Celina						9163506593	celina.lopez@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/02/2019	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active	8007764466				PPO - BBA		C	San Francisco
H4937	Part D Appeals Contact (Secondary)	Senior Manager, Operations		Salam	Shahid							Shahid.Salam@blueshieldca.com	4203 Town Center Boulevard		El Dorado Hills	CA	95762	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active	8007764466				PPO - BBA		C	San Francisco
H4937	Part D Application Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Part D Benefits Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Part D Claims Submission Contact	Lead Medicare Rx Benefits & Claims Specialist		Campbell	Leslie		5306263838					leslie.campbell@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/02/2019	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Part D Exceptions Contact	Director, Pharmacy Prior Authorization		March	Nancee							nancee.march@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active	8007764466				PPO - BBA		C	San Francisco
H4937	Part D Exceptions Contact (Secondary)	Senior Manager, Medicare Compliance		Mata	Marcos							Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active	8007764466				PPO - BBA		C	San Francisco
H4937	Part D Price File Contact (Back-up)	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106072901					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Part D Price File Contact (Optional)	Business Analyst, Rx Benefit/Claims Implementation		Ng	Alvin		5106072964					alvin.ng@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/14/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Part D Price File Contact (Primary)	Business Analyst, Rx Benefit/Claims Implementation		Ng	Alvin		5106072964					Alvin.Ng@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Part D Quality Assurance Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Part D Reporting Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					marcos.mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Patient Safety Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					dawn.becker-ellison@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/02/2019	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Payment Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Pharmacy Director	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Pharmacy Network Management Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106072901					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Pharmacy Network Management Contact (Secondary)	Senior Program Manager, Medicare Rx Compliance		Nelson	Kimberly	C	5106073281					Kim.Nelson@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Pharmacy Technical Help Desk Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik							Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active	8889700933				PPO - BBA		C	San Francisco
H4937	Physician Incentive Contact	Director, Provider Services - Network		Gonzalez	Maria		3238534445					Maria.Gonzalez2@blueshieldca.com	601 Potrero Grande Drive		Monterey Park	CA	91755	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Plan Directory Contact for Public Website			Services	Member		8007764466					membersvcs@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Plan to Plan Reconciliation Contact	Financial Analyst Consultant		Dahl	Chris		8182282575					BSCP2PRecon@blueshieldca.com	3021 Reynolds Ranch Parkway		Lodi	CA	95240	05/24/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Processor Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106073281					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Quality Contact	Senior Director, Program & Project Management		Blanchard	Heather		5106072420					heather.blanchard@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Reconciliation Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	12/16/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Reconciliation Contact (Secondary)	Senior Director, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Recovery Audit Contact	Senior Manager, Medicare Compliance	Mr.	Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Surveillance Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	System Contact	Sr. Director, IT Product Management		Chambers	Shelley		1916866073					Shelley.Chambers@blueshieldca.com	4203 Town Center Boulevard		El Dorado Hills	CA	95762	09/07/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Third Party Administrator (TPA) Liaison	Senior Manager, Finance Analytics		Chen	Jacob		3107442819					Jacob.Chen@blueshieldca.com	100 N. Sepulveda Boulevard		El Segundo	CA	90245	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	User Access Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Utilization Management Contact	Senior Director, Utilization & Medical Review		Albertsen	Mirela		9168410418					Mirela.Albertsen@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4937	Utilization Review Contact	Senior Director, Utilization & Medical Review		Albertsen	Mirela		9168410418					Mirela.Albertsen@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	Local CCP	Blue Shield of California	Local PPO		California Physicians' Service	30	Yes	Active					PPO - BBA		C	San Francisco
H4943	Agent/Broker Compensation Data Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Automated TrOOP Balance Transfer Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Backup User Access Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Best Available Evidence Contact	Director HP Enrollment		Wilson	Deanna		2542983340					Deanna.Wilson@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Bid Audit Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Bid Audit Site Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Bid Primary Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	CAP Report Contact for Public Website	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	CEO - CMS Administrator Contact	CEO and President	Mr.	Ingrum	Jeff		2542986090					Jeffrey.Ingrum@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	CEO - Senior Official for Contracting	CEO and President	Mr.	Ingrum	Jeff		2542986088					Jeffrey.Ingrum@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Chief Financial Officer	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Chief Operating Officer	Chief Operating Officer	Mr.	Richey	Victor		2148204200					Vic.Richey@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Chief Information Officer	Director of Information Systems	Mr.	Fort	Rob		2542983233					Rob.Fort@bswhealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Chief Information Security Officer	Director of Information Systems	Mr.	Fort	Rob		2542983233					Rob.Fort@bswhealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	CMMI Model Point of Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	CMS Casework Communication Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Complaints Tracking Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Contact for Fraud Investigations	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Coordination of Benefits Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Corporate Mailing						2542986088					Jeffrey.Ingrum@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Coverage Gap Discount Program (CGDP) Payment Contact	VP Finance		Cutroni	Michael		2542983085				2542983005	michael.cutroni@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	09/19/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Customer Service Operations Contact	Manager, Customer Advocacy		Perkins	Michelle		2542983393					Michelle.Perkins@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	DIR Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	DIR Contact (Secondary)	VP Finance		Cutroni	Michael		2542983085					michael.cutroni@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	09/19/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Electronic Health Record Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Emergency Part D Contact	Director Pharmacy Operations		Luebbert	Charlotte		2546243358					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Emergency Part D Contact (Secondary)	Manager Pharmacy Operations	Ms.	Symm	Sheila		2542929095					Sheila.Symm@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Employer Waiver Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Encounter Data & Risk Adjustment Operations Contact	Director Risk Adjustment		Coakley	Deborah		5059342320					Deborah.Coakley@BSWHealth.org	1206 West Campus Dr.		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Enrollment Contact	Director HP Enrollment		Wilson	Deanna		2542983340					Deanna.Wilson@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	EOB Transfer Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Financial Audit Contact	Chief Financial Officer	Mr.	Bush	Stephen		2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Financial Reporting Contact	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Formulary Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Formulary Contact (Secondary)	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	General Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Government Relations Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	HIPAA Privacy Officer	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	HIPAA Security Officer	Director IS	Mr.	Fort	Rob		2542983233					Rob.Fort@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Hospice Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Interoperability Contact	Director of Information Systems	Mr.	Fort	Rob		2542983233					Rob.Fort@bswhealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	MA Appeals/Grievances Contact	Director, Appeals and Grievance		Saravia	Sharon		2542986156					Sharon.Saravia@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	MA Claims Processing Contact for Public Website	Claims Manager		Fabianke	Elizabeth		2542983385					Elizabeth.Fabianke@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Marketing Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Medical Director	Chief Medical Officer	Dr.	Ramalingam	S		2542983487					S.Ramalingam@BSWHealth.org	1206 West Campus Dr		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Medicare Compliance Officer	Compliance Officer	Mrs	Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Medicare Coordinator	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Medicare Part D Opioid Overutilization Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Medication Therapy Management Contact	Clinical Pharmacist		Thomas	Megan		2542986154					Megan.Cunningham@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	OffShore Subcontractor Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Online Enrollment Center Contact (Back-up)	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Online Enrollment Center Contact (Primary)	Director HP Enrollment		Wilson	Deanna		2542983340					Deanna.Wilson@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Part C Application Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Part C Reporting Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Part D Appeals	Director, Appeals and Grievance		Saravia	Sharon							Sharon.Saravia@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	2542986156				HMO - Health Maintenance Organization		C	Denver
H4943	Part D Appeals Contact (Secondary)	Director, Appeals and Grievance		Saravia	Sharon						2542983086	sharon.saravia@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	2542986156				HMO - Health Maintenance Organization		C	Denver
H4943	Part D Application Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Part D Benefits Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Part D Claims Submission Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Part D Exceptions Contact	Manager Pharmacy Admin.		Thomas	Megan							Megan.Cunningham@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	2542986108				HMO - Health Maintenance Organization		C	Denver
H4943	Part D Exceptions Contact (Secondary)	Director Pharmacy Operations		Luebbert	Charlotte							Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	2542986151				HMO - Health Maintenance Organization		C	Denver
H4943	Part D Price File Contact (Back-up)	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Part D Price File Contact (Optional)	Manager Rx Operations		Symm	Sheila		2542986173					Sheila.Symm@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Part D Price File Contact (Primary)			Rx	Optum		6514955363					medops_planfinder@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Part D Quality Assurance Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Part D Reporting Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Patient Safety Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Payment Contact	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Pharmacy Director	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Pharmacy Network Management Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Pharmacy Network Management Contact (Secondary)	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Pharmacy Technical Help Desk Contact	OptumRx		Rx	Optum								1600 McConnor Parkway		Schaumburg	IL	601736801	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	8442309357				HMO - Health Maintenance Organization		C	Denver
H4943	Pharmacy Technical Help Desk Contact (Secondary)	SWHP Pharmacy Customer Service		Customer Service	Pharmacy								1206 W Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	8007287947				HMO - Health Maintenance Organization		C	Denver
H4943	Physician Incentive Contact	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Plan Directory Contact for Public Website	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Plan to Plan Reconciliation Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Processor Contact	Chief Financial Officer		Bush	Stephen		2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Quality Contact	Director of Quality		Martin	Kathleen		5033274425				2542983005	Kathleen.Martin@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Reconciliation Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Reconciliation Contact (Secondary)	Financial Advisor II		Albright	Irina		5122576254					Irina.Albright@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Recovery Audit Contact	Chief Financial Officer	Mr.	Bush	Stephen		2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	SNP Application Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	SNP State Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Surveillance Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	System Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Third Party Administrator (TPA) Liaison	VP Finance		Cutroni	Michael		2542983085				2542983005	michael.cutroni@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	09/19/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	User Access Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Utilization Management Contact	Director of Health Services		Starks	Chmyra		2542983386				2542983005	Chmyra.Starks@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4943	Utilization Review Contact	Director of Health Services		Starks	Chmyra		2542983386				2542983005	Chmyra.Starks@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/14/2022	2023	Scott & White Care Plans	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H4961	Agent/Broker Compensation Data Contact	VP, Sales		Simonds	Kristina		6572187635					KSimonds@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Automated TrOOP Balance Transfer Contact	PBM - Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Backup User Access Contact	Compliance Director		Spitzer	Chandra		6572745530					CSpitzer@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Best Available Evidence Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Bid Audit Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Bid Audit Site Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Bid Primary Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	CAP Report Contact for Public Website	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	CEO - CMS Administrator Contact	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	CEO - Senior Official for Contracting	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Chief Financial Officer	Chief Financial Officer	Mr.	Freeman	Thomas		6572187604					TFreeman@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Chief Operating Officer	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Kardes	Hakan		6572187772					hkardes@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	03/29/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Chief Information Security Officer	VP, Technology & CISO	Mr.	MacLeod	David		3033067531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	CMMI Model Point of Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	CMS Casework Communication Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Complaints Tracking Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Contact for Fraud Investigations	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Coordination of Benefits Contact	AVP, Membership & Eligibility		Torres	Carrie		6572187409	2109				CArreola@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Corporate Mailing						6572187713				8443202247	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/05/2019	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122			5622074634	adelatorre@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Customer Service Operations Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	DIR Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	DIR Contact (Secondary)	VP, Pharmacy		Liu	Ruby		3237287232	2316				RLiu@AHCUSA.com	1100 W. Town & Country Rd., Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Electronic Health Record Contact	AVP, Platform Product		Brown Hayes	Michael		7144979628					MBrown-Hayes@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	04/01/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Emergency Part D Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Emergency Part D Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		3108667966				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Employer Waiver Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment		Bogdanov	Eyosef		5623666179					ebogdanov@ahcusa.com	1100 W. Town and Country Rd.	Suite 1600	Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Enrollment Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	EOB Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Financial Audit Contact	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Financial Reporting Contact	Sr. Director, Accounting & Reporting		Tran	Sue Anne		6572187673	7673				stran@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Formulary Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Formulary Contact (Secondary)	PBM - Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	General Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Government Relations Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	HIPAA Privacy Officer	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	HIPAA Security Officer	VP, Technology & CISO		MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Hospice Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Interoperability Contact	VP, Data Engineering & BI CTO Data and Al		Sam	Georgie		8188807212					gsam@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/01/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	MA Appeals/Grievances Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	MA Claims Processing Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Marketing Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Medical Director	SVP Market Management WCR	Dr.	Kim	John		6572187640				5622074617	JKim@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Medicare Compliance Officer	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy	B	6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Medicare Coordinator	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Medicare Part D Opioid Overutilization Contact	PBM - Supv Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Medication Therapy Management Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	OffShore Subcontractor Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	CLynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Online Enrollment Center Contact (Back-up)	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Online Enrollment Center Contact (Optional)	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Online Enrollment Center Contact (Primary)	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Part C Application Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Part C Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Part D Appeals	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6127775393				PPO - BBA		C	San Francisco
H4961	Part D Appeals Contact (Secondary)	Sr. Manager, Appeals & Grievance		Jimenez	Gudelia							GJimenez@ahcusa.com	1100 W. Town and Country Road, Suite #300		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6572187488	2188			PPO - BBA		C	San Francisco
H4961	Part D Application Contact	CEO		Maroney	Dawn		5623346192				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Part D Benefits Contact	PBM - Director, Benefit Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Part D Claims Submission Contact	PBM - Functional Business Consultant Govt Programs		Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	02/03/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Part D Exceptions Contact	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8006936651				PPO - BBA		C	San Francisco
H4961	Part D Exceptions Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali							AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6572187709				PPO - BBA		C	San Francisco
H4961	Part D Price File Contact (Back-up)	PBM - Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Part D Price File Contact (Optional)	PBM - QA Analyst		Tastad	Emily		6127776931					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Part D Price File Contact (Primary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Part D Quality Assurance Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Part D Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Patient Safety Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Payment Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Personal Health Record Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Pharmacy Director	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Pharmacy Network Management Contact	PBM - AVP, Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	02/03/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Pharmacy Network Management Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	06/02/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/21/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				PPO - BBA		C	San Francisco
H4961	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				PPO - BBA		C	San Francisco
H4961	PHR Beneficiary Contact																	02/05/2019	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO	Alignment Health Plan	Alignment Healthcare USA, LLC	612	Yes	Active	8666342247				PPO - BBA		C	San Francisco
H4961	Physician Incentive Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Plan Directory Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Plan to Plan Reconciliation Contact	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122			5622074266	adelatorre@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Processor Contact	Manager, PBM Operations		Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/31/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Quality Contact	Sr. Director, Quality Management/Credentialing		Lacock	Lisa		6572187638					LLacock@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Reconciliation Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Reconciliation Contact (Secondary)	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122				adelatorre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Recovery Audit Contact	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	SNP Application Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	SNP State Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Surveillance Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	System Contact	VP, AVA Health Plan Systems & Operations		Bates	Patrick		6572187636	7636				PBates@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	03/25/2021	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Third Party Administrator (TPA) Liaison	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122				adelatorre@ahcusa.com	1100 W. Town and Country Rd, Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	User Access Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Utilization Management Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4961	Utilization Review Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H4982	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/11/2018	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/06/2019	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	12/11/2018	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H4982	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/11/2018	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4982	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF CALIFORNIA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H4999	Automated TrOOP Balance Transfer Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Backup User Access Contact	Director, Development		Hess	Ronald		6198852533					rhess@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Best Available Evidence Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Bid Primary Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	CAP Report Contact for Public Website	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active	8144565433				PACE - Nat		C	Philadelphia
H4999	CEO - CMS Administrator Contact	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street  Suite 201	Erie	PA	16507	03/22/2022	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	CEO - Senior Official for Contracting	CEO	Mr.	Fish	Richard		8144565433					rfish@oneseniorcare.com	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Chief Financial Officer	CFO	Mr.	Phillips	Jeffery		8144565433					jphillips@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	08/01/2022	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Chief Operating Officer	Executive Director	Mrs.	Lyons	Laura		8149699465					llyons@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Chief Information Officer	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	03/22/2022	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Chief Information Security Officer	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	03/22/2022	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	CMS Casework Communication Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Complaints Tracking Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Contact for Fraud Investigations	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Coordination of Benefits Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Corporate Mailing						8144565433					llyons@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street Suite 201	Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Coverage Gap Discount Program (CGDP) Payment Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Customer Service Operations Contact	Director of Center Operation		Kraus	Lisa		8148237906					lkraus@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	DIR Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	DIR Contact (Secondary)	Executive Director		Lyons	Laura	M	8149699465					llyons@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Emergency Part D Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Emergency Part D Contact (Secondary)	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Encounter Data & Risk Adjustment Operations Contact	Executive Director		Lyons	Laura		8144565433					llyons@lifenwpa.org	100 State Street   Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Enrollment Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	EOB Transfer Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433				8144542500	jkachersky@lifenwpa.org	100  State Street, Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Financial Audit Contact	VP, Finance and Quality	Mrs.	Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Financial Reporting Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Formulary Contact	Medical Director	Dr.	Shaffer	Kevin		8144565433					kshaffer@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	03/22/2022	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Formulary Contact (Secondary)	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	General Contact	Executive Director		Lyons	Laura		8144565433					llyons@lifenwpa.org	100 State Street Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Government Relations Contact	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	03/22/2022	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	HIPAA Privacy Officer	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	HIPAA Security Officer	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Interoperability Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	MA Appeals/Grievances Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	MA Claims Processing Contact for Public Website	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Marketing Contact	Marketing and Intakes		Campbell	Marcie		8144565433					mcampbell@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Medical Director	Medical Director	Dr.	Shaffer	Kevin		8144565433					kshaffer@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	03/22/2022	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Medicare Compliance Officer	Director of Quality	Mrs.	Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Medicare Coordinator	VP of Operations		Kraus	Lisa		8144565433					lkraus@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 200	Erie	PA	16507	07/10/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Medicare Part D Opioid Overutilization Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Medication Therapy Management Contact	Medical Director	Dr.	Shaffer	Kevin		8144565433					kshaffer@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	03/22/2022	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Part C Application Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Part D Appeals	VP, Finance and Quality		Kachersky	Jennifer							jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active	8144565433				PACE - Nat		C	Philadelphia
H4999	Part D Appeals Contact (Secondary)	Executive Director		Lyons	Laura						8144542500	llyons@lifenwpa.org	100 State Street  Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active	8444565433				PACE - Nat		C	Philadelphia
H4999	Part D Application Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Part D Benefits Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Part D Claims Submission Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Part D Exceptions Contact	Medical Director	Dr.	Shaffer	Kevin							kshaffer@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active	8144565433				PACE - Nat		C	Philadelphia
H4999	Part D Exceptions Contact (Secondary)	Executive Director		Lyons	Laura							llyons@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active	8149699465				PACE - Nat		C	Philadelphia
H4999	Part D Price File Contact (Back-up)	CFO		Phillips	Jeff		8144565433					jphillips@lifenwpa.org	100 State Street   Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Part D Price File Contact (Primary)	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Part D Quality Assurance Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Part D Reporting Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	100 State Street  Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Patient Safety Contact	Medical Director	Dr.	Shaffer	Kevin		8144565433					kshaffer@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	03/22/2022	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Payment Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Personal Health Record Contact	Director of Quality		Sheeder	Shelby		8145927615				8144542500	ssheeder@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Pharmacy Director	Medical Director	Dr.	Shaffer	Kevin		8144565433					kshaffer@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	03/22/2022	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Pharmacy Network Management Contact	Director, Contracts		Feldmann	William		8145927615					wfeldmann@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Pharmacy Network Management Contact (Secondary)	Executive Director		Lyons	Laura		8149699465					llyons@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Pharmacy Technical Help Desk Contact	VP, Finance and Quality		Kachersky	Jennifer							jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active	8144565433				PACE - Nat		C	Philadelphia
H4999	Pharmacy Technical Help Desk Contact (Secondary)	Executive Director		Lyons	Laura							llyons@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active	8149699465				PACE - Nat		C	Philadelphia
H4999	Plan Directory Contact for Public Website	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Plan to Plan Reconciliation Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Processor Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Quality Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Reconciliation Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Reconciliation Contact (Secondary)	CFO		Phillips	Jeff		8144565433					jphillips@lifenwpa.org	100 State Street   Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Recovery Audit Contact	VP, Finance and Quality	Mrs.	Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/30/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Surveillance Contact	Director, Marketing and Intake		Campbell	Marcie		8144565433					mcampbell@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	System Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Third Party Administrator (TPA) Liaison	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	User Access Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	01/26/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Utilization Management Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street   Suite 201		Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H4999	Utilization Review Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street   Suite 201		Erie	PA	16507	04/05/2023	2023	LIFE Northwestern Pennsylvania, LLC	National PACE	LIFE Northwestern Pennsylvania	National PACE		One Senior Care, Inc.	553	Yes	Active					PACE - Nat		C	Philadelphia
H5007	Automated TrOOP Balance Transfer Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Backup User Access Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Best Available Evidence Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Bid Primary Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	CAP Report Contact for Public Website	Health Plan Operations Manager		Wachsmuth	Rosalie		5032156556				5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	CEO - CMS Administrator Contact	Executive Director	Ms.	Tuller	Susan		2063205325				2067606339	susan.tuller@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	06/17/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	CEO - Senior Official for Contracting	Executive Director	Ms.	Tuller	Susan		2063205325				2067606339	susan.tuller@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	06/17/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Chief Financial Officer		Ms	Barr	Natalie		5032153859					natalie.barr@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	01/27/2021	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Chief Operating Officer		Ms.	Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Chief Information Officer		Ms.	Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Chief Information Security Officer		Ms.	Noordijk	Cindy		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	CMS Casework Communication Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	01/28/2021	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Complaints Tracking Contact	Quality, Compliance Manager		Vemuri	Susan		2063205325				2067606339	susan.vemuri@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Contact for Fraud Investigations	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	01/28/2021	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Coordination of Benefits Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Corporate Mailing						2063205325					velaa.chinn@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Coverage Gap Discount Program (CGDP) Payment Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Customer Service Operations Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	DIR Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	DIR Contact (Secondary)			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Emergency Part D Contact	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Emergency Part D Contact (Secondary)			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Encounter Data & Risk Adjustment Operations Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Enrollment Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	EOB Transfer Contact	PACEHealth Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Financial Audit Contact	Health Plan Operations Manager	Ms.	Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Financial Reporting Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Formulary Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Formulary Contact (Secondary)			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	General Contact	Director of Operations	Ms.	Schultz	Elizabeth		4255256908				2067606339	elizabeth.schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Government Relations Contact			Noordijk	Cindy		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	HIPAA Privacy Officer	Director, Clinical Programs & Compliance		Noordijk	Cynthia		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	01/28/2021	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	HIPAA Security Officer	Director, Clinical Programs & Compliance		Noordijk	Cynthia		5032154124					cynthia.noordijk@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	01/28/2021	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Interoperability Contact			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	MA Appeals/Grievances Contact			Chinn	Velaa		2063205325					velaa.chinn@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	MA Claims Processing Contact for Public Website	Mgr Admin and Support Svcs		Chinn	Velaa		2063205325				2067606339	velaa.chinn@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Marketing Contact	Marketing & Intake Representative		Kentta	Jenny		2063205325					jenny.kentta@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Medical Director	Medical Director		Kazemi	Assad		2063205325				2067606339	Assad.Kazemi@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Medicare Compliance Officer	Manager, Quality, Compliance & Education	Ms.	Vemuri	Susan		2067606414				2067606339	Susan.Vemuri@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Medicare Coordinator			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Medicare Part D Opioid Overutilization Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Medication Therapy Management Contact	Medical Director		Kazemi	Assad		2063205325				2067606339	assadullah.kazemi@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Part C Application Contact	Executive Director	Ms.	Tuller	Susan		2063205325				2067606339	susan.tuller@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	06/17/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Part D Appeals	Health Plan Operations Manager		Wachsmuth	Rosalie						5032150685	rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg 1, Suite 200		Portland	OR	97213	01/06/2021	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active	5032153681				PACE - Nat		C	Seattle
H5007	Part D Appeals Contact (Secondary)			Chinn	Velaa							velaa.chinn@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active	2063205325				PACE - Nat		C	Seattle
H5007	Part D Application Contact	Executive Director	Ms.	Tuller	Susan		2063205325				2067606339	susan.tuller@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	06/17/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Part D Benefits Contact		Ms.	Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Part D Claims Submission Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Part D Exceptions Contact	PACE Health Plan Data Analyst		Chambers	Perry						5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active	5032153672				PACE - Nat		C	Seattle
H5007	Part D Exceptions Contact (Secondary)			Wachsmuth	Rosalie							rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active	5032153681				PACE - Nat		C	Seattle
H5007	Part D Price File Contact (Back-up)			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Part D Price File Contact (Optional)	Mgr Admin and Support Svcs		Chinn	Velaa		2063205325					velaa.chinn@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Part D Price File Contact (Primary)			Chambers	Perry		5032153672					Perry.Chambers@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Part D Quality Assurance Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Part D Reporting Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Patient Safety Contact			Reed	Rebecca		5032153465					rebecca.reed@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Payment Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Personal Health Record Contact	Mgr Admin and Support Svcs		Chinn	Velaa		2063205325				2067606339	velaa.chinn@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Pharmacy Director			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Pharmacy Network Management Contact			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Pharmacy Network Management Contact (Secondary)			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Pharmacy Technical Help Desk Contact			Service	Customer							Rosalie.Wachsmuth@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active	8884455518				PACE - Nat		C	Seattle
H5007	Pharmacy Technical Help Desk Contact (Secondary)			Wachsmuth	Rosalie							rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active	5032153681				PACE - Nat		C	Seattle
H5007	Plan Directory Contact for Public Website			Bering	Rika		5032153857					rika.bering@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Plan to Plan Reconciliation Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Processor Contact	Mgr Admin and Support Svcs		Chinn	Velaa		2063205325				2067606339	velaa.chinn@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Quality Contact	Manager, Quality, Compliance & Education	Ms.	Vemuri	Susan		2067606414				2067606339	Susan.Vemuri@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Reconciliation Contact	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Reconciliation Contact (Secondary)	Health Plan Operations Manager		Wachsmuth	Rosalie		5032153681					Rosalie.Wachsmuth@providence.org	4400 NE Halsey, Building 1, Suite 200		Portland	OR	97213	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Recovery Audit Contact	Health Plan Operations Manager	Ms.	Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Surveillance Contact	Mgr Admin and Support Svcs		Chinn	Velaa		2063205325				2067606339	velaa.chinn@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	System Contact			Schultz	Elizabeth		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Third Party Administrator (TPA) Liaison	PACE Health Plan Data Analyst		Chambers	Perry		5032153672				5032150685	perry.chambers@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	User Access Contact			Schultz	Elizabeth		4255256908					Elizabeth.Schultz@providence.org	2811 South 102nd St, Suite 210		Tukwila	WA	98168	08/09/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Utilization Management Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5007	Utilization Review Contact			Wachsmuth	Rosalie		5032153681					rosalie.wachsmuth@providence.org	4400 NE Halsey, Bldg. 1, Suite 200		Portland	OR	97213	02/25/2022	2023	PROVIDENCE HEALTH SYSTEM	National PACE	Providence Health System	National PACE		Providence Health & Services	192	Yes	Active					PACE - Nat		C	Seattle
H5008	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H5008	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H5008	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H5008	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H5008	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5008	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5009	Agent/Broker Compensation Data Contact	VP Medicare Sales	Mr.	Hess	Brent		8013336143					Brent.Hess@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	07/06/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Automated TrOOP Balance Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Backup User Access Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St.	MS:E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Best Available Evidence Contact	Membership Ambassador	Ms.	Neufeld	Jeri		8006621470	2526			8883352988	ORMEMMEDAmbassador@regence.com	PO Box 1827		Medford	OR	97501	02/16/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Bid Audit Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Bid Audit Site Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Bid Primary Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	CAP Report Contact for Public Website	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	CEO - CMS Administrator Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/04/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	CEO - Senior Official for Contracting	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/09/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Chief Financial Officer	SVP & CFO	Mr.	Rains	Mike		2063326521					Mike.Rains@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Chief Operating Officer	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Chief Information Officer	SVP STRATEGIC TECH SOL & CIO	Mr	Rotival	Laurent		2063325034					Laurent.Rotival@cambiahealth.com	200 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Chief Information Security Officer	VP & CHIEF INFO SEC OFFICER	Mr	Anderson	Kirk		5037251608					Kirk.Anderson@cambiahealth.com	100 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	CMMI Model Point of Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	CMS Casework Communication Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Complaints Tracking Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Contact for Fraud Investigations	Senior Audit Investigator	Ms.	Grimes-Burke	Jennifer		5035873355					Jennifer.Grimes-Burke@regence.com	100 SW Market St	M/S E12B	Portland	OR	97201	06/16/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Coordination of Benefits Contact	Manager, Member Services	Ms	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	PO Box 1827	MS: B32M	Medford	OR	97501	07/09/2016	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Corporate Mailing						5032206237				5035884350	Jennifer.DelVillar@regence.com	100 SW Market Street		Portland	OR	97201	01/07/2013	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Sr I	Mr.	Gerken	Matthew		2063324809					Matthew.Gerken@cambiahealth.com	1800 9th Ave		Seattle	WA	98101	04/19/2016	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Customer Service Operations Contact	Manager Member Services	Ms	Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	DIR Contact	Manager Pharmacy Informatics		Kidd	Vicki		2083957739				2083337874	vicki.kidd@regence.com	1211 West Myrtle, Suite 110		Boise	ID	83702	01/08/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	DIR Contact (Secondary)	Dir. Gov. Pro Compliance / Medicare Compliance Off	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street E10C		Portland	OR	97201	07/22/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Emergency Part D Contact	VP Pharm Ops & Compliance	Mr.	Weiss	Justin		5032256677					Justin.Weiss@cambiahealth.com	200 SW Market St		Portland	OR	97201	12/20/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Emergency Part D Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Employer Waiver Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment, Manager	Mr.	Moore	Jason		2087982318					Jason.Moore@cambiahealth.com	1602 21st Ave		Lewiston	ID	83501	10/18/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Enrollment Contact	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	EOB Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Financial Audit Contact	Government Programs Audit Consultant	Mr.	Hutt	Brian		5032206160					Brian.Hutt@regence.com	200 SW Market Street	MS: E10C	Portland	OR	97201	05/09/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Financial Reporting Contact	Fin Acctg & Reporting, Assistant Director	Mr	Striplin	Daniel	W	5032256069					Dan.Striplin@regence.com	200 SW Market		Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Formulary Contact	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Ave		Portland	OR	97201	01/18/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	General Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Government Relations Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St.	MS:E10C	Portland	OR	97201	04/18/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	HIPAA Privacy Officer	VP Chief Compliance & Privacy Officer	Ms.	Erbes	Kristen		5035256533					kristen.erbes@regence.com	200 SW Market St	M/S: E14A	Portland	OR	97201	02/25/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	HIPAA Security Officer	Chief Information Security Officer	Mr.	Person	Steve		5037251654					Steve.Person@regence.com	1621 SW First Ave.		Portland	OR	97201	02/25/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Hospice Contact	Pharmacy Ops Oversight Specialist	Ms.	Pickens	Spring		5032255240					Spring.Pickens@regence.com	100 SW Market St	MS: WW5-56	Portland	OR	97201	02/05/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Interoperability Contact	VP Chief Tech Officer		Anderson	Kirk		5037251608					kirk.anderson@cambiahealth.com	Cambia Health Solutions	200 SW Market Street	Portland	OR	97201	02/09/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	MA Appeals/Grievances Contact	Director, Clinical Services Operations	Ms.	Sikora	Joelle		2063325320					Joelle.Sikora@regence.com	1800 Ninth Avenue		Seattle	WA	98101	05/09/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	MA Claims Processing Contact for Public Website	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Marketing Contact	Compliance Analyst		Meirose	Robyn		5033918668					robyn.meirose@regence.com	200 SW Market St  MS: E10C		Portland	OR	97201	09/15/2015	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Medical Director	SVP Chief Medical Officer	Ms.	Milavetz	Donna		8013336740					Donna.Milavetz@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	12/05/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Medicare Compliance Officer	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	07/14/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Medicare Coordinator	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827		Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Medicare Part D Opioid Overutilization Contact	Drug Management Program	Ms.	Anderson	Ally		8557297221					partdoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/14/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Medication Therapy Management Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Online Enrollment Center Contact (Back-up)	Dir Medicare Planning & Performance	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Online Enrollment Center Contact (Optional)	Manager Member Services	Ms.	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	2057 Commerce Dr		Medford	OR	97504	11/06/2017	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Online Enrollment Center Contact (Primary)	Spv Membership, GP OR Medicare Ops & Billing	Ms.	Cromwell	Krista		5416181286					Krista.Cromwell@regence.com	PO Box 1827	M/S: B32M	Medford	OR	97501	03/07/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Part C Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Part C Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				PPO - BBA		C	Seattle
H5009	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossig Rd	Eagan	MN	55120	03/21/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8006936651				PPO - BBA		C	Seattle
H5009	Part D Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Part D Benefits Contact	Product Manager III	Ms.	Holliston	Danica		5032254871					Danica.Holliston@regence.com	200 SW Market St  M/S: E10M		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Part D Claims Submission Contact	Functional Business Consultant - Government Prgrms	Mr.	Brook	Lance		4026862603					LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	08/05/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				PPO - BBA		C	Seattle
H5009	Part D Exceptions Contact (Secondary)	Asst Director Pharmacy Operations	Ms.	Yi	Edie							edie.yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	972071271	12/15/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	5032254801				PPO - BBA		C	Seattle
H5009	Part D Price File Contact (Back-up)	Database Reporting Analyst	Ms	Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Part D Price File Contact (Optional)	QA Analyst Sr	Ms.	Tastad	Emily		6127772557					emily.tastad@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/03/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Part D Price File Contact (Primary)	AD Pharmacy Informatics	Ms.	Kidd	Vicki		2083957739					Vicki.Kidd@regence.com	1211 West Myrtle		Boise	ID	83702	07/22/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Part D Quality Assurance Contact	Assistant Dir Pharmacy Operations	Ms.	Yi	Edie		5032254801				2083957744	Edie. Yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	97201	12/27/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Part D Reporting Contact	Director Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	12/23/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Patient Safety Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Payment Contact	Asst Director Fin Acctg & Reporting	Mr.	Striplin	Dan		5032256069					Dan.Striplin@cambiahealth.com	100 SW Market St	M/S: C2A	Portland	OR	97201	01/14/2014	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Pharmacy Director	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Avenue, M/S PDX - WW3-33		Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Pharmacy Network Management Contact	AVP, Network Mangement	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/18/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Management Relations		Lenhart	Alicia		6127773969				8778236373	Alicia.Lenhart@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	09/11/2020	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Pharmacy Technical Help Desk Contact	Director, Member Services Government Programs	Mr.	Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				PPO - BBA		C	Seattle
H5009	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jon							jonathan.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				PPO - BBA		C	Seattle
H5009	Plan Directory Contact for Public Website	Manager Member Services		Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Plan to Plan Reconciliation Contact	Pharmacy Operations Oversight Specialist, Sr.	Ms.	Manzer	Amy		5032255368					Amy.Manzer@regence.com	200 SW Market St	M/S: PDX-ZOF WW3-33	Portland	OR	97201	08/26/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing	Egan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Quality Contact	Director, Quality Management	Mr.	Mcclure	Andy		5032206189					Andrew.Mcclure@regence.com	1621 SW First Ave	M/S WW5-52	Portland	OR	97201	04/12/2019	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Reconciliation Contact	VP Finance Controller		Vannoy	Anjie		5032761865					Anjie.Vannoy@cambiahealth.com	100 SW Market St.	MS:PDX-WW2-21	Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Reconciliation Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS:E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Recovery Audit Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Surveillance Contact	Government Programs Compliance Officer		Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St  M/S: E10C		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	System Contact	Medicare Business Operations, Product Owner	Ms.	Fredinburg	Deana		5033754426					Deana.Fredinburg@regence.com	PO BOX 1827	M/S: B32AG	Medford	OR	97501	06/24/2022	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Third Party Administrator (TPA) Liaison	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	User Access Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Utilization Management Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5009	Utilization Review Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUESHIELD	Local CCP	Regence BlueShield	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Agent/Broker Compensation Data Contact	VP Medicare Sales	Mr.	Hess	Brent		8013336143					Brent.Hess@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	07/06/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Automated TrOOP Balance Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Backup User Access Contact	Cambia President and Chief Operating Officer	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St.	MS:E15A	Portland	OR	97201	10/17/2019	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Best Available Evidence Contact	Membership Ambassador	Ms.	Neufeld	Jeri		8006621470	2526			8883352988	ORMEMMEDAmbassador@regence.com	PO Box 1827		Medford	OR	97501	02/16/2018	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Bid Audit Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Bid Audit Site Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Bid Primary Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	CAP Report Contact for Public Website	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	CEO - CMS Administrator Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/04/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	CEO - Senior Official for Contracting	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/09/2022	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Chief Financial Officer	SVP & CFO	Mr.	Rains	Mike		2063326521					Mike.Rains@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Chief Operating Officer	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	12/31/2020	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Chief Information Officer	SVP STRATEGIC TECH SOL & CIO	Mr	Rotival	Laurent		2063325034					Laurent.Rotival@cambiahealth.com	200 SW Market St		Portland	OR	97201	04/12/2016	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Chief Information Security Officer	VP & CHIEF INFO SEC OFFICER	Mr	Anderson	Kirk		5037251608					Kirk.Anderson@cambiahealth.com	100 SW Market St		Portland	OR	97201	04/12/2016	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	CMMI Model Point of Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	CMS Casework Communication Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Complaints Tracking Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Contact for Fraud Investigations	Senior Audit Investigator	Ms.	Grimes-Burke	Jennifer		5035873355					Jennifer.Grimes-Burke@regence.com	100 SW Market St	M/S E12B	Portland	OR	97201	06/16/2022	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Coordination of Benefits Contact	Manager, Member Services	Ms	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	PO Box 1827	MS: B32M	Medford	OR	97501	07/09/2016	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Corporate Mailing						5032206237				5035884350	Jennifer.DelVillar@regence.com	100 SW Market Street		Portland	OR	97201	01/07/2013	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Sr I	Mr.	Gerken	Matthew		2063324809					Matthew.Gerken@cambiahealth.com	1800 9th Ave		Seattle	WA	98101	04/19/2016	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Customer Service Operations Contact	Manager Member Services	Ms	Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	DIR Contact	Manager Pharmacy Informatics		Kidd	Vicki		2083957739				2083337874	vicki.kidd@regence.com	1211 West Myrtle, Suite 110		Boise	ID	83702	01/08/2018	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	DIR Contact (Secondary)	Dir. Gov. Pro Compliance / Medicare Compliance Off	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street E10C		Portland	OR	97201	07/22/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Emergency Part D Contact	VP Pharm Ops & Compliance	Mr.	Weiss	Justin		5032256677					Justin.Weiss@cambiahealth.com	200 SW Market St		Portland	OR	97201	12/20/2022	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Emergency Part D Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Employer Waiver Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment, Manager	Mr.	Moore	Jason		2087982318					Jason.Moore@cambiahealth.com	1602 21st Ave		Lewiston	ID	83501	10/18/2019	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Enrollment Contact	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	EOB Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Financial Audit Contact	Government Programs Audit Consultant	Mr.	Hutt	Brian		5032206160					Brian.Hutt@regence.com	200 SW Market Street	MS: E10C	Portland	OR	97201	05/09/2019	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Financial Reporting Contact	Fin Acctg & Reporting, Assistant Director	Mr	Striplin	Daniel	W	5032256069					Dan.Striplin@regence.com	200 SW Market		Portland	OR	97201	01/08/2018	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Formulary Contact	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Ave		Portland	OR	97201	01/18/2018	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	General Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Government Relations Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St.	MS:E10C	Portland	OR	97201	04/18/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	HIPAA Privacy Officer	VP Chief Compliance & Privacy Officer	Ms.	Erbes	Kristen		5035256533					kristen.erbes@regence.com	200 SW Market St	M/S: E14A	Portland	OR	97201	02/25/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	HIPAA Security Officer	Chief Information Security Officer	Mr.	Person	Steve		5037251654					Steve.Person@regence.com	1621 SW First Ave.		Portland	OR	97201	02/25/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Hospice Contact	Pharmacy Ops Oversight Specialist	Ms.	Pickens	Spring		5032255240					Spring.Pickens@regence.com	100 SW Market St	MS: WW5-56	Portland	OR	97201	02/05/2018	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Interoperability Contact	VP Chief Tech Officer		Anderson	Kirk		5037251608					kirk.anderson@cambiahealth.com	Cambia Health Solutions	200 SW Market Street	Portland	OR	97201	02/09/2022	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	MA Appeals/Grievances Contact	Director, Clinical Services Operations	Ms.	Sikora	Joelle		2063325320					Joelle.Sikora@regence.com	1800 Ninth Avenue		Seattle	WA	98101	05/09/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	MA Claims Processing Contact for Public Website	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Marketing Contact	Compliance Analyst		Meirose	Robyn		5033918668					robyn.meirose@regence.com	200 SW Market St  MS: E10C		Portland	OR	97201	09/15/2015	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Medical Director	SVP Chief Medical Officer	Ms.	Milavetz	Donna		8013336740					Donna.Milavetz@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	12/05/2022	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Medicare Compliance Officer	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	07/14/2022	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Medicare Coordinator	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827		Medford	OR	97501	09/14/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Medicare Part D Opioid Overutilization Contact	Drug Management Program	Ms.	Anderson	Ally		8557297221					partdoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/14/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Medication Therapy Management Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Online Enrollment Center Contact (Back-up)	Dir Medicare Planning & Performance	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Online Enrollment Center Contact (Optional)	Manager Member Services	Ms.	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	2057 Commerce Dr		Medford	OR	97504	11/06/2017	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Online Enrollment Center Contact (Primary)	Spv Membership, GP OR Medicare Ops & Billing	Ms.	Cromwell	Krista		5416181286					Krista.Cromwell@regence.com	PO Box 1827	M/S: B32M	Medford	OR	97501	03/07/2018	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Part C Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Part C Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				PPO - BBA		C	Seattle
H5010	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossig Rd	Eagan	MN	55120	03/21/2022	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8006936651				PPO - BBA		C	Seattle
H5010	Part D Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Part D Benefits Contact	Product Manager III	Ms.	Holliston	Danica		5032254871					Danica.Holliston@regence.com	200 SW Market St  M/S: E10M		Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Part D Claims Submission Contact	Functional Business Consultant - Government Prgrms	Mr.	Brook	Lance		4026862603					LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	08/05/2019	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				PPO - BBA		C	Seattle
H5010	Part D Exceptions Contact (Secondary)	Asst Director Pharmacy Operations	Ms.	Yi	Edie							edie.yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	972071271	12/15/2022	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	5032254801				PPO - BBA		C	Seattle
H5010	Part D Price File Contact (Back-up)	Database Reporting Analyst	Ms	Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2020	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Part D Price File Contact (Optional)	QA Analyst Sr	Ms.	Tastad	Emily		6127772557					emily.tastad@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/03/2022	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Part D Price File Contact (Primary)	AD Pharmacy Informatics	Ms.	Kidd	Vicki		2083957739					Vicki.Kidd@regence.com	1211 West Myrtle		Boise	ID	83702	07/22/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Part D Quality Assurance Contact	Assistant Dir Pharmacy Operations	Ms.	Yi	Edie		5032254801				2083957744	Edie. Yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	97201	12/27/2022	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Part D Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Patient Safety Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Payment Contact	Asst Director Fin Acctg & Reporting	Mr.	Striplin	Dan		5032256069					Dan.Striplin@cambiahealth.com	100 SW Market St	M/S: C2A	Portland	OR	97201	01/14/2014	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Pharmacy Director	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Avenue, M/S PDX - WW3-33		Portland	OR	97201	01/08/2018	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Pharmacy Network Management Contact	AVP, Network Mangement	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/18/2020	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Management Relations		Lenhart	Alicia		6127773969				8778236373	Alicia.Lenhart@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	09/11/2020	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Pharmacy Technical Help Desk Contact	Director, Member Services Government Programs	Mr.	Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				PPO - BBA		C	Seattle
H5010	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jon							jonathan.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				PPO - BBA		C	Seattle
H5010	Plan Directory Contact for Public Website	Manager Member Services		Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Plan to Plan Reconciliation Contact	Pharmacy Operations Oversight Specialist, Sr.	Ms.	Manzer	Amy		5032255368					Amy.Manzer@regence.com	200 SW Market St	M/S: PDX-ZOF WW3-33	Portland	OR	97201	08/26/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing	Egan	MN	55121	04/19/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Quality Contact	Director, Quality Management	Mr.	Mcclure	Andy		5032206189					Andrew.Mcclure@regence.com	1621 SW First Ave	M/S WW5-52	Portland	OR	97201	04/12/2019	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Reconciliation Contact	VP Finance Controller		Vannoy	Anjie		5032761865					Anjie.Vannoy@cambiahealth.com	100 SW Market St.	MS:PDX-WW2-21	Portland	OR	97201	01/08/2018	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Reconciliation Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS:E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Recovery Audit Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Surveillance Contact	Government Programs Compliance Officer		Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St  M/S: E10C		Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	System Contact	Medicare Business Operations, Product Owner	Ms.	Fredinburg	Deana		5033754426					Deana.Fredinburg@regence.com	PO BOX 1827	M/S: B32AG	Medford	OR	97501	06/24/2022	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Third Party Administrator (TPA) Liaison	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St		Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	User Access Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Utilization Management Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5010	Utilization Review Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	ASURIS NORTHWEST HEALTH	Local CCP	Asuris Northwest Health	Local PPO		Cambia Health Solutions, Inc.	227	Yes	Active					PPO - BBA		C	Seattle
H5015	Agent/Broker Compensation Data Contact	President & CEO		Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Automated TrOOP Balance Transfer Contact	Pharmacy Director		Luu	Cindy		3614849214					cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Backup User Access Contact	Medicare Compliance Officer		Gifford	Tammy		3616768119					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Best Available Evidence Contact	Enrollment & Billing Manager		Muegge	Shmonica		3618276546					smuegge@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	07/21/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Bid Audit Contact	President & CEO		Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Bid Audit Site Contact	President & CEO		Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Bid Primary Contact	President & CEO		Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	CAP Report Contact for Public Website	VP of Operations		Spencer	Caroline		3618278970				3613331587	cspencer@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	CEO - CMS Administrator Contact	President & CEO	Mr.	Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	CEO - Senior Official for Contracting	President & CEO	Mr.	Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Chief Financial Officer	VP Finance	Mr.	Rodriguez	Jessie		3618940886				3615826810	jrodriguez@regencyhealthcare.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	02/20/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Chief Operating Officer	President & CEO	Mr.	Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Chief Information Officer	Chief Information Officer	Mr	Dossey	Jon		3614843980					jdossey@regencyhealthcare.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	05/09/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Chief Information Security Officer	Chief Information Officer	Mr	Dossey	Jon		3614843980				3615510303	jdossey@regencyhealthcare.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	05/09/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	CMS Casework Communication Contact	Member Services/A&G Manager		Clay	Lori		3618276215					lclay2@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Complaints Tracking Contact	Member Services/A&G Manager		Clay	Lori		3618276215					lclay2@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Contact for Fraud Investigations	Medicare Compliance Officer		Gifford	Tammy		3616768119					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Coordination of Benefits Contact	Financial Analyst		Batchelder	Holly		3615760694					hbatchelder@regencyhealthcare.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Corporate Mailing						3615760694					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst		Batchelder	Holly		3615760694					hbatchelder@regencyhealthcare.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Customer Service Operations Contact	VP of Operations		Spencer	Caroline		3618278970				3613331587	cspencer@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	DIR Contact	Financial Analyst		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	04/18/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	DIR Contact (Secondary)	Sr Financial Manager		Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	04/18/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Emergency Part D Contact	Pharmacy Director		Luu	Cindy		3614849214					cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Emergency Part D Contact (Secondary)	CEO		Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/05/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Encounter Data & Risk Adjustment Operations Contact	Sr. Director of Operations		Macias	Yvonne		3615760694					ymacias@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Enrollment Contact	Enrollment & Billing Manager		Muegge	Shmonica		3618276546					smuegge@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	07/21/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	EOB Transfer Contact	VP of Operations		Spencer	Caroline		3618278970				3613331587	cspencer@txihp.com	1908 N. Laurent	Suite 250	Austin	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Financial Audit Contact	Financial Analyst	Ms	Batchelder	Holly		3618940169					hbatchelder@regencyhealthcare.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Financial Reporting Contact	President & CEO	Mr.	Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Formulary Contact	Manager Formulary Operations		Ewigman	Andrea		4026720031					aewigman@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	07/21/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Formulary Contact (Secondary)	Director		Rossi	David		3304866311					drossi@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	04/18/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	General Contact	Medicare Compliance Officer		Gifford	Tammy		3616768119					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Government Relations Contact	President & CEO	Mr.	Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	HIPAA Privacy Officer	Medicare Compliance Officer		Gifford	Tammy		3616768119					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	HIPAA Security Officer	Medicare Compliance Officer		Gifford	Tammy		3616768119					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Hospice Contact	Member Services/A&G Manager		Clay	Lori		3618276215					lclay2@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Interoperability Contact	Chief Information Officer		Dossey	Jon		3614843980					jdossey@regencyhealthcare.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	05/09/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	MA Appeals/Grievances Contact	Member Services/A&G Manager		Clay	Lori		3618276215					lclay2@txihp.com	1908 N. Laurent	Suite 250	Austin	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	MA Claims Processing Contact for Public Website			Service	Customer		8559695907					info@txindependencehealthplan.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Marketing Contact	Compliance Officer		Gifford	Tammy		3616768119				3615415608	tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Medical Director	Medical Director	Dr.	Fry	Liam		3615760694					lfry@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Gifford	Tammy		3616768119					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Medicare Coordinator	Medicare Compliance Officer		Gifford	Tammy		3616768119					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Medicare Part D Opioid Overutilization Contact	Pharmacy Director		Luu	Cindy		3614849214					cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Medication Therapy Management Contact	Dir of Clinical Programs		Poore	Richard		6036285133					rpoore@healthdialog.com	7835 Freedom Avenue NW		North Canton	OH	44720	04/18/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	OffShore Subcontractor Contact	Medicare Compliance Officer		Gifford	Tammy		3616768119					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Part C Application Contact	President & CEO		Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Part C Reporting Contact	VP of Operations		Spencer	Caroline		3618278970				3613331587	cspencer@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Appeals	Pharmacy Director		Luu	Cindy							cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active	3614849214				HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Appeals Contact (Secondary)	Clinical Operations Supervisor		Herald	Samantha						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	04/18/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active	3303449574	0409			HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Application Contact	President & CEO		Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Benefits Contact	Pharmacy Director		Luu	Cindy		3614849214					cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Claims Submission Contact	Account Manager, Health Plans	Ms	Ehrenzeller	Vicki		9169392883					vehrenzeller@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/02/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Exceptions Contact	Director of Clinical Operations		Collins	Andrea							acollins@elixirsolutions.com	7835 Freedom Avenue NW		Canton	OH	44720	08/02/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active	3304103565				HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Exceptions Contact (Secondary)	Pharmacy Director		Luu	Cindy							cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active	3614849214				HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Price File Contact (Back-up)	Financial Analyst		Wentz	Christophe		3304864910					cwentz@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	04/18/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Price File Contact (Optional)	Pharmacy Director		Luu	Cindy		3614849214					cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Price File Contact (Primary)	Financial Manager		Campbell	Tim		3308886988					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		Canton	OH	44720	08/02/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Quality Assurance Contact	Pharmacy Director		Luu	Cindy		3614849214					cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Part D Reporting Contact	Pharmacy Director		Luu	Cindy		3614849214					cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Patient Safety Contact	Pharmacy Director		Luu	Cindy		3614849214					cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Payment Contact	President & CEO		Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Pharmacy Director	Pharmacy Director		Luu	Cindy		3614849214					cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Pharmacy Network Management Contact	Director of Pharmacy Network Contracting	Ms	Profio	Laura		3304864864				3304058094	lprofio@elixirsolutions.com	7835 Freedom Avenue NW		Canton	OH	44720	08/02/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Pharmacy Technical Help Desk Contact	Vice President of Operations	Mr	Conn	Todd							tconn@elixirsolutions.com	7835 Freedom Avenue NW		Canton	OH	44720	08/02/2023	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active	8662131594				HMO - Health Maintenance Organization		C	Dallas
H5015	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Director		Luu	Cindy							cluu@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active	3614849214				HMO - Health Maintenance Organization		C	Dallas
H5015	Plan Directory Contact for Public Website			Service	Customer		8559695907					info@txindependencehealthplan.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Plan to Plan Reconciliation Contact	Financial Analyst		Batchelder	Holly		3615760694					hbatchelder@regencyhealthcare.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Processor Contact	VP of Operations		Spencer	Caroline		3618278970				3613331587	cspencer@txihp.com	1908 N. laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Quality Contact	Medical Director	Dr.	Fry	Liam		3615760694					lfry@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Reconciliation Contact	Financial Analyst		Batchelder	Holly		3615760694					hbatchelder@regencyhealthcare.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Reconciliation Contact (Secondary)	President & CEO		Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Gifford	Tammy		3616768119					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	SNP Application Contact	President & CEO		Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	SNP State Contact	President & CEO		Dekowski	Devan		3616491371					dedekowski@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Surveillance Contact	Medicare Compliance Officer		Gifford	Tammy		3616768119					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	System Contact	VP of Operations		Spencer	Caroline		3618278970				3613331587	cspencer@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Third Party Administrator (TPA) Liaison	Financial Analyst		Batchelder	Holly		3615760694					hbatchelder@regencyhealthcare.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	User Access Contact	Medicare Compliance Officer		Gifford	Tammy		3616768119					tgifford@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Utilization Management Contact	Utilization Management Director		Mitchell	Jennie		3618278917					jmitchell2@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5015	Utilization Review Contact	Utilization Management Director		Mitchell	Jennie		3618278917					jmitchell2@txihp.com	1908 N. Laurent	Suite 250	Victoria	TX	77901	12/29/2022	2023	TEXAS INDEPENDENCE HEALTH PLAN, INC.	Local CCP	Texas Independence Health Plan	HMO/HMOPOS		Regency ISNP Holdings LLC	741	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5037	Automated TrOOP Balance Transfer Contact	Center Manager	Ms	Collinsworth	Tara		2765230599	310			2765236483	tara.collinsworth@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/01/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Backup User Access Contact	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Best Available Evidence Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Bid Primary Contact	CFO	Ms	Sprinkle	Stephanie		2765234202	310			2765236483	ssprinkle@meoc.org	PO Box 888		Big Stone Gap	VA	24219	04/16/2020	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	CAP Report Contact for Public Website	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	CEO - CMS Administrator Contact	Executive Director	Mr.	Wampler	Michael		2768702022				2765234208	mwampler@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	12/21/2021	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	CEO - Senior Official for Contracting	Executive Director	Mr.	Wampler	Michael		2765234202				2765234208	mwampler@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	02/21/2013	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Chief Financial Officer	CFO	Ms.	Sprinkle	Stephanie		4233068354				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	12/21/2021	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Chief Operating Officer	PACE Director and COO	Ms	Greer	Ruth		2763931692	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Chief Information Officer	IT Director	Mr.	Aguirre	Walter		2765234202	479			2765234208	waguirre@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/04/2021	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Chief Information Security Officer	IT Director	Mr.	Aguirre	Walter		2765234202	479				waguirre@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/04/2021	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	CMS Casework Communication Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Complaints Tracking Contact	Quality Manager		Turner	Bethany		2765230599				2765236483	bethany.turner@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/09/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Contact for Fraud Investigations	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Coordination of Benefits Contact	Administrative Specialist	Ms.	Turner	Bethany		2765230599	306			2765236483	bethany.turner@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	11/26/2018	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Corporate Mailing						2765230599				2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	04/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Coverage Gap Discount Program (CGDP) Payment Contact	Administrative Specialist	Ms.	Turner	Bethany		2765230599					bethany.turner@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	11/13/2017	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Customer Service Operations Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	DIR Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	DIR Contact (Secondary)	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Emergency Part D Contact	NP	Ms.	Wade	Melanie		2765230599				2765236480	melanie.wade@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/06/2023	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Emergency Part D Contact (Secondary)	Executive Director	Mr.	Wampler	Michael		2768702022				2765234208	mwampler@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	12/21/2021	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Encounter Data & Risk Adjustment Operations Contact	Administrative Specialist	Ms	Turner	Bethany		2765234202					bethany.turner@meoc.org	PO Box 888		Big Stone Gap	VA	24219	04/16/2020	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Enrollment Contact	Administrative Specialist	Ms.	Turner	Bethany		2765230599	310			2765236483	bethany.turner@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	11/13/2017	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	EOB Transfer Contact	Administrative Specialist	Ms.	Turner	Bethany		2765230599				2765236483	bethany.turner@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	11/13/2017	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Financial Audit Contact	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Financial Reporting Contact	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Formulary Contact	Medical Director/Primary Care Physician	Dr.	Cooperstein	Elizabeth		2765230599				2765236480	elizabeth.cooperstein@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/06/2023	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Formulary Contact (Secondary)	NP	Ms	Wade	Melanie		2765230599				2765236480	melanie.wade@meoc.org	1508  Third Ave	PO Box 888	Big Stone Gap	VA	24219	03/06/2023	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	General Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Government Relations Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	HIPAA Privacy Officer	IT Director	Mr.	Aguirre	Walter		2765234202	479			2765234208	waguirre@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/04/2021	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	HIPAA Security Officer	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	PO Box 888		Big Stone Gap	VA	24219	04/16/2020	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Interoperability Contact	PACE Director and COO		Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P.O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	MA Appeals/Grievances Contact	Quality Manager	Ms.	Turner	Bethany		2765230599				2765236483	bethany.turner@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/09/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	MA Claims Processing Contact for Public Website	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Marketing Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Medical Director	Medical Director/Primary Care Physician	Dr.	Cooperstein	Elizabeth		2765230599				2765236480	elizabeth.cooperstein@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/06/2023	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Medicare Compliance Officer	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Medicare Coordinator	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Medicare Part D Opioid Overutilization Contact	PACE Medical Director	Dr	Cooperstein	Elizabeth		2765230599	310			2765236483	elizabeth.cooperstein@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/06/2023	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Medication Therapy Management Contact	Medical Director/Primary Care Physician	Dr.	Cooperstein	Elizabeth		2765230599				2765236480	elizabeth.cooperstein@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/06/2023	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Online Enrollment Center Contact (Back-up)	Administrative Specialist	Ms.	Greer	Ruth		2765230599				2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Online Enrollment Center Contact (Optional)	IT Support Specialist	Mr.	Poff	Elliott		2765234202	458			2765234208	elliott.poff@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/04/2021	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Online Enrollment Center Contact (Primary)	Director of Information Technology	Mr.	Aguirre	Walter		2765234202	479			2765234208	waguirre@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/04/2021	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Part C Application Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Part D Appeals	Medical Director/Primary Care Physician	Dr.	Cooperstein	Elizabeth						2765236480	elizabeth.cooperstein@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/06/2023	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active	2765230599				PACE - Nat		C	Philadelphia
H5037	Part D Appeals Contact (Secondary)	CFO	Ms.	Sprinkle	Stephanie						2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active	8667937223				PACE - Nat		C	Philadelphia
H5037	Part D Application Contact	CFO	Ms	Sprinkle	Stephanie		2765234202	310			2765236483	ssprinkle@meoc.org	PO Box 888		Big Stone Gap	VA	24219	04/16/2020	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Part D Benefits Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Part D Claims Submission Contact	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Part D Exceptions Contact	PACE Director and COO	Ms	Greer	Ruth						2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active	8667937223				PACE - Nat		C	Philadelphia
H5037	Part D Exceptions Contact (Secondary)	PACE Center Manager	Ms.	Collinsworth	Tara						2765236480	tara.collinsworth@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/01/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active	8667937223				PACE - Nat		C	Philadelphia
H5037	Part D Price File Contact (Back-up)	Nurse Practitioner	Ms.	Wade	Melanie		2765230599				2765236480	melanie.wade@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/06/2023	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Part D Price File Contact (Optional)	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Part D Price File Contact (Primary)	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Part D Quality Assurance Contact	Quality Manager	Ms.	Turner	Bethany		2765230599	307			2765236483	bethany.turner@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/09/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Part D Reporting Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Patient Safety Contact	Quality Manager	Ms.	Turner	Bethany		2765230599	307			2765236483	bethany.turner@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/09/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Payment Contact	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Personal Health Record Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Pharmacy Director	Medical Director/Primary Care Physician	Dr.	Cooperstein	Elizabeth		2765230599				2765236480	elizabeth.cooperstein@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/06/2023	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Pharmacy Network Management Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Pharmacy Network Management Contact (Secondary)	NP	Ms	Wade	Melanie		2765230599				2765236480	melanie.wade@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/06/2023	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Pharmacy Technical Help Desk Contact	Director of Information Technology	Mr.	Aguirre	Walter						2765234208	waguirre@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/04/2021	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active	8667937223	479			PACE - Nat		C	Philadelphia
H5037	Pharmacy Technical Help Desk Contact (Secondary)	NP	Ms	Wade	Melanie						2765236480	melanie.wade@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/06/2023	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active	2765230599				PACE - Nat		C	Philadelphia
H5037	PHR Beneficiary Contact																	04/23/2009	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE	Mountain Empire PACE	Mountain Empire Older Citizens, Inc	362	Yes	Active	8667937223				PACE - Nat		C	Philadelphia
H5037	Plan Directory Contact for Public Website	IT Assistant Director	Mr.	Aguirre	Walter		2765230599	310			2765236483	waguirre@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	03/09/2020	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Plan to Plan Reconciliation Contact	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Processor Contact	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Quality Contact	Quality Manager	Ms.	Turner	Bethany		2765230599				2765236483	bethany.turner@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/09/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Reconciliation Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Reconciliation Contact (Secondary)	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Recovery Audit Contact	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Surveillance Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	System Contact	CFO	Ms.	Sprinkle	Stephanie		2765234202				2765234208	ssprinkle@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	09/30/2014	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Third Party Administrator (TPA) Liaison	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	User Access Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Utilization Management Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5037	Utilization Review Contact	PACE Director and COO	Ms	Greer	Ruth		2765230599	310			2765236483	rgreer@meoc.org	P. O. Box 888		Big Stone Gap	VA	24219	05/26/2022	2023	MOUNTAIN EMPIRE OLDER CITIZENS, INC.	National PACE	Mountain Empire PACE	National PACE		Mountain Empire Older Citizens, Inc	362	Yes	Active					PACE - Nat		C	Philadelphia
H5042	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Automated TrOOP Balance Transfer Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Backup User Access Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Best Available Evidence Contact	Manager, Membership & Billing		Salzer	Cheryl		5186414170					cheryl.salzer@cdphp.com	500 Patroon Creek Blvd.		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Bid Audit Contact	Medicare Actuary	Mr	Budhiraja	Puneet		5186415568				5186414605	Puneet.Budhiraja@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Bid Audit Site Contact	Medicare Actuary	Mr	Budhiraja	Puneet		5186415568				5186414605	Puneet.Budhiraja@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Bid Primary Contact	Medicare Actuary	Mr	Budhiraja	Puneet		5186415568				5186414605	Puneet.Budhiraja@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	CAP Report Contact for Public Website	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	CEO - CMS Administrator Contact	President and CEO	Dr	Bennett	John		5186415550				5186415506	john.bennett@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	CEO - Senior Official for Contracting	President and CEO	Dr	Bennett	John		5186415550				5186415506	john.bennett@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Chief Financial Officer	EVP/Finance/CFO	Mr	Kahlon	Paul		5186414050					paul.kahlon@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Chief Operating Officer	President - Health Plan Markets	Mr.	OGrady	Bryan		5186415110				5186415506	brian.ogrady@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Chief Information Officer	VP Enterprise Application Solutions	CIO	Rege	Umesh		5186414550					umesh.rege@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Chief Information Security Officer	VP Audit and Assurance/CISO/CRO	CISO	Rehm	Tammy		5186415575					tammy.rehm@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	CMS Casework Communication Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Complaints Tracking Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Contact for Fraud Investigations	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Coordination of Benefits Contact	Medicare Reimbursement Coordinator		Moye	Nancy		5186415274				5186414605	Medicare_Compliance_Inquiries@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Corporate Mailing						5186413000				5186414605	info@cdphp.com	Capital District Physicians' Health Plan	500 Patroon Creek Blvd	Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Coverage Gap Discount Program (CGDP) Payment Contact	Accounts Receivable Accountant		Ogden	Wendy		5186414057					wendy.ogden@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Customer Service Operations Contact	Director, Member Services		Spinner	Carmen		5186413741				5186413507	carmen.spinner@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	DIR Contact	Revenue Accounting Supervisor		Keller	Alexis		5183414012					Alexis.Keller@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	DIR Contact (Secondary)	Medicare Actuary	Mr	Budhiraja	Puneet		5186415568				5186414605	Puneet.Budhiraja@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Emergency Part D Contact			On Call	Manager		5183387262				5186413207	dennis.schoonmaker@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Employer Waiver Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Encounter Data & Risk Adjustment Operations Contact	VP Risk Adjustment and Encounter Operations		Chieco	Philip		5186415221					phil.chieco@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Enrollment Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	EOB Transfer Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Financial Audit Contact	Medicare Compliance Coordinator	Mrs	Noonan	Michelle		5186415282				5186414605	michelle.noonan@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Financial Reporting Contact	CFO	Mr	Kahlon	Paul		5186414050				5186414006	paul.kahlon@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Formulary Contact	Clinical Pharmacist		Reed	Lisa		5186413231				5186413208	Lisa.Reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Formulary Contact (Secondary)	Lead Managed Care Pharmacist		Reed	Lisa		5186413231				5186413208	lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	General Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Government Relations Contact	VP Communications and External Affairs		Skinner	Ali		5186415035				5186415506	ali.skinner@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	HIPAA Privacy Officer	Privacy Officer		Hinman	Todd		5186415261				5186415505	todd.hinman@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	HIPAA Security Officer	Information Security Officer		Rehm	Tammy		5186415575				5186414004	tammy.rehm@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Hospice Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664					luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Interoperability Contact	Mgr. Medicare Operations		Kozak	Stephanie		5186414661					stephanie.kozak@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	MA Appeals/Grievances Contact	Administrative Assistant		Krusienski	Melissa		5186413371				5186413203	melissa.krusienski@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	MA Claims Processing Contact for Public Website	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Marketing Contact	Mgr. Medicare Operations		Kozak	Stephanie		5186414661					stephanie.kozak@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Medical Director	EVP/Chief Medical Officer		Warner	Elizabeth		5186413309				5186413205	Elizabeth.Warner@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Medicare Compliance Officer	Medicare Compliance Officer	Mr	Schoonmaker	Dennis	M	5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Medicare Coordinator	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Medicare Part D Opioid Overutilization Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Medication Therapy Management Contact	Lead Managed Care Pharmacist		Reed	Lisa		5186413231				5186413208	lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	OffShore Subcontractor Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Online Enrollment Center Contact (Back-up)	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Online Enrollment Center Contact (Optional)	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Online Enrollment Center Contact (Primary)	Manager, Web Services		Monthony	Regina		5186415023				5186415506	regina.monthony@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Part C Application Contact	Product Manager Sales Innovation		Kozak	Stephanie		5186414661					Stephanie.kozak@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Part C Reporting Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Part D Appeals	Administrative Assistant		Krusienski	Melissa						5186413203	melissa.krusienski@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active	8882486522				PPO - BBA		C	New York
H5042	Part D Appeals Contact (Secondary)	Clinical Appeals Specialist		Julian	Lisa						5186413401	lisa.julian@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active	5186413343				PPO - BBA		C	New York
H5042	Part D Application Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Part D Benefits Contact	Lead Managed Care Pharmacist		Reed	Lisa		5186413231				5186413208	lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Part D Claims Submission Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Part D Exceptions Contact	Lead Managed Care Pharmacist		Reed	Lisa						5186413208	lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active	5186413231				PPO - BBA		C	New York
H5042	Part D Exceptions Contact (Secondary)	Lead Managed Care Pharmacist		Reed	Lisa						5186413208	lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active	5186413231				PPO - BBA		C	New York
H5042	Part D Price File Contact (Back-up)	Pharmacy Enterprise Medicare Advisor Lead		Sgambati	John		5186413313					John.Sgambati@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Part D Price File Contact (Optional)	Dir. Comm Pharmacy Prgrms and Medicare		Reed	Lisa		5186413231					lisa.reed@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Part D Price File Contact (Primary)	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Part D Quality Assurance Contact	Vice President of Pharmacy & Health Quality Pgms		Wood	Eileen		5186413215				5186413208	eileen.wood@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Part D Reporting Contact	Pharmacy Compliance Coordinator		Bedell	Luke		5186414664				5186414605	luke.bedell@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Patient Safety Contact	Vice President, Health Care Quality		Golderman	Renee		5186413240				5186413208	renee.golderman@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Payment Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Pharmacy Director	Vice President of Pharmacy & Health Quality Pgms		Wood	Eileen		5186413215				5186413208	eileen.wood@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Pharmacy Network Management Contact	Vice President of Pharmacy & Health Quality Pgrms		Wood	Eileen		5186413215				5186413508	eileen.wood@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Pharmacy Network Management Contact (Secondary)	Medicare Compliance Officer	Mr.	Schoonmaker	Dennis		5186415275				5186413208	dennis.schoonmaker@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Pharmacy Technical Help Desk Contact	Director, Customer Care		Ellerhorst	Lisa							lellerhorst@cap-rx.com	228 Park Avenue South	Suite 87234	New York	NY	10003	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active	8335991018				PPO - BBA		C	New York
H5042	Physician Incentive Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Plan Directory Contact for Public Website	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Plan to Plan Reconciliation Contact	Dir. Risk Adjustment and Recovery		Nasadoski	Tom		5186414601				5186414102	P2PADMIN@cdphp.com	Attn Risk Management - P2P	500 Patroon Creek Blvd	Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Processor Contact	Manager, Membership and Billing		Salzer	Cheryl		5186414170				5186414008	cheryl.salzer@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Quality Contact	Director, Health Care Quality		Golderman	Renee		5186413240				5186413208	renee.golderman@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Reconciliation Contact	Actuarial Director		Budhiraja	Puneet		5186415568					puneet.budhiraja@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Reconciliation Contact (Secondary)	Senior Healthcare Analyst		Vadyala	Sushma		5186414078					SushmaReddy.Vadyala@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Recovery Audit Contact	Medicare Compliance Officer	mr	Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	SNP Application Contact	Product Manager Sales Innovation		Spicer	Michael		5186415031					Michael.Spicer@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Surveillance Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	System Contact	Director, Product Performance		Chieco	Philip		5186415221				5186414605	phil.chieco@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Third Party Administrator (TPA) Liaison	Revenue Accountant		Ogden	Wendy		5186414057					wendy.ogden@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	User Access Contact	Medicare Compliance Officer		Schoonmaker	Dennis		5186415275				5186414605	dennis.schoonmaker@cdphp.com	500 Patroon Creek Corporate Center		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Utilization Management Contact	Director Utilization Management		Hannan	Priscilla		5186413423				5186413205	Priscilla.Hannan@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5042	Utilization Review Contact	Director Utilization Management		Hannan	Priscilla		5186413423					Priscilla.Hannan@cdphp.com	500 Patroon Creek Blvd		Albany	NY	12206	03/30/2023	2023	CDPHP UNIVERSAL BENEFITS, INC.	Local CCP	CDPHP Medicare Advantage	Local PPO		Capital District Physicians' Health Plan, Inc.	42	Yes	Active					PPO - BBA		C	New York
H5050	Agent/Broker Compensation Data Contact	Manager, Medicare Compliance		Lawrence	Winston		5105070510					winston.d.lawrence@kp.org	1 Kaiser Plaza, 12th Floor		Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Automated TrOOP Balance Transfer Contact	Project Manager III, Pharmacy Benefit Mgmt		Perez	Elizabeth	R	5623670592					Elizabeth.R.Perez@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	08/02/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Backup User Access Contact	Medicare Marketing & Enrollment Specialist	Mr.	Anderson	John		2066304260				2068770655	john.l.anderson@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C1W-04	1300 SW 27th St,  Bldg RCB, Mail Stop RCB-C1W-04	Renton	WA	980579055	04/08/2019	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Best Available Evidence Contact	Medicare Marketing & Enrollment Specialist	Mr.	Anderson	John		2066304260				2068770655	john.l.anderson@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C1W-04	1300 SW 27th St,  Bldg RCB, Mail Stop RCB-C1W-04	Renton	WA	980579055	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Bid Audit Contact	Executive Director Actuarial		Kenny	Kevin		5102677544					kevin.x.kenny@kp.org	300 Lakeside Drive, 28th Floor		Oakland	CA	94612	12/18/2020	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Bid Audit Site Contact	Compliance Consultant		Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/01/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Bid Primary Contact	Actuary		Tseng	Hsiang-Yi		3033062661					hsiang-yi.x.tseng@kp.org	300 Lakeside Dr.		Oakland	CA	94612	12/18/2020	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	CAP Report Contact for Public Website	Medicare Compliance Lead	Ms.	Cooper	Lynn		7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave		Denver	CO	80247	04/06/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	CEO - CMS Administrator Contact	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	CEO - Senior Official for Contracting	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Chief Financial Officer	SVP, CFO Business Units and Finance Operations	Mr.	Beltch	Robert	R	8184897560					rob.beltch@kp.org	1 Kaiser Plaza, Suite 806	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/15/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Chief Operating Officer	Executive Director, Medicare Market Strategy & Ops	Mr.	Miller	Paul		5033410073					paul.a.miller@kp.org	500 NE Multnomah St., Ste. 100		Portland	OR	97232	04/10/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Chief Information Officer	Chief Information Officer	Ms.	Comer	Diane		5102258777					Diane.B.Comer@kp.org	2600 Napa Valley Corporate Drive		Napa	CA	94558	09/17/2020	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Chief Information Security Officer	VP, Chief Information Security Officer	Mr.	Goddard	Jim		3037133890					James.P.Goddard@kp.org	6560 Greenwood Plaza Blvd.		Greenwood Village	CO	80111	09/01/2017	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	CMS Casework Communication Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	04/06/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Complaints Tracking Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	04/06/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Contact for Fraud Investigations	Director, Fraud Control and NSIU	Ms.	Janiga	Marita		5102716937				5108917977	marita.c.janiga@kp.org	One Kaiser Plaza	Ordway Building, 12th Floor	Oakland	CA	94612	12/20/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Coordination of Benefits Contact	Senior Director		Chung	Clarence		5623909293				5626583866	clarence.j.chung@kp.org	12254 Bellflower Blvd - Suite 106, 1st Floor		Downey	CA	90242	04/28/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Corporate Mailing						7205279215					lynn.m.cooper@kp.org	Lynn Cooper, Medicare Compliance Lead	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	02/16/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Coverage Gap Discount Program (CGDP) Payment Contact			Ballestros	Mayra		6262525164					mayra.x.lujano@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	02/15/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Customer Service Operations Contact	Operations Manager	Ms.	Lucas	Barbara		2065501626					Barbara.J.Lucas@kp.org	Naches Ave-SW. 2715		Renton	WA	980579055	04/08/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	DIR Contact	Senior Business Process Manager		Hsiue	Tony		5626583836					tony.x.hsiue@kp.org	12254 Bellflower Blvd.  Flr. 2		Downey	CA	90242	03/09/2020	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	DIR Contact (Secondary)	Sr. Financial Analyst		San	Kei		5626583445					Kei.San@kp.org	12254 Bellflower Blvd. Fl. 2		Downey	CA	90242	07/17/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Electronic Health Record Contact	Sr Manager, Meaningful Use PMO		Poole	Dolly		5106255813					dolly.poole@kp.org	1800 Harrison St.		Oakland	CA	94612	07/02/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Emergency Part D Contact	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/04/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Emergency Part D Contact (Secondary)	Manager Medicare Pharmacy Programs	Mr.	Popiel	Nicholas	B	3135060337					Nicholas.B.Popiel@kp.org	2921 Naches Ave., SW		Renton	WA	98057	12/21/2021	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Encounter Data & Risk Adjustment Operations Contact	Director, Risk Adjustment Submission	Ms.	Gu	Jialin		3033383507					jialin.gu@kp.org	2500 South Havana		Aurora	CO	80014	10/21/2019	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Enrollment Contact	Data Reporting Analyst	Mr.	Vasquez	Reynaldo	R	2069887504					reynaldo.r.vasquez@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C3W-08	1300 SW 27th St, Bldg RCB, Mail Stop RCB-C3W-08	Renton	WA	980579055	04/08/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	EOB Transfer Contact	Pharmacy Medicare Operations, Project Manager II		Bonoan	John	B	5624180564				5626583848	john.b.bonoan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	10/07/2021	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Financial Audit Contact	Compliance Consultant	Ms.	Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	07/06/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Financial Reporting Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Formulary Contact	Pharmacy Coordinator	Ms.	Toyoda	Yayoi		2066301053					Yayoi.Toyoda@kp.org	PO Box 9009, Bldg RCA, Mail Stop-RCA-B2N-02	2921 Naches Ave. SW, Bldg RCA, Mail Stop-RCA-B2N-02	Renton	WA	980579009	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Formulary Contact (Secondary)	PHARMACY PROJECT MGR I		Lin	Clement	J	5624459129					Clement.J.Lin@kp.org	12254 Bellflower Blvd		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	General Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	04/06/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Government Relations Contact	Senior Vice President, Government Relations	Mr.	Barrueta	Anthony	A	5102716835					Anthony.Barrueta@kp.org	One Kaiser Plaza		Oakland	CA	94612	10/07/2021	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	HIPAA Privacy Officer	Compliance Director		Anderson	Angela		5104353413					Angela.B.Anderson@kp.org	1800 Harrison Street	16th Floor	Oakland	CA	94612	11/06/2020	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	HIPAA Security Officer	Senior Director		Vourthis	Bill		9252065125					Bill.D.Vourthis@kp.org	5820 Owens Drive	Building E	Pleasanton	CA	94588	08/26/2020	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Hospice Contact	Membership Administration Technical Support	Mr.	Wells	John		2066302740					John.M.Wells@kp.org	PO Box 9010, Bldg RCR, Mail Stop RCR-A1E-07	2715 Naches Ave. SW, Bldg RCR, Mail Stop RCR-A1E-07	Renton	WA	980579010	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Interoperability Contact	National EDI Business Operations		Plattner	Cathy		6268336526					cathy.p.plattner@kp.org	75 N Fair Oaks Ave.		Pasadena	CA	91103	11/03/2021	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	MA Appeals/Grievances Contact	Senior Director, Grievance Operations	Ms.	Flynn	Kristine	P	9093677399					Kristine.Flynn@kp.org	10740 Fourth Street		Rancho Cucamonga	CA	91730	05/01/2019	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	MA Claims Processing Contact for Public Website	Dir Customer Engagement Mgmt		Galloway	Lonnie		9094772466					Lonnie.L.Galloway@kp.org	10740 4th Street		Rancho Cucamonga	CA	91730	08/02/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Marketing Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					KP-MedicareFilings@kp.org	10350 East Dakota Ave.		Denver	CO	80247	04/06/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Medical Director	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	11/16/2020	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Medicare Compliance Officer	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	04/06/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Medicare Coordinator	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	04/06/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Medicare Part D Opioid Overutilization Contact	Pharmacist Project Manager		Chong	Sue	H	5626583661					sue.h.chong@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	12/05/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Medication Therapy Management Contact	Pharmacy Quality and Medication Safety Coordinator	Ms.	Kim	Janet	M	2066301036					janet.m.kim@kp.org	PO Box 9009, Bldg RCA,  Mail Stop RCA-B2N-02	2921 Naches Ave. SW,  Bldg RCA,  Mail Stop RCA-B2N-02	Renton	WA	980579009	05/31/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	OffShore Subcontractor Contact	Compliance Consultant - Privacy and Security		Glenn	Jovan		9092512010					Jovan.Robinson@kp.org	10740 Fourth Street	2nd Floor  Cubicle: 023W02	Rancho Cucamonga	CA	91730	08/26/2020	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Online Enrollment Center Contact (Back-up)	Consultant Health Plan IT	Mr.	Van Atta	Paul		2066306890					Paul.A.Van.Atta@kp.org	PO Box 9010, Bldg RCR, Mail Stop RCR-A2S-01	2715 Naches Ave. SW, Bldg RCR, Mail Stop RCR-A2S-01	Renton	WA	980579010	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Online Enrollment Center Contact (Optional)	Consultant Health Plan IT	Mr.	Van Atta	Paul		2066306890					Paul.A.Van.Atta@kp.org	PO Box 9010, Bldg RCR, Mail Stop RCR-A2S-01	2715 Naches Ave. SW, Bldg RCR, Mail Stop RCR-A2S-01	Renton	WA	980579010	10/30/2019	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Online Enrollment Center Contact (Primary)	Consultant Health Plan IT	Mr.	Boyce	David		2066306852					David.R.Boyce@kp.org	PO Box 9010, Bldg RCR, Mail Stop RCR-A2S-03	2715 Naches Ave. SW, Bldg RCR, Mail Stop RCR-A2S-03	Renton	WA	980579010	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Part C Application Contact	Medicare Marketing & Enrollment Specialist	Mr.	Anderson	John		2066304260				2068770655	john.l.anderson@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C1W-04	1300 SW 27th St,  Bldg RCB, Mail Stop RCB-C1W-04	Renton	WA	980579055	12/05/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Part C Reporting Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	02/16/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Appeals	Senior Director, Grievance Operations	Ms.	Flynn	Kristine	P						Kristine.Flynn@kp.org	10740 Fourth Street		Rancho Cucamonga	CA	91730	05/01/2019	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	9093677399				HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Appeals Contact (Secondary)	Executive Director	Ms.	Benitz	Shirani	S						Shirani.S.Benitez@kp.org	10740 Fourth Street		Rancho Cucamonga	CA	91730	05/01/2019	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	9096357320				HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Application Contact	Medicare Marketing & Enrollment Specialist	Mr.	Anderson	John		2066304260				2068770655	john.l.anderson@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C1W-04	1300 SW 27th St,  Bldg RCB, Mail Stop RCB-C1W-04	Renton	WA	980579055	12/05/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Benefits Contact	Manager, Pharmacy Medicare Programs	Mr.	Popiel	Nicholas		2066301077				2069014410	nicholas.b.popiel@kp.org	PO Box 9009, Bldg RCA,  Mail Stop RCA-B2N-02	2921 Naches Ave. SW,  Bldg RCA,  Mail Stop RCA-B2N-02	Renton	WA	980579009	08/02/2021	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Claims Submission Contact	Manager, Pharmacy Medicare Programs	Mr.	Popiel	Nicholas		2066301077				2069014410	nicholas.b.popiel@kp.org	PO Box 9009, Bldg RCA,  Mail Stop RCA-B2N-02	2921 Naches Ave. SW,  Bldg RCA,  Mail Stop RCA-B2N-02	Renton	WA	980579009	08/02/2021	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Exceptions Contact	Manager, Pharmacy Ancillary Services	Ms.	Maktabi	Noushin						2069014410	Noushin.Maktabi@kp.org	PO Box 9009, Bldg RCA, Mail Stop RCA-B2N-02	2921 Naches Ave. SW, Bldg RCA, Mail Stop RCA-B2N-02	Renton	WA	980579009	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8007291174				HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Exceptions Contact (Secondary)	Director Clinical Pharmacy Programs	Ms.	Burks	Sharon						2069014410	Sharon.S.Burks@kp.org	PO Box 9009, Bldg RCA, Mail Stop RCA-B2N-02	2921 Naches Ave. SW, Bldg RCA, Mail Stop RCA-B2N-02	Renton	WA	980579009	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8007291174				HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Price File Contact (Back-up)	Financial Analyst		Kamikawa	Emely		5622998753				5626583712	emely.a.kamikawa@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Price File Contact (Optional)	Associate Consultant		Quan	Mariclare		5623850395					mariclare.a.quan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Price File Contact (Primary)	Pharmacy Pricing		Bullard	Myra		5623195747				5626583712	myra.c.bullard@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Quality Assurance Contact	Coordinator, Pharmacy ClinicalPrograms	Ms.	Forrester	Sara		2066301043				2069014410	Sara.H.Chung@kp.org	PO Box 9009, Bldg RCA,  Mail Stop RCA-B2N-02	2921 Naches Ave. SW, Bldg RCA, Mail Stop RCA-B2N-02	Renton	WA	980579009	02/23/2021	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Part D Reporting Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	02/16/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Patient Safety Contact	Manager, Pharmacy Medicare Programs	Mr.	Popiel	Nicholas		2066301077				2069014410	nicholas.b.popiel@kp.org	PO Box 9009, Bldg RCA,  Mail Stop RCA-B2N-02	2921 Naches Ave. SW,  Bldg RCA,  Mail Stop RCA-B2N-02	Renton	WA	980579009	08/02/2021	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Payment Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza, Suite 2552		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Pharmacy Director	Manager, Pharmacy Program	Mr.	Conway	Collin		2066301088				2069014410	Collin.S.Conway@kp.org	PO Box 9009, Mail Stop RCA-B2N-02	2921 Naches Ave. SW, GSE, Mail Stop RCA-B2N-02	Renton	WA	980579009	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Pharmacy Network Management Contact	Manager, Pharmacy Medicare Programs	Mr.	Conway	Collin		2066301088				2069014410	Collin.S.Conway@kp.org	PO Box 9009, Bldg RCA,  Mail Stop RCA-B2N-02	2921 Naches Ave. SW,  Bldg RCA,  Mail Stop RCA-B2N-02	Renton	WA	980579009	12/01/2020	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Medicare Programs	Mr.	Popiel	Nicholas		2066301077				2069014410	nicholas.b.popiel@kp.org	PO Box 9009, Bldg RCA,  Mail Stop RCA-B2N-02	2921 Naches Ave. SW,  Bldg RCA,  Mail Stop RCA-B2N-02	Renton	WA	980579009	08/02/2021	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Ancillary Services	Ms.	Maktabi	Noushin						2069014410	Noushin.Maktabi@kp.org	PO Box 9009, Bldg RCA, Mail Stop RCA-B2N-02	2921 Naches Ave. SW, Bldg RCA, Mail Stop RCA-B2N-02	Renton	WA	980579009	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8007291174				HMO - Health Maintenance Organization		C	San Francisco
H5050	Pharmacy Technical Help Desk Contact (Secondary)	Director Clinical Pharmacy Programs	Ms.	Burks	Sharon						2069014410	Sharon.S.Burks@kp.org	PO Box 9009, Bldg RCA, Mail Stop RCA-B2N-02	2921 Naches Ave. SW, Bldg RCA, Mail Stop RCA-B2N-02	Renton	WA	980579009	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8007291174				HMO - Health Maintenance Organization		C	San Francisco
H5050	PHR Beneficiary Contact																	06/08/2017	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS	Kaiser Foundation Health Plan of WA, Kaiser Permanente	Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8889014600	4600			HMO - Health Maintenance Organization		C	San Francisco
H5050	Plan Directory Contact for Public Website	Health Plan Operations		Assistance Unit	Provider		8887674670				5092497615	Elizabeth.B.Johnson@kp.org	Kaiser Permanente, Kaiser Foundation Health Plan of WA	PO Box 204 Mail Stop: ACN-AC17	Spokane	WA	992109809	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Plan to Plan Reconciliation Contact	Interim Director, Medicare Accounting		Wright	Mark	A	9253239443					mark.a.wright@kp.org	1 Kaiser Plaza, 25th Floor		Oakland	CA	94612	01/20/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Processor Contact	Medicare Compliance Consultant	Mr.	Carver	Jon	R	4257578659					jonathan.r.carver@kp.org	1300 SW 27th St.		Renton	WA	98057	09/05/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Quality Contact	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	05/25/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Reconciliation Contact	Controller, National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Reconciliation Contact (Secondary)	Vice President & Chief Financial Officer	Ms.	Shepler	Courtney	R	5102714644					courtney.r.shepler@kp.org	National Medicare Finance, 1 Kaiser Plaza, 13th Floor	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Recovery Audit Contact	Manager, Revenue Mgmt Compliance	Ms	Gonzalez	Heidy	G	6263723181					heidy.gonzalez@kp.org	74 S Fair Oaks Avenue		Pasadena	CA	91103	08/03/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	SNP Application Contact	Medicare Marketing & Enrollment Specialist		Anderson	John		2066304260				2068770655	john.l.anderson@kp.org	PO Box 9813, Bldg RCB, Mail Stop RCB-C1W-04	1300 SW 27th St,  Bldg RCB, Mail Stop RCB-C1W-04	Renton	WA	980579055	07/27/2020	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Surveillance Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	02/16/2023	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	System Contact	IT Engineer Applications	Mr.	Boyce	David	R	2066306852					david.r.boyce@kp.org	Naches Ave-SW. 2715,[WS008-1]		Renton	WA	980579055	04/08/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Third Party Administrator (TPA) Liaison	Senior Manager Accting	Ms.	Thornal	Sun	A	6264056311					Sun.A.Thornal@kp.org	393 E. Walnut St.		Downey	CA	91188	05/02/2019	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	User Access Contact	Medicare Compliance Lead	Ms.	Cooper	Lynn	M	7205279215					lynn.m.cooper@kp.org	10350 East Dakota Ave.		Denver	CO	80247	04/06/2022	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Utilization Management Contact	Manager, Health Plan Operations	Ms.	Brooks	Christy		5092417064				5097474606	Christy.L.Brooks@kp.org	P.O. Box 204, Mail Stop ACN	5615 W. Sunset Highway, Mail Stop ACN	Spokane	WA	992100204	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5050	Utilization Review Contact	Manager, Health Plan Operations	Ms.	Brooks	Christy		5092417064				5097474606	Christy.L.Brooks@kp.org	P.O. Box 204, Mail Stop ACN	5615 W. Sunset Highway, Mail Stop ACN	Spokane	WA	992100204	08/06/2018	2023	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5080	Automated TrOOP Balance Transfer Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Backup User Access Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Best Available Evidence Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Bid Primary Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	CAP Report Contact for Public Website	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	CEO - CMS Administrator Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	CEO - Senior Official for Contracting	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Chief Financial Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Chief Operating Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Chief Information Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Chief Information Security Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	CMS Casework Communication Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Complaints Tracking Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Contact for Fraud Investigations	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Coordination of Benefits Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Corporate Mailing						2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Customer Service Operations Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	DIR Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	DIR Contact (Secondary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Emergency Part D Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Emergency Part D Contact (Secondary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Encounter Data & Risk Adjustment Operations Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Enrollment Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	EOB Transfer Contact	CFO	Mrs	Prentis	Kristin		7328063224				7328063224	kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Financial Audit Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Financial Reporting Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Formulary Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Formulary Contact (Secondary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	General Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Government Relations Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	HIPAA Privacy Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	HIPAA Security Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Interoperability Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	MA Appeals/Grievances Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	MA Claims Processing Contact for Public Website	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Marketing Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Medical Director	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Medicare Compliance Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Medicare Coordinator	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Medicare Part D Opioid Overutilization Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/28/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Medication Therapy Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	OffShore Subcontractor Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Online Enrollment Center Contact (Back-up)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Online Enrollment Center Contact (Primary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Part C Application Contact	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenix	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Part D Appeals	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Chicago
H5080	Part D Appeals Contact (Secondary)	Executive Director	Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Chicago
H5080	Part D Application Contact	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenix	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Part D Benefits Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Part D Claims Submission Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Part D Exceptions Contact	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Chicago
H5080	Part D Exceptions Contact (Secondary)		Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Chicago
H5080	Part D Price File Contact (Back-up)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Part D Price File Contact (Primary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Part D Quality Assurance Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Part D Reporting Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Patient Safety Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Payment Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Personal Health Record Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Pharmacy Director	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Pharmacy Network Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Pharmacy Network Management Contact (Secondary)	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Pharmacy Technical Help Desk Contact	Executive Director	Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Chicago
H5080	Pharmacy Technical Help Desk Contact (Secondary)	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Chicago
H5080	PHR Beneficiary Contact																	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE	Beacon of Life SC			Yes	Pending	7325923400				PACE - Nat		C	Chicago
H5080	Plan Directory Contact for Public Website	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Plan to Plan Reconciliation Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Processor Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Quality Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Reconciliation Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Reconciliation Contact (Secondary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Recovery Audit Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Surveillance Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	System Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Third Party Administrator (TPA) Liaison	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	User Access Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Utilization Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5080	Utilization Review Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE INDIANA	National PACE	BoldAge PACE Indiana	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5085	Automated TrOOP Balance Transfer Contact	Executive Director		Bruno	Kelsey		2316524618					kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/06/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Backup User Access Contact	Quality  Director		Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/07/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Best Available Evidence Contact	Quality  Director		Yates	Mackenzie		8006896675				2316895038	mmarquardt@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	09/07/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Bid Primary Contact	Executive Director		Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/07/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	CAP Report Contact for Public Website	Marketing/Intake	Mrs.	Genther	Jaymie		2316524618				2316524620	jgenther@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	CEO - CMS Administrator Contact	Executive Director	Ms.	Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/07/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	CEO - Senior Official for Contracting	Executive Director	Ms.	Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/07/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Chief Financial Officer	Financial Officer	Mr.	Smith	Michael		8664278578				2317330035	msmith@visitingnurse.com	1909 Ruddiman Drive		North Muskegon	MI	49445	09/07/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Chief Operating Officer	Center Manager	Mrs.	Runions	Christine		2316524618				2316524620	crunions@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Chief Information Officer	Quality  Director	Mrs.	Yates	Mackenzie		2316524618				2316524620	myates@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	09/07/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Chief Information Security Officer	Executive Director	Ms.	Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/12/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	CMS Casework Communication Contact	Clinic Director	Ms	Bruno	Kelsey		8006896675				2316895038	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/07/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Complaints Tracking Contact	Quality  Director	Mrs.	Yates	Mackenzie		2316524618				2316524620	myates@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	09/12/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Contact for Fraud Investigations	Executive Director	Ms	Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/07/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Coordination of Benefits Contact	Executive Director	Ms.	Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/08/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Corporate Mailing						2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/08/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Coverage Gap Discount Program (CGDP) Payment Contact	Billing Administrator	Mrs	Deur	Rebecca		2316524618				2316524620	rdeur@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	12/18/2020	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Customer Service Operations Contact	Marketing/Intake Specialist	Mrs	Genther	Jaymie		2316524618				2316524620	jgenther@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	12/18/2020	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	DIR Contact	Executive Director	Ms.	Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/08/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	DIR Contact (Secondary)	Executive Director	Ms.	Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/12/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Emergency Part D Contact	Executive Director	Ms.	Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/12/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Emergency Part D Contact (Secondary)	Clinical Director	Mrs	Marquardt	Malorie		8006896675				2316895038	mmarquardt@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	10/21/2019	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Encounter Data & Risk Adjustment Operations Contact	Executive Director		Bruno	Kelsey		2316524618					kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/12/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Enrollment Contact	Marketing/Intake Specialist	Mrs	Genther	Jaymie		2316524618				2316524620	jgenther@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	12/18/2020	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	EOB Transfer Contact	Executive Director		Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/11/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Financial Audit Contact	Chief Financial Officer	Mr	Smith	Michael		8664278578				2317330035	msmith@visitingnurse.com	1909 Ruddiman Drive		North Muskegon	MI	49445	09/11/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Financial Reporting Contact	Financial Officer	Mr.	Smith	Michael		8664278578				2317330035	msmith@visitingnurse.com	1909 Ruddiman Drive		North Muskegon	MI	49445	09/11/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Formulary Contact	Executive Director	Ms.	Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/11/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Formulary Contact (Secondary)	Quality  Director	Mrs	Marquardt	Malorie		2316524618				2316534620	mmarquardt@communitypace.com	231 W Pine Lake Dr		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	General Contact	Executive Director		Bruno	Kelsey		2316524618					kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/11/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Government Relations Contact	Executive Director		Bruno	Kelsey		2316524618					kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/11/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	HIPAA Privacy Officer	Quality  Director	Mrs.	Yates	Mackenzie		2316524618				2316524620	myates@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	09/12/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	HIPAA Security Officer	Quality  Director	Mrs.	Yates	Mackenzie		2316524618				2316524620	myates@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	09/12/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Interoperability Contact	Clinic Director		Gustman	Melanie		2316524618				2316524620	mgustman@communitypace.com	231 W Pine Lake Dr		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	MA Appeals/Grievances Contact	Quality  Director	Mrs.	Yates	Mackenzie		2316524618				2316524620	myates@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	09/12/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	MA Claims Processing Contact for Public Website	Billing Administrator	Mrs	Deur	Rebecca		2316524618				2316524620	rdeur@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	12/18/2020	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Marketing Contact	Intake Director	Mrs	Genther	Jaymie		2316524618				2316524620	jgenther@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Medical Director		Dr.	Vanwieren	Gerald		8006896675				2316895038	gvanwieren@visitingnurse.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/24/2017	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Medicare Compliance Officer	Executive Director	Ms.	Bruno	Kelsey		2316524618				2316524620	kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/11/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Medicare Coordinator	Clinical Director	Mrs	Marquardt	Malorie		8006896675				2316895038	mmarquardt@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	10/21/2019	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Medicare Part D Opioid Overutilization Contact	Clinical Director	Mrs.	Marquardt	Malorie		2316524618				2316524620	mmarquardt@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	12/18/2020	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Medication Therapy Management Contact	Clinical Director	Mrs.	Marquardt	Malorie		2316524618				2316524620	mmarquardt@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	12/18/2020	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Part C Application Contact	Executive Director		Bruno	Kelsey		2316524618					kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/11/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Part D Appeals	Quality  Director	Mrs	Marquardt	Malorie						2316895038	mmarquardt@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active	2316524618				PACE - Nat		C	Kansas City
H5085	Part D Appeals Contact (Secondary)	Executive Director		Berry	Sarah							sberry@communitypace.com	231 W. Pine Lake Dr.		Newaygo	MI	49337	07/12/2021	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active	2316524618				PACE - Nat		C	Kansas City
H5085	Part D Application Contact	Executive Director		Berry	Sarah		2316524618				2316524620	sberry@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	07/12/2021	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Part D Benefits Contact	Executive Director		Berry	Sarah		2316524618				2316524620	sberry@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	07/12/2021	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Part D Claims Submission Contact	Billing Administrator	Mrs	Deur	Rebecca		2316524618				2316524620	rdeur@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	12/18/2020	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Part D Exceptions Contact	Executive Director		Berry	Sarah						2316524620	sberry@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	07/12/2021	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active	2316524618				PACE - Nat		C	Kansas City
H5085	Part D Price File Contact (Back-up)	Quality  Director	Mrs	Marquardt	Malorie		2316524618				2316524620	mmarquardt@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Part D Price File Contact (Primary)	Executive Director		Berry	Sarah		2316524618					sberry@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	07/12/2021	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Part D Quality Assurance Contact	Quality  Director	Mrs.	Marquardt	Malorie		2316524618				2316524620	mmarquardt@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Part D Reporting Contact	Executive Director		Berry	Sarah		2316524618				2316524620	sberry@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	07/12/2021	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Patient Safety Contact	Quality  Director	Mrs	Marquardt	Malorie		2316524618				2316524620	mmarquardt@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Payment Contact	Billing Administrator	Mrs.	Deur	Rebecca		2316524618				2316524620	rdeur@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	12/18/2020	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Pharmacy Director	Clinical Director	Mrs	Gustman	Melanie		2316524618				2316524620	mgustman@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Pharmacy Network Management Contact	Executive Director		Bruno	Kelsey		2316524618					kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/11/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Pharmacy Network Management Contact (Secondary)	Clinical Director	Mrs	Gustman	Melanie		2316524618				2316524620	mgustman@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Pharmacy Technical Help Desk Contact	Clinical Director	Mrs	Gustman	Melanie						2316524620	mgustman@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active	2316524618				PACE - Nat		C	Kansas City
H5085	Plan Directory Contact for Public Website	Intake Director	Mrs	Genther	Jaymie		2316524618				2316524620	jgenther@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Plan to Plan Reconciliation Contact	Executive Director		Berry	Sarah		2316524618				2316524620	sberry@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	07/12/2021	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Processor Contact	Executive Director		Berry	Sarah		2316524618				2316524620	sberry@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	07/12/2021	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Quality Contact	Quality Director	Mrs	Marquardt	Malorie		2316524618				2316524620	mmarquardt@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Reconciliation Contact	Executive Director		Berry	Sarah		2316524618				2316524620	sberry@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	07/12/2021	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Recovery Audit Contact	Quality  Director	Mrs	Marquardt	Malorie		2316524618				2316524620	mmarquardt@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Surveillance Contact	Quality  Director	Mrs.	Marquardt	Malorie		2316524618				2316524620	mmarquardt@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	System Contact	Executive Director		Berry	Sarah		2316524618				2316524620	sberry@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	07/12/2021	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Third Party Administrator (TPA) Liaison	Executive Director		Berry	Sarah		2316524618				2316524620	sberry@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	07/12/2021	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	User Access Contact	Clinical Director	Mrs.	Gustman	Melanie		2316524618				2316524620	mgustman@communitypace.com	231 W Pine Lake Drive		NEWAYGO	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Utilization Management Contact	Executive Director		Bruno	Kelsey		2316524618					kbruno@visitingnurse.com	231 W. Pine Lake Drive		Newaygo	MI	49337	09/11/2023	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5085	Utilization Review Contact	Quality  Director	Mrs	Marquardt	Malorie		2316524618				2316524620	mmarquardt@communitypace.com	231 West Pine Lake Drive		Newaygo	MI	49337	04/26/2022	2023	COMMUNITY PACE AT HOME, INC	National PACE	Community PACE at Home, Inc,	National PACE		Community PACE at Home, Inc	659	Yes	Active					PACE - Nat		C	Kansas City
H5087	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/13/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/24/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/13/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/13/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/13/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H5087	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/13/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H5087	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8669993945				HMO - Health Maintenance Organization		C	Dallas
H5087	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/13/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5087	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF CALIFORNIA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5106	Agent/Broker Compensation Data Contact	Manager, Sales Support & Operations	Mr.	Thompson	Seth		4128883167					Seth.Thompson@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Backup User Access Contact	Sr. Risk and Regulatory Intelligence Analyst	Ms.	Hegedus	Emily		6078219034					emily.hegedus@highmarkhealth.org	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Best Available Evidence Contact	Manager, Government Business Enrollment	Mr.	Stanhoff	David		4125445689					LISBAE@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Bid Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Bid Audit Site Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Bid Primary Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	CEO - CMS Administrator Contact	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	CEO - Senior Official for Contracting	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Chief Financial Officer	CFO Highmark Health Plan	Mr.	Bridges	Ja'Ron		4125441452					JaRon.Bridges@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/27/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Chief Operating Officer	SVP, Government Business Segment President	Ms.	Miller	Alexis	A	4125447389					Alexis.Miller@Highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Chief Information Officer	Senior Vice President, Infrastructure & Architectu	Mr.	Krebs	Mark		7173026255					mark.krebs@goenGen.com	120 Fifth Avenue		Pittsbrugh	PA	15222	09/25/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Chief Information Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	CMMI Model Point of Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/15/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	CMS Casework Communication Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Complaints Tracking Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne		4125444579				7176354209	Lynne.Walsh@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Contact for Fraud Investigations	VP Financial Investigation & Provider Review	Mr.	Spear	Kurt		4125447069					Kurt.Spear@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Coordination of Benefits Contact	Sr. Process Analyst	Ms.	Cassidy	Christina		4125444417					Christina.Cassidy@highmark.com	120 Fifth Avenue	PAP P5111	Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Corporate Mailing						4125447031					Thomas.Boettler@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant	Mr.	DeVan	Walter		7173026609					Walter.DeVanJr@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Customer Service Operations Contact	Director, Member & Provider Services		Scarnati	Chris		8148716712					Chris.Scarnati@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	DIR Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	DIR Contact (Secondary)	Senior Risk & Compliance Case Manager		Stetson	Kelsey		4125445816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Emergency Part D Contact	Director, Customer Experience		Scarnati	Chris		8148716712					Chris.Scarnati@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Emergency Part D Contact (Secondary)	Manager, Customer Service		Merritt	Meggan		3042992512					Meggan.Hostuttler@highmark.com	120 Fifth Avenue Place	Suite PKSB-2	Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Employer Waiver Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Encounter Data & Risk Adjustment Operations Contact	Director, Actuarial Services	Mr.	DelPrince	Vincent	M	4125443939					Vincent.Delprince@highmark.com	501 Penn Avenue		Pittsburgh	PA	15222	08/04/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Enrollment Contact	Director, Enrollment and Billing	Mr.	Palmer	David		4125446384					David.Palmer@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	EOB Transfer Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	bob.opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Financial Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Financial Reporting Contact	Vice President, Accounting & Reportin	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Formulary Contact	Senior Pharmacist, Clinical Pharmacy Services		DiTullio	Kelly		4128884336					Kelly.DiTullio@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Formulary Contact (Secondary)	Senior Pharmacist, Clinical Pharmacy Services		Humphries	Jessica		4128884890					jessica.humphries@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	General Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Government Relations Contact	SVP, Government Affiars	Mr.	Warfel	Michael	G	7173023979					michael.warfel@highmark.com	1800 Center St.		Camp Hill	PA	17011	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	HIPAA Privacy Officer	Chief Privacy and Data Ethics Officer	Ms.	Patrick	Justine		4125444643					justine.patrick@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	HIPAA Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Hospice Contact	Intake Coordinator		Welker	Jessica		7178883043					DrugHelp_Authorizations@highmark.com	120 5th Avenue Place		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Interoperability Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	MA Appeals/Grievances Contact	Manager, Appeals & Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	MA Claims Processing Contact for Public Website	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Marketing Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					Jillian.Pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Medical Director	VP, Executive Medical Director	Dr,	Law	Timothy		4125446445					timothy.law@highmark.com	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Medicare Coordinator	Director, Government Compliance	Ms.	Carl	Kathleen	A	4125447156					Kathleen.Carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Medicare Part D Opioid Overutilization Contact	Pharmacist	Ms.	Ali	Dewaa		4129040214					Dewaa.ali@highmark.com	120 Fifth Avenue PAP P4207		Pittsburgh	PA	15222	07/31/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Medication Therapy Management Contact	Senior Pharmacist	Ms.	Adlesic	Meredith		4128883749					Meredith.Adlesic@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	OffShore Subcontractor Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Online Enrollment Center Contact (Back-up)	Manager Enrollment & Billing	Mr.	Stanhoff	David		4125445689					LISBAE@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Online Enrollment Center Contact (Optional)	Manager, Business Platform	Mr.	Hudson	Brian		7173025964					Brian.Hudson@highmark.com	1800 Center St.		Camp Hill	PA	17011	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Online Enrollment Center Contact (Primary)	Director, Enrollment and Billing	Mr.	Palmer	David		4125446384					David.Palmer@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Part C Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Part C Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Part D Appeals	Manager, Member Appeals & Grievances	Ms.	Walsh	Lynne	M					7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	4125444579				PPO - BBA		C	Philadelphia
H5106	Part D Appeals Contact (Secondary)	Supervisor, Appeals & Grievances	Ms.	Miller	Rachel	M					7176354209	Rachel.Miller@highmark.com	Fifth Ave Place	120 Fifth Avenue, Ste 5322	Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	4125441596				PPO - BBA		C	Philadelphia
H5106	Part D Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Part D Benefits Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Part D Claims Submission Contact	Director Regulated Marketing Medicare Solutions		Dovico	Rosario		9145896300				8882822583	Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Part D Exceptions Contact			Affairs	Pharmacy							drughelp@highmark.com	120 Fifth Avenue	Suite SPECARE	Pittsburgh	PA	15222	08/04/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8006002227				PPO - BBA		C	Philadelphia
H5106	Part D Exceptions Contact (Secondary)	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	08/04/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8003443405	733326			PPO - BBA		C	Philadelphia
H5106	Part D Price File Contact (Back-up)	Pharmacy Analyst	Mr.	Nolder	Tim		4124398263					timothy.nolder@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Part D Price File Contact (Optional)	Director, Government Programs	Mr.	Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	02/14/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Part D Price File Contact (Primary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Part D Quality Assurance Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Part D Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Patient Safety Contact	Director, Clinical Pharmacy Operations	Mr.	Causer	Derek		4125445835					Derek.Causer@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Payment Contact	Vice President, Accounting and Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Pharmacy Director	Manager, Pharmacy Programs		Winterhalter	Christa		4128884108					Christa.Winterhalter@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Pharmacy Network Management Contact	Network Account Director, Retail Strat & Contract	Ms.	Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8009221557				PPO - BBA		C	Philadelphia
H5106	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Government Operations	Ms	Lynn Schill	Jodie							Jodie.LynnSchill@highmark.com	120 Fifth Avenue Pittsburgh, PA 15222		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	5705783579				PPO - BBA		C	Philadelphia
H5106	PHR Beneficiary Contact																	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO	Highmark Inc	Highmark Health	123	Yes	Active	8665886967				PPO - BBA		C	Philadelphia
H5106	Physician Incentive Contact	VP Prov Reimbursement & Network	Mr.	McDonald	Brendan		4125446611					brendan.mcdonald@highmarkhealth.org	120 5th Avenue Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Plan Directory Contact for Public Website			Service	Provider		8665886967					resourcecenter@highmark.com	120 Fifth Ave		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Plan to Plan Reconciliation Contact	Manager, Operational Accounting	Mr.	Stehr	Brett	J	7173022748					P2Precon@highmark.com	Highmark Inc. Attn: Cashier	PO Box 898820	Camp Hill	PA	170890407	06/28/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Processor Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Quality Contact	VP, Clinical Quality and Medical Policy	Dr.	Onuoha-Obilor	Stella		4125444335					Stella.Onuoha-Obilor@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Reconciliation Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Reconciliation Contact (Secondary)	Senior Risk * Compliance Case manager		Stetson	Kelsey		4125448816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Recovery Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Surveillance Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					jillian.pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	System Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Third Party Administrator (TPA) Liaison	Accountant		Jurgiewicz	Kimberly		5707807969					kimberly.jurgiewicz@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	User Access Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Utilization Management Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5106	Utilization Review Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK SENIOR SOLUTIONS COMPANY	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5117	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H5117	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/07/2018	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/15/2017	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Medical Director	Sr. VP, Medical Affairs	Dr.	Nelson	Vincent		3145056872					vincent.nelson@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/17/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H5117	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H5117	PHR Beneficiary Contact																	09/27/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8557661572				HMO - Health Maintenance Organization		C	Dallas
H5117	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Plan Directory Contact for Public Website			Services	Provider		8557661572					CorporateMedicareComplianceDept@CENTENE.COM	8585 Archives Avenue	Suite 310	Baton Rouge	LA	70809	03/31/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5117	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	LOUISIANA HEALTHCARE CONNECTIONS, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5124	Automated TrOOP Balance Transfer Contact	Finance Manager	Mr.	Johnson	Andy		3177828007				3177826992	Andy.Johnson@franciscanalliance.org	700 East Southport Rd		Indianapolis	IN	46227	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Backup User Access Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Best Available Evidence Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Bid Primary Contact	Finance Manager	Mr.	Johnson	Andy		3177828007				3177826992	Andy.Johnson@franciscanalliance.org	700 E. Southport Rd.		Indianapolis	IN	46227	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	CAP Report Contact for Public Website	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active	3175287223				PACE - Nat		C	Chicago
H5124	CEO - CMS Administrator Contact	CNO	Mrs.	Therady	Agnes		5742546401					Agnes.Therady@franciscanalliance.org	8111 South Emerson		Indianapolis	IN	46237	03/12/2021	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	CEO - Senior Official for Contracting	CNO	Mrs.	Therady	Agnes		5742546401					Agnes.Therady@FranciscanAlliance.org	8111 S. Emerson Ave.		Indianapolis	IN	46237	03/12/2021	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Chief Financial Officer	Chief Financial Officer	Mr	Wessel	Mark		3177054530					mark.wessel@franciscanalliance.org	4527 East 82nd Street		Indianapolis	IN	46250	09/05/2017	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Chief Operating Officer	CNO	Mrs.	Therady	Agnes		5742546401					Agnes.Therady@FranciscanAlliance.org	8111 S. Emerson Ave.		Indianapolis	IN	46237	03/12/2021	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Chief Information Officer		Mr	Wagner	Charles		3177826212					charles.wagner@franciscanalliance.org	8111 Emerson Ave		Indianapolis	IN	46237	05/13/2020	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Chief Information Security Officer		Mr	Wagner	Charles		3177826212					charles.wagner@franciscanalliance.org	8111 Emerson Ave		Indianapolis	IN	46237	05/13/2020	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	CMS Casework Communication Contact	Director of PACE	Mrs.	Matthys	Laura		2198642630					laura.matthys@franciscanalliance.org	2150 Gettler Street		Dyer	IN	46311	11/16/2021	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Complaints Tracking Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Contact for Fraud Investigations	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Coordination of Benefits Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Corporate Mailing						2198642630					laura.matthys@franciscanalliance.org	2150 Gettler Street		Dyer	IN	46311	11/16/2021	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Coverage Gap Discount Program (CGDP) Payment Contact			Johnson	Andy		3177828007					andy.johnson@franciscanalliance.org	700 E Southport Rd		Indianapolis	IN	46227	05/20/2016	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Customer Service Operations Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	DIR Contact	Financial Analyst		Johnson	Andy		3177828007					Andy.Johnson@franciscanalliance.org	700 East Southport Rd		Indianapolis	IN	46227	03/21/2018	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Emergency Part D Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Encounter Data & Risk Adjustment Operations Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175287223					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Enrollment Contact	Finance Manager	Mr.	Johnson	Andy		3177828007				3177826992	Andy.Johnson@franciscanalliance.org	700 East Southport Rd		Indianapolis	IN	46227	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	EOB Transfer Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933				3175286399	Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Financial Audit Contact	Finance Manager	Mr.	Johnson	Andy		3177828007				3177826992	Andy.Johnson@franciscanalliance.org	700 East Southport Rd		Indianapolis	IN	46227	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Financial Reporting Contact	PACE Accountant		Johnson	Andy		3177828007					Andy.Johnson@franciscanalliance.org	700 East Southport Rd		Indianapolis	IN	46227	01/23/2017	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Formulary Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	General Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Government Relations Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	HIPAA Privacy Officer	Compliance Officer		Heim	Joy		3177828009					Joy.Heim@franciscanalliance.org	700 East Southport Rd		Indianapolis	IN	46227	01/23/2017	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	HIPAA Security Officer	Compliance Officer		Heim	Joy		3177828009					Joy.Heim@franciscanalliance.org	700 East Southport Rd		Indianapolis	IN	46227	01/23/2017	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Interoperability Contact			Heim	Joy		3177828009					Joy.heim@franciscanalliance.org	700 East SouthPort Road		Indianapolis	IN	46227	10/18/2021	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	MA Appeals/Grievances Contact	Director of PACE	Mrs.	Matthys	Laura		2196709133					laura.matthys@franciscanalliance.org	2150 Gettler Street		Dyer	IN	46303	09/10/2021	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	MA Claims Processing Contact for Public Website	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Marketing Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Medical Director	Medical Dirctor	Dr	Priscu	Nicolas		3177828012					Nicolas.priscu@franciscanalliance.org	700 East Southport Rd		Indinapolis	IN	46227	08/26/2014	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Medicare Compliance Officer	Compliance Officer	Ms	Heim	Joy		3177828009					Joy.Heim@franciscanalliance.org	700 East Southport Rd		Indianapolis	IN	46227	01/23/2017	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Medicare Coordinator	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Medicare Part D Opioid Overutilization Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Medication Therapy Management Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Part C Application Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Part D Appeals	Interim PACE Administrative Director	Ms.	Escobedo	Kace							Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active	3175288933				PACE - Nat		C	Chicago
H5124	Part D Appeals Contact (Secondary)	Finance Manager	Mr.	Johnson	Andy						3177826992	Andy.Johnson@franciscanalliance.org	700 E. Southport Rd.		Indianapolis	IN	46227	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active	3177828007				PACE - Nat		C	Chicago
H5124	Part D Application Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Part D Benefits Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Part D Claims Submission Contact	Finance Manager	Mr.	Johnson	Andy		3177828007				3177826992	Andy.Johnson@franciscanalliance.org	700 E. Southport Rd.		Indianapolis	IN	46227	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Part D Exceptions Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace							Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active	3175288933				PACE - Nat		C	Chicago
H5124	Part D Price File Contact (Back-up)	Finance Manager	Mr.	Johnson	Andy		3177828007				3177826992	Andy.Johnson@franciscanalliance.org	700 E. Southport Rd.		Indianapolis	IN	46227	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Part D Price File Contact (Primary)	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Part D Quality Assurance Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Part D Reporting Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Patient Safety Contact	Director of PACE	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Payment Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Pharmacy Director	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Pharmacy Network Management Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Pharmacy Technical Help Desk Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace							Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active	3175288933				PACE - Nat		C	Chicago
H5124	Plan Directory Contact for Public Website	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Plan to Plan Reconciliation Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Processor Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Quality Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Reconciliation Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Recovery Audit Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Surveillance Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	System Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Third Party Administrator (TPA) Liaison	Finance Manager	Mr.	Johnson	Andy		3177828007				3177826992	andy.johnson@franciscanalliance.org	700 E Southport Rd		Indianapolis	IN	46227	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	User Access Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Utilization Management Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5124	Utilization Review Contact	Interim PACE Administrative Director	Ms.	Escobedo	Kace		3175288933					Kace.Escobedo@franciscanalliance.org	8325 E. Southport Rd, Suite 120		Indianapolis	IN	46259	07/12/2022	2023	FRANCISCAN ACO, INC.	National PACE	Franciscan  Senior Health & Wellness	National PACE		Franciscan Alliance, Inc.	563	Yes	Active					PACE - Nat		C	Chicago
H5140	Agent/Broker Compensation Data Contact	Medicare Sales Compliance & Audit Oversight Specia	Ms.	Aguayo	Nancy		6029168515					nancy.aguayo@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Automated TrOOP Balance Transfer Contact			Esp	Brian		8587906445					partdcat@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/12/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Backup User Access Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Best Available Evidence Contact	Mgr- Medicare Enrollment		Ramirez	Michelle		6029168404					michelle.ramirez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Bid Audit Contact	Director, Corporate & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		PHOENIX	AZ	85021	01/12/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Bid Primary Contact	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	01/12/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	CAP Report Contact for Public Website			Services	Member		4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	CEO - CMS Administrator Contact	President and CEO	Ms.	Kehaly	Pam		6028644610					pam.kehaly@azblue.com	8220 N. 23rd Ave.		Phoenix	AZ	85021	02/20/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	CEO - Senior Official for Contracting	President and CEO	Ms.	Kehaly	Pam		6028644610					pam.kehaly@azblue.com	8220 N. 23rd Ave.		Phoenix	AZ	85021	02/20/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Chief Financial Officer	Chief Financial Officer	Mr.	El-Tawil	Mark		6028645700					mark.el-tawil@azblue.com	8220 N 23rd Ave	MS C410	Phoenix	AZ	85021	02/12/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Chief Operating Officer	Chief Operating Officer	Mr.	Greenberg	Joe		6029166930					joe.greenberg@azblue.com	8220 N. 23rd Ave		Phoenix	AZ	85021	04/18/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Chief Information Officer	VP- CIO	Mr.	Pencek	Michael		6029166728					michael.pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Chief Information Security Officer	Director, Chief Information Security Officer	Mr.	Pencek	Michael		6029166728					Michael.Pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	CMS Casework Communication Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Complaints Tracking Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Contact for Fraud Investigations	Staff Vice President, Corp & Medicare Compliance	Ms.	Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Coordination of Benefits Contact	Mgr- Medicare Finance		Nguyen	Peter		6029168506					peter.nguyen@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Corporate Mailing						4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst/Accountant	Mr.	Westphal	Robert		6029168503					robert.westphal@azblue.com	8220 N 23rd Ave.		Phoenix	AZ	85021	08/07/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Customer Service Operations Contact	Staff VP, MA Ops & FEP Progs		Langum	Becca	S	6029166742					rebecca.langum@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	DIR Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	DIR Contact (Secondary)	Mgr- Medicare Finance		Nguyen	Peter		6029168506					peter.nguyen@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	02/26/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Emergency Part D Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Emergency Part D Contact (Secondary)	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N. 23rd Ave.		Phoenix	AZ	85021	12/28/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Encounter Data & Risk Adjustment Operations Contact	Sr. Manager, Risk Adjustment Operations		Hubler	Jamee		6029168220					Jamee.Hubler@azblue.com	8220 N. 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Enrollment Contact	Mgr- Medicare Enrollment		Ramirez	Michelle		6029168404					michelle.ramirez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	EOB Transfer Contact	Director, PDP Operations		Weideman	Stacy		6028644391				8583572494	stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Financial Audit Contact	Chief Audit Executive	Mrs.	Lohse	Deepa		6028644452					deepa.lohse@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	09/20/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Financial Reporting Contact	Director, Financial Reporting	Ms.	Acquafredda	Brandy		6028644683					brandy.acquafredda@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	03/09/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Formulary Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Formulary Contact (Secondary)	Director, Formulary Services		Zele	Carolyn		8587905737				8006833053	FMT@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	02/12/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	General Contact	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	01/12/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Government Relations Contact	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	01/12/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	HIPAA Privacy Officer	Director of Legal and Privacy Officer		Schrock	Anne		6028644315					anne.schrock@azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	05/14/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	HIPAA Security Officer	Director, Chief Information Security Officer	Mr.	Pencek	Michael		6029166728					Michael.Pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Hospice Contact	Sr Health Plan Rx Specialist		Norman	Laci		6029168577					laci.norman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Interoperability Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	MA Appeals/Grievances Contact			Services	Member		4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	MA Claims Processing Contact for Public Website	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	01/12/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Marketing Contact	Marketing Manager		Johnson	Nichelle		6028645215					MedSalesHPMSMaterial@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Medical Director	Medical Director	Dr	Raja	Rubina		6028642176					rubina.raja@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Medicare Compliance Officer	Director, Corporate and Medicare Compliance	Mrs.	Moore	Veronica		6023367600				6028643152	veronica.moore@azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	02/11/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Medicare Coordinator	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Medicare Part D Opioid Overutilization Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Medication Therapy Management Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Online Enrollment Center Contact (Primary)	Mgr- Medicare Enrollment		Ramirez	Michelle		6029168404					michelle.ramirez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Part C Application Contact	Director, Corporate & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		PHOENIX	AZ	85021	01/12/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Part C Reporting Contact	Director, Corporate & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		PHOENIX	AZ	85021	01/12/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Part D Appeals			Services	Member							contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active	8004468331				PPO - BBA		C	San Francisco
H5140	Part D Appeals Contact (Secondary)	Manager Disputes and Appeals Department		Angel	Clarissa							GrievanceAppeals@Azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	01/08/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active	6029168073				PPO - BBA		C	San Francisco
H5140	Part D Application Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Part D Benefits Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Part D Claims Submission Contact			Scherlippens	Carine		8587907415					MedicarePartDProjectManagers@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	02/12/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Part D Exceptions Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy							Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active	6028644391				PPO - BBA		C	San Francisco
H5140	Part D Price File Contact (Back-up)	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Part D Price File Contact (Primary)			Jordan	Felicia		8587906416					planfindercommunications@medimpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	02/12/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Part D Quality Assurance Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Part D Reporting Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Patient Safety Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Payment Contact	Finance Manager	Mr.	Nguyen	Peter		6029168506					peter.nguyen@azblue.com	8220 N 23rd Ave.		Phoenix	AZ	85021	01/13/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Pharmacy Director	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Pharmacy Network Management Contact	Supervisor, Pharmacy Network Support		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	02/12/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Pharmacy Network Management Contact (Secondary)	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services		Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct .		San Diego	CA	92131	11/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active	8774036038				PPO - BBA		C	San Francisco
H5140	Pharmacy Technical Help Desk Contact (Secondary)	Dir-Pharmacy Prgm, Clinical Therapeutics	Mr.	Weideman	Stacy							stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active	6028644391				PPO - BBA		C	San Francisco
H5140	Plan Directory Contact for Public Website			Services	Member		4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Plan to Plan Reconciliation Contact	Director, Financial Reporting		Acquafredda	Brandy		6028644683				6028645308	brandy.acquafredda@azblue.com	PO Box 81049		Phoenix	AZ	85069	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Processor Contact			Scherlippens	Carine		8587907415					MedicarePartDProjectManagers@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	02/12/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Quality Contact	VP Medicare Performance		Cash	Gerri		6028644668					gerrilin.cash@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/21/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Reconciliation Contact	Mgr- Medicare Finance		Nguyen	Peter		6024272128					peter.nguyen@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	02/26/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Reconciliation Contact (Secondary)	Director, Financial Reporting		Acquafredda	Brandy		6028644683					brandy.acquafredda@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	02/26/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Recovery Audit Contact	Director, Corporate and Medicare Compliance	Ms.	Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Surveillance Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	System Contact	Informatn Security Svcs- Lead	Ms.	O'Brien	Debi		6029167939					debi.o'brien@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Third Party Administrator (TPA) Liaison	Finacial Analyst/Accountant	Mr.	Westphal	Robert		6029168503					robert.westphal@azblue.com	8220 N 23rd Ave.		Phoenix	AZ	85021	08/07/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	User Access Contact	Informatn Security Svcs- Lead	Ms.	O'Brien	Debi		6029167939					debi.o'brien@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Utilization Management Contact	Mgr- Utilization Management		Guddendorf	Kelly		6028644358					kelly.guddendorf@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5140	Utilization Review Contact	Mgr- Utilization Management		Guddendorf	Kelly		6028644358					kelly.guddendorf@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona (AZ Blue)	Local PPO		Blue Cross Blue Shield of Arizona	447	Yes	Active					PPO - BBA		C	San Francisco
H5141	Agent/Broker Compensation Data Contact	Telesales Director	Mr.	Gorman	Scott		7576399577					scott.gorman@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	05/31/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Automated TrOOP Balance Transfer Contact	Finance Manager		Harte	Declan		2533067269					declan.harte@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	04/07/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Backup User Access Contact	Compliance Sr. Associate	Mrs.	Terrell	Linda		6153970882				2012554173	linda.terrell@cloverhealth.com	3401 Mallory Lane  Ste 210		Franklin	TN	37067	01/04/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Best Available Evidence Contact	Enrollment Dir	Ms	Newman	Jennifer		7542456377					jennifer.newman@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	07/18/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Bid Audit Contact	Chief Actuary	Ms.	Wang	Julie		6306702853				2012554173	julie.wang@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	05/31/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Bid Audit Site Contact	Chief Actuary	Ms.	Wang	Julie		6306702853				2012554173	julie.wang@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	05/31/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Bid Primary Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@Cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	CAP Report Contact for Public Website	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	Wendy.Richey@cloverhealth.com	3401 Mallory Lane ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Toy	Andrew		6463183182				2012554173	andrew.toy@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	01/04/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Toy	Andrew		6463183180				2012554173	andrew.toy@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	01/04/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Chief Financial Officer	CFO	Mr.	Leffler	Scott		4406543104				2012554173	scott.leffler@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	01/11/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Chief Operating Officer	Chief Operating Officer	Ms.	Reynoso	Jamie		2014322133					jamie.reynoso@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	08/24/2020	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Chief Information Officer	CEO	Mr.	Toy	Andrew		6463183182					andrew.toy@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	01/04/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Chief Information Security Officer	Chief Security Officer	Mr.	Ross	Christophe		4257378141					christopher.ross@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	01/11/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	CMMI Model Point of Contact	CCO	Mrs.	Richey	Wendy		5512252014					wendy.richey@Cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	CMS Casework Communication Contact	Compliance Director	Mr.	Davis	Robert		2013200506					robert.davis@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	11/06/2019	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Complaints Tracking Contact	Sr Compliance Director	Mr.	Davis	Robert		2012554173					robert.davis@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/02/2020	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Contact for Fraud Investigations	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Coordination of Benefits Contact	Enrollment Director	Ms.	Newman	Jennifer		7542456377					jennifer.newman@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	07/18/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Corporate Mailing						2014322133				2018587355	wendy.richey@cloverhealth.com	Clover Health	30 Montgomery Street, 15th Floor	Jersey City	NJ	07302	11/18/2019	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant	Mr.	Bhatt	Mital		5513584582				2018587355	Mital.Bhatt@Cloverhealth.com	30 Montgomery  St	Suite 803	Jersey City	NJ	07302	11/18/2020	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Customer Service Operations Contact	Chief Operating Officer	Ms	Reynoso	Jamie		2014322133				2012554173	jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	03/22/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	DIR Contact	Manager	Ms	Bhatt	Mital		5513584582					mital.bhatt@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	03/02/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	DIR Contact (Secondary)	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/18/2017	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Electronic Health Record Contact	Chief Operating Officer	Ms	Reynoso	Jamie		2015322133					jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	03/22/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Emergency Part D Contact	VP of Pharmacy	Mr.	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	03/23/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Emergency Part D Contact (Secondary)	Pharmacy Operations Manager	Ms.	Zawadzki	Marta		5513490059				2019183179	Marta.Zawadzki@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/21/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Employer Waiver Contact	CCO	Mrs.	Richey	Wendy		5512252014					wendy.richey@Cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Encounter Data & Risk Adjustment Operations Contact	COO	Ms.	Reynoso	Jamie		2014322133					jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	03/23/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Enrollment Contact	Enrollment Director	Ms	Newman	Jennifer		7542456377					jennifer.newman@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	07/18/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	EOB Transfer Contact	COO	Ms	Reynoso	Jamie		2014322133				2018587355	jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	03/22/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Financial Audit Contact	CFO	Mr.	Leffler	Scott		4406543104				2012554173	scott.leffler@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	01/05/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Financial Reporting Contact	CFO	Mr.	Leffler	Scott		4406543104				2012554173	scott.leffler@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	01/05/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Formulary Contact	VP of Pharmacy	Mr.	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	07/18/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Formulary Contact (Secondary)	Pharmacy Operations Manager	Ms.	Zawadzki	Marta		5513490059				2019183179	Marta.Zawadzki@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/21/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	General Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Government Relations Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	HIPAA Privacy Officer	Privacy Officer	Ms.	Smith	Stephanie		7246104449					stephanie.smith@cloverhealth.com	30 Montgomery Street. ,15th floor		Jersey City	NJ	07302	05/31/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	HIPAA Security Officer	Security Officer	Mr.	Ross	Christophe		4257378141					christopher.ross@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	05/31/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Hospice Contact	COO	Ms	Reynoso	Jamie		2014322133				2018587355	jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	03/22/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Interoperability Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014					wendy.richey@cloverhealth.com	3401 Mallory Lane  Ste 210		Franklin	TN	37067	06/03/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	MA Appeals/Grievances Contact	COO	Ms.	Reynoso	Jamie		2014322133				2018587355	jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	03/23/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	MA Claims Processing Contact for Public Website	Chief Information Officer	Mr.	Zumbum	Paul		2022156080					paul.zumbum@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	05/31/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Marketing Contact	Sr. Compliance Director	Mr.	Davis	Robert		2012554173				2012554171	robert.davis@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	03/23/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Medical Director	Chief Medical Officer / Medical Director	Dr.	Spektor	Mark		2014322133					mark.spektor@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	03/23/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Medicare Compliance Officer	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Medicare Coordinator	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Medicare Part D Opioid Overutilization Contact	Manager of Pharmacy Programs	Ms.	Zawadzki	Marta		5513490059				8665090944	Marta.Zawadzki@cloverhealth.com	30 Montgomery St	15th Floor	Jersery City	NJ	07302	09/21/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Medication Therapy Management Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/18/2017	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	OffShore Subcontractor Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	11/06/2019	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Online Enrollment Center Contact (Back-up)	Telesales Director	Mr.	Gorman	Scott		7576399577					scott.gorman@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	05/31/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Online Enrollment Center Contact (Primary)	Enrollment Director	Ms	Newman	Jennifer		7542456377					jennifer.newman@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	07/18/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Part C Application Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	11/06/2019	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Part C Reporting Contact	Chief Compliance Officer	Mrs	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	01/27/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Part D Appeals	VP Pharmacy	Mr	Pica	Mike							mike.pica@Cloverhealth.com	30 Montgomery Street 15th Floor		Jersery City	NJ	07302	01/27/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active	2014322133				PPO - BBA		C	New York
H5141	Part D Appeals Contact (Secondary)	Pharmacy Manager	Ms.	Zawadzki	Marta						2019183179	Marta.Zawadzki@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/21/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active	5513490059				PPO - BBA		C	New York
H5141	Part D Application Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/18/2017	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Part D Benefits Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/18/2017	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Part D Claims Submission Contact	VP Pharmacy	Mr.	Pica	Mike		8887781478				2014322133	mike.pica@cloverhealth.com	30 Montgomery  St	MC080	Jersey City	NJ	07302	01/28/2020	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Part D Exceptions Contact	VP of Pharmacy	Mr	Pica	Michael						2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/18/2017	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active	2014322133				PPO - BBA		C	New York
H5141	Part D Exceptions Contact (Secondary)	Pharmacy Operations Manager	Ms	Zawadzki	Marta						2019183179	Marta.Zawadzki@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/21/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active	5513490059				PPO - BBA		C	New York
H5141	Part D Price File Contact (Back-up)	Pharmacy manager	Ms	Zawadzki	Marta		5512674583					Marta.Zawadzki@cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/21/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Part D Price File Contact (Optional)	Pharmacy Manager	Ms	Zawadzki	Marta		5513490059					Marta.Zawadzki@cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/21/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Part D Price File Contact (Primary)	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/18/2017	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Part D Quality Assurance Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/18/2017	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Part D Reporting Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	02/12/2020	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Patient Safety Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/18/2017	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Payment Contact	Finance Director	Mr.	Evans	Jimea		4043124432					jimea.evans@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	07/18/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Personal Health Record Contact	CEO	Mr	Toy	Andrew		6463183182					andrew.toy@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	01/27/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Pharmacy Director	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/18/2017	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Pharmacy Network Management Contact	SV Pharmacy	Mr	Pica	Mike		2014322133				4803146023	mike.pica@Cloverhealth.com	30 Montgomery  St	MC080	Jersey City	NJ	07302	01/27/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Pharmacy Network Management Contact (Secondary)	Pharmacy manager	Ms	Zawadzki	Marta		5513490059					Marta.Zawadzki@cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/21/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Pharmacy Technical Help Desk Contact	VP of Pharmacy	Mr	Pica	Michael							mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	06/21/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active	8666934620				PPO - BBA		C	New York
H5141	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy manager	Ms	Zawadzki	Marta							Marta.Zawadzki@cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/21/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active	5513490059				PPO - BBA		C	New York
H5141	PHR Beneficiary Contact																	01/20/2016	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO	Clover Health	Clover Health Holdings, Inc.	491	Yes	Active	8886571207				PPO - BBA		C	New York
H5141	Physician Incentive Contact	President & CEO	Mr.	Toy	Andrew		6463183182					andrew.toy@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	01/04/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Plan Directory Contact for Public Website	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	11/06/2019	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Plan to Plan Reconciliation Contact	Accounting Manager	Mr	Bhatt	Mitah		5513584582					mitah.bhatt@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	01/27/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Processor Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	02/12/2020	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Quality Contact	COO	Ms	Reynoso	Jamie		2014322133				2018587355	jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	03/22/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Reconciliation Contact	VP, Controller	Ms.	Wei	Wei		7182497136					wei.wei@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	07/18/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Reconciliation Contact (Secondary)	CFO	Mr.	Leffler	Scott		6308629384				2012554173	scott.leffler@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	01/04/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Recovery Audit Contact	VP Controller	Ms.	Wei	Wei		7182497136				2012554173	wei.wei@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	07/14/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	SNP Application Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	SNP State Contact	SVP, Deputy, General Counsel	Ms.	Sores	Karen		2059087838					karen.sores@cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	07/14/2023	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Surveillance Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	System Contact	Chief Information Officer	Mr.	Zumbum	Paul		2022156080					pau;.zumbum@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	05/31/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Third Party Administrator (TPA) Liaison	Sr. Accountant	Mr.	Bhatt	Mital		5513584582				2018587355	Mital.Bhatt@Cloverhealth.com	30 Montgomery  St	Suite 803	Jersey City	NJ	07302	11/18/2020	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	User Access Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	10/28/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Utilization Management Contact	COO	Ms	Reynoso	Jamie		2010432213					jamie.reynoso@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	05/31/2022	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5141	Utilization Review Contact	COO	Ms	Reynoso	Jamie		2014322133					jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	03/22/2021	2023	CLOVER INSURANCE COMPANY	Local CCP	Clover Health	Local PPO		Clover Health Holdings, Inc.	491	Yes	Active					PPO - BBA		C	New York
H5167	Automated TrOOP Balance Transfer Contact	HIMS Manager	Mr.	Madwell	Jason		7194668777	657			7192140149	jmadwell@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Backup User Access Contact	Director of Information Technology	Mr.	Watson	Matt		7194668777	647				mwatson@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Best Available Evidence Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7194730628	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Bid Primary Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643				pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	CAP Report Contact for Public Website	VP PACE	Ms.	McDonough	Andi		7194668777	335				amcdonough@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	07/10/2020	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Olson	Nate		7194668777	625				nolson@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Olson	Nate		7194668777	625				nolson@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Chief Financial Officer	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193148912	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Chief Operating Officer	Chief Operating Officer	Mr.	Hartman	Mark		7194668777	687				mhartman@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Chief Information Officer	Director of Information Technology	Mr.	Watson	Matt		7194668777	647			7194730628	mwatson@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Chief Information Security Officer	Director of Information Technology	Mr.	Watson	Matt		7194668777	647			7194730628	mwatson@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	CMS Casework Communication Contact	VP Quality and Compliance	Ms.	Schlarb	Jacqueline		7194668777	685				jschlarb@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Complaints Tracking Contact	VP Quality and Compliance	Ms.	Schlarb	Jacqueline		7194668777	685				jschlarb@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Contact for Fraud Investigations	VP Quality and Compliance	Ms.	Schlarb	Jacqueline		7194668777	685				jschlarb@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Coordination of Benefits Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Corporate Mailing						7194668777	625			7194730628	nolson@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Customer Service Operations Contact	Vice President of PACE	Ms.	McDonough	Andi		7194668777	335				amcdonough@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	01/06/2021	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	DIR Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193170149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	DIR Contact (Secondary)	Controller	Ms.	Oliverius	Audrey		7194668777	392			7193140149	aoliverius@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Emergency Part D Contact	CFO	Mr	Masar	Paul		7194668777	643				pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Emergency Part D Contact (Secondary)	VP of Nursing	Ms.	VanMaldeghem	Santiana		7193142327					svanmaldehem@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	08/03/2022	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Encounter Data & Risk Adjustment Operations Contact	HIMS Manager	Mr.	Madwell	Jason		7194668777	640				jmadwell@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Enrollment Contact	Senior Revenue Analyst	Ms.	Madigan	Tracy		7194668777	640				tmadigan@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	EOB Transfer Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Financial Audit Contact	Chief Financial Officer	Mr.	Masar	Paul		7193142327	643			7193140149	pmasar@rmhcare.org	8595 Explorer Drive		Colorado Springs	CO	80920	08/09/2022	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Financial Reporting Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Formulary Contact	Chief Medical Officer	Dr.	McDowell	Amy		7194668777	302			7194730628	amcdowell@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Formulary Contact (Secondary)	Controller	Ms.	Oliverius	Audrey		7194668777	392				aoliverius@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	General Contact	Vice President of PACE	Ms.	McDonough	Andi		7194668777	335				amcdonough@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	01/06/2021	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Government Relations Contact	Chief Executive Officer	Mr.	Olson	Nate		7194668777	625				nolson@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	HIPAA Privacy Officer	VP Quality and Compliance	Ms.	Schlarb	Jacqueline		7194668777	685				jschlarb@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	HIPAA Security Officer	Director of Information Technology	Mr.	Watson	Matt		7194668777	647				mwatson@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Interoperability Contact	HIM Manager	Mr.	Madwell	Jason		7194668777	657				jmadwell@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	MA Appeals/Grievances Contact	VP Quality and Compliance	Ms.	Schlarb	Jacqueline		7194668777	685				jschlarb@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Marketing Contact	Director of Marketing & Community Engagement	Ms.	Galceran	Summer	N	7194668777	444				sgalceran@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Medical Director	CMO	Dr.	McDowell	Amy		7194668777	266				amcdowell@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Medicare Compliance Officer	VP Quality and Compliance	Ms.	Schlarb	Jacqueline		7194668777	685				jschlarb@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Medicare Coordinator	VP PACE	Ms.	McDonough	Andi		7193142327	335				amcdonough@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	08/03/2022	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Medicare Part D Opioid Overutilization Contact	Chief Medical Officer	Dr.	McDowell	Amy		7194668777	266				amcdowell@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Medication Therapy Management Contact	Chief Medical Officer	Dr.	McDowell	Amy		7194668777	266				amcdowell@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Online Enrollment Center Contact (Back-up)	Chief Operating Officer	Mr.	Hartman	Mark		7194668777	687				mhartman@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Online Enrollment Center Contact (Primary)	Director of Marketing & Community Engagement	Ms.	Galceran	Summer		7194668777	444				sgalceran@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Part C Application Contact	Director of Marketing & Community Engagement	Ms.	Galceran	Summer		7194668777	444				sgalceran@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Part D Appeals	VP Quality and Compliance	Ms.	Schlarb	Jacqueline							jschlarb@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active	7194668777	685			PACE - Nat		C	Dallas
H5167	Part D Appeals Contact (Secondary)	Compliance Manager	Ms.	Hardson	Kandace							khardson@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active	7194668777	827			PACE - Nat		C	Dallas
H5167	Part D Application Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Part D Benefits Contact	VP of Nursing	Ms.	VanMaldeghem	Santiana		7193142327					svanmaldeghem@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	08/03/2022	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Part D Claims Submission Contact	Chief Financial officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Part D Exceptions Contact	Chief Financial Officer	Mr.	Masar	Paul						7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active	7194668777	643			PACE - Nat		C	Dallas
H5167	Part D Exceptions Contact (Secondary)	Vice President of PACE	Ms.	McDonough	Andi						7194730628	amcdonough@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	01/06/2021	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active	8665038916	335			PACE - Nat		C	Dallas
H5167	Part D Price File Contact (Back-up)	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Part D Price File Contact (Optional)	Vice President of PACE	Ms.	McDonough	Andi		7194668777	335			7194730628	amcdonough@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	01/06/2021	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Part D Price File Contact (Primary)	Chief Medical Officer	Dr.	McDowell	Amy		7194668777	266				amcdowell@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Part D Quality Assurance Contact	VP Quality and Compliance	Ms.	Schlarb	Jacqueline		7194668777	685				jschlarb@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Part D Reporting Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Patient Safety Contact	VP Nursing	Ms.	VanMaldeghem	Santiana		7193142327					svanmaldeghem@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	08/03/2022	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Payment Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7194730628	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Personal Health Record Contact	HIM Manager	Mr.	Madwell	Jason		7194668777	657				jmadwell@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Pharmacy Director	Chief Medical Officer	Dr.	McDowell	Amy		7194668777	266				amcdowell@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Pharmacy Network Management Contact	VP of Nursing	Ms.	VanMaldeghem	Santiana		7194668777				7194730628	svanmaldeghem@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	05/31/2022	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Pharmacy Network Management Contact (Secondary)	Vice President of PACE	Ms.	McDonough	Andi		7194668777	335				amcdonough@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	01/06/2021	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Pharmacy Technical Help Desk Contact	VP of Nursing	Ms.	VanMaldeghem	Santiana						7194730628	svanmaldeghem@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	05/31/2022	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active	7194668777				PACE - Nat		C	Dallas
H5167	Pharmacy Technical Help Desk Contact (Secondary)	Vice President of PACE	Ms.	McDonough	Andi						7194730628	amcdonough@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	01/06/2021	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active	8665038916	335			PACE - Nat		C	Dallas
H5167	PHR Beneficiary Contact																	03/13/2017	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE	Rocky Mountain Health Care Services	Rocky Mountain Health Care Services	359	Yes	Active	8665038916				PACE - Nat		C	Dallas
H5167	Plan Directory Contact for Public Website	Director of Marketing & Community Engagement	Ms.	Galceran	Summer	N	7194668777	444				sgalceran@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Processor Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Quality Contact	VP Quality and Compliance	Ms.	Schlarb	Jacqueline		7194668777	685				jschlarb@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Reconciliation Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193140149	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Reconciliation Contact (Secondary)	Controller	Ms.	Oliverius	Audrey		7194668777	392				aoliverius@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Recovery Audit Contact	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643				pmaser@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Surveillance Contact	Director of Marketing & Community Engagement	Ms.	Galceran	Summer		7194668777	444				sgalceran@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	System Contact	VP Quality and Compliance	Ms.	Schlarb	Jacqueline		7194668777	685				jschlarb@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mr.	Masar	Paul		7194668777	643			7193148912	pmasar@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	User Access Contact	VP Quality and Compliance	Ms.	Schlarb	Jacqueline		7194668777	685				jschlarb@rmhcare.org	8595 Explorer Dr		Colorado Springs	CO	80920	04/17/2023	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Utilization Management Contact	VP Nursing	Ms.	VanMaldeghem	Santiana		7194668777				7194730628	svanmaldeghem@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	05/24/2022	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5167	Utilization Review Contact	VP Nursing	Ms.	VanMaldeghem	Santiana		7194668777				7194730628	svanmaldehem@rmhcare.org	2502 E. Pikes Peak Ave., Suite 100		Colorado Springs	CO	80909	05/24/2022	2023	ROCKY MOUNTAIN HEALTH CARE SERVICES	National PACE	Rocky Mountain PACE	National PACE		Rocky Mountain Health Care Services	359	Yes	Active					PACE - Nat		C	Dallas
H5178	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H5178	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H5178	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5178	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5190	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H5190	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/28/2018	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Medical Director	Chief Medical Director	Mr	Martorana	Jeff		9548391530	22182				jmartorana@centene.com	1301 International Parkway	Suite 400	Sunrise	FL	33323	03/30/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H5190	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H5190	PHR Beneficiary Contact																	09/27/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8779358022				HMO - Health Maintenance Organization		C	Dallas
H5190	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Plan Directory Contact for Public Website			Services	Provider		8667960530					CorporateMedicareComplianceDept@Centene.com	1301 International Parkway,	Suite 400	Sunrise	FL	33323	03/31/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5190	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUNSHINE STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5199	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/24/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H5199	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H5199	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H5199	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H5199	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H5199	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H5199	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H5199	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5199	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF ARIZONA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5209	Agent/Broker Compensation Data Contact	Chief Operating Officer	Ms.	Van Heesch	Betsy		4142877611					Betsy.VanHeesch@mychoicefamilycare.org	10201 West Innovation Drive, Suite 100		Wauwatosa	WI	53226	11/09/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Automated TrOOP Balance Transfer Contact	A/R and Enrollment Manager	Ms.	Anton	Jean		6082453084				6082453895	antonj@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Backup User Access Contact	Director of Regulatory Affairs	Ms.	Fahey	Emily		6082453573				6082468428	Emily.Fahey@mychoicewi.org	1617 Sherman Ave		Madison	WI	53704	04/25/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Best Available Evidence Contact	A/R and Enrollment Manager	Ms.	Anton	Jean		6082453084				6082453895	antonj@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Bid Audit Contact	Controller	Mr.	Heidenreich	Neil		6082453021					heidenreichn@carewisc.org	1617 Sherman Ave.		Madison	WI	53704	08/31/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Bid Audit Site Contact	Controller	Mr.	Heidenreich	Neil		6082453021					heidenreichn@carewisc.org	1617 Sherman Ave.		Madison	WI	53704	08/31/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Bid Primary Contact	Director of Regulatory and Compliance	Ms.	Fahey	Emily		6082453573					Emily.Fahey@mychoicewi.org	1617 Sherman Ave		Madison	WI	53704	01/13/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	CAP Report Contact for Public Website	Chief Compliance Officer	Mr.	Collins	Kevin		4142877612					Kevin.Collins@mychoicefamilycare.org	10201 West Innovation Dr., Suite 100		Wauwatosa	WI	53226	11/19/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	CEO - CMS Administrator Contact	General Counsel & Chief Compliance Officer	Mr.	Collins	Kevin		4142877612					Kevin.Collins@mychoicewi.org	10201 West Innovation Drive, Suite 100		Wauwatosa	WI	53226	12/27/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Ledger	Maria		4142877610					Maria.Ledger@mychoicefamilycare.org	10201 West Innovation Drive, Suite 100		Wauwatosa	WI	53226	11/09/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Chief Financial Officer	Chief Financial Officer	Mr.	Hodson	James		4142877613					james.hodson@mychoicefamilycare.org	10201 Innovation Dr., Suite 100		Wauwatosa	WI	53226	01/06/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Chief Operating Officer	Chief Operating Officer	Ms.	Van Heesch	Betsy		4142877611					Betsy.VanHeesch@mychoicefamilycare.org	10201 West Innovation Drive, Suite 100		Wauwatosa	WI	53226	01/02/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Chief Information Officer	Chief Information Officer	Mr.	Beauchene	Brion		4142877658					Brion. Beauchene@mychoicefamilycare.org	10201 W. Innovation Dr., Suite 100		Wauwatosa	WI	53226	03/03/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Chief Information Security Officer	Chief Information Officer	Mr.	Beauchene	Brion		4142877658					Brion. Beauchene@mychoicefamilycare.org	10201 W. Innovation Dr., Suite 100		Wauwatosa	WI	53226	03/03/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	CMS Casework Communication Contact	Member Rights Manager	Ms.	Lord	Carmen		6082453448				6082453366	lordc@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Complaints Tracking Contact	Member Rights Manager	Ms.	Lord	Carmen		6082453448				6082453366	lordc@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Contact for Fraud Investigations	Compliance Manager	Ms.	Awuor	Rose		6082453353				6082468428	awuorr@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	09/29/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Coordination of Benefits Contact	Claims Services Manager	Ms.	Roever	Deb		6082453804				6082453340	roeverd@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	10/15/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Corporate Mailing						6082400020				6082468428	info@mychoicewi.org	10201 West Innovation Drive	Suite 100	Wauwatosa	WI	53226	01/11/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Coverage Gap Discount Program (CGDP) Payment Contact	A/R and Enrollment Manager	Ms.	Anton	Jean		6082453084				6082453895	antonj@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Customer Service Operations Contact	Customer Service Manager	Ms.	Fritz	Wendy		6082453476				6082468428	fritzw@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	DIR Contact	A/R and Enrollment Manager	Ms.	Anton	Jean		6082453084				6082453895	antonj@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	DIR Contact (Secondary)	Financial Analyst		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Avenue, NW		North Canton	OH	44720	06/30/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Electronic Health Record Contact	Director, IT Business Services	Mr.	Schiefelbein	Tony		6082453402				6082453899	schiefelbeint@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	11/09/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Emergency Part D Contact	Pharmacy Services Manager	Ms.	Kveberg	Jean		6082453037					jean.kveberg@mychoicewi.org	1617 Sherman Ave.		Madison	WI	53704	05/31/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Emergency Part D Contact (Secondary)	Pharmacy Services Manager	Ms.	Kveberg	Jean		6082453037				6082453096	Jean.Kveberg@mychoicewi.org	1617 Sherman Avenue		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Encounter Data & Risk Adjustment Operations Contact	Director, Decision Support	Ms.	Capadona	Katie		6082453808					katie.capadona@mychoicewi.org	1617 Sherman Ave.		Madison	WI	53704	03/04/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Enrollment Contact	A/R and Enrollment Manager	Ms.	Anton	Jean		6082453084				6082453895	antonj@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	EOB Transfer Contact	Pharmacy Services Manager	Ms.	Kveberg	Jean		6082453037				6082453096	Jean.Kveberg@mychoicewi.org	1617 Sherman Ave.		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Financial Audit Contact	Controller	Mr.	Heidenreich	Neil		6082453021					heidenreichn@carewisc.org	1617 Sherman Ave.		Madison	WI	53704	08/31/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Financial Reporting Contact	Controller	Mr.	Heidenreich	Neil		6082453021				6082453895	heidenreichn@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	04/26/2019	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Formulary Contact	Pharmacy Services Manager	Ms.	Kveberg	Jean		6082453037				6082453096	Jean.Kveberg@mychoicewi.org	1617 Sherman Avenue		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Formulary Contact (Secondary)	Director of Clinical Audits		Rossi	David		3304866311					drossi@elixirsolutions.com	7835 Freedom Avenue, NW		North Canton	OH	44720	06/30/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	General Contact	Director of Regulatory Affairs	Ms.	Fahey	Emily		6082453573				6082468428	Emily.Fahey@mychoicewi.org	1617 Sherman Ave		Madison	WI	53704	04/25/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Government Relations Contact	Regulatory Affairs Manager	Ms.	Gardener	Dana		6082453486				6082468428	gardenerd@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	08/27/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	HIPAA Privacy Officer	General Counsel	Mr.	Collins	Kevin		4142877612					Kevin.Collins@mychoicefamilycare.org	10201 West Innovation Drive	Suite 100	Wauwatosa	WI	53226	11/19/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	HIPAA Security Officer	Director of Information Technology	Mr.	Beauchene	Brion		4142877658					Brion. Beauchene@mychoicefamilycare.org	10201 W. Innovation Dr., Suite 100		Wauwatosa	WI	53226	11/09/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Hospice Contact	Pharmacy Services Manager	Ms.	Holmes	Lani		6082453483				6082453096	Lani.Holmes@mychoicewi.org	1617 Sherman Ave.		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Interoperability Contact	Chief Information Officer	Mr.	Beauchene	Brion		4142877658					Brion.Beauchene@mychoicefamilycare.org	10201 W. Innovation Dr., Suite 100		Wauwatosa	WI	53226	11/10/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	MA Appeals/Grievances Contact	Member Rights Manager	Ms.	Lord	Carmen		6082453448				6082453366	lordc@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	12/14/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	MA Claims Processing Contact for Public Website	Claims Services Manager	Ms.	Roever	Deb		6082453804				6082453340	roeverd@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	10/15/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Marketing Contact	Chief Operating Officer	Ms.	Van Heesch	Betsy		8009630035					Betsy.VanHeesch@mychoicefamilycare.org	10201 West Innovation Drive	Suite 100	Wauwatosa	WI	53226	08/27/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Medical Director	Director of Clinical Resources and Supports		Eilbes	Melissa		4142877728					melissa.eilbes@mychoicewi.org	10201 West Innovation Drive, Suite 100		Wauwatosa	WI	53226	06/29/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Medicare Compliance Officer	Compliance Manager	Ms.	Awuor	Rose		6082453353					rose.awuor@mychoicewi.org	1617 Sherman Ave		Madison	WI	53704	09/15/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Medicare Coordinator	Regulatory Affairs Manager	Ms.	Gardener	Dana		6082453486				6082468428	gardenerd@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	08/27/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Medicare Part D Opioid Overutilization Contact	Pharmacy Services Manager	Ms.	Kveberg	Jean		6082453037				6082453096	Jean.Kveberg@mychoicewi.org	1617 Sherman Avenue		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Medication Therapy Management Contact	Director of Clinical Programs		Poore	Richard		6036285133					rpoore@healthdialog.com	7835 Freedom Avenue, NW		North Canton	OH	44720	06/30/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	OffShore Subcontractor Contact	Director of Regulatory Affairs	Ms.	Fahey	Emily		6082453573					emily.fahey@mychoicewi.org	1617 Sherman Avenue		Madison	WI	53704	11/02/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Online Enrollment Center Contact (Back-up)	Enrollment Reporting Specialist	Ms.	Wells	Linda		6082453025					wellsl@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	10/15/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Online Enrollment Center Contact (Primary)	A/R and Enrollment Manager	Ms.	Anton	Jean		6082453084				6082453895	antonj@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Part C Application Contact	Regulatory Affairs Manager	Ms.	Gardener	Dana		6082453486				6082468428	gardenerd@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	08/27/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Part C Reporting Contact	Director of Regulatory Affairs	Ms.	Fahey	Emily		6082453573				6082468428	Emily.Fahey@mychoicewi.org	1617 Sherman Ave		Madison	WI	53704	04/25/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Part D Appeals	Supervisor Clinical Operations		Herald	Samantha						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue, NW		North Canton	OH	44720	06/30/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active	3303449574	0409			HMO - Health Maintenance Organization		C	New York
H5209	Part D Appeals Contact (Secondary)	Pharmacy Services Manager	Ms.	Kveberg	Jean							jean.kveberg@mychoicewi.org	1617 Sherman Ave		Madison	WI	53704	05/31/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active	8009630035				HMO - Health Maintenance Organization		C	New York
H5209	Part D Application Contact	Regulatory Affairs	Ms.	Gardener	Dana		6082453486				6082468428	gardenerd@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	08/27/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Part D Benefits Contact	Pharmacy Services Manager	Ms.	Kveberg	Jean		6082453037					Jean.Kveberg@mychoicewi.org	1617 Sherman Ave.		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Part D Claims Submission Contact	Senior Account Manager		Montgomery	Nakisha		3308886976					nmontomery@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/30/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Part D Exceptions Contact	Pharmacy Services Manager	Ms.	Kveberg	Jean						6082453096	Jean.Kveberg@mychoicewi.org	1617 Sherman Avenue		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active	8009630035	3037			HMO - Health Maintenance Organization		C	New York
H5209	Part D Exceptions Contact (Secondary)	Pharmacy Services Manager	Ms.	Holmes	Lani						6082453096	Lani.Holmes@mychoicewi.org	1617 Sherman Avenue		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active	8009630035	3483			HMO - Health Maintenance Organization		C	New York
H5209	Part D Price File Contact (Back-up)	Director of Reporting and Analytics		Cambell	Tim		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Avenue, NW		North Canton	OH	44720	06/30/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Part D Price File Contact (Optional)	Pharmacy Services Manager	Ms.	Kveberg	Jean		6082453037					Jean.Kveberg@mychoicewi.org	1617 Sherman Ave.		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Part D Price File Contact (Primary)	Financial Analyst III	Mr.	Wentz	Chris		3308886988					cwentz@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/30/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Part D Quality Assurance Contact	Pharmacy Services Manager	Ms.	Kveberg	Jean		6082453037					Jean.Kveberg@mychoicewi.org	1617 Sherman Avenue		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Part D Reporting Contact	Pharmacy Services Manager	Ms.	Kveberg	Jean		6082453037				6082453096	Jean.Kveberg@mychoicewi.org	1617 Sherman Avenue		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Patient Safety Contact	Pharmacy Services Manager	Ms.	Kveberg	Jean		6082453037				6082453096	Jean.Kveberg@mychoicewi.org	1617 Sherman Avenue		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Payment Contact	A/R & Enrollment Manager	Ms.	Anton	Jean		6082453084				6082453895	antonj@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Pharmacy Director		Ms.	Kveberg	Jean		6082453037					jean.kveberg@mychoicewi.org	1617 Sherman Ave.		Madison	WI	53704	05/31/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Pharmacy Network Management Contact	Director Pharmacy Network Contracting		Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	7835 Freedom Avenue, NW		North Canton	OH	44720	06/30/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Pharmacy Network Management Contact (Secondary)	Pharmacy Services Manager	Ms.	Kveberg	Jean		6082453037					jean.kveberg@mychoicewi.org	1617 Sherman Ave.		Madison	WI	53704	05/31/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Pharmacy Technical Help Desk Contact	VP Operations		Conn	Todd							tconn@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/30/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active	8445506814				HMO - Health Maintenance Organization		C	New York
H5209	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Services Manager	Ms.	Kveberg	Jean							Jean.Kveberg@mychoicewi.org	1617 Sherman Ave.		Madison	WI	53704	06/24/2022	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active	6082453037				HMO - Health Maintenance Organization		C	New York
H5209	Physician Incentive Contact	Director of Provider Services	Ms.	Pagliaro	Nicole		4142877436					Nicole.Pagliaro@mychoicefamilycare.org	10201 W. Innovation Dr., Suite 100		Wauwatosa	WI	53226	11/09/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Plan Directory Contact for Public Website			Service	Customer		8009630035					info@mychoicewi.org	1617 Sherman Ave.		Madison	WI	53704	01/08/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Plan to Plan Reconciliation Contact	A/R & Enrollment Manager	Ms.	Anton	Jean		6082453084				6082453895	antonj@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Processor Contact	Claims Services Manager	Ms.	Roever	Deb		6082453804				6082453340	roeverd@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	10/15/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Quality Contact	Director of Quality	Ms.	Way-Messer	Sarah		6082453064				6082453366	ways@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	10/15/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Reconciliation Contact	A/R & Enrollment Manager	Ms.	Anton	Jean		6082453084				6082453895	antonj@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	03/02/2018	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Reconciliation Contact (Secondary)	Sr. Director Rebates, Trade Relations	Mr.	Bonus	Jason		3304864841				3304864801	jbonus@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/30/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Recovery Audit Contact	Chief Financial Officer	Mr.	Hodson	James		8009630035				6082468428	James.Hodson@mychoicefamilycare.org	10201 West Innovation Drive	Suite 100	Wauwatosa	WI	53226	08/27/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	SNP Application Contact	Regulatory Affairs Manager	Ms.	Gardener	Dana		6082453486				6082468428	gardenerd@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	09/29/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	SNP State Contact	Regulatory Affairs Manager	Ms.	Gardener	Dana		6082453486				6082468428	gardenerd@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	06/22/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Surveillance Contact	Chief Operating Officer	Ms.	Van Heesch	Betsy		8009630035				6082468428	Betsy.VanHeesch@mychoicefamilycare.org	10201 West Innovation Drive	Suite 100	Wauwatosa	WI	53226	08/27/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	System Contact	Director of Information Technology	Mr.	Beauchene	Brion		4142877658					Brion. Beauchene@mychoicefamilycare.org	10201 W. Innovation Dr., Suite 100		Wauwatosa	WI	53226	11/09/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Third Party Administrator (TPA) Liaison	Claims Services Manager	Ms.	Roever	Deb		6082453804					roeverd@carewisc.org	1617 Sherman Avenue		Madison	WI	53704	08/27/2020	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	User Access Contact	Chief Compliance Officer	Mr.	Collins	Kevin		4142877612					Kevin.Collins@mychoicefamilycare.org	10201 West Innovation Dr., Suite 100		Wauwatosa	WI	53226	11/19/2021	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Utilization Management Contact	Director of Clinical Resources and Supports	Ms.	Eilbes	Melissa		4142877728					melissa.eilbes@mychoicewi.org	10201 West Innovation Drive, Suite 100		Wauwatosa	WI	53226	05/31/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5209	Utilization Review Contact	Director of Clinical Resources and Supports	Ms.	Eilbes	Melissa		4142877728					melissa.eilbes@mychoicewi.org	10201 West Innovation Drive, Suite 100		Wauwatosa	WI	53226	05/31/2023	2023	My Choice Wisconsin Health Plan, Inc.	Local CCP	My Choice Wisconsin Health Plan	HMO/HMOPOS		My Choice Wisconsin, Inc.	400	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5211	Agent/Broker Compensation Data Contact	Chief Growth Officer		Shermo	Jennifer		7152219845				7152219500	shermo.jennifer@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	09/23/2021	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Automated TrOOP Balance Transfer Contact	Medicare Part D Coordinator		Hollatz	Lori		7152219814				7152219719	hollatz.lori@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	09/06/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Backup User Access Contact	Director of Product Development		Howey	Kristina		7152215406				7152219500	howey.kristina@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	08/19/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Best Available Evidence Contact	Enrollment Services Team Lead		Ronning	Amy		7152219590				7152219500	ronning.amy@securityhealth.org	1515 Saint Joseph  Avenue		Marshfield	WI	54449	05/17/2021	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Bid Audit Contact	Actuarial Services Manager		Naugle	Danielle		7152219692				7152219500	naugle.daniellel@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Bid Audit Site Contact	Actuarial Services Manager		Naugle	Danielle		7152219692				7152219500	naugle.daniellel@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Bid Primary Contact	Actuarial Services Manager		Naugle	Danielle		7152219692				7152219500	naugle.daniellel@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	CAP Report Contact for Public Website	Chief Legal and Compliance Officer		Boero	Lisa		7152217231				7152219500	shp.compliance.dept@securityhealth.org	1515 Saint Joseph  Avenue		Marshfield	WI	54449	01/14/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	CEO - CMS Administrator Contact	Chief Executive Officer	Mrs.	Hoglund	Krista		7152075308				7152219500	shpceo@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	12/13/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	CEO - Senior Official for Contracting	Chief Legal and Compliance Officer	Mrs.	Boero	Lisa		7152217231				7152219500	shp.compliance.dept@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	01/14/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Chief Financial Officer	Vice President of Finance	Mr.	Buel	Chris		7152219555				7152219500	buel.chris@securityhealth.org	1001 North Oak Avenue		Marshfield	WI	54449	11/08/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Chief Operating Officer	Chief Operating Officer	Mr	Nyman	David		7152219624				7152219500	nyman.david@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	07/06/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Chief Information Officer	Director of Information Systems	Mr.	Preston	Todd		7152218336				7152219500	preston.todd@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	09/06/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Chief Information Security Officer	Chief Information Security Officer, IS-Security	Mr.	Garneau	Greg		7152218892				7152219500	Garneau.Greg@marshfieldclinic.org	1000 N Oak Ave		Marshfield	WI	54449	06/21/2018	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	CMS Casework Communication Contact	Director of Compliance and Privacy		Wilson	Kelly		7152219960				7152219500	wilson.kelly@securityhealth.org	1515 Saint Joseph Ave.		Marshfield	WI	54449	11/08/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Complaints Tracking Contact	Director of Compliance and Privacy		Wilson	Kelly		7152219960				7152219500	wilson.kelly@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	02/14/2023	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Contact for Fraud Investigations	Chief Legal and Compliance Officer		Boero	Lisa		7152217231				7152219500	shp.compliance.dept@securityhealth.org	1515 Saint Joseph  Avenue		Marshfield	WI	544498000	01/14/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Coordination of Benefits Contact	Part D COB Specialist		Hollatz	Lori		7152219814				7152219500	hollatz.lori@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	07/20/2021	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Corporate Mailing						7152219897				7152219500	shpcsweb@securityhealth.org	1515 Saint Joseph Avenue	PO Box 8000	Marshfield	WI	54449	10/27/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant II		Staver	Jannel		7152219864				7152219500	staver.jannel@securityhealth.org	1515 Saint Joseph Avenue		Marshfied	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Customer Service Operations Contact	Director of Member Experience & Contact Center		Baur	Ken		8779980998				7152219500	baur.ken@securityhealth.org	1515  Saint Joseph Avenue		Marshfield	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	DIR Contact	Actuarial Services Manager		Naugle	Danielle		7152219692				7152219500	naugle.daniellel@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	02/19/2021	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	DIR Contact (Secondary)	Clinical Pharmacy Services Manager		Meverden	Marc		7152219920				7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	03/19/2018	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Emergency Part D Contact	Clinical Pharmacy Services Manager		Meverden	Marc		7156500864				7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Emergency Part D Contact (Secondary)	Pharmacy Services Director		Murphy	Eileen		7152219771				7152219719	murphy.eileen@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	06/22/2023	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Revenue Operations Specialist		Kolbeck	Patricia		7152219824				7152219500	kolbeck.patricia@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Enrollment Contact	Enrollment Team Lead		Zajackowski	Juliann		7152219925				7152219500	zajackowski.juliann@securityhealth.org	1515 Saint Joseph  Avenue		Marshfield	WI	54449	03/02/2020	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	EOB Transfer Contact	Medicare Part D Coordinator		Hollatz	Lori		7152219814				7152219719	hollatz.lori@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	09/06/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Financial Audit Contact	Director of Compliance and Privacy	Mrs.	Wilson	Kelly		7152219960				7152219500	shp.compliance.dept@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/08/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Financial Reporting Contact	Vice President of Finance		Buel	Chris		7152219555				7152219500	buel.chris@securityhealth.org	1515 Saint Joseph  Avenue		Marshfield	WI	54449	11/08/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Formulary Contact	Clinical Pharmacy Services Manager		Meverden	Marc		7152219920				7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Formulary Contact (Secondary)	Medicare Part D Coordinator		Hollatz	Lori		7152219814				7152219719	hollatz.lori@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	General Contact	Chief Growth Officer		Shermo	Jennifer		7152219845				7152219500	shermo.jennifer@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	08/18/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Government Relations Contact	Director of Product Development		Howey	Kristina		7152215406				7152219500	howey.kristina@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	08/19/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	HIPAA Privacy Officer	Chief Legal and Compliance Officer		Boero	Lisa		7152217231				7152219500	shp.compliance.dept@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	01/14/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	HIPAA Security Officer	Chief Legal and Compliance Officer		Boero	Lisa		7152217231				7152219500	shp.compliance.dept@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	01/14/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Hospice Contact	Interim PharmQuality Assurance-Auditing Specialist		Hollatz	Lori		7152219814				7152219500	hollatz.lori@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54440	01/14/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Interoperability Contact	Director of Information Systems		Preston	Todd		7152218336					preston.todd@securityhealth.org	1515 St Joseph Ave		Marshfield	WI	54449	02/08/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	MA Appeals/Grievances Contact	Director of Health Plan Quality		Jacobson	Paula		7152219644				7152219500	jacobson.paula@securityhealth.org	1515  Saint Joseph Avenue		Marshfield	WI	54449	02/17/2023	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	MA Claims Processing Contact for Public Website	Vice President of Operations		Foemmel	Sara		7152219950				7152219500	foemmel.sara@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	02/08/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Marketing Contact	Director of Marketing and Communications		Normington	Rebecca		7152219726				7152219500	normington.rebecca@securityhealth.org	1515 Saint Joseph  Avenue		Marshfield	WI	54449	02/08/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Medical Director	Interim Chief Clinical Officer		Davis	Mary		7152219131	36525			7152219500	davis.mary@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	05/17/2021	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Medicare Compliance Officer	Director of Compliance and Privacy	Mrs.	Wilson	Kelly		7152219960				7152219500	wilson.kelly@securityhealth.org	1515 Saint Joseph  Avenue		Marshfield	WI	54449	04/28/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Medicare Coordinator	Implementation Manager		Kean	Jeff		2088910185					kean.jeffrey@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	08/18/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Medicare Part D Opioid Overutilization Contact	Quality Assurance - Auditing Specialist		Byrne	Ronda		7152219781				7152219719	byrne.ronda@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	08/16/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Medication Therapy Management Contact	Clinical Pharmacy Services Manager		Meverden	Marc		7152219920				7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Online Enrollment Center Contact (Back-up)	Enrollment Team Leader		Zajackowski	Juliann		7152219925				7152219500	zajackowski.juliann@securityhealth.org	1515 Saint Joseph  Avenue		Marshfield	WI	54449	10/27/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Online Enrollment Center Contact (Primary)	Enrollment Services Team Lead		Ronning	Amy		7152219590				7152219500	ronning.amy@securityhealth.org	1515 Saint Joseph  Avenue		Marshfield	WI	54449	05/17/2021	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Part C Application Contact	Implementation Manager		Kean	Jeff		2088910185					kean.jeffrey@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	08/18/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Part C Reporting Contact	Implementation Manager		Kean	Jeff		2088910185					kean.jeffrey@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	08/18/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Part D Appeals	Clinical Pharmacy Services Manager		Meverden	Marc						7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active	8778735611				HMO - Health Maintenance Organization		C	Denver
H5211	Part D Appeals Contact (Secondary)	Medicare Part D Program Coordinator		Hollatz	Lori						7152219719	hollatz.lori@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active	8778735611				HMO - Health Maintenance Organization		C	Denver
H5211	Part D Application Contact	Implementation Manager		Kean	Jeff		2088910185					kean.jeffrey@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	08/18/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Part D Benefits Contact	Clinical Pharmacy Services Manager		Meverden	Marc		7152219920				7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Part D Claims Submission Contact	Clinical Pharmacy Services Manager	Mr.	Meverden	Marc		7152219920				7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Part D Exceptions Contact	Clinical Pharmacy Services Manager		Meverden	Marc						7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Ave.		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active	8778735611				HMO - Health Maintenance Organization		C	Denver
H5211	Part D Exceptions Contact (Secondary)	Medicare Part D Coordinator		Hollatz	Lori						7152219920	Hollatz.lori@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active	8778735611				HMO - Health Maintenance Organization		C	Denver
H5211	Part D Price File Contact (Back-up)	Clinical Pharmacy Services Manager		Meverden	Marc		7152219920				7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Part D Price File Contact (Optional)	Medicare Part D Coordinator		Hollatz	Lori		7152219814				7152219719	hollatz.lori@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Part D Price File Contact (Primary)	Medicare Part D Project Manager		Niemi	Kirstin		8587906455					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	09/13/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Part D Quality Assurance Contact	Clinical Pharmacy Services Manager		Meverden	Marc		7152219920				7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue	PO Box 8000	Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Part D Reporting Contact	Director of Product Development		Howey	Kristina		7152215406				7152219500	howey.kristina@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	08/19/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Patient Safety Contact	Clinical Pharmacy Services Manager		Meverden	Marc		7152219920				7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Payment Contact	Director of Finance and Accounting		Bell	Lacey		7152219160				7152219500	bell.lacey@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	02/04/2020	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Pharmacy Director	Pharmacy Services Director		Murphy	Eileen		7152219771				7152219719	murphy.eileen@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	06/22/2023	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Pharmacy Network Management Contact	Clinical Pharmacy Services Manager		Meverden	Marc		7152219920				7152219719	meverden.marc@securityhealth.orgorg	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Pharmacy Network Management Contact (Secondary)	Manager, PNS & Claims Operations		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Pharmacy Technical Help Desk Contact	Clinical Pharmacy Services Manager		Meverden	Marc						7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active	8778735611				HMO - Health Maintenance Organization		C	Denver
H5211	Pharmacy Technical Help Desk Contact (Secondary)	Director, Contact Center Services		Battle	Dorry							Customerservice@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active	8444011987				HMO - Health Maintenance Organization		C	Denver
H5211	Plan Directory Contact for Public Website	Director of Member Experience & Contact Center		Baur	Ken		7152219556				7152219500	baur.ken@securityhealth.org	1515  Saint Joseph Avenue		Marshfield	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Plan to Plan Reconciliation Contact	Director of Finance and Accounting		Bell	Lacey		7152219160				7152219500	bell.lacey@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	02/23/2023	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Processor Contact	Clinical Pharmacy Services Manager		Meverden	Marc		7152219920				7152219719	meverden.marc@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	11/06/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Quality Contact	Director of Health Plan Quality		Jacobson	Paula		7152219644				7152219500	jacobson.paula@securityhealth.org	1515  Saint Joseph Avenue		Marshfield	WI	54449	02/17/2023	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Reconciliation Contact	Director of Actuarial and Risk Adjustment Services		Westphal	Scott		7152219107				7152219500	westphal.scott@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	02/21/2021	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Reconciliation Contact (Secondary)	Actuarial Services Manager		Naugle	Danielle		7152219692					naugle.daniellel@securityhealth.org	1515 Saint Joseph Ave		Marshfield	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Recovery Audit Contact	Chief Legal and Compliance Officer	Mrs.	Boero	Lisa		7152217231				7152219500	shp.compliance.dept@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	02/08/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	SNP Application Contact	Implementation Manager		Kean	Jeff		2088910185					kean.jeffrey@securityhealth.org	1515 Saint Joseph Ave		Marshfield	WI	54449	08/18/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	SNP State Contact	Director of Product Development		Howey	Kristina		7152215406				7152219500	howey.kristina@securityhealth.org	1515 Saint Joseph Ave		Marshfield	WI	54449	08/19/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Surveillance Contact	Chief Legal and Compliance Officer		Boero	Lisa		7152217231				7152219500	shp.compliance.dept@securityhealth.org	1515 Saint Joseph  Avenue		Marshfield	WI	544498000	02/08/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	System Contact	Enrollment Team Lead		Zajackowski	Juliann		7152219925				7152219500	zajackowski.juliann@securityhealth.org	1515 Saint Joseph  Avenue		Marshfield	WI	54449	10/27/2017	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Third Party Administrator (TPA) Liaison	Accountant II		Staver	Jannel		7152219864				7152219500	staver.jannel@securityhealth.org	1515 Saint Joseph Avenue		Marshfied	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	User Access Contact	Director of Compliance and Privacy		Wilson	Kelly		7152219960				7152219500	wilson.kelly@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	04/28/2022	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Utilization Management Contact	Health Services Clinical Manager		Rock	Laurie		7152219939				7152219500	rock.laurie@securityhealth.org	1515 Saint Joseph Avenue		Marshfield	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5211	Utilization Review Contact	Health Services Clinical Manager		Rock	Laurie		7152219939				7152219500	rock.laurie@securityhealth.org	1515  Saint Joseph Avenue		Marshfield	WI	54449	12/31/2019	2023	SECURITY HEALTH PLAN OF WISCONSIN, INC.	Local CCP	Security Health Plan of Wisconsin, Inc.	HMO/HMOPOS		Marshfield Clinic Health System, Inc.	149	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H5212	Automated TrOOP Balance Transfer Contact			N/A (PACE)	N/A (PACE)		4149026044					michael.garlie@communitycareinc.org	N/A		Milwaukee	WI	53215	08/20/2008	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Backup User Access Contact	Chief Compliance & Quality Officer		Garlie	Michael	J	2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Best Available Evidence Contact	Accounting Specialist - Medicare	Ms.	Instefjord	Lori		2622079374					lori.instefjord@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	10/25/2016	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Bid Primary Contact	Financial Planning Manager	Mr.	Siddiqui	Imran		2622079372					kyle.raeder@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	06/22/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	CAP Report Contact for Public Website	Chief Compliance & Quality Officer		Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	CEO - CMS Administrator Contact	CEO	Mr	Munson	Kenneth		4142314000					kenneth.munson@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2013	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	CEO - Senior Official for Contracting	CEO	Mr	Munson	Kenneth		4142314000					kenneth.munson@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2013	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Chief Financial Officer	Chief Financial Officer	Ms.	Smith	Christy		4142314000					christy.smith@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/25/2017	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Chief Operating Officer	Chief Program Officer	Mr.	Kohl	Edward		4142314000					edward.kohl@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	12/21/2016	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Chief Information Officer	Chief Information Officer	Ms.	Kramer	Virginia		4142314292					virginia.kramer@communitycareinc.org	3220 W. Vliet Street		Milwaukee	WI	53208	02/25/2016	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Chief Information Security Officer	Chief Information Officer	Ms.	Kramer	Virginia		4142314292					virginia.kramer@communitycareinc.org	3220 W. Vliet Street		Milwaukee	WI	53208	02/26/2016	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	CMS Casework Communication Contact	Chief Compliance & Quality Officer		Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Complaints Tracking Contact	Chief Compliance & Quality Officer		Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Contact for Fraud Investigations	Chief Compliance & Quality Officer	Mr	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Coordination of Benefits Contact	Claims Manager	Ms.	Halloran	Colleen		2629538627					colleen.halloran@communitycareinc.org	1801 Dolphin Drive		Waukesha	WI	53186	03/23/2015	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Corporate Mailing						4142314000					kenneth.munson@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/14/2013	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Customer Service Operations Contact	Program Officer	Ms.	Carter	Kelly		2622079323					kelly.carter@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	06/22/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	DIR Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/21/2023	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	DIR Contact (Secondary)	Chief Financial Officer	Ms.	Smith	Christy		2622079373					christy.smith@communitycareinc.org	205 Bishops way		Brookfield	WI	53005	07/19/2016	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Emergency Part D Contact	Clinical  and Plan Services Pharmacy Manager	Mr.	Mayer	Dmitri		4142314107					dmitri.mayer@communitycareinc.org	3220 W. Vliet		Milwaukee	WI	53208	06/22/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Emergency Part D Contact (Secondary)	Clinical Pharmacy Specialist	Mrs	Farley Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	10/14/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Encounter Data & Risk Adjustment Operations Contact	Financial Planning Manager	Mr.	Siddiqui	Imran		2622079353					imran.siddiqui@communitycareinc.org	205 Bishop's Way		Brookfield	WI	53005	06/22/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Enrollment Contact	Claims Manager	Ms.	Halloran	Colleen		2629538627					colleen.halloran@communitycareinc.org	1801 Dolphin Drive		Waukesha	WI	53186	05/14/2014	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	EOB Transfer Contact	Operations Support Supervisor	Ms	Vang	Jane		8882987770				7158367683	jvang@pharmastar.com	P.O. Box 3217		Eau Claire	WI	547023217	03/02/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Financial Audit Contact	Chief Financial Officer	Ms.	Smith	Christy		2622079370					christy.smith@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/25/2017	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Financial Reporting Contact	Chief Financial Officer	Ms.	Smith	Christy		2622079352					christy.smith@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	07/19/2016	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Formulary Contact	Clinical  and Plan Services Pharmacy Manager	Mr.	Mayer	Dmitri		4142314107					dmitri.mayer@communitycareinc.org	3220 W. Vliet		Milwaukee	WI	53208	06/22/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Formulary Contact (Secondary)	Clinical Pharmacy Specialist	Ms.	Farley Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S. Layton Blvd.		Milwaukee	WI	53215	06/30/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	General Contact	Regulatory Affairs Specialist		Melnick	Nancy		2622079362					nancy.melnick@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	05/09/2013	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Government Relations Contact	Chief Executive Officer		Munson	Kenneth		2622079339					kenneth.munson@communitycareinc.org	205 Bishops Way		Brookkfield	WI	53005	03/23/2015	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	HIPAA Privacy Officer	Chief Compliance & Quality Officer		Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	HIPAA Security Officer	Chief Compliance & Quality Officer		Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Interoperability Contact	Chief Information Officer	Ms.	Kramer	Virginia		4142314292					Virginia.Kramer@communitycareinc.org	3220 W. Vliet Street		Milwaukee	WI	53208	04/12/2022	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	MA Appeals/Grievances Contact	Chief Compliance & Quality Officer		Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	MA Claims Processing Contact for Public Website	Claims Manager		Halloran	Colleen		2629538627					colleen.halloran@communitycareinc.org	1801 Dolphin Drive		Waukesha	WI	53186	12/19/2011	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Marketing Contact	Chief Administrative Officer	Ms.	Gilcreast	Sherrice		4142314139					sherrice.gilcreast@communitycareinc.org	3220 W. Vliet St.		Milwaukee	WI	53208	02/26/2016	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Medical Director	Medical Director	Dr.	Almas	Rakhshinda		2622079338					rakshinda.almas@communitycareinc.org	205 Biships Way		Brookfield	WI	53005	03/23/2015	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Medicare Compliance Officer	Chief Compliance and Quality Officer	Mr	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Medicare Coordinator	Chief Compliance & Quality Officer		Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Medication Therapy Management Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Part C Application Contact	Regulatory Affairs Specialist		Melnick	Nancy		2622079362					nancy.melnick@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	05/09/2013	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Part D Appeals	Chief Compliance & Quality Officer		Garlie	Michael							michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active	2622079307				PACE - Nat		C	Chicago
H5212	Part D Appeals Contact (Secondary)	Member Rights Specialist		Jerominski	Michael							michael.jerominski@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	04/18/2016	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active	2622079309				PACE - Nat		C	Chicago
H5212	Part D Application Contact	Regulatory Affairs Specialist		Melnick	Nancy		2622079362					nancy.melnick@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	05/09/2013	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Part D Benefits Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/29/2023	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Part D Claims Submission Contact	Client Support Supervisor	Ms	Vang	Jane		8882987770					jvang@pharmastar.com	2503 N. Hillcrest Pkwy.		Altoona	WI	54720	03/02/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Part D Exceptions Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan							megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/29/2023	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active	8669926600	22527			PACE - Nat		C	Chicago
H5212	Part D Price File Contact (Back-up)	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Part D Price File Contact (Primary)	Formulary & Plan Benefit Coordinator	Ms	Biren	Alicia		7158522061					abiren@pharmastar.com	Pharmastar	P.O. Box 3217	Eau Claire	WI	54702	03/02/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Part D Quality Assurance Contact	Chief Compliance & Quality Officer		Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Part D Reporting Contact	Regulatory Affairs Specialist		Melnick	Nancy		2622079362					nancy.melnick@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	05/09/2013	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Patient Safety Contact	Chief Compliance & Quality Officer		Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Payment Contact	Financial Planning Manager	Mr.	Siddiqui	Imran		2622079353					imran.siddiqui@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	06/22/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Pharmacy Director	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan	M	4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/29/2023	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Pharmacy Network Management Contact	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Pharmacy Technical Help Desk Contact			Service	Customer								2503 N. Hillcrest Parkway		Altoona	WI	547202569	03/08/2006	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active	8882987770				PACE - Nat		C	Chicago
H5212	Plan Directory Contact for Public Website			Hotline	Provider		8669372783					claimsinquiries@communitycareinc.org	1801 Dolphin Drive		Waukesha	WI	53186	02/17/2010	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Plan to Plan Reconciliation Contact	Accounting Specialist - Medicare	Ms	Instefjord	Lori		2622079374					lori.instefjord@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	10/25/2016	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Processor Contact	Client Support Supervisor	Ms	Vang	Jane		7158522064				7158367683	jvang@pharmastar.com	2503 N. Hillcrest Parkway		Altoona	WI	547202569	03/02/2021	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Quality Contact	Chief Compliance & Quality Officer		Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Reconciliation Contact	Accounting Specialist - Medicare	Ms.	Instefjord	Lori		2622079374					lori.instefjord@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	10/25/2016	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Reconciliation Contact (Secondary)	Member Accounting Specialist	Ms.	Locke	Kelly		2622079373					kelly.locke@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Recovery Audit Contact	Chief Compliance & Quality Officer	Mr.	Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Surveillance Contact	Chief Compliance & Quality Officer		Garlie	Michael		2622079307					michael.garlie@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	System Contact	Chief Information Officer		Kramer	Virginia		4142314292					Virginia.Kramer@communitycareinc.org	3220 W. Vliet Street		Milwaukee	WI	53208	05/09/2013	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Third Party Administrator (TPA) Liaison	Clinical Pharmacist	Mrs.	Farley-Snieg	Megan		4149022527					megan.farley-snieg@communitycareinc.org	1555 S Layton Blvd		Milwaukee	WI	53215	09/14/2023	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	User Access Contact	Chief Information Officer		Kramer	Virginia		4142314292					Virginia.Kramer@communitycareinc.org	3220 W. Vliet Street		Milwaukee	WI	53208	05/09/2013	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Utilization Management Contact	Medical Director	Dr.	Almas	Rakhshinda		2622079338					rakhshinda.almas@communitycareinc.org	205 Bishops Way		Brookfield	WI	53005	08/17/2020	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5212	Utilization Review Contact	Medical Director	Dr.	Almas	Rakhshinda		2622079338					rakhshinda.almas@communitycareinc.org	205 Bishops Waay		Brookfield	WI	53005	03/23/2015	2023	COMMUNITY CARE, INC.	National PACE	Community Care	National PACE		Community Care, Inc.	62	Yes	Active					PACE - Nat		C	Chicago
H5213	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Backup User Access Contact	Chief Information Officer		Babachicos	Cara		7209746739					cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Best Available Evidence Contact	Finance and Compliance Analyst	Mr.	Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Bid Primary Contact	Finance and Compliance Analyst	Mr.	Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	CAP Report Contact for Public Website	VP Clinical Compliance Audit Management		Teter	Lezlie		7206829848				3039961600	Lteter@innovage.com	3870 Rosin Court		Sacremento	CA	95834	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	9096779517				PACE - Nat		C	Dallas
H5213	CEO - CMS Administrator Contact	President & CEO	Mr.	Blair	Patrick		7209746704				3039961600	PBlair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	CEO - Senior Official for Contracting	President & CEO	Mr.	Blair	Patrick		7209746704				3039961600	PBlair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Chief Financial Officer	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Chief Operating Officer	COO	Ms.	Bent	Christine		7209742356				3039961600	cbent@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Chief Information Officer	CIO	Ms	Babachicos	Cara		3037202994					cbabachicos@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Chief Information Security Officer	Chief Information Security Officer	Mr	Smith	Alvin		7207896084				3039961600	ASmith2@innovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	CMS Casework Communication Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Complaints Tracking Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Contact for Fraud Investigations	Chief Legal Officer		D'Amato	Nicole		3038694664				3039961600	ndamato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Coordination of Benefits Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Corporate Mailing						3038694664				3039961600	bgutierrez@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Customer Service Operations Contact	Regional VP Operations COO	Mr.	Lohr	Clint		7209829868				3039961600	clohr@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	DIR Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Emergency Part D Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Encounter Data & Risk Adjustment Operations Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Enrollment Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	EOB Transfer Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Financial Audit Contact	Director of Finance	Ms.	Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Financial Reporting Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Formulary Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	General Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Government Relations Contact	Executive VP Government Relations		Steckel	Carol		7207896157				3039961600	CSteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	HIPAA Privacy Officer	Associate General Counsel	Mr.	Moxon	Jeff		7206613727				3039961600	crobertson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	HIPAA Security Officer	Chief Information Security Officer		Smith	Alvin		7207896084					asmith2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Interoperability Contact	SVP, Application Systems		Zierolf	Kris		7209742380					kzierolf@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	MA Appeals/Grievances Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	MA Claims Processing Contact for Public Website	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Marketing Contact	SVP, Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Medical Director	Chief Medical Officer	Dr.	Feifer	Rich		7206827305				3039961600	RFeifer@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Medicare Compliance Officer	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Medicare Coordinator	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Medicare Part D Opioid Overutilization Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 E. Lowry Blvd		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Medication Therapy Management Contact	SVP of Clinical Strategic Partnerships	Mrs.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Part C Application Contact	Executive VP Government Relations	Ms.	Steckel	Carol		7207896157				3039961600	CSteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Part D Appeals	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	Dallas
H5213	Part D Application Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Part D Benefits Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Part D Claims Submission Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Part D Exceptions Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	Dallas
H5213	Part D Price File Contact (Back-up)	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Part D Price File Contact (Primary)	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Part D Quality Assurance Contact	SVP of Clinical Strategic Partnerships		Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Part D Reporting Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Patient Safety Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Payment Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Pharmacy Director	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Pharmacy Network Management Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Pharmacy Technical Help Desk Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	Dallas
H5213	PHR Beneficiary Contact																	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE	Total Longterm Care, Inc.	Total Community Options, Inc.	230	Yes	Active	8772776163	732			PACE - Nat		C	Dallas
H5213	Plan Directory Contact for Public Website	Director of Marketing		Stavros	Sarah		3033006904				3039961600	sstavros@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Plan to Plan Reconciliation Contact	Financial and Compliance Analyst		Kizewski	Alex		7207896171				7209173390	AKizewsk@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Processor Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Quality Contact	Vice President of Quality		Curry	Jill		2153782123					JCurry@innovage.com	2000 Market Street	Suite 780	Philadelphia	PA	19103	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Reconciliation Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Recovery Audit Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817					mcinque@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Surveillance Contact	SVP, Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	System Contact	Director, PACE Finance		Hewitt	Jessica		7209746767					jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Third Party Administrator (TPA) Liaison	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	User Access Contact	Corporate Director of Compliance		Dickerson	Anzio		7208687356					adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Utilization Management Contact	Chief Quality & Population Health Officer	Dr.	Wells	Ann		7206827305				3039961600	awells@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5213	Utilization Review Contact	Chief Quality & Population Health Officer	Dr.	Wells	Ann		7206827305				3039961600	awells@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/26/2023	2023	TOTAL COMMUNITY CARE, L.L.C.	National PACE	InnovAge New Mexico PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Dallas
H5215	Agent/Broker Compensation Data Contact	Manager, Individual Sales		Gehrke	Kimberly		9207201569					kgehrke@networkhealth.com	1570 Midway Place		Menasha	WI	54952	06/24/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Automated TrOOP Balance Transfer Contact	Vice President - Pharmacy	Mr	Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	12/23/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Backup User Access Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	akeenan@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/20/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Best Available Evidence Contact	Manager, Enrollment		Ziegert	Amy		9207201414				9207201931	amzieger@networkhealth.com	1570 Midway Place		Menasha	WI	54952	08/08/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Bid Audit Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Bid Audit Site Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Bid Primary Contact	Senior Actuary		Lanier	Eric		9207201636				9207201912	elanier@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/09/2018	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	CAP Report Contact for Public Website	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	CEO - CMS Administrator Contact	CEO	Mrs.	Dicus-Johnson	Coreen		9202851898					coreen.dicusjohnson@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	07/27/2018	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	CEO - Senior Official for Contracting	CEO	Mrs.	Dicus-Johnson	Coreen		2627889303					Coreen.DicusJohnson@networkhealth.com	1570 Midway Place		Menasha	WI	54952	10/26/2017	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Chief Financial Officer	Chief Financial Officere	Mr	Ollech	Brian		9207201886					bollech@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	08/22/2017	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Chief Operating Officer	Vice President, Operations	Ms.	Vander Zanden	Jessica		9207201652					jvanderz@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Chief Information Officer	Chief Information Officer	Mr	Riley	Timothy		9207201895					triley@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/19/2016	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Chief Information Security Officer	Chief Information Security Officer	Mr	Bloedorn	Dave		9207201410					dbloedor@networkhealth.com	1570 Midway Place		Menasha	WI	54952	07/27/2018	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	CMS Casework Communication Contact	Director, Regulatory Affairs		Schuster	Shannon		9206287267					sschuste@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/17/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Complaints Tracking Contact	Director, Regulatory Affairs		Schuster	Shannon		9206287267				9207201912	sschuste@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/20/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Contact for Fraud Investigations	VP, Risk Adjustment & Payment Integrity		Weisbrod	Josh		9207201461					jweisbro@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Coordination of Benefits Contact	Director - Pharmacy		Wheaton	Andy		9207201612				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	04/18/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Corporate Mailing						9207201200					compliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	02/12/2018	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant		Cymerman	Tricia		9207201658					tcymerma@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/24/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Customer Service Operations Contact	Manager, Customer Service		Schwandner	Stacy		9207201309				9207201908	sschwand@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	07/27/2018	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	DIR Contact	Medicare Pharmacist		Peterson Sanders	Anna		9207201672					apeterso@networkhealth.com	1570 Midway Place		Menasha	WI	54952	02/18/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	DIR Contact (Secondary)	Director, Pharmacy		Wheaton	Andy		9207201612					awheaton@networkhealth.com	1570 Midway Place		Menasha	WI	54952	02/18/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Electronic Health Record Contact	VP, Care Services		Dencker	Sarah		9207201694					sdencker@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Emergency Part D Contact	Director, Pharmacy		Wheaton	Andy		9202058528					awheaton@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	12/14/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Emergency Part D Contact (Secondary)	Medicare Pharmacist		Peterson Sanders	Anna		9207201672					apeterso@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/20/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Employer Waiver Contact	VP, Medicare & Individual Programs		Whittemore	John		9853773986					jwhittem@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/20/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Encounter Data & Risk Adjustment Operations Contact	Vice President, Risk Adjustment		Weisbrod	Josh		9207201461					jweisbro@networkhealth.com	1570 Midway Place		Fond du Lac	WI	54935	10/18/2019	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Enrollment Contact	Manager, Enrollment and BA Integration		Ziegert	Amy		9207201414					amzieger@networkhealth.com	1570 Midway Place		Menasha	WI	54952	07/24/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	EOB Transfer Contact	Vice President - Pharmacy	Mr	Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/23/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Financial Audit Contact	Compliance Officer	Mrs.	Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Financial Reporting Contact	Dir Treasury Services		Leigh	Dennis		9207201837					FinanceReporting@networkhealth.com	1570 Midway  Place		Menasha	WI	54952	08/25/2016	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Formulary Contact	Vice President - Pharmacy		Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/23/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Formulary Contact (Secondary)	Manager, Pharmacy Benefits		Wheaton	Andy		9207201612				9207201906	awheaton@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/04/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	General Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Government Relations Contact	Compliance Officer		Keenan	Angela		9207201242					nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	HIPAA Privacy Officer	Compliance Officer		Keenan	Angela		9207201242				9207201912	compliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/20/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	HIPAA Security Officer	Security Officer	Mr	Bloedorn	Dave		9207201140					dbloedor@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/09/2018	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Hospice Contact	Pharmacy Benefits Program Manager		Kempfer	Amanda		9207201607					pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Interoperability Contact	Director, IT Development		Zirbel	Justin		9207201202					jzirbel@networkhealth.com	1570 Midway Place		Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	MA Appeals/Grievances Contact	Manager, Appeals and Grievances		Skinner	Jeanne		9207201382					jskinner@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/20/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	MA Claims Processing Contact for Public Website	Manager, Claims		Adamick	Crystal		9207201547					cadamick@networkhealth.com	1570 Midway Place		Menasha	WI	54952	02/12/2018	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Marketing Contact	Vice President - Marketing/Communications		Draheim	Melanie		9207201279				9207201912	mdraheim@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Medical Director	Chief Medical Officer	Dr.	Hassan	Mushir		2628259727					mhassan@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Medicare Compliance Officer	Compliance Officer	Mrs.	Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Medicare Coordinator	VP of Operations		Vander Zanden	Jessica		9207201652				9207201912	jvanderz@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/20/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Medicare Part D Opioid Overutilization Contact	Staff Pharmacist		Melis	Gary		9207201696					pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/09/2018	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Medication Therapy Management Contact	Network Account Director, Retail Strategy & Contra		Muralidharan	Adrienne		3143131932					amuralidharan@express-scripts.com	One Express Way		St. Louis	MO	63121	08/04/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	OffShore Subcontractor Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Online Enrollment Center Contact (Back-up)	Enrollment Lead		Dessell	Tracy		9207201223				9207201912	tdessell@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	08/08/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Online Enrollment Center Contact (Optional)	Compliance Officer		Keenan	Angela		9207201242					nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	08/08/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Online Enrollment Center Contact (Primary)	Manager, Enrollment		Ziegert	Amy		9207201414					amzieger@networkhealth.com	1570 Midway Place		Menasha	WI	54952	08/08/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Part C Application Contact	Compliance Officer		Keenan	Angela		9207201242					nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Part C Reporting Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Part D Appeals	Manager, Appeals and Grievances		Skinner	Jeanne						9207201382	jskinner@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/20/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active	8003785234				PPO - BBA		C	Chicago
H5215	Part D Appeals Contact (Secondary)	VP, Pharmacy		Regalia	Ted						9207201832	tregalia@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active	8003785234				PPO - BBA		C	Chicago
H5215	Part D Application Contact	Compliance Officer	Mrs	Keenan	Angela		9207201242					nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Part D Benefits Contact	Vice President - Pharmacy	Mr	Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/23/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Part D Claims Submission Contact	Vice President - Pharmacy		Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	12/23/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Part D Exceptions Contact	Manager, Appeals and Grievances		Skinner	Jeanne						9207201382	jskinner@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/20/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active	8003785234				PPO - BBA		C	Chicago
H5215	Part D Exceptions Contact (Secondary)	Vice President - Pharmacy	Mr	Regalia	Ted						9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/23/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active	8003785234				PPO - BBA		C	Chicago
H5215	Part D Price File Contact (Back-up)	Director, Pharmacy Benefits		Wheaton	Andrew		9207201612				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Part D Price File Contact (Optional)	Pharmacy Benefits Program Manager		Kempfer	Amanda		9207201607					pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Part D Price File Contact (Primary)	Sr. Manager, Regulated Markets		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	04/12/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Part D Quality Assurance Contact	Vice President - Pharmacy	Mr	Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	12/23/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Part D Reporting Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Patient Safety Contact	Staff Pharmacist	Mr	Melis	Gary		9207201696				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Payment Contact	Vice President - Finance		Leigh	Dennis		9207201837					FinanceReporting@networkhealth.com	1570 Midway  Place		Menasha	WI	54952	01/04/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Personal Health Record Contact	VP, Care Services		Dencker	Sarah		9207201694				9207201908	sdencker@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Pharmacy Director	Vice President - Pharmacy	Mr	Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	12/23/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Pharmacy Network Management Contact			Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		St Louis	MO	63121	01/19/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Pharmacy Technical Help Desk Contact	Director - Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkwy STE 150		Temple Terrace	FL	33637	12/17/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active	8009221557				PPO - BBA		C	Chicago
H5215	PHR Beneficiary Contact																	03/28/2007	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO	Network Health Insurance Corporation	Network Health, Inc.	670	Yes	Active	8003785234				PPO - BBA		C	Chicago
H5215	Physician Incentive Contact	VP, Network Development		Wille	Scott		2627889533					swille@networkhealth.com	1570 Midway Place		Menasha	WI	54952	04/04/2017	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Plan Directory Contact for Public Website			Service	Customer		8003785234				9207201908	sschwand@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	07/27/2018	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Plan to Plan Reconciliation Contact	Vice President - Finance		Leigh	Dennis		9207201837					FinanceReporting@networkhealth.com	1570 Midway  Place		Menasha	WI	54952	01/04/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Processor Contact	Sr. Director, Government Programs Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St Louis	MO	63121	08/04/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Quality Contact	VP, Quality and Clinical Integration		Benz	Elizabeth		2628259782					ebenz@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/17/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Reconciliation Contact	Vice President - Finance		Leigh	Dennis		9207201837					FinanceReporting@networkhealth.com	1570 Midway  Place		Menasha	WI	54952	01/04/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Reconciliation Contact (Secondary)	Senior Accountant		Cymerman	Tricia		9207201658					tcymerma@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/24/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Recovery Audit Contact	Compliance Officer	Mrs.	Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/13/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	SNP Application Contact	Director, Care Management	Mrs.	Reinsch	Laura		9207201711					lreinsch@networkhealth.com	1570 Midway Pl	PO Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	SNP State Contact	Managed Care Policy Analyst	Ms.	Froelich	Brooke		6082677281					BrookeS.Froelich@dhs.wi.gov	1 Wilson Street, Room 350		Madison	WI	537010309	06/03/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Surveillance Contact	Compliance Officer		Keenan	Angela		9207201624				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	System Contact	IT Infrastructure Manager	Mr	Petersen	Chris		9207201445					cpeterse@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	12/31/2019	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Third Party Administrator (TPA) Liaison	Senior Accountant		Cymerman	Tricia		9207201658					tcymerma@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/24/2020	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	User Access Contact	Information Security Risk Analyst	Ms	Pfefferle	Trish		9207201225					tpfeffer@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	07/27/2018	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Utilization Management Contact	Vice President - Care Services		Dencker	Sarah		9207201694					sdencker@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/04/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5215	Utilization Review Contact	Vice President - Care Services		Dencker	Sarah		9207201694					sdencker@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/04/2021	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	Local PPO		Network Health, Inc.	670	Yes	Active					PPO - BBA		C	Chicago
H5216	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	08/14/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H5216	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025807929				PPO - BBA		C	Kansas City
H5216	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H5216	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5024682494				PPO - BBA		C	Kansas City
H5216	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	8008658715				PPO - BBA		C	Kansas City
H5216	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025800475				PPO - BBA		C	Kansas City
H5216	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5216	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5232	Agent/Broker Compensation Data Contact	Sr. Sales Coordinator	Mr.	Hilfinger	George		4198872423				4198872017	george.hilfinger@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Automated TrOOP Balance Transfer Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Backup User Access Contact	Analyst III	Ms.	Stilwell	Denise		4198872711				4198872019	denise.stilwell@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Best Available Evidence Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872040	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Bid Audit Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Bid Audit Site Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Bid Primary Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	CAP Report Contact for Public Website	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	Nicole.Beadle@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	CEO - CMS Administrator Contact	President	Ms.	Johnston	Lori		4198872960				4198872030	Lori.Johnston@Promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	CEO - Senior Official for Contracting	President	Ms.	Johnston	Lori		4198872960				4198872030	Lori.Johnston@Promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Chief Financial Officer	Chief Financial Officer	Mr.	Martin	Jeff		4198872959				4198872031	jeff.martin@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Chief Operating Officer	Chief Operating Officer	Mr.	Wilson	Jered		4198872970				4198872030	Jered.Wilson@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Chief Information Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Chief Information Security Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	CMS Casework Communication Contact	Member Services Team Leader	Ms.	Harper	Leslie		4198872410				4198872047	leslie.harper@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Complaints Tracking Contact	Member Services Team Leader	Ms.	Harper	Leslie		4198872410				4198872047	leslie.harper@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Contact for Fraud Investigations	Senior Risk Analyst	Ms.	Bylow	Janet		4198872121				4198872036	janet.bylow@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Coordination of Benefits Contact	Director Risk Adjustment & Recoveries	Ms.	Curry	Deborah		4198872215				4198872398	Deborah.Curry@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Corporate Mailing						4198872500				4198872025	paramounthealthcare@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43597	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Coverage Gap Discount Program (CGDP) Payment Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Customer Service Operations Contact	Operations Manager, Member Services	Ms.	Trivedi	Kyle		4198872424				4198872047	kyle.trivedi@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	DIR Contact	Finance Supervisor	Mr.	DeHoff	Timothy		4198872947				5674024477	Timothy.DeHoff@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	DIR Contact (Secondary)	Director of Finance	Mr.	Potter	Rich		4198872006				5674024477	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Emergency Part D Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Emergency Part D Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Employer Waiver Contact	Sr. Medicare Project Coordinator	Ms.	Keys	Linda		4198872322				4198872017	linda.keys@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Encounter Data & Risk Adjustment Operations Contact	Director Risk Adjustment & Recoveries	Ms.	Curry	Deborah		4198872215				4198872398	Deborah.Curry@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Enrollment Contact	Director, Operational Services	Mr.	Gottfried	Kevin		4198872937				4198872016	kevin.gottfried@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	EOB Transfer Contact	Analyst II	Ms.	Ballinger	Tracy		4198872902				4198872020	tracy.ballinger@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Financial Audit Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Financial Reporting Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Formulary Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Formulary Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	General Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Government Relations Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	HIPAA Privacy Officer	Director, System Privacy	Ms.	Winterhalter	Sandy		5675859132				5675859640	sandy.winterhalter@promedica.org	100 Madison Avenue		Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	HIPAA Security Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872036	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Hospice Contact	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Interoperability Contact	CIO, ProMedica Insurance Corp, PHS-Administration	Mr.	Brackett	David		4198872102					david.brackett@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	MA Appeals/Grievances Contact	Appeals/Grievance Team Lead	Ms.	Graham	Beth		4198872446				4198872047	beth.graham@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	MA Claims Processing Contact for Public Website	Claims Team Leader	Ms.	Castle	Tracy		4198872611					Tracy.Castle@ProMedica.Org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Marketing Contact	Sr. Medicare Project Coordinator	Ms.	Keys	Linda		4198872322				4198872017	linda.keys@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Medical Director	Chief Medical Officer	Dr.	Bialecki-Haase	Dee		4198872296				4198872032	Dee.Bialecki-HaaseMD@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Medicare Compliance Officer	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Medicare Coordinator	Regulatory Coordinator	Ms.	Borell	Grace	C	4198872844				4198872011	grace.borell@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Medicare Part D Opioid Overutilization Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/27/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Medication Therapy Management Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Online Enrollment Center Contact (Back-up)	Marketing Account Executive	Mr.	Rivera Jr.	Mike		4198872484				4198872017	mike.riverajr@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Online Enrollment Center Contact (Optional)	Federal Program Enrollment Service Coordinator	Ms.	Bettinger	Suzanne		4198872487				4198872039	Suzanne.Bettinger@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Online Enrollment Center Contact (Primary)	Sr. Medicare Project Coordinator	Ms.	Keys	Linda		4198872322				4198872017	linda.keys@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Part C Application Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Part C Reporting Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Part D Appeals	Senior Pharmacist	Mr.	Bogner	Craig	M					5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active	8004623589				PPO - BBA		C	Chicago
H5232	Part D Appeals Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian						5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active	4198872204				PPO - BBA		C	Chicago
H5232	Part D Application Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Part D Benefits Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Part D Claims Submission Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Part D Exceptions Contact	Senior Pharmacist	Mr.	Bogner	Craig	M					5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active	8004623589				PPO - BBA		C	Chicago
H5232	Part D Exceptions Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian						5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active	4198872204				PPO - BBA		C	Chicago
H5232	Part D Price File Contact (Back-up)	Senior Consultant, Finance Med D	Mr.	Loveland	Chet		4806064873					Chet.Loveland@cvshealth.com	9501 E. Shea Blvd MC121		Scottsdale	AZ	85260	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Part D Price File Contact (Optional)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Part D Price File Contact (Primary)	Senior Manager, PBM Financial Operations	Ms.	Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Part D Quality Assurance Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Part D Reporting Contact	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Patient Safety Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Payment Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Pharmacy Director	Director, Pharmacy	Ms.	Zuber	Amber		4198872248				5675859454	amber.zuber@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Pharmacy Network Management Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Pharmacy Network Management Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Pharmacy Technical Help Desk Contact	Manager, Vendor Management	Mr.	Palmieri	Mike							Mike.Palmieri@Caremark.com	2401 Cherahala Blvd		Knoxville	TN	37932	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active	8666934620				PPO - BBA		C	Chicago
H5232	Physician Incentive Contact	Manager, Value Based Programs	Mr.	Mickunas	Chris		4198872088					chris.mickunas@promedica.org	2545 Farmers Drive		Columbus	OH	43235	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Plan Directory Contact for Public Website	Member Services Dept.		Services	Member		8004623589				4198872047	paramounthealthcare@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Plan to Plan Reconciliation Contact	Sr. Analyst		Lumbrezer	Cathy		4198872907					Cathy.Lumbrezer@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	03/24/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Processor Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Quality Contact	Manager, Quality Improvement/Disease Management	Ms.	Anello	Terrie		4198872301				4198872396	terrie.anello@Promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Reconciliation Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872020	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Reconciliation Contact (Secondary)	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Recovery Audit Contact	Manager, Risk Adjustment	Ms.	Curry	Deb		4198872215				4198872398	Deborah.Curry@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Surveillance Contact	Sr. Medicare Project Coordinator	Ms.	Keys	Linda		4198872322				4198872017	linda.keys@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	System Contact	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Third Party Administrator (TPA) Liaison	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	User Access Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Utilization Management Contact	Director, Utilization/Case Management	Ms.	Hass	Stephanie	N	4192812214				4198872028	stephanie.hass@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5232	Utilization Review Contact	Director, Utilization/Case Management	Ms.	Hass	Stephanie		4192812214				4198872028	stephanie.hass@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT INSURANCE COMPANY	Local CCP	Paramount Elite Medicare Plans	Local PPO		Promedica Health System, Inc.	191	Yes	Active					PPO - BBA		C	Chicago
H5253	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H5253	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H5253	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H5253	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H5253	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5253	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5256	Agent/Broker Compensation Data Contact	Director of Finance		Mitchell	Jill		5635568070	4831			5635565134	jmitchell@mahealthcare.com	1605 Associates Drive, Suite101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Backup User Access Contact	Comp Admin Assistant		Hoefler	Becca		5635568070				5635565134	bhoefler@mahealthcare.com	1605 Associates Dr., Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Bid Primary Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	CAP Report Contact for Public Website	Director of Operations		Hoffmann	Karen		5635568070	4817			5635565134	khoffman@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	CEO - CMS Administrator Contact	CEO	Mr.	Keeling	Zachary		5635568070					zkeeling@mahealthcare.com	1605 Associates Dr., Suite 101		Dubuque	IA	52002	01/03/2023	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Keeling	Zachary		5635568070				5635565134	zkeeling@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Chief Financial Officer	Director of Finance	Ms.	Mitchell	Jill		5635568070	4831			5635565134	jmitchell@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	01/03/2023	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Chief Operating Officer	Chief Operating Officer	Ms.	Mitchell	Jill		5635568070	4831			5635565134	jmitchell@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	07/28/2023	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Chief Information Officer	Director of Information Technology	Mr.	Wulfekuhle	Jeremy		5635844000					jwulfekuhle@mahealthcare.com	1500 Associates Drive		Dubuque	IA	52002	05/09/2016	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Chief Information Security Officer	Director of Information Technology	Mr.	Wulfekuhle	Jeremy		5635844000					jwulfekuhle@mahealthcare.com	1500 Associates Drive		Dubuque	IA	52002	05/09/2016	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	CMS Casework Communication Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Complaints Tracking Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Contact for Fraud Investigations	Director of Operations	Ms.	Hoffmann	Karen		5635568070	4817			5635565134	khoffman@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Corporate Mailing						5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Cost Report Contact	Director of Finance		Mitchell	Jill		5635568070	4831				jmitchell@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Customer Service Operations Contact	Member Services Supervisor		Boge	Laura		5695568070	4857			5695565134	lboge@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Encounter Data & Risk Adjustment Operations Contact	Configuration Manager		Heston	Joan		5635568070					jheston@maheatlcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Enrollment Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	EOB Transfer Contact	Claims Manager		Simmons	Sherie		5635568070	4825			5635565134	ssimmons@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Financial Reporting Contact	Director of Finance		Mitchell	Jill		5635568070	4831			5635565134	jmitchell@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	General Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635568070	4836			5635565134	jdigmann@mahealthcare.com	1605 Associates Dr., Suite 101		Dubuque	IA	52002	01/03/2023	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Government Relations Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Interoperability Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635568070					jdigmann@mahealthcare.com	1605 Associates Dr., Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	MA Appeals/Grievances Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	MA Claims Processing Contact for Public Website	Claims Manager		Simmons	Sherie		5635568070	4825			5635565134	ssimmons@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Marketing Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Medical Director	Chief Medical Officer	Dr.	Schultz	Hendrik		5635568070	4862			5635565134	hschultz@mahealthcare.com	1500 Associates Drive		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Medicare Compliance Officer	Director of Operations	Ms.	Hoffmann	Karen		5635568070	4817			5635565134	khoffman@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Medicare Coordinator	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Part C Application Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Part C Reporting Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Payment Contact	Director of Finance		Mitchell	Jill		5635568070	4831			5635565134	jmitchell@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Plan Directory Contact for Public Website	Marketing Specialist		Hoffmann	Julie		5635568070	4818			5635565134	jhoffmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Quality Contact	Chief Medical Officer	Dr.	Schultz	Hendrik		5635568070	4862			5635565134	hschultz@mahealthcare.com	1500 Associates Drive		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Surveillance Contact	Director of Operations		Hoffmann	Karen		5635568070	4817			5635565134	khoffman@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	System Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	User Access Contact	Medicare Compliance Analyst		Digmann	Jodi	A	5635844836				5635565134	jdigmann@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	02/11/2022	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Utilization Management Contact	Health Care Services Manager		Hollenback	Tammi		5635568070	4848			5635565134	thollenback@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5256	Utilization Review Contact	Health Care Services Manager		Hollenback	Tammi		5635568070	4848			5635565134	thollenback@mahealthcare.com	1605 Associates Drive, Suite 101		Dubuque	IA	52002	05/20/2021	2023	MEDICAL ASSOCIATES CLINIC HEALTH PLAN	1876 Cost	Medical Associates Clinic Health Plan of Wisconsin	1876 Cost		Medical Associates Clinic, P.C.	156	No	Active					Cost1		1	Kansas City
H5262	Agent/Broker Compensation Data Contact	Manager, Individual Sales		Schiro	Rick		6084714891					rick.schiro@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Automated TrOOP Balance Transfer Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Backup User Access Contact	Assistant Vice President Compliance & Government		Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Best Available Evidence Contact	Director of Enrollment		Krueger	Cindy		6084714900					cindy.krueger@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Bid Audit Contact	Director, Actuarial Services - Analytics		Felker	Matthew		6084714817					medicarebidspecialist@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Bid Audit Site Contact	Director, Actuarial Services - Analytics		Felker	Matthew		6084714817					medicarebidspecialist@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Bid Primary Contact	Director, Actuarial Services - Analytics		Felker	Matthew		6084714817					medicarebidspecialist@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	CAP Report Contact for Public Website	AVP Compliance and Government Regulatory Ops		Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	CEO - CMS Administrator Contact	President and CEO (Interim)	Ms	Senty, J.D.	Christine		6084714802					christine.senty@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/19/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	CEO - Senior Official for Contracting	President and CEO (Interim)	Ms	Senty, J.D.	Christine		6084714802					christine.senty@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/19/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Chief Financial Officer	Senior Vice President, CFO, Treasurer	Mr.	Butcher	Jeff		6084714771					jeffrey.butcher@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	01/13/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Chief Operating Officer	Vice President, Operations	Ms.	Schiffman	Debra		6086431408					debra.schiffman@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Chief Information Officer	Vice President and Chief Information Officer	Ms	Bay	Marybeth		6088269243					marybeth.bay@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Chief Information Security Officer	Vice President and Chief Information Officer	Ms.	Bay	Marybeth		6088269243					marybeth.bay@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	CMS Casework Communication Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Complaints Tracking Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Contact for Fraud Investigations	Assistant Vice President Compliance & Government	Ms.	Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Coordination of Benefits Contact	Director of Enrollment		Krueger	Cindy		6084714900					cindy.krueger@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Corporate Mailing						6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Cheung	Sheila		6088818082					sheila.cheung@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Customer Service Operations Contact	Senior Director of Customer Success		Greubel	Lori		6086441433					lori.greubel@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	DIR Contact	Senior Healthcare Informatics Analyst		Frank	Alice		6084714936					alice.frank@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	03/16/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	DIR Contact (Secondary)	Director, Actuarial Services - Analytics		Felker	Matthew		6084714817					matthew.felker@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	03/16/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Emergency Part D Contact	Pharmacy Manager		Suhr	Anessa		6083178565				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Emergency Part D Contact (Secondary)	Director of Clinical Pharmacy		Fejfar	Jeremy		6083851887				6088818308	jeremy.fejfar@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Encounter Data & Risk Adjustment Operations Contact	Lead Healthcare Informatics Analyst		Gault	Angie		6086048299					angie.gault@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Enrollment Contact	Director of Enrollment		Krueger	Cindy		6084714900					cindy.krueger@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	EOB Transfer Contact	Vice President, Operations		Schiffman	Debra		6086431408				6088818307	debra.schiffman@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Financial Audit Contact	Director, Actuarial Services - Analytics	Mr.	Felker	Matthew		6084714817					medicarebidspecialist@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Financial Reporting Contact	Senior Vice President, CFO, Treasurer	Mr.	Butcher	Jeff		6084714771					jeffrey.butcher@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	01/13/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Formulary Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Formulary Contact (Secondary)	Pharmacy Director of Government & Quality Programs		Fejfar	Jeremy		6088818603					jeremy.fejfar@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	General Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Government Relations Contact	Assistant Vice President Compliance & Government	Mrs.	Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	HIPAA Privacy Officer	Assistant Vice President Compliance & Government		Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	HIPAA Security Officer	Director of Business Intelligence & Data Warehouse		Pierce	Charlie		6088288584					charlie.pierce@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Hospice Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Interoperability Contact	AVP Compliance & Government Regulatory Operations		Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	MA Appeals/Grievances Contact	Manager, Appeals and Grievances		Salveson	Kate		6086431527					kathryn.salveson@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	MA Claims Processing Contact for Public Website			Service	Customer		8003945566					customerservice@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Marketing Contact	Director, Marketing Communications		Alexander	Cari		6084714864					cari.alexander@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Medical Director	Associate Chief Medical Officer	Dr.	Pak	Mary		6086404465					mary.pak@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Medicare Compliance Officer	Assistant Vice President Compliance & Government	Ms.	Skifton	Kelly	N	6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Medicare Coordinator	Director of Government Programs		Kirchberg	Mark		6086404461					mark.kirchberg@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Medicare Part D Opioid Overutilization Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	02/17/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Medication Therapy Management Contact	Pharmacy Director of Clinical Pharmacy	Mr	Fejfar	Jeremy		6088818603				6088818308	jeremy.fejfar@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Online Enrollment Center Contact (Back-up)	Enrollment Research Analyst		Petersen	Gerri		6088818197					geraldine.petersen@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Online Enrollment Center Contact (Optional)	Director of Enrollment		Krueger	Cindy		6084714900					cindy.krueger@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Online Enrollment Center Contact (Primary)	Enrollment Research Analyst		Petersen	Gerri		6088818197					geraldine.petersen@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Part C Application Contact	Director of Government Programs		Kirchberg	Mark		6086404461					mark.kirchberg@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Part C Reporting Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefis.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Part D Appeals	Appeals Manager		Salveson	Kate							kathryn.salveson@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active	6086431527				HMO - Health Maintenance Organization		C	Chicago
H5262	Part D Appeals Contact (Secondary)	Appeals Specialist		Specialists	Appeals						6086443500	appeals.specialists@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active	8003945566	308284			HMO - Health Maintenance Organization		C	Chicago
H5262	Part D Application Contact	Director of Government Programs		Kirchberg	Mark		6086404461					mark.kirchberg@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Part D Benefits Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Part D Claims Submission Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Part D Exceptions Contact	Pharmacy Manager		Suhr	Anessa						6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active	8003945566				HMO - Health Maintenance Organization		C	Chicago
H5262	Part D Price File Contact (Back-up)	Director of Pharmacy Government Programs		Fejfar	Jeremy		6088818603					jeremy.fejfar@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Part D Price File Contact (Optional)	Sr. Business Analyst, OptumRx		Kim	Kevin		6265334804					kevin.kim@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	06/23/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Part D Price File Contact (Primary)	Sr. Business Analyst, OptumRx		Kim	Kevin		6265334804					kevin.kim@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	09/20/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Part D Quality Assurance Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Part D Reporting Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Patient Safety Contact	Director of Pharmacy Government Programs	Mr	Fejfar	Jeremy		6088818603					jeremy.fejfar@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Payment Contact	Senior Vice President, CFO, Treasurer	Mr.	Butcher	Jeff		6084714771					jeffrey.butcher@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	01/13/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Pharmacy Director	Pharmacy Vice President		Gandhi	Jay		8477701300					jay.gandhi@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	06/15/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Pharmacy Network Management Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Pharmacy Network Management Contact (Secondary)	Pharmacy Program Director	Mr	Cory	Pat		6082621720					pat.cory@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Pharmacy Technical Help Desk Contact	Quartz Medicare Advantage Part D Help Desk		Medicare Advantage	Quartz							customerservice@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active	8887284689				HMO - Health Maintenance Organization		C	Chicago
H5262	Plan Directory Contact for Public Website			Service	Customer		8003945566					customerservice@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Plan to Plan Reconciliation Contact	Accountant		Cheung	Sheila		6088818082					sheila.cheung@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Processor Contact	Pharmacy Manager		Suhr	Anessa		6088818616					anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Quality Contact	Supervisor, Provider Quality & Analytics		Traastad	Maggie		6088818609					maggie.traastad@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Reconciliation Contact	Director, Actuarial Services - Analytics		Felker	Matthew		6084714817					medicarebidspecialist@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	02/21/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Reconciliation Contact (Secondary)	Actuarial Analyst		Andersen	Maura		6088818619					maura.andersen@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Recovery Audit Contact	Assistant Vice President Compliance & Government	Ms.	Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	SNP Application Contact	Director of Government Programs		Kirchberg	Mark		6086404461					mark.kirchberg@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	SNP State Contact	Medicaid Products & Government Affairs Director		Moody	Jonathan		6084714756					jonathan.moody@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Surveillance Contact	Assistant Vice President Compliance & Government	Ms.	Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	System Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Third Party Administrator (TPA) Liaison	Accountant		Cheung	Sheila		6088818082					sheila.cheung@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	User Access Contact	Assistant Vice President Compliance & Regulatory		Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	12/13/2022	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Utilization Management Contact	Senior Vice President, Health & Network Affairs	Dr.	Hanekom	David		6084714704					david.hanekom@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	01/13/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5262	Utilization Review Contact	Senior Vice President, Health & Network Affairs	Dr	Hanekom	David		6084714704					david.hanekom@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	01/13/2023	2023	QUARTZ HEALTH PLAN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5264	Agent/Broker Compensation Data Contact	Director - Sales	Mr	Weber	Michael		6088274014				6082520829	michael.weber@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Backup User Access Contact	GRC and Regulatory Audit Coordinator		Hewitt	Deb		6088285034					deb.hewitt@deancare.com	1255 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Bid Primary Contact	Director - Products		Jacobson	Jaclyn		8002791301					jaclyn.jacobson@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	CAP Report Contact for Public Website	Manager - Compliance		Herbst	Travis		6088272856					Travis Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	CEO - CMS Administrator Contact	Interm President & CFO	Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	CEO - Senior Official for Contracting		Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Chief Financial Officer	Chief Financial Officer	Mr	Ruplinger	Randy		6088274030					hpmscfo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Chief Operating Officer	President	Mr.	Docherty	David		6088274458					David.Docherty@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Abdul	Dan		9529922997					Daniel.Abdul@medica.com	301 Carlson		Minnetonka	MN	55305	02/01/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Chief Information Security Officer	Sr. Director of Information Risk Management - CISO	Mr.	Abbott	Brad		9529920081					Bradley.Abbott@medica.com	301 Carlson		Minnetonka	MN	55305	02/01/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	CMS Casework Communication Contact	Consumer Affairs Supervisor		Sikorski	TJ		9529928542					Thomas.Sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/23/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Complaints Tracking Contact	Consumer Affairs Supervisor		Riske	Christina		8002791302					Christina.Riske@deancare.com	1277 Deming Way		Madison	WI	53717	08/23/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Contact for Fraud Investigations	SIU Director		Monson	Peter		9509921149					Peter.Monson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Corporate Mailing						6088274301					hpmsceo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/20/2021	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Cost Report Contact	Sr. Financial and Business Development Analyst		Kvigne	Marcia		6088361400	4514				marcia.kvigne@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Customer Service Operations Contact	Manager Customer Service		Riske	Christina		8002791302					Christina.Riske@deancare.com	1277 Deming Way		Madison	WI	53717	08/23/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Employer Waiver Contact	Manager - Compliance		Herbst	Travis		6088272856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Encounter Data & Risk Adjustment Operations Contact	Director- Risk Adjustment Operations		Werwinski	Michelle		6088305958					Michelle.Werwinski@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Enrollment Contact	Enrollment & Billing Manager		Kaderabek	Kay	L	6088281976					kay.kaderabek@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	EOB Transfer Contact	Manager, Pharmacy		Borleske	Amanda		6088361400				6088274212	Amanda.Borleske@deancare.com	1277 Deming Way		Madison	WI	53717	07/07/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Financial Reporting Contact	Chief Financial Officer	Mr	Ruplinger	Randy		6088274030					hpmscfo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	General Contact	Manager - Compliance		Herbst	Travis		6088272856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Government Relations Contact	VP - Legal		Sutton	Dean		6088274301					dean.sutton@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Interoperability Contact	Director of Privacy		Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/24/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	MA Appeals/Grievances Contact	Manager - Customer Relations		Olson	Michelle		6088274469					michelle.olson@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	MA Claims Processing Contact for Public Website	Manager Claims		Sago	Murielle		8002791302					Murielle.Sago@deancare.com	1277 Deming Way		Madison	WI	53717	08/23/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Marketing Contact	Legal & Regulatory Analyst		Warren	Jennifer		6088305919					jennifer.warren1@deancare.com	1277 Deming Way		Madison	WI	53717	06/22/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Medical Director	Chief Medical Officer		Eichhorn, MD	Kevin		6088281955					kevin.eichhorn@ssmhealth.com	1277 Deming Way		Madison	WI	53717	05/21/2020	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Medicare Compliance Officer	VP - Compliance	Ms.	Koranteng	Milly		9529922090					Mildred.Koranteng@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/01/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Medicare Coordinator	Manager - Compliance		Herbst	Travis		6088272856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	OffShore Subcontractor Contact	Director of Privacy		Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/24/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Part C Application Contact	Director - Products		Jacobson	Jaclyn		8002791301					jaclyn.jacobson@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Part C Reporting Contact	Manager - Compliance		Herbst	Travis		6088272856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Payment Contact	Manager - Accounting		Lewis	Felicia		6088275950					felicia.lewis@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Plan Directory Contact for Public Website	Customer Service		Service	Customer		8884223326					DHP.CustomerRelationsResolutionTeam@medica.com	1277 Deming Way		Madison	WI	53717	02/01/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Quality Contact	Program Manager, Health Services		Smith	Julee		6088287579					Julee.Smith@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Surveillance Contact	Manager - Compliance		Herbst	Travis		6088272856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	System Contact	Manager - Compliance		Herbst	Travis		6088272856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	User Access Contact	Manager - Compliance		Herbst	Travis		6088272856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Utilization Management Contact	Mgr-RN Utilization Management		Drake	Amy		6088282807					Amy.Drake@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5264	Utilization Review Contact	Mgr-RN Utilization Management		Drake	Amy		6088282807					Amy.Drake@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	1876 Cost	Dean Health Plan, Inc.	1876 Cost		Medica Holding Company	439	No	Active					Cost1		1	Kansas City
H5273	Agent/Broker Compensation Data Contact	Vice President, Medicare Sales & Marketing	Ms.	McManus	Marie		6179729400	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Automated TrOOP Balance Transfer Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Backup User Access Contact	Medicare Compliance Program Manager		Tran	Brenda		7816121000	85880				brenda.tran@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Best Available Evidence Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Bid Audit Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Bid Audit Site Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Bid Primary Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852	84759				taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Chief Financial Officer	SVP Chief Financial Officer	Mr.	Walker	Scott		7816126840					r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Chief Operating Officer	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Chief Information Officer	SVP and Chief Information Officer	Ms.	Ferhatbegovic	Selma		7816121000	84633				Selma.Ferhatbegovic@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	CMS Casework Communication Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Complaints Tracking Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Contact for Fraud Investigations	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Coordination of Benefits Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Corporate Mailing						7816121000					Cain.Hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Customer Service Operations Contact	Manager, Member Services	Ms.	Villatoro	Yesly		7816121000	54152				yesly.villatoro@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	DIR Contact	Senior Manager, Pharmacy reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	DIR Contact (Secondary)	Pharmacy Analyst Senior	Ms.	Santino	Cristina		7816121000	82560				cristina.santino@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Emergency Part D Contact	Director, Pharmacy Operations		Bonica	Joseph		7816123342					joseph.bonica@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Emergency Part D Contact (Secondary)	Manager, Pharmacy Compliance		Lake	Matthew		7816123976					matthew.lake@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Employer Waiver Contact	Manager, Client Service	Ms.	Bartkiewicz	Mary		7816121000	83937				mary.bartkiewicz@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Data Analyst Lead	Ms.	Quinlan	Judith		7816121000	83377				judith.quinlan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Enrollment Contact	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	EOB Transfer Contact	Manager, Business Implementation		Nesmith	Tanisha		7816124861				6176730286	tanisha.nesmith@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Financial Audit Contact	Chief Financial Officer	Mr.	Walker	Scott		7816121000	86840				r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Financial Reporting Contact	SVP Finance & Chief Accounting Officer	Mr.	Porter	Mark		6179729400	85536				mark.porter@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Formulary Contact	Clinical Pharmacist Senior	Mr.	Kowalski	Alec		7816121000	82045				alec.kowalski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Formulary Contact (Secondary)	Clinical Pharmacist Senior		Shafir	Frances		7816122897					frances.shafir@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	General Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Government Relations Contact	Chief Government Affairs Officer	Ms.	Lewis	Kristin		7816121000	83621				kristin.lewis@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	HIPAA Privacy Officer	VP Privacy & Special Investigation	Mr.	Walsh	Chris		7816121000	82508				Christopher.walsh@point32health.org	1600 Crown Colony Drive		Quincy	MA	02169	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	HIPAA Security Officer	VP Chief  Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Hospice Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Interoperability Contact	Vice President & Chief Technology Officer		Querusio	David		7816122629					david.querusio@point32health.org	One Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	MA Claims Processing Contact for Public Website	Vice President, Claims	Mr.	Fernandez	David		6175844884					david.fernandez@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Marketing Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Medical Director	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Medicare Compliance Officer	Medicaid Compliance Officer	Mrs	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Medicare Coordinator	SVP, President Medicare	Ms.	Blake	Patty		7816124287					Patty.Blake@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Dohan	David		7816121000	82615				David.Dohan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Medication Therapy Management Contact	Sr Pharmacy Program Manager		Burns	Ashlyn		7816122239					ashlyn.burns@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	OffShore Subcontractor Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Online Enrollment Center Contact (Back-up)	Director, Enrollment & Payment - Senior Products	Ms.	Bullock	Jennifer		7816121000	83183				jennifer.bullock@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Online Enrollment Center Contact (Optional)	Supervisor, Enrollment	Ms.	Van De Mortel	Migdalia		7816121000	84104				Migdalia.Van.De.Mortel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Online Enrollment Center Contact (Primary)	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Part C Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Part C Reporting Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Part D Appeals	Director, Appeals & Grievances		Evans	Kathleen							Kathleen.Evans@point32health.org	1 Wellness Way		Canton	MA	02021	09/20/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	6179729400	87204			HMO - Health Maintenance Organization		C	Boston
H5273	Part D Appeals Contact (Secondary)	Program Manager Senior	Ms.	Mello	Sheri							sheri.mello@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	84862			HMO - Health Maintenance Organization		C	Boston
H5273	Part D Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Part D Benefits Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Part D Claims Submission Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Chan	Bryan							bryan.chan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	82370			HMO - Health Maintenance Organization		C	Boston
H5273	Part D Exceptions Contact (Secondary)	Supervisor, Pharmacy Utilization Management	Ms.	Griffith	Samantha							samantha.griffith@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	84551			HMO - Health Maintenance Organization		C	Boston
H5273	Part D Price File Contact (Back-up)	Advisor, Medicare Operations		Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Part D Price File Contact (Optional)	Sr. Pharmacy Implementation Specialist		Sullivan	Tim		7816124922					tim.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Part D Price File Contact (Primary)	Sr Business Analyst		Moore-Elliott	Shalandria		7637974305					shalandria.moore-elliott@optum.com	1600 McConnor Pwy.		Schaumburg	IL	60173	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Part D Quality Assurance Contact	Vice President, Behavioral Health	Ms.	Borrelli	Jill		6179729400	85397				jill.borrelli@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Part D Reporting Contact	Director, Pharmacy Financial & Reporting	Mr.	Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Patient Safety Contact	Sr Pharmacy Implementation Specialist		von Fritzinger	Lisa		7816123778					lisa.vonfritzinger@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Payment Contact	Program Manager III	Ms.	Cook	Tiffany		7816121000	84908				Tiffany.Cook@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Pharmacy Director	Vice President, Pharmacy	Ms.	Sullivan	Miriam		7816121000	84116				miriam.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations		Ashby	JoLynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Pharmacy Technical Help Desk Contact	Sr. Manager		Villaneuva	Juan							Juan.Villanueva@optum.com	3515 S Harbor Blvd.		Costa Mesa	CA	92626	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7148253761				HMO - Health Maintenance Organization		C	Boston
H5273	Pharmacy Technical Help Desk Contact (Secondary)	Associate Director, Pharmacy Help Desk		Betten	Brad							bradley.betten@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	8555240380				HMO - Health Maintenance Organization		C	Boston
H5273	Plan Directory Contact for Public Website	Supervisor, Marketing Materials Production	Mr.	Kayser	Kenneth		7816121000	83518				kenneth.kayser@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Plan to Plan Reconciliation Contact	Manager, Finance Operations	Ms.	Olson	Rachel		7816121000	84360				rachel.olson@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Processor Contact	Director, Claims	Ms.	Patel	Monal		7816121000	88187				monal.patel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Quality Contact	Senior Manager, Quality Informatics	Ms.	McCoy	Kelly		7816121000	83515				kelly.mccoy@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Reconciliation Contact	Senior Manager, Pharmacy Reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Reconciliation Contact (Secondary)	Director, Pharmacy Financial & Reporting		Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	09/11/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Recovery Audit Contact	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	SNP Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	SNP State Contact	Director Business Implementation		Chukwu	Matthew		7816123967					matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Surveillance Contact	Director, Sales Operations		McManus	Marie		6117972940	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	System Contact	Senior Manager, Business Account Management	Mr.	Allen	Jeffrey		7816121000	83167			6179729008	Jeffrey.Allen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Third Party Administrator (TPA) Liaison	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	User Access Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Utilization Management Contact	Director, Care Management	Ms.	Menery	Maureen		7816121000	83994				maureen.menery@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5273	Utilization Review Contact	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	CAREPARTNERS OF CONNECTICUT, INC.	Local CCP	CarePartners of Connecticut	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H5280	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	CAP Report Contact for Public Website			Services	Member		8556654623					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Government Relations Contact	MHO- Vice President, Government Contracts		Saelens	Holly		6145476818					holly.saelens@molinahealthcare.com	300 Corporate Exchange		Columbus	OH	43231	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	MA Claims Processing Contact for Public Website			Services	Member		8556654623					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	MMP Reporting Requirements Contact	MHI - Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate Suite 100		Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	MMP Point of Contact	MHI - Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate Suite 100		Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Plan Directory Contact for Public Website			Services	Member		8556654623					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5280	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Demo	Molina Healthcare of Ohio	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H5292	Automated TrOOP Balance Transfer Contact	VP of IT		Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Backup User Access Contact	SVP, Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Best Available Evidence Contact	VP of Operational Support		Rosen	Richard		3478423684					richard.rosen@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Bid Primary Contact	SVP, Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	CAP Report Contact for Public Website	VP of Quality		Konrad	Marcia		9142688418					marcia.konrad@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	CEO - CMS Administrator Contact	Executive Vice President	Ms.	Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	CEO - Senior Official for Contracting	Executive Vice President	Ms.	Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Chief Financial Officer	SVP of Finance	Mr.	Cavaliere	Andrew		3478423505					andy.cavaliere@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Chief Operating Officer	Senior Vice President	Ms.	Lau	Julieanne		3478423544					Julieanne.Lau@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Chief Information Officer	VP of IT	Mr.	Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Chief Information Security Officer	VP of IT	Mr.	Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	CMS Casework Communication Contact	Executive Vice President	Ms.	Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Complaints Tracking Contact	Director of Contracts and Compliance		Wong	Diana		3478423666					diana.wong@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Contact for Fraud Investigations	SVP, Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Coordination of Benefits Contact	SVP of Finance	Mr.	Cavaliere	Andrew		3478423505					andy.cavaliere@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Corporate Mailing						8007710088					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Coverage Gap Discount Program (CGDP) Payment Contact	AVP of Finance		Lugo	Michelle		3478423557					michelle.lugo@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Customer Service Operations Contact	VP of Member Services		Hron	Patty		3478423541					patty.hron@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	DIR Contact	AVP of Compliance		Khassanov	Yana		3478423509					yana.khassanov@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	DIR Contact (Secondary)	Director of Medicare		Williams	Sadirah		9292436197					Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Emergency Part D Contact	Director of Medicare		Williams	Sadirah		9292436197					Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Encounter Data & Risk Adjustment Operations Contact	VP of IT		Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Enrollment Contact	Executive Vice President	Ms.	Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	EOB Transfer Contact	SVP of Finance	Mr.	Cavaliere	Andrew		3478423505				8666907596	andy.cavaliere@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Financial Audit Contact	SVP of Finance	Mr.	Cavaliere	Andrew		3478423505					andy.cavaliere@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Financial Reporting Contact	SVP of Finance	Mr.	Cavaliere	Andrew		3478423505					andy.cavaliere@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Formulary Contact	Director of Medicare		Williams	Sadirah		3477787881					sadirah.williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	General Contact	Executive Vice President	Ms.	Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Government Relations Contact	Executive Vice President	Ms.	Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	HIPAA Privacy Officer	SVP, Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	HIPAA Security Officer	VP of IT		Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Interoperability Contact	VP of IT		Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	MA Appeals/Grievances Contact	VP of Quality		Konrad	Marcia		9142688418					marcia.konrad@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	MA Claims Processing Contact for Public Website	VP of Claims		Flanagan	Fiona		3478423526					fiona.flanagan@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Marketing Contact	Executive Vice President	Ms.	Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Medical Director	Medical Director		Gold	Jonathan		9147030550					jon.gold@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Medicare Compliance Officer	SVP, Regulatory Affairs	Ms.	Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Medicare Coordinator	AVP of Compliance		Khassanov	Yana		3478423509					yana.khassanov@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Medicare Part D Opioid Overutilization Contact	Director of Medicare		Williams	Sadirah		2018320060					Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	09/30/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Medication Therapy Management Contact	AVP of Compliance		Khassanov	Yana		3478423509					Yana.Khassanov@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Part C Application Contact	Executive Vice President	Ms.	Aldrich	Susan		8009509000					Susan.Aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Part D Appeals	Director of Medicare		Williams	Sadriah							Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending	2018320060				PACE - Nat		C	New York
H5292	Part D Appeals Contact (Secondary)	VP of Quality		Konrad	Marcia							marcia.konrad@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending	8009509000				PACE - Nat		C	New York
H5292	Part D Application Contact	Executive Vice President	Ms.	Aldrich	Susan		8009509000					Susan.Aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Part D Benefits Contact	AVP of Compliance		Khassanov	Yana		3478423509					Yana.Khassanov@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Part D Claims Submission Contact	Director of Medicare		Williams	Sadirah		2018320060					Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Part D Exceptions Contact	Director of Medicare		Williams	Sadirah							Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending	2018320060				PACE - Nat		C	New York
H5292	Part D Price File Contact (Back-up)	Director of Medicare		Williams	Sadirah		2018320060					Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Part D Price File Contact (Optional)	AVP of Compliance		Khassanov	Yana		3478423509					yana.khassanov@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Part D Price File Contact (Primary)	Director of Medicare		Williams	Sadirah		2018320060					Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Part D Quality Assurance Contact	Director of Medicare		Williams	Sadirah		2018320060					Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Part D Reporting Contact	SVP, Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Patient Safety Contact	Senior Vice President	Ms.	Lau	Julieanne		3478423554					julieanne.lau@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Payment Contact	SVP of Finance	Mr.	Cavaliere	Andrew		3478423505					andy.cavaliere@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Pharmacy Director	AVP of Compliance		Khassanov	Yana		3478423509					Yana.Khassanov@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Pharmacy Network Management Contact	Director of Medicare		Williams	Sadirah		2018320060					Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Pharmacy Technical Help Desk Contact	Director of Medicare		Williams	Sadirah							Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending	2018320060				PACE - Nat		C	New York
H5292	Plan Directory Contact for Public Website	AVP of Network Development		Altamirano	Bolivar		3478423527					bolivar.altamirano@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Plan to Plan Reconciliation Contact	AVP of Finance		Lugo	Michelle		3478423557					michelle.lugo@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Processor Contact	VP of Claims		Flanagan	Fiona		3478423526					fiona.flanagan@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Quality Contact	VP of Quality		Konrad	Marcia		9142688418					marcia.konrad@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Reconciliation Contact	SVP of Finance	Mr.	Cavaliere	Andrew		3478423505					andy.cavaliere@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Reconciliation Contact (Secondary)	AVP of Finance		Lugo	Michelle		3478423557					michelle.lugo@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Recovery Audit Contact	SVP of Finance	Mr.	Cavaliere	Andrew		3478423505					andy.cavaliere@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Surveillance Contact	Executive Vice President	Ms.	Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	System Contact	VP of IT		Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Third Party Administrator (TPA) Liaison	AVP of Finance		Lugo	Michelle		3478423557					michelle.lugo@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	User Access Contact	AVP of Compliance		Khassanov	Yana		3478423509				8887778279	Yana.Khassanov@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Utilization Management Contact	Executive Vice President	Ms.	Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5292	Utilization Review Contact	Medical Director		Gold	Jonathan		9147030550					jon.gold@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	08/31/2022	2023	ELDERSERVE HEALTH, INC.	National PACE	RiverSpring Health Plans	National PACE				Yes	Pending					PACE - Nat		C	New York
H5294	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H5294	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Medical Director	Chief Medical Director	Mr.	Harmon	David		5124163782	22182				dharmon@centene.com	5900 E. Ben White Blvd.		Austin	TX	78741	03/30/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H5294	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H5294	PHR Beneficiary Contact																	09/27/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8779358023				HMO - Health Maintenance Organization		C	Dallas
H5294	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Plan Directory Contact for Public Website			Services	Member		8779358023					CorporateMedicareComplianceDept@CENTENE.COM	5900 E. Ben White Blvd.		Austin	TX	78741	03/31/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5294	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5296	Agent/Broker Compensation Data Contact	VP, Sales		Simonds	Kristina		6572187635					KSimonds@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Automated TrOOP Balance Transfer Contact	PBM - Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Backup User Access Contact	Compliance Director		Spitzer	Chandra		6572745530					CSpitzer@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Best Available Evidence Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Bid Audit Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Bid Audit Site Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Bid Primary Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	CAP Report Contact for Public Website	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	CEO - CMS Administrator Contact	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	CEO - Senior Official for Contracting	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Chief Financial Officer	Chief Financial Officer	Mr.	Freeman	Thomas		6572187604					TFreeman@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/21/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Chief Operating Officer	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Kardes	Hakan		6572187772					hkardes@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	03/29/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Chief Information Security Officer	VP, Technology & CISO	Mr.	MacLeod	David		3033967531					DMacleod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	CMMI Model Point of Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	CMS Casework Communication Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Complaints Tracking Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Contact for Fraud Investigations	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Coordination of Benefits Contact	AVP, Membership & Eligibility		Torres	Carrie		6572187409	2109				CArreola@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Corporate Mailing						6572187713				8443202247	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/07/2020	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122			5622074634	adelatorre@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Customer Service Operations Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	DIR Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	DIR Contact (Secondary)	AVP, Pharmacy		Liu	Ruby		3237287232	2316				RLiu@AHCUSA.com	1100 W. Town & Country Rd., Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Electronic Health Record Contact	AVP, Platform Product		Brown Hayes	Michael		7144979628					MBrown-Hayes@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	04/01/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Emergency Part D Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Emergency Part D Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		3108667966				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Employer Waiver Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment		Bogdanov	Eyosef		5623666179					ebogdanov@ahcusa.com	1100 W. Town and Country Rd.	Suite 1600	Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Enrollment Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	EOB Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Financial Audit Contact	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Financial Reporting Contact	Sr. Director, Accounting & Reporting		Tran	Sue Anne		6572187673	7673				stran@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Formulary Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Formulary Contact (Secondary)	PBM - Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	General Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Government Relations Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	HIPAA Privacy Officer	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	HIPAA Security Officer	VP, Technology & CISO		MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Hospice Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Interoperability Contact	VP, Data Engineering & BI CTO Data and Al		Sam	Georgie		8188807212					gsam@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/01/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	MA Appeals/Grievances Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	MA Claims Processing Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Marketing Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Medical Director	SVP Market Management WCR	Dr.	Kim	John		6572187640				5622074617	JKim@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Medicare Compliance Officer	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy	B	6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Medicare Coordinator	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Medicare Part D Opioid Overutilization Contact	PBM - Supv Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Medication Therapy Management Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	OffShore Subcontractor Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	CLynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Online Enrollment Center Contact (Back-up)	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Online Enrollment Center Contact (Optional)	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Online Enrollment Center Contact (Primary)	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Part C Application Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Part C Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Appeals	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Appeals Contact (Secondary)	Sr. Manager, Appeals & Grievance		Jimenez	Gudelia							GJimenez@ahcusa.com	1100 W. Town and Country Road, Suite #300		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187488	2188			HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Application Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Benefits Contact	PBM - Director, Benefit Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Claims Submission Contact	PBM - Functional Business Consultant Govt Programs		Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Exceptions Contact	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Exceptions Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali							AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187709				HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Price File Contact (Back-up)	PBM - Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Price File Contact (Optional)	PBM - QA Analyst		Tastad	Emily		6127776931					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Price File Contact (Primary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Quality Assurance Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Part D Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Patient Safety Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Payment Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Personal Health Record Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Pharmacy Director	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Pharmacy Network Management Contact	PBM - AVP, Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Pharmacy Network Management Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/21/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H5296	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H5296	PHR Beneficiary Contact																	02/07/2020	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS	Alignment Health Plan	Alignment Healthcare USA, LLC	612	Yes	Active	8666342247				HMO - Health Maintenance Organization		C	San Francisco
H5296	Physician Incentive Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Plan Directory Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Plan to Plan Reconciliation Contact	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122			5622074266	adelatorre@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Processor Contact	Manager, PBM Operations		Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Quality Contact	Sr. Director, Quality Management/Credentialing		Lacock	Lisa		6572187638					LLacock@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Reconciliation Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Reconciliation Contact (Secondary)	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122				adelatorre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Recovery Audit Contact	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	SNP Application Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	SNP State Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Surveillance Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	System Contact	VP, AVA Health Plan Systems & Operations		Bates	Patrick		6572187636	7636				PBates@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Third Party Administrator (TPA) Liaison	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122				adelatorre@ahcusa.com	1100 W. Town and Country Rd, Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	User Access Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Utilization Management Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5296	Utilization Review Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5299	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H5299	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H5299	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H5299	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H5299	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H5299	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H5299	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H5299	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5299	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF NORTH CAROLINA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5302	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	08/11/2015	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H5302	PHR Beneficiary Contact																	08/11/2015	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				HMO - Health Maintenance Organization		C	Philadelphia
H5302	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/11/2015	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5302	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (GA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5322	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H5322	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H5322	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H5322	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H5322	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5322	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5325	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8887369118				8885547668	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/03/2018	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/25/2018	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H5325	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Plan Directory Contact for Public Website			Customer Service	Aetna		8005330367					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	02/01/2018	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5325	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5372	Agent/Broker Compensation Data Contact	SVP Health Plan Operations		Cochran	Rick		4026306924					rcochran@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/18/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Automated TrOOP Balance Transfer Contact	Director Enrollment, Eligibility &B OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Backup User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Best Available Evidence Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Bid Audit Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Bid Audit Site Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Bid Primary Contact	ACTUARY	Mr.	Copeland	Joe		3142095834					jcopeland@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	CAP Report Contact for Public Website	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	CEO - CMS Administrator Contact	COO	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	CEO - Senior Official for Contracting	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Chief Financial Officer	Chief Financial Officer	Mr.	Grabski	Ben		7633007611					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Chief Operating Officer	Chief Operating Officer	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Chief Information Officer	Chief Information Officer	Mr.	Saghabini	JeanClaude		6173124659					jsaghbini@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Chief Information Security Officer	Chief Information Security Officer	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	CMMI Model Point of Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	CMS Casework Communication Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Complaints Tracking Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Contact for Fraud Investigations	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Coordination of Benefits Contact			Inquiries	COB		8665979560					COBInquiry@lumeris.com	P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Corporate Mailing						8665979560					customerservice@essencehealthcare.com	CUSTOMER SERIVCE	P O BOX 5907	TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Coverage Gap Discount Program (CGDP) Payment Contact	Sr Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Customer Service Operations Contact	Vice President, Health Plan Operations	Ms.	Meyerhoffer	Linda		6366869682					rmeyerhoffer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	DIR Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	DIR Contact (Secondary)	Sr Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly	M	3142092795					pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Emergency Part D Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		6307425966					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Emergency Part D Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Encounter Data & Risk Adjustment Operations Contact	VP - Risk Adjustment Services	Mr.	Eschbach	Jason		6144397608					jeschbach@lumeris.com	13900 Riverport Drive		St. Louis	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Enrollment Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	EOB Transfer Contact	Director, Claims	Ms.	Wasserman	Rachelle		3147703520				3147706096	rwasserman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Financial Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Financial Reporting Contact	Corporate Accounting Director	Ms.	Pinkerton	Amanda		3145183519					apinkerton@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Formulary Contact		Ms	Nyawabila	Christina		8447906297					FAS@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Formulary Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	General Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Government Relations Contact	Chief Legal Officer	Ms.	Halterman	Gail		3142092717					ghalterman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Davis	Amy		3142093945					adavis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	HIPAA Security Officer	CISO	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Hospice Contact	Vice President, Clinical Operations		Cruz	Jennifer		3147703556					pharmacy@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Interoperability Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Darnell	Erika		3144382410					ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	MA Claims Processing Contact for Public Website			Service	Customer		8665979560				8884802577	customerservice@essencehealthcare.com	P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Marketing Contact	Manager, Compliance Marketing	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Medical Director	Senior Medical Officer, UM	Dr.	Fusco	Michael		3147703770					mfusco@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Medicare Compliance Officer	VP Compliance, Medicare Compliance Officer	Mr,	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Medicare Coordinator	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Medicare Part D Opioid Overutilization Contact	Snr. Clinical Pharmacist	Ms.	Pasagic	Melita		3147703775					mpasagic@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Medication Therapy Management Contact	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	OffShore Subcontractor Contact	SVP Corporate Accounting & Chief Compliance Office	Ms.	Venable	Erin		3142093957					evenable@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Online Enrollment Center Contact (Back-up)	Manager, Compliance	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Online Enrollment Center Contact (Optional)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Online Enrollment Center Contact (Primary)	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Part C Application Contact	Sr. Director CMS Applications & PBP submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Part C Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Appeals	Director, Appeals & Grievances	Ms.	Darnell	Erika							ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	3144382410				HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Appeals Contact (Secondary)	Sr. Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly	M						pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	3147209279				HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Benefits Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Claims Submission Contact		Ms.	Scherlippens	Carine		8587907415					Carine.Scherlippens@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Exceptions Contact		Ms.	Byers	June							June.Byers@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	8445136003				HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Exceptions Contact (Secondary)		Mr	Elias	Jason							Jason.Elias@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	8445136003				HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Price File Contact (Back-up)	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Price File Contact (Optional)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Price File Contact (Primary)		Ms.	Finder	Plan		8445136003					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Quality Assurance Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Part D Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Patient Safety Contact	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Payment Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Pharmacy Director	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Pharmacy Network Management Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Pharmacy Network Management Contact (Secondary)			Pharmacy Operations	MedImpact		8445136003					PharmacyOperationsSups@MedImpact.com	10182 Scripps Gateway Court		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services	Ms.	Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	8445136003				HMO - Health Maintenance Organization		C	Kansas City
H5372	Pharmacy Technical Help Desk Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly							ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	3147703788				HMO - Health Maintenance Organization		C	Kansas City
H5372	Physician Incentive Contact	Sr. Manager, Health Plan Finance	Mr.	Privott	David		3147703732					dprivott@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/21/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Plan Directory Contact for Public Website			Service	Customer		8665979560					customerservice@essencehealthcare.com	1P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Plan to Plan Reconciliation Contact	Sr Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Processor Contact		Ms.	Scott	Susan		8447906565					Susan.Scott@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Quality Contact	Snr. Director, Quality Improvement		Pattison	Lisa		5082728692					lpattison@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Reconciliation Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Reconciliation Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Recovery Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	SNP Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	SNP State Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Surveillance Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	System Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Third Party Administrator (TPA) Liaison	Client AP Specialist	Ms.	Brock	Letecea		3142548778					lbrock@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Utilization Management Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5372	Utilization Review Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	HMO/HMOPOS		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Kansas City
H5373	Agent/Broker Compensation Data Contact	Sr. Sales Coordinator	Mr.	Hilfinger	George		4198872423				4198872017	george.hilfinger@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Automated TrOOP Balance Transfer Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Backup User Access Contact	Analyst III	Ms.	Stilwell	Denise		4198872711				4198872019	denise.stilwell@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Best Available Evidence Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872040	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Bid Audit Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Bid Audit Site Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Bid Primary Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	CAP Report Contact for Public Website	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	Nicole.Beadle@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	CEO - CMS Administrator Contact	President	Ms.	Johnston	Lori		4198872960				4198872030	Lori.Johnston@Promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	CEO - Senior Official for Contracting	President	Ms.	Johnston	Lori		4198872960				4198872030	Lori.Johnston@Promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Chief Financial Officer	Chief Financial Officer	Mr.	Martin	Jeff		4198872959				4198872031	jeff.martin@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Chief Operating Officer	Chief Operating Officer	Mr.	Wilson	Jered		4198872970				4198872030	Jered.Wilson@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Chief Information Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Chief Information Security Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	CMS Casework Communication Contact	Member Services Team Leader	Ms.	Harper	Leslie		4198872410				4198872047	leslie.harper@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Complaints Tracking Contact	Member Services Team Leader	Ms.	Harper	Leslie		4198872410				4198872047	leslie.harper@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Contact for Fraud Investigations	Senior Risk Analyst	Ms.	Bylow	Janet		4198872121				4198872036	janet.bylow@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Coordination of Benefits Contact	Director Risk Adjustment & Recoveries	Ms.	Curry	Deborah		4198872215				4198872398	Deborah.Curry@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Corporate Mailing						4198872500				4198872025	paramounthealthcare@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43597	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Coverage Gap Discount Program (CGDP) Payment Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Customer Service Operations Contact	Operations Manager, Member Services	Ms.	Trivedi	Kyle		4198872424				4198872047	kyle.trivedi@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	DIR Contact	Finance Supervisor	Mr.	DeHoff	Timothy		4198872947				5674024477	Timothy.DeHoff@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	DIR Contact (Secondary)	Director of Finance	Mr.	Potter	Rich		4198872006				5674024477	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Emergency Part D Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Emergency Part D Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Employer Waiver Contact	Sr. Medicare Project Coordinator	Ms.	Keys	Linda		4198872322				4198872017	linda.keys@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Encounter Data & Risk Adjustment Operations Contact	Director Risk Adjustment & Recoveries	Ms.	Curry	Deborah		4198872215				4198872398	Deborah.Curry@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Enrollment Contact	Director, Operational Services	Mr.	Gottfried	Kevin		4198872937				4198872016	kevin.gottfried@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	EOB Transfer Contact	Analyst II	Ms.	Ballinger	Tracy		4198872902				4198872020	tracy.ballinger@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Financial Audit Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Financial Reporting Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Formulary Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Formulary Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	General Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Government Relations Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	HIPAA Privacy Officer	Director, System Privacy	Ms.	Winterhalter	Sandy		5675859132				5675859640	sandy.winterhalter@promedica.org	100 Madison Avenue		Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	HIPAA Security Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872036	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Hospice Contact	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Interoperability Contact	CIO, ProMedica Insurance Corp, PHS-Administration	Mr.	Brackett	David		4198872102					david.brackett@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	MA Appeals/Grievances Contact	Appeals/Grievance Team Lead	Ms.	Graham	Beth		4198872446				4198872047	beth.graham@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	MA Claims Processing Contact for Public Website	Claims Team Leader	Ms.	Castle	Tracy		4198872611					Tracy.Castle@ProMedica.Org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Marketing Contact	Sr. Medicare Project Coordinator	Ms.	Keys	Linda		4198872322				4198872017	linda.keys@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Medical Director	Chief Medical Officer	Dr.	Bialecki-Haase	Dee		4198872296				4198872032	Dee.Bialecki-HaaseMD@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Medicare Compliance Officer	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Medicare Coordinator	Regulatory Coordinator	Ms.	Borell	Grace	C	4198872844				4198872011	grace.borell@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Medicare Part D Opioid Overutilization Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/27/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Medication Therapy Management Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Online Enrollment Center Contact (Back-up)	Marketing Account Executive	Mr.	Rivera Jr.	Mike		4198872484				4198872017	mike.riverajr@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Online Enrollment Center Contact (Optional)	Membership Representative	Ms.	White	Sally		4198872976				4198872039	Sally.White@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928	Toledo	OH	436040928	08/15/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Online Enrollment Center Contact (Primary)	Membership Analyst	Ms.	Sherman	Tiffany		4192919984				4198872017	tiffany.sherman@promedica.org	300 Madison Ave. Suite 270	P.O Box 928	Toledo	OH	436040928	08/15/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Part C Application Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Part C Reporting Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Appeals	Senior Pharmacist	Mr.	Bogner	Craig	M					5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active	8004623589				HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Appeals Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian						5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active	4198872204				HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Application Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Benefits Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Claims Submission Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Exceptions Contact	Senior Pharmacist	Mr.	Bogner	Craig	M					5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active	8004623589				HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Exceptions Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian						5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active	4198872204				HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Price File Contact (Back-up)	Senior Consultant, Finance Med D	Mr.	Loveland	Chet		4806064873					Chet.Loveland@cvshealth.com	9501 E. Shea Blvd MC121		Scottsdale	AZ	85260	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Price File Contact (Optional)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Price File Contact (Primary)	Senior Manager, PBM Financial Operations	Ms.	Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Quality Assurance Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Part D Reporting Contact	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Patient Safety Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Payment Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Pharmacy Director	Director, Pharmacy	Ms.	Zuber	Amber		4198872248				5675859454	amber.zuber@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Pharmacy Network Management Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Pharmacy Network Management Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Pharmacy Technical Help Desk Contact	Manager, Vendor Management	Mr.	Palmieri	Mike							Mike.Palmieri@Caremark.com	2401 Cherahala Blvd		Knoxville	TN	37932	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H5373	Physician Incentive Contact	Manager, Value Based Programs	Mr.	Mickunas	Chris		4198872088					chris.mickunas@promedica.org	2545 Farmers Drive		Columbus	OH	43235	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Plan Directory Contact for Public Website	Member Services Dept.		Services	Member		8004623589				4198872047	paramounthealthcare@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Plan to Plan Reconciliation Contact	Sr. Analyst		Lumbrezer	Cathy		4198872907					Cathy.Lumbrezer@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	03/24/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Processor Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Quality Contact	Manager, Quality Improvement/Disease Management	Ms.	Anello	Terrie		4198872301				4198872396	terrie.anello@Promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Reconciliation Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872020	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Reconciliation Contact (Secondary)	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Recovery Audit Contact	Manager, Risk Adjustment	Ms.	Curry	Deb		4198872215				4198872398	Deborah.Curry@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Surveillance Contact	Sr. Medicare Project Coordinator	Ms.	Keys	Linda		4198872322				4198872017	linda.keys@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	System Contact	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Third Party Administrator (TPA) Liaison	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	User Access Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Utilization Management Contact	Director, Utilization/Case Management	Ms.	Hass	Stephanie	N	4192812214				4198872028	stephanie.hass@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5373	Utilization Review Contact	Director, Utilization/Case Management	Ms.	Hass	Stephanie		4192812214				4198872028	stephanie.hass@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	02/13/2023	2023	PARAMOUNT CARE OF INDIANA, INC.	Local CCP	Paramount Elite Medicare Plans	HMO/HMOPOS		Promedica Health System, Inc.	191	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5374	Agent/Broker Compensation Data Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Automated TrOOP Balance Transfer Contact			Rush	Jamie		5616901134					ESITroopTransfer@express-scripts.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Backup User Access Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1, Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Best Available Evidence Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N 107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Bid Audit Contact			Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Bid Audit Site Contact			Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Bid Primary Contact		Mr.	Granow	Les		5614440709					Les.Granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	CAP Report Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	CEO - CMS Administrator Contact		Dr.	Lerer	Rene		5614440780					rene.lerer@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	CEO - Senior Official for Contracting		Ms.	Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Chief Financial Officer		Mr.	Granow	Les		5614440709					les.granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Chief Operating Officer		Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Chief Information Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Chief Information Security Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	CMS Casework Communication Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Complaints Tracking Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Contact for Fraud Investigations			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Coordination of Benefits Contact		Ms.	Burdelik	Dawn		5618153729					dawn.burdelik@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Corporate Mailing						5616901134					compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Coverage Gap Discount Program (CGDP) Payment Contact		Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	Longevity Health Plan	485 Madison Avenue Suite 202	New York	NY	10022	03/11/2021	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Customer Service Operations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	DIR Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	DIR Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Electronic Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Emergency Part D Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Emergency Part D Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Encounter Data & Risk Adjustment Operations Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Enrollment Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	EOB Transfer Contact		Ms.	Socoski	Beth		5616901134				5616901134	Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Financial Audit Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Financial Reporting Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Formulary Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Formulary Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	General Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Government Relations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	HIPAA Privacy Officer		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	HIPAA Security Officer		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Hospice Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Interoperability Contact	CIO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	MA Appeals/Grievances Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	MA Claims Processing Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Marketing Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Medical Director		Mr.	Orgain	Javette		3127206656					javette.orgain@longevityhealthplan.com	Longevity Health Plan	1611 Church Street	Evanston	IL	60201	02/15/2021	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Medicare Compliance Officer		Ms.	Lacey	Jennifer		8133677169					Jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Medicare Coordinator	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Medicare Part D Opioid Overutilization Contact	Director, Clinical & Trend Solutions	Ms.	Muralidharan	Adrienne		5616901134					amuralidharan@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	02/15/2023	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Medication Therapy Management Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	OffShore Subcontractor Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Part C Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Part C Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Part D Appeals	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H5374	Part D Appeals Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H5374	Part D Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Part D Benefits Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		8002040016					Rosario_dovico@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H5374	Part D Exceptions Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H5374	Part D Price File Contact (Back-up)	Product Manager Advisor	Ms.	Williams	Stephanie		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Part D Price File Contact (Optional)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Part D Price File Contact (Primary)	sr mgr, Government Programs		Dolfi	Amanda		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Part D Quality Assurance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Part D Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Patient Safety Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Payment Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Personal Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Pharmacy Director	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra	Ms.	Kelly	Heather		8002040016					hakelly@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Pharmacy Network Management Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Pharmacy Technical Help Desk Contact	Director, Customer Service	Ms.	Moore	LaTasha						8882358551	LaTasha_Monroe@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H5374	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Account Manager	Ms.	Kolesar	Bhrena							Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H5374	Physician Incentive Contact		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Plan Directory Contact for Public Website	Medicare Compliance Director	Ms.	Socoski	Beth		8883133609					Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Plan to Plan Reconciliation Contact		Ms.	Zhai	Vicky		5616328915					Vicky.Zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Processor Contact		Ms.	Gibson	Sharon		6143766614					SGGibson@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Quality Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Reconciliation Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Reconciliation Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Recovery Audit Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	SNP Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	SNP State Contact		Ms.	Lacey	Jennifer		5614440706					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Surveillance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	System Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Third Party Administrator (TPA) Liaison	COO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	User Access Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Utilization Management Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5374	Utilization Review Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5377	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H5377	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H5377	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5377	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA MEDICAL PLAN OF PENNSYLVANIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5386	Agent/Broker Compensation Data Contact	Manager, Medicare and IFP Business Development		Truong	Don		8584998230					DOAN.TRUONG@SHARP.COM	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/19/2019	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Backup User Access Contact	Director of Medical Economics and Contracts		Limon	Gregory		8584998388					Gregory.Limon@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Best Available Evidence Contact	EDI Management Supervisor		Guglielmetti	Brett		8584998108					Brett.Guglielmetti@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	10/06/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Bid Audit Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Bid Audit Site Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Bid Primary Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	CAP Report Contact for Public Website	Dir Compliance/Reg Affairs		Mooney	Ryan		8584998237					ryan.mooney@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	07/08/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active	8555628853				HMO - Health Maintenance Organization		C	San Francisco
H5386	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Hayden-Cook	Melissa		8584998240					Melissa.Cook@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Hayden-Cook	Melissa		8584998240					Melissa.Cook@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Chief Financial Officer	Vice President and Chief Financial Officer	Ms.	Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Chief Operating Officer	Vice President and Chief Operating Officer	Ms.	Pels-Beck	Leslie		8584998327					Leslie.Pels-Beck@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	01/18/2018	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Chief Information Officer	CIO and SVP Information Systems	Mr	Reagin	Michael		8584996039					michael.reagin@sharp.com	4000 Ruffin Road	Suite D	San Diego	CA	92123	06/23/2020	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Chief Information Security Officer	Director, IT Security Operations	Mr	Franzen	Chase		8584996837					chase.franzen@sharp.com	3571 Corporate Court	ISD Administration	San Diego	CA	92123	12/07/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	CMS Casework Communication Contact	Supervisor, Appeals and Grievances		Randolph	Takeisha		8584998058					TAKEISHA.RANDOLPH@SHARP.COM	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/31/2018	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Complaints Tracking Contact	Supervisor, Appeals and Grievances		Randolph	Takeisha		8584998058					TAKEISHA.RANDOLPH@SHARP.COM	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/31/2018	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Contact for Fraud Investigations	Chief Operating Officer		Pels-Beck	Leslie		8584998327					Leslie.Pels-Beck@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	10/04/2017	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Coordination of Benefits Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Corporate Mailing						8584998050				8584998244	Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance		Piche	Paul		8584998201					Paul.Piche@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Customer Service Operations Contact	Manager, Customer Care		Meredith	Olivia		8584998019					olivia.meredith@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/19/2019	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	DIR Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	DIR Contact (Secondary)	Director of Finance		Piche	Paul		8584998201					paul.piche@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	03/16/2018	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Emergency Part D Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	12/23/2020	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Emergency Part D Contact (Secondary)	Pharmacy Benefits Specialist-Med D		Nguyen	Jenny		8584998190					jenny.nguyen@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/15/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Employer Waiver Contact	Manager, Product Development		Aragon	Benjamin		8584998320					ben.aragon@sharp.com	8520 Tech Way		San Diego	CA	92123	07/08/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Encounter Data & Risk Adjustment Operations Contact	Manager, EDI Management		Guglielmetti	Brett		8584998108					Brett.Guglielmetti@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	11/18/2019	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Enrollment Contact	EDI Management Supervisor		Guglielmetti	Brett		8584998108					Brett.Guglielmetti@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	10/06/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	EOB Transfer Contact	Director of Medical Economics and Contracts		Limon	Gregory		8584998388				8586362276	Gregory.Limon@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Financial Audit Contact	Manager of Accounting and Finance	Ms.	Lee	Summer		8584998203					Summer.Lee@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/23/2020	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Financial Reporting Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Formulary Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Formulary Contact (Secondary)	Pharmacy Benefits Specialist-Med D		Nguyen	Jenny		8584998190					jenny.nguyen@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/15/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	General Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Government Relations Contact	Dir Compliance/Reg Affairs		Mooney	Ryan		8584998237					ryan.mooney@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	07/08/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	HIPAA Privacy Officer	Dir Compliance/Reg Affairs		Mooney	Ryan		8584998237					ryan.mooney@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	92123	07/08/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	HIPAA Security Officer	CISO and VP IT Risk Management	Mr	Convey	Chris		8584996856					Christopher.convey@sharp.com	3571 Corporate Court	ISD Administration	San Diego	CA	92123	06/23/2020	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Hospice Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Interoperability Contact	Chief Financial Officer		Datko	Rita		8584998391					rita.datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	92123	05/03/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	MA Appeals/Grievances Contact	Supervisor, Appeals and Grievances		Randolph	Takeisha		8584998058					TAKEISHA.RANDOLPH@SHARP.COM	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/31/2018	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	MA Claims Processing Contact for Public Website	Director of Medical Economics and Contracts		Limon	Gregory		8584998388					Gregory.Limon@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Marketing Contact	Director, Marketing and Customer Strategy	Mr.	Carroll	Tom		8584998124					thomas.carroll@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	08/15/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Medical Director	Vice President and Chief Medical Officer	Dr.	Shames	Cary		8584998350				8586362426	Cary.Shames@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Pels-Beck	Leslie		8584998327					Leslie.Pels-Beck@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	05/26/2017	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Medicare Coordinator	Project Manager, SHP Finance		Stamas	Markita		8584998322					markita.stamas@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	07/08/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/03/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Medication Therapy Management Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/03/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Online Enrollment Center Contact (Back-up)	Director of Medical Economics and Contracts		Limon	Gregory		8584998388				8586362276	Gregory.Limon@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/23/2020	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Online Enrollment Center Contact (Optional)	Vice President and Chief Financial Officer	Ms.	Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/23/2020	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Online Enrollment Center Contact (Primary)	EDI Management Supervisor		Guglielmetti	Brett		8584998108					Brett.Guglielmetti@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	10/06/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Part C Application Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Part C Reporting Contact	Project Manager, SHP Finance		Stamas	Markita		8584998322					markita.stamas@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	07/08/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Appeals	Supervisor, Appeals and Grievances		Randolph	Takeisha							TAKEISHA.RANDOLPH@SHARP.COM	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/31/2018	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active	8555628853				HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Appeals Contact (Secondary)	Appeals and Grievance Coordinator		Garcia	Norma						8586362256	NORMA.GARCIA@SHARP.COM	8520 Tech Way	Suite 201	San Diego	CA	921231450	01/05/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active	8584998314				HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Application Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Benefits Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Claims Submission Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Exceptions Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary							zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	06/24/2020	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active	8555628853				HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Exceptions Contact (Secondary)	Pharmacy Benefits Specialist-Med D		Nguyen	Jenny							jenny.nguyen@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/15/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active	8555628853				HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Price File Contact (Back-up)	Pharmacy Benefits Specialist-Med D		Nguyen	Jenny		8584998190					jenny.nguyen@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/15/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Price File Contact (Optional)	Manager, Pharmacy Benefits		Tepedino	Kate		8584998353					kate.tepedino@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/23/2020	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Price File Contact (Primary)	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Quality Assurance Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Part D Reporting Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Patient Safety Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Payment Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Pharmacy Director	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Pharmacy Network Management Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary		8584995358					zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	05/27/2021	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Pharmacy Network Management Contact (Secondary)	Pharmacy Benefits Specialist-Med D		Nguyen	Jenny		8584998190					jenny.nguyen@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/15/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Pharmacy Technical Help Desk Contact	Director, Pharmacy Benefits	Mr.	Contreras	Zachary							zachary.contreras@sharp.com	8520 Tech Way	Suite 200	San Diego	CA	92123	06/24/2020	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	San Francisco
H5386	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Benefits Specialist-Med D		Nguyen	Jenny							jenny.nguyen@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	12/15/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active	8555628853				HMO - Health Maintenance Organization		C	San Francisco
H5386	Plan Directory Contact for Public Website	Vice President and Chief Operating Officer		Pels-Beck	Leslie		8584998244					Leslie.Pels-Beck@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Plan to Plan Reconciliation Contact	Manager, Accounting and Finance		Lee	Summer		8584998203					summer.lee@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	01/30/2018	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Processor Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Quality Contact	Director of Quality Improvement		Aguirre	Andres		8584998264					Andres.Aguirre@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	07/13/2018	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Reconciliation Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Reconciliation Contact (Secondary)	Director of Finance		Piche	Paul		8584998201					Paul.Piche@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Recovery Audit Contact	Vice President and Chief Financial Officer	Ms.	Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Surveillance Contact	Dir Compliance/Reg Affairs		Mooney	Ryan		8584998237					ryan.mooney@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	07/08/2022	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	System Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Third Party Administrator (TPA) Liaison	Accounting and Finance Manager		Lee	Summer		8584998203					Summer.Lee@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	92123	10/06/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	User Access Contact	Vice President and Chief Financial Officer		Datko	Rita		8584998391					Rita.Datko@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	06/01/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Utilization Management Contact	Medical Management Manager		Donaldson	Ruth		8584998145				8586362426	Ruth.Donaldson@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	08/09/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5386	Utilization Review Contact	Medical Management Manager		Donaldson	Ruth		8584998145				8586362426	Ruth.Donaldson@sharp.com	8520 Tech Way	Suite 201	San Diego	CA	921231450	08/09/2016	2023	SHARP HEALTH PLAN	Local CCP	Sharp Health Plan	HMO/HMOPOS		Sharp Healthcare	444	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5398	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H5398	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	01/24/2019	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Medical Director	Sr. VP, Medical Affairs	Dr.	Nelson	Vincent		3145056872					vincent.nelson@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/17/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H5398	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H5398	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8338166623				HMO - Health Maintenance Organization		C	Dallas
H5398	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Plan Directory Contact for Public Website			Services	Provider		8555659519					CorporateMedicareComplianceDept@CENTENE.COM	8325 Lenexa Drive	Suite 200	Lenexa	KS	66214	03/31/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5398	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5403	Automated TrOOP Balance Transfer Contact	Health Plan Manager		Li	Jiewen		4152928692				4152928745	jiewenl@onlok.org	1333 Bush Street		San Francisco	CA	94109	12/16/2019	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Backup User Access Contact	Director of Regulatory Affairs and Compliance		Chau	Jonathan		4152928852				4152928745	jchau@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/09/2017	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Best Available Evidence Contact	Senior Software Architect		Lin	Alan		6282088442				4152928745	alan@onlok.org	1333 Bush Street		San Francisco	CA	94109	04/23/2018	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Bid Primary Contact	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	CAP Report Contact for Public Website	Chief of Government Affairs and Compliance		Kunz	Eileen		4152928722				4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/16/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Li	Grace		4152928883				4152928745	graceli@onlok.org	1333 Bush Street		San Francisco	CA	94109	04/01/2016	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Li	Grace		4152928883				4152928745	graceli@onlok.org	1333 Bush Street		San Francisco	CA	94109	04/01/2016	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Chief Financial Officer	Interim Chief Financial Officer	Mr.	Gerlach	Carl		6282088477				4152928745	carl.gerlach@onlok.org	1333 Bush Street		San Francisco	CA	94109	10/06/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Chief Operating Officer	Chief Executive Officer	Ms.	Li	Grace		4152928883				4152928745	graceli@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/08/2021	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Chief Information Officer	Chief Technology and Information Security Officer	Mr.	Webb	Michael		6282088450				4152928745	mwebb@onlok.org	1333 Bush Street		San Francisco	CA	94109	09/28/2018	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Chief Information Security Officer	Chief Technology and Information Security Officer	Mr.	Webb	Michael		6282088450				4152928745	mwebb@onlok.org	1333 Bush Street		San Francisco	CA	94109	09/28/2018	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	CMS Casework Communication Contact	Health Plan Manager		Li	Jiewen		4152928692				4152928745	jiewenl@onlok.org	1333 Bush Street		San Francisco	CA	94109	12/16/2019	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Complaints Tracking Contact	Health Plan Manager		Li	Jiewen		4152928692				4152928745	jiewenl@onlok.org	1333 Bush Street		San Francisco	CA	94109	12/16/2019	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Contact for Fraud Investigations	Chief of Government Affairs and Compliance		Kunz	Eileen		4152928722				4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/16/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Coordination of Benefits Contact	Interim Chief Financial Officer		Gerlach	Carl		6282088477				4152928745	carl.gerlach@onlok.org	1333 Bush Street		San Francisco	CA	94109	10/06/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Corporate Mailing						4152928888				4152928745	info@onlok.org	1333 Bush Street		San Francisco	CA	94109	04/01/2008	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Coverage Gap Discount Program (CGDP) Payment Contact	Interim Chief Financial Officer		Gerlach	Carl		6282088477				4152928745	carl.gerlach@onlok.org	1333 Bush Street		San Francisco	CA	94109	10/06/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Customer Service Operations Contact	Chief of Government Affairs and Compliance		Kunz	Eileen		4152928722				4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/16/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	DIR Contact	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Emergency Part D Contact	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Encounter Data & Risk Adjustment Operations Contact	Senior Director of Health Plan Services		Pitkin	Tammie		4087953987				4152928745	tpitkin@onlok.org	1333 Bush Street		San Francisco	CA	94109	12/16/2019	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Enrollment Contact	Senior Director of Health Plan Services		Pitkin	Tammie		4087953987				4152928745	tpitkin@onlok.org	1333 Bush Street		San Francisco	CA	94109	12/16/2019	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	EOB Transfer Contact	Health Plan Manager		Li	Jiewen		4152928692				4152928745	jiewenl@onlok.org	1333 Bush Street		San Francisco	CA	94109	12/16/2019	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Financial Audit Contact	Interim Chief Financial Officer	Mr.	Gerlach	Carl		6282088477				4152928745	carl.gerlach@onlok.org	1333 Bush Street		San Francisco	CA	94109	10/06/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Financial Reporting Contact	Interim Chief Financial Officer		Gerlach	Carl		6282088477				4152928745	carl.gerlach@onlok.org	1333 Bush Street		San Francisco	CA	94109	10/06/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Formulary Contact	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	General Contact	Chief of Government Affairs and Compliance		Kunz	Eileen		4152928722				4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/16/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Government Relations Contact	Chief of Government Affairs and Compliance		Kunz	Eileen		4152928722				4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/16/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	HIPAA Privacy Officer	Chief of Government Affairs and Compliance		Kunz	Eileen		4152928722				4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/16/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	HIPAA Security Officer	Chief Technology and Information Security Officer		Webb	Michael		6282088450				4152928745	mwebb@onlok.org	1333 Bush Street		San Francisco	CA	94109	09/28/2018	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Interoperability Contact			Pitkin	Tammie		4087953987				4152928745	tpitkin@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	MA Appeals/Grievances Contact	Health Plan Manager		Li	Jiewen		4152928692				4152928745	jiewenl@onlok.org	1333 Bush Street		San Francisco	CA	94109	12/16/2019	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	MA Claims Processing Contact for Public Website	Senior Software Architect		Lin	Alan		6282088442				4152928745	alan@onlok.org	1333 Bush Street		San Francisco	CA	94109	04/23/2018	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Marketing Contact	Director of Regulatory Affairs and Compliance		Chau	Jonathan		4152928852				4152928745	jchau@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/09/2017	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Medical Director	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Medicare Compliance Officer	Director of Regulatory Affairs and Compliance	Mr.	Chau	Jonathan		4152928852				4152928745	jchau@onlok.org	1333 Bush Street		San Francisco	CA	94109	04/21/2023	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Medicare Coordinator	Chief of Government Affairs and Compliance		Kunz	Eileen		4152928722				4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/16/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy Services		Yi	Thomas		4152928327				4152928745	tyi@onlok.org	1333 Bush Street		San Francisco	CA	94109	03/20/2019	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Medication Therapy Management Contact	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Part C Application Contact	Chief of Government Affairs and Compliance		Kunz	Eileen		4152928722				4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/16/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Part D Appeals	Chief of Government Affairs and Compliance		Kunz	Eileen						4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	02/04/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active	8889966565				PACE - Nat		C	San Francisco
H5403	Part D Appeals Contact (Secondary)	Senior Director of Health Plan Services		Pitkin	Tammie						4152928745	tpitkin@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/06/2021	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active	8889966565				PACE - Nat		C	San Francisco
H5403	Part D Application Contact	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Part D Benefits Contact	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Part D Claims Submission Contact	Director of Pharmacy Services		Yi	Thomas		4152928327				4152928745	tyi@onlok.org	1333 Bush Street		San Francisco	CA	94109	05/23/2014	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Part D Exceptions Contact	Chief Medical Officer	Dr.	Lui	Benjamin						4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active	8889966565				PACE - Nat		C	San Francisco
H5403	Part D Price File Contact (Back-up)	Senior Software Architect		Lin	Alan		6282088442				4152928745	alan@onlok.org	1333 Bush Street		San Francisco	CA	94109	04/23/2018	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Part D Price File Contact (Primary)	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Part D Quality Assurance Contact	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Part D Reporting Contact	Chief of Government Affairs and Compliance		Kunz	Eileen		4152928722				4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/16/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Patient Safety Contact	Director of Pharmacy Services		Yi	Thomas		4152928327				4152928745	tyi@onlok.org	1333 Bush Street		San Francisco	CA	94109	05/23/2014	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Payment Contact	Interim Chief Financial Officer		Gerlach	Carl		6282088477				4152928745	carl.gerlach@onlok.org	1333 Bush Street		San Francisco	CA	94109	10/06/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Pharmacy Director	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Pharmacy Network Management Contact	Chief Medical Officer	Dr.	Lui	Benjamin		4152922882				4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Pharmacy Technical Help Desk Contact	Chief Medical Officer	Dr.	Lui	Benjamin						4152928745	blui@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active	8889966565				PACE - Nat		C	San Francisco
H5403	Plan Directory Contact for Public Website	Health Plan Manager		Li	Jiewen		4152928692				4152928745	jiewenl@onlok.org	1333 Bush Street		San Francisco	CA	94109	12/16/2019	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Plan to Plan Reconciliation Contact	Director of Regulatory Affairs and Compliance		Chau	Jonathan		4152928852				4152928745	jchau@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/09/2017	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Processor Contact	Senior Software Architect		Lin	Alan		6282088442				4152928745	alan@onlok.org	1333 Bush Street		San Francisco	CA	94109	04/23/2018	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Quality Contact	Medical Director	Dr.	Eng	Jessica		4152928605				4152928745	jessica.eng@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Reconciliation Contact	Interim Chief Financial Officer		Gerlach	Carl		6282088477				4152928745	carl.gerlach@onlok.org	1333 Bush Street		San Francisco	CA	94109	10/06/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Recovery Audit Contact	Interim Chief Financial Officer	Mr.	Gerlach	Carl		6282088477				4152928745	carl.gerlach@onlok.org	1333 Bush Street		San Francisco	CA	94109	10/06/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Surveillance Contact	Chief of Government Affairs and Compliance		Kunz	Eileen		4152928722				4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/16/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	System Contact	Senior Software Architect		Lin	Alan		6282088442				4152928745	alan@onlok.org	1333 Bush Street		San Francisco	CA	94109	04/23/2018	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Third Party Administrator (TPA) Liaison			Chau	Jonathan		4152928852					jchau@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2016	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	User Access Contact	Chief of Government Affairs and Compliance		Kunz	Eileen		4152928722				4152928745	ekunz@onlok.org	1333 Bush Street		San Francisco	CA	94109	01/16/2015	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Utilization Management Contact	Medical Director	Dr.	Eng	Jessica		4152928605				4152928745	jessica.eng@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5403	Utilization Review Contact	Medical Director	Dr.	Eng	Jessica		4152928605				4152928745	jessica.eng@onlok.org	1333 Bush Street		San Francisco	CA	94109	06/03/2022	2023	ON LOK SENIOR HEALTH SERVICES	National PACE	On Lok PACE	National PACE		On Lok, Inc.	176	Yes	Active					PACE - Nat		C	San Francisco
H5405	Automated TrOOP Balance Transfer Contact	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Backup User Access Contact	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Best Available Evidence Contact	CMO	Dr.	Mittelberger	James		5104331150	7117			5104528836	JMittelberger@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/03/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Bid Primary Contact	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	CAP Report Contact for Public Website	CEO		Zamora	Maria		5104528812				5104528836	mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/09/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active	8443191150				PACE - Nat		C	San Francisco
H5405	CEO - CMS Administrator Contact	CEO	Ms.	Zamora	Maria		5104528812				5104528836	mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/09/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	CEO - Senior Official for Contracting	CEO	Ms.	Zamora	Maria		5104528812				5104528836	mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/09/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Chief Financial Officer	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Chief Operating Officer	CEO	Ms.	Zamora	Maria		5104528812				5104528836	mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/18/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Chief Information Officer	VP of Information and Cloud Services	Mr.	Lola	Justin		5104331150	7103				jlola@cei.elders.org	510 17th St. Suite 400		Oakland	CA	94612	05/03/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Chief Information Security Officer	VP of Information and Cloud Services	Mr.	Lola	Justin		5104331150	7103				jlola@cei.elders.org	510 17th Street, Suite 400		Oakland	CA	94612	05/03/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	CMS Casework Communication Contact	Compliance Director		Ceruzzi	Alice		5104331150	7138			5104528836	ACeruzzi@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	11/30/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Complaints Tracking Contact	Compliance Director		Ceruzzi	Alice		5104331150	7138			5104528836	ACeruzzi@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	11/30/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Contact for Fraud Investigations	CEO	Ms.	Zamora	Maria		5104528812				5104528836	mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/09/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Coordination of Benefits Contact	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Corporate Mailing						5104331160	8821			5104528836	mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Coverage Gap Discount Program (CGDP) Payment Contact			Moon	Geoff		5104331160	7158			5108440189	gmoon@cei.eders.org	510 17th Street 3rd Floor		Oakland	CA	94612	05/26/2016	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Customer Service Operations Contact	CEO	Ms.	Zamora	Maria		5104528812				5104528836	mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/09/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	DIR Contact	Financial Analyst	Mr.	Moon	Geoff		5104331160	7158			5108440189	gmoon@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	05/16/2012	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	DIR Contact (Secondary)	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Emergency Part D Contact	Financial Analyst	Mr.	Moon	Geoff		5104331160	7158			5108440189	gmoon@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	05/16/2012	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Emergency Part D Contact (Secondary)	CMO	Dr.	Mittelberger	James		5104331150	7117			5104528836	JMittelberger@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/03/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Encounter Data & Risk Adjustment Operations Contact	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street	510 17th Street	Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Enrollment Contact	Director of Sales and Enrollment	Ms.	Yi	Chi		5104331160	8825			5104528836	cyi@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	04/06/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	EOB Transfer Contact	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Financial Audit Contact	Financial Analyst	Mr.	Moon	Geoff		5104431160	7158			5104528836	gmoon@cei.elders.org	510 17th Street		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Financial Reporting Contact	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Formulary Contact	Financial Analyst	Mr.	Moon	Geoff		5104331160	7158			5108440189	gmoon@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	05/16/2012	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	General Contact	CEO	Ms.	Zamora	Maria		5104528812				5104528836	mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/09/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Government Relations Contact	CEO	Ms.	Zamora	Maria		5104528812				5104528836	mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/09/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	HIPAA Privacy Officer	Dir. of Compliance	Ms.	Ceruzzi	Alice		5104331150	7138				ACeruzzi@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	11/30/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	HIPAA Security Officer	VP of Information Services and Cloud Services	Mr.	Lola	Justin		4157170276					jlola@cei.elders.org	510-17th St		Oakland	CA	94612	05/03/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Interoperability Contact	VP of Information Services and Cloud Services		Lola	Justin		5104331150	7103				JLola@cei.elders.org	510 17th Street		Oakland	CA	94612	05/03/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	MA Appeals/Grievances Contact	CEO	Ms.	Zamora	Maria		5104528812				5104528836	mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/09/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	MA Claims Processing Contact for Public Website	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Marketing Contact	Director of Planning and Communication	Ms.	Garrett	Dianna		5104331160	8022			5104528836	dgarrett@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	10/09/2013	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Medical Director	CMO	Dr.	Mittelberger	James		5104331150	7117			5104528836	JMittelberger@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/03/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Medicare Compliance Officer	Director, Compliance	Ms.	Ceruzzi	Alice		5104331150	7138				ACeruzzi@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	11/30/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Medicare Coordinator	Director of Sales and Enrollment	Ms.	Yi	Chi		5104331160	8825			5104528836	cyi@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	04/06/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Medicare Part D Opioid Overutilization Contact	CMO	Dr.	Mittelberger	James		5104331150	7117			5104528836	JMittelberger@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/03/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Medication Therapy Management Contact	CMO	Dr.	Mittelberger	James		5104331160	7117			5104528836	JMittelberger@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/03/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Online Enrollment Center Contact (Back-up)	Director of Sales and Enrollment		Yi	Chi		5104331160					cyi@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	04/06/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Online Enrollment Center Contact (Optional)	Director of Sales and Enrollment	Ms.	Yi	Chi		5104331150					cyi@cei.elders.org	510 17th St.		Oakland	CA	94612	04/06/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Online Enrollment Center Contact (Primary)			Black	Erica		5104331160					eblack@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	05/26/2016	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Part C Application Contact	Compliance Director	Ms.	Ceruzzi	Alice		5104331150	7138			5104528836	CBenedict@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	11/30/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Part D Appeals	CEO	Ms.	Zamora	Maria							mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/09/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active	5104528812	3187117			PACE - Nat		C	San Francisco
H5405	Part D Appeals Contact (Secondary)	Compliance Director	Ms.	Ceruzzi	Alice						5104528836	aceruzzi@cei.elders.org	510 17th Street		Oakland	CA	94612	02/08/2023	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active	5104331150	7138			PACE - Nat		C	San Francisco
H5405	Part D Application Contact	Financial Analyst	Mr.	Moon	Geoff		5104331160	7158			5108440189	gmoon@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	05/16/2012	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Part D Benefits Contact	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Part D Claims Submission Contact	Financial Analyst	Mr.	Moon	Geoff		5104331160	7158			5108440189	gmoon@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	05/16/2012	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Part D Exceptions Contact	Financial Analyst	Mr.	Moon	Geoff						5108440189	gmoon@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	07/10/2012	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active	5104331160	7158			PACE - Nat		C	San Francisco
H5405	Part D Exceptions Contact (Secondary)	CFO	Ms.	Holden	Laura						5104528836	LHolden@cei.elders.org	510 17th Street	2nd Floor	Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active	5104331150	7140			PACE - Nat		C	San Francisco
H5405	Part D Price File Contact (Back-up)	CEO	Ms	Zamora	Maria		5104528812				5104528836	mzamora@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/09/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Part D Price File Contact (Primary)	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Part D Quality Assurance Contact	Financial Analyst	Mr.	Moon	Geoff		5104331150				5104528836	gmoon@cei.edlers.org	510-17th St., Suite 400		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Part D Reporting Contact	Financial Analyst	Mr.	Moon	Geoff		5104331160	7158			5108440189	gmoon@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	05/16/2012	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Patient Safety Contact	Safety Officer		Zepeda	Crystal		5104331150	5181			5104528836	cmccloud@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/03/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Payment Contact	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Pharmacy Director	CMO	Dr	Mittelberger	James		5104331160	7117			5104528836	JMittelberger@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	04/14/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Pharmacy Network Management Contact	Financial Analyst	Mr.	Moon	Geoff		5104331160	7158			5108440189	gmoon@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	05/16/2012	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Pharmacy Network Management Contact (Secondary)	Consultant - Pharma Star	Ms.	Brempell	Melissa		7158522043					mbrempell@pharmastar.com	P.O. Box 3217		Eau Claire	WI	54702	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Pharmacy Technical Help Desk Contact	Financial Analyst	Mr.	Moon	Geoff						5108440189	gmoon@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	05/16/2012	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active	5104331160	7158			PACE - Nat		C	San Francisco
H5405	Pharmacy Technical Help Desk Contact (Secondary)	CEO	Ms.	Zamora	Maria						5104528836	mzamora@cei.elders.org	510 17th Street, Suite 400		Oakland	CA	94612	03/09/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active	5104528812				PACE - Nat		C	San Francisco
H5405	Plan Directory Contact for Public Website			Black	Erica		5104331150					eblack@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	05/26/2016	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Plan to Plan Reconciliation Contact	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Processor Contact			Black	Erica		5104331150					eblack@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	05/26/2016	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Quality Contact	Director of Quality Improvement	Mr.	Amin	Farhan		5104331150	7374				famin@cei.elders.org	510-17th St., Suite 400		Oakland	CA	94612	03/03/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Reconciliation Contact	Financial Analyst	Mr.	Moon	Geoff		5104331160	7158			5108440189	gmoon@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	05/16/2012	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Reconciliation Contact (Secondary)	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Recovery Audit Contact	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street 3rd Floor		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Surveillance Contact	Director of Sales and Enrollment	Ms.	Yi	Chi		5103188827					cyi@cei.elders.org	510 17th St.		Oakland	CA	94612	04/06/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	System Contact	VP of Information Services and Cloud Services	Mr.	Lola	Justin		5104331150	7103				JLola@cei.elders.org	510 17th Street		Oakland	CA	94612	05/03/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Third Party Administrator (TPA) Liaison	CFO	Ms.	Holden	Laura		5104331150	7140			5104528836	LHolden@cei.elders.org	510 17th Street, Suite 400		Oakland	CA	94612	08/25/2021	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	User Access Contact	VP of Information Services and Cloud Services		Lola	Justin		5104331150	7103				jlola@cei.elders.org	510 17th St., Suite 400		Oakland	CA	94612	05/03/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Utilization Management Contact	Sr. Vice President of Operations		King	Jane		5103187165	3187165				jane@cei.elders.org	510-17th Street, Suite 400		Oakland	CA	94612	04/06/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5405	Utilization Review Contact	Sr. Vice President of Operations		King	Jane		5103187165	3187165				jane@cei.elders.org	510-17th Street, Suite 400		Oakland	CA	94612	04/06/2022	2023	CENTER FOR ELDERS INDEPENDENCE	National PACE	Center For Elders' Independence	National PACE		Center For Elders Independence	53	Yes	Active					PACE - Nat		C	San Francisco
H5406	Automated TrOOP Balance Transfer Contact	Finance Manager	Mr.	Salas	Rafael		9164913415				9164916408	salasr@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	04/22/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Backup User Access Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Best Available Evidence Contact	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Bid Primary Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	CAP Report Contact for Public Website	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	CEO - CMS Administrator Contact	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	CEO - Senior Official for Contracting	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Chief Financial Officer	Finance Manager	Mr.	Salas	Rafael		9164913415				9164916408	salasr@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Chief Operating Officer	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Chief Information Officer	Clinical Application Director, I	Ms.	McEnroe	Casi		9167337221					mcenrocl@sutterhealth.org	3707 Schriever Ave		Mather	CA	95655	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Chief Information Security Officer	information Security Officer	Mr.	Lindley	Erick		9168092707					lindlej@sutterhealth.org	9100 Foothills Blvd		Roseville	CA	95747	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	CMS Casework Communication Contact	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Complaints Tracking Contact	Quality Coordinator	Ms.	Robello-Kladde	Renee		9164913406					RobellRC@sutterhealth.org	444 N 3rd St	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Contact for Fraud Investigations	Ethics and Compliance Officer	Ms.	Yau	Allison	Y	5102928000					Allison.Yau@sutterhealth.org	2450 Ashby Ave.	2nd/Floor Room 2766	Berkeley	CA	94546	08/29/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Coordination of Benefits Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Corporate Mailing						8335607223	63490			9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Ste 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Customer Service Operations Contact	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	DIR Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	DIR Contact (Secondary)	Ethics and Compliance Officer	Ms.	Yau	Allison	Y	5102928000					Allison.Yau@sutterhealth.org	2450 Ashby Ave.	2nd/Floor Room 2766	Berkeley	CA	94546	08/29/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Emergency Part D Contact	Medical Director	MD	Khalsa	Maninder		8335607223					KhalsaM@sutterhealth.org	444 North 3rd Street, Ste 150		Sacramento	CA	95811	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Emergency Part D Contact (Secondary)	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Encounter Data & Risk Adjustment Operations Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Enrollment Contact	Regional Manager, Market Development	Ms.	Grefrath	Lynette		8335607223				9164913408	grefral@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	08/10/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	EOB Transfer Contact	Finance Manager	Mr.	Salas	Rafael		9164913415				9164916408	salasr@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Financial Audit Contact	Finance Manager	Mr.	Salas	Rafael		9164913415				9164916408	salasr@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Financial Reporting Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Formulary Contact	Medical Director	MD	Khalsa	Maninder		8335607223					KhalsaM@sutterhealth.org	444 North 3rd Street, Ste 150		Sacramento	CA	95811	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	General Contact	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Government Relations Contact	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	HIPAA Privacy Officer	Privacy Officer	Ms.	Beckmann	Lori		9162814753					beckmal@sutterhealth.org	9100 FoothillsBlvd		Roseville	CA	95747	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	HIPAA Security Officer	Regional Info Security Officer	Ms.	Lancanshire	Andrew		9165413562					lancasa@sutterhealth.org	2750 Gateway Oaks		Sacramento	CA	95833	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Interoperability Contact	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	MA Appeals/Grievances Contact	QA Coordinator	Ms.	Robello-Kladde	Renee	C	8335607223				9164913408	RobellRC@sutterhealth.org	444 N. 3rd Street	Suite 150	Sacramento	CA	95823	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	MA Claims Processing Contact for Public Website	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Marketing Contact	Regional Manager, Market Development	Ms.	Grefrath	Lynette		8335607223				9164913408	grefral@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	08/10/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Medical Director	Medical Director	MD	Khalsa	Maninder		8335607223					KhalsaM@sutterhealth.org	444 North 3rd Street, Ste 150		Sacramento	CA	95811	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Medicare Compliance Officer	Compliance Officer	Ms.	Yau	Allison	Y	5303011499					Allison.Yau@sutterhealth.org	2880 Gateway Oaks Dr	Sutter Health Office of General Counsel,  Ethics & Comp	Sacramento	CA	95833	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Medicare Coordinator	Compliance Officer	Ms.	Yau	Allison	Y	5303011499					Allison.Yau@sutterhealth.org	2880 Gateway Oaks Dr	#407	SACRAMENTO	CA	95833	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Medicare Part D Opioid Overutilization Contact	Medical Director	MD	Khalsa	Maninder		8335607223					KhalsaM@sutterhealth.org	444 North 3rd Street, Ste 150		Sacramento	CA	95811	05/03/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Medication Therapy Management Contact	Medical Director	Dr.	Khalsa	Maninder		8335607223					KhalsaM@sutterhealth.org	444 North 3rd Street	Ste 150	Sacramento	CA	95811	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Part C Application Contact	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Part D Appeals	Finance Manager	Mr.	Salas	Rafael						9164916408	salasr@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active	8335607223				PACE - Nat		C	San Francisco
H5406	Part D Appeals Contact (Secondary)	Finance Manager	Mr.	Salas	Rafael						9164916408	salasr@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active	8335607223				PACE - Nat		C	San Francisco
H5406	Part D Application Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Part D Benefits Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Part D Claims Submission Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Part D Exceptions Contact	Finance Manager	Mr.	Salas	Rafael						9164916408	salasr@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active	8335607223				PACE - Nat		C	San Francisco
H5406	Part D Exceptions Contact (Secondary)	Executive Director	Ms.	Erdmann	Julie	A					9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active	8335607223				PACE - Nat		C	San Francisco
H5406	Part D Price File Contact (Back-up)	Medical Director	MD	Khalsa	Maninder		8335607223					KhalsaM@sutterhealth.org	444 North 3rd Street, Ste 150		Sacramento	CA	95811	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Part D Price File Contact (Primary)	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Part D Quality Assurance Contact	Quality Coordinator	Ms.	Robello-Kladde	Renee		9164913406					RobellRC@sutterhealth.org	444 N 3rd St	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Part D Reporting Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Patient Safety Contact	Quality Coordinator	Ms.	Robello-Kladde	Renee		9164913406					RobellRC@sutterhealth.org	444 N 3rd St	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Payment Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Pharmacy Director	Regional Pharmacy Director	Mr.	Stice	Ryan		9168777047					sticer@sutterhealth.org	2700 Gateway Oaks		Sacramento	CA	95833	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Pharmacy Network Management Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Pharmacy Network Management Contact (Secondary)	Regional Pharmacy Director	Mr.	Stice	Ryan		9168777047					sticer@sutterhealth.org	2700 Gateway Oaks		Sacramento	CA	95833	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Pharmacy Technical Help Desk Contact	Project & Technical Services Coordinator	Ms.	Burgess	Jewel						9164913484	burgesjr@sutterhealth.org	444 North 3rd Street	Ste 150	Sacramento	CA	95811	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active	8335607223				PACE - Nat		C	San Francisco
H5406	Pharmacy Technical Help Desk Contact (Secondary)	Accounting Technician	Ms.	Aceves	Maria						9164913484	acevesm@sutterhealth.org	444 North 3rd Street	Ste 150	Sacramento	CA	95811	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active	8335607223				PACE - Nat		C	San Francisco
H5406	PHR Beneficiary Contact																	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE	Sutter SeniorCare PACE	Sutter Valley Hospitals	222	Yes	Active	8335607223				PACE - Nat		C	San Francisco
H5406	Plan Directory Contact for Public Website	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Plan to Plan Reconciliation Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Processor Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Quality Contact	Quality Coordinator	Ms.	Robello-Kladde	Renee		9164913406					RobellRC@sutterhealth.org	444 N 3rd St	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Reconciliation Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Reconciliation Contact (Secondary)	Accounting Technician	Ms.	Aceves	Maria		8335607223				9164916408	acevesm@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Recovery Audit Contact	Finance Manager	Mr.	Salas	Rafael		9164913415				9164916408	salasr@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Surveillance Contact	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	System Contact	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Third Party Administrator (TPA) Liaison	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	User Access Contact	Finance Manager	Mr.	Salas	Rafael		9164913415					salasr@sutterhealth.org	444 N 3rd Street	Suite 150	Sacramento	CA	95811	04/28/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Utilization Management Contact	Medical Director	MD	Khalsa	Maninder		8335607223					KhalsaM@sutterhealth.org	444 North 3rd Street, Ste 150		Sacramento	CA	95811	05/18/2021	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5406	Utilization Review Contact	Executive Director	Ms.	Erdmann	Julie	A	8335607223				9164913408	Julie.Erdmann@sutterhealth.org	444 North 3rd Street	Suite 150	Sacramento	CA	95811	11/08/2022	2023	SUTTER VALLEY HOSPITALS	National PACE	Sutter SeniorCare PACE	National PACE		Sutter Valley Hospitals	222	Yes	Active					PACE - Nat		C	San Francisco
H5410	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/14/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H5410	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H5410	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H5410	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H5410	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H5410	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H5410	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5410	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING OF FLORIDA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5420	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H5420	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H5420	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H5420	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H5420	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5420	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	Preferred Care Network, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5422	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/11/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/11/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H5422	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H5422	PHR Beneficiary Contact																	02/07/2019	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H5422	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5422	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	BLUE CROSS BLUE SHIELD HEALTHCARE PLAN OF GEORGIA	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5425	Agent/Broker Compensation Data Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Automated TrOOP Balance Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189				mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Backup User Access Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Best Available Evidence Contact	Director, Enrollment & Reconciliation		Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/28/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Bid Audit Contact	CVP Strategic Iniatives & Product Development	Ms	Selby	Jill		5629898382					jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Bid Audit Site Contact	CVP Strategic Initiatives & Product Development	Ms	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/09/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Bid Primary Contact	CVP Strategic Initiatives & Product Development	Ms	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	CAP Report Contact for Public Website	Chief Operating Officer	Ms.	Monk	Nancy		5629898320				5629895225	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	CEO - CMS Administrator Contact	President, Medicare	Mrs.	Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	CEO - Senior Official for Contracting	Chief Executive Officer	Dr,	Jain	Sachin		5929898314				5629895225	sjain@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/30/2020	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Chief Financial Officer	Chief Financial Officer	Mr	Plumb	Michael		5629971589					MPlumb@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	11/02/2020	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Chief Operating Officer	Chief Operating Officer	Mrs.	Monk	Nancy		5629898320				5629895225	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Chief Information Officer	Chief Information Officer	Mr.	Goode	Josh		5623082789					jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/08/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Chief Information Security Officer	Chief Information Officer	Mr.	Goode	Josh		5623082789				5629895225	jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	CMS Casework Communication Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Complaints Tracking Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Contact for Fraud Investigations	Chief Risk Executive		Hawkins	Ginette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	03/07/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Coordination of Benefits Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189				mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Corporate Mailing						5629895100				5629895200	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/11/2012	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	Isaac	Sharon		5629894423					sisaac@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2018	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Customer Service Operations Contact	Director, (Customer) Member Services	Ms.	McBeath	Kim		5629971805				5629895181	kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/27/2014	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	DIR Contact	Financial Accounting Specialist	Ms.	McClour	Tina		5625083546					tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/21/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	DIR Contact (Secondary)	Manager Revenue Accounting	Ms.	Moreno	Sonia		5623081122					smoreno@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	03/03/2016	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Emergency Part D Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		3237027662				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/21/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Emergency Part D Contact (Secondary)	Director,  Technical Pharmacy Operations	Ms.	Vaca	Ivette		5622091104				5629973196	ivaca@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/22/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Employer Waiver Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Encounter Data & Risk Adjustment Operations Contact	Chief Data Officer		Leung	Moon		5629895269					mleung@scanhealthplan.com	3800 Kilroy Airport Way suite 100		Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Enrollment Contact	Director, Enrollment & Reconciliation		Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/28/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	EOB Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189				5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Financial Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Financial Reporting Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/11/2012	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Formulary Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Formulary Contact (Secondary)	Clinical Pharmacist	Ms.	Truong	Weilan		5629973187				5629973196	wtruong@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/03/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	General Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Government Relations Contact	VP of Government Relations		Hill	Ryann		2023499008				5629899439	rhill@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	HIPAA Privacy Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835					a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	HIPAA Security Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835					a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Hospice Contact	Manager, Pharmacy Experience & Access	Mr.	Tran	Tri		5623082884				5629973196	TMTran@scanhealthplan.com	3800 Kilroy Airport Way		Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Interoperability Contact	VP, IT Software & Services	Mr.	Carren	Marc		5629971821					mcarren@scanhealthplan.com	3800 Kilroy Airport Way, Suite 100		Long Beach	CA	90806	02/10/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	MA Appeals/Grievances Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	MA Claims Processing Contact for Public Website	Vice President, Claims & Shared Services	Mr.	Wheeler	Nathan		5623084341					nwheeler@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Marketing Contact	Compliance Specialist	Mr.	Lin	Richard		5623081156					rlin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	10/02/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Medical Director	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431				5629899439	RBatraM.D@scanhelathplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Medicare Compliance Officer	Compliance Officer	Ms.	Hawkins	Ginette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/23/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Medicare Coordinator	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist Programs	Ms.	Kelley	Mackenzie		5629973165				5629973196	mkelley@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/26/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Medication Therapy Management Contact	Director Pharmacy Quality & 5 Star	Mr.	Dinh	Matthew		5629895261				5629973196	mdinh@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/03/2020	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	OffShore Subcontractor Contact	Dir, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131					ecordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment and Reconciliation	Ms.	Gongora	Irene		5629895209				5629895243	IGongora@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/31/2015	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Online Enrollment Center Contact (Primary)	Director, Enrollment & Reconciliation	Mr.	Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Part C Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Part C Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Part D Appeals	Director, Grievance & Appeals	Ms.	Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way MS 220		Long Beach	CA	90801	02/02/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	5629895100	1290			HMO - Health Maintenance Organization		C	San Francisco
H5425	Part D Appeals Contact (Secondary)	Director, Grievance & Appeals		Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way MS 220		Long Beach	CA	90801	01/11/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	5629895100	1290			HMO - Health Maintenance Organization		C	San Francisco
H5425	Part D Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Part D Benefits Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	04/29/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Part D Exceptions Contact	Senior Pharmacy Manager	Mr.	Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/01/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	San Francisco
H5425	Part D Price File Contact (Back-up)	Manager, Regulated Markets Product		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfiled	OH	45014	04/11/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Part D Price File Contact (Optional)	Pharmacy Analyst		Ramirez	Anthony		5623084348	4347				a.ramirez@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Part D Price File Contact (Primary)	Sr. Manager, Regulated Markets		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	04/11/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Part D Quality Assurance Contact	CVP/Chier Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Part D Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Patient Safety Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Payment Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/11/2012	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Pharmacy Director	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Pharmacy Network Management Contact	Network Acct Director, Retail Strategy	Ms.	Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		St Louis	MO	63121	01/23/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkwy	STE 150	Temple Terrace	FL	33637	12/01/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	San Francisco
H5425	Physician Incentive Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Plan Directory Contact for Public Website	Director, (Customer) Member Services	Ms.	McBeath	Kim		8777787226					kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/03/2020	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Plan to Plan Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	P2PAdmin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/09/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Processor Contact	Senior Director Government Programs, Medicare	Ms.	Gibson	Sharon		8052361175					sggibson@express-scripts.com	One Express Way		St. Louis	MO	63121	01/03/2018	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Quality Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/02/2015	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Reconciliation Contact (Secondary)	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Recovery Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	SNP Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	SNP State Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Surveillance Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	System Contact	Chief  Technology Exective	Mr.	Goode	Josh		5623082789					jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/27/2016	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Third Party Administrator (TPA) Liaison	Financial Accounting Specialist	Ms.	McClour	Tina		5629894459					tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2018	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	User Access Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Utilization Management Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431				5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5425	Utilization Review Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431				5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5427	Agent/Broker Compensation Data Contact	VP of Finance		Caruso	David		8135066000	11006				CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Automated TrOOP Balance Transfer Contact	Manager Pharmacy Clinical Ops		Marrocco	Brianna		8135066000	66072				PartD@freedomh.com	4200 W Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	04/19/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Best Available Evidence Contact	Vice President, Enrollment		Conner	Claudius		8134598739				8135066151	CMSEnrollment@freedomh.com	4200 W. Cypress Street		Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Bid Audit Contact	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Bid Audit Site Contact	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Bid Primary Contact	Product Management Director	Ms.	McKee	Heather		9043474771	351				Heather.McKee@anthem.com	3115 Trout Creek Court		St. Augustine	FL	32092	04/18/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	CAP Report Contact for Public Website	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	04/05/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	04/05/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Chief Operating Officer		Ms	Newman	Elena		3053420885					cms@freedomh.com	9250 W Flagler St		Miami	FL	33174	06/28/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	5800 Northampton Blvd		Norfolk	VA	23502	04/18/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	04/18/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	CMS Casework Communication Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Complaints Tracking Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	04/19/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Coordination of Benefits Contact	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Corporate Mailing						8135066000				8135066151	cms@freedomh.com	4200 W Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Acctg Database Analyst Sr		Racine	Max		8058163930					Max.Racine@Anthem.com	120 S Via Merida	Mail Stop: CAT202-J003	Thousand Oaks	CA	91362	04/22/2019	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Customer Service Operations Contact	Director of Member Services		Doroteo	Carlos		8135066000	11342			8135066150	CMSMemberServices@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	DIR Contact	Compliance Officer		Kortsch	Diane		4143369395					dkortsch@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/06/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	DIR Contact (Secondary)	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Emergency Part D Contact	Manager Pharmacy Clinical Ops		Marrocco	Brianna		7274516800	66072			8135066152	bmarrocco@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	01/20/2021	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Emergency Part D Contact (Secondary)	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Encounter Data & Risk Adjustment Operations Contact	Director - MRA Informatics		Shah	Parin		8135066000	11368				pshah@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Enrollment Contact	Vice President, Enrollment	Mr	Conner	Claudius		8134598739				8135066151	dmpatel@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	EOB Transfer Contact	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	PartDOps@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Financial Audit Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395					CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/06/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Financial Reporting Contact	VP of Finance		Caruso	David		8135066000	11006				CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Formulary Contact	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	PartD@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Formulary Contact (Secondary)	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	General Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395					cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Government Relations Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395					cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	HIPAA Privacy Officer	Privacy Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	04/18/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Hospice Contact	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	PartD@freedomh.com	2240 Belleair Road	Suite 250	Clearwater	FL	33764	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Interoperability Contact	Dir II Technology	Mr	Kumbhani	Dev		8135066000	11146				cms@freedomh.com	4200 Cypress St		Tampa	FL	33607	04/11/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	MA Appeals/Grievances Contact	Director Healthcare Management		Szabla	Sara		8135066000	11413				cms@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/02/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	MA Claims Processing Contact for Public Website	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Marketing Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Medical Director	Managing Medical Director	MD	Stern	Mark		8135066000	11214			8135066168	HealthServices@freedomh.com	5420 Bay Center Drive	Suite 200	Tampa	FL	33609	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	08/11/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Medicare Coordinator	Compliance Officer	Ms	Kortsch	Diane		4143369395					cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Medicare Part D Opioid Overutilization Contact	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	bmarrocco@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	01/08/2020	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Medication Therapy Management Contact	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	PartD@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Online Enrollment Center Contact (Back-up)			Cardona	Marie		8135066000	11157				CMSEnrollment@freedomh.com	3405 W. Dr. Martin Luther King Blvd.	Suite 250	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Online Enrollment Center Contact (Optional)	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Online Enrollment Center Contact (Primary)	Vice President, Enrollment		Conner	Claudius		8134598739				8135066151	CMSEnrollment@freedomh.com	4200 Cypress St		Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	04/18/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Part C Reporting Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Appeals	Pharmacist		Marrocco	Brianna						8135066152	bmarrocco@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	01/08/2020	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	7274516800	66072			HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Appeals Contact (Secondary)	Compliance Officer		Kortsch	Diane						8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	4143369395				HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	04/18/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Benefits Contact	Pharmacy Clinical Operations Manager		Marrocco	Brianna		8135066000	66072				cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/06/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Claims Submission Contact	Pharmacy Clinical Operations Manager		Marrocco	Brianna		8135066000	66072				cms@freedomh.com	4200 W Cypress St	Suite 800	Tampa	FL	33607	03/06/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Exceptions Contact	Pharmacist		Marrocco	Brianna						8135066152	bmarrocco@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33762	01/08/2020	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	7274516800	66072			HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Exceptions Contact (Secondary)	Compliance Officer		Kortsch	Diane						8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	4143369395				HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					daniela.mendez@carelon.com	1723 Loma Rd		Montebello	CA	90640	02/08/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Price File Contact (Optional)	Director II Technology		KUMBHANI	DEVCHAND		8135066000	11146				CMSTechsupport@freedomh.com	4200 W Cypress St		Tampa	FL	33607	05/10/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					amanda.nicholson-sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	02/08/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Quality Assurance Contact	Compliance Officer		Kortsch	Diane		4143369395					cms@freedomh.com	4200 Cypress St.	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Part D Reporting Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Patient Safety Contact	Managing Medical Director	Mr	Stern	Mark		8135066000	11214			8135066151	cms@freedomh.com	5420 Bay Center Drive	Suite 200	Tampa	FL	33609	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Payment Contact	Fin Acctg Database Analyst Sr	Mr.	Racine	Max	J	8058163930					Max.Racine@Anthem.com	2000 Corporate Center Drive	Mail Stop: CANP02-I001	Newbury Park	CA	91320	04/26/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Personal Health Record Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Pharmacy Director	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	PartD@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Pharmacy Network Management Contact	Director Of Operations-PR		Goluch	Adrian		8135066000	11354			8135066152	agoluch@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Pharmacy Network Management Contact (Secondary)	Compliance Officer		Kortsch	Diane		4143369395				8135066151	PartD@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Pharmacy Technical Help Desk Contact	Director Pharmacy Oversight		Warner	Raymond							raymond.warner@ingenio-rx.com	21215 Burbank Blvd		Woodland Hills	CA	91367	04/20/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774267				HMO - Health Maintenance Organization		C	Chicago
H5427	Pharmacy Technical Help Desk Contact (Secondary)	Manager Pharmacy Advocacy, Customer Service		Erbe	Michael						8135066152	PartD@freedomh.com	3515 Harbor Blvd.		Costa  Mesa	CA	92626	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8664431095				HMO - Health Maintenance Organization		C	Chicago
H5427	PHR Beneficiary Contact																	06/07/2010	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS	Freedom Health, Inc.	Elevance Health, Inc.	1	Yes	Active	8004012740				HMO - Health Maintenance Organization		C	Chicago
H5427	Physician Incentive Contact	Director GBD Finance	Mr	Caruso	David		8135066000	11006				cms@freedomh.com	4200 W Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Plan Directory Contact for Public Website	Director of Member Services		Doroteo	Carlos		8004012740					cms@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Plan to Plan Reconciliation Contact	P2P Contact		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd	Ste 100 Mailstop CA9304-R04H	Woodland Hills	CA	91367	06/14/2021	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Processor Contact	Director II Technology		KUMBHANI	DEVCHAND		8135066000	11146				CMSTechsupport@freedomh.com	4200 W Cypress St		Tampa	FL	33607	05/10/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Quality Contact	Director Quality Management		Patel	Shetal		8135066000	11413				HealthServices@freedomh.com	5420 Bay Center Drive	Suite 100	Tampa	FL	33609	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Reconciliation Contact	Compliance Officer		Kortsch	Diane		4143369395					CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/06/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Reconciliation Contact (Secondary)	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Recovery Audit Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	04/18/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	SNP State Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395					cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Surveillance Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	System Contact	Director II Technology	Mr	KUMBHANI	DEVCHAND		8135066000	11146				CMSTechsupport@freedomh.com	4200 W Cypress St		Tampa	FL	33607	05/10/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Third Party Administrator (TPA) Liaison	Finance Acctg Database Analyst Sr		Racine	Max		8058163930					Max.Racine@Anthem.com	120 S Via Merida	Mail Stop: CAT202-J003	Thousand Oaks	CA	91362	04/22/2019	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	User Access Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395					cms@freedomh.com	4200 W Cypress St		Tampa	FL	33607	04/19/2023	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Utilization Management Contact	Director Healthcare Management		Szabla	Sara		8135066000	11409				HealthServices@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/02/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5427	Utilization Review Contact	Director Healthcare Management		Szabla	Sara		8135066000	11409				HealthServices@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/02/2022	2023	FREEDOM HEALTH, INC.	Local CCP	Freedom Health, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5430	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Corporate Mailing						8132063477					crysten.troutman@wellcare.com	P. O. Box 31386		Tampa	FL	33631	02/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Employer Waiver Contact	Director, Product Management		Henao	Angela		8132063757					product_SNP@wellcare.com	8725 Henderson Road	Ren 1	Tampa	FL	33634	02/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Government Relations Contact	Vice President, Complex Care Products	Ms.	Arden	Gale		3147254477	47759				garden@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	04/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	MA Claims Processing Contact for Public Website	Senior Director, Claims Operations		Everett	Thomas		8888889355					WebClaimsInquiries@wellcare.com	5520 Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	OffShore Subcontractor Contact	Manager, Regulatory Compliance		Wilson	Ashley		3145056491					Ashley.L.Wilson@centene.com	7676 Forsyth Blvd.		St. Louis	MO	63105	11/07/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Online Enrollment Center Contact (Primary)	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Benefits Contact	Supervisor, Clinical Audit (Pharmacy)	Mr.	Mantella	Jason		4084574913					giacinto.mantella@centene.com	1850 W. Rio Salado Pkwy. Suite 211		Tempe	AZ	85281	04/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H5430	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Lugge	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H5430	Physician Incentive Contact	Sr. Director, Contracting & Network Development	Mr.	Figueroa	Jaime	J	3145056543					Jaime.J.Figueroa@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Quality Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	04/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Utilization Management Contact	Deputy Chief Medical Officer		Shaps	Howard		3145191783					Howard.Shaps@wellcare.com	13551 Triton Park Blvd, Ste 120		Louisville	KY	40223	02/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5430	Utilization Review Contact	Deputy Chief Medical Officer		Shaps	Howard		3145191783					Howard.Shaps@wellcare.com	13551 Triton Park Blvd, Ste 120		Louisville	KY	40223	02/01/2021	2023	ONE CARE BY CARE1ST HEALTH PLAN OF ARIZONA, INC.	Local CCP	WellCare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5431	Agent/Broker Compensation Data Contact	Director I, Compliance	Mrs.	Abreu	Inez	B	7864494677				3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Automated TrOOP Balance Transfer Contact	Data Analyst	Mr.	Roberts	Jerryon		3052349292	250				Jerryon_Roberts@Health-Sun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/09/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	04/19/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Best Available Evidence Contact	Florida Medicare President	Ms.	Newman	Elena		3059212623				3054603907	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/27/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Bid Audit Contact	Medical Economics Director	Ms.	Campo	Cecile		3052349292	351				HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Bid Audit Site Contact	Director II Compliance	Mrs.	Troutman	Crysten		8134864656					HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Bid Primary Contact	Product Management Director	Ms.	McKee	Heather		9043474771	351				Heather.McKee@anthem.com	3115 Trout Creek Court		St. Augustine	FL	32092	05/23/2019	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	CAP Report Contact for Public Website	Director II, Compliance	Mrs.	Troutman	Crysten		8134864656					HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	02/17/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/15/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/17/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Chief Operating Officer	Florida Medicare President	Ms.	Newman	Elena		3059212623				3054603907	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/27/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	5800 Northampton Blvd		Norfolk	VA	23502	03/29/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Chief Information Security Officer		Mr.	Senges	Daniel		3054488100	316				HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	CMS Casework Communication Contact	Director I, Compliance	Mrs.	Abreu	Inez	B	7864494677				3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Complaints Tracking Contact	Director I, Compliance	Mrs.	Abreu	Inez	B	7864494677				3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	04/26/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Coordination of Benefits Contact	Payment Integrity Manager, Claims	Ms.	Tortora	Idany		3054488100	262			3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Corporate Mailing						3052349292				3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Coverage Gap Discount Program (CGDP) Payment Contact	Fin Acctg Database Analyst Sr	Mr.	Racine	Max	J	8058163930					Max.Racine@Anthem.com	2000 Corporate Center Drive	Mail Stop: CANP02-I001	Newbury Park	CA	91320	05/20/2020	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Customer Service Operations Contact	Member Services Manager	Ms.	Gallardo	Viviana		3054488100	559			3054449148	cms_memberservices@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	DIR Contact	Medical Economics Director	Ms.	Campo	Cecile		3052349292	351				HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	DIR Contact (Secondary)	Director I, Compliance	Mrs.	Abreu	Inez	B	7864494677				3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Emergency Part D Contact	Director Clinical Programs		Martinez	Massiel		3059260380					cms_partd@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/27/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Emergency Part D Contact (Secondary)	Director II Compliance	Mrs.	Troutman	Crysten		8134864656					HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Encounter Data & Risk Adjustment Operations Contact	Compliance Manager Medicare Risk & Recovery		Cabrera	Patricia		6148806257					Patricia.Cabrera@anthem.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Enrollment Contact	Director of Operations	Mrs.	Danese	Annette		3054211970				3056750652	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	EOB Transfer Contact	Data Analyst	Mr.	Roberts	Jerryon		3052349292	250			3054449148	cms_troop@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Formulary Contact	Director of the Med D CPOps	Mr.	Vercueil	Alfonso		9492336807					Alfonso.Vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Formulary Contact (Secondary)	Director Clinical Programs		Martinez	Massiel		3054488100	353				cms_partd@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	General Contact	VP, Medicare Compliance	Ms.	Turano	Michelle		8138306984					MedicareCO@anthem.com	4200 W. Cypress Street		Tampa	FL	33607	08/24/2020	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Government Relations Contact	Director II Compliance	Mrs.	Troutman	Crysten		8134864656					HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	08/09/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/26/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	HIPAA Security Officer	Director II, Technology	Ms.	Hernandez	Raquel		3057999347					HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	11/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Hospice Contact	Director Clinical Programs		Martinez	Massiel		3054488100	353				cms_partd@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Interoperability Contact	Director II, Technology	Ms.	Hernandez	Raquel		3057999347					HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	05/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	MA Appeals/Grievances Contact	Grievances and Appeals Manager	Ms.	Anda	Diana		3058045087				3054603907	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	MA Claims Processing Contact for Public Website	HealthSun Provider Inquiry		Inquiry	Provider		8779997776				7863935722	Provider_Call_Unit@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/04/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Marketing Contact	Director I, Compliance	Mrs.	Abreu	Inez	B	7864494677				3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Medical Director	Chief Medical Officer	Dr.	Rios, D.O.	Jeannette	M	7868310456				3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Medicare Compliance Officer	VP, Compliance	Ms.	Turano	Michelle		8138306984					MedicareCO@anthem.com	4200 W. Cypress Street		Tampa	FL	33607	02/04/2019	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Medicare Coordinator	VP, Medicare Compliance	Ms.	Turano	Michelle		8138306984					MedicareCO@anthem.com	4200 W. Cypress Street		Tampa	FL	33607	08/24/2020	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341					CMSRx@Carelon.com	740 W Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Medication Therapy Management Contact	Director Clinical Programs		Martinez	Massiel		3054488100	353				cms_partd@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Online Enrollment Center Contact (Back-up)	Operations Expert	Mr.	Rivera	Alexander		3054488100	297			3056750652	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Online Enrollment Center Contact (Optional)	Director I, Compliance	Mrs.	Abreu	Inez	B	7864494677				3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/10/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Online Enrollment Center Contact (Primary)	Director of Operations	Mrs.	Danese	Annette		3054211970				3056750652	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Part C Application Contact	Director, Medicare Compliance Strategy		Meidl	Chris		9209238340					christopher.meidl@anthem.com	N17 W24340 Riverwood Drive	Mail Drop WIW901-A250	Waukesha	WI	53188	02/28/2019	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Part C Reporting Contact	Director II Compliance	Mrs.	Troutman	Crysten		8134864656					HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Appeals	Grievance and Appeals Manager	Ms.	Anda	Diana						3054603907	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8773362069				HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Appeals Contact (Secondary)	Director Clinical Programs		Martinez	Massiel						3054449148	cms_partd@healthsun.com	9250 W. Flagler Street	Suite 400	Coconut Grove	FL	33134	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8773362069				HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Application Contact	Director, Medicare Compliance Strategy		Meidl	Chris		9209238340					christopher.meidl@anthem.com	N17 W24340 Riverwood Drive	Mail Drop WIW901-A250	Waukesha	WI	53188	02/28/2019	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Benefits Contact	Director Clinical Programs		Martinez	Massiel		3054488100	353				cms_partd@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Claims Submission Contact	Director Clinical Programs		Martinez	Massiel		3054488100	353				cms_partd@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/04/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Exceptions Contact	Appeals and Grievances Manager		Anda	Diana							cms_memberservices@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8773362069				HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Exceptions Contact (Secondary)	Operations Director II	Ms.	Williford	Elayne						3054603907	cms_memberservices@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/04/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8773362069				HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Price File Contact (Optional)	Director Clinical Programs		Martinez	Massiel		3054488100	353				cms_partd@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Quality Assurance Contact	Clinical Quality Program Administrator	Ms.	Pratt	Gina		3054488100	10378			3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Part D Reporting Contact	Director II Compliance	Mrs.	Troutman	Crysten		8134864656					HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Patient Safety Contact	Director Clinical Programs		Martinez	Massiel		3054488100	353				cms_partd@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Payment Contact	Fin Acctg Database Analyst Sr	Mr.	Racine	Max	J	8058163930					Max.Racine@Anthem.com	2000 Corporate Center Drive	Mail Stop: CANP02-I001	Newbury Park	CA	91320	08/09/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Pharmacy Director	Director Clinical Programs		Martinez	Massiel		3054488100	353				cms_partd@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Pharmacy Network Management Contact	Director Clinical Programs		Martinez	Massiel		3054488100	353				cms_partd@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	12/10/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Pharmacy Network Management Contact (Secondary)	Florida Medicare President	Ms.	Newman	Elena		3059212623				3054603907	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/27/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Pharmacy Technical Help Desk Contact	Director Pharmacy Oversight	Mr.	Warner	Raymond							darren.gettings@Ingenio-RX.com	21215 Burbank Blvd		Woodland Hills	CA	91367	04/20/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H5431	Pharmacy Technical Help Desk Contact (Secondary)	Florida Medicare President	Ms.	Newman	Elena							HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/27/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8773362069				HMO - Health Maintenance Organization		C	Chicago
H5431	Plan Directory Contact for Public Website	HealthSun Member Services		Services	Member		8773362069				3054485783	MemberServicesStaff@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/04/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	06/14/2021	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Processor Contact	Operations Director II	Ms.	Williford	Elayne		3054488100	10630			3054603907	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Quality Contact	Clinical Quality Program Administrator	Ms.	Pratt	Gina		3054488100	10378			3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Reconciliation Contact	Florida Medicare President	Ms.	Newman	Elena		3059212623				3054603907	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/27/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Recovery Audit Contact	Director II, Compliance	Mrs.	Troutman	Crysten		8134864656					HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	SNP Application Contact	Director, Medicare Compliance Strategy		Meidl	Chris		9209238340					christopher.meidl@anthem.com	N17 W24340 Riverwood Drive	Mail Drop WIW901-A250	Waukesha	WI	53188	02/28/2019	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Surveillance Contact	Director I, Compliance	Ms.	Abreu	Inez		7864494677				3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	System Contact	Florida Medicare President	Ms.	Newman	Elena		3059212623				3054603907	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/27/2023	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Third Party Administrator (TPA) Liaison	Medical Economics Director	Ms.	Campo	Cecile		3052349292	351				HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	User Access Contact	Director I, Compliance	Mrs.	Abreu	Inez	B	7864494677				3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Utilization Management Contact	Director Medical management	Mr.	Pedroso	Luisisney		3054488100	10241			3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5431	Utilization Review Contact	Director, Medical Management	Mr.	Vazquez	Guillermo		3054488100	346			3054449148	HSComplianceMailbox@healthsun.com	9250 W. Flagler Street	Suite 600	Miami	FL	33174	01/12/2022	2023	HEALTHSUN HEALTH PLANS, INC.	Local CCP	HealthSun Health Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5433	Agent/Broker Compensation Data Contact	Manager		Gomez	Gisela		7142468757					ggomez@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Zlotkus	Steve		8587906250				8587906052	PartDCAT@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Backup User Access Contact	Manager		Gomez	Gisela		7142468757					ggomez@caloptima.org	505 City Parkway West		Orange	CA	92868	02/24/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Best Available Evidence Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Bid Audit Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Bid Audit Site Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Bid Primary Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	CAP Report Contact for Public Website	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Hunn	Michael		9493380005					michael.hunn@caloptima.org	505 City Parkway West		Orange	CA	92868	12/14/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Hunn	Michael		6579001481					michael.hunn@caloptima.org	505 City Parkway West		Orange	CA	92868	03/08/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Chief Financial Officer	Chief Financial Officer	Ms.	Huang	Nancy		6572356935					nhuang@caloptima.org	505 City Parkway West		Orange	CA	92868	12/10/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Chief Operating Officer	Chief Operating Officer	Ms.	Kim	Yunkyung		7142468408					yunkyung.kim@caloptima.org	505 City Parkway West		Orange	CA	92868	11/30/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Chief Information Officer	Chief Information Officer	Mr.	Younan	Wael		6579001154					wael.younan@caloptima.org	505 City Parkway West		Orange	CA	92868	04/25/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Chief Information Security Officer	Chief Information Security Officer	Mr.	Younan	Wael		6579001154					wael.younan@caloptima.org	505 City Parkway West		Orange	CA	92868	04/25/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	CMS Casework Communication Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468471				7142468649	kgericke@caloptima.org	CalOptima	505 City Parkway West	Orange	CA	92868	02/22/2013	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Complaints Tracking Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Contact for Fraud Investigations	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Coordination of Benefits Contact			Cardenas	Albert		7142468878					COBinquiries@caloptima.org	505 City Parkway West		Orange	CA	92868	04/21/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Corporate Mailing						6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Coverage Gap Discount Program (CGDP) Payment Contact	Controller	Mr.	Kaing	Jason		6579001373					jason.kaing@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Customer Service Operations Contact	Interim Executive Director, Operations	Ms.	Khamseh	Ladan		7142468866					lkhamseh@caloptima.org	505 City Parkway West		Orange	CA	92868	09/16/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	DIR Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	02/17/2012	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	DIR Contact (Secondary)	Program Specialist		Kurth	Jennifer		7142468767					jkurth@caloptima.org	505 City Parkway West		Orange	CA	92868	03/08/2016	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Electronic Health Record Contact	Director, Information Services		Onishi	Nora		7142468630					nonishi@caloptima.org	505 City Parkway West		Orange	CA	92868	12/10/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Emergency Part D Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7148150329				7142468649	kgericke@caloptima.org	CalOptima	505 City Parkway West	Orange	CA	92868	02/22/2013	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Emergency Part D Contact (Secondary)	Manager		Li	Tina		6579001173					tina.li@caloptima.org	505 City Parkway West		Orange	CA	92868	01/05/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Encounter Data & Risk Adjustment Operations Contact	Director, Financial Compliance		Klipfel	Kelly		7142468528					kklipfel@caloptima.org	505 City Parkway West		Orange	CA	92868	12/10/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Enrollment Contact	Manager		Gomez	Gisela		7142468757					ggomez@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	EOB Transfer Contact	Director, Clinical Pharmacy Mangement		Gericke	Kristin		7142468471				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Financial Audit Contact	Director, Regulatory Affairs & Compliance Medicare	Ms.	Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Financial Reporting Contact	Controller	Mr.	Kaing	Jason		6579001373					jason.kaing@caloptima.org	505 City Parkway West		Orange	CA	92868	06/29/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Formulary Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	02/22/2013	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Formulary Contact (Secondary)	Manager		Li	Tina		6579001173					tina.li@caloptima.org	505 City Parkway West		Orange	CA	92868	01/05/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	General Contact	Director, Regulatory Affairs & Compliance		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	06/06/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Government Relations Contact	Manager		Gomez	Gisela		7142468757					ggomez@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	HIPAA Privacy Officer	Director, Privacy		Ho	Fay		7142468892					fho@caloptima.org	505 City Parkway West		Orange	CA	92868	09/08/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	HIPAA Security Officer	Director, Privacy		Ho	Fay		7142468892					fho@caloptima.org	505 City Parkway West		Orange	CA	92868	09/08/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Hospice Contact	Director, Clinical Pharmacy Management		Gericke	Kris		7142468460					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Interoperability Contact	IT Project Manager, Sr	Mr.	DeFrain	Phil		7142468477					pdefrain@caloptima.org	505 City Parkway West		Orange	CA	92868	01/04/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	MA Appeals/Grievances Contact	Director, Grievances & Appeals Resolution Services		Moses	Tyronda		6579338407					tyronda.moses@caloptima.org	505 City Parkway West		Orange	CA	92868	09/16/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	MA Claims Processing Contact for Public Website	Director, Claims Administration		Tungol	Cesar		7147966141					ctungol@caloptima.org	505 City Parkway West		Orange	CA	92868	12/10/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Marketing Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Medical Director	OneCare Medical Director	Dr.	Arabo	Steven		6572356890					steven.arabo@caloptima.org	505 City Parkway West		Orange	CA	92868	04/27/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Medicare Compliance Officer	Director of Regulatory Affairs and Compliance, Med	Ms.	Phillips	Annie		6572356994					medicarecomplianceofficer@caloptima.org	505 City Parkway West		Orange	CA	92868	07/21/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Medicare Coordinator	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Medicare Part D Opioid Overutilization Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/31/2018	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Medication Therapy Management Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	02/22/2013	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	OffShore Subcontractor Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Online Enrollment Center Contact (Back-up)	OneCare Customer Service Department		Garcia	Jesse		8774122734					onecareenrollment@caloptima.org	505 City Parkway West		Orange	CA	92868	11/09/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Online Enrollment Center Contact (Optional)	OneCare Customer Service Department		Partners	OneCare		8774122734					onecareenrollment@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Online Enrollment Center Contact (Primary)	OneCare Customer Service Department		Cardenas	Albert		8774122734					onecareenrollment@caloptima.org	505 City Parkway West		Orange	CA	92868	11/09/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Part C Application Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Part C Reporting Contact	Manager		Gomez	Gisela		7142468757					ggomez@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Appeals	Director, Clinical Pharmacy Management		Gericke	Kristin						7144816459	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	03/24/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active	7142468460				HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Appeals Contact (Secondary)	Manager		Li	Tina							tina.li@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active	6579001173				HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Application Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Benefits Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	02/22/2013	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Claims Submission Contact			Rivera-Aquino	Denisse		8582915269					PDE@Medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Exceptions Contact	Director, Clinical Pharmacy Management		Gericke	Kristin						7142468649	kgericke@caloptima.org	CalOptima	505 City Parkway West	Orange	CA	92868	02/22/2013	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active	8774122734				HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Exceptions Contact (Secondary)	Manager		Li	Tina							tina.li@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active	6579001173				HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Price File Contact (Back-up)	Medicare Part D Manager		Keller	Shanon		8587906455				8587906038	planfindercommunications@medImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	04/16/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Price File Contact (Optional)	Medicare Part D Manager		Keller	Shanon		8587906455				8587906038	planfindercommunications@medImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	04/16/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Price File Contact (Primary)	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	02/22/2013	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Quality Assurance Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	02/22/2013	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Part D Reporting Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Patient Safety Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	02/22/2013	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Payment Contact	Controller	Mr.	Kaing	Jason		6579001373					jason.kaing@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Pharmacy Director	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	02/22/2013	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Pharmacy Network Management Contact	Manager, PNS & Claims Operations		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/28/2015	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Pharmacy Network Management Contact (Secondary)	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services		Brewer	Kathy							customerservice@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active	8008195532				HMO - Health Maintenance Organization		C	San Francisco
H5433	Pharmacy Technical Help Desk Contact (Secondary)	Director, Clinical Pharmacy Management		Gericke	Kristin						7142468649	kgericke@caloptima.org	CalOptima	505 City Parkway West	Orange	CA	92868	02/22/2013	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active	8774122734				HMO - Health Maintenance Organization		C	San Francisco
H5433	Physician Incentive Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Plan Directory Contact for Public Website			Service	Customer		8774122734					acardenas@caloptima.org	505 City Parkway West		Orange	CA	92868	02/28/2017	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Plan to Plan Reconciliation Contact	Controller	Mr.	Kaing	Jason		6579001373					p2p@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Processor Contact	Director, Medicare Programs		Davis-Jones	De'Lona	M	8587906229					DeLona.Davis-Jones@Medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Quality Contact	Executive Director, Quality Improvement		Lee	Linda		6579001069					Linda.lee@caloptima.org	505 City Parkway West		Orange	CA	92868	04/27/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Reconciliation Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	03/11/2015	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Reconciliation Contact (Secondary)	Controller	Mr.	Kaing	Jason		6579001373					jason.kaing@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Recovery Audit Contact	Director, Regulatory Affairs & Compliance Medicare	Ms.	Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	SNP Application Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	SNP State Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Surveillance Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	System Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Third Party Administrator (TPA) Liaison	Controller	Mr.	Kaing	Jason		6579001373					jason.kaing@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	User Access Contact	Manager		Gomez	Gisela		7142468757					ggomez@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Utilization Management Contact	Executive Director		Giardina	Kelly		6579001013					kelly.giardina@caloptima.org	505 City Parkway West		Orange	CA	92868	09/08/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5433	Utilization Review Contact	Executive Director		Giardina	Kelly		6579001013					Kelly.giardina@caloptima.org	505 City Parkway West		Orange	CA	92868	09/08/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	Local CCP	CalOptima Health OneCare	HMO/HMOPOS		Orange County Health Authority	39	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5434	Agent/Broker Compensation Data Contact	VP FBM Growth Strat & Enable		Davis	Andrea		8478265793					andrea.davis@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	11/29/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Automated TrOOP Balance Transfer Contact	Manager, PBM operations	Ms.	Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/27/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Backup User Access Contact	Corporate Compliance Specialist		Figueroa	Carmen		9049056658					carmen.figueroa@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Best Available Evidence Contact	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	01/24/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Bid Audit Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Bid Audit Site Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Bid Primary Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	CAP Report Contact for Public Website	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/24/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	CEO - CMS Administrator Contact	EVP Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 400	Jacksonville	FL	32246	01/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	CEO - Senior Official for Contracting	EVP, Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 100, 8th Flr	Jacksonville	FL	32246	01/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Chief Financial Officer	SVP and CFO	Mr.	Justice	Thurman		9049055085					Thurman.Justice@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 8th Floor	Jacksonville	FL	32246	08/21/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Chief Operating Officer	EVP, Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 100, 8th Flr	Jacksonville	FL	32246	11/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Chief Information Officer	SVP Chief Information Officer	Mr.	Anderson	Gary		9049050180					gary.anderson@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 8th Floor	Jacksonville	FL	32246	01/27/2016	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Chief Information Security Officer	VP Chief Information & Security Officer	Mr.	Raymond	Jason		9049050070					jason.raymond@floridablue.com	4800 Deewood Campus Parkway	DCC Building 600, 2nd Floor	Jacksonville	FL	32246	08/11/2016	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	CMS Casework Communication Contact	Sr Manager Med Ops & Integrity		Irizarry	Haydee		3212330635					Haydee.Irizarry@bcbsfl.com	4800 Deerwood Campus Parkway	Bldg. 400 2nd Floor	Jacksonville	FL	32246	04/25/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Complaints Tracking Contact	Sr Manager Med Ops & Integrity		Irizarry	Haydee		3212330635					Haydee Irizarry@bcbsfl.com	4800 Deerwood Campus Parkway	Bldg. 400 2nd Floor	Jacksonville	FL	32246	04/25/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Contact for Fraud Investigations	Manager II Data Integrity & SIU		Ramos	Jose		9049055835					jose.romas@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 400, 6th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Coordination of Benefits Contact	Manager PBM Operations		Hanson	Michelle		6127776755				3127776706	COBMedD@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	02/16/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Corporate Mailing						9049054668					Hillary.Simpson@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	03/16/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant III, Corporate Receivables		Avis	Tammi		9049054034					Tammi.Avis@bcbsfl.com	4800 Deerwood Campus Pkwy	Bldg 100, 5th Floor	Jacksonville	FL	32246	04/25/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Customer Service Operations Contact	Sr Director Member Contact		Gamble	LaTonya		9049052057					latonya.gamble@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	DIR Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/24/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	DIR Contact (Secondary)	VP Medicare Chief Actuary		Phelps	Joshua		8048557732					joshua.phelps@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 6th Floor	Jacksonville	FL	32246	02/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Emergency Part D Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9045259651					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	12/23/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Emergency Part D Contact (Secondary)	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/24/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Employer Waiver Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4thFloor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Encounter Data & Risk Adjustment Operations Contact	FBM Sr. Dir. Risk Adjustment		York	Dawn		9044636818					dawn.york@bcbsfl.com	4800 Deerwood Parkway		Jacksonville	FL	32246	07/18/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Enrollment Contact	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	01/24/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	EOB Transfer Contact	Sr Director Member Contact		Gamble	LaTonya		9049052057				9043576121	latonya.gamble@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Financial Audit Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Financial Reporting Contact	VP Medicare CFO		Dorsett	Kareen		9049051754					Kareen.Dorsett@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400	Jacksonville	FL	32246	08/20/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Formulary Contact	Medicare Clinical Pharmacist		Shore	Stephanie		9049050114					stephanie.shore@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	08/08/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	General Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Government Relations Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	HIPAA Privacy Officer	Asst. General Counsel & Privacy Officer		Resnick	Steven		9049055025					steven.resnick@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	HIPAA Security Officer	VP Chief Information Security Officer		Raymond	Jason		9049050070					jason.raymond@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 600, 2nd Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Hospice Contact	Medical Clinical Pharmacist Pharmacy Govt Prog		Adams	Tangela		9049050002					tangela.adams@floridablue.com	4800 Deerwood Campus Pkwy	DCC 900, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Interoperability Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th FL	Jacksonville	FL	32246	01/26/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	MA Appeals/Grievances Contact	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	MA Claims Processing Contact for Public Website	FBM Sr. Dir. Claims		Allen	Jessica		9049053152					Jessica.Allen2@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	11/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Marketing Contact	FBM Spec.IV Product Operations		Lilly	Wanda		9043573900					wanda.lilly@bcbsfl.com	4800 Deerwood Campus Parkway	Building 400, 3rd Floor	Jacksonville	FL	32246	04/27/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Medical Director	VP Medicare Solutions	Dr.	Malko	Elizabeth		9049050491					Elizabeth.Malko@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	01/24/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Medicare Compliance Officer	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Medicare Coordinator	EVP, Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 100, 8th Flr	Jacksonville	FL	32246	11/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Medication Therapy Management Contact	Director Government Pharmacy Programs		Bryant-Riggins	Victoria		9049050194					victoria.bryant-riggins@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	08/27/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	OffShore Subcontractor Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Online Enrollment Center Contact (Back-up)	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	01/24/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Online Enrollment Center Contact (Optional)	Sr. Manager		Hogan	Kate		9049055131					kate.hogan@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 300 4th Flr	Jacksonville	FL	32246	05/06/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Online Enrollment Center Contact (Primary)			EMB Analysts	FBM Ops		9049051711					FB_Medicare_Ops_EMB_Analysts@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 2nd Floor	Jacksonville	FL	32246	05/06/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Part C Application Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Part C Reporting Contact	Corporate Compliance Specialist		Figueroa	Carmen		9049056658					carmen.figueroa@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Part D Appeals	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia							cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773736	56307			PPO - BBA		C	Atlanta
H5434	Part D Appeals Contact (Secondary)	Director Government Pharmacy Programs		Bryant-Riggins	Victoria							victoria.bryant-riggins@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	12/29/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773636	50194			PPO - BBA		C	Atlanta
H5434	Part D Application Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Part D Benefits Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	07/16/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Part D Claims Submission Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Part D Exceptions Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia							cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773736	56307			PPO - BBA		C	Atlanta
H5434	Part D Exceptions Contact (Secondary)	Regulatory Manager & Audit Response		Gonzales	Santiago						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55120	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	8006936651				PPO - BBA		C	Atlanta
H5434	Part D Price File Contact (Back-up)	QA Analyst		Tastad	Emily		6127772557					emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Part D Price File Contact (Optional)	Director Government Pharmacy Programs		Bryant-Riggins	Victoria		9049050194					victoria.bryant-riggins@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/24/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Part D Price File Contact (Primary)	Delivery System Coordinator		Rodriguez	Janina		3059217232					Janina.Rodriguez@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	08/04/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Part D Quality Assurance Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/24/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Part D Reporting Contact	Corporate Compliance Specialist		Figueroa	Carmen		9049056658					carmen.figueroa@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Patient Safety Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 5th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Payment Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Pharmacy Director	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Pharmacy Network Management Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services		Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55122	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Pharmacy Technical Help Desk Contact	Director, Member Services		Pretlow	Jennifer							jennifer.pretlow@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	8888776420				PPO - BBA		C	Atlanta
H5434	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Member Services		Garza-Rodriguez	Melissa							MGarzarodriguez@primetherapeutics.com	1305 Corporate Center Drive		Eagan	MN	55121	07/30/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	2143366770				PPO - BBA		C	Atlanta
H5434	Plan Directory Contact for Public Website			Mbr Svcs	Medicare		8009266565					Chrissy.This@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	05/05/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Plan to Plan Reconciliation Contact	Accounting Specialist		Williams	Lynn		9049054568					lynn.williams@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 3rd Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Processor Contact	FBM Sr. Dir. Claims		Allen	Jessica		9049053152					Jessica.Allen2@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	11/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Quality Contact	Sr. Dir. Medicare Quality Improvement		Wright	Carole		3059217224					carole.wright@bcbsfl.com	8600 NW 36th St.		Doral	FL	33166	07/17/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Reconciliation Contact	VP Medicare Chief Actuary		Phelps	Joshua		8048557732					joshua.phelps@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	02/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Reconciliation Contact (Secondary)	VP Medicare CFO		Dorsett	Kareen		9049051754					Kareen.Dorsett@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400	Jacksonville	FL	32246	09/10/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Recovery Audit Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	SNP Application Contact	Sr. Director SNP		De Llano	Yisel		3059217225					yisel.dellano@floridablue.com	8400 NW 33rd Street Suite 100		Miami	FL	33122	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	SNP State Contact	Sr. Director Special Projects		Salo	Dan		2134488616					Dan.Salo@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	08/04/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Surveillance Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	System Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Third Party Administrator (TPA) Liaison	Medical Clinical Pharmacist Pharmacy Govt Prog		Adams	Tangela		9049050002					tangela.adams@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 400,  3rd Floor	Jacksonville	FL	32246	01/24/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	User Access Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Utilization Management Contact	GWCS Sr Dir Clinical Ops		Sparandeo	Dominick		9049055332					Dominick.Sparandeo@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	10/15/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5434	Utilization Review Contact	GWCS Sr Dir Clinical Ops		Sparandeo	Dominick		9049055332					Dominick.Sparandeo@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	10/15/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Local CCP	Florida Blue	Local PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					PPO - BBA		C	Atlanta
H5435	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PFFS - Private Fee for Service		C	San Francisco
H5435	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PFFS - Private Fee for Service		C	San Francisco
H5435	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PFFS - Private Fee for Service		C	San Francisco
H5435	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	PFFS Terms and Conditions of Payment Contact for Public Website			Graham	Jennfier		9529314176					bid_box@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	03/27/2018	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PFFS - Private Fee for Service		C	San Francisco
H5435	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5435	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	PFFS	UnitedHealthcare	PFFS		UnitedHealth Group, Inc.	239	Yes	Active					PFFS - Private Fee for Service		C	San Francisco
H5439	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H5439	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2020	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/07/2018	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Medical Director	Chief Medical Officer	Dr.	Chen	Alex		8186766564					alex.y.chen@healthnet.com	21281 Burbank Blvd		Woodland Hills	CA	91367	03/30/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H5439	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H5439	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H5439	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H5439	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/09/2017	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2020	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H5439	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H5439	PHR Beneficiary Contact																	09/27/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8445825177				PPO - BBA		C	Dallas
H5439	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Plan Directory Contact for Public Website	Provider & Provider Directory Information		Services	Provider		8002754737					CorporateMedicareComplianceDept@CENTENE.COM	PO Box 10198		Van Nuys	CA	91410	03/31/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5439	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET LIFE INSURANCE COMPANY	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5447	Agent/Broker Compensation Data Contact	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Automated TrOOP Balance Transfer Contact	Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	Relay.Health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Backup User Access Contact	Director, Technical Solutions		Garza	Roger		2103586369					RGarza@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	02/10/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Best Available Evidence Contact	Director		Spaustat	Helen		2105102545					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Dr.	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Bid Audit Contact	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Bid Primary Contact	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	09/20/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	CAP Report Contact for Public Website	Chief Compliance & Quality Officer		Lomba	Susan		2105102463					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Dr.	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	CEO - CMS Administrator Contact	Chief Operating Officer	Ms.	Scepanski	Theresa		2103586201					TScepanski@cfhp.com	12238 Silicon Drive	STE 100	SAN ANTONIO	TX	78249	04/16/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	CEO - Senior Official for Contracting	Chief Operating Officer	Ms.	Scepanski	Theresa		2103586201					TScepanski@cfhp.com	12238 Silicon Drive	STE 100	SAN ANTONIO	TX	78249	04/16/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Chief Financial Officer	Chief Financial Officer	Mr.	Isaac	Daverick		2103586013					DIsaac@cfhp.com	12238 Silicon Drive	STE 100	SAN ANTONIO	TX	78249	05/03/2021	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Chief Operating Officer	Chief Operating Officer	Ms.	Scepanski	Theresa		2103586201					TScepanski@cfhp.com	12238 Silicon Drive	STE 100	SAN ANTONIO	TX	78249	07/23/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Chief Information Officer	Executive Director, Information Systems	Ms.	Fehlhaber	Terry		2103586051					TFehlhaber@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Chief Information Security Officer	Executive Director, Information Systems	Ms.	Fehlhaber	Terry		2103586051					TFehlhaber@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	CMS Casework Communication Contact	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	09/20/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Complaints Tracking Contact	Chief Compliance & Quality Officer		Lomba	Susan		2105102463					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Dr.	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Contact for Fraud Investigations	Director, Special Investigations Unit		Spaustat	Helen		2105102545					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Drive	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Coordination of Benefits Contact	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	09/20/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Corporate Mailing						2103586396					JRazo@cfhp.com	12238 Silicon Drive	STE 100	San Antonio	TX	78249	04/28/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Financial Accounting		Romero	Lorena		2103586181					lromero@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	03/02/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Customer Service Operations Contact	Executive Director, Member Services		Gonzalez	Mary Helen		2103586062					MGonzalez@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	DIR Contact	Director, Financial Accounting		Romero	Lorena		2103586181					lromero@cfhp.com	12238 Silicon Drive	STE 100	San Antonio	TX	78249	03/02/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	DIR Contact (Secondary)	Executive Director Medicare & NM		Rodriguez	Martha		2103586190					mrodriguez2@cfhp.com	12238 Silicon Drive, Ste 100		San Antonio	TX	78249	11/14/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Electronic Health Record Contact	Chief Compliance & Quality Officer		Lomba	Susan		2105102463					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Drive	Suite 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Emergency Part D Contact	PharmD, MBA		Favila	Patricia		2103586402					pfavila@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Emergency Part D Contact (Secondary)	Pharmacist		Younts	Stephanie		2103586171					syounts@cfhp.com	12238 Silicon Drive, Suite 100		San Antonio	TX	78249	06/23/2021	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Encounter Data & Risk Adjustment Operations Contact	Executive Director, Information Systems	Ms.	Fehlhaber	Terry		2103586051					TFehlhaber@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Enrollment Contact	Enrollment Manager		Gonzales	Thelma		2103586161					TGonzales2@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	EOB Transfer Contact	Claims Manager		Hudson Hecox	Chryseis		2105102487				2103586014	CHudsonHecox@cfhp.com	12238 Silicon Dr.	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Financial Audit Contact	Manager, Finance	Ms.	Romero	Lorena		2103586181					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Financial Reporting Contact	Director, Financial Accounting		Romero	Lorena		2103586181					lromero@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	03/02/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Formulary Contact	Exec. Director, Pharmacy Services		Favila	Patricia		2103586402					pfavila@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	04/07/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	04/27/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	General Contact	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	09/20/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Government Relations Contact	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	HIPAA Privacy Officer	Chief Compliance & Quality Officer		Lomba	Susan		2105102463					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Dr.	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	HIPAA Security Officer	Executive Director, Information Systems	Ms.	Fehlhaber	Terry		2103586051					TFehlhaber@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	02/10/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Hospice Contact	Director, Clinical Services, Commercial		Rollston	Deborah		2103586112					drollston@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Interoperability Contact	Executive Director Information Systems		Fehlhaber	Terry		2103586051					tfehlhaber@cfhp.com	12238 Silicon Drive		San Antonio	TX	78249	10/29/2021	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	MA Appeals/Grievances Contact	Chief Compliance & Quality Officer		Lomba	Susan		2105102463					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Dr.	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	MA Claims Processing Contact for Public Website	Claims Manager		Hudson Hecox	Chryseis		2105102487				2103586014	CHudsonHecox@cfhp.com	12238 Silicon Dr.	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Marketing Contact	Executive Director, Corporate Communications		Razo	Judy		2103586396					JRazo@cfhp.com	12238 Silicon Drive	STE 100	San Antonio	TX	78249	10/25/2021	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Medical Director	Interim, Chief Medical Officer	Dr.	Yao	Jessica		2103586102					JYao@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	04/03/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Medicare Compliance Officer	Chief Compliance & Quality Officer	Ms.	Lomba	Susan		2105102463					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Drive	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Medicare Coordinator	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	09/20/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Medicare Part D Opioid Overutilization Contact	PharmD, MBA		Favila	Patricia		2103586402					pfavila@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Medication Therapy Management Contact	PharmD, MBA		Favila	Patricia		2103586402					pfavila@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	OffShore Subcontractor Contact	Exec. Dir. Pharmacy Services		Favila	Patricia		2103586402					pfavila@cfhp.com	12238 Silicon Dr.	Suite 100	San Antonio	TX	78249	09/02/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Online Enrollment Center Contact (Back-up)	Ex. Director Corporate Communications		Razo	Judy		2103586396					jrazo@cfhp.com	12238 Silicon Drive, Suite 100		San Antonio	TX	78249	10/25/2021	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Online Enrollment Center Contact (Optional)	Sr. Mgr., Medicare Advantage		Sandoval-Gomez	Laura		2103586295					LSandoval-Gomez@cfhp.com	12238 Silicon Drive	Suite 100	San Antonio	TX	78249	04/28/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Online Enrollment Center Contact (Primary)	Sr. Manager, Enrollment Unit		Gonzales	Thelma		2103586161					tgonzales2@cfhp.com	12238 Silicon Drive, Suite 100		San Antonio	TX	78249	09/20/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Part C Application Contact	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	09/20/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Part C Reporting Contact	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	09/20/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Part D Appeals	Supervisor, Grievance & Appeals		Fritsche	Jacki						6082985881	Jacki.Fritsche@Navitus.com	361 Integrity Drive		Madison	WI	53717	04/07/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active	6082985781				HMO - Health Maintenance Organization		C	Dallas
H5447	Part D Appeals Contact (Secondary)	Exec. Dir., Pharmacy Services		Favila	Patricia						2103586385	tfavila@cfhp.com	12238 Silicon Drive	Suite 100	San Antonio	TX	78249	04/27/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active	2103586402				HMO - Health Maintenance Organization		C	Dallas
H5447	Part D Application Contact	Director Pharmacy Services		Favila	Patricia		2103586402					pfavila@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	06/23/2021	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Part D Benefits Contact	PharmD, MBA		Favila	Patricia		2103586402					pfavila@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Part D Claims Submission Contact	Manager, Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/10/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Part D Exceptions Contact	Sr. Manager, Clinical Prior Authorization		LeClair	Christophe						9202214676	Christopher.LeClair@Navitus.com	1025 West Navitus Drive		Appleton	WI	54913	04/07/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Dallas
H5447	Part D Exceptions Contact (Secondary)	Exec. Dir., Pharmacy Services		Favila	Patricia							pfavila@cfhp.com	12238 Silicon Drive	Suite 100	San Antonio	TX	78249	04/27/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active	2103586402				HMO - Health Maintenance Organization		C	Dallas
H5447	Part D Price File Contact (Back-up)	Exec. Director Pharmacy Services		Favila	Patricia		2103586402					pfavila@cfhp.com	12238 Silicon Drive	STE 100	San Antonio	TX	78249	04/07/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Part D Price File Contact (Primary)			Plan Finder	Navitus		5122313140					Plan.Finder@Navitus.com	361 Integrity Drive		Madison	WI	53717	04/03/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Part D Quality Assurance Contact	PharmD, MBA		Favila	Patricia		2103586402					pfavila@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Part D Reporting Contact	Exec. Director, Pharmacy Services		Favila	Patricia		2103586402					pfavila@cfhp.com	12238 Silicon Drive	STE 100	San Antonio	TX	78249	04/12/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Patient Safety Contact	Interim, Chief Medical Officer	Dr.	Yao	Jessica		2103586102					JYao@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Payment Contact	Director, Finance		Romero	Lorena		2103586181					dl_cfhp_regulatory@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Pharmacy Director	PharmD, MBA		Favila	Patricia		2103586402					pfavila@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688				6087292688	Jan.Robinson@Navitus.com	361 Integrity Drive		Madison	WI	53717	04/07/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Pharmacy Services		Favila	Patricia		2103586402				2103586385	pfavila@cfhp.com	12238 Silicon Drive	Suite 100	San Antonio	TX	78249	04/27/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Pharmacy Technical Help Desk Contact	Sr. Manager, Customer Care Acounts		Nett	Danielle						9202214724	Danielle.Nett@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	04/07/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Dallas
H5447	Pharmacy Technical Help Desk Contact (Secondary)	Exec. Dir., Pharmacy Services		Favila	Patricia						2103586385	pfavila@cfhp.com	12238 Silicon Drive	Suite 100	San Antonio	TX	78249	04/27/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active	2103586402				HMO - Health Maintenance Organization		C	Dallas
H5447	Plan Directory Contact for Public Website	Executive Director, Corporate Communications		Razo	Judy		2105102472					JRazo@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Plan to Plan Reconciliation Contact	Director, Finance		Romero	Lorena		2103586181					dl_cfhp_regulatory@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Processor Contact	Executive Director, Information Systems	Ms.	Fehlhaber	Terry		2103586051					TFehlhaber@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Quality Contact	Chief Compliance & Quality Officer		Lomba	Susan		2105102463					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Dr.	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Reconciliation Contact	Director, Finance		Romero	Lorena		2103586181					dl_cfhp_regulatory@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Recovery Audit Contact	Dir., Special Investigations Unit	Ms.	Spaustat	Helen		2105102545					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	SNP Application Contact	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Drive	Ste. 100	San Antonio	TX	78249	09/20/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	SNP State Contact	Director Medicare Advantage Plans		Gamboa	Brandie		2103586491					bgamboa@cfhp.com	12238 Silicon Drive	Suite 100	San Antonio	TX	78249	09/20/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Surveillance Contact	Dir., Special Investigations Unit		Spaustat	Helen		2105102545					DL_CFHP_Regulatory@cfhp.com	12238 Silicon Dr.	STE 100	San Antonio	TX	78249	12/05/2022	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	System Contact	Executive Director, Information Systems	Ms.	Fehlhaber	Terry		2103586051					TFehlhaber@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Third Party Administrator (TPA) Liaison	Director, Finance		Romero	Lorena		2103586181					dl_cfhp_regulatory@cfhp.com	12238 Silicon Drive	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	User Access Contact	Executive Director, Information Systems	Ms.	Fehlhaber	Terry		2103586051					TFehlhaber@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	01/30/2020	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Utilization Management Contact	Director, Clinical Services Commercial		Rollston	Deborah		2103586112					drollston@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5447	Utilization Review Contact	Director, Clinical Services, Commercial		Rollston	Deborah		2103586112					drollston@cfhp.com	12238 Silicon Dr	STE 100	San Antonio	TX	78249	08/25/2023	2023	COMMUNITY FIRST HEALTH PLANS, INC.	Local CCP	Community First Health Plans	HMO/HMOPOS		Bexar County Hospital District	751	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5454	Agent/Broker Compensation Data Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/07/2023	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Automated TrOOP Balance Transfer Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Backup User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Best Available Evidence Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Bid Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Bid Audit Site Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/27/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Bid Primary Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	CAP Report Contact for Public Website	Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/28/2020	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8773841241				HMO - Health Maintenance Organization		C	Chicago
H5454	CEO - CMS Administrator Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	CEO - Senior Official for Contracting	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Chief Financial Officer	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Chief Operating Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Chief Information Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Chief Information Security Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	CMMI Model Point of Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	CMS Casework Communication Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Complaints Tracking Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Contact for Fraud Investigations	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Coordination of Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Corporate Mailing						8476968500					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway		Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	Thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Customer Service Operations Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	DIR Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	DIR Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Emergency Part D Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Emergency Part D Contact (Secondary)	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Encounter Data & Risk Adjustment Operations Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/18/2023	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Enrollment Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	EOB Transfer Contact	Claims Manager	Mr.	Salgado	Miguel		8476968578				8008861082	Miguel.Salgado@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	10/04/2021	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Financial Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Financial Reporting Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Formulary Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3308886015	Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Formulary Contact (Secondary)	Pharmacy Director		Lopez	Eduardo		7542085867					elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/07/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	General Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Government Relations Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	HIPAA Privacy Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	HIPAA Security Officer	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539				8555158166	Eric.Annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Hospice Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Interoperability Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	MA Appeals/Grievances Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	MA Claims Processing Contact for Public Website	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Marketing Contact	VP of Marketing	Ms.	Branco	Margaret		7187957495					margaret.branco@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/06/2023	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Medical Director		Dr	Butt	Tariq		3125458471					tariq.butt@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	11/09/2021	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Medicare Compliance Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Medicare Coordinator	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Medicare Part D Opioid Overutilization Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Medication Therapy Management Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3304058084	Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	OffShore Subcontractor Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Online Enrollment Center Contact (Primary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 302	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Part C Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Part C Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Part D Appeals			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy	Suite 450	Dublin	OH	43017	12/28/2020	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H5454	Part D Appeals Contact (Secondary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica							Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue		Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	7542085865				HMO - Health Maintenance Organization		C	Chicago
H5454	Part D Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Part D Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Part D Claims Submission Contact			Dovico	Rosario		2012696398					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	12/31/2020	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Part D Exceptions Contact			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	6143363326				HMO - Health Maintenance Organization		C	Chicago
H5454	Part D Price File Contact (Back-up)			Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Part D Price File Contact (Optional)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Part D Price File Contact (Primary)			Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	12/31/2020	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Part D Quality Assurance Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Part D Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Patient Safety Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Payment Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Pharmacy Director	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Pharmacy Network Management Contact			Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Pharmacy Network Management Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Pharmacy Technical Help Desk Contact			Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	08/04/2021	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H5454	Plan Directory Contact for Public Website	Vice President, Provider Operations	Ms.	Cuevas	Elizabeth		7542085880					Elizabeth.Cuevas@clearspringhealthcare.com	250 South Northwest Highway Suite 302	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Plan to Plan Reconciliation Contact	Senior Accountant	Ms.	Wrenn	Alisa		2249855588				3124290194	Alisa.Wrenn@Clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Processor Contact			Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Quality Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Reconciliation Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Recovery Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	SNP Application Contact	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	02/15/2023	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Surveillance Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	System Contact	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539					eric.annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Third Party Administrator (TPA) Liaison	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Utilization Management Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5454	Utilization Review Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH OF ILLINOIS, INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	02/13/2019	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/13/2019	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Electronic Health Record Contact	Chief Information Officer	Mr.	Betancourt	Roger		3053419099					rbetancourt@simplyhealthcareplans.com	9250 W Flagler Street	Suite 600	Miami	FL	331743460	03/21/2017	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H5471	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H5471	PHR Beneficiary Contact																	02/13/2019	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H5471	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Reconciliation Contact (Secondary)	Chief Financial Officer	Mrs	Prince	Holly		3059212610				3054085858	hprince@simplyhealthcareplans.com	9250 W. Flagler Street	Suite 600	Miami	FL	331743460	01/27/2016	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5471	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	SIMPLY HEALTHCARE PLANS, INC.	Local CCP	Simply Healthcare Plans, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5472	Agent/Broker Compensation Data Contact	VP, Sales		Simonds	Kristina		6572187635					KSimonds@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Automated TrOOP Balance Transfer Contact	PBM - Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Backup User Access Contact	Compliance Director		Spitzer	Chandra		6572745530					CSpitzer@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Best Available Evidence Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Bid Audit Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Bid Audit Site Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Bid Primary Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	CAP Report Contact for Public Website	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	CEO - CMS Administrator Contact	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	CEO - Senior Official for Contracting	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Chief Financial Officer	Chief Financial Officer	Mr.	Freeman	Thomas		6572187604					TFreeman@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Chief Operating Officer	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Kardes	Hakan		6572187772					hkardes@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Chief Information Security Officer	VP, Technology & CISO	Mr.	MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	CMMI Model Point of Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	CMS Casework Communication Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Complaints Tracking Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Contact for Fraud Investigations	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Coordination of Benefits Contact	AVP, Membership & Eligibility		Torres	Carrie		6572187409	2109				CArreola@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Corporate Mailing						6572187713				8443202247	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122			5622074634	adelatorre@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Customer Service Operations Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	DIR Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	DIR Contact (Secondary)	AVP, Pharmacy		Liu	Ruby		3237287232	2316				RLiu@AHCUSA.com	1100 W. Town & Country Rd., Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Electronic Health Record Contact	AVP, Platform Product		Brown Hayes	Michael		7144979628					MBrown-Hayes@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Emergency Part D Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Emergency Part D Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		3108667966				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Employer Waiver Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment		Bogdanov	Eyosef		5623666179					ebogdanov@ahcusa.com	1100 W. Town and Country Rd.	Suite 1600	Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Enrollment Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	EOB Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Financial Audit Contact	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Financial Reporting Contact	Sr. Director, Accounting & Reporting		Tran	Sue Anne		6572187673	7673				stran@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Formulary Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Formulary Contact (Secondary)	PBM - Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	General Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Government Relations Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	HIPAA Privacy Officer	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	HIPAA Security Officer	VP, Technology & CISO		MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Hospice Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Interoperability Contact	VP, Data Engineering & BI CTO Data and Al		Sam	Georgie		8188807212					gsam@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	MA Appeals/Grievances Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	MA Claims Processing Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Marketing Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Medical Director	SVP Market Management WCR	Dr.	Kim	John		6572187640				5622074617	JKim@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Medicare Compliance Officer	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy	B	6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Medicare Coordinator	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Medicare Part D Opioid Overutilization Contact	PBM - Supv Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Medication Therapy Management Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	OffShore Subcontractor Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	CLynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Online Enrollment Center Contact (Back-up)	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Online Enrollment Center Contact (Optional)	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Online Enrollment Center Contact (Primary)	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Part C Application Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Part C Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Appeals	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Appeals Contact (Secondary)	Sr. Manager, Appeals & Grievance		Jimenez	Gudelia							GJimenez@ahcusa.com	1100 W. Town and Country Road, Suite #300		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187488	2188			HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Application Contact	CEO		Maroney	Dawn		5623346192				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Benefits Contact	PBM - Director, Benefit Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Claims Submission Contact	PBM - Functional Business Consultant Govt Programs		Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Exceptions Contact	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Exceptions Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali							AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187709				HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Price File Contact (Back-up)	PBM - Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Price File Contact (Optional)	PBM - QA Analyst		Tastad	Emily		6127776931					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Price File Contact (Primary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Quality Assurance Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Part D Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Patient Safety Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Payment Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Personal Health Record Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Pharmacy Director	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Pharmacy Network Management Contact	PBM - AVP, Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Pharmacy Network Management Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H5472	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H5472	PHR Beneficiary Contact																	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS	Alignment Health Plan	Alignment Healthcare USA, LLC	612	Yes	Active	8666342247				HMO - Health Maintenance Organization		C	San Francisco
H5472	Physician Incentive Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Plan Directory Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Plan to Plan Reconciliation Contact	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122			5622074266	adelatorre@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Processor Contact	Manager, PBM Operations		Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Quality Contact	Sr. Director, Quality Management/Credentialing		Lacock	Lisa		6572187638					LLacock@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Reconciliation Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Reconciliation Contact (Secondary)	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122				adelatorre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Recovery Audit Contact	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	SNP Application Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	SNP State Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Surveillance Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	System Contact	VP, AVA Health Plan Systems & Operations		Bates	Patrick		6572187636	7636				PBates@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Third Party Administrator (TPA) Liaison	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122				adelatorre@ahcusa.com	1100 W. Town and Country Rd, Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	User Access Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Utilization Management Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5472	Utilization Review Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5475	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Corporate Mailing						8132063477					crysten.troutman@wellcare.com	P. O. Box 31386		Tampa	FL	33631	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H5475	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H5475	PHR Beneficiary Contact																	09/27/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8668928340				HMO - Health Maintenance Organization		C	Dallas
H5475	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/01/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5475	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5493	Automated TrOOP Balance Transfer Contact	Regional Finance Director		Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Backup User Access Contact	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Best Available Evidence Contact	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Bid Primary Contact	Regional Finance Director		Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	CAP Report Contact for Public Website	Executive Director		Crumley	Molly		3026603355				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	04/11/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	CEO - CMS Administrator Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	CEO - Senior Official for Contracting	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Chief Financial Officer	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Chief Operating Officer	COO	Ms.	Lewis	Anne		4066472980					anne.lewis@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	04/28/2022	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Chief Information Officer	Director Enterprise IT Operation	Mr.	Gillespie	Jeff		6142348636					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Chief Information Security Officer	VP Information Security	Mr	Jenning	Preston		6105503083				3025758236	Preston.Jennings@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	CMS Casework Communication Contact	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Complaints Tracking Contact	Quality Assurance and Compliance Part D Officer		Thomas	Clare	M	3026603359				3025758236	cthomas@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Contact for Fraud Investigations	Quality Assurance and Compliance Part D Officer		Thomas	Clare	M	3026603359				3025758236	cthomas@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Coordination of Benefits Contact	Regional Finance Director	Ms.	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Corporate Mailing						3026603355				3025758236	Linda.Harris-Ashton@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Coverage Gap Discount Program (CGDP) Payment Contact	Regional Finance Director	Ms.	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Customer Service Operations Contact	Quality Assurance and Compliance Part D Officer		Thomas	Clare	M	3026603359				3025758236	cthomas@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	DIR Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	DIR Contact (Secondary)	Director of Finance	MS	Harris-Ashton	Linda		3026603355				3025758236	Linda.Harris-Ashton@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	02/16/2022	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Emergency Part D Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Emergency Part D Contact (Secondary)	Quality Assurance & Compliance Part D Officer	Ms	Thomas	Clare	M	3026603359				3025758236	cthomas@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Encounter Data & Risk Adjustment Operations Contact	Director of Coding and Documentation		Creaney	Emy		7343431939					creaneye@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	10/25/2019	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Enrollment Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	EOB Transfer Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231				4134932024	Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Financial Audit Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Financial Reporting Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231				6102719530	Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Formulary Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2679917601				2679917618	joseph.garbarino@trinity-health.org	1930 South Broad Street		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Formulary Contact (Secondary)	Regional Finance Director	Mr	Schmotzer	David		2153394533				6102719530	David.Schmotzer@Trinity-Health.org	1930 South Broad Street	Unit 3	Philadelphia	PA	19145	08/13/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	General Contact	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Government Relations Contact	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	HIPAA Privacy Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	HIPAA Security Officer	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Interoperability Contact	Enterprise Director IT Operations		Gillespie	Jeff		7343433079					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	MA Appeals/Grievances Contact	Quality Assurance & Compliance Part D Officer	Ms	Thomas	Clare	M	3026603359				3025758236	cthomas@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	MA Claims Processing Contact for Public Website	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231				6102719530	Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Marketing Contact	Director Marketing & Communications	Ms	Lark	Azia		9735182754					azia.lark@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	02/03/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Medical Director	Medical Director		Baradaran	Parinaz		3026603395				3025758238	Parinaz.Baradaran@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Medicare Compliance Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Medicare Coordinator	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@mercyhealth.org	1930 South Broad Street		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@mercyhealth.org	1930 South Broad Street		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Part C Application Contact	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Part D Appeals	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad St	Unit 3	Phildelphia	PA	19145	08/13/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H5493	Part D Appeals Contact (Secondary)	Director Quality & Compliance		Thomas	Clare							CThomas@trinity-health.org	1072 Justison St		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	3026603359				PACE - Nat		C	Philadelphia
H5493	Part D Application Contact	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Part D Benefits Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Part D Claims Submission Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Part D Exceptions Contact	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad Street	Unit 3	Philadelphia	PA	19145	08/13/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H5493	Part D Exceptions Contact (Secondary)	Director Quality & Compliance		Thomas	Clare							CThomas@trinity-health.org	1072 Justison St		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	3026603359				PACE - Nat		C	Philadelphia
H5493	Part D Price File Contact (Back-up)	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Part D Price File Contact (Optional)	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231				6102714530	Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Part D Price File Contact (Primary)	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Part D Quality Assurance Contact	Quality Assurance & Compliance Part D Officer	Ms	Thomas	Clare	M	3026603359				3025758236	cthomas@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Part D Reporting Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Patient Safety Contact	Quality Assurance & Compliance Part D Officer	Ms	Thomas	Clare	M	3026603359				3025758236	cthomas@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Payment Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Pharmacy Director	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@mercyhealth.org	1930 South Broad Street		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Pharmacy Network Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@mercyhealth.org	1930 South Broad Street		Philadelphia	PA	19145	08/02/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Pharmacy Network Management Contact (Secondary)	Executive Director	Ms	Milligan	Amy	L	3026603352				3025758236	amilligan@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Pharmacy Technical Help Desk Contact	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad St	Unit 3	Phildelphia	PA	19145	08/02/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H5493	Pharmacy Technical Help Desk Contact (Secondary)	Executive Director	Ms	Milligan	Amy	L					3025758236	amilligan@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active	3026603352				PACE - Nat		C	Philadelphia
H5493	Plan Directory Contact for Public Website	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	08/22/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Plan to Plan Reconciliation Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Processor Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Quality Contact	Quality Assurance & Compliance Part D Officer	Ms	Thomas	Clare	M	3026603359				3025758236	cthomas@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/03/2021	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Reconciliation Contact	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Reconciliation Contact (Secondary)	Director of Finance	Ms	Harris-Ashton	Linda		3026603355				3025758236	Linda.Harris-Ashton@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	02/16/2022	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Recovery Audit Contact	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	04/11/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Surveillance Contact	Executive Director	Ms	Crumley	Molly		3026603352				3025758236	mcrumley@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	04/11/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	System Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Third Party Administrator (TPA) Liaison	Regional Finance Director	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@Trinity-Health.org	200 Hillside Circle		West Springfield	MA	01089	09/25/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	User Access Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Utilization Management Contact	Medical Director		Baradaran	Parinaz		3026603395				3025758238	Parinaz.Baradaran@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/15/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5493	Utilization Review Contact	Medical Director		Baradaran	Parinaz		3026603395				3025758238	Parinaz.Baradaran@trinity-health.org	1072 Justison Street		Wilmington	DE	19801	09/15/2023	2023	LIFE AT ST. FRANCIS HEALTHCARE, INC.	National PACE	Saint Francis LIFE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H5496	Agent/Broker Compensation Data Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	12/07/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Automated TrOOP Balance Transfer Contact	Clinical Pharmacist		Cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	12/23/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Backup User Access Contact	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Best Available Evidence Contact	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Bid Audit Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Bid Audit Site Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Bid Primary Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	CAP Report Contact for Public Website	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	CEO - CMS Administrator Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	CEO - Senior Official for Contracting	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Chief Financial Officer	Chief Financial Officer	Mrs.	Bindra	Meeta		6268385100	5155				Meeta.Bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	04/16/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Chief Operating Officer		Dr	TBD	TBD		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Chief Information Officer	Information System Manager	Mr	Lam	Wilfred		6268385100	701			6265216028	wlam@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	12/07/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Chief Information Security Officer	Information System Manager	Mr	Lam	Wilfred		6268385126				6265216028	wlam@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	CMS Casework Communication Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Complaints Tracking Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Contact for Fraud Investigations	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Coordination of Benefits Contact	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Corporate Mailing						6267080333					pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director of Finance	Ms	McCloud	Georgetta		6268385100	919				georgetta.mccloud@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	06/05/2023	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Customer Service Operations Contact	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	DIR Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	DIR Contact (Secondary)	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Electronic Health Record Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Emergency Part D Contact	Clinical Pharmacist		Cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	12/23/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Emergency Part D Contact (Secondary)	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Encounter Data & Risk Adjustment Operations Contact	Information System Manager	Mr	Lam	Wilfred		6268385100	701			6265216028	wlam@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	12/07/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Enrollment Contact	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	EOB Transfer Contact	Information System Manager	Mr	Lam	Wilfred		6268385100	701			6265216028	wlam@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	12/07/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Financial Audit Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675				6265216028	eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	12/14/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Financial Reporting Contact	Controller	Mrs	Bindra	Meeta		6268385100	5155			6265216028	meeta.bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	12/07/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Formulary Contact	CEO	Dr	Cho	Evelyn		6267270465				6265216028	evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	07/28/2022	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Formulary Contact (Secondary)	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	General Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Government Relations Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	HIPAA Privacy Officer	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	HIPAA Security Officer	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Hospice Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Interoperability Contact	Vice president Operations		Lao	Pablo		6266965712					pablo.lau@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	10/22/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	MA Appeals/Grievances Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	MA Claims Processing Contact for Public Website		Dr	TBD	TBD		6267558831				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Marketing Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	12/07/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Medical Director	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Medicare Compliance Officer	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Medicare Coordinator	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	12/23/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Medication Therapy Management Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	OffShore Subcontractor Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/26/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Online Enrollment Center Contact (Back-up)	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Online Enrollment Center Contact (Optional)	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Online Enrollment Center Contact (Primary)	Membership Manger Sr.		Munoz	Alicia		6268385100	416				Alicia.Munoz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Part C Application Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Part C Reporting Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Appeals	Compliance Officer	Ms	Ruiz	Erica							eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active	8008388271				HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Appeals Contact (Secondary)	Clinical Services Supervisor	RN	Lane	Nichole						6263809049	nichole.lane@iictx.com	1100 East Green Street		Pasadena	CA	91106	01/03/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active	8008388271				HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Application Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Benefits Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Claims Submission Contact	Compliance Officer		Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	07/21/2022	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Exceptions Contact	Clinical Pharmacist		Cho	Evelyn							evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	12/23/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active	8336673497				HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Exceptions Contact (Secondary)	Compliance Officer	Ms	Ruiz	Erica							eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active	8008388271				HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Price File Contact (Back-up)	Manger Rebates		Davidson	Erin		8086261950					edavison@elixirsolutions.com	8957 Canyon Falls Blvd.		Twinsburg	OH	44087	12/07/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Price File Contact (Optional)	Rebate Manager		Davison	Erin		3308886036					edavison@envisionrx.com	8957 Canyon Falls Blvd.		Twinsburg	OH	44087	06/23/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Price File Contact (Primary)	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Quality Assurance Contact	Clinical Pharmacist		cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	12/23/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Part D Reporting Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/25/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Patient Safety Contact	Clinical Pharmacist		cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	12/23/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Payment Contact	CFO	Mrs	Bindra	Meeta		6268385100	5155			6265216028	meeta.bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	06/06/2022	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Personal Health Record Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/26/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Pharmacy Director	Clinical Pharmacist		cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	12/23/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Pharmacy Network Management Contact	CEO	Dr	Cho	Evelyn		6267270465				6265216028	evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	07/28/2022	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Pharmacy Network Management Contact (Secondary)	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/26/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Pharmacy Technical Help Desk Contact	Vice president Operations		Conn	Todd							tconn@elixirsolutions.com	2181 E. Aurora Road	Suite 201	Twinsburg	OH	44087	11/24/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active	8336673497				HMO - Health Maintenance Organization		C	San Francisco
H5496	Pharmacy Technical Help Desk Contact (Secondary)	Compliance Officer	Ms	Ruiz	Erica							eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/26/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active	8008388271				HMO - Health Maintenance Organization		C	San Francisco
H5496	Plan Directory Contact for Public Website	Compliance Officer	Ms	Ruiz	Erica		8007087903					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	02/01/2022	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Plan to Plan Reconciliation Contact	Controller	Mrs	Bindra	Meeta		6268385100	5155			6265216028	meeta.bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	12/07/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Processor Contact	Clinical Pharmacist		cho	Evelyn		6267270465					evelyn.cho@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	12/23/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Quality Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Reconciliation Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/26/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Reconciliation Contact (Secondary)	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Recovery Audit Contact	Controller	Mrs	Bindra	Meeta		6268385100	5155				meeta.bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	12/07/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	SNP Application Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	SNP State Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Surveillance Contact	Compliance Officer	Ms	Ruiz	Erica		5622395675					eruiz@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	10/26/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	System Contact	Information System Manager	Mr	Lam	Wilfred		6268385100	701			6265216028	wlam@imperialhealthplan.com	1100 East Green Street		Pasadena	CA	91106	12/07/2021	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Third Party Administrator (TPA) Liaison	CFO	Mrs	Bindra	Meeta		6268385100	5155			6265216028	meeta.bindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	06/06/2022	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	User Access Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Utilization Management Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5496	Utilization Review Contact	CEO	Dr	Bindra	Pavel		6268385110				6265216028	pbindra@imperialhealthholdings.com	1100 East Green Street		Pasadena	CA	91106	02/10/2020	2023	IMPERIAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Imperial Health Plan of California, Inc.	HMO/HMOPOS		Imperial Health Plan of California	667	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5521	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	12/05/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8042966237				PPO - BBA		C	Philadelphia
H5521	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	7132085765				PPO - BBA		C	Philadelphia
H5521	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/09/2015	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6026183945				PPO - BBA		C	Philadelphia
H5521	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6122633491				PPO - BBA		C	Philadelphia
H5521	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	02/15/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	15222	02/15/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8002386279				PPO - BBA		C	Philadelphia
H5521	PHR Beneficiary Contact																	11/15/2012	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				PPO - BBA		C	Philadelphia
H5521	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/11/2015	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	02/08/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	02/08/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5521	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8887369118				8885547668	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/03/2018	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8042966237				PPO - BBA		C	Philadelphia
H5522	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	7132085765				PPO - BBA		C	Philadelphia
H5522	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/05/2017	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6026183945				PPO - BBA		C	Philadelphia
H5522	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6122633491				PPO - BBA		C	Philadelphia
H5522	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8002386279				PPO - BBA		C	Philadelphia
H5522	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Plan Directory Contact for Public Website			Customer Service	Aetna		8002900190					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	11/26/2014	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	02/08/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	02/08/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5522	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H5525	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	08/14/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H5525	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025807929				PPO - BBA		C	Kansas City
H5525	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H5525	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5024682494				PPO - BBA		C	Kansas City
H5525	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	8008658715				PPO - BBA		C	Kansas City
H5525	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025800475				PPO - BBA		C	Kansas City
H5525	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5525	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA BENEFIT PLAN OF ILLINOIS, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5526	Agent/Broker Compensation Data Contact	Manager, Sales Support & Operations	Mr.	Thompson	Seth		4128883167					Seth.Thompson@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	10/03/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Backup User Access Contact	Sr. Risk and Regulatory Intelligence Analyst	Ms.	Hegedus	Emily		6078219034					emily.hegedus@highmarkhealth.org	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Best Available Evidence Contact	Manager		Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Bid Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	03/18/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Bid Audit Site Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	03/21/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Bid Primary Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	08/03/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	07/28/2021	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	CEO - CMS Administrator Contact	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	CEO - Senior Official for Contracting	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Chief Financial Officer	CFO Highmark Health Plan	Mr.	Bridges	Ja'Ron		4125441452					JaRon.Bridges@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/27/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Chief Operating Officer	SVP, Government Business Segment President	Ms.	Miller	Alexis	A	4125447389					Alexis.Miller@Highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/10/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Chief Information Officer	Senior Vice President, Intrastructure & Security	Mr.	Dick	Gary		4125444321					Gary.Dick@hmhs.com	120 Fifth Avenue		Pittsbrugh	PA	15222	10/29/2021	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Chief Information Security Officer	Chief Information Security Officer	Ms.	Anderson	Melissa		4125447950					melissa.anderson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	CMMI Model Point of Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/15/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	CMS Casework Communication Contact	Manager, Government Programs Enrollment & Billing		Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Complaints Tracking Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne		4125444579				7176354209	Lynne.Walsh@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Contact for Fraud Investigations	VP Financial Investigation & Provider Review	Mr.	Spear	Kurt		4125447069					Kurt.Spear@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	03/21/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Coordination of Benefits Contact	Sr. Process Analyst	Ms.	Cassidy	Christina		4125444417					Christina.Cassidy@highmark.com	120 Fifth Avenue	PAP P5111	Pittsburgh	PA	15222	06/03/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Corporate Mailing						4125447031					Thomas.Boettler@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Pricing & Risk Revenue Analytics		DePonceau	Aaron		7168877124					Aaron.Deponceau@highmark.com	257 West Genesee Street		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Customer Service Operations Contact	Manager, Member Customer Service		Sheridan	Rebecca	L	5182205661				5184232294	rebecca.sheridan@highmark.com	40 Century Hill Drive		Latham	NY	12110	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	DIR Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	DIR Contact (Secondary)	Senior Risk & Compliance Case Manager		Stetson	Kelsey		4125445816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	02/23/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Emergency Part D Contact	Manager, Member Customer Service		Sheridan	Rebecca	L	5182205661				5184232294	rebecca.sheridan@highmark.com	40 Century Hill Drive		Latham	NY	12110	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Emergency Part D Contact (Secondary)	Supervisor, Pharmacy Customer Service	Ms.	Bouck	Sarah	R	5182205632					sarah.bouck@highmark.com	40 Century Hill Drive		Latham	NY	12110	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Employer Waiver Contact	Manager, Product Development & Management		Connors	Vince		7168877129				7168877022	Vincent.Connors@highmark.com	257 West Genesee Street		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Encounter Data & Risk Adjustment Operations Contact	Director, Actuarial Services	Mr.	DelPrince	Vincent	M	4125443939					Vincent.Delprince@highmark.com	501 Penn Avenue		Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Enrollment Contact	Federal Programs Eligibility & Billing Manager		Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	EOB Transfer Contact	Manager, Claims	Ms.	Johannes	Karin		7168876875				7168876875	karin.johannes@highmark.com	257 West Genesee St.		Buffalo	NY	14202	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Financial Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/15/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Financial Reporting Contact	Vice President, Accounting & Reportin	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	10/06/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Formulary Contact	Senior Pharmacist, Clinical Pharmacy Services		DiTullio	Kelly		4128884336					Kelly.DiTullio@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Formulary Contact (Secondary)	Senior Pharmacist, Clinical Pharmacy Services		Humphries	Jessica		4128884890					jessica.humphries@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	General Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Government Relations Contact	SVP, Government Affiars	Mr.	Warfel	Michael	G	7173023979					michael.warfel@highmark.com	1800 Center St.		Camp Hill	PA	17011	03/18/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	HIPAA Privacy Officer	Chief Privacy and Data Ethics Officer	Ms.	Patrick	Justine		4125444643					Justine.Patrick@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	HIPAA Security Officer	Chief Information Security Officer	Ms.	Anderson	Melissa		4125447950					melissa.anderson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	12/20/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Hospice Contact	Intake Coordinator		Welker	Jessica		7178883043					DrugHelp_Authorizations@highmark.com	120 5th Avenue Place		Pittsburgh	PA	15222	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Interoperability Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	MA Appeals/Grievances Contact	Manager, Appeals & Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	MA Claims Processing Contact for Public Website	Manager, Claims	Ms.	Johannes	Karin		7168876875					Karin.Johannes@highmark.com	257 West Genesee St.		Buffalo	NY	14202	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Marketing Contact	Government Compliance		Gormley	Megan	E	7168878968					Megan.Gormley@highmarkhealth.org	257 West Genesee Street		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Medical Director	VP, Executive Medical Director	Dr,	Law	Timothy		4125446445					timothy.law@highmark.com	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	07/28/2021	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Medicare Coordinator	Director, Government Compliance	Ms.	Carl	Kathleen	A	4125447156					Kathleen.Carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Medicare Part D Opioid Overutilization Contact	Pharmacist	Ms.	Ali	Dewaa		4129040214					Dewaa.ali@highmark.com	120 Fifth Avenue PAP P4207		Pittsburgh	PA	15222	07/31/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Medication Therapy Management Contact	Senior Pharmacist	Ms.	Adlesic	Meredith		4128883749					Meredith.Adlesic@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	OffShore Subcontractor Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Online Enrollment Center Contact (Back-up)	Sr. Rep		Shear	Sally		6077663075				8882822583	Sally.Shear@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Online Enrollment Center Contact (Primary)	Manager		Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Part C Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Part C Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Part D Appeals	Manager, Member Appeals & Grievances	Ms.	Walsh	Lynne	M					7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	4125444579				PPO - BBA		C	Philadelphia
H5526	Part D Appeals Contact (Secondary)	Supervisor, Appeals & Grievances	Ms.	Miller	Rachel	M					7176354209	Rachel.Miller@highmark.com	Fifth Ave Place	120 Fifth Avenue, Ste 5322	Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	4125441596				PPO - BBA		C	Philadelphia
H5526	Part D Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Part D Benefits Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Part D Claims Submission Contact	Director Regulated Marketing Medicare Solutions		Dovico	Rosario		9145896300				8882822583	Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Part D Exceptions Contact			Affairs	Pharmacy							drughelp@highmark.com	120 Fifth Avenue	Suite SPECARE	Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8006002227				PPO - BBA		C	Philadelphia
H5526	Part D Exceptions Contact (Secondary)	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8003443405	733326			PPO - BBA		C	Philadelphia
H5526	Part D Price File Contact (Back-up)	Director, Government Programs	Ms	Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Part D Price File Contact (Optional)	Pharmacy Analyst		Nolder	Timothy		4125448137					timothy.nolder@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/14/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Part D Price File Contact (Primary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Part D Quality Assurance Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Part D Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Patient Safety Contact	Director, Clinical Pharmacy Operations	Mr.	Causer	Derek		4125445835					Derek.Causer@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	12/20/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Payment Contact	Federal Programs Eligibility & Billing Manager	Ms.	Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Pharmacy Director	Manager, Pharmacy Programs		Winterhalter	Christa		4128884108					Christa.Winterhalter@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Pharmacy Network Management Contact	Network Account Director, Retail Strategy&Contract		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	11/30/2016	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	12/17/2021	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8009221557				PPO - BBA		C	Philadelphia
H5526	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Government Operations	Ms	Lynn Schill	Jodie							Jodie.LynnSchill@highmark.com	120 Fifth Avenue Pittsburgh, PA 15222		Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active	5705783579				PPO - BBA		C	Philadelphia
H5526	PHR Beneficiary Contact																	10/28/2021	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO	Highmark Western and Northeastern New York Inc	Highmark Health	123	Yes	Active	8003292792				PPO - BBA		C	Philadelphia
H5526	Physician Incentive Contact	VP Prov Reimbursement & Network	Mr.	McDonald	Brendan		4125446611					brendan.mcdonald@highmarkhealth.org	120 5th Avenue Place		Pittsburgh	PA	152223099	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Plan Directory Contact for Public Website			Service	Customer		8773271395					customerservice@bcbswny.com	PO Box 13599		Albany	NY	12212	02/21/2020	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Plan to Plan Reconciliation Contact	Manager, Operational Accounting		Stehr	Brett		7173022748					P2Precon@highmark.com	Highmark, Inc Attn: Cashier	PO Box 898820	Camp Hill	PA	17089	06/28/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Processor Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Quality Contact	VP, Clinical Quality and Medical Policy	Dr.	Onuoha-Obilor	Stella		4125444335					Stella.Onuoha-Obilor@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/02/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Reconciliation Contact	Director, Pricing & Risk Revenue & EI & Analytics		Deponceau	Aaron		7168877124					Aaron.Deponceau@highmark.com	257 West Genesee St.		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Reconciliation Contact (Secondary)	Senior Risk * Compliance Case manager		Stetson	Kelsey		4125448816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	02/23/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Recovery Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	SNP Application Contact	Program Manager, Federal  Programs		Mariacher	Jill		7168877940					Jill.Mariacher@highmark.com	257 West Genesee Street		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Surveillance Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					jillian.pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	System Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Third Party Administrator (TPA) Liaison	Accountant		Jurgiewicz	Kimberly		5707807969					kimberly.jurgiewicz@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/02/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	User Access Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Utilization Management Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5526	Utilization Review Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	Local CCP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H5528	Agent/Broker Compensation Data Contact	Medicare Sales Director		Casas	Edward		3472138107					ecasas@emblemhealth.com	55 Water Street		New York	NY	10041	06/02/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Automated TrOOP Balance Transfer Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					JEwen@emblemhealth.com	55 Water St		New York	NY	10041	06/25/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Backup User Access Contact	Director, Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Best Available Evidence Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Bid Audit Contact	Director, Medicare Audit & Assessment		Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	12/03/2014	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Bid Audit Site Contact	Sr. Medicare Audit Spec.		Chan	Tat		6464470218					tchan@emblemhealth.com	55 Water Street		New York	NY	10041	05/28/2020	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Bid Primary Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	CAP Report Contact for Public Website	Dir., Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	CEO - CMS Administrator Contact	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin-Corp Exec. Office	New York	NY	10041	03/02/2017	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	CEO - Senior Official for Contracting	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin - Corp Exec. Office	New York	NY	10041	05/09/2019	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Chief Financial Officer	Chief Financial Officer	Ms.	Tamborino	Heather		6464476174					htamborino@emblemhealth.com	55 Water Street		New York	NY	10041	07/02/2020	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Chief Operating Officer	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Chief Information Officer	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Chief Information Security Officer	AVP, IT Governance	Mr.	McDermott	Thomas	M	6464474110					tmcdermott@emblemhealth.com	55 Water Street		New York	NY	10041	06/29/2018	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	CMMI Model Point of Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	CMS Casework Communication Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Complaints Tracking Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Contact for Fraud Investigations	Director, Special Investigations		Lupo	Chris		6318442453					Clupo@EmblemHealth.com	395 North Service Road		Melville	NY	11747	03/02/2017	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Coordination of Benefits Contact	Director, Payment Integrity & Financial Recovery		LaPlante	Brian		8606742840					blaplante@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	01/10/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Corporate Mailing						6464475044					Cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Coverage Gap Discount Program (CGDP) Payment Contact	Treasury Operations Analyst		Saint-Hilaire	Ana		6464474279					ASaint-Hilaire@emblemhealth.com	55 Water St		New York	NY	10041	04/02/2020	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Customer Service Operations Contact	VP, Ops Strategy & Service Delivery		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	DIR Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	DIR Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Emergency Part D Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Emergency Part D Contact (Secondary)	Pharm. Govt. Programs Manager		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Employer Waiver Contact	AVP, Product Dev., Admin., & Perf. Analysis		Averyanova	Nataliya		6464475044					naveryanova@emblemhealth.com	55 Water Street		New York	NY	10041	04/18/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Encounter Data & Risk Adjustment Operations Contact	Enterprise Director of Gov''''''''t		Guenther	Anne Marie		8606745847					aconnors@connecticare.com	175 Scott Swamp Rd		Farmington	CT	06034	01/14/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Enrollment Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	EOB Transfer Contact	Director, Claims Processing & Provider File Mgmt		Meka	Joann		8604098915				8604098455	jmeka@connecticare.com	175 South Swamp Road		Farmington	CT	06034	05/28/2020	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Financial Audit Contact	Director, Medicare Audit & Assessment	Mr	Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	12/03/2014	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Financial Reporting Contact	Dir., Financial Reporting		Heitzer	Frances		6464477885					fheitzer@emblemhealth.com	55 Water Street		New York	NY	10041	07/18/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Formulary Contact	Sr. Formulary Specialist		Sitilides Cimino	Irene		6864477926					isitilidescimino@emblemhealth.com	55 Water Street		New York	NY	10041	11/15/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Formulary Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	05/12/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	General Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Government Relations Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	HIPAA Privacy Officer	VP, Corporate Compliance		Lurin	Joseph		6464475203					jlurin@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	HIPAA Security Officer	VP, Technology and CISO		McDermott	Thomas		6464474110					TMcDermott@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Hospice Contact	Senior Medicare Pharmacy Specialist		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Interoperability Contact	Dir., Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	MA Appeals/Grievances Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	MA Claims Processing Contact for Public Website	VP, Claims Operations		Henderson	Linda		6464476795					lhenderson@emblemhealth.com	175 Scott Swamp Road		Farmington	CT	06032	05/28/2020	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Marketing Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Medical Director	Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	05/28/2020	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Medicare Compliance Officer	Director, Medicare Compliance/MCO	Ms.	Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Medicare Coordinator	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Medicare Part D Opioid Overutilization Contact	Dir., Pharm. Quality Provider and Safety Prgms.		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road		Farmington	CT	06034	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Medication Therapy Management Contact	Clinical Pharmacy Program Leader		Mhajan	Ruby		6464477632					rumhajan@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	OffShore Subcontractor Contact	Lead Admin., Regulatory Pgm.		Kelly	Veronica		6464477494					vkelly@emblemhealth.com	55 Water Street		New York	NY	10041	11/26/2019	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Online Enrollment Center Contact (Back-up)	Knowledge Manager, Enroll. & Bill.		Gonzalez	Gabriel		6464477722					gabriel.gonzalez@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Online Enrollment Center Contact (Optional)	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Online Enrollment Center Contact (Primary)	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Part C Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Part C Reporting Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Part D Appeals	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active	6464477215				PPO - BBA		C	New York
H5528	Part D Appeals Contact (Secondary)	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active	6464477215				PPO - BBA		C	New York
H5528	Part D Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Part D Benefits Contact	Sr. Pharm. Gov't. Prog. Spec		Dean	Wendy		8604098966					wdean@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	07/18/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Part D Claims Submission Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Part D Exceptions Contact	Director, Pharmacy Solutions		Colby	Andrew							acolby@emblemhealth.com	55 Water street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active	6464473340				PPO - BBA		C	New York
H5528	Part D Exceptions Contact (Secondary)	Sr.  Govt Prog. Pharm. Spec.		Kerman	Jeff							jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	05/12/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active	6464477698				PPO - BBA		C	New York
H5528	Part D Price File Contact (Back-up)	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Part D Price File Contact (Optional)	Sr. Govt Prog. Pharm Spec.		Kerman	Jeff		6464477698					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	07/22/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Part D Price File Contact (Primary)	Sr. Manager Regulated Markets		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/11/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Part D Quality Assurance Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Part D Reporting Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Patient Safety Contact	Dir., Pharm. Quality Provider and Safety Prgms.		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road	P.O. Box 4050	Farmington	CT	060344050	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Payment Contact	VP Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Personal Health Record Contact	Director, Medicare Compliance		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Pharmacy Director	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Pharmacy Network Management Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Pharmacy Network Management Contact (Secondary)	Sr. Govt Prog. Pharm. Specialist		Kerman	Jeff		6464477698					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	01/12/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active	8009221557	2			PPO - BBA		C	New York
H5528	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Client Ops Director		Brown	Gregory							grbrown@emblemhealth.com	55 Water street		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active	4015251683				PPO - BBA		C	New York
H5528	PHR Beneficiary Contact																	04/20/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO	EmblemHealth	EmblemHealth, Inc.	361	Yes	Active	8773447364				PPO - BBA		C	New York
H5528	Plan Directory Contact for Public Website	VP, Ops Strategy & Service Delivery		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Plan to Plan Reconciliation Contact	Accounts Payable Manager		Siozios	Jacqueline		6464473017					jsiozios@emblemhealth.com	55 Water Street		New York	NY	10041	08/16/2022	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Processor Contact	AVP, Claims Operations		Gauthier	Kathleen	H	8604096435					kgauthier@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	07/18/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Quality Contact	Data Analytics & Reporting Leader		Goldfarb	Julie		6315775110	65110				jgoldfarb@emblemhealth.com	55 Water Street		New York	NY	10041	01/10/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Reconciliation Contact	Dir., Enrollment & Billing		Ewen	Jillian	L	8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	07/15/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Reconciliation Contact (Secondary)	VP Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	07/15/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Recovery Audit Contact	Director, Medicare Audit & Assessment	Mr.	Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road		Albany	NY	12205	12/03/2014	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	SNP Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	SNP State Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Surveillance Contact	Director, Medicare Compliance/MCO	Ms.	Borenkind	Carly		3479784977					Cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	System Contact	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	05/09/2019	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Third Party Administrator (TPA) Liaison	Lead Accountant		Simochkina	Ludmila		7185599146					lsimochkina@emblemhealth.com	2151 Ocean Ave	apt 2 B	Brooklyn	NY	11229	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	User Access Contact	Lead Medicare Regulatory Spec.		Handy	Michelle		5184466949					mhandy@EmblemHealth.com	80 Wolf Road		Albany	NY	12205	11/14/2016	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Utilization Management Contact	Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5528	Utilization Review Contact	Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC.	Local CCP	EmblemHealth	Local PPO		EmblemHealth, Inc.	361	Yes	Active					PPO - BBA		C	New York
H5533	Agent/Broker Compensation Data Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Automated TrOOP Balance Transfer Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2021	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Backup User Access Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Best Available Evidence Contact	Customer Service		Health Plan	UPMC		8775393080					upmchp@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Bid Audit Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Bid Audit Site Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Bid Primary Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	CAP Report Contact for Public Website	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	CEO - CMS Administrator Contact	President	Ms.	Holder	Diane	P	4124547640				4124547750	holderd@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/04/2023	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	CEO - Senior Official for Contracting	President	Ms.	Holder	Diane	P	4124547640				4124547750	holderd@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/04/2023	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Chief Financial Officer	Chief Financial Officer	Mr.	Gebbens	Gordon		4124545559					gebbgx@UPMC.EDU	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	07/18/2016	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Chief Operating Officer	Chief Operating Officer	Ms.	Jenkins	Mary Beth	L	4124547764					jenkinsml@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	12/09/2015	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Chief Information Officer	Chief Information Officer	Mr.	McCallister	Ed		4124547711					mccallisterew@upmc.edu	USX Tower, 60th Floor	600 Grant Street	Pittsburgh	PA	15219	03/14/2016	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Chief Information Security Officer	Vice President, ISD	Mr	Haas	Scott		4124546162					haassm@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	03/14/2016	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	CMS Casework Communication Contact	Sr. Administrator, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Complaints Tracking Contact	Sr. Administrator, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Contact for Fraud Investigations	Sr. Director Fraud & Abuse		Workman	Craig		4124545524					workmanc@upmc.edu	USX Tower, 47th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Coordination of Benefits Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Corporate Mailing						4124547500					upmchp@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst		Kelly	Alexis		4124547856				4124542110	medicarereporting@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/05/2021	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Customer Service Operations Contact	Customer Service		Health Plan	UPMC		8775393080					upmchp@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	01/18/2012	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	DIR Contact	Director, Pharmacy Finance		Bovier	Jacqueline		4124547584					bovierjd@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	06/18/2015	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	DIR Contact (Secondary)	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Emergency Part D Contact	Vice President, Customer Engagement & Enrollment		Palmerine	Anne		4129777828					palmerineac3@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Operations		Kienzle	Paul		7242070388					kienzlepa@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Encounter Data & Risk Adjustment Operations Contact	Director, Government Revenue		Plank	Tim		4124547747					planktm@upmc.edu	USX Tower, 36th Floor	600 Grant Street	Pittsburgh	PA	15219	10/28/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Enrollment Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	EOB Transfer Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Financial Audit Contact	AVP, Medicare Operations	Mr.	Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	08/14/2020	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Financial Reporting Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Formulary Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Formulary Contact (Secondary)	Specialist, Pharmacy Operations	Ms.	Lindemuth	Nicole		4124548589					lindemuthnl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	08/29/2012	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	General Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Government Relations Contact	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Grumbine	Megan		7034021772					grumbinem@upmc.edu	USX Tower, 41st Floor	600 Grant St.	Pittsburgh	PA	15219	11/03/2020	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	HIPAA Security Officer	Chief Privacy Officer	Ms.	Grumbine	Megan		7034021772					grumbinem@upmc.edu	USX Tower, 41st Floor	600 Grant St.	Pittsburgh	PA	15219	11/03/2020	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Hospice Contact	Pharmacy Coordinator	Ms.	Lindemuth	Nicole		4124548589					lindemuthnl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	06/24/2020	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Interoperability Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	02/16/2022	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	MA Appeals/Grievances Contact	Sr. Administrator, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	MA Claims Processing Contact for Public Website	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Marketing Contact	Director, Medicare Marketing		McVey	Alicia		4124545525					mcveyal@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	08/03/2017	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Medical Director	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Medicare Coordinator	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Medicare Part D Opioid Overutilization Contact	Sr. Manager, Clinical Pharmacy		Zandier	Lauren		4124542950				4124545295	craigl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	10/23/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Medication Therapy Management Contact	Sr. Manager Clinical Pharmacy		Zandier	Lauren		4124542950				4124545295	craigl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	10/23/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Online Enrollment Center Contact (Back-up)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Online Enrollment Center Contact (Optional)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Online Enrollment Center Contact (Primary)	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Part C Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	11/01/2017	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Part C Reporting Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Part D Appeals	Manager, C&G		Richards	Rebecca						4124547920	richardsr3@upmc.edu	USX Tower, 42nd Floor	600 Grant Street	Pittsburgh	PA	15219	02/25/2021	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active	4124540116				PPO - BBA		C	Philadelphia
H5533	Part D Appeals Contact (Secondary)	Manager, Pharmacy Compliance		Chaussinand	Matt							chaussinandm@upmc.edu	600 Grant St., USX, 12th Floor		Pittsburgh	PA	15219	02/25/2021	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active	4124545914				PPO - BBA		C	Philadelphia
H5533	Part D Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	11/01/2017	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Part D Benefits Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions		Dovico	Rosario		2012696398					rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	04/23/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Part D Exceptions Contact			Services	Pharmacy							upmchp@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	08/29/2012	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active	8003964139				PPO - BBA		C	Philadelphia
H5533	Part D Price File Contact (Back-up)	Sr. Manager, Government Programs		Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	01/12/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Part D Price File Contact (Optional)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Part D Price File Contact (Primary)	Director, Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107 St. #11202		Overland	KS	66207	07/28/2020	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Part D Quality Assurance Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Part D Reporting Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Patient Safety Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Payment Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Personal Health Record Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Pharmacy Director	Sr. Director, Pharmacy Operations		Kienzle	Paul		7242070388					kienzlepa@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Pharmacy Network Management Contact	Network Account Director		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	10/31/2016	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Pharmacy Technical Help Desk Contact	DIrector, Customer Service		Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	07/29/2021	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active	8009221557				PPO - BBA		C	Philadelphia
H5533	PHR Beneficiary Contact																	12/21/2007	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO	MyHealth	UPMC Health System	249	Yes	Active	4128032065				PPO - BBA		C	Philadelphia
H5533	Physician Incentive Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Plan Directory Contact for Public Website			Marketing	Medicare		8773813765					upmchp@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Plan to Plan Reconciliation Contact	Business Analyst		Michalski	Jeff		4124545715				4124542110	medicarereporting@upmc.edu	c/o UPMC Health Plan Attn: Dave Soltesz P2P	US Steel Tower, 600 Grant Street, 21st Floor	Pittsburgh	PA	15219	10/03/2022	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Processor Contact	Sr Director - Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	01/12/2018	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Quality Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Reconciliation Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Reconciliation Contact (Secondary)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Recovery Audit Contact	Sr. Director, Medicare Operations	Mr.	Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	SNP Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	11/01/2017	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	SNP State Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Surveillance Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	System Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Third Party Administrator (TPA) Liaison	Business Analyst		Kelly	Alexis		4124547856				4124542110	kellya9@upmc.edu	c/o UPMC Health Plan Attn: Alexis Kelly P2P	US Steel Tower, 600 Grant Street, 9th Floor	Pittsburgh	PA	15219	04/16/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	User Access Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Utilization Management Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5533	Utilization Review Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH NETWORK, INC.	Local CCP	UPMC for Life	Local PPO		UPMC Health System	249	Yes	Active					PPO - BBA		C	Philadelphia
H5538	Automated TrOOP Balance Transfer Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Backup User Access Contact	Executive Director	Mr.	Garrett	Travis		4172140524					travis.garrett@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Best Available Evidence Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Bid Primary Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	CAP Report Contact for Public Website	Executive Director	Mr.	Garrett	Travis		4172140524					travis.garrett@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	CEO - CMS Administrator Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	CEO - Senior Official for Contracting	Executive Director	Mr.	Garrett	Travis		4172140524					travis.garrett@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	01/20/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Chief Financial Officer	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Chief Operating Officer	Chief Operating Officer	Ms.	Lewis	Anne		4066472980					anne.lewis@trinity-health.org	6113 Norma Jean Lane		Billings	MT	59101	06/16/2022	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Chief Information Officer	Regional Director of IT Operations	Mr.	Latimer	Mike		6142348636					mike.latimer@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	06/16/2022	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Chief Information Security Officer	Regional Information Security Officer	Ms.	Matthews	Lynne		6105503083					lmatthews@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	10/28/2022	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	CMS Casework Communication Contact	Executive Director	Mr.	Garrett	Travis		4172140524					travis.garrett@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Complaints Tracking Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Contact for Fraud Investigations	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Coordination of Benefits Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Corporate Mailing						9177035808					antonio.dias@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	06/16/2022	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Coverage Gap Discount Program (CGDP) Payment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Customer Service Operations Contact	Executive Director	Mr.	Garrett	Travis		4172140524					travis.garrett@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	DIR Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Emergency Part D Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Encounter Data & Risk Adjustment Operations Contact	Director of Coding and Documentation		Creaney	Emy		7343431939					creaneye@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Enrollment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	EOB Transfer Contact	Regional director Finance	Ms.	Fuhrmeister	Nicole		2157788707				9104834930	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Financial Audit Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Financial Reporting Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Formulary Contact	Manager Part D Compliance	Mr.	Garbarino	Joseph		2153394362					joseph.garbarino@mercyhealth.org	1930 S. Broad Street	Unit 3	Philadelphia	PA	19145	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	General Contact	Executive Director	Mr.	Garrett	Travis		4172140524					travis.garrett@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Government Relations Contact	Executive Director	Mr.	Garrett	Travis		4172140524					travis.garrett@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	HIPAA Privacy Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	HIPAA Security Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Interoperability Contact	Regional Director of IT Operations		Latimer	Mike		6142348636					mike.latimer@trinity-health.org	20555 Victory Parkway		Livonia	MI	48152	06/16/2022	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	MA Appeals/Grievances Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	MA Claims Processing Contact for Public Website	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Marketing Contact	Director Marketing and Communications	Ms.	Lark	Azia		9735182754					azia.lark@trinity-health.org	20255 Victor Parkway		Livonia	MI	48152	02/03/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Medical Director	Medical Director	Dr	Maguchi	Megumi		8508060830					megumi.maguchi@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Medicare Compliance Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Medicare Coordinator	Executive Director	Mr.	Garrett	Travis		4172140524					travis.garrett@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Part C Application Contact			Lewis	Anne		4066472980					anne.lewis@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	04/03/2022	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Part D Appeals	Manager Part D Compliance	Mr.	Garbarino	Joseph							joseph.garbarino@mercyhealth.org	1930 S. Broad Street	Unit 3	Philadelphia	PA	19145	06/16/2022	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending	2153394362				PACE - Nat		C	Atlanta
H5538	Part D Application Contact			Lewis	Anne		4066472980					anne.lewis@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	04/03/2022	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Part D Benefits Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Part D Claims Submission Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Part D Exceptions Contact	Manager Part D Compliance	Mr.	Garbarino	Joseph							joseph.garbarino@mercyhealth.org	1930 S. Broad Street	Unit 3	Philadelphia	PA	19145	06/16/2022	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending	2153394362				PACE - Nat		C	Atlanta
H5538	Part D Price File Contact (Back-up)	Executive Director	Mr.	Garrett	Travis		4172140524					travis.garrett@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Part D Price File Contact (Primary)	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Part D Quality Assurance Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Part D Reporting Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Patient Safety Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Payment Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Pharmacy Director	Manager Part D Compliance	Mr.	Garbarino	Joseph		2153394362					joseph.garbarino@mercyhealth.org	1930 S. Broad Street	Unit 3	Philadelphia	PA	19145	06/16/2022	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Pharmacy Network Management Contact	Manager Part D Compliance	Mr.	Garbarino	Joseph		2153394362					joseph.garbarino@mercyhealth.org	1930 S. Broad Street	Unit 3	Philadelphia	PA	19145	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Pharmacy Technical Help Desk Contact	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@mercyhealth.org	1930 South Broad St	Unit 3	Philadelphia	PA	19145	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending	2153394362				PACE - Nat		C	Atlanta
H5538	PHR Beneficiary Contact																	06/16/2022	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE	Trinity Health PACE	Trinity Health Corporation	234	Yes	Pending	9177035808				PACE - Nat		C	Atlanta
H5538	Plan Directory Contact for Public Website	Executive Director	Mr.	Garrett	Travis		4172140524					travis.garrett@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Plan to Plan Reconciliation Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Processor Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Quality Contact	Regional Director QI/Compliance	Ms	Baldwin	Diane		2512878426					diane.baldwin@mercylifeal.com	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Reconciliation Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Recovery Audit Contact	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707				2512878478	nicole.fuhrmeister@trinity-health.org	2900 Springhill Ave		Mobile	AL	36607	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Surveillance Contact	Executive Director	Mr.	Garrett	Travis		4172140524					travis.garrett@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	System Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Third Party Administrator (TPA) Liaison	Regional Director Finance	Ms	Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	4508 Chestnut Street		Philadelphia	PA	19139	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	User Access Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Utilization Management Contact	Medical Director	Dr	Maguchi	Megumi		8508060830					megumi.maguchi@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5538	Utilization Review Contact	Medical Director	Dr	Maguchi	Megumi		8508060830					megumi.maguchi@trinity-health.org	5020 Commerce Park Circle		Pensacola	FL	32505	08/04/2023	2023	TRINITY HEALTH PACE OF PENSACOLA	National PACE	Trinity Health PACE of Pensacola	National PACE		Trinity Health Corporation	234	Yes	Pending					PACE - Nat		C	Atlanta
H5549	Agent/Broker Compensation Data Contact	Vice President, Sales and Partnership Development	Mr.	Robinson	David		6466280096					David.Robinson@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Automated TrOOP Balance Transfer Contact	Manager, Membership and Eligibility Unit	Ms.	Tang	Cheryl		2127603147					Cheryl.Tang@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Backup User Access Contact	Director, Product Management		Tricomi	Michael		6464774885					michael.tricomi2@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Best Available Evidence Contact	Manager, Membership and Eligibility Unit	Ms.	Tang	Cheryl		2127603147					Cheryl.Tang@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Bid Audit Contact	Executive Vice President and CFO	Mr.	Patterson	Keith		2126094131					Keith.Patterson@vnshealth.org	220 East 42nd Street	6th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Bid Audit Site Contact	Executive Vice President and CFO	Mr.	Patterson	Keith		2126094131					Keith.Patterson@vnshealth.org	220 East 42nd Street	6th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Bid Primary Contact	Product Manager	Mr.	Powell	Jonathan	J	3479960153					Jonathan.Powell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	CAP Report Contact for Public Website	Vice President, Compliance & Regulatory Affairs		Goggin-Callahan	Doug		2017792584					Douglas.Goggin-Callahan@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	CEO - CMS Administrator Contact	President and Chief Executive Officer	Mr.	Savitt	Daniel		2126091520					Daniel.Savitt@vnshealth.org	220 East 42nd Street	6th Floor	New York	NY	10017	06/16/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	CEO - Senior Official for Contracting	President and Chief Executive Officer	Mr.	Savitt	Daniel		2126091520					Daniel.Savitt@vnshealth.org	220 East 42nd Street	6th Floor	New York	NY	10017	06/16/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Chief Financial Officer	CFO	Mr.	Patterson	Keith		2126094131					Keith.Patterson@vnshealth.org	220 East 42nd Street	6th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Chief Operating Officer	Chief Operating Officer	Mr.	Ellis	Marshall		2022761731					Marshall.Ellis@vnshealth.org	220 East 42nd Street		New  York	NY	10017	06/16/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Chief Information Officer	Chief Information Officer	Mr.	Plaszcz	Robert		2126095407					Robert.Plaszcz@vnsny.org	5 Penn Plaza	12th Floor	New York	NY	10001	10/10/2018	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Chief Information Security Officer	IT Security Policy Director	Mr.	Bain	Justin		2126095560					Justin.Bain@vnshealth.org	5 Penn Plaza	12th Floor	New York	NY	10001	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	CMMI Model Point of Contact	Ms.		Aquino	Josie		9177817999					Josie.Aquino@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	CMS Casework Communication Contact	Vice President, Compliance & Regulatory Affairs		Goggin-Callahan	Doug		2017792584					Douglas.Goggin-Callahan@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Complaints Tracking Contact	Vice President, Quality & Member Safety	Ms.	Brickner	Mihriban		2126091687					Mihriban.GursoyBrickner@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	05/09/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Contact for Fraud Investigations	Manager, Special Investigations Unit	Mr,	Conroy	James	P	6468420369					james.conroy@vnshealth.org	220 East 42nd Street	6th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Coordination of Benefits Contact	Manager, Membership and Eligibility Unit	Ms.	Tang	Cheryl		2127603147					Cheryl.Tang@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Corporate Mailing						2126095641					Mariella.Rodriguez@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Manager	Ms.	Strougo	Shama		9172731356					shama.strougo@vnshealth.org	220E 42nd Street	7th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Customer Service Operations Contact	Vice President, Contact Center Services & Admin	Ms.	Vitale	Nancy		2126268071					Nancy.Vitale@vnshealth.org	500 7th Avenue	11th Floor	New York	NY	10018	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	DIR Contact	Director, Actuarial Services	Mr.	Rong	Lei		3478863611					Lei.Rong@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	DIR Contact (Secondary)	Vice President, Pharmacy Services	Ms.	Shell	Sofya		2122906557					Sofya.Shell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Emergency Part D Contact	Vice President, Pharmacy Services	Ms.	Shell	Sofya		9174078732					Sofya.Shell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Emergency Part D Contact (Secondary)	Associate Director, Pharmacy Services	Ms.	Devineni	Ramya		6462760482					Ramya.Devineni@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Employer Waiver Contact	Director, Product Management		Tricomi	Michael		6464774885					michael.tricomi2@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Encounter Data & Risk Adjustment Operations Contact	Director, Encounter Reporting and Risk Adjustment		Edmudson	Ben		3473228132					BEN.EDMUDSON@vnshealth.org	220 East 42nd Street, 3rd floor		New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Enrollment Contact	Manager, Membership and Eligibility Unit	Ms.	Tang	Cheryl		2127603147					Cheryl.Tang@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	EOB Transfer Contact	Director, Service Operations	Mr.	Nunez	Ramennis		2126097474				6464597725	Ramennis.Nunez@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Financial Audit Contact	Vice President and Corporate Controller	Ms.	Guilfoyle	Jacqueline		2126094162					Jacqueline.Guilfoyle@vnshealth.org	220 East 42nd Street	7th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Financial Reporting Contact	Vice President and Corporate Controller	Ms.	Guilfoyle	Jacqueline		2126094162					Jacqueline.Guilfoyle@vnshealth.org	220 East 42nd Street	7th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Formulary Contact	Vice President, Pharmacy Services	Ms.	Shell	Sofya		2122906557					Sofya.Shell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Formulary Contact (Secondary)	Manager, Formulary Ops & Analysis	Ms.	Nyawabila	Christina		8587906297					FMT@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	07/30/2021	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	General Contact	Vice President, Compliance & Regulatory Affairs		Goggin-Callahan	Doug		2017792584					Douglas.Goggin-Callahan@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Government Relations Contact	Vice President, Government Affairs	Mr.	Lowenstein	Daniel		2126091514					Dan.Lowenstein@vnshealth.org	220 East 42nd Street	6th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	HIPAA Privacy Officer	Chief Compliance & Privacy Officer	Ms.	Miyazaki-Grant	Annie		2126097470				6464597729	Annie.Miyazaki@vnshealth.org	220 East 42nd Street	6th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	HIPAA Security Officer	IT Security Policy Director	Mr.	Bain	Justin		2126095560					Justin.Bain@vnshealth.org	5 Penn Plaza	12th Floor	New York	NY	10001	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Hospice Contact	Pharmacy Services Specialist	Ms.	Rahman	Ishrat		2126091751					Ishrat.Rahman@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Interoperability Contact	VP, IT Enterprise Services	Ms.	Mozes	Nancy		2126095789					Nancy.Mozes@vnshealth.org	220 East 42nd Street		New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	MA Appeals/Grievances Contact	Vice President, Quality & Member Safety	Ms.	Brickner	Mihriban		2126091687					Mihriban.GursoyBrickner@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	05/09/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	MA Claims Processing Contact for Public Website	Director, Service Operations	Mr.	Nunez	Ramennis		2126097474					Ramennis.Nunez@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Marketing Contact	Director, Marketing	Ms.	Zanca	Cindy		2126091776					Cindy.Zanca@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Medical Director	Chief Medical Officer	Dr.	Dobkin	Jay		2122906524					Jay.Dobkin@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Medicare Compliance Officer	Vice President, Compliance & Regulatory Affairs	Mr.	Goggin-Callahan	Doug		2017792584					Douglas.Goggin-Callahan@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Medicare Coordinator	Chief Operating Officer	Mr.	Ellis	Marshall		2022761731					Marshall.Ellis@vnshealth.org	220 East 42nd Street		New York	NY	10017	06/16/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Medicare Part D Opioid Overutilization Contact	Vice President, Pharmacy Services	Ms.	Shell	Sofya		2122906557				6462734885	Sofya.Shell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Medication Therapy Management Contact	Vice President, Pharmacy Services	Ms.	Shell	Sofya		2122906557				2122904855	Sofya.Shell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	OffShore Subcontractor Contact	Mgr., Legal Support Services	Ms.	Abdel-Gleil	Karema		2126091754					karema.abdel-gleil@vnshealth.org	220 East 42nd Street		New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Online Enrollment Center Contact (Back-up)	Reconciliation Specialist, MEU	Ms.	Castro	Annellys		2129469194					Annellys.Castro@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Online Enrollment Center Contact (Optional)	Reconciliation Specialist, MEU	Ms.	Castro	Annellys		2129469194					Annellys.Castro@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Online Enrollment Center Contact (Primary)	Manager, Membership and Eligibility Unit	Ms.	Tang	Cheryl		2127603147					Cheryl.Tang@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Part C Application Contact	Director, Product Management		Tricomi	Michael		6464774885					michael.tricomi2@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Part C Reporting Contact	Regulatory Data Validation Manager	Mr.	Wu	George		2129469286					George.Wu@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Part D Appeals	Vice President, Pharmacy Services	Ms.	Shell	Sofya							Sofya.Shell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active	2122906557				HMO - Health Maintenance Organization		C	New York
H5549	Part D Appeals Contact (Secondary)	Medicare Part D Manager	Ms.	Devineni	Ramya							Ramya.Devineni@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active	2122906447				HMO - Health Maintenance Organization		C	New York
H5549	Part D Application Contact	Director, Product Management		Tricomi	Michael		6464774885					michael.tricomi2@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Part D Benefits Contact	Vice President, Pharmacy Services	Ms.	Shell	Sofya		2122906557					Sofya.Shell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Part D Claims Submission Contact	Director, Service Operations	Mr.	Nunez	Ramennis		2126097474					Ramennis.Nunez@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Part D Exceptions Contact	Vice President, Pharmacy Services	Ms.	Shell	Sofya							Sofya.Shell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active	2122906557				HMO - Health Maintenance Organization		C	New York
H5549	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Services	Ms.	Devineni	Ramya							Ramya.Devineni@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active	2122906447				HMO - Health Maintenance Organization		C	New York
H5549	Part D Price File Contact (Back-up)	Vice President, Pharmacy Services	Ms.	Shell	Sofya		2122906557					Sofya.Shell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Part D Price File Contact (Optional)	Manager, Pharmacy Services	Ms.	Devineni	Ramya		2122906447					Ramya.Devineni@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Part D Price File Contact (Primary)	Program Manager	Ms.	Keller	Shanon		8587906455					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	07/30/2021	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Part D Quality Assurance Contact	Vice President, Quality & Member Safety	Ms.	Brickner	Mihriban		2126091687					Mihriban.GursoyBrickner@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Part D Reporting Contact	Regulatory Data Validation Manager	Mr.	Wu	George		2129469286					George.Wu@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Patient Safety Contact	Vice President, Quality & Member Safety	Ms.	Brickner	Mihriban		2126091687					Mihriban.GursoyBrickner@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Payment Contact	Divisional Controller	Ms.	Wu	Amy		2126095715					Amy.Wu@vnshealth.org	220 East 42nd Street	7th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Personal Health Record Contact	Manager, Medical Records	Ms.	Denis	Maria		7185363109				6466402882	Maria.Denis@vnshealth.org	5 Penn Plaza	12th Floor	New York	NY	10001	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Pharmacy Director	Vice President, Pharmacy Services	Ms.	Shell	Sofya		2122906557					Sofya.Shell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Pharmacy Network Management Contact	Vice President, Pharmacy Services	Ms.	Shell	Sofya		2122906557					Sofya.Shell@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Pharmacy Network Management Contact (Secondary)	Supervisor, Pharmacy Network Support	Ms.	Frey	Jessica		8582915348					Jessica.Frey@MedImpact.com	10181 Scripps Gateway CT		San Diego	CA	92131	07/30/2021	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services	Ms.	Brewer	Kathy							customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/08/2022	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active	8886727205				HMO - Health Maintenance Organization		C	New York
H5549	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Contact Center Shared Services	Ms.	Bedoya	Tatiana							Tatiana.Bedoya@vnshealth.org	220 East 42nd Street		New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active	8667831444				HMO - Health Maintenance Organization		C	New York
H5549	PHR Beneficiary Contact																	01/18/2022	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS	VNSNY CHOICE	Visiting Nurse Service of New York	309	Yes	Active	8667831444				HMO - Health Maintenance Organization		C	New York
H5549	Physician Incentive Contact	Sr. VP, Chief Quality & Performance Improvement	Ms.	Gursoy-Brickner	Mihriban		2126091687					Mihriban.GursoyBrickner@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Plan Directory Contact for Public Website	Director, Marketing	Ms.	Zanca	Cindy		8667831444					Cindy.Zanca@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Plan to Plan Reconciliation Contact	Manager, Membership and Eligibility Unit	Ms.	Tang	Cheryl		2127603147					Cheryl.Tang@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Processor Contact	Director, Service Operations	Mr.	Nunez	Ramennis		2126091944					Ramennis.Nunez@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Quality Contact	Vice President, Quality & Member Safety	Ms.	Brickner	Mihriban		2126091687					Mihriban.GursoyBrickner@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Reconciliation Contact	Executive Vice President and CFO	Ms.	Patterson	Keith		2126094131					Keith.Patterson@vnshealth.org	220 East 42nd Street	6th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Reconciliation Contact (Secondary)	Director, Actuarial Services	Mr.	Rong	Lei		3478863611					Lei.Rong@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Recovery Audit Contact	Vice President, Compliance & Regulatory Affairs	Mr.	Goggin-Callahan	Doug		2017792584					Douglas.Goggin-Callahan@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	SNP Application Contact	Director, Product Improvement		Tricomi	Michael		6464774885					Michael.Tricomi2@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	SNP State Contact	Director, Compliance & Regulatory Affairs		Mendon	Priya		6467615745					Priya.Mendon@vnshealth.org	220 East 42nd Street	6th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Surveillance Contact	Vice President, Compliance & Regulatory Affairs		Goggin-Callahan	Doug		2017792584					Douglas.Goggin-Callahan@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	System Contact	Chief Information Officer	Mr.	Plaszcz	Robert		2126095407					Robert.Plaszcz@vnsny.org	5 Penn Plaza	12th Floor	New York	NY	10001	10/16/2018	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Third Party Administrator (TPA) Liaison	Vice President and Corporate Controller	Ms.	Guilfoyle	Jacqueline		2126094162					jacqueline.guilfoyle@vnshealth.org	220 East 42nd Street	7th Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	User Access Contact	Regulatory Data Validation Manager		Wu	George		2126094910					George.Wu@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Utilization Management Contact	Vice President, Clinical Operations	Ms.	Cavin	Kelly		3125048770					Kelly.Cavin@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5549	Utilization Review Contact	Vice President, Clinical Operations	Ms.	Cavin	Kelly		3125048770					Kelly.Cavin@vnshealth.org	220 East 42nd Street	3rd Floor	New York	NY	10017	08/15/2023	2023	VNS CHOICE	Local CCP	VNS Health Medicare	HMO/HMOPOS		Visiting Nurse Service of New York	309	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5576	Agent/Broker Compensation Data Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Automated TrOOP Balance Transfer Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Backup User Access Contact	Medicare Advantage Compliance Program Manager	Mrs.	Rainer	Sally		3183720214					Sally.Rainer@bcbsla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Best Available Evidence Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Bid Audit Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccpuit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Bid Audit Site Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Bid Primary Contact	Vice President, Monroe Operations	Mrs.	Self	Jessica		3189982853					jself@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	CEO - CMS Administrator Contact	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	130 DeSiard Street, Suite 300		Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	CEO - Senior Official for Contracting	CEO	Mr.	Camerlinck	Bryan		2252952537					Bryan.Camerlinck@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/23/2023	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Chief Financial Officer	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Chief Operating Officer	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Chief Information Officer	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Chief Information Security Officer	Chief Information Security Officer	Mr.	Sotnikov	Slava		2252987036					slava.sotnikov@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	CMS Casework Communication Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Complaints Tracking Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Contact for Fraud Investigations	Manager, Special Investigations	Mrs.	Cowart	Kandyce		2252952073					kandyce.cowart@bcbsla.com	5525 Reitz Avnue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Coordination of Benefits Contact	Medicare Enrollment Supervisor	Mrs.	Drake	Michele		3189983083					mdrake@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Corporate Mailing						3183610900					jself@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St. Suite 300		Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Customer Service Operations Contact	Director of Member Services	Mrs.	Trichel	Amy		3189982870					atrichel@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	DIR Contact	Chief Financial Officer	Mrs	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	DIR Contact (Secondary)	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Electronic Health Record Contact	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Emergency Part D Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3185372903					cdearman@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Emergency Part D Contact (Secondary)	Medicare Compliance Officer	Mr.	Miller	Wesley		2252522096					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Employer Waiver Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Encounter Data & Risk Adjustment Operations Contact	Director of Quality Improvement		Murphy	Paul		3189983098					pmurphy@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Enrollment Contact	Medicare Enrollment Supervisor	Mrs.	Drake	Michele		3189983083					mdrake@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	EOB Transfer Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076				3188129987	ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Financial Audit Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Financial Reporting Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076				3188129987	ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Formulary Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Formulary Contact (Secondary)	Medicare Team Lead, Formulary Services		Paddock	Deanna		6087292628					Deanna.Paddock@Navitus.com	2601 W. Beltline Highway, Suite 600		Madison	WI	53713	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	General Contact	VP of MA Operations and Plan Performance	Mr.	Gray	Paul		2253549898					paul.gray@bcbsla.com	225 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Government Relations Contact	Deputy General Counsel	Mrs.	Harvey	Korey		2252972762					korey.harvey@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	HIPAA Privacy Officer	VP Internal Audit, Compliance & Privacy	Mrs.	Saporito	Mary		2252981742					mary.saporito@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	HIPAA Security Officer	VP of Internal Audit, Compliance & Privacy	Mrs.	Saporito	Mary		2252981742					mary.saporito@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Hospice Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Interoperability Contact	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	MA Appeals/Grievances Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076				3188129987	ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Marketing Contact	SVP and Marketing Officer	Mr.	Keller	Brian		2252981582					brian.keller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Medical Director	Chief Medical Director	Dr.	Raulerson	Robert		3189983701					rraulerson@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Medicare Coordinator	Medicare Advantage Compliance Program Manager	Mrs.	Rainer	Sally		3183720214					Sally.Rainer@bcbsla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Medication Therapy Management Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	OffShore Subcontractor Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Online Enrollment Center Contact (Back-up)	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Online Enrollment Center Contact (Optional)	Medicare Advantage Compliance Program Manager	Mrs.	Rainer	Sally		3183720214					Sally.Rainer@bcbsla.com	130 DeSiard St	Suite 30	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor	Mrs.	Drake	Michele		3189983083				3188071115	mdrake@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Part C Application Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Part C Reporting Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Part D Appeals	Appeals Supervisor	Mrs.	Olivo	Cassidy							cmolivo@vhpla.com	130 DeSiard Street, Suite 300		Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation	3189982859				HMO - Health Maintenance Organization		C	Denver
H5576	Part D Appeals Contact (Secondary)	Senior Appeals Specialist	Mrs.	Stowe	Emily							edstowe@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation	3189983193				HMO - Health Maintenance Organization		C	Denver
H5576	Part D Application Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Part D Benefits Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Part D Claims Submission Contact	Supervisor		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Part D Exceptions Contact	Director of Pharmacy	Mr.	Dearman	Clyde							cdearman@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation	3189982710				HMO - Health Maintenance Organization		C	Denver
H5576	Part D Exceptions Contact (Secondary)	Medicare Compliance Officer	Mr.	Miller	Wesley							Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation	2252987965				HMO - Health Maintenance Organization		C	Denver
H5576	Part D Price File Contact (Back-up)			Dahlke	Nicole		9202214162					plan.finder@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Part D Price File Contact (Optional)	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard St  Suite 300		Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Part D Price File Contact (Primary)			Finder	Plan		6087291578					plan.finder@navitus.com	361 Integrity Drive		Madison	WI	53714	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Part D Quality Assurance Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Part D Reporting Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Patient Safety Contact	Clinical Pharmacist	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Payment Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Personal Health Record Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Pharmacy Director	Pharmacy Director	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Pharmacy Network Management Contact	Associate Director Pharmacy Network Management		Burdick	Tammy		9202214089					Tammy.Burdick@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Pharmacy Network Management Contact (Secondary)	Pharmacy Director	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard St Suite 300		Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Pharmacy Technical Help Desk Contact	Pharmacy Director	Mr.	Dearman	Clyde							cdearman@vhpla.com	130 DeSiard St Suite 300		monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation	8667040109				HMO - Health Maintenance Organization		C	Denver
H5576	Pharmacy Technical Help Desk Contact (Secondary)	Medicare Compliance Officer	Mr.	Miller	Wesley							Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation	2252987965				HMO - Health Maintenance Organization		C	Denver
H5576	PHR Beneficiary Contact																	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS	Vantage Health Plan, Inc	Louisiana Health Service & Indemnity Company	617	Yes	Consolidation	8667040109				HMO - Health Maintenance Organization		C	Denver
H5576	Physician Incentive Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Plan Directory Contact for Public Website	Director of Member Service	Mrs.	Trichel	Amy		8888231910					atrichel@vhpla.com	130 DeSiard Street, Suite 300		Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Processor Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Quality Contact	Director of Quality Improvement	Mr.	Murphy	Paul		3189983098					pmurphy@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Reconciliation Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Reconciliation Contact (Secondary)	Chief Financial Officer		Haygood	Rhonda		3189983900					rhaygood@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	07/13/2020	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Recovery Audit Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	SNP Application Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	SNP State Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Surveillance Contact	SVP and Chief Marketing Officer	Mr.	Keller	Brian		2252981582					brian.keller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	System Contact	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St. Suite 300		Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	User Access Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Retiz Ave		Baton Rouge	LA	70809	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Utilization Management Contact	Chief Medical Director	Dr.	Raulerson	Robert		3189983701					rraulerson@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5576	Utilization Review Contact	Chief Medical Director	Dr.	Raulerson	Robert		3189983701					rraulerson@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	VANTAGE HEALTH PLAN, INC.	Local CCP	Vantage Health Plan	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Consolidation					HMO - Health Maintenance Organization		C	Denver
H5577	Agent/Broker Compensation Data Contact	Account Payable & Payroll VP		Serrano	Adriane		7877582500	2072				adrianes@medicalcardsystem.com	PO Box 191720		Hato Rey	PR	00919	04/15/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Automated TrOOP Balance Transfer Contact	Enrollment VP		Rios	Hector		7877582500	2874				hector.rios@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Backup User Access Contact	Compliance Director		Ramos	Kelsey		7877582500	5796				kramos@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	05/04/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Best Available Evidence Contact	VP & Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Bid Audit Contact	Actuarial Senior VP		Kianes	Luis	F	7877582500	4590				lkianesr@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Bid Audit Site Contact	Actuarial Senior VP		Kianes	Luis	F	7877582500	4590				lkianesr@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Bid Primary Contact	Actuarial Senior VP		Kianes	Luis	F	7877582500	4590				lkianesr@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	CAP Report Contact for Public Website	Public Relations & Corp. Communication Supervisor		Rodriguez	Ivette		7877582500	5202				ivrodriguez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	12/04/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	O'Drobinak	James	P	7877582500	5002			7872500380	jim.odrobinak@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Ninth Floor	San Juan	PR	00918	03/03/2016	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	O'Drobinak	James	P	7877582500	5002			7872500380	jim.odrobinak@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/03/2016	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Chief Financial Officer	Chief Financial Officer	Mr.	Aponte	Jose		7877582500	5022			7876222098	joseap@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Chief Operating Officer	Chief Operating Officer	Mr.	Torres	Roberto		7877582500	5380				roberto.torres@medicalcardsytem.com	MCS Plaza	255 Ponce de Leon Avenue, Ninth Floor	San Juan	PR	00918	12/04/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Chief Information Officer	Information Technology Senior VP	Mrs.	Ramos	Gannett		7877582500	5700				GRamosA@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	01/28/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Chief Information Security Officer	IT Security & Risk Management AVP	Mr.	Torres	Jorge		7876007580					JTorresV@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	02/15/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	CMMI Model Point of Contact	Product Development MA SVP		De Jesus	Carlos		7877582500	5221				carlos.dejesus@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/28/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	CMS Casework Communication Contact	Grievances & Appeals Director		Roman	Beatriz		7877582500	5799			7876207765	broman@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/15/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Complaints Tracking Contact	Grievances & Appeals Director		Roman	Beatriz		7877582500	5799			7876207765	broman@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/15/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Contact for Fraud Investigations	Special Investigation AVP		Roussel	Elizabeth		7877582500	2071			7872002862	elizabeth.roussel@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Coordination of Benefits Contact	Classicare Enrollment & Reconciliation AVP		Campos	Jose		7877582500	2939				jose.campos@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon, Second Floor	San Juan	PR	00918	07/28/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Corporate Mailing						7877582500	2661			7872002862	maite.morales@medicalcardsystem.com	MCS Plaza	PO BOX 191720	San Juan	PR	009191720	09/15/2016	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Schaffer	David		7877582500	2920			7876222098	davids@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Customer Service Operations Contact	Service Operations AVP		Melendez	Rebecca		7877582500	5602			7876222463	rebeccam@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/28/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	DIR Contact	Financial Analysis Director		Vazquez	Jason		7877582500	2195			7876222098	jason.vazquez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/11/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	DIR Contact (Secondary)	Controller		Schaffer	David		7877582500	2920			7876222098	davids@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Electronic Health Record Contact	VP & Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Emergency Part D Contact	Pharmacy Executive Vice President		Rodriguez	Carolyn		7877582500	5746			7876222429	carodriguez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/16/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Emergency Part D Contact (Secondary)	VP & Medicare Compliance Officer		Pastrana	Isis	C	7874783428					isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	12/21/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Employer Waiver Contact	Finance SVP		Velez	Yumac		7877582500	5952			7876222098	yumac.velez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/15/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Encounter Data & Risk Adjustment Operations Contact	Encounter Data System AVP		Soler	Eva	Y	7877582500	2599				RAPS_EDS@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Enrollment Contact	Enrollment VP		Rios	Hector		7877582500	2874				hector.rios@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	EOB Transfer Contact	Pharmacy AVP		Serrano	Debra		7877582500	5743			7876222429	dserrano@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/16/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Financial Audit Contact	VP & Medicare Compliance Officer	Mrs.	Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Financial Reporting Contact	Controller		Schaffer	David		7877582500	2920			7876222098	davids@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Formulary Contact	Pharmacy Formulary & Benefits Management Director		Arroyo	Viviana		7877582500	5718				PH_Formulary&Benefits@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	08/13/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Formulary Contact (Secondary)	Formulary Operations Clinical Pharmacist		Shaw	Andrea		4405038080					formularypharmacists@envisionrx.com	2181 E. Aurora Road		Twinsburg	OH	44087	03/02/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	General Contact	VP & Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Government Relations Contact	VP & Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	HIPAA Privacy Officer	Legal Affairs Specialist & Privacy Officer		Lourido	Gustavo		7877582500	5702				glourido@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	12/04/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	HIPAA Security Officer	IT Security & Risk Management AVP	Mr.	Torres	Jorge		7876007580					JTorresV@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	02/15/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Hospice Contact	Utilization Management Director		Burgos	Grace		7877582500	5747				grace.burgos@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	05/09/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Interoperability Contact	Information Technology Senior VP		Ramos	Gannett		7877582500	5700				GRamosA@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	01/28/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	MA Appeals/Grievances Contact	Grievances & Appeals Director		Roman	Beatriz		7877582500	5799			7876207765	broman@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/15/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	MA Claims Processing Contact for Public Website	Claims VP		Roque	Keila		7877582500	2621				keilar@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/11/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Marketing Contact	Marketing Director - Acquisition		Agosto	Mariel		7877582500	5233				mariel.agosto@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	12/04/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Medical Director	Chief Medical Officer		Hernandez	Ines		7876164576				7876222442	irhernandez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Medicare Compliance Officer	VP & Medicare Compliance Officer	Mrs.	Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Medicare Coordinator	Chief Administrative Officer		Morales	Maite		7877582500	2661			7872002862	maite.morales@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Medicare Part D Opioid Overutilization Contact	Pharmacy Clinical Service Director		Robles	Gisela	I	7877582500	4897				GRobles1@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/06/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Medication Therapy Management Contact	Pharmacy Clinical Service Director		Robles	Gisela	I	7877582500	4897				GRobles1@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	08/13/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	OffShore Subcontractor Contact	VP & Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Online Enrollment Center Contact (Back-up)	Classicare Enrollment & Reconciliation AVP		Campos	Jose		7877582500	2939				jose.campos@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Online Enrollment Center Contact (Optional)	Enrollment Manager		Hernandez	Limaris		7877582500	5825				limaris.hernandez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Online Enrollment Center Contact (Primary)	Enrollment VP		Rios	Hector		7877582500	2874				hector.rios@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Part C Application Contact	Product Development MA SVP		De Jesus	Carlos		7877582500	5221				carlos.dejesus@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/28/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Part C Reporting Contact	VP & Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Part D Appeals	Utilization Management Director		Burgos	Grace							grace.burgos@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	05/09/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	7875042233				HMO - Health Maintenance Organization		C	New York
H5577	Part D Appeals Contact (Secondary)	Pharmacy Clinical Operations VP		Rosado	Arelys						7876222429	arelys.rosado@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/16/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	7877582500	5745			HMO - Health Maintenance Organization		C	New York
H5577	Part D Application Contact	Product Development MA SVP		De Jesus	Carlos		7877582500	5221				carlos.dejesus@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/28/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Part D Benefits Contact	Pharmacy Clinical Operations VP		Rosado	Arelys		7877582500	5745			7876222429	arelys.rosado@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/16/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Part D Claims Submission Contact	Pharmacy Executive Vice President		Rodriguez	Carolyn		7877582500	5746			7876222429	carodriguez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/16/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Part D Exceptions Contact	Pharmacy Clinical Operations VP		Rosado	Arelys							arelys.rosado@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	7877582500	5745			HMO - Health Maintenance Organization		C	New York
H5577	Part D Exceptions Contact (Secondary)	Pharmacy Executive Vice President		Rodriguez	Carolyn						7876222429	carodriguez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/16/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	7877582500	5746			HMO - Health Maintenance Organization		C	New York
H5577	Part D Price File Contact (Back-up)	Rebate Analyst		Bentley	Rebecca		3308886988					rbentley@elixirsolutions.com	2181 E Aurora Rd #201		Twinsburg	OH	44087	08/18/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Part D Price File Contact (Optional)	Pharmacy Formulary Management & Benefits Manager		Perez	Luis		7877582500	5744				luperez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/15/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Part D Price File Contact (Primary)	Pharmacy AVP		Serrano	Debra		7877582500	5743				dserrano@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Part D Quality Assurance Contact	Pharmacy Executive Vice President		Rodriguez	Carolyn		7877582500	5746			7876222429	carodriguez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/16/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Part D Reporting Contact	Auditing Monitoring and Reporting Director		Reyes	Yarelis		7877582500	2774				yarelis.reyes@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/28/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Patient Safety Contact	Pharmacy Clinical Service Director		Robles	Gisela	I	7877582500	4897				GRobles1@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	08/13/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Payment Contact	Controller		Schaffer	David		7877582500	2920			7876222098	davids@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Personal Health Record Contact	VP & Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Pharmacy Director	Pharmacy Executive Vice President		Rodriguez	Carolyn		7877582500	5746			7876222429	carodriguez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/16/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Pharmacy Network Management Contact	Pharmacy AVP		Serrano	Debra		7877582500	5743				dserrano@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Pharmacy Network Management Contact (Secondary)	Pharmacy Executive Vice President		Rodriguez	Carolyn		7877582500	5746			7876222429	carodriguez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/16/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Pharmacy Technical Help Desk Contact	Utilization Management Director		Burgos	Grace							grace.burgos@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	12/30/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	8446331064				HMO - Health Maintenance Organization		C	New York
H5577	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Coverage Determination Supervisor		Morales	Edna						7876222429	edna.morales@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	12/30/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active	8446331064				HMO - Health Maintenance Organization		C	New York
H5577	PHR Beneficiary Contact																	09/23/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS	Medical Card System	MHH Healthcare, L.P.	669	Yes	Active	8666278183				HMO - Health Maintenance Organization		C	New York
H5577	Physician Incentive Contact	VP & Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Plan Directory Contact for Public Website	Public Relations & Corp. Communication Supervisor		Rodriguez	Ivette		7877582500	5202				ivrodriguez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	12/04/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Plan to Plan Reconciliation Contact	Financial Reporting Manager		Perez	Javier		7877582500	2604				javperez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Processor Contact	Claims VP		Roque	Keila		7877582500	2621				keilar@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/11/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Quality Contact	Quality Improvement VP		Lee	Linda		7877582500	2366				linda.lee@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/08/2013	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Reconciliation Contact	Finance SVP		Velez	Yumac		7877582500	5952			7876222098	yumac.velez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/15/2021	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Reconciliation Contact (Secondary)	Controller		Schaffer	David		7877582500	2920			7876222098	davids@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Recovery Audit Contact	VP & Medicare Compliance Officer	Mrs.	Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	SNP Application Contact	Quality Improvement VP		Lee	Linda		7877582500	2366				linda.lee@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	03/08/2013	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	SNP State Contact	VP & Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Surveillance Contact	VP & Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	System Contact	Information Technology Senior VP	Mrs.	Ramos	Gannett		7877582500	5700				GRamosA@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	01/28/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Third Party Administrator (TPA) Liaison	Budget & Financial Analysis Lead		Marcano	Jomary		7877582500	3323				jomary.marcano@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	04/28/2022	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	User Access Contact	VP & Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Utilization Management Contact	Chief Medical Officer		Hernandez	Ines		7876164576				7876222442	irhernandez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5577	Utilization Review Contact	Chief Medical Officer		Hernandez	Ines		7876164576				7876222442	irhernandez@medicalcardsystem.com	MCS Plaza	255 Ponce de Leon Avenue, Second Floor	San Juan	PR	00918	07/27/2020	2023	MCS ADVANTAGE, INC.	Local CCP	MCS Classicare	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5580	Agent/Broker Compensation Data Contact	Sales & Service Manager	Mr.	Nathe	Jeff		6024538341				6024317499	NatheJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Automated TrOOP Balance Transfer Contact	Director, Finance	Ms.	Wilson	Robyn		6026591424					WilsonR3@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Backup User Access Contact	Head of Medicare	Mr.	Patton	Jeff		6024538315					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Best Available Evidence Contact	Enrollment Services Manager	Ms.	Romero	Tammie		6024536054				6024147228	RomeroT@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Bid Audit Contact	Head of Medicare	Mr.	Patton	Jeff		6024538316					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Bid Audit Site Contact	Head of Medicare	Mr.	Patton	Jeff		6024538316					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Bid Primary Contact	Head of Medicare	Mr.	Patton	Jeff		6024538316					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs	Macias	Christina		9097923937					MaciasC1@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	11/03/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Gary	Tad		6027982504					GaryT@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	01/05/2023	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Gary	Tad		6027982504					GaryT@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	02/24/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Chief Financial Officer	Chief Financial Officer	Mr.	Ek	Randell		6026591457					EkR@mercycareplan.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Chief Operating Officer	Chief Operating Officer	Mr.	Hargens	Brad		6024147512					Hargensb@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	02/24/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Chief Information Officer	VP, Govt Program Delivery	Mr.	Atkin	James	R	8602736718					AtkinJR@aetna.com	151 Farmington Avenue		Hartford	CT	06156	02/19/2016	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Chief Information Security Officer	VP Corporate Security	Mr.	Gallagher	Sean		8602732590					GallagherS@aetna.com	151 Farmington Avenue	Mail Code CT1501	Hartford	CT	06156	12/28/2020	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	CMS Casework Communication Contact	Medicare Compliance Officer	Mrs	Macias	Christina		9097923937					MaciasC1@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	11/03/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Complaints Tracking Contact	Enrollment Services Manager	Ms.	Romero	Tammie		6024536054					RomeroT@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Contact for Fraud Investigations	SIU Team Leader	Ms.	Kielb	Tabitha		8606363319				8606362400	KielbTJ@aetna.com	151 E Farmington Ave		Hartford	CT	06156	10/24/2018	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Coordination of Benefits Contact	Director of Finance	Mr.	Chilton	Keith		6024538022					ChiltonK@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Corporate Mailing						6024538315					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Mr.	Chilton	Keith		6024538022					ChiltonK@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Customer Service Operations Contact	Director Customer Service	Ms.	Smith	Reesa		6024535588					Reesa.Smith@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	DIR Contact	Director of Finance	Mr.	Chilton	Keith		6024538022					ChiltonK@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	DIR Contact (Secondary)	Director, Finance	Ms.	Wilson	Robyn		6026591424					WilsonR3@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Emergency Part D Contact	Pharmacy Director	Mrs	Pourarsalan	Hiva		4699908010					pourarsalanh@aetna.com	6254 Sudbury Drive		Dallas	TX	75214	12/14/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Emergency Part D Contact (Secondary)	Pharmacy Director	Ms	Vergil	Gina		4026997768					VergilG@Aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	12/14/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Encounter Data & Risk Adjustment Operations Contact	Senior Project Manager	Mr.	Swartz	Harley		6024536187					Swartzh@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	09/07/2023	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Enrollment Contact	Enrollment Services Manager	Ms.	Romero	Tammie		6024536054				6024147228	RomeroT@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	EOB Transfer Contact	Pharmacy Director	Mrs.	Pourarsalan	Hiva		4699908010				6027982713	pourarsalanh@aetna.com	6254 Sudbury Drive		Dallas	TX	75214	12/14/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Financial Audit Contact	Chief Financial Officer	Mr.	Ek	Randell		6026591457					EkR@mercycareplan.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Financial Reporting Contact	Chief Financial Officer	Mr.	Ek	Randell		6026591457					EkR@mercycareplan.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Formulary Contact	Pharmacy Director	Ms.	Pourarsalan	Hiva		4699908010					pourarsalanh@aetna.com	6254 Sudbury Drive		Dallas	TX	75214	12/14/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Formulary Contact (Secondary)	Pharmacy Director	Ms	Vergil	Gina		4026997768					VergilG@Aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	12/14/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	General Contact	Head of Medicare	Mr.	Patton	Jeff		6024538315					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Government Relations Contact	Head of Medicare	Mr.	Patton	Jeff		6024538315					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	HIPAA Privacy Officer	Medicare Compliance Officer	Mrs	Macias	Christina		9097923937					MaciasC1@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	11/03/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	HIPAA Security Officer	Medicare Compliance Officer	Mrs	Macias	Christina		9097923937					MaciasC1@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	11/03/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Hospice Contact	Head of Medicare	Mr.	Patton	Jeff		6024538315					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Interoperability Contact	Exec Director, Interoperability PMO		Valeno	Barbara		9043511001					ValenoB@cvshealth.com	9000 Southside Blvd		Jacksonville	FL	32256	02/04/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	MA Appeals/Grievances Contact	Appeals Manager	Ms.	Andersen	Jill		9592997717					AndersenJ@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	MA Claims Processing Contact for Public Website	Bus Unit Customer Ops Head	Ms.	Gurule	Colleen		6026591722					GuruleS@aetna.com	4500 E Cotton Center Boulevard	Bldg 1	Phoenix	AZ	85040	02/17/2016	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Marketing Contact	Director, Medicare Product	Mrs.	Richardson	Shannon		6024535592					RichardsonS4@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	02/04/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Medical Director	Chief Medical Officer	Dr.	Singh	Gagan		6024536001					SinghG16@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	09/07/2023	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Macias	Christina		9097923937					MaciasC1@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	11/03/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Medicare Coordinator	Head of Medicare	Mr.	Patton	Jeff		6024538315					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Medicare Part D Opioid Overutilization Contact	Pharmacy Director	Ms.	Pourarsalan	Hiva		4699908010					pourarsalanh@aetna.com	6254 Sudbury Drive		Dallas	TX	75214	01/05/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Medication Therapy Management Contact	Pharmacy Director	Ms.	Pourarsalan	Hiva		4699908010					pourarsalanh@aetna.com	6254 Sudbury Drive		Dallas	TX	75214	12/14/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	OffShore Subcontractor Contact	Medicare Compliance Officer	Mrs	Macias	Christina		9097923937					MaciasC1@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	11/03/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Online Enrollment Center Contact (Back-up)	Sr Eligibility Consultant	Ms.	Griffy	Kathleen		6024538336					GriffyK@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Online Enrollment Center Contact (Optional)	Customer Service Supervisor	Ms.	Romero	Tammie		6024536054				6024147023	RomeroT@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Online Enrollment Center Contact (Primary)	Enrollment Services Manager	Ms.	Romero	Tammie		6024536054				6024147023	RomeroT@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Part C Application Contact	Head of Medicare	Mr.	Patton	Jeff		6024538315					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Part C Reporting Contact	Director, Medicare Product	Mrs.	Richardson	Shannon		6024535592					RichardsonS4@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	02/04/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Part D Appeals	Appeals Supervisor		Spencer	Tiffane						8552305544	SpencerT4@AETNA.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	01/07/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active	8609004547				HMO - Health Maintenance Organization		C	San Francisco
H5580	Part D Appeals Contact (Secondary)	Appeals Manager		Hung	Pam						8552305544	HungP@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	12/21/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active	8609004547				HMO - Health Maintenance Organization		C	San Francisco
H5580	Part D Application Contact	Head of Medicare	Mr.	Patton	Jeff		6024538315					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Part D Benefits Contact	Pharmacy Director	Ms.	Pourarsalan	Hiva		4699908010					pourarsalanh@aetna.com	6254 Sudbury Drive		Dallas	TX	75214	12/14/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Part D Claims Submission Contact	Pharmacy Director	Ms.	Pourarsalan	Hiva		4699908010					pourarsalanh@aetna.com	6254 Sudbury Drive		Dallas	TX	75214	12/14/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Part D Exceptions Contact	Appeals Supervisor		Spencer	Tiffane						8552305544	SpencerT4@AETNA.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	05/20/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active	8609004547				HMO - Health Maintenance Organization		C	San Francisco
H5580	Part D Exceptions Contact (Secondary)	Manager		Hung	Pam							HungP@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	12/21/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active	8609004547				HMO - Health Maintenance Organization		C	San Francisco
H5580	Part D Price File Contact (Back-up)	Advisor		Loveland	Chet		8018363750					chet.loveland@cvshealth.com	9501 Shea Blvd	MC121	Scottsdale	AZ	85260	12/21/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Part D Price File Contact (Primary)	Manager		Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	9501 Shea Blvd	MC121	Scottsdale	AZ	85260	12/21/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Part D Quality Assurance Contact	Pharmacy Director	Ms.	Pourarsalan	Hiva		4699908010					pourarsalanh@aetna.com	6254 Sudbury Drive		Dallas	TX	75214	12/14/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Part D Reporting Contact	Director, Medicare Product	Mrs.	Richardson	Shannon		6024535592					RichardsonS4@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	02/04/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Patient Safety Contact	Pharmacy Director	Ms.	Pourarsalan	Hiva		4699908010					pourarsalanh@aetna.com	6254 Sudbury Drive		Dallas	TX	75214	12/14/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Payment Contact	Chief Financial Officer	Mr.	Ek	Randell		6026591457					EkR@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Pharmacy Director	Chief Pharmacist Medicaid	Ms.	Saba	Stephanie		6027982867					Stephanie.Saba@aetna.com	4500 E Cotton Center Boulevard	Bldg 1	Phoenix	AZ	85040	02/17/2016	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Pharmacy Network Management Contact	Director, Network Systems & Standards		Lindsey	Lisa		4803914503					Lisa.lindsey@cvshealth.com	9501 E Shea Blvd, MC080		Scottsdale	AZ	85260	12/24/2019	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Pharmacy Technical Help Desk Contact	Pharmacy Help Desk	Mr.	Smith	Robert	W						Robert.Smith7@CVSHealth.com	750 W John Carpenter Fwy	MC:983	Irving	TX	75039	11/21/2018	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active	8555394721				HMO - Health Maintenance Organization		C	San Francisco
H5580	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Help Desk	Mr.	Smith	Robert	W						Robert.Smith7@CVSHeath.com	750 W John Carpenter FWY	MC:983	Irving	TX	75039	11/21/2018	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active	8555394721				HMO - Health Maintenance Organization		C	San Francisco
H5580	Physician Incentive Contact	Chief Innovation Officer	Mrs.	Lundeen	Christi	J	4804382622					LundeenC1@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	03/09/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Plan Directory Contact for Public Website	Director, Medicare Product	Mrs.	Richardson	Shannon		6024535592					RichardsonS4@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	02/04/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Plan to Plan Reconciliation Contact	Director of Finance	Mr.	Chilton	Keith		6024538022					ChiltonK@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Processor Contact	Director, Network Systems & Standards	Mr.	Ceklic	Vladimir		4802092887					vladimir.ceklic@cvshealth.com	9501 E Shea Blvd,	Mail Code 121	Scottsdale	AZ	85260	12/21/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Quality Contact	Director of Prevention and Wellness	Ms.	Soeder	Colleen		6023773167					SoederC@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Reconciliation Contact	Director, Finance	Ms.	Wilson	Robyn		6026591424					WilsonR3@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Reconciliation Contact (Secondary)	Director of Finance	Mr.	Chilton	Keith		6024538022					ChiltonK@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Recovery Audit Contact	Head of Medicare	Mr.	Patton	Jeff		6024538315					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	SNP Application Contact	Head of Medicare	Mr.	Patton	Jeff		6024538315					PattonJ@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	SNP State Contact	Medicaid Compliance Director	Mrs.	Brown	Heidi		4805094021					BrownH7@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/31/2023	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Surveillance Contact	Medicare Compliance Officer	Mrs	Macias	Christina		9097923937					MaciasC1@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	11/03/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	System Contact	Director, IT	Mr.	Bangert	Sean		6024538402					BangertS@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Third Party Administrator (TPA) Liaison	Director of Finance	Mr.	Chilton	Keith		6024538022					ChiltonK@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	User Access Contact	Medicare Compliance Officer	Mrs	Macias	Christina		9097923937					MaciasC1@mercycareaz.org	4500 E Cotton Center Blvd		Phoenix	AZ	85040	11/03/2022	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Utilization Management Contact	VP Medical Management	Ms.	Buhrow	Suzanne		6026591595					Buhrows@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5580	Utilization Review Contact	VP Medical Management	Ms.	Buhrow	Suzanne		6026591595					Buhrows@aetna.com	4500 E Cotton Center Blvd		Phoenix	AZ	85040	08/03/2021	2023	MERCY CARE	Local CCP	Mercy Care Advantage	HMO/HMOPOS		Mercy Care	214	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Agent/Broker Compensation Data Contact	Vice President of Medicare Operations		ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Automated TrOOP Balance Transfer Contact	Controller		Patel	Achal		4807604813				4807604619	Achal.Patel@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Backup User Access Contact	Vice President of Medicare Operations		ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Best Available Evidence Contact	Manager Operations Center- Call Center		Cruz Herrera	Elizabeth		4803034419				4807604708	Elizabeth.CruzHerrera@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Bid Audit Contact	Staff VP Health Plan Operations		Ladich	Matthew		4803034439					matthew.ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Bid Audit Site Contact	Staff VP Health Plan Operations		Ladich	Matthew		4803034439					matthew.ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Bid Primary Contact	Staff VP Health Plan Operations		Ladich	Matthew		4803034439					matthew.ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	CAP Report Contact for Public Website	Vice President of Medicare Operations		Ladich	Matthew		4803034439					matthew.ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Nau	Shawn	H	9282142291					Shawn.Nau@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Nau	Shawn	H	9282142291					Shawn.Nau@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Chief Financial Officer	Chief Financial Officer	Ms	Magallanes	Tammy		5206097835					Tammy.Magallanes@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Chief Operating Officer	Chief Operating Officer	Mrs	Policky	Diana		4803502237					Diana.Policky@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Chief Information Officer	Director, Health Plan Systems	Mrs	Small	Melissa		4807604538					Melissa.Small@azblue.com	8220 N 23rd Ave	Suite 900	Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Chief Information Security Officer	Information Technology	Mr	Matti	Firas		4803034424				4807842933	Firas.Matti@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	CMS Casework Communication Contact	Vice President of Clinical Operations		Lewis	Ellen		4802127841				4807842933	Ellen.Lewis@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Complaints Tracking Contact	Grievance Coordinator		Otter	Patti		4803502202					Patricia.Otter@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Contact for Fraud Investigations	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600				4807604784	veronica.moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Coordination of Benefits Contact	Manager, Provider Asst. Customer Service Ops Medic		Williams	Tammy		8003228670				4807604708	tammy.williams@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Corporate Mailing						4803034439				4807842933	Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Patel	Achal		4807604813				4807604619	Achal.Patel@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Customer Service Operations Contact	Vice President of Operations Center - Call Center		Irmer	Suzan		4803334507				4807604708	Suzan.Irmer@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	DIR Contact	Clinical Pharmacy Program Manager		Sanders	Stephanie		5209063358				8889086747	Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	DIR Contact (Secondary)	Controller		Patel	Achal		4807604813				4807604619	Achal.Patel@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Electronic Health Record Contact	Vice President of Medicare Operations		Ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Emergency Part D Contact	HCP Pharmacist		Rodriguez	Leslie		6028194784					Leslie.Rodriguez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Emergency Part D Contact (Secondary)	Clinical Pharmacy Program Manager		Sanders	Stephanie		5209063358				8889086747	Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Encounter Data & Risk Adjustment Operations Contact	Vice President of Medicare Operations		ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Enrollment Contact	Manager Operations Center- Call Center		Cruz Herrera	Elizabeth		4803034419				4807604708	Elizabeth.CruzHerrera@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	EOB Transfer Contact	Controller		Patel	Achal		4807604813				4807604619	Achal.Patel@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Financial Audit Contact	Controller	Mr	Patel	Achal		4807604813				4807604619	Achal.Patel@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Financial Reporting Contact	Controller		Patel	Achal		4807604813				4807604619	Achal.Patel@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Formulary Contact	Clinical Pharmacy Program Manager		Sanders	Stephanie		5209063358				8889086747	Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	General Contact			Services	Member		8006568991				4807842933	comments@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Government Relations Contact	Vice President of Medicare Operations		ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	HIPAA Privacy Officer	Director of Legal and Privacy Officer		Schrock	Anne		6028644315					Anne.Schrock@azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	03/16/2022	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	HIPAA Security Officer	Director, Chief Information Security Officer		Pencek	Michael		6029166728					Michael.Pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Hospice Contact	Clinical Pharmacy Program Manager		Sanders	Stephanie		5209063358				8889086747	Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Interoperability Contact			Quincey	Mark		6028642032					Mark.Quincey@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	03/16/2022	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	MA Appeals/Grievances Contact	Vice President of Reimbursement Services		Kingry	Matthew		4802661409				4807842933	Matthew.Kingry@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	MA Claims Processing Contact for Public Website	Vice President of Reimbursement Services		Kingry	Matthew		4802661409				4807842933	Matthew.Kingry@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Marketing Contact	Vice President of Medicare Operations		ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Medical Director	Chief Medical Officer	Dr	Carroll	Mark		4807604611					Mark.Carroll@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Medicare Compliance Officer	Director of Corporate & Medicare Compliance	Ms	Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	10/25/2021	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Medicare Coordinator	Medicare Compliance Officer		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/03/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacy Program Manager		Sanders	Stephanie		5209063358				8889086747	Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Medication Therapy Management Contact	Clinical Pharmacy Program Manager		Sanders	Stephanie		5209063358				8889086747	Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Online Enrollment Center Contact (Back-up)	Enrollment Coordinator		Cabrales	Lilia		4809686866				4807604708	Lilia.Cabrales@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Online Enrollment Center Contact (Optional)	Manager Operations Center- Call Center		Cruz Herrera	Elizabeth		4803034419				4807604708	Elizabeth.CruzHerrera@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Online Enrollment Center Contact (Primary)	Enrollment Supervisor		Grady	Michael		4809686866	5049			4807604708	Michael.Grady@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Part C Application Contact	Vice President of Medicare Operations		ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Part C Reporting Contact	Vice President of Medicare Operations		ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Appeals	HCP Pharmacist		Rodriguez	Leslie							Leslie.Rodriguez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active	6028194784				HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Appeals Contact (Secondary)	Clinical Pharmacy Program Manager		Sanders	Stephanie						8889086747	Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active	5209063358				HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Application Contact	Vice President of Medicare Operations		ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Benefits Contact	HCP Pharmacist		Rodriguez	Leslie		6028194784					Leslie.Rodriguez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Claims Submission Contact	HCP Pharmacist		Rodriguez	Leslie		6028194784					Leslie.Rodriguez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Exceptions Contact	HCP Pharmacist		Rodriguez	Leslie							Leslie.Rodriguez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active	6028194784				HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Exceptions Contact (Secondary)	Clinical Pharmacy Program Manager		Sanders	Stephanie						8889086747	Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active	5209063358				HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Price File Contact (Back-up)	Senior Consultant		Loveland	Chet		4806064873				4013357984	Chet.Loveland@cvshealth.com	8801 E. Raintree Drive	MC121	Scottsdale	AZ	85260	04/02/2021	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Price File Contact (Optional)	Senior Consultant		Loveland	Chet		4806064873				4013357984	Chet.Loveland@cvshealth.com	8801 E. Raintree Drive	MC121	Scottsdale	AZ	85260	05/26/2020	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Price File Contact (Primary)	CVSHealth Sr. Manager		Schilcher	Sydney		6024057057				4803357984	Sydney.Schilcher@CVSHealth.com	8801 E. Raintree Drive	MC121	Scottsdale	AZ	85260	01/02/2020	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Quality Assurance Contact	HCP Pharmacist		Rodriguez	Leslie		6028194784					Leslie.Rodriguez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Part D Reporting Contact	Clinical Pharmacy Program Manager		Sanders	Stephanie		5209063358					Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Patient Safety Contact	Clinical Pharmacy Program Manager		Sanders	Stephanie		5209063358				8889086747	Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Payment Contact	Controller		Patel	Achal		4807604813				4807604619	Achal.Patel@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Pharmacy Director	Clinical Pharmacy Program Manager		Sanders	Stephanie		5209063358				8889086747	Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Pharmacy Network Management Contact	HCP Pharmacist		Rodriguez	Leslie		6028194784					Leslie.Rodriguez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Pharmacy Network Management Contact (Secondary)	Pharmacy Benefit Analyst		Jackson	Eric		6028293361				8882914542	Eric.Jackson@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Pharmacy Technical Help Desk Contact	Client Operations Advisor		Free	Jennifer						4803146432	Jennifer.Free@CVSHealth.com	CVS Health	9501 E. Shea Blvd	Scottsdale	AZ	85260	02/27/2020	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	San Francisco
H5587	Plan Directory Contact for Public Website			Services	Member		8006568991				4807842933	comments@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Plan to Plan Reconciliation Contact	Controller		Patel	Achal		4807604813				4807604619	Achal.Patel@azblue.com	P.O. Box 743242		Los Angeles	CA	900743242	05/13/2022	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Processor Contact	Pharmacy Benefit Analyst		Jackson	Eric		6028293361				8882914542	Eric.Jackson@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Quality Contact	Vice President of Medicare Operations		ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Reconciliation Contact	Clinical Pharmacy Program Manager		Sanders	Stephanie		5209063358				8889086747	Stephanie.Sanders@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Reconciliation Contact (Secondary)	Controller		Patel	Achal		4807604813				4807604619	Achal.Patel@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Recovery Audit Contact	Vice President of Medicare Operations	Mr	Ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	SNP Application Contact	Vice President of Medicare Operations		ladich	Matthew		4803034439					Matthew.Ladich@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	SNP State Contact	Chief Operating Officer		Policky	Diana		4803502237					Diana.Policky@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Surveillance Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	10/25/2021	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	System Contact	Director Information Systems		Small	Melissa		4807604538				4807842933	Melissa.Small@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Third Party Administrator (TPA) Liaison	Controller		Patel	Achal		4807604813				4807604619	Achal.Patel@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	User Access Contact	Information Security Svcs- Lead	Ms.	O''Brien	Debi		6029167939					debi.o''brien@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Utilization Management Contact	Vice President of Clinical Operations		Lewis	Ellen		4802127841				4807842933	Ellen.Lewis@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5587	Utilization Review Contact	Vice President of Clinical Operations		Lewis	Ellen		4802127841				4807842933	Ellen.Lewis@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/24/2023	2023	HEALTH CHOICE ARIZONA, INC.	Local CCP	BCBSAZ Health Choice	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5590	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H5590	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2020	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2020	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/10/2017	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1850 W. Rio Salado Parkway		Tempe	AZ	85281	07/19/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Medical Director	Medical Director	Dr	Krauss	Robert		8779358020					rkrauss@centene.com	1850 W. Rio Salado Parkway	Suite 201	Tempe	AZ	85281	03/30/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1850 W. Rio Salado Parkway		Tempe	AZ	85281	07/19/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2020	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H5590	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H5590	PHR Beneficiary Contact																	09/27/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8009777522				HMO - Health Maintenance Organization		C	Dallas
H5590	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Plan Directory Contact for Public Website			Services	Provider		8773915921					CorporateMedicareComplianceDept@CENTENE.COM	1850 W. Rio Salado Parkway	Suite 201	Tempe	AZ	85281	03/31/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5590	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	Bridgeway Health Solutions of Arizona, Inc.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5591	Agent/Broker Compensation Data Contact	Director, Medicare Sales		Cestaro	Connor		2077313136					connor.cestaro@martinspoin.org	P.O. Box 9746	891 Washington Ave.	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Backup User Access Contact	Interim CISO		Baker	Brandon		2077769821					brandon.baker@martinspoint.org	331 Veranda Street		Portland	ME	04014	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Best Available Evidence Contact	Manager, Member Operations		Whelan	James		2072742738					james.whelan@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Bid Audit Contact	VP, Health Plan Products		Orlando	Matt		2072536192					matthew.orlando@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Bid Audit Site Contact	VP, Health Plan Products		Orlando	Matt		2072536192					matthew.orlando@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Bid Primary Contact	VP, Health Plan Products		Orlando	Matt		2072536192					matthew.orlando@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	CAP Report Contact for Public Website	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	CEO - CMS Administrator Contact	President and Chief Executive Officer	Dr.	Kasuba	Paul		2077913710					paul.kasuba@martinspoint.org	331 Veranda Street	P. O.  Box 9746	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	CEO - Senior Official for Contracting	President and Chief Executive Officer	Dr.	Kasuba	Paul		2077913710					paul.kasuba@martinspoint.org	331 Veranda Street	P. O.  Box 9746	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Chief Financial Officer	Chief Financial Officer	Ms	Jackson	Amanda		2072536115					amanda.jackson@martinspoint.org	331 Veranda Street	P. O.  Box 9746	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Chief Operating Officer	Chief Operating Officer	Ms	Di Re	Bernadette		2077913860					bernadette.dire@martinspoint.org	331 Veranda Street	P. O.  Box 9746	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Chief Information Officer	VP Information Technology	Ms	Downs	Amie		2072536184					amie.downs@martinspoint.org	331 Veranda Street		Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Chief Information Security Officer	Interim CISO	Mr	Baker	Brandon		2077769821					brandon.baker@martinspoint.org	331 Veranda Street		Portland	ME	04014	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	CMS Casework Communication Contact	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Complaints Tracking Contact	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	PO Box 9746	331 Veranda Street	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Contact for Fraud Investigations	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	PO Box 9746	331 Veranda Street	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Coordination of Benefits Contact	Manager, Member Operations		Whelan	James		2072742738					james.whelan@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Corporate Mailing						2077913710					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant III		Allard	Kathleen		2078282490					kathleen.allard@martinspoint.org	P. O. Box 9746		Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Customer Service Operations Contact	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	DIR Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	DIR Contact (Secondary)	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Emergency Part D Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Emergency Part D Contact (Secondary)	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Employer Waiver Contact	Product		Myers	Shane		2072536371					shane.myers@martinspoint.org	P.O. Box 9746	891 Washington Avenue	Portland	ME	04104	01/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Encounter Data & Risk Adjustment Operations Contact			Hostetter	Andrew		2072536715					andrew.hostetter@martinspoint.org	PO Box 9746		Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Enrollment Contact	Manager, Member Operations		Whelan	James		2072742738					james.whelan@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	EOB Transfer Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535				2072536202	elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Financial Audit Contact	MCO	Ms	Loomis	Elizabeth		5182290535				2078287845	elizabeth.loomis@martinspoint.org	P.O. Box 9746		Portland	ME	04104	09/28/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Financial Reporting Contact	Corporate Controller	Mr.	Evans	Warren		2072536204				2072536227	warren.evans@martinspoint.org	P.O. Box 9746		Portland	ME	04103	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Formulary Contact	Medicare Clinical Pharmacist		Brown	Nancy	J	4013333987	7941			8003730238	njbrown@pharmacare.com	695 George Washington Highway		Lincoln	RI	02865	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Formulary Contact (Secondary)	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	General Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Government Relations Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	HIPAA Privacy Officer	Interim Privacy Officer		True	Erica		2077913848					erica.true@martinspoint.org	331 Veranda Street		Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	HIPAA Security Officer	Interim CISO		Baker	Brandon		2077769821					brandon.baker@martinspoint.org	331 Veranda Street		Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Hospice Contact	Senior Medicare Part D Specialist		Creighton-Galinas	Sheila		2078282471					sheila.creighton-galinas@martinspoint.org	891 Washington Ave	PO Box 9746	Portland	ME	041045040	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Interoperability Contact			Reburn	Sarah		2072536966					sarah.reburn@martinspoint.org	PO Box 9746		Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	MA Appeals/Grievances Contact	Member Operations Manager		Whelan	James		2072742738					james.whelan@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	MA Claims Processing Contact for Public Website	Director, Provider Operations		Turkewitz	Todd		2072742718					todd.turkewitz@martinspoint.org	P.O. Box 9746	891 Washington Avenue	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Marketing Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Medical Director	Physician & Health Plan Programs Medical Director	Dr.	Wesolowski	Martin		2076994759					martin.wesolowski@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Medicare Compliance Officer	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Medicare Coordinator	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Medication Therapy Management Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Online Enrollment Center Contact (Back-up)	Supervisor Enrollment and Premium Biling		Whelan	James		2072742738					james.whelan@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Online Enrollment Center Contact (Optional)	Director Member Engagement		Reburn	Sarah		2072536966					sarah.reburn@martinspoint.org	PO Box 9746	891 Washington Ave	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Online Enrollment Center Contact (Primary)	Systems Analyst, Enrollment		Tucker	Thad		2072536398					thad.tucker@martinspoint.org	P.O. Box 9746	891 Washington Ave.	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Part C Application Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Part C Reporting Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Part D Appeals			Representative	Appeals							appealsmedicare@caremark.com	CVS Caremark	9501 E. Shea Blvd. MC 109	Scottsdale	AZ	85260	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active	8668849479				HMO - Health Maintenance Organization		C	New York
H5591	Part D Appeals Contact (Secondary)	Manager, Pharmacy Operations		Theriault	Anne							anne.theriault@martinspoint.org	PO Box 9746	891 Washington Ave.	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active	2077663144				HMO - Health Maintenance Organization		C	New York
H5591	Part D Application Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Part D Benefits Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Part D Claims Submission Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Part D Exceptions Contact	Appeals Representative		Representative	Appeals							appealsmedicare@caremark.com	CVS Caremark	9501 E. Shea Blvd MC 109	Scottsdale	AZ	85260	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active	8688849479				HMO - Health Maintenance Organization		C	New York
H5591	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Operations		Theriault	Anne							anne.theriault@martinspoint.org	PO Box 9746	891 Washington Ave.	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active	2077663144				HMO - Health Maintenance Organization		C	New York
H5591	Part D Price File Contact (Back-up)	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Part D Price File Contact (Primary)	Medicare Operations		Loveland	Chet		4806064873					Chet.Loveland@CVSHealth.com	CVS Caremark	9501 E. Shea Blvd.	Scottsdale	AZ	85260	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Part D Quality Assurance Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Part D Reporting Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Patient Safety Contact	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Payment Contact	Corporate Controller		Evans	Warren		2072536204					warren.evans@martinspoint.org	P. O. Box 9746		Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Pharmacy Director	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Pharmacy Network Management Contact	Director, Network Operations		Smith	Shawn		4803914844				4803146964	Shawn.Smith@caremark.com	CVS Caremark	9501 E. Shea Blvd. MC143	Scottsdale	AZ	85260	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Pharmacy Technical Help Desk Contact	Manager, Vendor Management		Palmieri	Mike							mike.palmieri@caremark.com	CVS Caremark	2401 Cherahala Blvd. MC650	Knoxville	TN	37932	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H5591	Plan Directory Contact for Public Website	Director Compliance & MCO	Ms	Loomis	Elizabeth		8887327364					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Plan to Plan Reconciliation Contact	Accountant II		Ayub	Rehema		2072536991					rehema.ayub@martinspoint.org	P. O. Box 9746	891 Washington Ave	Portland	ME	04103	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Processor Contact	Director, Provider Operations		Turkewitz	Todd		2072742718					todd.turkewitz@martinspoint.org	P.O. Box 9746	891 Washington Avenue	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Quality Contact	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	PO Box 9746	331 Veranda Street	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Reconciliation Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Reconciliation Contact (Secondary)	Corporate Controller		Evans	Warren		2072536118					warren.evans@martinspoint.org	P. O. Box 9746		Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Recovery Audit Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		8887327364					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	SNP Application Contact	Product		Myers	Shane		2072536371					shane.myers@martinspoint.org	P.O. Box 9746	891 Washington Avenue	Portland	ME	04104	01/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	SNP State Contact	Product		Myers	Shane		2072536371					shane.myers@martinspoint.org	P.O. Box 9746	891 Washington Avenue	Portland	ME	04104	01/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Surveillance Contact	Director Compliance & MCO		Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	System Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535				2072536922	elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Third Party Administrator (TPA) Liaison	Manager, Pharmacy Operations		Theriault	Anne		2077663144					anne.theriault@martinspoint.org	P.O. Box 9746	891 Washington Ave	Portland	ME	04101	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	User Access Contact	Director Compliance & MCO	Ms	Loomis	Elizabeth		5182290535					elizabeth.loomis@martinspoint.org	P.O. Box 9746	331 Veranda Street Bldg 2	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Utilization Management Contact	Director, Health Management		Howard	Tracy		2072536912					tracy.howard@martinspoint.org	P.O. Box 9746	891 Washington Avenue	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5591	Utilization Review Contact	Director, Health Management		Howard	Tracy		2072536912					tracy.howard@martinspoint.org	P.O. Box 9746	891 Washington Avenue	Portland	ME	04104	09/11/2023	2023	MARTIN'S POINT GENERATIONS ADVANTAGE, INC.	Local CCP	Martin's Point Generations Advantage	HMO/HMOPOS		Martin's Point Health Care, Inc.	287	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5593	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/11/2018	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/06/2019	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	12/11/2019	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	12/11/2018	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H5593	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	12/11/2018	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	12/11/2019	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5593	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF IOWA INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5594	Agent/Broker Compensation Data Contact	VP of Finance		Caruso	David		8135066000	11006				CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Automated TrOOP Balance Transfer Contact	Manager Pharmacy Clinical Ops		Marrocco	Brianna		8135066000	66072				PartD@freedomh.com	4200 W Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	04/19/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Best Available Evidence Contact	Vice President, Enrollment		Conner	Claudius		8134598739				8135066151	CMSEnrollment@freedomh.com	4200 W. Cypress Street		Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Bid Audit Contact	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Bid Audit Site Contact	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Bid Primary Contact	Product Management Director	Ms.	McKee	Heather		9043474771	351				Heather.McKee@anthem.com	3115 Trout Creek Court		St. Augustine	FL	32092	04/18/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	CAP Report Contact for Public Website	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	04/05/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	04/05/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Chief Operating Officer		Ms	Newman	Elena		3053420885					cms@freedomh.com	9250 W Flagler St		Miami	FL	33174	06/28/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	5800 Northampton Blvd		Norfolk	VA	23502	04/18/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	04/18/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	CMS Casework Communication Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Complaints Tracking Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	04/19/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Coordination of Benefits Contact	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Corporate Mailing						8135066000				8135066151	cms@freedomh.com	4200 W Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Acctg Database Analyst Sr		Racine	Max		8058163930					Max.Racine@Anthem.com	120 S Via Merida	Mail Stop: CAT202-J003	Thousand Oaks	CA	91362	04/22/2019	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Customer Service Operations Contact	Director of Member Services		Doroteo	Carlos		8135066000	11342			8135066150	CMSMemberServices@freedomh.com	4200 Cypress Street	Suite 500	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	DIR Contact	Compliance Officer		Kortsch	Diane		4143369395					dkortsch@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/06/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	DIR Contact (Secondary)	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Emergency Part D Contact	Manager Pharmacy Clinical Ops		Marrocco	Brianna		7274516800	66072			8135066152	bmarrocco@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Emergency Part D Contact (Secondary)	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Encounter Data & Risk Adjustment Operations Contact	Director - MRA Informatics		Shah	Parin		8135066000	11368				pshah@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Enrollment Contact	Vice President, Enrollment	Mr	Conner	Claudius		8134598739				8135066151	dmpatel@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	EOB Transfer Contact	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	PartDOps@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Financial Audit Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395					CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/06/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Financial Reporting Contact	VP of Finance		Caruso	David		8135066000	11006				CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Formulary Contact	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	PartD@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Formulary Contact (Secondary)	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	General Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395					cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Government Relations Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395					cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	HIPAA Privacy Officer	Privacy Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	04/18/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Hospice Contact	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	PartD@freedomh.com	2240 Belleair Road	Suite 250	Clearwater	FL	33764	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Interoperability Contact	Dir II Technology	Mr.	Kumbhani	Dev		8135066000	11146				cms@freedomh.com	4200 Cypress St		Tampa	FL	33607	04/11/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	MA Appeals/Grievances Contact	Director Healthcare Management		Szabla	Sara		8135066000	11413				cms@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/02/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	MA Claims Processing Contact for Public Website	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Marketing Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Medical Director	Managing Medical Director	MD	Stern	Mark		8135066000	11214			8135066168	HealthServices@freedomh.com	5420 Bay Center Drive	Suite 200	Tampa	FL	33609	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	08/11/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Medicare Coordinator	Compliance Officer	Ms	Kortsch	Diane		4143369395					cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Medicare Part D Opioid Overutilization Contact	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	bmarrocco@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	07/05/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Medication Therapy Management Contact	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	PartD@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Online Enrollment Center Contact (Back-up)			Cardona	Marie		8135066000	11157				CMSEnrollment@freedomh.com	3405 W. Dr. Martin Luther King Blvd.	Suite 250	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Online Enrollment Center Contact (Optional)	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Online Enrollment Center Contact (Primary)	Vice President, Enrollment		Conner	Claudius		8134598739				8135066151	CMSEnrollment@freedomh.com	4200 Cypress St		Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	04/18/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Part C Reporting Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Appeals	Pharmacist		Marrocco	Brianna						8135066152	bmarrocco@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	01/08/2020	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	7274516800	66072			HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Appeals Contact (Secondary)	Compliance Officer		Kortsch	Diane						8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	4143369395				HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	04/18/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Benefits Contact	Pharmacy Clinical Operations Manager		Marrocco	Brianna		8135066000	66072				cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/06/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Claims Submission Contact	Pharmacy Clinical Operations Manager		Marrocco	Brianna		8135066000	66072				cms@freedomh.com	4200 W Cypress St	Suite 800	Tampa	FL	33607	03/06/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Exceptions Contact	Pharmacist		Marrocco	Brianna						8135066152	bmarrocco@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33762	01/08/2020	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	7274516800	66072			HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Exceptions Contact (Secondary)	Compliance Officer		Kortsch	Diane						8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	4143369395				HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					daniela.mendez@carelon.com	1723 Loma Rd		Montebello	CA	90640	02/08/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Price File Contact (Optional)	Director II Technology		KUMBHANI	DEVCHAND		8135066000	11146				CMSTechsupport@freedomh.com	4200 W Cypress St		Tampa	FL	33607	05/10/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					amanda.nicholson-sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	02/08/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Quality Assurance Contact	Compliance Officer		Kortsch	Diane		4143369395					cms@freedomh.com	4200 Cypress St.	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Part D Reporting Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Patient Safety Contact	Managing Medical Director	Mr	Stern	Mark		8135066000	11214			8135066151	cms@freedomh.com	5420 Bay Center Drive	Suite 200	Tampa	FL	33609	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Payment Contact	Fin Acctg Database Analyst Sr	Mr.	Racine	Max	J	8058163930					Max.Racine@Anthem.com	2000 Corporate Center Drive	Mail Stop: CANP02-I001	Newbury Park	CA	91320	04/26/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Personal Health Record Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Pharmacy Director	Pharmacist		Marrocco	Brianna		7274516800	66072			8135066152	PartD@freedomh.com	2240 Belleair Rd Ste 250		Clearwater	FL	33764	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Pharmacy Network Management Contact	Director Of Operations-PR		Goluch	Adrian		8135066000	11354			8135066152	agoluch@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Pharmacy Network Management Contact (Secondary)	Compliance Officer		Kortsch	Diane		4143369395				8135066151	PartD@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Pharmacy Technical Help Desk Contact	Director Pharmacy Oversight		Warner	Raymond							raymond.warner@ingenio-rx.com	21215 Burbank Blvd		Woodland Hills	CA	91367	04/20/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774267				HMO - Health Maintenance Organization		C	Chicago
H5594	Pharmacy Technical Help Desk Contact (Secondary)	Manager Pharmacy Advocacy, Customer Service		Erbe	Michael						8135066152	PartD@freedomh.com	3515 Harbor Blvd.		Costa  Mesa	CA	92626	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8664431095				HMO - Health Maintenance Organization		C	Chicago
H5594	PHR Beneficiary Contact																	01/08/2020	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS	Freedom Health, Inc.	Elevance Health, Inc.	1	Yes	Active	8004012740				HMO - Health Maintenance Organization		C	Chicago
H5594	Physician Incentive Contact	Director GBD Finance	Mr	Caruso	David		8135066000	11006				cms@freedomh.com	4200 W Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Plan Directory Contact for Public Website	Director of Member Services		Doroteo	Carlos		8004012740					cms@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Plan to Plan Reconciliation Contact	P2P Contact		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd	Ste 100 Mailstop CA9304-R04H	Woodland Hills	CA	91367	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Processor Contact	Director II Technology		KUMBHANI	DEVCHAND		8135066000	11146				CMSTechsupport@freedomh.com	4200 W Cypress St		Tampa	FL	33607	05/10/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Quality Contact	Director Quality Management		Patel	Shetal		8135066000	11413				HealthServices@freedomh.com	5420 Bay Center Drive	Suite 100	Tampa	FL	33609	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Reconciliation Contact	Compliance Officer		Kortsch	Diane		4143369395					CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/06/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Reconciliation Contact (Secondary)	VP of Finance	Mr	Caruso	David		8135066000	11006			8135066151	CMSFinance@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Recovery Audit Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	04/18/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	SNP State Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395					cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Surveillance Contact	Compliance Officer		Kortsch	Diane		4143369395				8135066151	cms@freedomh.com	4200 Cypress St	Suite 800	Tampa	FL	33607	03/01/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	System Contact	Director II Technology	Mr	KUMBHANI	DEVCHAND		8135066000	11146				CMSTechsupport@freedomh.com	4200 W Cypress St		Tampa	FL	33607	05/10/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Third Party Administrator (TPA) Liaison	Finance Acctg Database Analyst Sr		Racine	Max		8058163930					Max.Racine@Anthem.com	120 S Via Merida	Mail Stop: CAT202-J003	Thousand Oaks	CA	91362	04/22/2019	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	User Access Contact	Compliance Officer	Ms	Kortsch	Diane		4143369395					cms@freedomh.com	4200 W Cypress St		Tampa	FL	33607	04/19/2023	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Utilization Management Contact	Director Healthcare Management		Szabla	Sara		8135066000	11409				HealthServices@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/02/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5594	Utilization Review Contact	Director Healthcare Management		Szabla	Sara		8135066000	11409				HealthServices@freedomh.com	4200 Cypress Street	Suite 800	Tampa	FL	33607	03/02/2022	2023	OPTIMUM HEALTHCARE, INC.	Local CCP	Optimum HealthCare, Inc.	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5599	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Automated TrOOP Balance Transfer Contact	Director, Pharmacy		Patel	Sharon		7188966500					Sharon.d.patel@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	02/20/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Best Available Evidence Contact	Manager, Medicare Enrollment	Ms.	Almendarez	Celestina		7183936104					CAlmendarez@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H5599	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	05/11/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	09/27/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	01/31/2020	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	DIR Contact	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	DIR Contact (Secondary)	Senior Director, Predictive Analytics		Lamour	David		8132067536					david.lamour@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Emergency Part D Contact	Director, Medicare Pharmacy		Patel	Sharon		9292180035				8778825892	sharon.patel@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	01/05/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Emergency Part D Contact (Secondary)	Pharmacist, Medicare Pharmacy	Ms.	Chou	Christine		3476843897					cchou@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/15/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Enrollment Contact	Manager, Medicare Enrollment	Ms.	Almendarez	Celestina		7183936104					CAlmendarez@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	EOB Transfer Contact	Plan Chief Financial Officer	Mr.	Meixner	Thomas		7183936172				7183936172	Thomas.Meixner@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	06/15/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	05/11/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Hospice Contact	Senior Director, Long Term Care		Reed	Mark		3172170776					MAReed@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	06/15/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	05/11/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Medical Director	Sr. Vice President, Markets	Mr	Marchello	Vincent		7183936564					vmarchello@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services		Patel	Sharon		9292180035				8778825892	Sharon.d.patel@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	02/20/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Medication Therapy Management Contact	Director, Medicare Pharmacy		Patel	Sharon		9292180035				8778825892	Sharon.d.patel@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	02/20/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Online Enrollment Center Contact (Back-up)	Sr. Director, Enrollment	Mr	Krugman	Boris		7183936341					bkrugman@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	05/11/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Online Enrollment Center Contact (Optional)	Quality Specialist II		Lin	Qing		7186855273					qlin1@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	05/11/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Online Enrollment Center Contact (Primary)	Manager, Medicare Enrollment	Ms.	Almendarez	Celestina		7183936104					CAlmendarez@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Appeals	Supervisor, Pharmacist		Patel	Sharon							Sharon.d.patel@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	02/20/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active	7188966500				HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Appeals Contact (Secondary)	Pharmacist, Medicare Pharmacy	Ms.	Chou	Christine							cchou@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active	7168966500	11316			HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	05/11/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Claims Submission Contact	VP, Pharmacy Operations	Mr.	Moncayo	Erick		7183936310					emoncayo@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Exceptions Contact	Director, Medicare Pharmacy		Patel	Sharon						8778825892	Sharon.d.patel@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	02/20/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active	9292180035				HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Exceptions Contact (Secondary)	Pharmacist, Medicare Pharmacy	Ms.	Chou	Christine							cchou@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active	7168966500	11316			HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Price File Contact (Back-up)	Director, Regulatory Operations	Ms.	Brandler	Erminia		9176894133					Erminia.Brandler@fideliscare.org	25-01 Jackson Avenue		Long Island City	NY	11101	04/27/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Price File Contact (Primary)	Director, Regulatory Operations	Ms.	Brandler	Erminia		9999999999					erminia.brandler@fideliscare.org	25-01 Jackson Avenue		Long Island City	NY	11101	04/27/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Pharmacy Director	VP, Pharmacy Operations	Mr.	Moncayo	Erick		7183936310					emoncayo@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Pharmacy Network Management Contact	VP, Contract Management	Ms.	Stubblefield	Brenda		7189060850					bstubblefield@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Pharmacy Technical Help Desk Contact	Director,  Pharmacy		Patel	Sharon							sharon.patel@fideliscare.org	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Dallas
H5599	Pharmacy Technical Help Desk Contact (Secondary)	Director,  Pharmacy	Ms	Patel	Sharon							sharon.patel@fideliscare.org	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H5599	PHR Beneficiary Contact																	09/27/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8002471447				HMO - Health Maintenance Organization		C	Dallas
H5599	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/15/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Plan Directory Contact for Public Website			Member Services	Fidelis		8002471447				8009778226	fidelis@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Processor Contact	Vice President, IT	Ms.	Hurley	Claudia		7165646100				7165643645	churley@fideliscare.org	480 CrossPoint Parkway		Getzville	NY	14068	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Recovery Audit Contact	Director, Regulatory Operations	Ms.	Brandler	Erminia		9176894133					Erminia.Brandler@fideliscare.org	25-01 Jackson Avenue		Long Island City	NY	11101	04/27/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/11/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	System Contact	Vice President, IT	Ms.	Hurley	Claudia		7165646100				7165643645	churley@fideliscare.org	480 CrossPoint Parkway		Getzville	NY	14068	03/26/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Utilization Management Contact	Sr. VP, Population Health Clinical Operations		Maginn	Mary Beth		7183936590					mmaginn@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	06/15/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5599	Utilization Review Contact	Sr. VP, Population Health Clinical Operations		Maginn	Mary Beth		7183936590					mmaginn@fideliscare.org	2501 Jackson Avenue		Long Island City	NY	11101	06/16/2022	2023	NEW YORK QUALITY HEALTHCARE CORPORATION	Local CCP	Wellcare by Fidelis Care	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Agent/Broker Compensation Data Contact	Director of Insurance Products		Score	Natalie		3036027650				3036022099	Natalie.Score@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/03/2021	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Judge	April		8587907010				8587906052	PartDCAT@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	04/14/2014	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Backup User Access Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Best Available Evidence Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Bid Audit Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Bid Audit Site Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Bid Primary Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	CAP Report Contact for Public Website		Mrs.	Artale Bross	Lisa		3036024347				3036027024	lisa.artalebross@dhha.org	601 Broadway	Mail Code 7776	Denver	CO	80204	09/27/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	CEO - CMS Administrator Contact	CEO/Executive Director	Mr.	McCarthy	Greg		3036022001				3036022094	Greg.McCarthy@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	01/05/2023	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	CEO - Senior Official for Contracting	CEO/Executive Director	Mr.	McCarthy	Greg		3036022001				3036022094	Greg.McCarthy@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2017	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Chief Financial Officer	CFO	Mr.	Caldwell	Joseph		3036020634				3036022094	Joseph.Caldwell@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	06/28/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Chief Operating Officer	Chief Operating Officer	Mr.	Wagner	Michael		3036022595				3036022094	Michael.Wagner@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	06/28/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Chief Information Officer	CEO/Executive Director	Mr.	McCarthy	Greg		3036022001				3036022094	Greg.McCarthy@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	06/27/2017	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Chief Information Security Officer	Cheif Information Security Officer	Mr.	Frietzsche	Randall		3036025005					Randall.Frietzsche@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	802044507	10/15/2018	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	CMS Casework Communication Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/11/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Complaints Tracking Contact	Utilization Management Operations Manager		Culter	Corie		3036024313					Corie.Culter@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	11/21/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Contact for Fraud Investigations	Director Health Plan Compliance		Artale Bross	Lisa		3036024347				3036027024	lisa.artalebross@dhha.org	601 Broadway	Mail Code 7776	Denver	CO	80204	11/15/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Coordination of Benefits Contact	Health Plan Compliance Analyst		Castaneda	Daisy		3036022612				3036022094	Daisy.Castaneda@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	05/23/2023	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Corporate Mailing						3036022001				3036022094	Greg.McCarthy@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	802044507	04/12/2018	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Financial Analyst		Wu	Connie		3036022007				3036022094	connie.wu@dhha.org	777 Bannock	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Customer Service Operations Contact	Chief Administrative Officer		Wagner	Michael		3036022595					Michael.Wagner@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	04/12/2018	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	DIR Contact	Financial Analyst		Schreiber	Mark		3036022497				3036022094	Mark.Schreiber@dhha.org	777 Bannock	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	DIR Contact (Secondary)	CEO/Executive Director	Mr.	McCarthy	Greg		3036022001				3036022094	Greg.McCarthy@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	12/09/2021	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Emergency Part D Contact	Pharmacy Director		Winters	Ruie		3036020604					Ruie.WintersIII@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	01/05/2023	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Emergency Part D Contact (Secondary)	Pharmacy Technician Supervisor		Chavez	Andrea		3036022074					Andrea.Chavez@dhha.org	777 Bannock St	Mail Code 6000	Denver	CO	80204	09/01/2023	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Encounter Data & Risk Adjustment Operations Contact	Director of Actuarial Services		Stob	Rebecca		6263187974					rebecca.stob@dhha.org	777 Bannock Street	MC 6000	Denver	CO	80204	09/11/2023	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Enrollment Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	EOB Transfer Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Financial Audit Contact	Medicare Compliance Officer	Mrs.	Artale Bross	Lisa		3036024347					lisa.artalebross@dhha.org	601 Broadway	Mail Code 7776	Denver	CO	80204	09/27/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Financial Reporting Contact	CEO/Executive Director	Mr.	McCarthy	Greg		3036022001				3036022094	Greg.McCarthy@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	12/09/2021	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Formulary Contact	Pharmacy Director		Winters	Ruie		3036020604					Ruie.WintersIII@dhha.org	777 Bannock St.	MC 6000	Denver	CO	80204	09/01/2023	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Formulary Contact (Secondary)	Supervisor, Formulary Services		Rogers	Victoria		8587907009				8587906052	FMT@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	04/14/2014	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	General Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Government Relations Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	HIPAA Privacy Officer	Privacy Officer		Grimpo	Michael		3036025115					Michael.Grimpo@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	802044507	10/15/2018	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	HIPAA Security Officer	Cheif Information Security Officer		Frietzsche	Randall		3036025005					Randall.Frietzsche@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	802044507	10/15/2018	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Hospice Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Interoperability Contact	Director of Information Systems		Wilson	Lucas		3036022029					lucas.wilson@dhha.org	777 Bannock St	MC 6000	Denver	CO	80204	12/09/2021	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	MA Appeals/Grievances Contact	Utilization Management Operations Manager		Culter	Corie		3036024313					Corie.Culter@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	11/21/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	MA Claims Processing Contact for Public Website			Services	HealthPlan		3036022111				3036022099	dhmpinfo@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	12/09/2021	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Marketing Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Medical Director	Medical Director	Dr.	Seals	Christine		3036029825					Christine.Seals@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	10/29/2019	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Artale Bross	Lisa		3036024347				3036027024	lisa.artalebross@dhha.org	601 Broadway	Mail Code 7776	Denver	CO	80204	09/27/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Medicare Coordinator	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Medicare Part D Opioid Overutilization Contact	Pharmacy Director		Winters	Ruie		3036020604					RuieWintersIII@dhha.org	777 Bannock St	MC 6000	Denver	CO	80204	06/28/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Medication Therapy Management Contact	Pharmacy Director		Winters	Ruie		3036020604					Ruie.WintersIII@dhha.org	777 Bannock St	MC 6000	Denver	CO	80204	06/28/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	OffShore Subcontractor Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Online Enrollment Center Contact (Back-up)			Services	HealthPlan		3036022111				3036022099	dhmpinfo@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	03/27/2019	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Online Enrollment Center Contact (Optional)			Services	HealthPlan		3036022111				3036022099	dhmpinfo@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	03/27/2019	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Online Enrollment Center Contact (Primary)			Services	HealthPlan		3036022111				3036022099	dhmpinfo@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	03/27/2019	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Part C Application Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Part C Reporting Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Part D Appeals	Utilization Management Operations Manager		Culter	Corie							Corie.Culter@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	11/21/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active	3036024313				HMO - Health Maintenance Organization		C	Dallas
H5608	Part D Appeals Contact (Secondary)	Lead Grievance and Appeal Specialist		Lopez	Ramona						3036022138	Ramona.Lopez@dhha.org	777 Bannock St., MC 6000		Denver	CO	802044507	01/28/2019	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active	3036022105				HMO - Health Maintenance Organization		C	Dallas
H5608	Part D Application Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Part D Benefits Contact	Pharmacy Director		Winters	Ruie		3036020604					Ruie.WintersIII@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	06/28/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Part D Claims Submission Contact			Orescanin	Cookie		8587905667					cookie.orescanin@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/27/2012	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Part D Exceptions Contact	Pharmacy Director		Winters	Ruie							Ruie.WintersIII@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	06/28/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active	3036020604				HMO - Health Maintenance Organization		C	Dallas
H5608	Part D Exceptions Contact (Secondary)			Grondin	Don							don.grondin@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	04/25/2014	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active	8587906536				HMO - Health Maintenance Organization		C	Dallas
H5608	Part D Price File Contact (Back-up)	Medicare Part D Project Manager		Maldonado	Cheryl		8587906397				8587906052	PlanFinderCommunications@medimpact.com	10181 Scripps Gateway Ct.,		San Diego	CA	92131	04/25/2014	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Part D Price File Contact (Primary)	Pharmacy Director		Winters	Ruie		3036020604					Ruie.WintersIII@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	06/28/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Part D Quality Assurance Contact	Pharmacy Director		Winters	Ruie		3036020604					Ruie.WintersIII@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	06/28/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Part D Reporting Contact	Pharmacy Director		Winters	Ruie		3036020604					Ruie.Winters@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	06/28/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Patient Safety Contact	Pharmacy Director		Winters	Ruie		3036020604					Ruie.WintersIII@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	05/24/2023	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Payment Contact	CEO/Executive Director	Mr.	McCarthy	Greg		3036022001				3036022094	Greg.McCarthy@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	12/09/2021	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Pharmacy Director	Pharmacy Director		Winters	Ruie		3036020604					Ruie.WintersIII@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	06/28/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Pharmacy Network Management Contact	Supervisor, Pharmacy Network Support		Burke	Sharon		8587907148				8587906011	Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	04/14/2014	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Pharmacy Network Management Contact (Secondary)	Pharmacy Director		Winters	Ruie		3036020604					Ruie.WintersIII@dhha.org	777 Bannock St	MC6000	Denver	CO	80204	05/24/2023	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services		Brewer	Kathy							Customerservice@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/12/2021	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active	8773919291				HMO - Health Maintenance Organization		C	Dallas
H5608	Pharmacy Technical Help Desk Contact (Secondary)			Brewer	Kathy							Customerservice@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/12/2021	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active	8773919291				HMO - Health Maintenance Organization		C	Dallas
H5608	Physician Incentive Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Plan Directory Contact for Public Website			Services	HealthPlan		3036022111				3036022099	dhmpinfo@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	10/29/2019	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Plan to Plan Reconciliation Contact	Financial Analyst		Schreiber	Mark		3036022497				3036022094	Mark.Schreiber@dhha.org	777 Bannock	Mail Code 6000	Denver	CO	80204	08/10/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Processor Contact	Director, Medicare Programs		Scherlippens	Carine		8587907415				8587906052	Carine.Scherlippens@Medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	04/14/2014	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Quality Contact	Medical Director	Dr.	Seals	Christine		3036029825					Christine.Seals@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	12/09/2021	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Reconciliation Contact	Financial Analyst		Schreiber	Mark		3036022497				3036022094	Mark.Schreiber@dhha.org	777 Bannock	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Reconciliation Contact (Secondary)	CEO/Executive Director	Mr.	McCarthy	Greg		3036022001				3036022094	Greg.McCarthy@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	12/09/2021	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Recovery Audit Contact	Medicare Compliance Officer	Mrs.	Artale Bross	Lisa		3036024347					lisa.artalebross@dhha.org	601 Broadway	Mail Code 7776	Denver	CO	80204	09/27/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	SNP Application Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	SNP State Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Surveillance Contact	Medicare Compliance Officer		Artale Bross	Lisa		3036024347					lisa.artalebross@dhha.org	601 Broadway	Mail Code 7776	Denver	CO	80204	09/27/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	System Contact	Government Products Manager		Chrissinger	Cailey		3036022427				3036022094	Cailey.Chrissinger@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Third Party Administrator (TPA) Liaison	Sr. Financial Analyst		Wu	Connie		3036022007				3036022094	connie.wu@dhha.org	777 Bannock	Mail Code 6000	Denver	CO	80204	08/09/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	User Access Contact	Information Systems Manager		Novak	Robb		3036029844					Robb.Novak@dhha.org	777 Bannock Street	Mail Code 6000	Denver	CO	80204	12/30/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Utilization Management Contact	UM Management Operations Manager		Culter	Corie		3036024313				3036023239	Corie.Culter@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	11/21/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5608	Utilization Review Contact	UM Management Operations Manager		Culter	Corie		3036024313				3036023239	Corie.Culter@dhha.org	777 Bannock St.	Mail Code 6000	Denver	CO	802044507	11/21/2022	2023	DENVER HEALTH MEDICAL PLAN, INC.	Local CCP	Elevate Medicare Advantage	HMO/HMOPOS		Denver Health and Hospital Authority	77	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5610	Automated TrOOP Balance Transfer Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Backup User Access Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Best Available Evidence Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Bid Primary Contact	Chief Operating Officer		Muszynski	Thomas		6169132014				6169132003	tom.muszynski@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	CAP Report Contact for Public Website	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active	8006106299	2012			PACE - Nat		C	Chicago
H5610	CEO - CMS Administrator Contact	Chief Executive Officer	Mrs.	McKnight	Tracey		6169132011				6169132003	tracey.mcknight@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	CEO - Senior Official for Contracting	Chief Executive Officer	Mrs.	McKnight	Tracey		6169132011				6169132003	tracey.mcknight@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	08/23/2023	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Chief Financial Officer	CFO	Mr.	Quist	Steve		6162355123				6169132003	steve.quist@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	02/24/2023	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Chief Operating Officer	Chief Operating Officer	Mr.	Muszynski	Tom		6169132014				6169132003	tom.muszynski@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Chief Information Officer	VP of Information Services	Mr.	Engle	Jeff		6162355272				6163564960	jeff.engle@hollandhome.org	2100 Raybrook Ave SE	Suite 300	Grand Rapids	MI	49546	04/29/2019	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Chief Information Security Officer	VP of Information Services	Mr.	Engle	Jeff		6162355272				6163564950	jeff.engle@hollandhome.org	2100 Raybrook Ave SE	Suite 300	Grand Rapids	MI	49546	04/29/2019	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	CMS Casework Communication Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Complaints Tracking Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Contact for Fraud Investigations	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Coordination of Benefits Contact	Director of Claims		Haggerty	Becky		6169541578				6169541520	becky.haggerty@relianceccp.org	2100 Raybrook SE	Suite 203	Grand Rapids	MI	49506	08/07/2019	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Corporate Mailing						6169132006				6169132005	tom.muszynski@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Quality		Poeller	Dawn	M	6169132006				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Customer Service Operations Contact	Director of Quality & Compliance		Poeller	Dawn		6169132012				6169132005	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	08/23/2023	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	DIR Contact	Controller		Matro	Philip		6162355090				6162355059	philip.matro@hollandhome.org	2100 Raybrook Ave SE	Suite 300	Grand Rapids	MI	49546	08/23/2023	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	DIR Contact (Secondary)	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Emergency Part D Contact	Chief Operating Officer		Muszynski	Tom		6169132014				6169132003	tom.muszynski@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Emergency Part D Contact (Secondary)	Controller		Matro	Philip		6162355090				6162355059	philip.matro@hollandhome.org	2100 Raybrook Avenue SE	Suite 300	Grand Rapids	MI	49546	01/12/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Encounter Data & Risk Adjustment Operations Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Enrollment Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	EOB Transfer Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Financial Audit Contact	Controller	Mr.	Matro	Philip		6162355090				6162355059	philip.matro@hollandhome.org	2100 Raybrook Ave SE	Suite 300	Grand Rapids	MI	49546	08/23/2023	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Financial Reporting Contact	Controller		Matro	Philip		6162355090				6162355059	philip.matro@hollandhome.org	2100 Raybrook Ave SE	Suite 300	Grand Rapids	MI	49546	04/27/2021	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Formulary Contact	Pharmacist		Hoholik	Aaron		6169132032				6169132037	aaron.hoholik@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	General Contact	Director of Quality		Poeller	Dawn		6169132006				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Government Relations Contact	CEO		McKnight	Tracey		6169132011				6169132003	tracey.mcknight@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49506	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	HIPAA Privacy Officer	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	HIPAA Security Officer	VP of Information Systems		Engle	Jeff		6162355272				6163564950	jeff.engle@hollandhome.org	2100 Raybrook Ave SE	Suite 300	Grand Rapids	MI	49506	08/23/2023	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Interoperability Contact	COO		Muszynski	Tom		6169132014				6169132003	tom.muszynski@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	01/12/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	MA Appeals/Grievances Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	MA Claims Processing Contact for Public Website	Director of Claims		Haggerty	Becky		6169541578				6169541520	becky.haggerty@relianceccp.org	2100 Raybrook Ave SE	Suite 230	Grand Rapids	MI	49506	08/23/2023	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Marketing Contact	Community Outreach/Intake Supervisor		Horsley-Pettigrew	Veronica		6169132031				6169132003	veronica.horsley-pettigrew@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Medical Director	Medical Director		Chiavaras	James		6169133088				6169132037	james.chiavaras@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Medicare Compliance Officer	Director of Quality	Ms.	Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Medicare Coordinator	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Medicare Part D Opioid Overutilization Contact	Pharmacist		Hoholik	Arron		6169132032				6169132037	aaron.hoholik@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Medication Therapy Management Contact	Pharmacist		Hoholik	Aaron		6169132032				6169132037	aaron.hoholik@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Part C Application Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Part D Appeals	Director of Quality		Poeller	Dawn						6169132005	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active	8006106299	2012			PACE - Nat		C	Chicago
H5610	Part D Appeals Contact (Secondary)	COO		Muszynski	Tom						6169132003	tom.muszynski@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	01/04/2021	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active	6169130214				PACE - Nat		C	Chicago
H5610	Part D Application Contact	Chief Operating Officer		Muszynski	Thomas		6169132014				6169132003	tom.muszynski@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Part D Benefits Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Part D Claims Submission Contact	Chief Operating Officer		Muszynski	Thomas		6169132014				6169132003	tom.muszynski@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Part D Exceptions Contact	Director of Quality		Poeller	Dawn						6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active	8006106299	2012			PACE - Nat		C	Chicago
H5610	Part D Price File Contact (Back-up)	Pharmacist		Hoholik	Aaron		6169132032				6169132037	aaron.hoholik@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Part D Price File Contact (Optional)	Pharmacist		Hoholik	Aaron		6169132032				6169132005	aaron.hoholik@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Part D Price File Contact (Primary)	Chief Operating Officer	Mr.	Muszynski	Thomas		6169132014				6169132003	tom.muszynski@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Part D Quality Assurance Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Part D Reporting Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Patient Safety Contact	Pharmacist		Hoholik	Aaron		6169132032				6169132003	aaron.hoholik@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Payment Contact	Contoller		Matro	Philip		6162355090				6162355059	philip.matro@hollandhome.org	2100 Raybrook Ave SE	Suite 300	Grand Rapids	MI	49546	04/27/2021	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Pharmacy Director	Pharmacist		Hoholik	Aaron		6169132032				6169132037	aaron.hoholik@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Pharmacy Network Management Contact	Pharmacist		Hoholik	Aaron		6169132032				6169132037	aaron.hoholik@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Pharmacy Network Management Contact (Secondary)	Pharmacist		Hoholik	Aaron		6169132032				6169132037	aaron.hoholik@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Pharmacy Technical Help Desk Contact	Pharmacist		Hoholik	Aaron						6169132037	aaron.hoholik@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active	1800610629				PACE - Nat		C	Chicago
H5610	Plan Directory Contact for Public Website	Community Outreach		Horsley-Pettigrew	Veronica		6169132031				6169132003	veronica.horsley-pettigrew@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Plan to Plan Reconciliation Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Processor Contact	COO		Muszynski	Tom		6169132014				6169132003	tom.muszynski@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Quality Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Reconciliation Contact	Finance Manager		Matro	Philip		6162355090				6162355059	philip.matro@hollandhome.org	2100 Raybrook Ave SE	Suite 300	Grand Rapids	MI	49546	08/23/2023	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Reconciliation Contact (Secondary)	CFO		Quist	Steve		6162355123				6169132003	steve.quist@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	02/24/2023	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Recovery Audit Contact	Controller	Mr.	Matro	Philip		6162355090				6162355059	philip.matro@hollandhome.org	2100 Raybrook Ave SE	Suite 300	Grand Rapids	MI	49546	08/23/2023	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Surveillance Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	System Contact	Chief Operating Officer	Mr.	Muszynski	Thomas		6169132014				6169132003	tom.muszynski@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Third Party Administrator (TPA) Liaison	Director of Quality		Poeller	Dawn	M	6169132006				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	User Access Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Utilization Management Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5610	Utilization Review Contact	Director of Quality		Poeller	Dawn		6169132012				6169132003	dawn.poeller@careresources.org	4150 Kalamazoo Avenue SE		Grand Rapids	MI	49508	11/04/2022	2023	CARE RESOURCES	National PACE	Care Resources	National PACE		Care Resources	267	Yes	Active					PACE - Nat		C	Chicago
H5619	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H5619	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H5619	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5619	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	ARCADIAN HEALTH PLAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H5622	Automated TrOOP Balance Transfer Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Backup User Access Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Best Available Evidence Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Bid Primary Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	CAP Report Contact for Public Website	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	CEO - CMS Administrator Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	CEO - Senior Official for Contracting	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Chief Financial Officer	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Chief Operating Officer	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Chief Information Officer	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Chief Information Security Officer	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	CMS Casework Communication Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Complaints Tracking Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Contact for Fraud Investigations	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Coordination of Benefits Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Corporate Mailing						5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Coverage Gap Discount Program (CGDP) Payment Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Customer Service Operations Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	DIR Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Emergency Part D Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Encounter Data & Risk Adjustment Operations Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Enrollment Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	EOB Transfer Contact	Project Manager	Ms.	Lozado	Karen		5025990175				5025990175	klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Financial Audit Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Financial Reporting Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Formulary Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	General Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Government Relations Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	HIPAA Privacy Officer	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	HIPAA Security Officer	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Interoperability Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	MA Appeals/Grievances Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	MA Claims Processing Contact for Public Website	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Marketing Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Medical Director	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Medicare Compliance Officer	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Medicare Coordinator	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Medicare Part D Opioid Overutilization Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Medication Therapy Management Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Part C Application Contact			Tucker	John		8039601154					john.tucker@paceadvisorygroup.org	4500 Fort Jackson Blvd.	Suite 140	Cola	SC	29209	08/10/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Part D Appeals	Project Manager	Ms.	Lozado	Karen							klozado@hosparus.org	6200 Dutchman''s Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending	5025990175				PACE - Nat		C	Atlanta
H5622	Part D Application Contact			Tucker	John		8039601154					john.tucker@paceadvisorygroup.org	4500 Fort Jackson Blvd.	Suite 140	Cola	SC	29209	08/10/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Part D Benefits Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Part D Claims Submission Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Part D Exceptions Contact	Project Manager	Ms.	Lozado	Karen							klozado@hosparus.org	6200 Dutchman''s Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending	5025990175				PACE - Nat		C	Atlanta
H5622	Part D Price File Contact (Back-up)	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Part D Price File Contact (Primary)	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Part D Quality Assurance Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Part D Reporting Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Patient Safety Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Payment Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Pharmacy Director	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Pharmacy Network Management Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Pharmacy Technical Help Desk Contact	Project Manager	Ms.	Lozaado	Karen							klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending	5025990175				PACE - Nat		C	Atlanta
H5622	Plan Directory Contact for Public Website	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Plan to Plan Reconciliation Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Processor Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Quality Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Reconciliation Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Recovery Audit Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchman''s Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Surveillance Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	System Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Third Party Administrator (TPA) Liaison	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	User Access Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Utilization Management Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5622	Utilization Review Contact	Project Manager	Ms.	Lozado	Karen		5025990175					klozado@hosparus.org	6200 Dutchmans Lane		Louisville	KY	40205	09/13/2022	2023	CARE GUIDE PARTNERS, INC.	National PACE	Care Guide Partners	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H5628	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	CAP Report Contact for Public Website			Services	Member		8886651328					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	MA Claims Processing Contact for Public Website			Services	Member		8886651328					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H5628	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H5628	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H5628	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H5628	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	08/03/2017	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H5628	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H5628	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Plan Directory Contact for Public Website			Services	Member		8886651328					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5628	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF UTAH, INC.	Local CCP	Molina Healthcare of Utah & Idaho	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5629	Automated TrOOP Balance Transfer Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Backup User Access Contact	IT Manager		Valladolid	Mark		6192396900					mvalladolid@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	05/10/2012	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Best Available Evidence Contact	Marketing Director		Gois	Amanda		6196773800				6196773888	marketing@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Bid Primary Contact	CFO		Sanner	Randall		6192396900					rsanner@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	05/27/2020	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	CAP Report Contact for Public Website	Compliance Manager		Cueva	Celeste		6196773869					ccueva@stpaulspace.org	111 Elm Street		San Diego	CA	92101	04/14/2023	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	CEO - CMS Administrator Contact	Chief Executive Officer/Executive Director	Mrs.	Hubbard	Carol		6196773800				6196773888	director@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	CEO - Senior Official for Contracting	Chief Executive Officer/Executive Director	Mrs.	Hubbard	Carol		6196773800				6196773888	director@stpaulspace.org	111 Elm Street		San Diego	CA	92101	05/26/2023	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Chief Financial Officer	Chief Financial Officer	Mr.	Sanner	Randall		6192396900				6192391256	rsanner@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	05/27/2020	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Chief Operating Officer	Chief Executive Officer/Executive Director	Mrs.	Hubbard	Carol		6196773800				6196773888	director@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Chief Information Officer	IT Director	Mr.	Valladolid	Mark		6192396900					mvalladolid@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Chief Information Security Officer	IT Director	Mr.	Valladolid	Mark		6192396900					mvalladolid@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	CMS Casework Communication Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Complaints Tracking Contact	Helath Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Contact for Fraud Investigations	Compliance Manager		Cueva	Celeste		6196773869					ccueva@stpaulspace.org	111 Elm Street		San Diego	CA	92101	05/16/2023	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Coordination of Benefits Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Corporate Mailing						6192396900				6192391256	cao@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Coverage Gap Discount Program (CGDP) Payment Contact	Health Plan Manager	Ms.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	02/22/2021	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Customer Service Operations Contact	Operations Director	Mr.	Aldrete	Alberto		6196773800				6196773888	aaldrete@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	DIR Contact	Health Plan Manager	Ms.	Jones	Cassandra	M	6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	DIR Contact (Secondary)	CFO	Mr.	Sanner	Randall		6192396900					rsanner@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Emergency Part D Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Emergency Part D Contact (Secondary)	Compliance Manager		Cueva	Celeste		6196773869					ccueva@stpaulspace.org	111 Elm Street		San Diego	CA	92101	04/14/2023	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Encounter Data & Risk Adjustment Operations Contact	Health Plan Manager	Ms.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	02/22/2021	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Enrollment Contact	Marketing Director		Gois	Amanda		6196773800				6196773888	marketing@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	EOB Transfer Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Financial Audit Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Financial Reporting Contact	Chief Financial Officer	Mr.	Sanner	Randall		6192396900				6192391256	rsanner@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	05/27/2020	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Formulary Contact	Chief Executive Officer/Executive Director	Mrs.	Hubbard	Carol		6196773800				6196773888	director@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	General Contact	Chief Executive Officer/Executive Director	Mrs.	Hubbard	Carol		6196773800				6196773888	director@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Government Relations Contact	Chief Executive Officer/Executive Director		Hubbard	Carol		6196773800				6196773888	director@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	HIPAA Privacy Officer	Compliance Manager		Cueva	Celeste		6196773869					ccueva@stpaulspace.org	111 Elm Street		San Diego	CA	92101	04/17/2023	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	HIPAA Security Officer	IT Director		Valladolid	Mark		6192396900					mvalladolid@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Interoperability Contact			Ferguson	Ulyson		6192396900	3086				uferguson@stpaulseniors.org	328 Maple St		San Diego	CA	92103	06/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	MA Appeals/Grievances Contact	Quality Improvement Manager		Espinoza	Frank		6196773800				6196773888	fespinoza@stpaulspace.org	111 Elm Street		San Diego	CA	92101	11/03/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	MA Claims Processing Contact for Public Website	Health Plan Manager		Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Sttreet		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Marketing Contact	Marketing Director		Gois	Amanda		6196773800				6196773888	marketing@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Medical Director	Medical Director	Dr.	Lee	Victor		6196773800				6196773888	vlee@stpaulspace.org	111 Elm Street		San Diego	CA	92101	05/18/2017	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Medicare Compliance Officer	Compliance Manager	Mrs.	Cueva	Celeste		6196773869					ccueva@stpaulspace.org	111 Elm Street		San Diego	CA	92101	04/17/2023	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Medicare Coordinator	Operations Director		Aldrete	Alberto		6196773800				6196773888	aaldrete@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Lee	Victor		6196773800				6196773888	vlee@stpaulspace.org	111 Elm Street		San Diego	CA	92101	11/21/2018	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Medication Therapy Management Contact	Medical Director	Dr.	Lee	Victor		6196773800				6196773888	vlee@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Part C Application Contact	Chief Executive Officer/Executive Director		Hubbard	Carol		6196773800				6196773888	director@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Part D Appeals	Quality Improvement Manager		Espinoza	Frank						6196773888	fespinoza@stpaulspace.org	111 Elm Street		San Diego	CA	92101	04/14/2023	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active	6196773800				PACE - Nat		C	San Francisco
H5629	Part D Appeals Contact (Secondary)	Health Plan Director		da Rosa	Cassandra							cdarosa@stpaulspace.org	111 Elm Street		San Diego	CA	92101	04/14/2023	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active	6196773860				PACE - Nat		C	San Francisco
H5629	Part D Application Contact	Chief Executive Officer/Executive Director		Hubbard	Carol		6196773800				6196773888	director@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Part D Benefits Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Part D Claims Submission Contact	Health Plan Manager		Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Part D Exceptions Contact	Medical Director	Dr.	Lee	Victor						6196773888	vlee@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active	1800735292				PACE - Nat		C	San Francisco
H5629	Part D Price File Contact (Back-up)	Health Plan Manager		Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Part D Price File Contact (Optional)	Chief Financial Officer	Mr.	Sanner	Randall		6192396900				6192391256	rsanner@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	05/27/2020	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Part D Price File Contact (Primary)	Chief Financial Officer	Mr.	Sanner	Randall		6192396900				6192391256	rsanner@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	05/27/2020	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Part D Quality Assurance Contact	Quality Improvement Manager		Espinoza	Frank		6196773800				6196773888	fespinoza@stpaulspace.org	111 Elm Street		San Diego	CA	92101	04/14/2023	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Part D Reporting Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Patient Safety Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Payment Contact	Chief Financial Officer	Mr.	Sanner	Randall		6192396900				6192391256	rsanner@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	05/27/2020	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Personal Health Record Contact	Health Plan Manager		Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	04/26/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Pharmacy Director	Medical Director	Dr.	Lee	Victor		6196773800				6196773888	vlee@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Pharmacy Network Management Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Pharmacy Network Management Contact (Secondary)	Medical Director	Dr.	Lee	Victor		6196773800				6196773888	vlee@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Pharmacy Technical Help Desk Contact	Health Plan Manager	Mrs.	Jones	Cassandra						6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active	8007352922				PACE - Nat		C	San Francisco
H5629	Plan Directory Contact for Public Website	Health Plan Manager	Mrs.	Jones	Casssandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Plan to Plan Reconciliation Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Processor Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Quality Contact	Quality Improvement Manager		Espinoza	Frank		6196773800				6196773888	fespinoza@stpaulspace.org	111 Elm Street		San Diego	CA	92101	04/14/2023	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Reconciliation Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Reconciliation Contact (Secondary)	Chief Financial Officer	Mr.	Sanner	Randall		6192396900				6192391256	rsanner@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	05/27/2020	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Recovery Audit Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Surveillance Contact	Marketing Director	Mrs.	Gois	Amanda		6192396900					marketing@stpaulspace.org	328 Maple Street		San Diego	CA	92103	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	System Contact	IT Manager		Valladolid	Mark		6192396900					mvalladolid@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	05/10/2012	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Third Party Administrator (TPA) Liaison	Health Plan Manger	Ms.	Jones	Cassandra		6196773800				6196773888	cparra@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/19/2018	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	User Access Contact	Chief Financial Officer	Mr.	Sanner	Randall		6192396900				6192391256	rsanner@stpaulseniors.org	328 Maple Street		San Diego	CA	92103	05/27/2020	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Utilization Management Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5629	Utilization Review Contact	Health Plan Manager	Mrs.	Jones	Cassandra		6196773800				6196773888	cjones@stpaulspace.org	111 Elm Street		San Diego	CA	92101	03/01/2022	2023	COMMUNITY ELDERCARE OF SAN DIEGO	National PACE	St. Paul's PACE	National PACE		St. Pauls Episcopal Home	653	Yes	Active					PACE - Nat		C	San Francisco
H5644	Agent/Broker Compensation Data Contact	Manager, Individual Sales		Gehrke	Kimberly		9207201569					kgehrke@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Automated TrOOP Balance Transfer Contact	Vice President - Pharmacy	Mr	Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Backup User Access Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	akeenan@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Best Available Evidence Contact	Director, Operations		Techlin	Cara		9207201502				9207201931	ctechlin@networkhealth.com	1570 Midway Place		Menasha	WI	54952	12/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Bid Audit Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Bid Audit Site Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Bid Primary Contact	Senior Actuary		Lanier	Eric		9207201636				9207201912	elanier@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	CAP Report Contact for Public Website	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	CEO - CMS Administrator Contact	CEO	Mrs.	Dicus-Johnson	Coreen		9202851898					coreen.dicusjohnson@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	CEO - Senior Official for Contracting	CEO	Mrs.	Dicus-Johnson	Coreen		2627889303					Coreen.DicusJohnson@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Chief Financial Officer	Chief Financial Officere	Mr	Ollech	Brian		9207201886					bollech@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Chief Operating Officer	Vice President, Operations	Ms.	Vander Zanden	Jessica		9207201652					jvanderz@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Chief Information Officer	Chief Information Officer	Mr	Riley	Timothy		9207201895					triley@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Chief Information Security Officer	Chief Information Security Officer	Mr	Bloedorn	Dave		9207201410					dbloedor@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	CMS Casework Communication Contact	Director, Regulatory Affairs		Schuster	Shannon		9206287267					sschuste@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Complaints Tracking Contact	Director, Regulatory Affairs		Schuster	Shannon		9206287267				9207201912	sschuste@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Contact for Fraud Investigations	VP, Risk Adjustment & Payment Integrity		Weisbrod	Josh		9207201461					jweisbro@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Coordination of Benefits Contact	Director - Pharmacy		Wheaton	Andy		9207201612				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Corporate Mailing						9207201200					compliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant		Cymerman	Tricia		9207201658					tcymerma@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Customer Service Operations Contact	Manager, Customer Service		Schwandner	Stacy		9207201309				9207201908	sschwand@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	DIR Contact	Medicare Pharmacist		Peterson Sanders	Anna		9207201672					apeterso@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	DIR Contact (Secondary)	Director, Pharmacy		Wheaton	Andy		9207201612					awheaton@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Electronic Health Record Contact	VP, Care Services		Dencker	Sarah		9207201694					sdencker@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Emergency Part D Contact	Director, Pharmacy		Wheaton	Andy		9202058528					awheaton@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	12/14/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Emergency Part D Contact (Secondary)	Medicare Pharmacist		Peterson Sanders	Anna		9207201672					apeterso@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/20/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Employer Waiver Contact	VP, Medicare & Individual Programs		Whittemore	John		9853773986					jwhittem@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Encounter Data & Risk Adjustment Operations Contact	Vice President, Risk Adjustment		Weisbrod	Josh		9207201461					jweisbro@networkhealth.com	1570 Midway Place		Fond du Lac	WI	54935	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Enrollment Contact	Manager, Enrollment and BA Integration		Ziegert	Amy		9207201414					amzieger@networkhealth.com	1570 Midway Place		Menasha	WI	54952	07/24/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	EOB Transfer Contact	Vice President - Pharmacy	Mr	Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Financial Audit Contact	Compliance Officer	Mrs.	Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Financial Reporting Contact	Dir Treasury Services		Leigh	Dennis		9207201837					FinanceReporting@networkhealth.com	1570 Midway  Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Formulary Contact	Vice President - Pharmacy		Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Formulary Contact (Secondary)	Manager, Pharmacy Benefits		Wheaton	Andy		9207201612				9207201906	awheaton@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	General Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Government Relations Contact	Compliance Officer		Keenan	Angela		9207201242					nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	HIPAA Privacy Officer	Compliance Officer		Keenan	Angela		9207201242				9207201912	compliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	HIPAA Security Officer	Security Officer	Mr	Bloedorn	Dave		9207201140					dbloedor@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Hospice Contact	Pharmacy Benefits Program Manager		Kempfer	Amanda		9207201607					pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Interoperability Contact	Director, IT Development		Zirbel	Justin		9207201202					jzirbel@networkhealth.com	1570 Midway Place		Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	MA Appeals/Grievances Contact	Manager, Appeals and Grievances		Skinner	Jeanne		9207201382					jskinnner@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/20/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	MA Claims Processing Contact for Public Website	Manager, Claims		Adamick	Crystal		9207201547					cadamick@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Marketing Contact	Vice President - Marketing and Communications		Draheim	Melanie		9207201279				9207201912	mdraheim@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Medical Director	Chief Medical Officer	Dr.	Hassan	Mushir		2628259727					mhassan@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Medicare Compliance Officer	Compliance Officer	Mrs.	Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Medicare Coordinator	VP of Operations		Vander Zanden	Jessica		9207201652				9207201912	jvanderz@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Medicare Part D Opioid Overutilization Contact	Staff Pharmacist		Melis	Gary		9207201696					pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Medication Therapy Management Contact	Network Account Director, Retail Strategy & Contra		Muralidharan	Adrienne		3143131932					amuralidharan@express-scripts.com	One Express Way		St. Louis	MO	63121	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	OffShore Subcontractor Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Online Enrollment Center Contact (Back-up)	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Online Enrollment Center Contact (Primary)	Manager, Enrollment and BA Integration		Ziegert	Amy		9207201414					amzieger@networkhealth.com	1570 Midway Place		Menasha	WI	54952	09/26/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Part C Application Contact	Compliance Officer		Keenan	Angela		9207201242					nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Part C Reporting Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Appeals	Manager, Appeals and Grievances		Skinner	Jeanne						9207201382	jskinner@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/20/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active	8003785234				HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Appeals Contact (Secondary)	VP, Pharmacy		Regalia	Ted						9207201832	tregalia@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active	8003785234				HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Application Contact	Compliance Officer	Mrs	Keenan	Angela		9207201242					nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Benefits Contact	Vice President - Pharmacy	Mr	Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Claims Submission Contact	Vice President - Pharmacy		Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Exceptions Contact	Manager, Appeals and Grievances		Skinner	Jeanne						9207201382	jskinner@networkhealth.com	1570 Midway Place		Menasha	WI	54952	01/20/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active	8003785234				HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Exceptions Contact (Secondary)	Vice President - Pharmacy	Mr	Regalia	Ted						9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active	8003785234				HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Price File Contact (Back-up)	Director, Pharmacy Benefits		Wheaton	Andrew		9207201612				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place		Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Price File Contact (Optional)	Pharmacy Benefits Program Manager		Kempfer	Amanda		9207201607					pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Price File Contact (Primary)	Sr. Manager, Regulated Markets		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Quality Assurance Contact	Vice President - Pharmacy	Mr	Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Part D Reporting Contact	Compliance Officer		Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Patient Safety Contact	Staff Pharmacist	Mr	Melis	Gary		9207201696				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Payment Contact	Vice President - Finance		Leigh	Dennis		9207201837					FinanceReporting@networkhealth.com	1570 Midway  Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Personal Health Record Contact	VP, Care Services		Dencker	Sarah		9207201694				9207201908	sdencker@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Pharmacy Director	Vice President - Pharmacy	Mr	Regalia	Ted		9207201654				9207201906	pharmacybenefits@networkhealth.com	1570 Midway Place	PO Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Pharmacy Network Management Contact			Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		St Louis	MO	63121	01/19/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Pharmacy Technical Help Desk Contact	Director - Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkwy STE 150		Temple Terrace	FL	33637	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H5644	PHR Beneficiary Contact																	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS	Network Health Insurance Corporation	Network Health, Inc.	670	Yes	Active	8003785234				HMO - Health Maintenance Organization		C	Chicago
H5644	Physician Incentive Contact	VP, Network Development		Wille	Scott		2627889533					swille@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Plan Directory Contact for Public Website			Service	Customer		8003785234				9207201908	sschwand@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Plan to Plan Reconciliation Contact	Vice President - Finance		Leigh	Dennis		9207201837					FinanceReporting@networkhealth.com	1570 Midway  Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Processor Contact	Sr. Director, Government Programs Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St Louis	MO	63121	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Quality Contact	VP, Quality and Clinical Integration		Benz	Elizabeth		2628259782					ebenz@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Reconciliation Contact	Vice President - Finance		Leigh	Dennis		9207201837					FinanceReporting@networkhealth.com	1570 Midway  Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Reconciliation Contact (Secondary)	Senior Accountant		Cymerman	Tricia		9207201658					tcymerma@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Recovery Audit Contact	Compliance Officer	Mrs.	Keenan	Angela		9207201242				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	SNP Application Contact	Director, Care Management	Mrs.	Reinsch	Laura		9207201711					lreinsch@networkhealth.com	1570 Midway Pl	PO Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	SNP State Contact	Managed Care Policy Analyst	Ms.	Froelich	Brooke		6082677281					BrookeS.Froelich@dhs.wi.gov	1 Wilson Street, Room 350		Madison	WI	537010309	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Surveillance Contact	Compliance Officer		Keenan	Angela		9207201624				9207201912	nhcompliance@networkhealth.com	1570 Midway Place		Menasha	WI	54952	04/13/2023	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	System Contact	IT Infrastructure Manager	Mr	Petersen	Chris		9207201445					cpeterse@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Third Party Administrator (TPA) Liaison	Senior Accountant		Cymerman	Tricia		9207201658					tcymerma@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	User Access Contact	Information Security Risk Analyst	Ms	Pfefferle	Trish		9207201225					tpfeffer@networkhealth.com	1570 Midway Place	P.O. Box 120	Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Utilization Management Contact	Vice President - Care Services		Dencker	Sarah		9207201694					sdencker@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5644	Utilization Review Contact	Vice President - Care Services		Dencker	Sarah		9207201694					sdencker@networkhealth.com	1570 Midway Place		Menasha	WI	54952	11/01/2022	2023	NETWORK HEALTH INSURANCE CORPORATION	Local CCP	Network Health Medicare Advantage Plans	HMO/HMOPOS		Network Health, Inc.	670	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Agent/Broker Compensation Data Contact	AVP, Sales		Popkin	Shaina		6572488003					spopkin@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	08/24/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Backup User Access Contact	Information Systems	Mr.	Adams	Jason		6263882390	2273			6263882317	jadams@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	04/19/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Best Available Evidence Contact	Director of Information Systems	Mr.	Kirby	Kevin	W	6263882383				6263882317	kkirby@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Bid Audit Contact	CFO	Mr.	Uma	Chet	S	6263882390	2895				cuma@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Bid Audit Site Contact	CFO		Uma	Chet		6263882390	2895				cuma@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Bid Primary Contact	CFO		Uma	Chet		6263882390	2895				cuma@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	CAP Report Contact for Public Website	CA Compliance Officer	Mrs.	Shieh	Annie	H	6268258653				6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	04/19/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	CEO - CMS Administrator Contact	CEO	Mr.	Dewers	Shawn		6265887100				6263882322	sdewers@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	04/19/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	CEO - Senior Official for Contracting	CEO	Mr.	Dewers	Shawn		6263882208				6263882322	sdewers@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	04/19/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Chief Financial Officer	CFO	Mr.	Uma	Chet		6263882390	2895				chetuma@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	04/19/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Chief Operating Officer	CFO	Mr.	Uma	Chet		6263882390	2895				chetuma@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	09/22/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Chief Information Officer	IT Director	Mr.	Kirby	Kevin	W	6263882307				6263882317	kkirby@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	04/19/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Chief Information Security Officer	AVP, Head of Information Security	Mr.	Simms	Curtis		6363007586					csimms@brighthealthgroup.com	8000 Norman Center Drive	Suite 401	Bloomington	MN	55437	05/08/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	CMS Casework Communication Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	04/19/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Complaints Tracking Contact	Manager, Appeals & Grievance	Ms.	Bautista	Darline		8662554795					darline.bautista@brighthealthcare.com	2400 E. Katella Ave	11th floor	Anaheim	CA	92806	05/23/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Contact for Fraud Investigations	Special Investigations Unit		SIU	Bright		6514675357					siu@brighthealthcare.com	Bright Health Mailroom,Attn:Special Investigations Unit	777 NW Blue Parkway	Lees Summit	MO	64086	09/22/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Coordination of Benefits Contact	Director, Pharmacy Operations	Mr.	Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Corporate Mailing						6263882390				6263882321	centralhealth@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	04/19/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Analyst	Ms.	Han	Catherine		6263882390	1154				catherinehan@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	04/19/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Customer Service Operations Contact	Director of Member Services	Ms.	Huang	Judy		6263882390	1128				jhuang@centralhealthplan.com	2400  E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	DIR Contact	Director of Pharmacy		Choi	Mary Anne		6263882390	3829			6263882368	mchoi@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	DIR Contact (Secondary)	Director of Finance	Ms.	Wu	Shalin		6263882390	2254				shalinwu@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Electronic Health Record Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Emergency Part D Contact	Senior Clinical Pharmacist		Jones	Edwina		7704031003				8776783655	edwina.jones@brighthealthcare.com	8000 Norman Center Drive	Suite 401	Bloomington	MN	55437	08/23/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Emergency Part D Contact (Secondary)	Director, Pharmacy Operations	Mr.	Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Encounter Data & Risk Adjustment Operations Contact	Information Systems Director	Mr.	Kirby	Kevin	W	6263882307				6263882317	kkirby@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Enrollment Contact	Eligibility and Capitation Manager		Wong	Mei		6263882390	2251			6263882371	mwong@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Financial Audit Contact	CFO	Mr.	Uma	Chet		6263882390	2895				chetuma@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Financial Reporting Contact	CFO	Mr.	Uma	Chet		6263882390	2895				chetuma@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Formulary Contact	Senior Clinical Pharmacist		Jones	Edwina		7704031003					edwina.jones@brighthealthcare.com	8000 Norman Center Drive	Suite 401	Bloomington	MN	55437	08/23/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Formulary Contact (Secondary)	Director, Pharmacy Operations	Mr.	Begey	Eric		8606203553					ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	08/23/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	General Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Government Relations Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	HIPAA Privacy Officer	Senior Compliance Counsel	Mrs.	Shieh	Annie	S	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	HIPAA Security Officer	Head of Information Security	Mr.	Simms	Curtis		6363007586				6263882317	csimms@brighthealthgroup.com	8000 Norman Center Drive	Suite 401	Bloomington	MN	55437	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Hospice Contact	Director, Pharmacy Operations		Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Interoperability Contact	Director of Information Systems	Mr.	Kirby	Kevin	W	6263882383				6263882317	kkirby@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	MA Appeals/Grievances Contact	Director of Member Services	Ms.	Huang	Judy		6263882390	1128				jhuang@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	MA Claims Processing Contact for Public Website	MA Claims Processing Contact		Claims	MA		6263882386				6263882361	mbrsvcs@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Marketing Contact	AVP, Marketing	Ms.	Romero-San	Elena		6268258467					eromero-san@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Medical Director	Chief Medical Officer	Dr.	Chieng	An Pang		6263882390	3835			6263882378	APChieng@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Medicare Compliance Officer	Senior Compliance Counsel	Mrs.	Shieh	Annie		6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Medicare Coordinator	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Jones	Edwina		7704031003					edwina.jones@brighthealthcare.com	8000 Norman Center Drive	Suite 401	Bloomington	MN	55437	08/23/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Medication Therapy Management Contact	Director, Pharmacy Operations		Mehta	Reena		8669058540				8776783655	rmehta@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	OffShore Subcontractor Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/03/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Online Enrollment Center Contact (Back-up)	Eligibility and Capitation Manager		Wong	Mei		6263882390	2251			6263882371	mwong@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	09/22/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Online Enrollment Center Contact (Optional)	Director of Information Systems	Mr.	Kirby	Kevin	W	6263882383				6263882317	kkirby@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Online Enrollment Center Contact (Primary)	Enrollment Supervisor		Manzano	Jesus		6263882390	93178			6263882371	jmanzano@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	09/22/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Part C Application Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Part C Reporting Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Appeals	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer PKWY		Dublin	OH	43017	12/15/2022	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Appeals Contact (Secondary)	Director, Pharmacy Operations		Begey	Eric						8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8606203553				HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Application Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	S	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Benefits Contact	Director, Pharmacy Operations		Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Claims Submission Contact	Director - Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	12/15/2022	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Exceptions Contact	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer PKWY		Dublin	OH	43017	12/15/2022	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Exceptions Contact (Secondary)	Director, Pharmacy Operations		Begey	Eric						8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8606203553				HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Price File Contact (Back-up)	Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	12/15/2022	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Price File Contact (Optional)	Director, Pharmacy Operations		Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer PKWY		Dublin	OH	43017	12/15/2022	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Quality Assurance Contact	Director, Pharmacy Operations		Mehta	Reena		8669058540				8776783655	rmehta@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Part D Reporting Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	S	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Patient Safety Contact	Director, Pharmacy Operations		Mehta	Reena		8669058540				8776783655	rmehta@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Payment Contact	CFO	Mr.	Uma	Chet		6263882390	2895				cuma@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Personal Health Record Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Pharmacy Director	Director, Pharmacy Operations		Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra		Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	08/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Operations		Begey	Eric		8606203553				8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Pharmacy Technical Help Desk Contact	Director, Customer Services		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N Telecom PKWY	STE 150	Temple Terrace	FL	33637	01/05/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H5649	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy Operations		Begey	Eric						8776783655	ebegey@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active	8606203553				HMO - Health Maintenance Organization		C	Chicago
H5649	Physician Incentive Contact	Chief Medical Officer	Dr.	Chieng	An Pang		6263882390	3835			6263882378	APChieng@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Plan Directory Contact for Public Website			Department	Marketing		6263882390	3106			6263882379	marketing@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	07/11/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Plan to Plan Reconciliation Contact	Director of Information Systems	Mr.	Kirby	Kevin	W	6263882383				6263882317	kkirby@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	07/11/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Processor Contact	Sr. Director, Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	12/15/2022	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Quality Contact	Director, Quality Compliance	Ms.	Kemp	Sara		3016765004					skemp@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Reconciliation Contact	CFO	Mr.	Uma	Chet		6263882390	2895				cuma@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Reconciliation Contact (Secondary)	Director of Finance	Ms.	Wu	Shalin		6263882390	2254				shalinwu@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Recovery Audit Contact	CFO	Mr.	Uma	Chet		6263882390	2895				cuma@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	SNP Application Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	S	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	SNP State Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Surveillance Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	H	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	System Contact	Director of Information Systems	Mr.	Kirby	Kevin	W	6263882383				6263882317	kkirby@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Third Party Administrator (TPA) Liaison	Finance Analyst	Ms.	Han	Catherine		6263882390	1154				catherinehan@centralhealthplan.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	07/11/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	User Access Contact	Senior Compliance Counsel	Mrs.	Shieh	Annie	S	6263882390	2885			6263882367	ashieh@brighthealthgroup.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	05/04/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Utilization Management Contact	Director, Utilization Management	Ms.	Raboin	Amanda		6263882390	1523			6263882378	araboin@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5649	Utilization Review Contact	Director, Utilization Management	Ms.	Raboin	Amanda		6263882390	1523			6263882378	araboin@brighthealthcare.com	2400 E. Katella Ave 11th floor		Anaheim	CA	92806	06/12/2023	2023	CENTRAL HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Central Health Medicare Plan	HMO/HMOPOS		Bright Health Group, Inc.	663	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5652	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H5652	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H5652	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H5652	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H5652	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5652	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	SIERRA HEALTH AND LIFE INSURANCE COMPANY, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5703	Agent/Broker Compensation Data Contact	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Automated TrOOP Balance Transfer Contact	Manager of Technical Delivery and Oversight		Gajarajan	Nivi		2678258648				5074447774	ngajarajan2@performrx.com	PerformRx	200 Stevens Dr.	Philadelphia	PA	19113	05/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Backup User Access Contact	Compliance Officer		Marks	Jeff		5074316068				5074447774	jmarks@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Best Available Evidence Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Bid Audit Contact	Chief Financial Officer		Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Bid Audit Site Contact	Chief Financial Officer		Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Bid Primary Contact	Chief Financial Officer		Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	CAP Report Contact for Public Website	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	CEO - CMS Administrator Contact	Chief Executive Officer	Ms	Lind	Leota		5074447772				5074447774	llind@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	CEO - Senior Official for Contracting	Chief Executive Officer	Ms	Lind	Leota		5074447772				5074447774	llind@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Chief Financial Officer	Chief Financial Officer	Mr	Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Chief Operating Officer	Chief Executive Officer	Ms	Lind	Leota		5074447772				5074447774	llind@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Chief Information Officer		Mr	Hoenck	Matt		5074316391				5074447774	mhoenck@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Chief Information Security Officer		Mr	Hoenck	Matt		5074316391				5074447774	mhoenck@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	CMS Casework Communication Contact	Grievance and Appeals Manager		Miller	Suzette		5074316373				5074447774	sumiller@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Complaints Tracking Contact	Grievance and Appeals Manager		Miller	Suzette		5074316373				5074447774	sumiller@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Contact for Fraud Investigations	Compliance Officer		Marks	Jeff		5074316068				5074447774	jmarks@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Coordination of Benefits Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Corporate Mailing						5074447770				5074447774	amcgregor@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	06/22/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Customer Service Operations Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	DIR Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	06/22/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	DIR Contact (Secondary)	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	02/18/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Emergency Part D Contact	Pharmacy Manager		Bailey	Sarah		5074315477				5074447774	sbailey@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Emergency Part D Contact (Secondary)	Director of Operations		Lewer	Cheryl		5074316377					clewer@mnscha.org	6380 West Frontage Road		Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Encounter Data & Risk Adjustment Operations Contact	Chief Financial Officer		Schufman	Scott		5074316599				5074447770	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Enrollment Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	CLewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	EOB Transfer Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Financial Audit Contact	Chief Financial Officer	Mr	Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Financial Reporting Contact	Controller		Toquam	Erica		5074316591				5074447774	etoquam@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Formulary Contact	Director of Clinical Services		Megargell	Lauren		2159374135					lmegargell@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	06/02/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Formulary Contact (Secondary)	Manager, Formulary/DUR		DeHoratius	Patrick		2159375078					patrick.dehoratius@performrx.com	PerformRx	200 Steven Drive	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	General Contact	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Government Relations Contact	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	HIPAA Privacy Officer	Compliance Officer		Marks	Jeff		5074316068				5074447774	jmarks@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	HIPAA Security Officer			Hoenck	Matt		5074316391				5074447774	mhoenck@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Hospice Contact	Director of Health Services		Worrall	Kim		5074316397				5074447774	kworrall@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Interoperability Contact			Hoenck	Matt		5074316391					mhoenck@mnscha.org	6380 West Frontage Road		Medford	MN	55049	04/11/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	MA Appeals/Grievances Contact	Grievance and Appeals Manager		Miller	Suzette		5074316373				5074447774	sumiller@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	MA Claims Processing Contact for Public Website	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Marketing Contact	Director of Community Engagement		Braaten	Kelly		5074316572				5074447774	kbraaten@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Medical Director	Chief Medical Director	Dr.	Miller	Timothy		5074316388				5074447774	tmiller@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Medicare Compliance Officer	Compliance Officer	Mr	Marks	Jeff		5074316068				5074447774	jmarks@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Medicare Coordinator	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/22/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Medicare Part D Opioid Overutilization Contact	Director Clinical Outcomes & Therapeutic Optimizat		McMahon	Courtney		2159378563					cmcmahon@performrx.com	PerformRx	200 Steven Dr.	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Medication Therapy Management Contact	Director Clinical Outcomes & Therapeutic Opt.		McMahon	Courtney		2159378563					cmcmahon@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Online Enrollment Center Contact (Back-up)	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Online Enrollment Center Contact (Primary)	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Part C Application Contact	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Part C Reporting Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Appeals	Clinical Pharmacist, Manager of Pharmacy Prior Aut		Unterbrink	Elizabeth						8772918760	eunterbrink@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	4844967688				HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Appeals Contact (Secondary)	Clinical Pharmacist, Manager of Pharmacy Prior Aut		McHale	Shawn						8772918760	smchale@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	01/04/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	2158636370				HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Application Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Benefits Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Claims Submission Contact	Director of Clinical Operations		Ortiz	Noel		2159375352					nortiz@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	05/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Exceptions Contact	Clinical Pharmacist, Manager of Pharmacy Prior Aut		Unterbrink	Elizabeth						2158635100	eunterbrink@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	4844967688				HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Exceptions Contact (Secondary)	Clinical Pharmacist, Manager of Pharmacy Prior Aut		McHale	Shawn						2158635100	smchale@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/01/2016	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	2158636370				HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Price File Contact (Back-up)	Medicare Financial Operations Analyst III		Weihe	Heather		7875231212					heather.weihe@abarcahealth.com	Abarca Health	650 Ave Munoz Rivera	San Juan	PR	00918	05/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Price File Contact (Optional)	Medicare Financial Operations Analyst III		Gonzalez	Brittany		7875231212	1444				brittany.gonzalez@abarcahealth.com	Abarca Health	650 Ave Munoz Rivera	San Juan	PR	00918	04/28/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Price File Contact (Primary)	Director, Service Operations		Leal	Avelina		2158636540				2158635100	aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	04/28/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Quality Assurance Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Part D Reporting Contact	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Patient Safety Contact	Director Clinical Outcomes & Therapeutic Opt.		McMahon	Courtney		2159378563					cmcmahon@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/02/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Payment Contact	Controller		Toquam	Erica		5074316591				5074447774	etoquam@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Personal Health Record Contact			Hoenck	Matt		5074316391				5074447774	mhoenck@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Pharmacy Director	VP Clinical Programs, Pharmacy Clinical Services		Maiorini	Andrew		2159378565					Amaiorini@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/01/2016	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Pharmacy Network Management Contact	Director, Service Operations		Leal	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	04/28/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Pharmacy Technical Help Desk Contact	Director, Service Operations		Leal	Avelina							aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/04/2015	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	8669356681				HMO - Health Maintenance Organization		C	Chicago
H5703	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Care Center		Lee	Pamela							plee@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	11/08/2017	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active	8669356681				HMO - Health Maintenance Organization		C	Chicago
H5703	Plan Directory Contact for Public Website	Communications Manager		Gartner	Chris		5074313021				5074447774	cgartner@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Plan to Plan Reconciliation Contact	Controller		Toquam	Erica		5074316591				5074447774	etoquam@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Processor Contact	Director of Clinical Operations		Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	05/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Quality Contact	Quality Manager		Smith	Justin		5074316387				5074447774	jsmith@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Reconciliation Contact	Controller		Toquam	Erica		5074316591				5074447774	etoquam@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Reconciliation Contact (Secondary)	Chief Financial Officer		Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Recovery Audit Contact	Chief Financial Officer	Mr	Schufman	Scott		5074316599				5074447774	sschufman@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	SNP Application Contact	Chief Executive Officer		Lind	Leota		5074447772				5074447774	llind@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	SNP State Contact	Chief Executive Officer		Lind	Leota		5074447772				5074447774	llind@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Surveillance Contact	Director of Community Engagement		Braaten	Kelly		5074316572				5074447774	kbraaten@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	System Contact	Director of IT and Analytics		Hoenck	Matt		5074316391				5074447774	mhoenck@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Third Party Administrator (TPA) Liaison	Director of Operations		Lewer	Cheryl		5074316377				5074447774	clewer@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	06/22/2022	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	User Access Contact	Compliance and Government Relations Manager		Krenz	Kayla		5074316938				5074447774	kkrenz@mnscha.org	South Country Health Alliance	6380 West Frontage Road	Medford	MN	55049	10/26/2021	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Utilization Management Contact	Manager of Utilization Management		Beckel	Ashley		5074316583				2158635100	abeckel@mnscha.org	6380 West Frontage Road		Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5703	Utilization Review Contact	Manager of Utilization Management		Beckel	Ashley		5074316583				2158635100	abeckel@mnscha.org	6380 West Frontage Road		Medford	MN	55049	01/23/2023	2023	SOUTH COUNTRY HEALTH ALLIANCE	Local CCP	South Country Health Alliance	HMO/HMOPOS		South Country Health Alliance	212	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5746	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5133167654				HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract	8144498744				HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5133167654				HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5407984087				HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract	8333774266				HMO - Health Maintenance Organization		C	Chicago
H5746	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract	3135973173				HMO - Health Maintenance Organization		C	Chicago
H5746	PHR Beneficiary Contact																	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Withdrawn Contract	8004671199				HMO - Health Maintenance Organization		C	Chicago
H5746	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5746	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	05/26/2023	2023	AMERIGROUP COMMUNITY CARE OF NEW MEXICO, INC.	Local CCP	Amerigroup Community Care of New Mexico	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H5774	Agent/Broker Compensation Data Contact	Sales & Accounts Management Senior VP		Perez Fernandez	Gustavo	A	7877494949	8325026			7876258721	gustavo.perez@ssspr.com	PO Box 363628		San Juan	PR	00936	01/10/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Automated TrOOP Balance Transfer Contact	MA Revenue Management Director	Mr	Rosich	Luis		7879751365	8321176			7879933257	lrosich@sssadvantage.com	PO Box 11320		San Juan	PR	00922	11/01/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Backup User Access Contact	Privacy Analyst	Ms	Lopez	Stephanie	L	7877449494	8322688			7879933260	stephanie.lopez2@ssspr.com	PO Box 11320		San Juan	PR	00922	11/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Best Available Evidence Contact	MA Enrollment & Reconciliation Director		Toste	Maria		7877494949	8322541			7875224307	mtoste@sssadvantage.com	PO Box 11320		San Juan	PR	00922	06/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Bid Audit Contact	Product Development  VP	Mrs	Rojas Sola	Marie	E	7877494949	8321325				marie.rojas@ssspr.com	PO Box 0363628		San Juan	PR	00936	10/17/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Bid Audit Site Contact	Chief Growth & Customer Exp. Officer	Ms	Fernandez	Ivelisse	M	7877494949	8321074			7876200939	ivelisse.fernandez@ssspr.com	P.O. Box 11320		San Juan	PR	00922	02/11/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Bid Primary Contact	Product Development VP	Mrs	Rojas Sola	Marie	E	7877494949	8321325				marie.rojas@ssspr.com	P.O. Box 363628		San Juan	PR	00936	10/17/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	CAP Report Contact for Public Website	Digital Marketing Manager	Mrs	Ruiz Martinez	Norma	J	7487494949	8321083				nruiz@ssspr.com	PO Box 363628		San Juan	PR	00936	02/11/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	CEO - CMS Administrator Contact	President Triple-S Salud and President Triple-S Ad	Mr	Justice	Thurman	R	8605971073				7879933260	thurman.justice@bcbsfl.com	1820 Ocean Front		Neptune Beach	FL	32266	04/10/2023	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	CEO - Senior Official for Contracting	President Triple-S Salud and President Triple-S Ad	Mr	Justice	Thurman	R	8605971073				7877494019	thurman.justice@bcbsfl.com	1820 Ocean Front		Neptune Beach	FL	32266	04/10/2023	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Chief Financial Officer	Chief Financial Officer	Mr.	Veach	Daryl		7877494949					daryl.veach@ssspr.com	P.O. Box 363628		San Juan	PR	009363628	09/29/2023	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Chief Operating Officer	President Triple-S Salud and President Triple-S Ad	Mr	Justice	Thurman	R	8605971073				7877494019	thurman.justice@bcbsfl.com	1820 Ocean Front		Neptune Beach	FL	32266	04/10/2023	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Chief Information Officer	Business Operations Monitoring Senior VP	Mrs	Gonzalez Lassalle	Carmen	M	7877494949	8324113				cgonzalezl@ssspr.com	PO Box 363628		San Juan	PR	00936	05/24/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Chief Information Security Officer	Information and Cyber Security Director	Mr.	Vidal Yordan	Carlos	R	7877494949	8326004			7877744820	carlos.vidal@ssspr.com	PO Box 363628		San Juan	PR	00936	03/02/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	CMS Casework Communication Contact	Appeals and Grievances Manager	Mrs	Martinez	Aixa		7877494949	8322307			7879933261	aixam@sssadvantage.com	PO Box 11320		San Juan	PR	00922	08/12/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Complaints Tracking Contact	Appeals and Grievances Manager	Mrs.	Martinez	Aixa		7877494949	8322307			7879933261	aixam@sssadvantage.com	PO Box 11320		San Juan	PR	00922	08/12/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Contact for Fraud Investigations	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Coordination of Benefits Contact	MA Enrollment & Reconcilliation Director	Mrs.	Toste	Maria		7877494949	8322541			7875224307	mtoste@sssadvantage.com	PO Box 11320		San Juan	PR	00922	04/26/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Corporate Mailing						7877494949	8322438				jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Coverage Gap Discount Program (CGDP) Payment Contact	Part D Reporting Analyst	Mrs	Cortes	Johannie		7877494949	8322448			7876258717	johannie@sssadvantage.com	PO Box 11320		San Juan	PR	009229905	08/12/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Customer Service Operations Contact	Customer Service Manager	Mr	Jaxon	Harold		7876649288				7876200931	harold.jaxon@ssspr.com	PO Box 363628		San Juan	PR	00922	12/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	DIR Contact	Part D Reporting Analyst	Mrs	Cortes	Johannie		7879751365	8322448			7879933257	johannie@ssspr.com	PO Box 11320		San Juan	PR	00922	12/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	DIR Contact (Secondary)	MA Premium Management Manager	Mrs.	Ruiz Sanchez	Alexsandra		7877494949	8322185				alexsandra.ruiz@ssspr.com	PO Box 11320		San Juan	PR	00922	03/02/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Electronic Health Record Contact	Health Plan Information Technology VP	Mr.	Abrams Guzman	Jose	L	7877494949	8320040			7879933256	jose.abrams@ssspr.com	PO Box 11320		San Juan	PR	00922	03/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Emergency Part D Contact	Pharmacy Vice-president	Mrs	Muniz	Omarys		7877494949	8324535			7875224004	omaris.muniz@ssspr.com	PO Box 363628		San Juan	PR	00939	12/20/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Emergency Part D Contact (Secondary)	Pharmacy Regulatory & Compliance Manager	Mrs.	Cordero	Cindy		7877494949	8321797			7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Employer Waiver Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Encounter Data & Risk Adjustment Operations Contact	MA Revenue Management Director	Mr.	Rosich	Luis		7879751365	8321176			7879933257	lrosich@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Enrollment Contact	Enrollment Director	Mrs.	Cruz	Nayda	G	7877494949	8320212			7875224307	ngcruz@ssspr.com	PO Box 11320		San Juan	PR	00922	02/09/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	EOB Transfer Contact	Pharmacy Regulatory & Compliance Manager	Mrs.	Cordero Miranda	Cindy	N	7877494949	8322461			7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	00936	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Financial Audit Contact	Healthcare Finance VP	Mr	Marrero	Monica		7877494949					monica.marrero@ssspr.com	PO Box 11320		San Juan	PR	00922	12/21/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Financial Reporting Contact	Corporate Financial Reporting Director	Ms	Montes Santiago	Loyda	I	7877494949	8321967			7877494019	loyda.montes@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/18/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Formulary Contact	Pharmacy Senior Manager		Santos	Zoraida		7877494949	8324181			7875224004	zsantos@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/30/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Formulary Contact (Secondary)	Clinical Pharmacist	Ms	Vargas	Viviana		7875231212	1171				viviana.vargas@abarcahealth.com	650 Avenida Muoz Rivera	Suite 701	San Juan	PR	00918	01/19/2017	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	General Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Government Relations Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	HIPAA Privacy Officer	Privacy Officer	Ms	Padilla	Lucy		7877494949	8322502			7879333260	lpadilla@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	HIPAA Security Officer	Cyber Security Director/CISO	Mr.	Vidal Yordan	Carlos	R	7877494949	8326004				carlos.vidal@ssspr.com	PO Box 363628		San Juan	PR	00936	05/24/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Hospice Contact	Medical Director	Mrs	Rivas	Jadeyra		7877494949	8322358			7875224004	jadeyra.rivas@ssspr.com	PO Box 11320		San Juan	PR	00922	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Interoperability Contact	Innov. & Integration Sr Director	Mr.	Mora Silva	Fernando		7877494949	8322073			7879933256	fmoras@sssadvantage.com	PO Box 11320		San Juan	PR	00922	07/08/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	MA Appeals/Grievances Contact	Appeals and Grievances Manager	Mrs	Martinez	Aixa		7877494949	8322307			7879933261	aixam@sssadvantage.com	PO Box 11320		San Juan	PR	00922	08/12/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	MA Claims Processing Contact for Public Website	Claims Director	Mrs	Roldan-Marin	Francheska	M	7877494949	8324942				froldan@ssspr.com	PO Box 11320		San Juan	PR	00922	10/17/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Marketing Contact	Marketing & Content Department Manager	Mrs.	Martin	Gabriela		7877494949	8321073			7877494060	gmartinb@ssspr.com	PO Box 363628		San Juan	PR	00936	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Medical Director	Chief Medical Officer	Dr.	Novoa	Jose		7877494949	8325171			0000000000	jnovoa@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Medicare Compliance Officer	Compliance Officer & VP	Mrs	Cardenas	Jenny	D	7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	009229905	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Medicare Coordinator	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Medicare Part D Opioid Overutilization Contact	Pharmacy Senior Manager	Mrs	Santos	Zoraida		7877494949	8324181			7875224004	zsantos@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/30/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Medication Therapy Management Contact	Pharmacy Senior Manager		Santos	Zoraida		7877494949	8324181			7875224004	zsantos@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/30/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	OffShore Subcontractor Contact	Privacy Officer		Padilla	Lucy		7877494949	8322502			7879933260	lpadilla@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Online Enrollment Center Contact (Back-up)	MA Enrollment Manager	Mrs	Marcano	Zoe		7877494949	8322628			7875224307	zoem@sssadvantage.com	PO Box 11320		San Juan	PR	00922	06/23/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Online Enrollment Center Contact (Optional)	Enrollment Manager	Ms	Marcano	Zoe	C	7877494949	8322628				zoem@sssadvantage.com	PO Box 11320		San Juan	PR	009209905	04/27/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Online Enrollment Center Contact (Primary)	Enrollment Director	Mrs	Cruz	Nayda	G	7877494949	8320212			7875224307	ngcruz@ssspr.com	PO Box 11320		San Juan	PR	00922	02/09/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Part C Application Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Part C Reporting Contact	Compliance Audit and Monitoring Director	Ms	Marrero	Monica		7877494949	8322303				monica.marrero@ssspr.com	PO Box 11320		San Juan	PR	009229905	03/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Appeals	Appeals and Grievances Manager	Mrs	Martinez	Aixa						7879933261	aixam@sssadvantage.com	PO Box 11320		San Juan	PR	00922	01/18/2017	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8886201919	4047			HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Appeals Contact (Secondary)	Reg Strategy, Grievances & Appeals Director	Mrs.	Cuprill	Diana						7879933261	dcuprill@sssadvantage.com	PO Box 11320		San Juan	PR	00922	12/29/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	7877494949	832350			HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Application Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Benefits Contact	Pharmacy Vice-president	Mrs	Muniz	Omarys		7877494949	8324535			7875224004	omaris.muniz@ssspr.com	PO Box 11320		San Juan	PR	00922	12/20/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Claims Submission Contact	Pharmacy Regulatory & Compliance Manager	Mrs.	Cordero Miranda	Cindy	N	7877494949	8322461			7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Exceptions Contact	Pharmacy Senior Manager	Mrs	Graxirena	Dalia						7875224004	dgraxire@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	7877494949	8321812			HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Exceptions Contact (Secondary)	Pharmacy Regulatory & Compliance Manager	Mrs	Cordero Miranda	Cindy	N					7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	7877494949	8321797			HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Price File Contact (Back-up)	Data Analyst II		De Jesus	Cesar		7875231212	1169				cesar.dejesus@abarcahealth.com	650 Avenida Muoz Rivera	Suite 701	San Juan	PR	00918	09/03/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Price File Contact (Optional)	Pharmacy Regulatory & Compliance Manager	Mrs.	Cordero Miranda	Cindy	N	7877494949	8321797			7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Price File Contact (Primary)	Data Analyst II		Reed	Lindsay		8473466370	1125				lindsay.reed@abarcahealth.com	650 Avenida Muoz Rivera	Suite 701	San Juan	PR	00918	09/03/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Quality Assurance Contact	Pharmacy Regulatory & Compliance Manager	Mrs	Cordero Miranda	Cindy	N	7877494949	8321797			7875224004	cindy.cordero@ssspr.com	PO Box 363628		San Juan	PR	009363628	03/30/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Part D Reporting Contact	Compliance Audit and Monitoring Director	Ms	Marrero	Monica		7877494949	8322303				monica.marrero@ssspr.com	PO Box 11320		San Juan	PR	009229905	03/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Patient Safety Contact	Pharmacy Senior Manager		Santos	Zoraida		7877494949	8324181			7875224004	zsantos@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/30/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Payment Contact	Revenue and Members Operation  Senior VP	Mrs	Reyes	Ivette		7877494949	8322419				ireyes@sssadvantage.com	PO Box 11320		San Juan	PR	00922	08/18/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Personal Health Record Contact	Privacy Officer	Ms.	Padilla	Lucy		7877494949	8322502			7879933260	lpadilla@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Pharmacy Director	Pharmacy Vice-president	Mrs	Muniz	Omarys		7877494949	8324535			7875224004	omaris.muniz@ssspr.com	PO Box 11320		San Juan	PR	00922	12/20/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Pharmacy Network Management Contact	Director of Service Operations		Hernandez	Hector		7875231212	1123				hector.hernandez@abarcahealth.com	650 Avenida Muoz Rivera	Suite 701	San Juan	PR	00918	01/04/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Pharmacy Network Management Contact (Secondary)	Pharmacy Vice-president	Mrs	Muniz	Omarys		7877494949	8324535			7875224004	omaris.muniz@ssspr.com	PO Box 363628		San Juan	PR	00939	12/20/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Pharmacy Technical Help Desk Contact	Director of Service Operations		Hernandez	Hector						7875231240	hector.hernandez@abarcahealth.com	650 Avenida Muoz Rivera	Suite 701	San Juan	PR	00918	01/04/2021	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8559222722				HMO - Health Maintenance Organization		C	Atlanta
H5774	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Vice-president	Mrs	Muniz	Omarys						7875224004	omaris.muniz@ssspr.com	PO Box 363628		San Juan	PR	00939	12/20/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	7877494949	8324535			HMO - Health Maintenance Organization		C	Atlanta
H5774	PHR Beneficiary Contact																	01/11/2016	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS	Triple-S Advantage	Guidewell Mutual Holding Corporation	594	Yes	Active	8886201919				HMO - Health Maintenance Organization		C	Atlanta
H5774	Physician Incentive Contact	Medical Groups Performance Management VP	Mr.	Mendez	Francisco	J	7877494949	8322385			7876200939	francisco.j.mendez@ssspr.com	PO Box 11320		San Juan	PR	00922	02/11/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Plan Directory Contact for Public Website	PCP Perform and Engagement Vicepresident	Ms	Mendez	Zoraida		7877494949	8322629			7876200939	zoraida.mendez@ssspr.com	PO Box 11320		San Juan	PR	00922	02/11/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Plan to Plan Reconciliation Contact	MA Revenue Management Director	Mr	Rosich	Luis		7879751365	8321176			7879933257	lrosich@sssadvantage.com	PO Box 11320		San Juan	PR	00922	11/01/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Processor Contact	Claims Director	Ms	Aponte	Iris		7877494949	4316			7877494143	imaponte@ssspr.com	PO Box 363628		San Juan	PR	009363628	11/02/2017	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Quality Contact	Quality and Stars Director	Ms	Hernande	Patricia		7877494949	8322554			7879933256	patriciah@sssadvantage.com	P.O. Box 11320		San Juan	PR	00922	09/03/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Reconciliation Contact	MA Revenue Management Director	Mr	Rosich	Luis		7879751365	8321176			7879933257	lrosich@sssadvantage.com	PO Box 11320		San Juan	PR	00922	11/01/2019	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Reconciliation Contact (Secondary)	Senior VP of Revenue and cost Management	Mrs	Reyes	Ivette		7877494949	8322419				ireyes@sssadvantage.com	P.O. Box 11320		San Juan	PR	00922	08/18/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Recovery Audit Contact	Compliance Audit and Monitoring Director	Ms	Marrero	Monica		7877494949	8322303				monica.marrero@ssspr.com	PO Box 11320		San Juan	PR	009229905	03/21/2022	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	SNP Application Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	SNP State Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Surveillance Contact	Compliance Officer & VP	Ms	Cardenas	Jenny		7877494949	8322438			7879933260	jennycar@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	System Contact	Privacy Officer	Ms.	Padilla	Lucy		7877494949	8322502			7879933260	lpadilla@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Third Party Administrator (TPA) Liaison	Part D Reporting Analyst	Mrs.	Cortes	Johannie		7877494949	8322448			7876258717	johannie@sssadvantage.com	PO Box 11320		San Juan	PR	009229905	08/12/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	User Access Contact	Privacy Officer	Ms	Padilla	Lucy		7877494949	8322502			7879933260	lpadilla@sssadvantage.com	PO Box 11320		San Juan	PR	00922	03/09/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Utilization Management Contact	Senior VP of Clinical Management Strategic & Opera	MS	Phillips	Tammie		7877494949	8324859			7877494097	tammie.phillips@ssspr.com	PO Box 363628		San Juan	PR	009363628	09/03/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5774	Utilization Review Contact	Senior VP of Clinical Management Strategic & Opera	Ms	Phillips	Tammie		7877494949	8324859			7877494097	tammie.phillips@ssspr.com	PO Box 363628		San Juan	PR	009363628	09/03/2020	2023	TRIPLE S ADVANTAGE, INC.	Local CCP	Triple S Advantage	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5779	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Corporate Mailing						8132063477					crysten.troutman@wellcare.com	P. O. Box 31386		Tampa	FL	33631	02/02/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H5779	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H5779	PHR Beneficiary Contact																	09/27/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8668928340				HMO - Health Maintenance Organization		C	Dallas
H5779	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5779	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H5793	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	09/15/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Medicare Coordinator	Executive Director, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	02/18/2021	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/10/2015	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	06/13/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H5793	PHR Beneficiary Contact																	11/15/2012	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				HMO - Health Maintenance Organization		C	Philadelphia
H5793	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/11/2015	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5793	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (CT)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5810	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	CAP Report Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/11/2015	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	MA Claims Processing Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/11/2015	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H5810	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H5810	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H5810	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H5810	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H5810	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H5810	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Plan Directory Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/02/2021	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5810	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF CALIFORNIA	Local CCP	Molina Healthcare of California	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5822	Automated TrOOP Balance Transfer Contact	Director of Medical	Mrs.	Hashmi	Bushra		7852322044	1130			7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle	Building A	Topeka	KS	66606	03/10/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Backup User Access Contact	Director of PACE Operations		Webb-Cohen	Candace		7852322044					ccohen@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Best Available Evidence Contact	VP / Executive Director of PACE		Chaffee	Leanna		7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Bid Primary Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	CAP Report Contact for Public Website	President/CEO		Sullivan	Shawn		7852322044				7852325567	ssullivan@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	12/31/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	CEO - CMS Administrator Contact	President/CEO		Sullivan	Shawn		7852322044				7852325567	ssullivan@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	12/31/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	CEO - Senior Official for Contracting	Chief Executive Officer		Sullivan	Shawn		7852322044				7852325567	ssullivan@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	12/31/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Chief Financial Officer	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Chief Operating Officer	CAO	Mrs.	Mosinski	Kerri		7852322044	1054			7852325567	kmosinski@midlandcc.org	200 SW Frazier Cir		Topeka	KS	66606	03/15/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Chief Information Officer	VP of  Operational Support Services	Mr	Ramirez	Jesse		7852322044				7852675567	jramirez@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	01/08/2021	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Chief Information Security Officer	VP of Operational Support Services	Mr	Ramirez	Jesse		7852322044					jramirez@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	01/08/2021	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	CMS Casework Communication Contact	Director of Quality		Reeves	Johnathan		7852322044				7852325567	jreeves@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Complaints Tracking Contact	Director of Compliance		Corpstein	Joann		7852322044				7852325567	jcorpstein@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Contact for Fraud Investigations	Director of Quality and Compliance		Corpstein	Joann		7859794321				7852325567	jcorpstein@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	02/19/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Coordination of Benefits Contact	VP / Executive Director of PACE		Chaffee	Leanna		7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Corporate Mailing						7852322044				7852325567	ssullivan@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	12/31/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Customer Service Operations Contact	VP / Executive Director of PACE		Chaffee	Leanna		7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	DIR Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	DIR Contact (Secondary)	Director of Medical Services		Hashmi	Bushra		7852322044				7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/10/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Emergency Part D Contact	CEO/President		Sullivan	Shawn		7852322044	1054			7852325567	ssullivan@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	12/31/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Emergency Part D Contact (Secondary)	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Encounter Data & Risk Adjustment Operations Contact	Director of Medical Services		Hashmi	Bushra		7852322044				7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/10/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Enrollment Contact	VP / Executive Director of PACE		Chaffee	Leanna		7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	EOB Transfer Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Financial Audit Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Financial Reporting Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Formulary Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Formulary Contact (Secondary)	Director of Medical Services		Hashmi	Bushra		7852322044				7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/10/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	General Contact	VP / Executive Director of PACE		Chaffee	Leanna	E	7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	09/08/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Government Relations Contact	President/CEO		Sullivan	Shawn		7852322044				7852325567	ssullivan@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	12/31/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	HIPAA Privacy Officer	Director of Quality and Compliance		Corpstein	Joann		7859794321				7852325567	jcorpstein@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	02/19/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	HIPAA Security Officer	VP of Operational Support Services		Ramirez	Jesse		7852322044				7852325567	jramirez@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	01/08/2021	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Interoperability Contact	Director of Compliance	Mrs.	Corpstein	Joann		7852322044					jcorpstein@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/15/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	MA Appeals/Grievances Contact	Director of Quality		Reeves	Johnathan		7852322044				7852325567	jreeves@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	MA Claims Processing Contact for Public Website	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Marketing Contact	CEO	Mr.	Sullivan	Shawn		7852322044				7852325567	ssullivan@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/15/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Medical Director	Medical Director	Dr.	Wiles	Mark		7852322044				7852325567	mwiles@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	09/08/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Medicare Compliance Officer	Director of Quality and Compliance	Ms	Corpstein	Joann		7859794321				7852325567	jcorpstein@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	02/19/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Medicare Coordinator	VP / Executive Director of PACE		Chaffee	Leanna		7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	09/08/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Medicare Part D Opioid Overutilization Contact	Director of Medical Services		Hashmi	Bushra		7852322044				7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/10/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Medication Therapy Management Contact	Director of Medical Services		Hashmi	Bushra		7852322044				7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/10/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Online Enrollment Center Contact (Back-up)	VP / Executive Director of PACE		Chaffee	Leanna		7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Online Enrollment Center Contact (Optional)	VP / Executive Director of PACE		Chaffee	Leanna		7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Online Enrollment Center Contact (Primary)	VP / Executive Director of PACE		Chaffee	Leanna		7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Part C Application Contact	CEO		Sullivan	Shawn		7852322044				7852325567	ssullivan@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Part D Appeals	Director of Medical Services		Hashmi	Bushra						7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active	8663949600				PACE - Nat		C	Kansas City
H5822	Part D Appeals Contact (Secondary)	VP / Executive Director of PACE		Chaffee	Leanna						7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active	8004913691				PACE - Nat		C	Kansas City
H5822	Part D Application Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Part D Benefits Contact	Director of Medical Services		Hashmi	Bushra		7852322044				7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/10/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Part D Claims Submission Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Part D Exceptions Contact	CMO		Wiles	Mark						7852325567	mwiles@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active	7852322044				PACE - Nat		C	Kansas City
H5822	Part D Exceptions Contact (Secondary)	Director of Medical Services		Hashmi	Bushra						7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active	7852322044				PACE - Nat		C	Kansas City
H5822	Part D Price File Contact (Back-up)	Director of Medical Services		Hashmi	Bushra		7852322044				7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/10/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Part D Price File Contact (Optional)	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Part D Price File Contact (Primary)	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Part D Quality Assurance Contact	Director of Medical Services		Hashmi	Bushra		7852322044				7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/10/2020	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Part D Reporting Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Patient Safety Contact	Director of Medical Services		Hashmi	Bushra		7852322044				7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Payment Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Personal Health Record Contact	Director of Compliance		Corpstein	Joann		7852322044				7852325567	jcorpstein@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Pharmacy Director	CMO		Wiles	Mark		7852322044				7852325567	mwiles@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Pharmacy Network Management Contact	VP / Executive Director of PACE		Chaffee	Leanna		7852322044				7852325567	lchafee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Pharmacy Network Management Contact (Secondary)	VP / Executive Director of PACE		Chaffee	Leanna		7852322044					lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Pharmacy Technical Help Desk Contact	VP / Executive Director of PACE		Chaffee	Leanna						7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active	7852322044				PACE - Nat		C	Kansas City
H5822	Pharmacy Technical Help Desk Contact (Secondary)	VP of Operations		Ramirez	Jesse						7852325567	jramirez@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active	7852322044				PACE - Nat		C	Kansas City
H5822	PHR Beneficiary Contact																	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE	Midland Care Connection	Midland Care Connection, Inc.	291	Yes	Active	8004913691				PACE - Nat		C	Kansas City
H5822	Plan Directory Contact for Public Website	CEO		Sullivan	Shawn		7852322044					ssullivan@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Plan to Plan Reconciliation Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Processor Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Quality Contact	Director of Quality		Reeves	Johnathan		7852322044				7852325567	jreeves@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	08/16/2021	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Reconciliation Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Cir		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Reconciliation Contact (Secondary)	Director of Medical Services		Hashmi	Bushra		7852322044				7852325567	bhashmi@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Recovery Audit Contact	CFO	Mr.	Lehman	Daniel	L	7852322044				7852325567	dlehman@midlandcc.org	200 SW Frazier Cir		Topeka	KS	66606	07/24/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Surveillance Contact	CEO		Sullivan	Shawn		7852322044				7852325567	ssullivan@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	System Contact	Director of Quality		Reeves	Johnathan		7852322044					jreeves@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	04/06/2022	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Third Party Administrator (TPA) Liaison	Chief Executive Officer	Ms	Bailey	Patty		7202043214					pbailey@peakpacesolutions.com	PEAK PACE SOLUTIONS, LLC	345 Marshall Avenue, Suite 101	St. Louis	MO	63119	05/18/2016	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	User Access Contact	VP / Executive Directtor of PACE		Chaffee	Leanna		7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Utilization Management Contact	VP / Executive Director of PACE		Chaffee	Leanna		7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5822	Utilization Review Contact	VP / Executive Director of PACE		Chaffee	Leanna		7852322044				7852325567	lchaffee@midlandcc.org	200 SW Frazier Circle		Topeka	KS	66606	03/20/2023	2023	MIDLAND CARE CONNECTION	National PACE	Midland Care PACE	National PACE		Midland Care Connection, Inc.	291	Yes	Active					PACE - Nat		C	Kansas City
H5823	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	CAP Report Contact for Public Website			Services	Member		8006651029					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	MA Claims Processing Contact for Public Website			Services	Member		8006651029					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H5823	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H5823	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H5823	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H5823	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H5823	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H5823	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Plan Directory Contact for Public Website			Services	Member		8006651029					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5823	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF WASHINGTON, INC.	Local CCP	Molina Healthcare of Washington, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5826	Agent/Broker Compensation Data Contact	VP Community Engagement		Stevens	Melissa		2067317757				2065218834	melissa.stevens@chpw.org	1111 Third Ave, Suite 400		Seattle	WA	98101	07/21/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Automated TrOOP Balance Transfer Contact	Senior Accountant		Slack	Lynne		2066527148				2065218834	Lynne.Slack@chpw.org	1111 Third Ave, Suite 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Backup User Access Contact	FWA Program Manager		Glew	Miles		2065157844				2065218834	miles.glew@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Best Available Evidence Contact	VP Customer Experience	Ms	Norwood	Charyl		2066138885				2065218834	charyl.norwood@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Bid Audit Contact	VP Healthcare Econmics		DiGiuseppe	David		2066138946				2065218834	david.digiuseppe@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/03/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Bid Audit Site Contact	VP Healthcare Econmics		DiGiuseppe	David		2066138946				2065218834	david.digiuseppe@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/03/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Bid Primary Contact	Director Actuarial Services		Corrough	Elaine		2066138958				2065218834	elaine.corrough@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/06/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	CAP Report Contact for Public Website	VP, Compliance Officer	Ms	Zerda	Marie	A	2066135091				2066527017	marie.zerda@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	CEO - CMS Administrator Contact	Chief Executive Officer	Ms	Berge	Leanne		2066138828				2066135097	Leanne.Berge@chpw.org	1111 Third Ave, Suite 400		Seattle	WA	98101	01/05/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	CEO - Senior Official for Contracting	Chief Executive Officer	Ms	Berge	Leanne		2066138828				2066135097	leanne.berge@chpw.org	1111 Third Ave, Suite 400		Seattle	WA	98101	01/09/2017	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Chief Financial Officer	Chief Financial Officer	Ms	Kessel	Stacy		2066138963				2065218834	stacy.kessel@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Chief Operating Officer	Chief Operations Officer	Mr	Lederman	Alan		2065154704				2066527001	alan.lederman@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/01/2018	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Chief Information Officer	VP Information Technology	Ms	Gleeson	Deborah		2065157990					Deb.Gleeson@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Chief Information Security Officer	Chief Information Security Officer	Mr	Banks	Jonathan		4788324640					Jonathan.Banks@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	01/31/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	CMMI Model Point of Contact	Gov't Payors Program Manager		Wass	AnnaCather		2064804758				2065218834	annacatherine.wass@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/03/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	CMS Casework Communication Contact	VP Customer Experience	Ms	Norwood	Charyl		2066138885				2065218834	charyl.norwood@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Complaints Tracking Contact	VP Customer Experience	Ms	Norwood	Charyl		2066138885				2065218834	charyl.norwood@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Contact for Fraud Investigations	FWA Program Manager		Glew	Miles		2065157844				2065218834	miles. glew@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Coordination of Benefits Contact	VP Customer  Experience	Ms	Norwood	Charyl		2066138885				2065218834	charyl.norwood@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Corporate Mailing						2066135091				2066527017	marie.zerda@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant		Slack	Lynne		2066527148				2065218834	Lynne.Slack@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Customer Service Operations Contact	Director of Customer Service		Leibbrand	Julie		2066527268				2065218834	julie.leibbrand@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	DIR Contact	Chief Financial Officer	Ms	Kessel	Stacy		2066138963				2066528834	stacy.kessel@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	DIR Contact (Secondary)	Director Financial Reporting	Mrs	Catipon	Maria		2066138931				2065218834	maria.catipon@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	12/30/2020	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Emergency Part D Contact	Senior Director Pharmacy	Mr	Daoud	Omar		2066527185				2065218834	Omar.Daoud@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	01/05/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Emergency Part D Contact (Secondary)	Director of Pharmacy	Mr	Daoud	Omar		2064755779				2065218834	omar.daoud@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	01/03/2022	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Encounter Data & Risk Adjustment Operations Contact	VP BPO Operations		Arcieri	Donna		2066138853				2065218834	Donna.Arcieri@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	06/11/2022	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Enrollment Contact	VP Customer Experience	Ms	Norwood	Charyl		2066138885				2065218834	charyl.norwood@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	EOB Transfer Contact	Senior Accountant		Slack	Lynne		2066527148				2065218834	Lynne.Slack@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Financial Audit Contact	VP Finance	Mrs	Faulring	Marie	A	2066138997				2065218833	marie.faulring@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Financial Reporting Contact	VP Finance	Mrs	Faulring	Marie	A	2066138997				2065218833	marie.faulring@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Formulary Contact	Director of Pharmacy		Daoud	Omar		2064755779				2065218834	Omar.Daoud@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Formulary Contact (Secondary)	Director of Pharmacy	Mr	Daoud	Omar		2064755779				2065218834	omar.daoud@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	General Contact	VP Compliance Officer		Zerda	Marie		2067991406				2065218834	marie.zerda@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/03/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Government Relations Contact	Gov't Payors Program Manager		Wass	AnnaCather		2064804758				2065218834	annacatherine.wass@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/03/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	HIPAA Privacy Officer	VP, Compliance Officer	Ms	Zerda	Marie	A	2066135091				2066527017	marie.zerda@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	HIPAA Security Officer	Chief Information Security Officer	Mr	Banks	Jonathan		4788324640					Jonathan.Banks@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	01/31/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Hospice Contact	Director of Pharmacy		Daoud	Omar		2064755779				2065218834	omar.daoud@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Interoperability Contact	VP Information Technology	Ms	Gleeson	Deborah		2065157990				2065218834	deb.gleeson@chpw.org	1111 Third Ave	400	Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	MA Appeals/Grievances Contact	VP Customer Experience	Ms	Norwood	Charyl		2066138885				2065218834	charyl.norwood@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	MA Claims Processing Contact for Public Website	VP Business Process Operations		Arcieri	Donna		2066138853				2065218834	donna.arcieri@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Marketing Contact	VP Community Engagement		Stevens	Melissa		2067317757				2065218834	melissa.stevens@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/21/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Medical Director	Chief Medical Officer	Dr	Sherman	Paul		2066527496				2065218834	paul.sherman@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	10/22/2019	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Medicare Compliance Officer	VP, Compliance Officer	Ms	Zerda	Marie	A	2066135091				2066527017	marie.zerda@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Medicare Coordinator	VP Customer Experience	Ms	Norwood	Charyl		2066138885				2065218834	charyl.norwood@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Daoud	Omar		2064755779				2065218834	Omar.Daoud@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Medication Therapy Management Contact	Director - Clinical & Trend Solutions		Muralidharan	Adrienne		3143131932					amuralidharan@express-scripts.com	One Express Way		St. Louis	MO	63121	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	OffShore Subcontractor Contact	Gov't Payors Program Manager		Wass	AnnaCather		2064804758				2065218834	annacatherine.wass@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/03/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Online Enrollment Center Contact (Back-up)	Medicare Eligibility Coordinator		Warbington	Michael		2065157824				2065218834	michael.warbington@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Online Enrollment Center Contact (Optional)	Eligibility Specialist		Aceva	Casey		2066135088				2065218834	casey.aceva@chpw.org	1111 THird Ave, Ste 400		Seattle	WA	98101	09/21/2016	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Online Enrollment Center Contact (Primary)	VP Customer Experience	Ms	Norwood	Charyl		2066138885				2065218834	charyl.norwood@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Part C Application Contact	Gov't Payors Program Manager		Wass	AnnaCather		2064804758				2065218834	annacatherine.wass@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/03/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Part C Reporting Contact	VP Information Technology	Ms	Gleeson	Deborah		2065157990				2065218834	deb.gleeson@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Part D Appeals	Supervisor Eligibility & Appeals	Mr	Campbell	Eric						2065218834	eric.campbell@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active	8009420247				HMO - Health Maintenance Organization		C	Seattle
H5826	Part D Appeals Contact (Secondary)	VP Customer Experience	Ms	Norwood	Charyl						2065218834	charyl.norwood@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active	8009420247				HMO - Health Maintenance Organization		C	Seattle
H5826	Part D Application Contact	Gov't Payor Program Manager		Wass	AnnaCather		2064084758				2065218834	annacatherine.wass@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/03/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Part D Benefits Contact	Director of Pharmacy		Daoud	Omar		2064755779				2065218834	omar.daoud@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Part D Claims Submission Contact	Director-Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					rosario_dovico@express-scripts.com	One Express Way		St Louis	MO	63121	05/24/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Part D Exceptions Contact	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	05/05/2022	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Seattle
H5826	Part D Exceptions Contact (Secondary)	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	05/05/2022	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Seattle
H5826	Part D Price File Contact (Back-up)	Manager, Regulated Markets Products		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	05/24/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Part D Price File Contact (Primary)	Sr. Manager, Regulated Markets		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	05/24/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Part D Quality Assurance Contact	VP Health Services		Hardman	Ma'ata		2066527207				2065218834	maata.hardman@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Part D Reporting Contact	VP Information Technology	Ms	Gleeson	Deborah		2065157990				2065218834	deb.gleeson@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Patient Safety Contact	Director of Pharmacy		Daoud	Omar		2064755779				2065218834	omar.daoud@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Payment Contact	VP Finance	Mrs	Faulring	Marie	A	2066138997				2065218833	marie.faulring@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98059	12/30/2020	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Pharmacy Director	Director of Pharmacy		Daoud	Omar		2064755779				2065218834	omar.daoud@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Pharmacy Network Management Contact	Network Acct Director, Retail Strategy/Contracting		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	05/24/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Pharmacy Network Management Contact (Secondary)	Sr Manager- Network Contracting		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/23/2015	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Pharmacy Technical Help Desk Contact	Director Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY	STE 150	Temple Terrace	FL	33637	11/22/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Seattle
H5826	Plan Directory Contact for Public Website	Customer Service Department		Care	Customer		8009420247				2065218834	CustomerCare@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Plan to Plan Reconciliation Contact	Senior Accountant	Ms.	Slack	Lynne		2066527148				2065218834	Lynne.Slack@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Processor Contact	VP BPO Operations		Arcieri	Donna		2066138853					donna.arcieri@chpw.org	1111 Third Ave, Suite 400		Seattle	WA	98101	12/30/2020	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Quality Contact	VP Health Services		Hardman	Ma'ata		2066527207				2065218834	maata.hardman@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Reconciliation Contact	Director Financial Reporting	Mrs	Catipon	Maria		2066138931				2065218834	maria.catipon@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	12/30/2020	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Reconciliation Contact (Secondary)	Senior Accountant	Ms.	Slack	Lynne		2066527148				2065218834	Lynne.Slack@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Recovery Audit Contact	VP, Compliance Officer	Ms	Zerda	Marie	A	2066135091				2066527017	marie.zerda@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	SNP Application Contact	Gov't Payors Program Manager		Wass	AnnaCather		2064804758				2065218834	annacatherine.wass@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/03/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	SNP State Contact	Gov't Payors Program Manager		Wass	AnnaCather		2064804758				2065218834	annacatherine.wass@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	07/03/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Surveillance Contact	VP, Compliance Officer	Ms	Zerda	Marie	A	2066135091				2066527017	marie.zerda@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	System Contact	VP Information Technology	Ms	Gleeson	Deborah		2065157990					Deb.Gleeson@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	08/01/2023	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Third Party Administrator (TPA) Liaison	Senior Accountant	Ms.	Slack	Lynne		2066527148				2065218834	Lynne.Slack@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	User Access Contact	VP, Compliance Officer	Ms	Zerda	Marie	A	2066135091				2066527017	marie.zerda@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Utilization Management Contact	Sr Director Utilization Management		Fowler	Justin		2066138955				2065218834	justin.fowler@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5826	Utilization Review Contact	Sr Director Utilization Management		Fowler	Justin		2066138955				2065218834	justin.fowler@chpw.org	1111 Third Ave, Ste 400		Seattle	WA	98101	05/11/2021	2023	COMMUNITY HEALTH PLAN OF WASHINGTON	Local CCP	Community Health Plan of WA Medicare Advantage	HMO/HMOPOS		Community Health Plan of Washington	275	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5828	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	02/10/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/10/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/10/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	02/10/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	02/10/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H5828	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H5828	PHR Beneficiary Contact																	02/10/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H5828	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	02/10/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5828	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	02/10/2020	2023	AMERIGROUP TENNESSEE, INC.	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5843	Agent/Broker Compensation Data Contact	Medicare Sales Operations Director	Ms	Perry	Danielle		6024004768					Danielle.Perry@bannerhealth.com	2901 N Central Ave	Ste. 160	Phoenix	AZ	85012	03/29/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Automated TrOOP Balance Transfer Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N. Central Ave Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Backup User Access Contact	Compliance Senior Director	Ms	Corlette	Kristina		6027472431					BMAComplianceOfficer@BannerHealth.com	2901 N Central Ave., Ste 160		Phoenix	AZ	85012	12/05/2022	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Best Available Evidence Contact	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Bid Audit Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Bid Audit Site Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Bid Primary Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	CAP Report Contact for Public Website	Chief Operations Officer	Mrs	Spiekermeier	Sarah		5208745520				5208747083	Sarah.Spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Stringham	James		6025684179				5208747083	James.Stringham2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Stringham	James		6025684179				5208747083	James.Stringham2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Chief Financial Officer	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Chief Operating Officer	Chief Operations Officer	Mrs	Spiekermeier	Sarah		5208745520				5208747083	Sarah.Spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Chief Information Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Chief Information Security Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	CMS Casework Communication Contact	Director, Grievance and Appeals	Mr	Maccioli	James		6027476021				5208747083	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/31/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Complaints Tracking Contact	Director, Grievance and Appeals	Mr	Maccioli	James		6024746021				5208747083	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/31/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Contact for Fraud Investigations	Director of Compliance	Ms	Dorazio	Terri		5208742847				5208747072	Theresa.Dorazio@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Coordination of Benefits Contact	Director Reimbursement Services		Groves	Lori		6024692249					Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Corporate Mailing						5208745550				5208747083	silvia.parra@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant		Cosentino	Rebekah		5208502776					Rebekah.Cosentino@bannerhealth.com	2901 N Central Ave. Ste 160		Phoenix	AZ	85012	01/12/2022	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Customer Service Operations Contact	Customer Care Director	Mrs	Carrillo	Veronica		5208745349				5208747083	Veronica.Carrillo@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	DIR Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	DIR Contact (Secondary)	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave. Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Electronic Health Record Contact	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Emergency Part D Contact	Pharmacy On Call Cell Phone		On Call	Pharmacy		5202601860				5208747083	BUHPgovernmentprograms@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Emergency Part D Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Encounter Data & Risk Adjustment Operations Contact	Sr. Director Payment Integrity & Reimbursement	Mr.	Horton	Tanner		4806845016					Tanner.Horton2@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	03/09/2022	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Enrollment Contact	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	EOB Transfer Contact	Director Reimbursement Services		Groves	Lori		6024692254				5208747083	Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Financial Audit Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Financial Reporting Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Formulary Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Formulary Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	General Contact	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	03/22/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Government Relations Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	HIPAA Privacy Officer	Director of Compliance	Ms	Dorazio	Terri		5208742847				5208747072	Theresa.Dorazio@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	HIPAA Security Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Hospice Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Interoperability Contact	Interoperability Healthcare Leader	Mr	Mathew	Rakesh		6027277420					Rakesh.Mathew@bannerhealth.com	2901 N Central Ave. Ste 160		Phoenix	AZ	85012	12/20/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	MA Appeals/Grievances Contact	Director, Grievance and Appeals	Mr	Maccioli	James		6027476021				5208747083	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/31/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	MA Claims Processing Contact for Public Website	Director Reimbursement Services		Groves	Lori		6024692249					Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Marketing Contact	Marketing Manager	Ms	Medina	AnaMaria		5208745082				5208747083	AnaMaria.Medina@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Medical Director	Chief Medical Officer	Dr	Stein	Sandra		5209040346					Sandra.Stein@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	09/05/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Medicare Compliance Officer	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	03/22/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Medicare Coordinator	Senior Manager Government Programs	Ms	Flores	Vanessa		5208745781				5208747083	buhpgovernmentprograms@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Medicare Part D Opioid Overutilization Contact	Express Scripts Director Clinical & Trend Solution		Muralidharan	Adrienne		3143131932					amuralidharan@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	12/21/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Medication Therapy Management Contact	Director (Clinical & Trend Solutions)		Muralidharan	Adrienne		3143131932				8587906052	amuralidharan@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	12/21/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	OffShore Subcontractor Contact	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	03/22/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Online Enrollment Center Contact (Back-up)	Medicare Sales Operations Director	Ms	Perry	Danielle		6024004768					Danielle.Perry@bannerhealth.com	2901 N Central Ave	Ste. 160	Phoenix	AZ	85012	02/14/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Online Enrollment Center Contact (Optional)	Enrollment Supervisor	Ms	Espinoza	Brianna		5208744192				5205855252	Brianna.Espinoza@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Online Enrollment Center Contact (Primary)	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Part C Application Contact	Sr Director, Medicare Administrator	Ms	Chaydez	Myrna		6024355378					Myrna.Chaydez@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Part C Reporting Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Appeals	Director, Grievance and Appeals	Mr	Maccioli	James						8664658340	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8778743930				HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Appeals Contact (Secondary)	Associate Director, Grievance & Appeals	Mrs	Garcia	Renee						5208743462	Renee.Garcia2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8778743930				HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Application Contact	Sr Director, Medicare Administrator	Ms	Chaydez	Myrna		6024355378					Myrna.Chaydez@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Benefits Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Claims Submission Contact	Director Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	Express Scripts	One Express Way	St Louis	MO	63121	01/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Exceptions Contact	Express Scripts Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	Express Scripts	5151 Blazer Pkwy	Dublin	OH	43017	12/21/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Exceptions Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael							Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8888075695				HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Price File Contact (Back-up)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Price File Contact (Optional)	Express Scripts Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	Express Scripts	4865 Dixie Hwy	Fairfield	OH	45014	02/01/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Price File Contact (Primary)	Express Scripts Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	Express Scripts	5151 Blazer Pkwy	Dublin	OH	43017	02/01/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Quality Assurance Contact	Sr. Director Quality Management	Mrs	Robles Caraveo	Sandra		6233266425					sandra.roblescaraveo@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	02/16/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Part D Reporting Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Patient Safety Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Payment Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Personal Health Record Contact	Sr. Director Quality Management	Mrs	Robles Caraveo	Sandra		6233266425					sandra.roblescaraveo@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	02/16/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Pharmacy Director	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Pharmacy Network Management Contact	Express Scripts Network Accountant Director		Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	01/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Pharmacy Network Management Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 360		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Pharmacy Technical Help Desk Contact	Express Scripts (Director, Customer Services)		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	Express Scripts	13051 N Telecom PKWY STE 150	Temple Terrace	FL	33637	08/02/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8009036215				HMO - Health Maintenance Organization		C	San Francisco
H5843	Pharmacy Technical Help Desk Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael							Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active	8888075695				HMO - Health Maintenance Organization		C	San Francisco
H5843	PHR Beneficiary Contact																	06/14/2022	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS	Express Scripts	Banner Health	389	Yes	Active	3143131932				HMO - Health Maintenance Organization		C	San Francisco
H5843	Physician Incentive Contact	Payer Account Program Sr. Manager	Ms	Ruiz	Marcela		5208745215				5208747083	Marcela.Ruiz@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Plan Directory Contact for Public Website	BMA Customer Care		Care	Customer		5208743930				5208743434	memberservicesinquiries@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Plan to Plan Reconciliation Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Processor Contact	Director Reimbursement Services		Groves	Lori		6024692249					Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Quality Contact	Sr. Director Quality Management	Mrs	Robles Caraveo	Sandra		6233266425					sandra.roblescaraveo@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	02/16/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Reconciliation Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Reconciliation Contact (Secondary)	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave. Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Recovery Audit Contact	Finance CRU Director	Mr	Schreiber	Thomas		5208745240				5208747083	thomas.schreiber@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	SNP Application Contact	Chief Operations Officer	Mrs	Spiekermeier	Sarah		6237554652					sarah.spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	SNP State Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Surveillance Contact	Marketing Associate Director	Ms.	Medina	AnaMaria		5208745082					AnaMaria.Medina@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	System Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Third Party Administrator (TPA) Liaison	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	User Access Contact	Chief Operations Officer	Mrs	Spiekermeier	Sarah		6237554652					sarah.spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Utilization Management Contact	RN Director Utilization Management	Ms	Messing	Carla		6026171632					carla.messing@bannerhealth.com	525 W Brown Rd		Mesa	AZ	85201	09/14/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5843	Utilization Review Contact	Medical Management Associate Director	Ms	Wilson	Traci	R	4802702342					Traci.Wilson@bannerhealth.com	525 W Brown Rd		Mesa	AZ	85201	09/14/2021	2023	BANNER HEALTH PLAN, INC.	Local CCP	Banner Medicare Advantage	HMO/HMOPOS		Banner Health	389	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Agent/Broker Compensation Data Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager	Mr.	Zlotkus	Steve		8587906250					partdcat@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	08/16/2019	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Backup User Access Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Best Available Evidence Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Bid Audit Contact	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	03/14/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Bid Audit Site Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Bid Primary Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	CAP Report Contact for Public Website	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	01/11/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	CEO - CMS Administrator Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	CEO - Senior Official for Contracting	President	Mr.	Weinstein	Michael	A	3238605200				3234678450	michael.weinstein@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Chief Financial Officer	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	03/14/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Chief Operating Officer	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Chief Information Officer	Chief Information Officer	Mr.	Tychicus	Mohandoss		3238605360					mohandoss.tychicus@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Chief Information Security Officer	Director of Compliance, Deputy General Counsel	Mr.	Talukdar	Ashoke		3238605223				3234678450	ashoke.talukdar@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	CMMI Model Point of Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	CMS Casework Communication Contact	Risk Manager, Grievance & Appeals	Ms.	Beneche	Emelyne		9545223132	53292			8889657430	emelyne.beneche@aidshealth.org	700 SE 3rd Ave, 4th Floor		Fort Lauderdale	FL	33316	04/28/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Complaints Tracking Contact	Risk Manager, Grievance & Appeals	Ms.	Beneche	Emelyne		9545223132	53292			8889657430	emelyne.beneche@aidshealth.org	700 SE 3rd Ave, 4th Floor		Fort Lauderdale	FL	33316	04/28/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Contact for Fraud Investigations	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	01/11/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Coordination of Benefits Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Corporate Mailing						3234365000				3233379141	php@positivehealthcare.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance - Finanical Compliance	Mr.	Vazquez	David		3238605260				3239628513	david.vazquez@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Customer Service Operations Contact	Health Plan Administrator	Mr.	O'Malley	Michael		8002630067				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	DIR Contact	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	02/17/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	DIR Contact (Secondary)	Director of Finance - Finanical Compliance	Mr.	Vazquez	David		3238605260				3239628513	david.vazquez@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Electronic Health Record Contact	Director of Care Coordination	Ms.	Smith	Tiffany		9545223132	3222			8889727976	tiffany.smith@aidshealth.org	700 SE 3rd Ave 4rd Floor		Fort Lauderdale	FL	33316	06/07/2023	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Emergency Part D Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		7143287404				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Emergency Part D Contact (Secondary)	Health Plan Administrator	Mr.	O'Malley	Michael		8186487834				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Employer Waiver Contact	Health Plan Administrator	Mr.	O'Malley	Michael		8002630067				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Encounter Data & Risk Adjustment Operations Contact	Associate Director of Risk Adjustment	Mr.	Twentyman	Thomas		3233379147					thomas.twentyman@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Enrollment Contact	Health Plan Administrator	Mr.	O'Malley	Michael		8002630067				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	EOB Transfer Contact	Assoc. Director Data and Information Architecture	Ms.	Adeli	Natalya		3238605317				8882358552	natalya.adeli@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Financial Audit Contact	Chief Financial Officer/Financial Services and Com	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	03/14/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Financial Reporting Contact	Chief Financial Officer/Financial Services and Com	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	03/14/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Formulary Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Formulary Contact (Secondary)	Manager, Formulary Administration & Maitenance	Ms.	Nyawabila	Christina		8587906297					FAS@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	General Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Government Relations Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	HIPAA Privacy Officer	Director of Compliance, Deputy General Counsel	Mr.	Talukdar	Ashoke		3238605223				3234678450	ashoke.talukdar@aidshealth.org	6255 W. Sunset Blvd., 21st Floor		Los Angeles	CA	90028	03/10/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	HIPAA Security Officer	Director of Compliance, Deputy General Counsel	Mr.	Talukdar	Ashoke		3238605223				3234678450	ashoke.talukdar@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Hospice Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Interoperability Contact	IT Project Manager	Mr.	Hayek	Joe		3237662176	56034				yousef.hayek@aidshealth.org	2146 W Adams Blvd		Los Angeles	CA	90018	04/28/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	MA Appeals/Grievances Contact	Risk Manager, Grievance & Appeals	Ms.	Beneche	Emelyne		9545223132	53292			8889657430	emelyne.beneche@aidshealth.org	700 SE 3rd Ave, 4th Floor		Fort Lauderdale	FL	33316	04/28/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	MA Claims Processing Contact for Public Website	Director of Managed Care Operations	Ms.	Carter	Rebecca		8886620626				8882359274	rebecca.carter@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Marketing Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Medical Director	Medical Director	Dr.	Howell	Scott	C	8056600703				8889749948	scott.howell@ahf.org	6255 Sunset Blvd. 19th floor		Los Angeles	CA	90028	08/24/2023	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Medicare Compliance Officer	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	01/11/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Medicare Coordinator	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Medicare Part D Opioid Overutilization Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	04/28/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Medication Therapy Management Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		7143287404				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	06/07/2023	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	OffShore Subcontractor Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Online Enrollment Center Contact (Back-up)	Director of Member Services	Ms.	Ramos	Melissa		3234365008				8882358552	melissa.ramos2@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Online Enrollment Center Contact (Primary)	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Part C Application Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Part C Reporting Contact	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	01/11/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Appeals	Pharmacy Director - Managed Care	Mr.	Dao	Anthony						8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active	8885541334				HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Appeals Contact (Secondary)	Health Plan Administrator	Mr.	O'Malley	Michael						8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active	8884365018				HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Application Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Benefits Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Claims Submission Contact	Assoc. Director Data and Information Architecture	Ms.	Adeli	Natalya		3238605317					natalya.adeli@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Exceptions Contact	Pharmacy Director - Managed care	Mr.	Dao	Anthony						8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active	8885541334				HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Exceptions Contact (Secondary)	Health Plan Administrator	Mr.	O'Malley	Michael						8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active	8884365018				HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Price File Contact (Back-up)	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Price File Contact (Optional)	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Price File Contact (Primary)	Medicare Part D Project Manager	Ms.	Niemi	Kirstin		8587906544					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	08/16/2019	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Quality Assurance Contact	National Director of Quality	Ms.	Uranaka	Christine		9545940827				8882358482	christine.uranaka@aidshealth.org	1001 N. Martel Ave.		Los Angeles	CA	90046	04/28/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Part D Reporting Contact	Medicare Part D Project Manager	Ms.	Scott	Susan		8587906565					medicarepartdprojectmanagers@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	08/16/2019	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Patient Safety Contact	Director of Care Coordination	Ms.	Smith	Tiffany		9545223132	3222			8889727976	tiffany.smith@aidshealth.org	700 SE 3rd Ave., 4rd Floor		Fort Lauderdale	FL	33316	06/07/2023	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Payment Contact	Associate Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W. Sunset Blvd., 21st Floor		Los Angeles	CA	90028	03/14/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Personal Health Record Contact	Director of Care Coordination	Ms.	Smith	Tiffany		9545223132	3222			8889727976	tiffany.smith@aidshealth.org	700 SE 3rd Ave 4rd Floor		Fort Lauderdale	FL	33316	06/07/2023	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Pharmacy Director	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Pharmacy Network Management Contact	Pharmacy Director - Managed Care	Mr.	Dao	Anthony		3234365005				8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Pharmacy Network Management Contact (Secondary)	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Pharmacy Technical Help Desk Contact	Pharmacy Director - Managed care	Mr.	Dao	Anthony						8882382244	anthony.dao@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active	8885541334				HMO - Health Maintenance Organization		C	San Francisco
H5852	Pharmacy Technical Help Desk Contact (Secondary)	Lead Pharmacy Services Coordinator	Ms.	Marquez	Celica						8882382244	pharmacyhelpdesk@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active	8885541334				HMO - Health Maintenance Organization		C	San Francisco
H5852	PHR Beneficiary Contact																	08/15/2019	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS	AIDS Healthcare Foundation	AIDS Healthcare Foundation	3	Yes	Active	8002630067				HMO - Health Maintenance Organization		C	San Francisco
H5852	Physician Incentive Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Plan Directory Contact for Public Website	Health Plan Administrator	Mr.	O'Malley	Michael		8332676768				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	10/01/2021	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3238605283	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	04/28/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Processor Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Quality Contact	National Director of Quality	Ms.	Uranaka	Christine		9545940827				8882358482	christine.uranaka@aidshealth.org	1001 N. Martel Ave.		Los Angeles	CA	90046	04/28/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Reconciliation Contact	Chief Financial Officer	Mr.	Honig Mojica	Lyle		3238605244				3239628513	lyle.honig@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	04/28/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Reconciliation Contact (Secondary)	Director of Finance	Mr.	Vazquez	David		3238605260				3239628513	david.vazquez@aidshealth.org	6255 W Sunset Blvd 21st Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Recovery Audit Contact	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	01/11/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	SNP Application Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172				8882358482	michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	SNP State Contact	Chief of Managed Care	Ms.	Stidham	Donna	M	8056600703				3233379141	donna.stidham@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Surveillance Contact	Compliance Officer	Ms.	Holzner	Sandra		3233379153					sandra.holzner@ahf.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	01/11/2022	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	System Contact	Assoc. Director Data and Information Architecture	Ms.	Adeli	Natalya		3238605317					natalya.adeli@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	12/29/2020	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Third Party Administrator (TPA) Liaison	Director of Finance - Finanical Compliance	Mr.	Vazquez	David		3238605260					david.vazquez@aidshealth.org	6255 W. Sunset Blvd., 21st Floor		Los Angeles	CA	90028	05/05/2016	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	User Access Contact	Health Plan Administrator	Mr.	O'Malley	Michael		3233379172					michael.omalley@aidshealth.org	6255 W Sunset Blvd 19th Floor		Los Angeles	CA	90028	10/01/2021	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Utilization Management Contact	Director of Care Coordination	Ms.	Smith	Tiffany		9545223132	3222			8889727976	tiffany.smith@aidshealth.org	700 SE 3rd Ave 4rd Floor		Fort Lauderdale	FL	33316	06/07/2023	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5852	Utilization Review Contact	Director of Care Coordination	Ms.	Smith	Tiffany		9545223132	3222			8889727976	tiffany.smith@aidshealth.org	700 SE 3rd Ave 4rd Floor		Fort Lauderdale	FL	33316	06/07/2023	2023	AIDS HEALTHCARE FOUNDATION	Local CCP	AHF	HMO/HMOPOS		AIDS Healthcare Foundation	3	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5854	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H5854	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H5854	PHR Beneficiary Contact																	11/05/2015	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H5854	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5854	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	ANTHEM HEALTH PLANS, INC.	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5859	Agent/Broker Compensation Data Contact	Vice President of Medicare		Senz	Chris		5034161496				5034163723	senzc@careoregon.org	315 SW 5TH Avenue		Portland	OR	97204	07/15/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Automated TrOOP Balance Transfer Contact	Pharmacy Benefit Coordinator		Stone	Amber		5034164941					stonea@careoregon.org	315 SW Fifth Avenue		Portland	OR	97204	08/19/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Backup User Access Contact	System Coordination Manager		Crace	Colleen		5034161722				5034161437	cracec@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/27/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Best Available Evidence Contact	Enrollment Supervisor		Schulte	Rachel		5034168908				5034163723	schulter@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/09/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Bid Audit Contact	Chief Financial Officer		Learn	Teresa		5034161415				5034163721	learnt@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/21/2016	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Bid Audit Site Contact	VP, Medicare		Senz	Chris		5034161496				5034163723	senzc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	12/02/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Bid Primary Contact	VP, Medicare		Senz	Chris		5034161496					senzc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	12/02/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	CAP Report Contact for Public Website	VP Audit and Compliance	Mr.	Zorn	Christian		5034164700					zornc@careoregon.org	315 SW 5th Ave.	315 SW Fifth Avenue	Portland	OR	97204	02/04/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active	8182036923				HMO - Health Maintenance Organization		C	Seattle
H5859	CEO - CMS Administrator Contact	CEO	Mr.	Hunter	Eric		5034167788				5034164726	huntere@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	01/05/2023	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	CEO - Senior Official for Contracting	CEO	Mr.	Hunter	Eric		5035682252				5034164726	huntere@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Chief Financial Officer	CFO	Ms.	Learn	Teresa		5034161415				5034168101	learnt@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Chief Operating Officer	CEO	Mrs.	Dowd	Amy		5034164885				5034164726	dowda@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/18/2019	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Chief Information Officer	VP, Information Systems, Analytics	Mr.	Corley	Nathan		5034167919				5034168117	corleyn@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/09/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Chief Information Security Officer	VP  Audit and Compliance	Mr.	Zorn	Christian		5034164700				5034168117	zornc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	02/04/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	CMMI Model Point of Contact	VP, Medicare		Senz	Chris		5034161496					senzc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	12/02/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	CMS Casework Communication Contact	Medicare Program Manager		Duran Rey	Whitney		5034168040				5034163720	duranreyw@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	07/15/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Complaints Tracking Contact	Medicare Program Manager		Duran Rey	Whitney		5034168040				5034163723	duranreyw@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	07/15/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Contact for Fraud Investigations	VP  Audit and Compliance		Zorn	Christian		5034164700				5034168117	zornc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	10/28/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Coordination of Benefits Contact	Enrollment Manager		Foster	Cody		5034167887				5034163723	COBServices@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	04/18/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Corporate Mailing						5034164279				5034163723	yanazzob@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	04/11/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Reporting & Analysis Manager		Lin	Echo		5034161414				5034168101	line@careoregon.org	315 SW Fifth Avenue		Portland	OR	97204	04/11/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Customer Service Operations Contact	Customer Service Manager		Mattila	Karen		5034168033				5034163723	mattilak@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	08/19/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	DIR Contact	Senior Accountant - Financial Reporting & Analysis		Lin	Echo		5034161414				5034168101	line@careoregon.org	315 SW Fifth Avenue		Portland	OR	97204	02/27/2023	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	DIR Contact (Secondary)	Pharmacy Clinical Coordinator Medicare Lead		Nguyen	Viet		5034161429				5034161428	nguyent@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/22/2019	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Emergency Part D Contact	Senior Pharmacy Clinical Coordinator		Nguyen	Viet	T	5039155767					nguyent@careoregon.org	315 SW Fifth Ave		Portland	OR	97204	12/28/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Emergency Part D Contact (Secondary)	Pharmacy Benefit and Project Manager		Corbett	Amber		5034168066					corbetta@careoregon.org	315 SW Fifth Avenue		Portland	OR	97204	08/19/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Encounter Data & Risk Adjustment Operations Contact	Risk Asjustment Manager		Barnwell	Amy Jo		5034165753					barnwella@careoregon.org	315 SW 5th Ave		Portland	OR	97204	01/26/2023	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Enrollment Contact	Enrollment Supervisor		Schulte	Rachel		5034168908				5034163723	schulter@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/09/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	EOB Transfer Contact	System Coordination Manager		Crace	Colleen		5034161722				5034163720	cracec@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/09/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Financial Audit Contact	Controller	Mr.	Jackson	Tony		5034168078				5034163720	jacksont@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/19/2019	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Financial Reporting Contact	CFO		Learn	Teresa		5034161415				5034163721	learnt@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue,	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Formulary Contact	Pharmacy Clinical Coordinator Medicare Lead		Nguyen	Viet		5034161429				5034161428	nguyent@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Formulary Contact (Secondary)	Clinical Pharmacy Coordinator		Elliott	Analisa		5034164756					elliotta@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	General Contact	VP of Medicare		Senz	Chris		5034161496				5034163723	senzc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	06/21/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Government Relations Contact	Chief of Staff		Rigsby	Jeremiah		5034164699				5034163720	rigsbyj@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/09/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	HIPAA Privacy Officer	VP  Audit and Compliance		Zorn	Christian		5034164700				5034168117	zornc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	10/28/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	HIPAA Security Officer	VP  Audit and Compliance		Zorn	Christian		5034164700				5034168117	zornc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	10/28/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Hospice Contact	Pharmacy Clinical Coordinator Medicare Lead		Nguyen	Viet		5034161429				5034161428	nguyent@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Interoperability Contact	VP, Information Systems, Analytics	Mr.	Corley	Nathan		5034167919				5034168117	corleyn@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	12/21/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	MA Appeals/Grievances Contact	Quality Assurance Manager		Webb	Daron		5034163681					webbd@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	01/26/2023	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	MA Claims Processing Contact for Public Website	Director, Claims		Villiarimo	Lynska		5034163733					villiarimol@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/09/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Marketing Contact	Medicare Program Manager		Duran Rey	Whitney		5034168040				5034163720	duranreyw@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	07/15/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Medical Director	Chief Medical Office		Shah, D.O.	Amit		5034161751				5034163713	shaha@careoregon.org	Health Plan of CareOregon, Inc.	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Medicare Compliance Officer	VP  Audit and Compliance	Mr.	Zorn	Christian		5034164700				5034168117	zornc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	02/27/2023	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Medicare Coordinator	Medicare Program Manager		Duran Rey	Whitney		5034168040				5034168117	duranreyw@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	07/15/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Medicare Part D Opioid Overutilization Contact	Pharmacy Clinical Coordinator Medicare Lead		Nguyen	Viet		5034161429				5034161428	nguyent@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	11/19/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Medication Therapy Management Contact	Senior Clinical Pharmacy Coordinator		Nguyen	Viet		5034161429					nguyent@careoregon.org	CareOregon Advantage		Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Online Enrollment Center Contact (Back-up)	Enrollment Coordinator		Watkins	Terri		5034163632				5034163723	watkinst@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/09/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Online Enrollment Center Contact (Optional)	Enrollment Coordinator		Bragg	Julie		5034165994				5034168117	braggj@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/09/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Online Enrollment Center Contact (Primary)	Enrollment Supervisor		Schulte	Rachel		5034168908				5034163723	schulter@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/09/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Part C Application Contact	VP, Medicare		Senz	Chris		5034161496				5034168117	senzc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	12/02/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Part C Reporting Contact	Medicare Program Specialist		Duran Rey	Whitney		5034168040				5034163720	duranreyw@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	07/15/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Appeals	Pharmacy Clinical Coordinator Medicare Lead		Nguyen	Viet						5034161428	nguyent@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active	5034161429				HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Appeals Contact (Secondary)	Clinical Pharmacy Coordinator		Elliott	Analisa						5034161428	elliotta@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	04/15/2019	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active	5034164756				HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Application Contact	VP, Medicare		Senz	Chris		5034161496				5034168117	senzc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	12/02/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Benefits Contact	Pharmacy Clinical Coordinator Medicare Lead		Nguyen	Viet		5034161429				5034161428	nguyent@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Claims Submission Contact	Pharmacy Benefits Coordinator		Brue	Wesley		5034165920					bruew@careoregon.org	CareOregon Advantage	315 SW 5th Avenue	Portland	OR	97204	09/09/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Exceptions Contact	Pharmacy Clinical Coordinator Medicare Lead		Nguyen	Viet						5034161428	nguyent@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active	5034161429				HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Exceptions Contact (Secondary)	Clinical Pharmacy Coordinator		Elliott	Analisa						5034161428	elliotta@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	04/15/2019	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active	5034164756				HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Price File Contact (Back-up)	SR Business Analyst		Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	OptumRx	1600 McConner Parkway	Schaumburg	IL	60173	10/05/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Price File Contact (Optional)	Pharmacy Clinical Coordinator Medicare Lead		Nguyen	Viet		5034161429				5034161428	nguyent@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	10/05/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Price File Contact (Primary)	SR Business Analyst		Moore-Elliott	Shalandria		7637974305					shalandria.moore-elliott@optum.com	1600 McConnor Pkwy		Schaumburg	IL	60173	10/05/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Quality Assurance Contact	Pharmacy Clinical Coordinator Medicare Lead		Nguyen	Viet		5034161429				5034161428	nguyent@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Part D Reporting Contact	Pharmacy Clinical Coordinator Medicare Lead		Nguyen	Viet		5034161429				5034161428	nguyent@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	04/15/2019	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Patient Safety Contact	Pharmacy Clinical Coordinator Medicare Lead		Nguyen	Viet		5034161429				5034161428	nguyent@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Payment Contact	Financial Reporting & Analysis Manager		Lin	Echo		5034161414				5034168101	line@careoregon.org	315 SW Fifth Avenue		Portland	OR	97204	04/11/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Pharmacy Director	Vice President of Pharmacy		Slater	James		5034163633				5034161428	slaterj@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	08/19/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Pharmacy Network Management Contact	Manager Retail Network Operations		Hagan	Kyle		3039895828				8773390784	Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	08/19/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Pharmacy Network Management Contact (Secondary)	Executive Director, Pharmacy		Slater	James		5034163633				5034161428	slaterj@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	02/01/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Pharmacy Technical Help Desk Contact	Senior Director, Member Services		Nunnally	Josh							josh.nunnally@optum.com	11000 Optum Cir		Eden Prarie	MN	55344	12/13/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active	8663257344				HMO - Health Maintenance Organization		C	Seattle
H5859	Pharmacy Technical Help Desk Contact (Secondary)	Assistant Director, Member Services		Betten	Brad							bradley.betten@optum.com	11000 Optum Cir		Eden Prairie	MN	55344	08/19/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active	7633616109				HMO - Health Maintenance Organization		C	Seattle
H5859	Physician Incentive Contact	VP  Value Based Contract		Mitchell	Angela		5034163425					mitchella@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue, Suite 900	Portland	OR	97204	08/19/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Plan Directory Contact for Public Website	Medicare Program Manager		Duran Rey	Whitney		5034168040				5034163720	duranreyw@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	11/23/2022	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Plan to Plan Reconciliation Contact	Financial Reporting & Analysis Manager		Lin	Echo		5034161414				5034168101	line@careoregon.org	315 SW Fifth Avenue		Portland	OR	97204	04/11/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Processor Contact	Senior Manager, Benefit Administration		Cassata	Mercedes		6307809152					mercedes.cassata@optum.com	1600 McConnor Pkwy		Schaumburg	IL	60173	08/19/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Quality Contact	Senior Medical Director, Operations		Luther	Doug		5034161477					lutherd@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	07/11/2019	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Reconciliation Contact	Senior Accountant - Financial Reporting & Analysis		Lin	Echo		5034161414				5034168101	line@careoregon.org	315 SW Fifth Avenue		Portland	OR	97204	02/27/2023	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Reconciliation Contact (Secondary)	Director, Financial Reporting & Analysis		Yoshimori	Hiroshi		5034164935				5034168101	yoshimorih@careoregon.org	315 SW Fifth Avenue		Portland	OR	97204	02/28/2023	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Recovery Audit Contact	VP Audit and Compliance	Mr.	Zorn	Chris		5034164700				5034168117	zornc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	07/13/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	SNP Application Contact	VP, Medicare		Senz	Chris		5034161496				5034163720	senzc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	12/02/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	SNP State Contact	Operations and Policy Analyst, Dual Eligibles	Ms.	Valentine	Jennifer		5039472328				5039455221	JENNIFER.B.VALENTINE@dhsoha.state.or.us	Division of Medical Assistance Programs (DMAP)	500 Summer Street NE, E-35	Salem	OR	97301	07/11/2019	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Surveillance Contact	VP Audit and Compliance		Zorn	Chris		5034164700					zornc@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	12/02/2021	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	System Contact	VP, Information Systems, Analytics	Mr.	Corley	Nathan		5034167919				5034168117	corleyn@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue, Suite 900	Portland	OR	97204	09/09/2020	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Third Party Administrator (TPA) Liaison	Financial Reporting & Analysis Manager		Lin	Echo		5034161414				5034168101	line@careoregon.org	315 SW Fifth Avenue		Portland	OR	97204	04/11/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	User Access Contact	System Coordinator		Laney	Jan		5034161765				5034161437	laneyj@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	03/15/2018	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Utilization Management Contact	Senior Manager of Care Management		Brink	Darin		5034161417				5034163713	brinkd@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/20/2016	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5859	Utilization Review Contact	Senior Manager of Care Management		Brink	Darin		5034161417				5034163713	brinkd@careoregon.org	CareOregon Advantage	315 SW Fifth Avenue	Portland	OR	97204	09/20/2016	2023	HEALTH PLAN OF CAREOREGON, INC.	Local CCP	CareOregon Advantage	HMO/HMOPOS		CareOregon, Inc.	48	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5883	Agent/Broker Compensation Data Contact	Manager	Mr.	Delaney	Brandon		3134482712					bdelaney@bcbsm.com	600 East Lafayette Blvd.	MC 520J	Detroit	MI	48226	03/16/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Automated TrOOP Balance Transfer Contact	Manager	Mr.	Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1705	Detroit	MI	48226	10/08/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Backup User Access Contact	Manager	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/18/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Best Available Evidence Contact	Manager	Mrs.	Love	Lonita		2482235350					LLove@bcbsm.com	20500 Civic Center Drive	C300	Southfield	MI	48075	10/08/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Bid Audit Contact	Director		Weicker	Brian		3132259571					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	06/17/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Bid Audit Site Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/14/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Bid Primary Contact	Director	Ms.	Munoz	Karen		2486654020					kmunoz@bcbsm.com	600 East Lafayette Blvd.	TC 1516	Detroit	MI	48226	03/16/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	CAP Report Contact for Public Website	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	09/13/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	CEO - CMS Administrator Contact	President and Chief Executive Officer	Mrs.	Levine	Kathryn	G	2484553575				8668052405	KLevine@bcbsm.com	20500 Civic Center Drive	C469	Southfield	MI	48076	01/05/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	CEO - Senior Official for Contracting	President and Chief Executive Officer	Mrs.	Levine	Kathryn	G	2484553575				8668052405	KLevine@bcbsm.com	20500 Civic Center Drive	C469	Southfield	MI	48076	07/23/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Chief Financial Officer	VP, Finance and Treasurer	Mr.	Harris	Waymond	E	3132256544					WHarris@bcbsm.com	600 E. Lafayette	MC 1800	Detroit	MI	48226	06/07/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Chief Operating Officer	President and Chief Executive Officer	Mrs.	Levine	Kathryn	G	2484553575				8668052405	KLevine@bcbsm.com	20500 Civic Center Drive	C469	Southfield	MI	48076	07/23/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Chief Information Officer	Vice President	Mr.	Cieszynski	Brent		3132258766					BCieszynski@bcbsm.com	600 East Lafayette Blvd.	MC S260	Detroit	MI	48226	11/15/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Chief Information Security Officer	Vice President	Mr.	Cieszynski	Brent		3132258766					BCieszynski@bcbsm.com	600 East Lafayette Blvd.	MC S260	Detroit	MI	48226	11/15/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	CMMI Model Point of Contact	Manager	Ms.	Facchini	Victoria		2486654657					VFacchini@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	03/17/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	CMS Casework Communication Contact	Manager	Mrs.	Love	Lonita		2482235350					LLove@bcbsm.com	20500 Civic Center Drive	C300	Southfield	MI	48075	10/08/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Complaints Tracking Contact	Senior Business Analyst, BCNA Enrollment		Surman	Daniel		2482235357				8666014392	dsurman@bcbsm.com	20500 Civic Center Drive	C300	Southfield	MI	48075	12/28/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Contact for Fraud Investigations	Manager, Fraud Investigation	Mr.	Zasadny	Brian		3132255956					BZasadny@bcbsm.com	600 East Lafayette Blvd.	MC 1825	Detroit	MI	48226	03/16/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Coordination of Benefits Contact	Manager, COB Payment Integrity		Besant	Tracy		8664043866					Tbesant@bcbsm.com	611 Cascade West Parkway, S.E.	G801	Grand Rapids	MI	49546	09/19/2023	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Corporate Mailing						2486654472					spriebe@bcbsm.com	600 East Lafayette Blvd.	TC 1516	Detroit	MI	48826	10/08/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Medicare Program Administration		Priebe	Scott		2486654472					spriebe@bcbsm.com	600 East Lafayette Blvd.	TC 1516	Detroit	MI	48226	02/01/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Customer Service Operations Contact	Director	Ms.	Judson	Johanna		3132255856					jjudson@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	03/16/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	DIR Contact	Manager, Pharmacy Rebates		Gustafson	Tim		3134480118					TGustafson@bcbsm.com	Tower 500 Renaissance Center	512F	Detroit	MI	482431929	03/07/2023	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	DIR Contact (Secondary)	Director of Pharmacy Contr & Rebate	Mr.	Perry	Glen		3134485949					GPerry1@bcbsm.com	Tower 500 Renaissance Center 512H		Detroit	MI	48243	03/10/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Emergency Part D Contact	Manager	Mr.	Nalamolu	Chandra		3132256810					hnalamolu@bcbsm.com	600 East Lafayette Blvd		Detroit	MI	48226	01/04/2023	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Emergency Part D Contact (Secondary)	Director	Mrs.	Underhill	Molly		6163753398					MUnderhill@bcbsm.com	600 East Lafayette Blvd.	TC 1300	Detroit	MI	48226	12/28/2020	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Encounter Data & Risk Adjustment Operations Contact	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	09/13/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Enrollment Contact	Manager	Mrs.	Love	Lonita		2482235350					LLove@bcbsm.com	20500 Civic Center Drive	C300	Southfield	MI	48075	11/15/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	EOB Transfer Contact	Manager	Mrs.	Rawson	Lori		6169565796				8773459942	lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	11/24/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Financial Audit Contact	Director	Mr.	Weicker	Brian		3132259571					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	06/17/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Financial Reporting Contact	Director, Finance	Mr.	Bluhm	Ken		3132259095					kbluhm@bcbsm.com	600 East Lafayette Blvd.	MC 0801	Detroit	MI	48226	11/16/2020	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Formulary Contact	Manager	Ms.	Facchini	Victoria		2486654657					VFacchini@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	03/17/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Formulary Contact (Secondary)	Senior Healthcare Analyst	Mr	Patel	Hiral		2486654494					hpatel5@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	03/17/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	General Contact	Compliance Consultant	Ms.	White	Jasmin		2486654235					jwhite4@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/15/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Government Relations Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/14/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	HIPAA Privacy Officer	VP, Enterprise Compliance and Privacy Official	Ms.	Lange	Kelly		3132258554					KLange@bcbsm.com	600 E Lafayette East	MC 1304	Detroit	MI	48226	12/27/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	HIPAA Security Officer	Vice President	Mr.	Cieszynski	Brent		3132258766					BCieszynski@bcbsm.com	600 E. Lafayette Blvd.	MC S260	Detroit	MI	48226	11/15/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Hospice Contact	Manager	Mrs.	Rawson	Lori		6169565796					Lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Interoperability Contact	Director	Mr.	Kett	James		3132250224					jkett@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	02/11/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	MA Appeals/Grievances Contact	Manager	Mr.	McCarty	Kevin		2483507488				8665227345	KMcCarty@bcbsm.com	P.O. Box 284		Southfield	MI	48086	02/03/2023	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	MA Claims Processing Contact for Public Website	Manager	Ms.	Shippy	Karen		8004503680					KShippy@bcbsm.com	611 Cascade West Parkway, S.E.	G801	Grand Rapids	MI	49546	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Marketing Contact	Director		Parrish	Loralie		5173254050					Lparrish1@bcbsm.com	600 East Lafayette Blvd.	MC 1401	Detroit	MI	48226	09/19/2023	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Medical Director	Vice President	Dr.	Jois, MD	Preeti		3132256585					pjois@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	12/01/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Medicare Compliance Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/03/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Medicare Coordinator	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	09/13/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Medicare Part D Opioid Overutilization Contact	Pharmacist		Mott	Krystyna		8002874163				8778958667	MedicarePartDOverutilizationMonitoring@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	12/27/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Medication Therapy Management Contact	Manager	Ms.	Moon	Kim		3132695657					kmoon@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	09/19/2023	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	OffShore Subcontractor Contact	Manager	Mrs.	Stretch	Kaitlin		2486654275					kstretch@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Online Enrollment Center Contact (Back-up)	Team Lead II	Ms.	Gaither	Tia		2482235335					TGaither@bcbsm.com	20500 Civic Center Drive	C300	Southfield	MI	48075	11/18/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Online Enrollment Center Contact (Optional)	Manager		Siegmund	Donna	M	2486654623					dsiegmund@bcbsm.com	600 East Lafayette Blvd.	TC1516	Detroit	MI	48226	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Online Enrollment Center Contact (Primary)	Manager	Mrs.	Love	Lonita		2483507388					LLove@bcbsm.com	20500 Civic Center Drive	C300	Southfield	MI	48075	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Part C Application Contact	Manager	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/18/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Part C Reporting Contact	Manager	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	12/28/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Appeals	Manager	Mr.	Petkoff	Ryan						8004598027	dramspriorauthmedicareD@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/16/2020	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8004373803				HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Appeals Contact (Secondary)	Senior Business Analyst		Plain	Sheree						8666014392	splain@bcbsm.com	20500 CIvic Center Drive	C300	Southfield	MI	48076	12/28/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	2482235241				HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Application Contact	Manager	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/18/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Benefits Contact	Manager	Mrs.	Rawson	Lori		6169565796					lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	11/15/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Claims Submission Contact	Manager		Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Exceptions Contact	Manager	Mr.	Petkoff	Ryan						8004598027	dramspriorauthmedicareD@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/16/2020	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8004373803				HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Exceptions Contact (Secondary)	Supervisor	Ms.	Jones	Amber						2484553692	BCNpharmacy2@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	01/14/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8004373803				HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Price File Contact (Back-up)	Senior Health Care Analyst		Khinchuk	Emily		2486654545					ekhinchuk@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Price File Contact (Optional)	Senior Healthcare Analyst	Ms.	Desaraju	Vidhya		2486654514					vdesaraju@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	12/28/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Price File Contact (Primary)	Manager	Mr.	Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Quality Assurance Contact	Director	Ms.	Underhill	Molly		2483955505					munderhill@bcbm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/16/2020	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Part D Reporting Contact	Manager	Mr.	Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Patient Safety Contact	Director		Connelly	Theresa		2483955529					Tconnelly@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	09/19/2023	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Payment Contact	Manager	Ms.	Smith	Mary	L	2484553516					MSmithf45a8@bcbsm.com	20500 Civic Center Drive	H105	Southfield	MI	48076	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Pharmacy Director	Director	Ms.	Underhill	Molly		6163753398					munderhill@bcbm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/18/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Pharmacy Network Management Contact	Director	Mr.	Perry	Glen		3134485949					gperry1@bcbsm.com	600 East Lafayette Blvd.	512H	Detroit	MI	48226	06/17/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Pharmacy Network Management Contact (Secondary)	Manager	Mrs.	Rawson	Lori		6169565796					Lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Pharmacy Technical Help Desk Contact	Mgr	Mrs.	Rawson	Lori							lrawson@bcbsm.com	600 East Lafayette Blvd., TC 1309	ESI (or PBM) toll free number. DO NOT CHANGE!	Detroit	MI	48226	01/04/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H5883	Pharmacy Technical Help Desk Contact (Secondary)	Manager	Mr.	Nalamolu	Chandra							hnalamolu@bcbsm.com	600 East Lafayette Blvd. TC 1309	ESI (or PBM) toll free number. DO NOT CHANGE	Detroit	MI	48226	01/04/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H5883	Physician Incentive Contact	Vice President	Mr.	Coscione	Robert		3134480083					RCoscione@bcbsm.com	600 East Lafayette Blvd.	MC 511E	Detroit	MI	48226	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Plan Directory Contact for Public Website	Director	Ms.	Judson	Johanna		8003448525					jjudson@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	03/16/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Plan to Plan Reconciliation Contact	Financial Coordinator, Finance and Accounting	Ms.	Tomasic	Cynthia		2484552726					bcnp2padmin@bcbsm.com	600 East Lafayette Blvd.	MC 0802	Detroit	MI	48226	03/25/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Processor Contact	Manager	Mrs.	Rawson	Lori		6169565796					LRawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Quality Contact	Director	Ms.	Bolton	Belinda		2484552773					BBolton@bcbsm.com	20500 Civic Center Drive	C330	Southfield	MI	48076	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Reconciliation Contact	Director		Priebe	Scott		2486654472					spriebe@bcbsm.com	600 East Lafayette Blvd.	TC 1516	Detroit	MI	48226	11/17/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Reconciliation Contact (Secondary)	Manager		Siegmund	Donna	M	2486654623					dsiegmund@bcbsm.com	600 East Lafayette Blvd.	TC1516	Detroit	MI	48226	02/24/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Recovery Audit Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/14/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	SNP Application Contact	Manager	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/18/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Surveillance Contact	Director		Crawford	Constance		2486654231					ccrawford@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	06/17/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	System Contact	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	09/13/2021	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Third Party Administrator (TPA) Liaison	Manager		Siegmund	Donna	M	2486654623					dsiegmund@bcbsm.com	600 East Lafayette Blvd.	TC 1516	Detroit	MI	48226	02/24/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	User Access Contact	Analyst	Mr.	Teklinski	Greg		2486654284					gteklinski@bcbsm.com	600 East Lafayette Blvd.	MC S140	Detroit	MI	48226	03/16/2022	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Utilization Management Contact	Director	Mrs.	Szydlowski	Taryn		2487996453					TSzydlowski@bcbsm.com	20500 Civic Center Drive	C336	Southfield	MI	48076	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5883	Utilization Review Contact	Director	Mrs.	Szydlowski	Taryn		2487996453					Tszydlowski@bcbsm.com	20500 Civic Center Drive	C336	Southfield	MI	48076	10/16/2019	2023	BLUE CARE NETWORK OF MICHIGAN	Local CCP	Blue Care Network	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5900	Agent/Broker Compensation Data Contact	Director, Finance Operations		Hoeg	Andrea		5153764509					commissioninquiry@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	02/16/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Automated TrOOP Balance Transfer Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	03/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Backup User Access Contact	Manager		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	07/06/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Best Available Evidence Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	02/09/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Bid Audit Contact	Director		Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Bid Audit Site Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/14/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Bid Primary Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	CAP Report Contact for Public Website	Managing Director		Pickens	Veronica		2483955887					vpickens@bcsbm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	CEO - CMS Administrator Contact	Plan President	Mr.	Hamor	Briggs		5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	05/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	CEO - Senior Official for Contracting	Plan President	Mr.	Hamor	Briggs		5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	05/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Chief Financial Officer	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Chief Operating Officer	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Chief Information Officer	IT Director II	Mrs.	Krause	Amy		3132256638					akrause@bcbsm.com	600 East Lafayette Blvd. MC 0506		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Cieszynski	Brent		3132258766					bcieszynski@bcbsm.com	600 Lafayette East		Detroit	MI	48226	08/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	CMMI Model Point of Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	CMS Casework Communication Contact	Compliance Consultant		White	Jasmin		2486654235					JWhite4@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Complaints Tracking Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Contact for Fraud Investigations	Manager		Zasadny	Brian		3132255956					bzasadny@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Coordination of Benefits Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Corporate Mailing						5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	03/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	1000 Town Center		Southfield	MI	48075	12/28/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Customer Service Operations Contact	Director, Workforce Management, Analytics, & Supp		Weber	Julie		3132250555					jweber@bcbsm.com	600 East Lafayette		Detroit	MI	48226	11/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	DIR Contact	VP Chief Medical Officer		Munir	Naim		5153766818					MunirN@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	03/02/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	DIR Contact (Secondary)	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Electronic Health Record Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Emergency Part D Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Emergency Part D Contact (Secondary)	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Employer Waiver Contact	Manager, Functional Operations		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center	TC1505	Southfeld	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Encounter Data & Risk Adjustment Operations Contact	Director,RASubs &ElectronicSupp Data		Jensen	Robert		2486654115					robert.jenson@advantasure.com	1000 Town Center		Southfield	MI	48075	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Enrollment Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	02/09/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	EOB Transfer Contact	Director, Medicare Programs		Frank	Jesica		5153767878				8556337633	frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Financial Audit Contact	Director	Mr.	Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Financial Reporting Contact	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Formulary Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Formulary Contact (Secondary)	Manager, Functional Operations		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center	TC1505	Southfeld	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	General Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Government Relations Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	HIPAA Privacy Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	HIPAA Security Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Hospice Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Interoperability Contact	Manager, Functional Operations		Kingsley	Chris		2484444160					Christopher.kingsley@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	MA Appeals/Grievances Contact	Chief Operating Officer		Hower	Johanna		8048594034					Johanna.Hower@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	08/11/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	MA Claims Processing Contact for Public Website	Manager, Claims and Recovery Operations		Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Marketing Contact	Plan President	Mr.	Hamor	Briggs		5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	05/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Medical Director	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Medicare Compliance Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/03/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Medicare Coordinator	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	02/09/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Medicare Part D Opioid Overutilization Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	02/15/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Medication Therapy Management Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	OffShore Subcontractor Contact	Manager	Mrs.	Stretch	Kaitlin		2486654275					kstretch@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	02/09/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Online Enrollment Center Contact (Back-up)	Enrollment Business Lead		Schulz	Bryan		5084390769					Bryan.Schulz@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	02/09/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Online Enrollment Center Contact (Optional)	Manager		Woods	Cheyenne		2484173449					cheyenne.woods@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Online Enrollment Center Contact (Primary)	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	02/09/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Part C Application Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Part C Reporting Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Part D Appeals	Manager		Moran	Vickie							Vickie.Moran@CVSHealth.com	620 Epsilon Dr		Pittsburgh	PA	15238	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	4125263320				PPO - BBA		C	Chicago
H5900	Part D Appeals Contact (Secondary)	Director		Christensen	Ann							Ann.Christensen@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	6023883829				PPO - BBA		C	Chicago
H5900	Part D Application Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Part D Benefits Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Part D Claims Submission Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Part D Exceptions Contact	Director, Medicare Programs		Frank	Jesica							frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8553440930				PPO - BBA		C	Chicago
H5900	Part D Exceptions Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8553440930				PPO - BBA		C	Chicago
H5900	Part D Price File Contact (Back-up)	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Part D Price File Contact (Optional)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Part D Price File Contact (Primary)	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Part D Quality Assurance Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Part D Reporting Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Patient Safety Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Payment Contact	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Personal Health Record Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Pharmacy Director	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Pharmacy Network Management Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Pharmacy Network Management Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Pharmacy Technical Help Desk Contact	Director, Medicare Programs		Frank	Jesica							frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8006008065				PPO - BBA		C	Chicago
H5900	Pharmacy Technical Help Desk Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8006008065				PPO - BBA		C	Chicago
H5900	Physician Incentive Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Plan Directory Contact for Public Website	Manager		Nelson	Jessica		8557162556					Jessica.Nelson@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Plan to Plan Reconciliation Contact	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Processor Contact	Manager, Claims and Recovery Operations		Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Quality Contact	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Reconciliation Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Reconciliation Contact (Secondary)	Manager, Pharmacy Operations		Jones	Marini		3135706777					Marini.Jones@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Recovery Audit Contact	Manager, Program Oversight	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	SNP Application Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	SNP State Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Surveillance Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	System Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Third Party Administrator (TPA) Liaison	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	1000 Town Center		Southfield	MI	48075	12/28/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	User Access Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/11/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Utilization Management Contact	Managing Director, Medical Management	Dr.	Park	Gerald		2485047408					Gerald.Park@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5900	Utilization Review Contact	Managing Director, Medical Management	Dr.	Park	Gerald		2485047408					Gerald.Park@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H5902	Automated TrOOP Balance Transfer Contact	NA	Mr.	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Backup User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Best Available Evidence Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Bid Primary Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	CAP Report Contact for Public Website	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Chief Financial Officer	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Chief Operating Officer	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Chief Information Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Chief Information Security Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	CMS Casework Communication Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Complaints Tracking Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Contact for Fraud Investigations	Executive Director	Ms	Miloro	Roxanne		8149432273	27004			8142487902	Rmiloro@seniorlifeebensburg.com	2891 Fairway Drive		Altoona	PA	16602	04/21/2023	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Coordination of Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Corporate Mailing						8145356000	22101			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Coverage Gap Discount Program (CGDP) Payment Contact			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Customer Service Operations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	DIR Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Emergency Part D Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Encounter Data & Risk Adjustment Operations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	10/18/2019	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Enrollment Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	EOB Transfer Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Financial Audit Contact	CFO	Mr	Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Financial Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Formulary Contact			N/A	N/A		1234567890	123				N/A@n/a.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	General Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Government Relations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	HIPAA Privacy Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	HIPAA Security Officer	IT Director		Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Interoperability Contact	Chief Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	MIrwin@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	02/16/2022	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	MA Appeals/Grievances Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Marketing Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Medical Director	Medical Director		Ratchford	Donald		8145356000	26007				DRatchford@physiciansolutionsgrp.com	401 Broad Street		Johnstown	PA	15906	02/26/2018	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Medicare Compliance Officer	Executive Director	Mrs.	Miloro	Roxanne		8144726060	27004				RMiloro@SeniorLifeEbensburg.com	429 Manor Drive		Ebensburg	PA	15931	12/09/2019	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Medicare Coordinator	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Medicare Part D Opioid Overutilization Contact	Medical Director		Ratchford	Donald		8145356000	26007				DRatchford@physiciansolutionsgrp.com	401 Broad Street		Johnstown	PA	15906	10/31/2018	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Medication Therapy Management Contact	Chief Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	03/13/2019	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Part C Application Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Part D Appeals	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H5902	Part D Appeals Contact (Secondary)	Chief Executive Officer	Mr.	i	Mark						8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	12/29/2020	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active	8145356000	22101			PACE - Nat		C	Philadelphia
H5902	Part D Application Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Part D Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Part D Claims Submission Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Part D Exceptions Contact	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H5902	Part D Price File Contact (Back-up)			N/A	N/A		1234567890	123				N/A@N/A.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Part D Price File Contact (Primary)			N/A	N/A		1234567890	123				N/A@N/A.com	N/A		N/A	PA	15906	01/22/2013	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Part D Quality Assurance Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Part D Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Patient Safety Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Payment Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Pharmacy Director			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Pharmacy Network Management Contact			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Pharmacy Technical Help Desk Contact			Rowland	Bob							Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active	7242751203	219			PACE - Nat		C	Philadelphia
H5902	Plan Directory Contact for Public Website	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Processor Contact	Claims Manager		Best	Karen		8145356000	22104			8142487902	KBest@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Quality Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@paceconsultingsolutions.com	401 Broad Street		Johnstown	PA	15906	10/03/2016	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Reconciliation Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Recovery Audit Contact	CFO	Mr	Dodson	David	M	8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Surveillance Contact			Irwin	Mark		8145356000	22101				Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	System Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Third Party Administrator (TPA) Liaison			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Utilization Management Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5902	Utilization Review Contact	ChieExecutive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE ALTOONA, INC.	National PACE	Senior LIFE Altoona / Ebensburg / Indiana	National PACE		Senior LIFE Altoona, Inc.	542	Yes	Active					PACE - Nat		C	Philadelphia
H5926	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	CAP Report Contact for Public Website			Services	Member		8006653072					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		3167066990					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/27/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	MA Claims Processing Contact for Public Website			Services	Member		8006653072					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H5926	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H5926	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H5926	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H5926	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	08/03/2017	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H5926	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H5926	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Plan Directory Contact for Public Website			Services	Member		8006653072					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Reconciliation Contact	Director, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					Rohit.Gupta2@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/15/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5926	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Local CCP	Molina Healthcare of Michigan	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5928	Agent/Broker Compensation Data Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Automated TrOOP Balance Transfer Contact	Senior Manager, Medicare Operations		Halley	Derek		8182286374					Derek.Halley@blueshieldca.com	6300 Canoga Ave,		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Backup User Access Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Best Available Evidence Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Bid Audit Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Bid Audit Site Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Bid Primary Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	CAP Report Contact for Public Website	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	CEO - CMS Administrator Contact	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/16/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	CEO - Senior Official for Contracting	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/16/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Chief Financial Officer	Senior Director, Medicare Finance	Mr.	Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Chief Operating Officer	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/16/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Chief Information Officer	Chief Information Officer	Ms.	Davis	Lisa		5106073600					Lisa.Davis@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Chief Information Security Officer	Chief Information Officer	Ms.	Davis	Lisa		5106073600					Lisa.Davis@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	CMS Casework Communication Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Complaints Tracking Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Contact for Fraud Investigations	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					marcos.mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Coordination of Benefits Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					alfonso.loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Corporate Mailing						5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Customer Service Operations Contact	Director		Mathews	Carolyn		5626135004					Carolyn.Mathews@blueshieldca.com	3021 Reynolds Ranch Pkwy		Lodi	CA	95240	09/07/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	DIR Contact	VP Pharmacy Services		Lum	Alison		5106073697					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	03/02/2022	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	DIR Contact (Secondary)	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/02/2022	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Electronic Health Record Contact	Compliance Manager		Martinez	Jesus		3238896638	3326				Jesus.Martinez@blueshieldca.com	601 Potrero Grande Drive		Monterey Park	CA	91755	12/27/2018	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Emergency Part D Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Emergency Part D Contact (Secondary)	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Employer Waiver Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland HIlls	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Encounter Data & Risk Adjustment Operations Contact	Senior Director, Actuary		Rodgers	John		3107442643					John.Rodgers@blueshieldca.com	100 N. Sepulveda Boulevard		El Segundo	CA	90245	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Enrollment Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	EOB Transfer Contact	Medicare Project & Program Manager		Zuehlke	Erica		2093713036				8558953519	zuehlke@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/07/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Financial Audit Contact	Senior Manager, Medicare Compliance	Mr.	Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Ave		Woodland Hills	CA	91367	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Financial Reporting Contact	Senior Director, Medicare Finance		Ballou	Taylor		5625806311					Taylor.ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Formulary Contact	Director, Formulary Strategy and P&T		Nguyen	Nhi		9168410342					Nhi.Nguyen@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Formulary Contact (Secondary)	Principal Pharmacist, Formulary Management		Trinh	Andy		3238276322					Andy.Trinh@blueshieldca.com	601 Potrero Grande Drive		Monterey Park	CA	91755	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	General Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Ave		Woodland Hills	CA	91367	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Government Relations Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	HIPAA Privacy Officer	Chief Privacy Officer		Keystone	David		5103013363					david.keystone@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/27/2022	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	HIPAA Security Officer	Chief Privacy Officer		Keystone	David		5103013363					david.keystone@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/27/2022	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Hospice Contact	Senior Program Manager		Fields	Torrie		4152295839					Torrie.Fields@blueshieldca.com	50 Beale St.		San Francisco	CA	94105	02/12/2018	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Interoperability Contact	VP Enterprise Digital Growth		Grimm	David		6196864233					david.grimm@blueshieldca.com	2275 Rio Bonito Way	Suite 250	San Diego	CA	92108	02/15/2022	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	MA Appeals/Grievances Contact	Supervisor, Medicare Appeals and Grievances		Lopez	Celina		8182286183				9163506593	celina.lopez@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	07/14/2020	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	MA Claims Processing Contact for Public Website	Senior Manager, Medicare Operations		Halley	Derek		8182286374					Derek.Halley@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Marketing Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Medical Director	Medicare Medical Director	Dr.	Siddiq	Khaliq		5627137953					Khaliq.Siddiq@blueshieldca.com	555 Anton Boulevard	Suite 800	Costa Mesa	CA	92626	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Medicare Compliance Officer	Senior Director, Medicare Compliance	Mr.	Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Medicare Coordinator	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Medicare Part D Opioid Overutilization Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					OpioidDUR@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/13/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Medication Therapy Management Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					Dawn.Becker-Ellison@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	OffShore Subcontractor Contact	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Online Enrollment Center Contact (Back-up)	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					marcos.mata@blueshieldca.com	6300 Canoga Ave		Woodland Hills	CA	91367	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Online Enrollment Center Contact (Optional)	WH Application Development and Support		Miller	Terri		8182282155					terri.miller@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	07/14/2020	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Online Enrollment Center Contact (Primary)	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Part C Application Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Part C Reporting Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Appeals	Supervisor, Medicare Appeals and Grievances		Lopez	Celina						9163506593	celina.lopez@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	07/14/2020	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active	8007764466				HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Appeals Contact (Secondary)	Senior Manager, Operations		Salam	Shahid							Shahid.Salam@blueshieldca.com	4203 Town Center Boulevard		El Dorado Hills	CA	95762	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active	8007764466				HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Application Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Benefits Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Claims Submission Contact	Lead Medicare Rx Benefits & Claims Specialist		Campbell	Leslie		5306263838					leslie.campbell@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Exceptions Contact	Director, Pharmacy Prior Authorization		March	Nancee							nancee.march@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active	8007764466				HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Exceptions Contact (Secondary)	Senior Manager, Medicare Compliance		Mata	Marcos							Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active	8007764466				HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Price File Contact (Back-up)	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106072901					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Price File Contact (Optional)	Business Analyst, Rx Benefit/Claims Implementation		Ng	Alvin		5106072964					alvin.ng@blueshieldca.com	601 12th Street		Oakland	CA	94105	01/14/2020	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Price File Contact (Primary)	Business Analyst, Rx Benefit/Claims Implementation		Ng	Alvin		5106072964					Alvin.Ng@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Quality Assurance Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Part D Reporting Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					marcos.mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Patient Safety Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					dawn.becker-ellison@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	07/14/2020	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Payment Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Pharmacy Director	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Pharmacy Network Management Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106072901					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Pharmacy Network Management Contact (Secondary)	Senior Program Manager, Medicare Rx Compliance		Nelson	Kimberly	C	5106073281					Kim.Nelson@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Pharmacy Technical Help Desk Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik							Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active	8889700933				HMO - Health Maintenance Organization		C	San Francisco
H5928	Pharmacy Technical Help Desk Contact (Secondary)	VP Pharmacy	Mrs	Lum	Alison						3238896254	Alison.Lum@blueshieldca.com	601 Potrero Grande Drive		Monterey Park	CA	91755	12/28/2020	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active	4159902891				HMO - Health Maintenance Organization		C	San Francisco
H5928	PHR Beneficiary Contact																	05/08/2019	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS	Blue Shield of California Promise Health Plan	California Physicians' Service	30	Yes	Active	8005440088				HMO - Health Maintenance Organization		C	San Francisco
H5928	Physician Incentive Contact	Director, Provider Services - Network		Gonzalez	Maria		3238534445					Maria.Gonzalez2@blueshieldca.com	601 Potrero Grande Drive		Monterey Park	CA	91755	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Plan Directory Contact for Public Website			Services	Member		8007764466					membersvcs@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Plan to Plan Reconciliation Contact	Financial Analyst Consultant		Dahl	Chris		8182282575					BSCP2PRecon@blueshieldca.com	3021 Reynolds Ranch Parkway		Lodi	CA	95240	05/24/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Processor Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106073281					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Quality Contact	Director, Case Management		Taylor	Christy		6197194536					christy.taylor@blueshieldca.com	313 Camino Del Rio	North, Ste. 1300	San Diego	CA	92108	12/16/2022	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Reconciliation Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Reconciliation Contact (Secondary)	Senior Director, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Recovery Audit Contact	Senior Manager, Medicare Compliance	Mr.	Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	SNP Application Contact			Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Surveillance Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	System Contact	Sr. Director, IT Product Management		Chambers	Shelley		1916866073					Shelley.Chambers@blueshieldca.com	4203 Town Center Boulevard		El Dorado Hills	CA	95762	09/07/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Third Party Administrator (TPA) Liaison	Senior Manager, Finance Analytics		Chen	Jacob		3107442819					Jacob.Chen@blueshieldca.com	100 N. Sepulveda Boulevard		El Segundo	CA	90245	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	User Access Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Utilization Management Contact	Senior Director, Utilization & Medical Review		Albertsen	Mirela		9168410418					Mirela.Albertsen@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5928	Utilization Review Contact	Senior Director, Utilization & Medical Review		Albertsen	Mirela		9168410418					Mirela.Albertsen@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/04/2021	2023	California Physicians' Service	Local CCP	Blue Shield of California	HMO/HMOPOS		California Physicians' Service	30	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5932	Agent/Broker Compensation Data Contact	Manager, Sales Support & Operations	Mr.	Thompson	Seth		4128883167					Seth.Thompson@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Automated TrOOP Balance Transfer Contact	VP, Pharmacy	Mr.	Yarnell	Eric		4129188830					EYarnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Backup User Access Contact	Manager, Medicare Compliance	Mr.	Dumnich	John		4129188431					jdumnich@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Best Available Evidence Contact	Senior Director,Operations	Ms.	Magliocco	Michelle		4122554810					mmagliocco@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Bid Audit Contact	Senior Director, Medicare Product	Mr.	Laverick	Aaron	H	4122557195					alaverick@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Bid Primary Contact	Senior Director, Medicare Product	Mr.	Laverick	Aaron	H	4122557195					alaverick@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Arthurs Peck	Dawn		4129188771				4129188771	Dawn.Arthurs-Peck@highmarkhealth.org	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	CEO - CMS Administrator Contact	President and CEO	Ms.	Duffield	Ellen		4122557273					eduffield@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	CEO - Senior Official for Contracting	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/21/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Chief Financial Officer	CFO Highmark Health Plan	Mr.	Bridges	Ja'Ron		4125441452					JaRon.Bridges@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/27/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Chief Operating Officer	SVP, Government Business Segment President	Ms.	Miller	Alexis	A	4125447389					Alexis.Miller@Highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/21/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Chief Information Officer	VP, Information Technology	Mr	Putila	Matt		4122554163					mputila@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Chief Information Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	CMS Casework Communication Contact	Director, Appeals & Grievances	Ms.	McKinney	Lisa		4122554604					lmckinney@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Complaints Tracking Contact	Sr. Quality Analyst, A&G	Ms.	Barbagallo	Toni Marie		4122557287					tbarbagallo@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Contact for Fraud Investigations	Director, Fraud, Waste and Abuse	Dr.	Berdell	Melissa		4126907432					mberdell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Coordination of Benefits Contact	Sr. Director, Operations	Ms.	Magliocco	Michelle		4122554810					COB-TPLMedicare@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Corporate Mailing						4122554640					medicareassured@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Operational Accounting	Mr.	Pellis	Matt		4122557173					mpellis@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Customer Service Operations Contact	Manager Business Operations	Mr.	Hartman	Josh		8006855209					jhartman@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	DIR Contact	VP, Controller		Cogan	Chris		4122554693					ccogan@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	DIR Contact (Secondary)	SVP, Chief Financial Officer	Mr.	Bridges	Ja'Ron		4122554162					jbridges@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Emergency Part D Contact	VP, Pharmacy	Mr.	Yarnell	Eric		4122558830				8889188830	eyarnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Emergency Part D Contact (Secondary)	Lead Compliance Analyst, Pharmacy	Ms.	Donohue	Julia		4124206467					jdonohue@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Encounter Data & Risk Adjustment Operations Contact	Senior Encounters Analyst	Mr.	McKay	Douglas		4129188447					GHP_Medicare_Encounters@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Enrollment Contact	Senior Director, Operations	Ms.	Magliocco	Michelle		4122554810					mmagliocco@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	EOB Transfer Contact	SVP, Operations	Mr.	Burgess	James		4122551318				4122551318	jburgess@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Financial Audit Contact	VP, Controller	Mr.	Cogan	Chris		4122554693					CCogan@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Financial Reporting Contact	Vice President, Accounting & Reportin	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Formulary Contact	Pharmacy Relations & Formulary Specialist	Ms.	Stein	Victoria		1412255725					vstein@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Formulary Contact (Secondary)			McDonnell	Kallyn		4129188692					KMcDonnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	General Contact	Medicare Compliance Officer	Ms.	Arthurs Peck	Dawn		4129188771				4129188771	Dawn.Arthurs-Peck@highmarkhealth.org	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Government Relations Contact	Medicare Compliance Officer	Ms.	Arthurs Peck	Dawn		4129188771					Dawn.Arthurs-Peck@highmarkhealth.org	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	HIPAA Privacy Officer	Chief Privacy and Data Ethics Officer	Ms.	Patrick	Justine		4125444643					justine.patrick@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	HIPAA Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Hospice Contact	Supervisor, Pharmacy Call Center	Mr.	Woods	Shane		4129188763					SWoods2@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Interoperability Contact	VP,  Data Analytics & Strategy	Mr.	Castle	Brian		4129188449					bcastle@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	MA Appeals/Grievances Contact	Director, Appeals and Grievances		McKinney	Lisa		4122554605					lmckinney@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	MA Claims Processing Contact for Public Website	SVP, Operations	Mr.	Burgess	James		4122551318					jburgess@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Marketing Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					Jillian.Pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Medical Director	Senior Medical Director	Dr.	Negin	Nathan		4122554335					nnegin@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Arthurs Peck	Dawn		4129188771					Dawn.Arthurs-Peck@highmarkhealth.org	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Medicare Coordinator	SVP, Operations	Mr.	Burgess	James		4122551318					jburgess@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Medicare Part D Opioid Overutilization Contact	VP, Pharmacy	Mr.	Yarnell	Eric		4129188830				4129188830	EYarnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Medication Therapy Management Contact	Senior Director,  Stars Quality	Dr.	Serrano	Daniel	N	4129188572					dserrano@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Online Enrollment Center Contact (Optional)	Manager, Enrollment, Systems Admin/Enrollment	Ms.	Blumentritt	Kristen		4122554172					KBlumentritt@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Online Enrollment Center Contact (Primary)	Senior Director, Operations	Ms.	Magliocco	Michelle		4122554810					mmagliocco@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part C Application Contact	Senior Director, Medicare Product	Mr.	Laverick	Aaron	H	4122557195					alaverick@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Arthurs Peck	Dawn		4129188771				4129188771	Dawn.Arthurs-Peck@highmarkhealth.org	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Appeals	Supervisor, Medicare Appeals		Earlewine	Melissa							mearlewine@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active	4122557203				HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Appeals Contact (Secondary)	Manager, Appeals		Wright	Kristie							kwright@highmarkwholecare.com	Four Gateway Center	444 Liberty Avenue, Suite 2100	Pittsburgh	PA	15222	11/01/2022	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active	4124206431				HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Application Contact	Senior Director, Medicare Product	Mr.	Laverick	Aaron	H	4122557195					alaverick@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Benefits Contact	VP, Pharmacy	Mr.	Yarnell	Eric		4129188830				8882452049	EYarnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Claims Submission Contact	Dir Initiative Mgt	Mr.	Smith	Cory		4129188825					csmith@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Exceptions Contact	VP, Pharmacy	Mr.	Yarnell	Eric						8882452049	EYarnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active	4129188830				HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Exceptions Contact (Secondary)	Director, Pharmacy Clinical Operations	Ms.	Nogrady	Lisa							lnogrady@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active	4122554256				HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Price File Contact (Back-up)	Director,  Pharmacy Business Operations	Ms.	Funkhouser	Christina		4122157123					cfunkhouser@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Price File Contact (Optional)	Director, Pharmacy Quality		Szekely	Jessica		4122554515					jessica.szekely@highmark.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	08/17/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Price File Contact (Primary)	VP, Pharmacy	Mr.	Yarnell	Eric		4129188830					EYarnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Quality Assurance Contact	VP, Pharmacy	Mr.	Yarnell	Eric		4129188830				4129188830	EYarnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsbugh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Part D Reporting Contact	Medicare Compliance Officer	Ms.	Arthurs Peck	Dawn		4129188771				4129188771	Dawn.Arthurs-Peck@highmarkhealth.org	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Patient Safety Contact	Vice President, Pharmacy Business Administration	Mr.	Yarnell	Eric		4129188830				4129188830	EYarnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Payment Contact	SVP, Chief Financial Officer	Mr.	Bridges	Ja'Ron		4122554162					jbridges@highmarkwholecare.com	Four Gateway Center	444 Liberty Avenue, Suite 2100	Pittsburgh	PA	15222	11/01/2022	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Pharmacy Director	VP, Pharmacy	Mr.	Yarnell	Eric		4129188830				4129188830	EYarnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Pharmacy Network Management Contact	Director,  Pharmacy Business Operations	Ms.	Funkhouser	Christina		4122157123					cfunkhouser@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Pharmacy Network Management Contact (Secondary)	VP, Pharmacy	Mr.	Yarnell	Eric		4129188830					EYarnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Pharmacy Technical Help Desk Contact			Wholecare	Highmark								Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	08/16/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active	8006855209				HMO - Health Maintenance Organization		C	Philadelphia
H5932	Pharmacy Technical Help Desk Contact (Secondary)	VP, Pharmacy		Yarnell	Eric						4129188830	eyarnell@highmarkwholecare.com	Four Gateway Center	444 Liberty Ave, Ste 2100	Pittsburgh	PA	15222	11/01/2022	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active	8006855209				HMO - Health Maintenance Organization		C	Philadelphia
H5932	Physician Incentive Contact	Senior Director, Stars Quality	Mr.	O'Donnell	William		4129188572					wodonnell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Plan Directory Contact for Public Website	Manager Business Operations	Mr.	Hartman	Josh		8006855209					jhartman@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Plan to Plan Reconciliation Contact	Sr Financial Analyst	Ms.	Trautvetter	Jill		4122557132					jtrautvetter@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Processor Contact	Director, Claims Processing	Ms.	Goheen	Theresa		4129188706					tgoheen@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Quality Contact	Interim Director, Quality Improvement	Ms.	Uncapher	Patricia		4129188790					puncapher@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Reconciliation Contact	VP, Controller		Cogan	Chris		4122554693					CCogan@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Reconciliation Contact (Secondary)	Chief Financial Officer	Mr.	Bridges	Ja'Ron		4122554162					jbridges@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Recovery Audit Contact	Director, Fraud, Waste and Abuse	Dr.	Berdell	Melissa		4126907432					mberdell@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	SNP Application Contact	Senior Director, Medicare Product	Mr.	Laverick	Aaron	H	4122557195					alaverick@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	SNP State Contact	Medicare Compliance Officer	Ms.	Arthurs Peck	Dawn		4129188771					Dawn.Arthurs-Peck@highmarkhealth.org	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Surveillance Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					jillian.pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	System Contact	Medicare Compliance Officer	Ms.	Arthurs Peck	Dawn		4129188771					Dawn.Arthurs-Peck@highmarkhealth.org	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Third Party Administrator (TPA) Liaison	Senior Financial Analyst		Trautvetter	Jill		4122557132					jtrautvetter@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	User Access Contact	Medicare Compliance Officer	Ms.	Arthurs Peck	Dawn		4129188771					Dawn.Arthurs-Peck@highmarkhealth.org	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Utilization Management Contact	Director, Clinical Operations	Ms.	Layman	Katrina		4122554173					klayman@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5932	Utilization Review Contact	Director, Clinical Operations	Ms.	Layman	Katrina		4122554173					klayman@highmarkwholecare.com	Fifth Avenue Place	120 Fifth Avenue	Pittsburgh	PA	15222	06/15/2023	2023	GATEWAY HEALTH PLAN, INC.	Local CCP	Highmark Wholecare Medicare Assured	HMO/HMOPOS		Highmark Health	123	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H5934	Automated TrOOP Balance Transfer Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Backup User Access Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Best Available Evidence Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Bid Primary Contact	Director of Accounting		Iffland	Bill		2394824673				2399856411	bill.iffland@hopehcs.org	9470 HealthPark Circle		Ft. Myers	FL	33908	07/28/2015	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	CAP Report Contact for Public Website	Manager, Quality		Vazquez	Delamliz		2399856402					Lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Ft. Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	CEO - CMS Administrator Contact	President & CEO	Ms.	Lampley	Jill		2394824673				2394827298	jill.lampley@hopehcs.org	9470 HealthPark Circle		Fort Myers	FL	33908	09/13/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	CEO - Senior Official for Contracting	President & CEO	Ms.	Lampley	Jill		2394824673				2394827298	jill.lampley@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33908	09/13/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Chief Financial Officer	CFO	Ms.	Lampley	Jill	S	2394824673				2394827298	jill.lampley@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33908	02/01/2008	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Chief Operating Officer		Ms	Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Chief Information Officer		Mr.	Rivera	John		2399857734					john.rivera@hopehcs.org	9470 Healthpark Circle		Fort Myers	FL	33908	04/29/2016	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Chief Information Security Officer		Mr.	Rivera	John		2399857734					john.rivera@hopehcs.org	9470 Healthpark Circle		Fort Myers	FL	33908	04/29/2016	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	CMS Casework Communication Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Complaints Tracking Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Contact for Fraud Investigations	CFO	Ms.	Lampley	Jill	S	2394824673				2394827298	jill.lampley@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33908	05/04/2018	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Coordination of Benefits Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Corporate Mailing						2394824673				2394827298	samira.beckwith@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33908	02/01/2008	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Coverage Gap Discount Program (CGDP) Payment Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Customer Service Operations Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	DIR Contact	Director of Accounting		Iffland	Bill		2399857767				2394259800	Bill.Iffland@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33901	03/15/2012	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Emergency Part D Contact	CFO	Ms.	Lampley	Jill	S	2394824673				2394827298	jill.lampley@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33908	12/22/2014	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Encounter Data & Risk Adjustment Operations Contact	Director of Pace		Vazquez	Delmaliz		2399856402					Lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Ft. Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Enrollment Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	EOB Transfer Contact			Vazquez	Delmaliz		2399856402				8666597223	lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Financial Audit Contact	Director of Accounting	Mr.	Iffland	Bill		2399857767				2394259800	Bill.Iffland@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33901	03/15/2012	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Financial Reporting Contact	Director of Accounting		Iffland	Bill		2394824673				2399856411	bill.iffland@hopehcs.org	9470 HealthPark Circle		Ft. Myers	FL	33908	07/28/2015	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Formulary Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	General Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Government Relations Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	HIPAA Privacy Officer	CFO	Ms.	Lampley	Jill	S	2394824673				2394827298	jill.lampley@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33908	05/04/2018	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	HIPAA Security Officer	CFO	Ms.	Lampley	Jill	S	2394824673				2394827298	jill.lampley@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33908	05/04/2018	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Interoperability Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	MA Appeals/Grievances Contact		Mr.	Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	MA Claims Processing Contact for Public Website			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Marketing Contact	Mission Support Coordinator		Wolfarth	Emily		2394899195				2394827298	Emily.Wolfarth@hopehospice.org	9470 HealthPark Circle		Ft. Myers	FL	33908	08/22/2013	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Medical Director	Medical Director	Dr.	Ross	Robin		2399856406					robin.ross@hopehcs.org	2668 Winkler Ave.		Fort Myers	FL	33901	04/27/2018	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Medicare Compliance Officer	Director of Pace	Ms.	Vazquez	Delmaliz		2399856402				2399856411	Lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Ft. Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Medicare Coordinator			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Ross	Robin		2399856406					robin.ross@hopehcs.org	2668 Winkler Ave.		Fort Myers	FL	33901	03/15/2019	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Medication Therapy Management Contact	Medical Director	Dr.	Ross	Robin		2399856406					robin.ross@hopehcs.org	2668 Winkler Ave.		Fort Myers	FL	33901	05/04/2018	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Part C Application Contact	Director of Pace		Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Part D Appeals	Director of Pace		Vazquez	Delmaliz							lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active	8666597223				PACE - Nat		C	Atlanta
H5934	Part D Application Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Part D Benefits Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Part D Claims Submission Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Part D Exceptions Contact			Vazquez	Delmaliz							lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active	8666597223				PACE - Nat		C	Atlanta
H5934	Part D Price File Contact (Back-up)			Joseph	Nicholas		2399856405					nicholas.joseph@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Part D Price File Contact (Primary)			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Part D Quality Assurance Contact			Vazquez Ayala	Lissie		2399856400				2399856411	lissie.vazquesayala@hopehcs.org	2668 Winkler Ave		Fort Myers	FL	33901	05/01/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Part D Reporting Contact	Director of Accounting		Iffland	Bill		2394824673	17767			2399856411	bill.iffland@hopehcs.org	9470 HealthPark Circle		Ft. Myers	FL	33908	03/04/2016	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Patient Safety Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Payment Contact	Director of Accounting		Iffland	Bill		2399857767				2394259800	Bill.Iffland@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33901	05/03/2013	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Pharmacy Director			Murphy	Brenna		8568404854					bmurphy@carekinesis.com	228 Strawbridge Drive		Moorestown	NJ	08057	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Pharmacy Network Management Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Pharmacy Technical Help Desk Contact			Galaida	Lisa							lisa.galaida@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	02/17/2022	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active	8666597223				PACE - Nat		C	Atlanta
H5934	PHR Beneficiary Contact																	03/15/2012	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE	Hope HealthCare Services	Hope Hospice and Community Services, Inc.	283	Yes	Active	8007953272				PACE - Nat		C	Atlanta
H5934	Plan Directory Contact for Public Website			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Plan to Plan Reconciliation Contact		Mr.	Iffland	Bill		2399857767					bill.iffland@hopehcs.org	9470 HealthPark Circle		Fort Myers	FL	33908	03/03/2017	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Processor Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Quality Contact			Vazquez	Delmaliz		8554543104					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Ft. Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Reconciliation Contact	Director of Accounting		Iffland	Bill		2399857767				2394259800	Bill.Iffland@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33901	03/15/2012	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Recovery Audit Contact	Director of Accounting	Mr.	Iffland	Bill		2399857767				2394259800	Bill.Iffland@hopehospice.org	9470 HealthPark Circle		Fort Myers	FL	33901	03/15/2012	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Surveillance Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	System Contact	Director of Pace		Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Third Party Administrator (TPA) Liaison			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/24/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	User Access Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Utilization Management Contact			Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5934	Utilization Review Contact		Mr.	Vazquez	Delmaliz		2399856402					lissie.vazquezayala@hopehcs.org	2668 Winkler Avenue		Fort Myers	FL	33901	04/19/2023	2023	HOPE HOSPICE AND COMMUNITY SERVICES, INC.	National PACE	Hope PACE	National PACE		Hope Hospice and Community Services, Inc.	283	Yes	Active					PACE - Nat		C	Atlanta
H5937	Agent/Broker Compensation Data Contact	Associate Vice President Sales		Eck	Brian		6126763380					beck@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/08/2018	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Automated TrOOP Balance Transfer Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					FIR_Transactions@ucare.org	500 Stinson Boulevard NE		Minnneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Backup User Access Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Best Available Evidence Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Bid Audit Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Bid Audit Site Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Bid Primary Contact	Corporate Actuary		Uding	Chris		6126763372					bids@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	CAP Report Contact for Public Website	Senior Regulatory  Auditor		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/14/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Chief Financial Officer	SVP and Chief Financial Officer	Ms.	Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/11/2016	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Chief Operating Officer	SVP and Chief Administrative Officer	Ms.	Schmitt	Pat		6126763460					pschmitt@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Chief Information Officer	Chief Information Officer	Mr	McDonald	Darin		9493098524					dmcdonald@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	06/13/2021	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Chief Information Security Officer	Chief Information Security Officer, Director	Mr	Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	CMS Casework Communication Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Complaints Tracking Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Contact for Fraud Investigations	Manager SIU		Weidemann	Angie		6128171655					aweidemann@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Coordination of Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Corporate Mailing						6126766500				6126766501	sschwartz@ucare.org	UCare	500 Stinson Boulevard NE	Minneapolis	MN	55413	02/11/2016	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Senior		Ly	Tong		6126277157					tly@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/17/2021	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Customer Service Operations Contact	CS Support Services Sr Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	DIR Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	DIR Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Emergency Part D Contact	Customer Service Workforce Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Emergency Part D Contact (Secondary)	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	600 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Encounter Data & Risk Adjustment Operations Contact			Olberding	Milissia		6126763205					molberding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/29/2019	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Enrollment Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	EOB Transfer Contact	CS Support Services Sr Manager		Vang	Pakou		6126763585				6128842145	pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Financial Audit Contact	Controller	Mr.	Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/11/2016	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Financial Reporting Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/11/2016	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Formulary Contact	Pharmacy Supervisor		Merk	Zachariah		6126763483					zmerk@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	07/29/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Formulary Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	General Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Government Relations Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	HIPAA Privacy Officer	Associate General Counsel - Privacy Officer		Heacox	Katie		5073408378					kheacox@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	HIPAA Security Officer	Chief Information Security Officer, Director		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Hospice Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Interoperability Contact	VP, Deputy General Counsel		Owen	Elizabeth		6513992800					eowen@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	MA Appeals/Grievances Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	MA Claims Processing Contact for Public Website	CCO Audit & Compliance Manager		Tenhoff	Reed		6126763664					rtenhoff@ucare.og	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/11/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Marketing Contact	Government Relations Materials Coordinator		Morales	Ana Sophia		6122945641					amorales@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/22/2021	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Medical Director	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	McMahon	Jane		6124567817					federalgrleadershipteam@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/30/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Medicare Coordinator	Federal Government Relations Manager		Mitchell	Milonda		6122945143					mmitchell1@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/12/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030					anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Medication Therapy Management Contact	Pharmacy Quality Manager		Bower	Erika		6122945800				6128842321	ebower@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/10/2021	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	OffShore Subcontractor Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Online Enrollment Center Contact (Back-up)	MBE Operations Manager		Rooney	Courtney		6126763468					crooney@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	11/12/2020	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Part C Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/11/2016	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Part C Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/13/2021	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Appeals	A&G Regulatory and Compliance Specialist		Wood	Nakia							cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945668				HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Appeals Contact (Secondary)	Manager Appeals & Grievances		Paciorek	Joshua							jpaciorek@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945225				HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Claims Submission Contact	Data Analyst Sr.		Krishnan	Kamali		6122945146					kkrishnan@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/30/2019	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Exceptions Contact	Vice President Pharmacy Management		Mitsch	Patrick						6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945051				HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Exceptions Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam						6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	6122945030				HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Price File Contact (Back-up)	Pharmacy Operations Manager Sr.		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Price File Contact (Optional)	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Price File Contact (Primary)	Sr Manager, Government Programs		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	01/18/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Quality Assurance Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Part D Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/13/2019	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Patient Safety Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Payment Contact	Chief Financial Officer		Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/11/2016	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Pharmacy Director	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	patmitsch@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Pharmacy Network Management Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Pharmacy Technical Help Desk Contact	Director, Customer Service		Moore	LaTasha							LaTasha_Monroe@expressscripts.com	13051 N Telecom Parkway	Suite 150	Temple Terrace	FL	33637	01/18/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H5937	PHR Beneficiary Contact																	02/11/2016	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS	UCare	UCare Minnesota	238	Yes	Active	8775231515				HMO - Health Maintenance Organization		C	Chicago
H5937	Physician Incentive Contact	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/06/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Plan Directory Contact for Public Website	CS Support Services Sr Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Plan to Plan Reconciliation Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/11/2016	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Processor Contact	Pharmacy Operations Manager Sr		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Quality Contact	Vice President Quality Management		Hanley	Greg		6122945296					ghanley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/28/2016	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Reconciliation Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Reconciliation Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Recovery Audit Contact	Audit Director	Mr.	Schach	Steve		6126763562					sschach@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	554132615	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	SNP Application Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	SNP State Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Surveillance Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	System Contact	Chief Information Security Officer, Director		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Third Party Administrator (TPA) Liaison	Accountant		Zator	Chris		6126763563					czator@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/15/2021	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	User Access Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/19/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Utilization Management Contact	VP Clinical Services		Wickman	Amy		6126763418					awickman@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5937	Utilization Review Contact	Clinical Regulatory Specialist		Brown	Julie	B	6126763433					jbbrown@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	HMO/HMOPOS		UCare Minnesota	238	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H5938	Agent/Broker Compensation Data Contact	Sr. VP Marketing and Admin Services	Mr.	Glennon	Tom		8503833393				8505237261	tpglennon@chp.org	PO Box 15349		Tallahassee	FL	32317	01/12/2015	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Automated TrOOP Balance Transfer Contact	Director, PBM Operations	Mrs.	allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	12/30/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Backup User Access Contact	Compliance and Privacy Officer	Mr.	Kaminski	Frank	C	8505237304				8505237419	fckaminski@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/15/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Best Available Evidence Contact	Enrollment Director	Ms.	Iscrupe	Catherine		8503833502				8503833590	caiscrupe@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/15/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Bid Audit Contact	Executive  Vice President, Finance & CFO	Mr.	Bass	Sabin	C	8505237326				8503833441	scbass@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/04/2019	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Bid Audit Site Contact	Executive Vice President, Finance & CFO	Mr.	Bass	Sabin	C	8505237326				8503833441	scbass@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/04/2019	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Bid Primary Contact	Executive  Vice President, Finance & CFO	Mr.	Bass	Sabin	C	8505237326				8503833441	scbass@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/04/2019	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	CAP Report Contact for Public Website	Compliance and Privacy Officer	Mr.	Kaminski	Frank	C	8505237304				8505237419	fckaminski@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/15/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	CEO - CMS Administrator Contact	President & Chief Executive Officer	Mr.	Bass	Sabin	C	8503833362				8503833497	scbass@chp.org	P.O. Box 15349		Tallahassee	FL	32317	07/10/2023	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	CEO - Senior Official for Contracting	President & Chief Executive Officer	Mr.	Bass	Sabin	C	8503833362				8503833497	scbass@chp.org	P.O. Box 15349		Tallahassee	FL	32317	07/10/2023	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Chief Financial Officer	CFO	Mr.	Bedenbaugh	Jeff	Y	8503833306				8503833441	jybedenbaugh@chp.org	P.O. Box 15349		Tallahassee	FL	32317	07/17/2023	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Chief Operating Officer	Chief Operating Officer and SVP of QI and Clinical	Ms.	White	Polly	A	8505237266				8505237362	pawhite@chp.org	P O Box 15349		Tallahassee	FL	32317	12/27/2018	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Chief Information Officer	Sr VP Chief Information Officer	Mr	Smith	Eric	M	8503833431				8503833441	emsmith@chp.org	P .O. Box 15349		Tallahassee	FL	32317	01/25/2016	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Chief Information Security Officer	Sr VP Chief Information Officer	Mr.	Smith	Eric	M	8503833431				8503833441	emsmith@chp.org	P O Box15349		Tallahassee	FL	32317	03/14/2016	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	CMS Casework Communication Contact	Director, Member Services	Ms.	Mackey	Felecia		8505237302				8503833339	ffmackey@chp.org	PO Box 15349		Tallahassee	FL	32317	08/15/2011	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Complaints Tracking Contact	Member Services Director	Ms	Mackey	Felecia		8505237302				8503833339	ffmackey@chp.org	P.O. Box 15349		Tallahassee	FL	32308	05/11/2015	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Contact for Fraud Investigations	Compliance and Privacy Officer	Mr.	Kaminski	Frank	C	8505237304				8505237419	fckaminski@chp.org	PO Box 15349		Tallahassee	FL	32317	11/15/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Coordination of Benefits Contact	Director, PBM Operations	Mrs.	Allie	Cindy		6127776722				6127776706	cobmedd@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	12/30/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Corporate Mailing						8503833311				8503833339	tpglennon@chp.org	P.O. Box 15349		Tallahassee	FL	32317	01/26/2017	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Bawek	Paul	A	8503833427				8503833441	pabawek@chp.org	P.O. Box 15349		Tallahassee	FL	32308	12/13/2018	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Customer Service Operations Contact	Director, Member Services	Ms.	Mackey	Felecia		8503833311				8503833338	ffmackey@chp.org	P.O. Box 15349		Tallahassee	FL	32317	12/05/2019	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	DIR Contact	Actuarial Services Director	Ms.	Cornman	Adriel	W	8505237481				8503833441	awcornman@chp.org	P.O. 15349		Tallahassee	FL	32317	07/17/2023	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	DIR Contact (Secondary)	Actuarial Analyst	Ms	Dolly	Elaine	M	8505235619				8505237326	emdolly@chp.org	P O Box 15349		Tallahassee	FL	32317	03/13/2017	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Electronic Health Record Contact	Associate Medical Director	Dr	Omotayo	Adekunle	F	8505237242				8503833497	afomotayo@chp.org	P. O. Box 15349		Tallahassee	FL	32317	08/04/2014	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Emergency Part D Contact	Pharmacist		Nacin	Renee		8503833506					crnacin@chp.org	PO Box 15349		Tallahassee	FL	32317	12/31/2020	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Emergency Part D Contact (Secondary)	Compliance Director	Mr.	Kaminski	Frank	C	8505237304				8505237419	fckaminski@chp.org	P.O. Box 15349		Tallahassee	FL	32317	12/26/2018	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Data Services Manager	Ms	Grabowski	Rebecca	A	8505235610				8503833441	ragrabowski@chp.org	P.O.Box 15349		Tallahassee	FL	32317	11/15/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Enrollment Contact	Enrollment Supervisor	Ms.	Iscrupe	Catherine		8503833502				8503833590	caiscrupe@chp.org	P.O. Box 15349		Tallahassee	FL	32317	04/13/2009	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	EOB Transfer Contact	Director, PBM Operations	Mrs.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/30/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Financial Audit Contact	Compliance and Privacy Officer	Mr.	Kaminski	Frank	C	8505237304					fckaminski@chp.org	P.O. Box 15349		Tallahassee	FL	32317	07/17/2023	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Financial Reporting Contact	Comptroller	Mr.	Bawek	Paul		8503833427				8503833441	pabawek@chp.org	P.O. Box 15349		Tallahassee	FL	32317	04/13/2009	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Formulary Contact	Medical Director	Dr.	Omotayo	Adekunle	F	8505237242				8503833497	afomotayo@chp.org	P.O. Box 15349		Tallahassee	FL	32317	10/23/2018	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Formulary Contact (Secondary)	Supervisor Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	12/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	General Contact	Compliance and Privacy Officer	Mr.	Kaminski	Frank	C	8505237304				8505237419	fckaminski@chp.org	PO Box 15349		Tallahassee	FL	32317	11/15/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Government Relations Contact	President and Chief Executive Officer	Mr.	Hogan	John		8503833492				8503833497	jmhogan@chp.org	P.O. Box 15349		Tallahassee	FL	32317	04/13/2009	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	HIPAA Privacy Officer	Compliance and Privacy Officer	Mr.	Kaminski	Frank	C	8505237304				8505237419	fckaminski@chp.org	P.O. Box 15349		Tallahassee	FL	32317	03/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	HIPAA Security Officer	Sr. Vice President, Chief Information Officer	Mr.	Smith	Eric		8503833431				8503833441	emsmith@chp.org	P.O. Box 15349		Tallahassee	FL	32317	04/13/2009	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Hospice Contact	Manager Medication Management Services	Mrs.	Duncan	Anne	A	8505235648				8503833413	amduncan@chp.org	PO BOX 15349		Tallahassee	FL	32317	12/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Interoperability Contact	Compliance and Privacy Officer	Mr.	Kaminski	Frank		8505237304					fckaminski@chp.org	PO Box 15349		Tallahassee	FL	32317	04/13/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	MA Appeals/Grievances Contact	Grievance and Appeals Manager	Ms.	Alexander	Suzie	M	8505235680				8503833413	appeals@chp.org	P.O. Box 15349		Tallahassee	FL	32317	10/23/2018	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	MA Claims Processing Contact for Public Website	CFO	Mr.	Bedenbaugh	Jeff	Y	8503833306				8503833441	jybedenbaugh@chp.org	P.O. Box 15349		Tallahassee	FL	32317	07/17/2023	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Marketing Contact	Medicare Sales Manager	Ms.	Kilgore	Toni		8503833344				8505237334	tvkilgore@chp.org	P.O. Box 15349		Tallahassee	FL	32317	06/04/2018	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Medical Director	Medical Director	Dr.	Omotayo	Adekunle	F	8505237242				8503833497	afomotayo@chp.org	P.O. Box 15349		Tallahassee	FL	32317	10/03/2017	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Medicare Compliance Officer	Compliance and Privacy Officer	Mr.	Kaminski	Frank	C	8505237304				8505237419	fckaminski@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/15/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Medicare Coordinator	Compliance and Privacy Officer	Mr	Kaminski	Frank	C	8505237304				8505237419	fckaminski@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/15/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	12/30/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Medication Therapy Management Contact	Supervisor MTM Case/Care Management	MR.	Helbling	Matthew		8666862223				8666862220	MTM.leadership@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55120	12/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Online Enrollment Center Contact (Back-up)	Sr. Enrollment Rep	Ms.	Dorsey	Ossie		8503833459				8505237369	ohdorsey@chp.org	P.O. Box 15349		Tallahassee	FL	32317	04/13/2009	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Online Enrollment Center Contact (Primary)	Enrollment Manager	Ms.	Iscrupe	Cathy		8503833502				8505237369	enrollment@chp.org	P.O. Box 15349		Tallahassee	FL	32317	06/06/2011	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Part C Application Contact	Sr. VP Marketing and Admin Services	Mr	Glennon	Tom		8503833393				8505237261	tpglennon@chp.org	PO Box 15349		Tallahassee	FL	32317	01/12/2015	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Part C Reporting Contact	Medicare Sales Manager	Ms	Kilgore	Toni	V	8503833344				8505237334	tvkilgore@chp.org	P.O. Box 15349		Tallahassee	FL	32317	06/04/2018	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Appeals	Regulatory Director		Davis	Megan						8006936703	Clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	Clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55120	12/30/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Application Contact	Sr. VP Marketing and Admin Services	Mr	Glennon	Tom		8503833393				8505237261	tpglennon@chp.org	PO Box 15349		Tallahassee	FL	32317	01/12/2015	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Benefits Contact	Director, Benefits Operations	Mrs.	Gergin	Ashley		5073018360					Agergin@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	12/30/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Claims Submission Contact	Functional Business Consultant-Government Programs	Mr.	Brooke	Lance		4026862603					lbrooke@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/30/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Exceptions Contact	Regulatory Director		Davis	Megan						8006936703	Clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	Clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55120	12/30/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Price File Contact (Back-up)	Business Solutions Analyst Sr.	Mrs.	Trudeau	Ashley		6127771338					Ashley.trudeau@primetherapeutics.com	Prime Therapeutics LLC 2900 Ames Crossing Road		Eagan	MN	55121	12/30/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Price File Contact (Optional)	Business Solutions Analyst Lead	Mr.	Bushman	John		6127599623					John.Bushman@primetherapeutics.com	Prime Therapeutics LLC 2900 Ames Crossing Road		Eagan	MN	55121	12/30/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Price File Contact (Primary)	Compliance Officer	Mr.	Kaminski	Frank		8505237304					fckaminski@chp.org	PO Box 15349		Tallahassee	FL	32317	03/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Quality Assurance Contact	Pharmacist		Nacin	Renee		8503833506					crnacin@chp.org	PO Box 15349		Tallahassee	FL	32317	12/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Part D Reporting Contact	Manager Medication Management Services	Mrs.	Duncan	Annne	M	8505235648					amduncan@chp.org	P.O. Box 15349		Tallahassee	FL	32317	12/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Patient Safety Contact	Pharmacist		Nacin	Renee		8503833506					crnacin@chp.org	PO Box 15349		Tallahassee	FL	32317	12/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Payment Contact	Executive Vice President, Finance & CFO	Mr.	Bass	Sabin	C	8505237326				8503833441	scbass@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/04/2019	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Pharmacy Director	Pharmacist		Nacin	Renee		8503833506					crnacin@chp.org	PO Box 15349		Tallahassee	FL	32317	12/31/2020	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Pharmacy Network Management Contact	VP Network  Management	Ms.	Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Pharmacy Network Management Contact (Secondary)	Senior Director Network Client Services	Ms.	Hanley	Megan		6127773969					megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	12/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Pharmacy Technical Help Desk Contact	Director Member Services	Mr.	Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC 2900 Ames Crossing Road		Eagan	MN	55121	12/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8665903010				HMO - Health Maintenance Organization		C	Atlanta
H5938	Pharmacy Technical Help Desk Contact (Secondary)	Dir. member SVCS Government Programs	mr	Bunch	Jonathan							jbunch@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	10/18/2019	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active	8665903010				HMO - Health Maintenance Organization		C	Atlanta
H5938	Physician Incentive Contact	Medical Director	Dr.	Omotayo	Adekunle	F	8505237242				8503833497	afomotayo@chp.org	P.O. Box 15349		Tallahassee	FL	32317	05/13/2019	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Plan Directory Contact for Public Website	Network Services Supervisor	Ms.	Maige	Beth		8505237307				8503833413	emmaige@chp.org	P.O. Box 15349		Tallahassee	FL	32317	04/13/2009	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Plan to Plan Reconciliation Contact	Actuarial Services Manager	Mr	Jones	David	D	8505237481				8503833441	ddjones@chp.org	P.O. 15349		Tallahassee	FL	32317	03/03/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Processor Contact	Director, PBM Operations	Mrs.	Allie	Cindy		6127776722				6127776706	Medicareclaimresearch@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	12/30/2022	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Quality Contact	Director, Quality Improvement	Ms	Goble	Mary	A	8503833498				8505237320	magoble@chp.org	P.O. Box 15349		Tallahassee	FL	32317	12/27/2018	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Reconciliation Contact	Actuarial Services Manager	Mr	Jones	David	D	8505237481				8503833441	ddjones@chp.org	P. O. Box  15349		Tallahassee	FL	32317	03/03/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Reconciliation Contact (Secondary)	Actuarial Analyst ll	Ms	Dolly	Elaine	M	8505235619				8503833441	emdolly@chp.org	P O Box 15349		Tallahassee	FL	32317	03/13/2017	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Recovery Audit Contact	Compliance and Privacy Officer	Mr.	Kaminski	Frank	C	8505237304				8505237419	fckaminski@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/15/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Surveillance Contact	Compliance and Privacy Officer	Mr.	Kaminski	Frank	C	8505237304				8505237419	fckaminski@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/15/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	System Contact	Sr. Vice President, Chief Information Officer	Mr.	Smith	Eric		8503833431				8503833441	emsmith@chp.org	P.O. Box 15349		Tallahassee	FL	32317	04/13/2009	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Third Party Administrator (TPA) Liaison	Accountant	Ms	Williams	Camise	Q	8505237253				8503833441	cqwilliams@chp.org	P. O . Box 15349		Tallahassee	FL	32317	09/27/2018	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	User Access Contact	Compliance and Privacy Officer	Mr.	Kaminski	Frank	C	8505237304				8505237419	fckaminski@chp.org	P.O. Box 15349		Tallahassee	FL	32317	11/15/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Utilization Management Contact	Director Care Coordination	Mrs.	Davis	Brenda	G	8505237301				8503833310	bgdavis@chp.org	P.o. Box 15349		Tallahassee	FL	32317	03/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5938	Utilization Review Contact	Director Care Coordination	Mrs.	Davis	Brenda	G	8505237301				8503833310	bgdavis@chp.org	P.o. Box 15349		Tallahassee	FL	32317	03/30/2021	2023	CAPITAL HEALTH PLAN	Local CCP	Capital Health Plan	HMO/HMOPOS		Guidewell Mutual Holding Corporation	594	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H5943	Agent/Broker Compensation Data Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Automated TrOOP Balance Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189			5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Backup User Access Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Best Available Evidence Contact	Director, Enrollment & Reconciliation		Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/28/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Bid Audit Contact	CVP Strategic Iniatives & Product Development	Ms	Selby	Jill		5629898382					jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Bid Audit Site Contact	CVP Strategic Initiatives & Product Development	Ms	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Bid Primary Contact	CVP Strategic Initiatives & Product Development	Ms	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	CAP Report Contact for Public Website	Chief Operating Officer	Ms.	Monk	Nancy		5629898320				5629895225	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	CEO - CMS Administrator Contact	President, Medicare	Mrs.	Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	CEO - Senior Official for Contracting	Chief Executive Officer	Dr.	Jain	Sachin		5629898314				5629895225	sjain@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/30/2020	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Chief Financial Officer	Chief Financial Officer	Mr	Plumb	Michael		5629971589					MPlumb@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	11/02/2020	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Chief Operating Officer	Chief Operating Officer	Mrs.	Monk	Nancy		5629898320				5629895225	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Chief Information Officer	Chief Information Officer	Mr.	Goode	Josh		5623082789					jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Chief Information Security Officer	Chief Information Officer	Mr.	Goode	Josh		5623082789				5629895225	jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	CMS Casework Communication Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/18/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Complaints Tracking Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Contact for Fraud Investigations	Chief Risk Executive		Hawkins	Gineette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	03/07/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Coordination of Benefits Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189			5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Corporate Mailing						5629895100				5629895200	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/11/2012	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	Isaac	Sharon		5629894423					sisaac@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2018	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Customer Service Operations Contact	Director, (Customer) Member Services	Ms.	McBeath	Kim		5629971805				5629895181	kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/27/2014	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	DIR Contact	Financial Accounting Specialist	Ms.	McClour	Tina		5629894459				5629890101	tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	03/03/2016	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	DIR Contact (Secondary)	Manager Revenue Accounting	Ms.	Moreno	Sonia		5623081122					smoreno@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	03/03/2016	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Emergency Part D Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		3237027662				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/21/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Emergency Part D Contact (Secondary)	Director,  Technical Pharmacy Operations	Ms.	Vaca	Ivette		5629971544				5629973196	ivaca@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/02/2016	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Employer Waiver Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Encounter Data & Risk Adjustment Operations Contact	Chief Data Officer		Leung	Moon		5629895269					mleung@scanhealthplan.com	3800 Kilroy Airport Way suite 100		Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Enrollment Contact	Director, Enrollment & Reconciliation		Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/28/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	EOB Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189				5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Financial Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Financial Reporting Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/11/2012	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Formulary Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Formulary Contact (Secondary)	Clinical Pharmacist	Ms.	Truong	Weilan		5629973187				5629973196	wtruong@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/03/2021	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	General Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Government Relations Contact	VP of Government Relations		Hill	Ryann		2023499008				5629899439	rhill@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	HIPAA Privacy Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835					a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	HIPAA Security Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835					a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Hospice Contact	Manager, Pharmacy Experience and Access	Mr.	Tran	Tri		5623082884				5629973196	TMTran@scanhealthplan.com	3800 Kilroy Airport Way		Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Interoperability Contact	VP, IT Software & Services	Mr.	Carren	Marc		5629971821					mcarren@scanhealthplan.com	3800 Kilroy Airport Way, Suite 100		Long Beach	CA	90806	02/10/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	MA Appeals/Grievances Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	MA Claims Processing Contact for Public Website	Vice President, Claims & Shared Services	Mr.	Wheeler	Nathan		5623084341					nwheeler@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Marketing Contact	Compliance Specialist	Mr.	Lin	Richard		5623081156					rlin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	10/02/2021	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Medical Director	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629899439	RBatraM.D@scanhelathplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Medicare Compliance Officer	Compliance Officer	Ms.	Hawkins	Ginette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	07/16/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Medicare Coordinator	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist Programs	Ms.	Kelley	Mackenzie		5629973165				5629973196	mkelley@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/26/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Medication Therapy Management Contact	Director Pharmacy Quality & 5 Star	Mr.	Dinh	Matthew		5629895261				5629973196	mdinh@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/03/2020	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	OffShore Subcontractor Contact	Dir, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131				5629895120	ecordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment and Reconciliation	Ms.	Gongora	Irene		5629895209				5629895243	IGongora@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/31/2015	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Online Enrollment Center Contact (Primary)	Director, Enrollment & Reconciliation	Mr.	Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Part C Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Part C Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Part D Appeals	Director, Grievance & Appeals		Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/12/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active	5626371290	1290			HMO - Health Maintenance Organization		C	San Francisco
H5943	Part D Appeals Contact (Secondary)	Director, Grievance & Appeals		Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way Mail Stop 220		Long Beach	CA	90801	01/11/2021	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active	5629895100	1290			HMO - Health Maintenance Organization		C	San Francisco
H5943	Part D Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Part D Benefits Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	04/29/2021	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Part D Exceptions Contact	Senior Pharmacy Manager	Mr.	Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/01/2021	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	San Francisco
H5943	Part D Price File Contact (Back-up)	Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfiled	OH	45014	12/01/2021	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Part D Price File Contact (Optional)	Pharmacy Analyst		Ramirez	Anthony		5623084348	4348			5629973196	a.ramirez@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/01/2021	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Part D Quality Assurance Contact	CVP/Chier Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Part D Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Patient Safety Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Payment Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/11/2012	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Pharmacy Director	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Pharmacy Network Management Contact	Network Acct Director, Retail Strategy	Ms.	Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		St Louis	MO	63121	01/23/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkwy	STE 150	Temple Terrace	FL	33637	12/01/2021	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	San Francisco
H5943	Physician Incentive Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Plan Directory Contact for Public Website	Director, (Customer) Member Services	Ms.	McBeath	Kim		8777787226					kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/03/2020	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Plan to Plan Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	P2PAdmin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/09/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Processor Contact	Senior Director Government Programs, Medicare	Ms.	Gibson	Sharon		8052361175					sggibson@express-scripts.com	One Express Way		St. Louis	MO	63121	01/03/2018	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Quality Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/02/2015	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Reconciliation Contact (Secondary)	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Recovery Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	SNP Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	SNP State Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Surveillance Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	System Contact	Chief  Technology Exective	Mr.	Goode	Josh		5623082789					jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/02/2016	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Third Party Administrator (TPA) Liaison	Financial Accounting Specialist	Ms.	McClour	Tina		5629894459					tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2018	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	User Access Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Utilization Management Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5943	Utilization Review Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	VillageHealth	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Agent/Broker Compensation Data Contact	Vice President of Medicare Sales	Mr.	Tolle	Rob		4699997675					Rob.Tolle@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	04/16/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Manosca	Nova		8587905873					PartDCAT@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/31/2016	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Backup User Access Contact			Rassmussen	Eric		7754204825					eric.rassmussen@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Best Available Evidence Contact	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Bid Audit Contact	Chief Compliance Officer	Mr	Ramirez	Philip		7757709348				7757709360	philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	07/09/2019	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Bid Audit Site Contact	Sr. Program Manager	Mr	Cahill	Eric		7757709245				7757709360	eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Bid Primary Contact	Sr. Program Manager	Mr	Cahill	Eric		7757709245				7757709360	eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	CAP Report Contact for Public Website	Marketing Director		Belli	Libby		7757709450					libby.belli@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	08/20/2018	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	CEO - CMS Administrator Contact	CEO	Mr	Jemmoua	Kamal		7757709325					kamal.jemmoua@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	04/17/2019	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	CEO - Senior Official for Contracting	CEO	Mr.	Jemmoua	Kamal		7757709325					kamal.jemmoua@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	04/17/2019	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Chief Financial Officer	Chief Financial Officer	Mr.	Hsieh	David		6103823300					david.hsieh@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Chief Operating Officer	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Chief Information Officer	Vice President of IT	Mr.	Rasmussen	Eric		7757709234				7757709060	eric.rasmussen@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89510	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Chief Information Security Officer	CISO - UHS	Mrs.	Sassaman	Kim		6103824858					kim.sassaman@uhsinc.com	367 S Gulph RD		King of Prussia	PA	19406	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	CMMI Model Point of Contact	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/28/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	CMS Casework Communication Contact	Chief Compliance Officer	Mr.	Ramirez	Philip	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Complaints Tracking Contact	Director of Operations		Revada	Liz		7757709207					liz.revada@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Contact for Fraud Investigations	SIU Investigator	Mrs.	Kast	Shannon		7754204840					Shannon.Kast@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Coordination of Benefits Contact	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Corporate Mailing						7757709245					eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	12/17/2018	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Coverage Gap Discount Program (CGDP) Payment Contact	Pharmacy Director		Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89052	03/26/2018	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Customer Service Operations Contact	Chief Operating Officer		Koltz	Patrick		7757709240					patrick.koltz@uhsinc.com	1510 Meadow Wood Ln		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	DIR Contact	CEO	Mr	Jemmoua	Kamal		6109924579				7757709360	kamal.jemmoua@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	04/17/2019	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	DIR Contact (Secondary)	Director Pharmacy	Mr.	Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/09/2018	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Electronic Health Record Contact	Director Health Services		Estipona	Steve		7757709462					steve.estipona@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	12/17/2018	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Emergency Part D Contact	Director Pharmacy	Mr.	Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/28/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Emergency Part D Contact (Secondary)	Manager of Pharmacy Services	.	Holybee	Jonni		7757373028					jonni.holybee@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Employer Waiver Contact	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	04/16/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Encounter Data & Risk Adjustment Operations Contact	Chief Development Officer		Henriques	Dominic		7757709282					dominic.henriques@uhsinc.com	1510 Meadow Wood Ln		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Enrollment Contact	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	EOB Transfer Contact	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240				9999999999	Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Financial Audit Contact	Manager of Finance	Mr.	Lopez	Robert		7757709374					Robert.lopez3@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	08/01/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Financial Reporting Contact	Manager of Finance	Mr.	Lopez	Robert		7757709374					Robert.lopez3@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	08/01/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Formulary Contact	Sup Formulary Operations		Nyawabila	Christina		8587906297					FMT@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/31/2016	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Formulary Contact (Secondary)	Pharmacy Director		Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	07/09/2019	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	General Contact	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	04/16/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Government Relations Contact	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	04/16/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	HIPAA Privacy Officer	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	04/16/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	HIPAA Security Officer	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	04/16/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Hospice Contact	Health Services Director		Estipona	Steve		7757709462					Steve.Estipona@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	01/31/2018	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Interoperability Contact	VP Information Technology	Mr.	Rassmussen	Eric		7754204825					eric.rassmussen@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	MA Appeals/Grievances Contact	Director of Operations		Revada	Liz		7757709207					liz.revada@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Marketing Contact	Chief Compliance Officer		Ramirez	Philip	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Medical Director	Chief Medical Director	Dr.	Biondi	Traci		7757701510					traci.biondi@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/09/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	07/31/2018	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Medicare Coordinator	Chief Compliance Officer	Mr.	Ramirez	Philip	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Medicare Part D Opioid Overutilization Contact			Emoto	Julianne		8587905846					julianne.emoto@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/09/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Medication Therapy Management Contact	Clinical Solutions Mgr II		Nguyen	Linh		8587906627					MTMP@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/31/2016	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	OffShore Subcontractor Contact	Strategic Services Manager	Mrs.	Evans	Ilene		7757709245					ilene.evans@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Online Enrollment Center Contact (Back-up)	Director of Medicare Sales	Ms.	Saintil	Adrienne		7757701564					Adrienne.Saintil@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/28/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Online Enrollment Center Contact (Optional)	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Online Enrollment Center Contact (Primary)	Vice President of Medicare Sales	Mr.	Tolle	Rob		4699997675					Rob.Tolle@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	06/12/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Part C Application Contact	Sr. Program Manager	Mr.	Cahill	Eric		7757709245					eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Part C Reporting Contact	Chief Compliance Officer	Mr.	Ramirez	Philip	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Part D Appeals	Part D Appeals 1	Ms.	Redd Guinto	Karen							karen.reddguinto@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8587906584				HMO - Health Maintenance Organization		C	San Francisco
H5945	Part D Appeals Contact (Secondary)	Part D Appeals 2		Redd Guinto	Karen							karen.reddguinto@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8587906584				HMO - Health Maintenance Organization		C	San Francisco
H5945	Part D Application Contact	Sr Program Manager	Mr	Cahill	Eric	J	7754204835					eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/31/2021	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Part D Benefits Contact	Director of Pharmacy	Mr	Huang	David		3177528432					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	12/23/2019	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Part D Claims Submission Contact	Sup Medicare PDE Operations		Blansfield	John		8582915304					PDE@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	08/02/2017	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Part D Exceptions Contact	Manager, QA & Client Services		Nguyen	Quan							Quan.nguyen@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/28/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8587907151				HMO - Health Maintenance Organization		C	San Francisco
H5945	Part D Exceptions Contact (Secondary)	Dir PA Clinical Programs		McGurran	Shawn							Shawn.McGurran@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/28/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8587906682				HMO - Health Maintenance Organization		C	San Francisco
H5945	Part D Price File Contact (Back-up)	Medicare Part D Program MGR I		Niemi	Kristin		8587906455					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	03/28/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Part D Price File Contact (Primary)	Medicare D Program MGR I		Niemi	Kristin		8587906455					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/28/2018	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Part D Quality Assurance Contact	Director Pharmacy		Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/21/2017	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Part D Reporting Contact	Medicare Part D Project Manager		Scott	Susan		8587906565					MedicarePartDProjectManagers@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/31/2016	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Patient Safety Contact	Pharmacy Services Manager	.	Holybee	Jonni		7757709244					jonni.holybee@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Payment Contact	Manager of Finance	Mr.	Lopez	Robert		7757709374					Robert.lopez3@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	08/01/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Pharmacy Director	Pharmacy Director	Mr.	Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Ren	NV	89502	03/28/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Pharmacy Network Management Contact	Director, Configuration Services		Lujan	Jennifer		8587906565					jennifer.lujan@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	11/20/2017	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Pharmacy Network Management Contact (Secondary)	Manager, PNS & Claims Operations		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/31/2016	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Pharmacy Technical Help Desk Contact	Direct Contact Center Services		Battle	Dorry							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/22/2017	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8445877389				HMO - Health Maintenance Organization		C	San Francisco
H5945	Pharmacy Technical Help Desk Contact (Secondary)	Direct Contact Center Services		Battle	Dorry							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/31/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8445877389				HMO - Health Maintenance Organization		C	San Francisco
H5945	Physician Incentive Contact	Director of Network Management	Jr	Maronde	James		7757709300					james.marondejr@uhsinc.com	639 Isbell Road Ste. 400		Reno	NV	89509	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Plan Directory Contact for Public Website	Marketing Director		Belli	Libby		7757709450					libby.belli@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	09/07/2017	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Plan to Plan Reconciliation Contact	Manager of Finance	Mr.	Lopez	Robert		7757709374					Robert.lopez3@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	08/01/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Processor Contact	Director, Medicare Programs		Davis-Jones	DeLona		8587906229					DeLona.Davis-Jones@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	08/02/2017	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Quality Contact	Director of Quality Improvement		Martinez	Johanna		7757709524					johanna.martinez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	11/14/2019	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Reconciliation Contact	Manager of Finance	Mr.	Lopez	Robert		7757709374					Robert.lopez3@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	08/01/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Reconciliation Contact (Secondary)	Chief Finance Officer	Mr.	Hsieh	David		6103824858					david.hsieh@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	08/01/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Recovery Audit Contact	Chief Compliance Officer	Mr.	Ramirez	Philip	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	SNP Application Contact	Sr Program Manager	Mr.	Cahill	Eric	J	7754204835					eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/31/2021	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	SNP State Contact	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	04/16/2020	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Surveillance Contact	Director of Operations	Ms.	Revada	Liz		7757709207					liz.revada@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/08/2022	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	System Contact	VP Information Technology		Rassmussen	Eric		7754204825					eric.rassmussen@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Third Party Administrator (TPA) Liaison	Pharmacy Director		Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89052	03/28/2018	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	User Access Contact	Chief Compliance Officer	Mr.	Ramirez	Philip	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Utilization Management Contact	Manager, QA & Client Services		Nguyen	Quan		8587907151					Quan.nguyen@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	08/02/2017	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5945	Utilization Review Contact	Dir PA Clinical Programs		McGurran	Shawn		8587906682					Shawn.McGurran@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/31/2016	2023	PROMINENCE HEALTHFIRST	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5959	Agent/Broker Compensation Data Contact	Director, Channel Management and Oversight		Lopez	Kris		6516627792					kris.lopez@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/03/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Automated TrOOP Balance Transfer Contact	Director, PBM Operations		Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/21/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Backup User Access Contact	Government Compliance Officer		Hogan	Carrie		6516621900					carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Best Available Evidence Contact	Manager, Business Services		Daniels	Cassandra		6516623468					Cassandra.Daniels@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/03/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Bid Audit Contact	Asst. Actuary		Zeterlu	Angela		6516620420					angela.zeterlu@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Bid Audit Site Contact	Asst. Actuary		Zeterlu	Angela		6516620420					angela.zeterlu@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Bid Primary Contact	Asst. Actuary		Zeterlu	Angela		6516620420					angela.zeterlu@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	CAP Report Contact for Public Website	Government Compliance Officer		Hogan	Carrie		6516621900					carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	CEO - CMS Administrator Contact	President & Chief Executive Officer	Ms.	Erickson	Dana		6516628904					Dana.erickson@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	CEO - Senior Official for Contracting	President Government Markets, SVP	Ms.	Engel	Monica		6516627329					monica.engel@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Chief Financial Officer	Senior Vice President, Chief Financial Officer	Mr.	Uribe	John		6516629501					John.Uribe@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Chief Operating Officer	President Government Markets, SVP	Ms.	Engel	Monica		6516627329					monica.engel@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Chief Information Officer	Director	Mr	Wike	Tim		6516629066					tim.wike@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Chief Information Security Officer	VP Digital Platforms & Cybersecurity	Mr	Groshong	Chris		6516628786					Christopher.Groshong@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/12/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	CMS Casework Communication Contact	Manager Appeals & Grievances		Bazzarre	Tom		6516629643					Tom.bazzarre@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	07/14/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Complaints Tracking Contact	Manager Appeals & Grievances		Bazzarre	Tom		6516629643					Tom.bazzarre@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	07/14/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Contact for Fraud Investigations	Director Operational Risk Management Performance		Dickinson	Richard	A	6516623532					richard.dickinson@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Coordination of Benefits Contact	Business Services  Mgr		Daniels	Cassandra		6516623468					government.program.service.request@bcbsmn.com	3400 Yankee Dr		Eagan	MN	55122	06/27/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Corporate Mailing						8663408654					contact@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	01/16/2018	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst Sr		Voves	Alex		6516623606					Alex.Voves@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Customer Service Operations Contact	Director, Business Transformation		Hovick	Denise		6516628864					denise.hovick@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	DIR Contact	Actuary		Legatt	Sarah		6516626757					sarah.legatt@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	DIR Contact (Secondary)	Financial Analyst, Sr		Voves	Alex		6516623606					alex.voves@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Electronic Health Record Contact	Medical Director	Dr	Fendrich	Amy		6516620854					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/04/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Emergency Part D Contact	Director, Pharmacy Ops Support		Ibrahim	Sonya		6516627412					sonya.ibrahim@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Emergency Part D Contact (Secondary)	Director, Pharmacy Operations		Mitchell	Angela		6516623607					angela.mitchell@clearstonesolutions.com	3400 Yankee Drice		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Employer Waiver Contact	Director Gov't Program Management for Medicare		Hower	Sara		6516624156					sara.hower@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/04/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Encounter Data & Risk Adjustment Operations Contact	Director, Enterprise Risk Adjustment		Lee	Rachel		6516629701					Rachel.Lee@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/18/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Enrollment Contact	Mgr Business Infrastructure Services		McWaters	Alisha		6516621755					alisha.mcwaters@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	EOB Transfer Contact	Director, PBM Operations		Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/21/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Financial Audit Contact	Manager, Regulatory Internal Audit	Mr	Haile-Selassie	Moguss		6516628966					moguss.haile-selassie@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/09/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Financial Reporting Contact	Dir Sr Corporate Controller		Long	Darlene		6516621704					Darlene.Long@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Formulary Contact	Pharmacist Business Segment Director		Boreen	Donna		6516621264					donna.boreen@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	01/29/2018	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/14/2020	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	General Contact	Director Medicare Operations		Snegosky	Jeff		6127194387					Jeff.snegosky@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Government Relations Contact	Chief Lobbyist		Nelson	Lin		6516627123					lin.nelson@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	HIPAA Privacy Officer	Deputy General Counsel/Privacy Officer	Ms	Roberge	Kathy		6516622890					kathleen.roberge@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	HIPAA Security Officer	SVP Chief Operating Officer		Smith	Carey		6516622739					carey.smith@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Hospice Contact	Operations Business Analyst		Dick	Beth		6516629644					beth.dick@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	03/19/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Interoperability Contact	Government Compliance Officer		Hogan	Carrie		6516621900					carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	MA Appeals/Grievances Contact	Manager Consumer Service Center		Brown	Robyn		6516627446					robyn.brown@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	MA Claims Processing Contact for Public Website	Manager, Business Services		Daniels	Cassandra		6516623468					cassandra.daniels@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Marketing Contact	Compliance Manager- Government Markets		Danisch	Gary		6516622072					Gary.danisch@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/15/2021	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Medical Director	Medical Director	Dr	Fendrich	Amy		6516620854					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/04/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Medicare Compliance Officer	Government Compliance Officer	Ms.	Hogan	Carrie		6516621900					carrie.hogan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Medicare Coordinator	Director Medicare Operations		Daniels	Cassie		6516623468					Cassandra.Daniels@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Medicare Part D Opioid Overutilization Contact	Supv Pharmacists		Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/07/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Medication Therapy Management Contact	Mgr. Pharmacy Services		Sharma	Anita		6516629221					anita.sharma@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	OffShore Subcontractor Contact	Compliance Manager- Government Markets		Danisch	Gary		6516622072					Gary.danisch@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Online Enrollment Center Contact (Back-up)	Manager, Business Services		Daniels	Cassandra		6516623468				6516623500	cassandra.daniels@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Online Enrollment Center Contact (Primary)	Mgr Business Infrastructure Services		McWaters	Alisha		6516621755					alisha.mcwaters@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Part C Application Contact	Product Consultant, Pr		Snyder	Amanda		6516623774					Amanda.Snyder@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/07/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Part C Reporting Contact	Director Medicare Operations		Littrell	Sue		6516622670					sue.littrell@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Part D Appeals	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/31/2021	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active	8006936651				PPO - BBA		C	Chicago
H5959	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/07/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active	8006936651				PPO - BBA		C	Chicago
H5959	Part D Application Contact	Product Consultant, Pr		Snyder	Amanda		6516623774					Amanda.Snyder@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/07/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Part D Benefits Contact	Director, Benefit Operations		Gergen	Ashley		6517772506					agergen@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/14/2020	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Part D Claims Submission Contact	Functional Business Consultant - Gov't Programs		Brooke	Lance		4026862603				4029702545	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/14/2020	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Part D Exceptions Contact	Med D Coverage		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/31/2021	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active	8006936651				PPO - BBA		C	Chicago
H5959	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/07/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active	8006936651				PPO - BBA		C	Chicago
H5959	Part D Price File Contact (Back-up)	Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/14/2020	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Part D Price File Contact (Optional)			Tastad	Emily		6518085779					emily.tastad@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	02/16/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Part D Price File Contact (Primary)			Aschoff	Ted		6516628777					theodore.aschoff@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Part D Quality Assurance Contact	Director, Pharmacy Ops Support		Ibrahim	Sonya		6516627412					Sonya.Ibrahim@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Part D Reporting Contact	Director Medicare Operations		Littrell	Sue		6516622670					sue.littrell@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Patient Safety Contact	Pharmacist Business Segment Director		Boreen	Donna		6516621264					donna.boreen@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	10/13/2020	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Payment Contact	Dir Sr Corporate Controller		Long	Darlene		6516621704					Darlene.Long@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Pharmacy Director	Pharmacist Business Segment Director		Boreen	Donna		6516621264					Donna.Boreen@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	01/29/2018	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Pharmacy Network Management Contact	AVP, Network Mangement		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/31/2021	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Pharmacy Network Management Contact (Secondary)	Sr Dir, Network Management		Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/29/2020	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Pharmacy Technical Help Desk Contact	Director, Member Services		Pretlow	Jennifer							jennifer.pretlow@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Rd	Eagan	MN	55121	06/30/2021	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active	8006482778				PPO - BBA		C	Chicago
H5959	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	06/30/2021	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active	8006482778				PPO - BBA		C	Chicago
H5959	PHR Beneficiary Contact																	07/17/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO	Blue Cross and Blue Shield of Minnesota	Aware Integrated, Inc.	642	Yes	Active	8003822000				PPO - BBA		C	Chicago
H5959	Physician Incentive Contact	Dir. Product Mgmt		Hower	Sara		6516624156					Sara.Hower@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/03/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Plan Directory Contact for Public Website	Digital Content Strategist		Cosgrove	Patrick		6516623727					patrick.cosgrove@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/02/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Plan to Plan Reconciliation Contact	Manager, Financial Reporting		Harrelson	Michael		6516628490				6516622200	Michael.Harrelson@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Processor Contact	Director, PBM Operations		Allie	Cindy		6127776722				6127777606	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/21/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Quality Contact	Director Program Management		Galle Franklin	Jeanne		6516628837					jeanne.gallefranklin@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/23/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Reconciliation Contact	Financial Analyst, Sr		Voves	Alex		6516623606					alex.voves@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Reconciliation Contact (Secondary)	Actuary		Legatt	Sarah		6516626757					sarah.legatt@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Recovery Audit Contact	Director, Government Markets Audit	Mr.	Longar	Tom		6516629724					thomas.longar@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	04/04/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	SNP Application Contact	Product Consultant, Pr		Snyder	Amanda		6516623774					Amanda.Snyder@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/07/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	SNP State Contact	Manager, Special Needs Plan		Kosel	Karla		6516624166					Karla.Kosel@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/03/2022	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Surveillance Contact	Director, Channel Management and Oversight		Lopez	Kris		6516627792					Kris.Lopez@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/13/2021	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	System Contact	Director	Mr.	Wike	Tim		6516629066					tim.wike@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Third Party Administrator (TPA) Liaison	Financial Analyst Senior		Voves	Alex		6516623606					Alex.Voves@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	08/21/2023	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	User Access Contact	Compliance Manager Government Markets		Danisch	Gary		6516622072					Gary.danisch@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	04/13/2021	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Utilization Management Contact	Medical Director	Dr	Fendrich	Amy		6516620854					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/04/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5959	Utilization Review Contact	Medical Director	Dr	Fendrich	Amy		6516620854					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/29/2019	2023	BCBSM, Inc.	Local CCP	Blue Cross and Blue Shield of Minnesota	Local PPO		Aware Integrated, Inc.	642	Yes	Active					PPO - BBA		C	Chicago
H5965	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/15/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/15/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/15/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H5965	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H5965	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/15/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H5965	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H5965	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H5965	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/15/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H5965	PHR Beneficiary Contact																	09/27/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H5965	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/15/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5965	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF WASHINGTON	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H5969	Agent/Broker Compensation Data Contact	Senior Director of Product Management	Mr	Cravalho	Andreas		8089731546				8089730726	acravalho@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	08/13/2021	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Automated TrOOP Balance Transfer Contact	Enrollment Manager	Ms.	Brown	Virginia		8089737535					vbrown@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	04/26/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Backup User Access Contact	Compliance Manager	Ms.	Kalawa	Pua		8089731653					pkalawa@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	07/01/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Best Available Evidence Contact	Enrollment Manager	Ms	Brown	Virginia		8089737535				8089737373	vbrown@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Bid Audit Contact	Chief Financial Officer	Mr.	Luper	Joel		8089735967				8089732625	jluper@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	01/09/2023	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Bid Audit Site Contact	Chief Financial Officer	Mr.	Luper	Joel		8089735967				8089732625	Jluper@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	01/09/2023	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Bid Primary Contact	Chief Financial Officer	Mr.	Luper	Joel		8089735967				8089732625	Jluper@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	01/09/2023	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	CAP Report Contact for Public Website	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Culley-Trotman	Francoise	E	8138466424				8089732625	fculley-trotman@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Culley-Trotman	Francoise	E	8138466424				8089732625	fculley-trotman@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Chief Financial Officer	Chief Financial Officer	Mr.	Luper	Joel		8089735967				8089732625	JLuper@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	01/09/2023	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Chief Operating Officer	Chief Executive Officer	Ms.	Culley-Trotman	Francoise	E	8089732476				8089732625	fculley-trotman@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Chief Information Officer	Chief Information Officer	Mr.	Morgan	Todd		8089731711					tmorgan@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Chief Information Security Officer	Chief Information Officer	Mr.	Morgan	Todd		8089731711					tmorgan@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	CMS Casework Communication Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Complaints Tracking Contact	Vice President of Operations	Mr.	Brennan	Pat		8089731655				8089732632	pbrennan@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Contact for Fraud Investigations	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Coordination of Benefits Contact	Enrollment Manager	Ms	Brown	Virginia		8089737535				8089737373	vbrown@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Corporate Mailing						8089732476				8089732625	fculley-trotman@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	08/13/2021	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Coverage Gap Discount Program (CGDP) Payment Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Customer Service Operations Contact	Director of Plan Operations	Mr.	Janicek	Jerome		8089736320				8089733810	jjanicek@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	DIR Contact	Chief Financial Officer	Mr.	Luper	Joel		8089735967				8089732625	JLuper@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	01/09/2023	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	DIR Contact (Secondary)	Financial Planning and Analysis Manager	Ms.	Lum	Kris		8089737481				8089737404	klum@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Emergency Part D Contact	Pharmacy Director	Ms.	Bannister	Hanh		7147151026				8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	12/23/2021	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Emergency Part D Contact (Secondary)	Pharmacy Manager of Clinical Services	Ms.	Chock	Evelyn		8087818072				8089736327	echock@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	12/30/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Employer Waiver Contact	Chief Executive Officer	Ms.	Culley-Trotman	Francoise	E	8089732476				8089732625	fculley-trotman@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Encounter Data & Risk Adjustment Operations Contact	Financial Planning and Analysis Manager	Ms.	Lum	Kris		8089737481				8089737404	klum@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Enrollment Contact	Enrollment Manager	Ms	Brown	Virginia		8089737535				8089737373	vbrown@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	EOB Transfer Contact	Claims Manager	Mr	Takamine	Davin		8089730727				8089732140	dtakamine@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Financial Audit Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Financial Reporting Contact	Chief Financial Officer	Mr.	Luper	Joel		8089735967				8089732625	JLuper@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	01/09/2023	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Formulary Contact	Pharmacy Director	Ms.	Bannister	Hanh		8089736843				8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	06/01/2021	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Formulary Contact (Secondary)	Clinical Pharmacy Operations Manager		Redfern	Andrea	G	4045484033				4045484033	Andrea.Redfern@ingenio-rx.com	4931 Payson Way SE		Atlanta	GA	30339	06/01/2021	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	General Contact	Chief Executive Officer	Ms.	Culley-Trotman	Francoise	E	8089732476				8089732625	fculley-trotman@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Government Relations Contact	Chief Customer Officer	Ms	Arcena	Paula		8089736426				8089730204	parcena@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	HIPAA Privacy Officer	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	HIPAA Security Officer	IT Manager	Mr	Rushworth	Robert		8089731567				8089730726	rrushworth@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Hospice Contact	Pharmacy Director	Ms.	Bannister	Hanh		8089736843				8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Interoperability Contact	Chief Information Officer	Mr.	Morgan	Todd		8089731711					tmorgan@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	MA Appeals/Grievances Contact	Vice President of Plan Operations	Mr.	Brennan	Pat		8089731655				8089732140	pbrennan@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	MA Claims Processing Contact for Public Website	Claims Manager	Mr	Takamine	Davin		8089730727				8089732140	dtakamine@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Marketing Contact	Sr. Director of Product Management	Mr	Cravalho	Andreas		8089731546				8089730204	acravalho@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Medical Director	Chief Medical Officer	Dr	Okamoto	Gary		8089731564				8089730726	gokamoto@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Medicare Compliance Officer	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Medicare Coordinator	Compliance Manager	Ms.	Kalawa	Pua		8089731653					pkalawa@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	07/01/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Medicare Part D Opioid Overutilization Contact	Chief Medical Officer	Dr	Okamoto	Gary		8089731564				8089730726	gokamoto@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Medication Therapy Management Contact	Pharmacy Director	Ms.	Bannister	Hanh		8089736843				8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	OffShore Subcontractor Contact	Chief Executive Officer	Ms.	Culley-Trotman	Francoise	E	8089732476				8089732625	fculley-trotman@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Online Enrollment Center Contact (Back-up)	Enrollment Manager	Ms	Brown	Virginia		8089737535				8089737373	vbrown@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Online Enrollment Center Contact (Optional)	Enrollment Manager	Ms	Brown	Virginia		8089737535				8089737373	vbrown@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Online Enrollment Center Contact (Primary)	Enrollment Manager	Ms	Brown	Virginia		8089737535				8089737373	vbrown@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Part C Application Contact	Chief Executive Officer	Ms.	Culley-Trotman	Francoise	E	8089732476				8089732625	fculley-trotman@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Part C Reporting Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Appeals	Grievance and Appeals Manager	Mr.	Sebastian	Raymond						8089732140	rsebastian@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active	8669732471				HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Appeals Contact (Secondary)	Senior Vice President of Operations	Mr.	Brennan	Pat						8089732140	pbrennan@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active	8089731655				HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Application Contact	Chief Executive Officer	Ms.	Culley-Trotman	Francoise	E	8089732476				8089732625	fculley-trotman@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Benefits Contact	Pharmacy Director	Ms.	Bannister	Hanh		8089736843				8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Claims Submission Contact	Pharmacy Director	Ms.	Bannister	Hanh		8089736843				8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Exceptions Contact	Pharmacy Director	Ms.	Bannister	Hanh						8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active	8669737418				HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Exceptions Contact (Secondary)	Pharmacy Director	Ms.	Bannister	Hanh						8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active	8669737418				HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Price File Contact (Back-up)	Business Change Manager	Ms.	Nicholson-Sampson	Amanda		8053190159				8053190159	amanda.nicholson-sampson@carelon.com	2716 Brewer St.		Lakewood	CA	90712	02/08/2023	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Price File Contact (Optional)	Business Change Manager	Ms.	Mendez	Daniela		3232193390				3232193390	daniela.mendez@carelon.com	1723 Loma Road		Montebello	CA	90640	02/08/2023	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Price File Contact (Primary)	Pharmacy Director	Ms.	Bannister	Hanh		8089736843				8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Quality Assurance Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	07/01/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Part D Reporting Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Patient Safety Contact	Pharmacy Director	Ms.	Bannister	Hanh		8089736843				8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Payment Contact	Chief Financial Officer	Mr.	Luper	Joel		8089735967				8089732625	JLuper@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	01/09/2023	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Pharmacy Director	Pharmacy Director	Ms.	Bannister	Hanh		8089736843				8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Pharmacy Network Management Contact	Pharmacy Director	Ms.	Bannister	Hanh		8089736843				8089736327	hbannister@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Pharmacy Network Management Contact (Secondary)	Chief Medical Officer	Dr	Okamoto	Gary		8089731564				8089730726	gokamoto@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Pharmacy Technical Help Desk Contact	Director Pharmacy Management	Mr.	Warner	Raymond							Raymond.Warner@Ingenio-RX.com	21215 Burkbank Blvd		Woodland Hills	CA	91367	04/26/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	San Francisco
H5969	Pharmacy Technical Help Desk Contact (Secondary)	Program Director	Ms.	De Leon	Rosanna							Rosanna.DeLeon@Ingenio-RX.com	2 Speedwell Ave.		Morrison	NJ	07960	04/26/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active	2012411560				HMO - Health Maintenance Organization		C	San Francisco
H5969	Physician Incentive Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	07/01/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Plan Directory Contact for Public Website			Customer Service	AlohaCare		8089736395				8089737410	info@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Luper	Joel		8089735967				8089732625	JLuper@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	01/09/2023	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Processor Contact	Claims Manager	Mr	Takamine	Davin		8089730727				8089732140	dtakamine@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Quality Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	Jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	07/01/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Reconciliation Contact	Chief Financial Officer	Mr.	Luper	Joel		8089735967				8089732625	JLuper@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	01/09/2023	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Reconciliation Contact (Secondary)	Financial Planning & Analysis Manager	Ms.	Lum	Kris		8089737481				8089737404	klum@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Recovery Audit Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	SNP Application Contact	Chief Executive Officer	Ms.	Culley-Trotman	Francoise	E	8089732476				8089732625	fculley-trotman@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	SNP State Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Surveillance Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	System Contact	IT Manager	Mr.	Rushworth	Robert		8089731567				8089730726	rrushworth@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Third Party Administrator (TPA) Liaison	Enrollment Manager	Ms	Brown	Virginia		8089737535				8089737373	vbrown@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	User Access Contact	Compliance Officer	Ms.	Mellor	June		8089730690				8089737410	jmellor@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Utilization Management Contact	Vice President of Health Services	Ms.	Broderick	Samra		8089732369				8089730726	sbroderick@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5969	Utilization Review Contact	Vice President of Health Services	Ms.	Broderick	Samra		8089732369				8089730726	sbroderick@alohacare.org	1357 Kapiolani Blvd., Suite G101		Honolulu	HI	96814	03/03/2022	2023	ALOHACARE	Local CCP	AlohaCare	HMO/HMOPOS		AlohaCare	10	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H5970	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H5970	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025807929				PPO - BBA		C	Kansas City
H5970	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H5970	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5024682494				PPO - BBA		C	Kansas City
H5970	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	8008658715				PPO - BBA		C	Kansas City
H5970	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025800475				PPO - BBA		C	Kansas City
H5970	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5970	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H5978	Automated TrOOP Balance Transfer Contact	NA	Mr.	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Backup User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Best Available Evidence Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Bid Primary Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	CAP Report Contact for Public Website	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Chief Financial Officer	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Chief Operating Officer	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Chief Information Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Chief Information Security Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	CMS Casework Communication Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Complaints Tracking Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Contact for Fraud Investigations	Executive Director	Ms	Sauers	Robert		6109545433	31167			8142487902	Rsauers@seniorlifelehighvalley.com	3365 High Point Blvd		Bethlehem	PA	18017	04/19/2023	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Coordination of Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Corporate Mailing						8145356000	22101			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Coverage Gap Discount Program (CGDP) Payment Contact			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Customer Service Operations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	DIR Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Emergency Part D Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Encounter Data & Risk Adjustment Operations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	10/18/2019	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Enrollment Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	EOB Transfer Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Financial Audit Contact	CFO	Mr	Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Financial Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Formulary Contact			N/A	N/A		1234567890	123				N/A@n/a.com	N/A		N/A	PA	15906	03/24/2014	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	General Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Government Relations Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	HIPAA Privacy Officer	IT Director	Mr.	Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	HIPAA Security Officer	IT Director		Keck	Cliff		4129630700	144				Ckeck@pas-lp.com	209 Sigma Drive		Pittsburgh	PA	15238	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Interoperability Contact	Chief Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	MIrwin@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	02/16/2022	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	MA Appeals/Grievances Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Marketing Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Medical Director	Medical Director		Collier	AnnElise		6109545433	100				Acollier@PhysicianSolutionsGRP.com	3365 High Point Blvd		Bethlehem	PA	18017	04/19/2023	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Medicare Compliance Officer	Executive Director	Mr	Sauers	Robert		6109545433	31167				RSauers@SeniorLifeLehighValley.com	3365 High Point Boulevard		Bethlehem	PA	18017	06/24/2020	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Medicare Coordinator	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Medicare Part D Opioid Overutilization Contact	Medical Director		Collier	AnnElise		6109545433	100				Acollier@PhysicianSolutionsGRP.com	3365 High Point Blvd		Bethlehem	PA	18017	04/19/2023	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Medication Therapy Management Contact	Chief Executive Officer	Mr.	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	03/13/2019	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Part C Application Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Part D Appeals	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H5978	Part D Appeals Contact (Secondary)	Chief Executive Officer	Mr.	Irwin	Mark						8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	12/29/2020	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active	8145356000	22101			PACE - Nat		C	Philadelphia
H5978	Part D Application Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Part D Benefits Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Part D Claims Submission Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Part D Exceptions Contact	Chief Financial Officer	Mr	Dodson	David						8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active	8145356000	22102			PACE - Nat		C	Philadelphia
H5978	Part D Price File Contact (Back-up)			N/A	N/A		1234567890	123				N/A@N/A.com	N/A		N/A	PA	15906	03/24/2014	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Part D Price File Contact (Primary)			N/A	N/A		1234567890	123				N/A@N/A.com	N/A		N/A	PA	15906	03/24/2014	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Part D Quality Assurance Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Part D Reporting Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Patient Safety Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Payment Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Pharmacy Director			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Pharmacy Network Management Contact			Rowland	Bob		7242751203	219				Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Pharmacy Technical Help Desk Contact			Rowland	Bob							Browland@granerx.com	464 Nixon Road		Cheswick	PA	15024	10/03/2016	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active	7242751203	219			PACE - Nat		C	Philadelphia
H5978	Plan Directory Contact for Public Website	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Processor Contact	Claims Manager		Best	Karen		8145356000	22104			8142487902	KBest@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Quality Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Reconciliation Contact	CFO		Dodson	David		8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Recovery Audit Contact	CFO	Mr	Dodson	David	M	8145356000	22102				Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Surveillance Contact			Irwin	Mark		8145356000	22101				Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	System Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Third Party Administrator (TPA) Liaison			N/A	N/A		1234567899					N/A@N/A.com	N/A		N/A	PA	15906	03/10/2016	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	User Access Contact	Chief Financial Officer	Mr	Dodson	David		8145356000	22102			8142487902	Ddodson@PACE-CS.com	401 Broad Street		Johnstown	PA	15906	01/20/2021	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Utilization Management Contact	Chief Executive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5978	Utilization Review Contact	ChieExecutive Officer	Mr	Irwin	Mark		8145356000	22101			8142487902	Mirwin@pace-cs.com	401 Broad Street		Johnstown	PA	15906	02/23/2017	2023	SENIOR LIFE LEHIGH VALLEY, INC.	National PACE	Senior LIFE Lehigh Valley / Reading	National PACE		Senior LIFE Lehigh Valley, Inc.	562	Yes	Active					PACE - Nat		C	Philadelphia
H5989	Agent/Broker Compensation Data Contact	VP, Associate General Counsel	Ms.	Jan	Munizeh		6467675166					mjan@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Automated TrOOP Balance Transfer Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Backup User Access Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Best Available Evidence Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Bid Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Bid Audit Site Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Bid Primary Contact	Manager, Product Implementation	Mr.	Buntin	Bryant		2125192962					bbuntin@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	CAP Report Contact for Public Website	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	CEO - CMS Administrator Contact	President & CEO	Ms.	Wang	Pat		2128011500					pwang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	01/04/2023	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	CEO - Senior Official for Contracting	President & CEO	Ms.	Wang	Pat		2128011500					pwang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Chief Financial Officer	Chief Financial Officer	Mr.	Bermel	John		2124792777					jbermel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Chief Operating Officer	SVP, Operations	Ms.	Weinseiss	Karen		6466773595					kweinseiss@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Chief Information Officer	SVP, CIO	Mr.	Sweeney	GT		6467675199					gtsweeney@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Chief Information Security Officer	VP, Chief Security Information Officer	Mr.	Miller	Brian		6467675750					bmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	CMS Casework Communication Contact	Complaints Manager	Ms.	Gabriel	Charisse		6467675697					cgabriel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Complaints Tracking Contact	Complaints Manager	Ms.	Gabriel	Charisse		6467675697					cgabriel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Contact for Fraud Investigations	VP, Associate General Counsel	Mr.	Kianovsky	Nahum		2128013240					nkianovsky@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Coordination of Benefits Contact	Director, Payment Integrity Team	Ms.	Hutchinson	Chris		9176982415					chutchinson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Corporate Mailing						6463138967					clogreira@healthfirst.org	Healthfirst Medicare Plan	100 Church Street, 18th Floor	New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Manager, Accounting	Ms.	Tyme	Denise		6462732814					dtyme@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Customer Service Operations Contact	VP,  Member Services	Ms.	O'Connor	Kimberly		2128011639					koconnor@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	DIR Contact	Sr. Manager, Pharmacy Finance	Mr.	Denman	Hunter		2128013297					hdenman@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	DIR Contact (Secondary)	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					Tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Emergency Part D Contact	VP, Pharmacy	Mr.	Modi	Bhavesh		9734494186					bmodi@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/28/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Emergency Part D Contact (Secondary)	Director, Pharmacy Regulatory & Compliance	Ms.	Andreu	Kim		3475743277					kandreu@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/28/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters	Mr.	Miller	Robert		2125193011					rmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Enrollment Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	EOB Transfer Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753				6463134645	jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Financial Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Financial Reporting Contact	Chief Financial Officer	Mr.	Bermel	John		2124792777					jbermel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Formulary Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Formulary Contact (Secondary)	Medicare Clinical Pharmacist	Ms.	Baja	Melodie		6468565983					mbaja@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	General Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Government Relations Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	HIPAA Privacy Officer	AVP, Chief Privacy Officer	Ms.	Radler	Laurie		9172863902					lradler@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	HIPAA Security Officer	VP, Chief Security Information Officer	Mr.	Miller	Brian		6467675750					bmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Hospice Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Interoperability Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	MA Appeals/Grievances Contact	VP, Appeals & Grievances	Ms.	Johnston	Meredith		6467674748					mjohnston@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	MA Claims Processing Contact for Public Website	VP, Claims	Mr.	Johnson	Eric		2127292245					ejohnson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Marketing Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Medical Director	Chief Clinical Officer	Dr.	Schechtman	Jay		2128016170					jschechtman@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Medicare Compliance Officer	Chief Compliance Officer & Head of Internal Audit	Mr.	Hackendorn	John		2124534495					jhackendorn@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Medicare Coordinator	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/05/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Medication Therapy Management Contact	Sr. Pharmacy Manager	Mr.	Wiggall	Alex		2125198212					awiggall@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Online Enrollment Center Contact (Primary)	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Part C Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Part C Reporting Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Part D Appeals	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah							hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H5989	Part D Appeals Contact (Secondary)	Sr. Manager, Pharmacy Regulatory & Compliance	Ms.	Alenkina	Karolina							kalenkina@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H5989	Part D Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Part D Benefits Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Part D Claims Submission Contact	Manager, Pharmacy Benefits	Ms.	Grodzitsky	Janet		6467675231					jparedes@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Part D Exceptions Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah							hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H5989	Part D Exceptions Contact (Secondary)	Medicare Clinical Pharmacist	Ms.	Baja	Melodie							mbaja@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8882601010				HMO - Health Maintenance Organization		C	New York
H5989	Part D Price File Contact (Back-up)	Senior Manager, PBM Financial Operations	Ms.	Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	CVS Health	9501 E. Shea Blvd	Scottsdale	AZ	85260	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Part D Price File Contact (Optional)	Advisor, Med D Finance	Mr.	Pertgen	Richard		8045258502					richard.pertgen@cvshealth.com	CVS Health	9501 E Shea Blvd, MC121	Scottsdale	AZ	85260	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Part D Price File Contact (Primary)	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Part D Quality Assurance Contact	AVP, Pharmacy	Ms.	Kourlas	Helen		2122096456					hkourlas@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Part D Reporting Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Patient Safety Contact	Manager, Pharmacy	Ms.	Gandara Rodriguez	Alexandra		2124792775					agandararodriguez@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Payment Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Pharmacy Director	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Pharmacy Network Management Contact	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist	Ms.	An	Diana		3476911405					dan@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Pharmacy Technical Help Desk Contact	Director, Client Operations	Ms.	Dayoub	Joselyn							dayoubj@cvshealth.com	CVS Health	800 NW Chipman Rd, Ste 5830	Lees Summit	MO	64063	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H5989	Physician Incentive Contact	VP, Deputy General Counsel	Mr.	Schiller	Robert		2124974347					rschiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Plan Directory Contact for Public Website			Services	Provider		8888011660					hfprovsrvs@healthfirst.org	P.O. Box 5168		New York	NY	102745168	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Plan to Plan Reconciliation Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor	Attn:  Treasury Department	New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Processor Contact	Director of Client Services Adjudication Solutions	Mr.	Mangin	Marty		3124981167					martin.mangin@cvshealth.com	CVS Health	2211 Sanders Road, 2215-5	Northbrook	IL	60062	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Quality Contact	VP, Clinical Quality	Ms.	Washington	Laisha		2128016186					lawashington@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Reconciliation Contact	VP, Actuarial Services	Ms.	Liang	Angela		2124535538					aliang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Recovery Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	SNP Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	SNP State Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Surveillance Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	System Contact	SVP, CIO	Mr.	Sweeney	GT		6467675199					gtsweeney@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Third Party Administrator (TPA) Liaison	Sr. Manager, Accounting	Ms.	Tyme	Denise		6462732814					dtyme@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	User Access Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Utilization Management Contact	VP, Utilization Management	Ms.	Gunderson	Christine		2123242688					cgunderson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5989	Utilization Review Contact	VP, Utilization Management	Ms.	Gunderson	Christine		2123242688					cgunderson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST HEALTH PLAN, INC.	Local CCP	Healthfirst Medicare Plan	HMO/HMOPOS		Healthfirst, Inc.	391	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Agent/Broker Compensation Data Contact	Medicare Sales Director		Casas	Edward		3472138107					ecasas@emblemhealth.com	55 Water Street		New York	NY	10041	06/02/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Automated TrOOP Balance Transfer Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					JEwen@emblemhealth.com	55 Water St		New York	NY	10041	06/25/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Backup User Access Contact	Director, Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Best Available Evidence Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Bid Audit Contact	Director, Medicare Audit & Assessment		Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	12/10/2018	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Bid Audit Site Contact	Sr. Medicare Audit Spec.		Chan	Tat		6464470218					tchan@emblemhealth.com	55 Water Street		New York	NY	10041	05/28/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Bid Primary Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	CAP Report Contact for Public Website	Dir., Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	CEO - CMS Administrator Contact	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin-Corp Exec. Office	New York	NY	10041	12/27/2018	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	CEO - Senior Official for Contracting	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin - Corp Exec. Office	New York	NY	10041	05/09/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Chief Financial Officer	Chief Financial Officer	Ms.	Tamborino	Heather		6464476174					htamborino@emblemhealth.com	55 Water Street		New York	NY	10041	07/02/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Chief Operating Officer	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Chief Information Officer	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Chief Information Security Officer	VP, Technology and CISO	Mr.	McDermott	Thomas	M	6464474110					tmcdermott@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	CMMI Model Point of Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	CMS Casework Communication Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/25/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Complaints Tracking Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/25/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Contact for Fraud Investigations	Director, Special Investigations		Lupo	Chris		6318442453					Clupo@EmblemHealth.com	395 North Service Road		Melville	NY	11747	12/10/2018	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Coordination of Benefits Contact	Director, Payment Integrity & Financial Recovery		LaPlante	Brian		8606742840					blaplante@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	01/10/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Corporate Mailing						6464475044					Cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Coverage Gap Discount Program (CGDP) Payment Contact	Treasury Operations Analyst		Saint-Hilaire	Ana		6464474279					ASaint-Hilaire@emblemhealth.com	55 Water St		New York	NY	10041	04/01/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Customer Service Operations Contact	VP, Ops Strategy & Service Delivery		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	DIR Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	DIR Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Emergency Part D Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Emergency Part D Contact (Secondary)	Pharm. Govt. Programs Manager		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Employer Waiver Contact	AVP, Product Dev., Admin., & Perf. Analysis		Averyanova	Nataliya		6464475044					naveryanova@emblemhealth.com	55 Water Street		New York	NY	10041	04/18/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Encounter Data & Risk Adjustment Operations Contact	Dir., Enterprise Gov't Submissions		Guenther	Anne Marie		8606745847					aconnors@connecticare.com	175 Scott Swamp Rd		Farmington	CT	06034	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Enrollment Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	EOB Transfer Contact	Director, Claims Processing & Provider File Mgmt		Meka	Joann		8604098915				8604098455	jmeka@connecticare.com	175 South Swamp Road		Farmington	CT	06034	05/28/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Financial Audit Contact	Director, Medicare Audit & Assessment	Mr	Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	12/27/2018	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Financial Reporting Contact	Director, Financial Reporting		Heitzer	Frances		6464477885					FHeitzer@emblemhealth.com	55 Water Street		New York	NY	10041	04/19/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Formulary Contact	Sr. Formulary Specialist		Sitilides Cimino	Irene		6864477926					isitilidescimino@emblemhealth.com	55 Water Street		New York	NY	10041	11/15/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Formulary Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	05/12/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	General Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Government Relations Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	HIPAA Privacy Officer	VP, Corporate Compliance		Lurin	Joseph		6464475203					jlurin@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	HIPAA Security Officer	VP, Technology and CISO		McDermott	Thomas		6464474110					TMcDermott@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Hospice Contact	Pharm. Govt. Programs Manager		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Interoperability Contact	Dir, Medicare Compliance /MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	MA Appeals/Grievances Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	MA Claims Processing Contact for Public Website	VP, Claims Operations		Henderson	Linda		6464476795					lhenderson@emblemhealth.com	175 Scott Swamp Road		Farmington	CT	06032	10/23/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Marketing Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Medical Director	Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	05/28/2020	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Medicare Compliance Officer	Director, Medicare Compliance/MCO	Ms.	Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Medicare Coordinator	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Medicare Part D Opioid Overutilization Contact	Dir., Pharm. Quality Provider and Safety Prgms.		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road		Farmington	CT	06034	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Medication Therapy Management Contact	Clinical Pharmacy Program Leader		Mhajan	Ruby		6464477632					rumhajan@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	OffShore Subcontractor Contact	Lead Admin., Regulatory Pgm.		Kelly	Veronica		6464477494					vkelly@emblemhealth.com	55 Water Street		New York	NY	10041	11/26/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Online Enrollment Center Contact (Back-up)	Knowledge Manager, Enroll. & Bill.		Gonzalez	Gabriel		6464477722					gabriel.gonzalez@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Online Enrollment Center Contact (Optional)	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Online Enrollment Center Contact (Primary)	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Part C Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Part C Reporting Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Part D Appeals	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464477215				HMO - Health Maintenance Organization		C	New York
H5991	Part D Appeals Contact (Secondary)	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464477215				HMO - Health Maintenance Organization		C	New York
H5991	Part D Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Part D Benefits Contact	Sr. Pharm. Gov't. Prog. Spec		Dean	Wendy		8604098966					wdean@connecticare.com	175 Scott Swamp Road		Farmington	CT	06034	07/18/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Part D Claims Submission Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Part D Exceptions Contact	VP, Pharmacy Solutions		Colby	Andrew							acolby@emblemhealth.com	55 Water street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464473340				HMO - Health Maintenance Organization		C	New York
H5991	Part D Exceptions Contact (Secondary)	Sr.  Govt Prog. Pharm. Spec.		Kerman	Jeff							jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	05/12/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	6464477698				HMO - Health Maintenance Organization		C	New York
H5991	Part D Price File Contact (Back-up)	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Part D Price File Contact (Optional)	Sr. Govt Prog. Pharm Spec.		Kerman	Jeff		6464477698					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	07/25/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Part D Price File Contact (Primary)	Sr. Manager Regulated Markets		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/11/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Part D Quality Assurance Contact	Director, Medicare Compliance		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Part D Reporting Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Patient Safety Contact	Dir., Pharm Quality and Provider		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road	P.O. Box 4050	Farmington	CT	060344050	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Payment Contact	VP Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Personal Health Record Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		6464477141					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Pharmacy Director	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Pharmacy Network Management Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Pharmacy Network Management Contact (Secondary)	Sr. Govt Prog. Pharm. Specialist		Kerman	Jeff		6464477698					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	01/12/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	8009221557	2			HMO - Health Maintenance Organization		C	New York
H5991	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Client Ops Director		Brown	Gregory							grbrown@emblemhealth.com	55 Water street		New York	NY	10041	10/10/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active	4015251683				HMO - Health Maintenance Organization		C	New York
H5991	PHR Beneficiary Contact																	04/20/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS	EmblemHealth	EmblemHealth, Inc.	361	Yes	Active	8773447364				HMO - Health Maintenance Organization		C	New York
H5991	Plan Directory Contact for Public Website	VP, Ops Strategy & Service Delivery		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Plan to Plan Reconciliation Contact	Accounts Payable Manager		Siozios	Jacqueline		6464473017					jsiozios@emblemhealth.com	55 Water Street		New York	NY	10041	08/16/2022	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Processor Contact	AVP, Claims Operations		Gauthier	Kathleen	H	8604096435					kgauthier@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	07/18/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Quality Contact	Data Analytics & Reporting Leader		Goldfarb	Julie		6315775110	65110				jgoldfarb@emblemhealth.com	55 Water Street		New York	NY	10041	01/10/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Reconciliation Contact	Dir., Enrollment & Billing		Ewen	Jillian	L	8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	07/15/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Reconciliation Contact (Secondary)	VP Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	07/15/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Recovery Audit Contact	Director, Medicare Audit & Assessment	Mr.	Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road		Albany	NY	12205	12/10/2018	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	SNP Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	SNP State Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Surveillance Contact	Director, Medicare Compliance/MCO	Ms.	Borenkind	Carly		3479784977					Cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	System Contact	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	05/09/2019	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Third Party Administrator (TPA) Liaison	Lead Accountant		Simochkina	Ludmila		7185599146					lsimochkina@emblemhealth.com	2151 Ocean Ave	apt 2 B	Brooklyn	NY	11229	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	User Access Contact	Lead Medicare Regulatory Spec.		Handy	Michelle		5184466949					mhandy@EmblemHealth.com	80 Wolf Road		Albany	NY	12205	12/10/2018	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Utilization Management Contact	Chief medical Officier		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5991	Utilization Review Contact	Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	HEALTH INSURANCE PLAN OF GREATER NEW YORK	Local CCP	EmblemHealth	HMO/HMOPOS		EmblemHealth, Inc.	361	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	CAP Report Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	12/14/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	09/16/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	MA Claims Processing Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H5992	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H5992	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H5992	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H5992	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	09/16/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	09/16/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	09/16/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H5992	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H5992	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Plan Directory Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5992	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	SENIOR WHOLE HEALTH OF NEW YORK, INC.	Local CCP	Senior Whole Health of New York	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H5993	Automated TrOOP Balance Transfer Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Backup User Access Contact	Development Director	Mr.	Koetz	Andrew		8725883183					development@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Best Available Evidence Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Bid Primary Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	CAP Report Contact for Public Website			Wildt	Jonathan		8725883000					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending	8725883000				PACE - Nat		C	Chicago
H5993	CEO - CMS Administrator Contact	CEO	Mr.	Brooks	James		8725883009					jamesbrooks@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	CEO - Senior Official for Contracting	CEO	Mr.	Brooks	James		8725883009					jamesbrooks@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Chief Financial Officer	CFO	Mr.	Dons	Chris		8725883032					christopherdons@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Chief Operating Officer	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Chief Information Officer	CIO	Ms.	Herter	Rachel		8725883105					RachelHerter@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Chief Information Security Officer	CDO	Mr.	Cortez	Roger		8725883162					RogerCortez@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	CMS Casework Communication Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Complaints Tracking Contact			Sianghio	Alyssa		8725883015					development@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Contact for Fraud Investigations			Sianghio	Alyssa		8725883015					development@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Coordination of Benefits Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Corporate Mailing						8725883000					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Coverage Gap Discount Program (CGDP) Payment Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Customer Service Operations Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	DIR Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Emergency Part D Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Encounter Data & Risk Adjustment Operations Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Enrollment Contact			Sianghio	Alyssa		8725883015					development@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	EOB Transfer Contact			Wildt	Jonathan		8725883000				8725883001	PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Financial Audit Contact	CFO	Mr.	Dons	Chris		8725883032					christopherdons@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Financial Reporting Contact			Dons	Chris		8725883032					christopherdons@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Formulary Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	General Contact			Wildt	Jonathan		8725883014					pace@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Government Relations Contact			Sianghio	Alyssa		8725883015					development@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	HIPAA Privacy Officer			Sianghio	Alyssa		8725883015					development@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	HIPAA Security Officer			Cortez	Roger		8725883162					RogerCortez@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Interoperability Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	MA Appeals/Grievances Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	MA Claims Processing Contact for Public Website			Wildt	Jonathan		8725883000					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Marketing Contact			Sianghio	Alyssa		8725883015					development@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Medical Director	CCO - Operations	Dr.	Detmer	Wayne		8725883102					WayneDetmer@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Medicare Compliance Officer	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Medicare Coordinator	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Medicare Part D Opioid Overutilization Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Medication Therapy Management Contact	Pharmacy Director	Dr.	Shah	Chris		8725883252					Christophershah@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Part C Application Contact			Sianghio	Alyssa		8725883015					development@lawndale.org	3860 W. Ogden Avenue		Chicago	IL	60623	10/19/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Part D Appeals			Wildt	Jonathan							PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending	8725883000				PACE - Nat		C	Chicago
H5993	Part D Application Contact			Sianghio	Alyssa		8725883015					development@lawndale.org	3860 W. Ogden Avenue		Chicago	IL	60623	10/19/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Part D Benefits Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Part D Claims Submission Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Part D Exceptions Contact			Wildt	Jonathan							PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending	8725883000				PACE - Nat		C	Chicago
H5993	Part D Price File Contact (Back-up)			Dons	Chris		8725883032					christopherdons@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Part D Price File Contact (Primary)	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Part D Quality Assurance Contact		Dr.	Rowell	Bruce		8725883103					brucerowell@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Part D Reporting Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Patient Safety Contact			Sianghio	Alyssa		8725883015					development@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Payment Contact			Dons	Chris		8725883032					christopherdons@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Pharmacy Director	Pharmacy Director	Dr.	Shah	Chris		8725883252					Christophershah@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Pharmacy Network Management Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Pharmacy Technical Help Desk Contact			Shah	Chris							pace@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending	8725883000				PACE - Nat		C	Chicago
H5993	Plan Directory Contact for Public Website			Wildt	Jonathan		8725883000					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/20/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Plan to Plan Reconciliation Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Processor Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Quality Contact			Rowell	Bruce		8725883107					BruceRowell@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Reconciliation Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Recovery Audit Contact	CFO	Mr.	Dons	Chris		8725883032					christopherdons@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Surveillance Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	System Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Third Party Administrator (TPA) Liaison	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	User Access Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Utilization Management Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5993	Utilization Review Contact	COO	Mr.	Wildt	Jonathan		8725883014					PACE@lawndale.org	3860 W Ogden Ave		Chicago	IL	60623	12/21/2022	2023	LAWNDALE CHRISTIAN HEALTH CENTER	National PACE	Lawndale Christian Health Center	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H5995	Agent/Broker Compensation Data Contact	VP Sales Operations		Hohenberg	Brandon		5058600441					brandon.hohenberg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Esp	Bryan		8587906445					PartDCAT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/04/2015	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Backup User Access Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Best Available Evidence Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Bid Audit Contact	Chief Compliance Officer	Mrs.	Flynn	Jordan		6026924381					jordan.flynn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Bid Audit Site Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/20/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Bid Primary Contact	VP of Product		Viveiros	Matt		9175826324					matt.viveiros@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	CAP Report Contact for Public Website	Chief Compliance Officer		Flynn	Jordan		9713040068				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	6026924381				HMO - Health Maintenance Organization		C	Seattle
H5995	CEO - CMS Administrator Contact	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	CEO - Senior Official for Contracting	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Chief Financial Officer	Chief Financial Officer	Mr.	Stewart	Mark		4012848679					mark.stewart@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Chief Operating Officer	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Chief Information Officer	Chief Information Officer	Mr.	Snyder	Dan		9712089848					dan.snyder@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Chief Information Security Officer	Information Security Officer	Mr.	Rohver	Eric		5414922164					eric.rohveri@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	CMS Casework Communication Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Complaints Tracking Contact	Director of Appeals and Grievances		Vaughn	Sara		9712094307				5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Contact for Fraud Investigations	HIPAA Privacy Officer/FWA Program Manager		Saunders Ricks	Rhonda		9713040043				5035841772	rhonda.saundersricks@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Coordination of Benefits Contact	Chief Operations Officer	Mrs.	Callhan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Corporate Mailing						8776728620				5035841772	compliance@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/20/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Controller		Kirkpatrick	James		5034285602					james.kirkpatrick@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/17/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Customer Service Operations Contact	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	DIR Contact	Vice President of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	DIR Contact (Secondary)	Director of Actuarial Services		Guest IV	William		5039677386					william.guestIV@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Emergency Part D Contact	VP Pharmacy Operations	Ms.	Liu	Helen		9707129377					helen.liu@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Emergency Part D Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Encounter Data & Risk Adjustment Operations Contact	CFO		Stewart	Mark		4012848679					mark.stewart@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Enrollment Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	EOB Transfer Contact	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441				9512067316	jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Financial Audit Contact	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Financial Reporting Contact	CFO		Stewart	Mark		4012848679				5416728670	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Formulary Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Formulary Contact (Secondary)	Supervisor, Formulary Services		Nyawabila	Christina		8587906297					FMT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/04/2015	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	General Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Government Relations Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	HIPAA Privacy Officer	HIPAA Privacy Officer/FWA Program Manager		Saunders Ricks	Rhonda		9713040043				5035841772	rhonda.saundersricks@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	HIPAA Security Officer	ISO	Mr.	Rohver	Eric		5414922164					eric.rohveri@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Hospice Contact	VP of Pharmacy Operations	Ms.	Liu	Helen		9707129377					helen.liu@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Interoperability Contact	Chief Technology Officer		Snyder	Dan		9712089848					dan.snyder@atriohp.com	1965 Ryan Dr. SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	MA Appeals/Grievances Contact	Director of Appeals and Grievances		Vaughn	Sara		9712094307				5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	MA Claims Processing Contact for Public Website	customer service		Service	Customer		8776728620				5416728670	customerservice@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	10/05/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Marketing Contact	Compliance Manager	Mr.	Allotta	Tony		8303090299					tony.allotta@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	06/09/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Medical Director	Chief Medical Director		Wethers	Darren		3143782525					darren.wethers@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Medicare Coordinator	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Medicare Part D Opioid Overutilization Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	01/19/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Medication Therapy Management Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	OffShore Subcontractor Contact	Chief Legal Officer, General Counsel		Wilson	Charles		5039677387				5035841772	charles.wilson@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	05/18/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Online Enrollment Center Contact (Optional)	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Online Enrollment Center Contact (Primary)	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Part C Application Contact	Chief Legal Officer		Wilson	Charles		5039677387				8662569002	charles.wilson@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	02/15/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Part C Reporting Contact	Compliance Manager	Mrs.	Luma	Yoleine		9172080084					yoleine.luma@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/09/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Appeals	Director of Appeals and Grievances		Vaughn	Sara						5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	8776728620	3			HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Appeals Contact (Secondary)	VP of Pharmacy Operationss		Liu	Helen						5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	9707129377				HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Application Contact	Chief Legal Officer		Wilson	Charles		5039677387				8662569002	charles.wilson@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	02/15/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Benefits Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Claims Submission Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Exceptions Contact	Director of Appeals and Grievances		Vaughn	Sara						5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	11/11/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	8776728620	3			HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Exceptions Contact (Secondary)	VP of Pharmacy Operations	Ms.	Liu	Helen						5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	9717129377				HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Price File Contact (Back-up)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Price File Contact (Optional)	Medicare Part D Project Manager		Maldonado	Cheryl		8587906397					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct,		San Diego	CA	92131	04/09/2014	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Price File Contact (Primary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Quality Assurance Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Part D Reporting Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Patient Safety Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Payment Contact	President & CEO		Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Personal Health Record Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Pharmacy Director	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Pharmacy Network Management Contact	Supervisor, Pharmacy Network Support		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	03/13/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Pharmacy Network Management Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Pharmacy Technical Help Desk Contact	Director, Contact Center Services		Brewer	Kathy							Customerservice@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/08/2018	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	8006819571				HMO - Health Maintenance Organization		C	Seattle
H5995	Pharmacy Technical Help Desk Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen							helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active	9707129377				HMO - Health Maintenance Organization		C	Seattle
H5995	PHR Beneficiary Contact																	05/09/2018	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS	ATRIO Health Plans	ATRIO Health Plans	5	Yes	Active	8776728620				HMO - Health Maintenance Organization		C	Seattle
H5995	Plan Directory Contact for Public Website	Customer Service		Service	Customer		8776728620				5416728670	customerservice@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	10/05/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Plan to Plan Reconciliation Contact	Chief Financial Officer		Stewart	Mark		4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Processor Contact	Director, Medicare Programs		Scherlippens	Carine		8587907415					Carine.Scherlippens@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	04/09/2014	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Quality Contact	Chief Medical Director		Wethers	Darren		3143782525					darren.wethers@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Reconciliation Contact	Chief Financial Officer		Stewart	Mark		4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Reconciliation Contact (Secondary)	Director of Actuarial Services		Guest IV	William		5039677386					william.guestIV@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	02/17/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Recovery Audit Contact	CFO	Mr.	Stewart	Mark		4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	SNP Application Contact	Director of SNP Programs		Yaun	Caroline		9526886695					caroline.yaun@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	09/08/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	SNP State Contact	Director of SNP Programs		Yaun	Caroline		9526886695					caroline.yaun@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	09/08/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Surveillance Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	System Contact	Chief Technology Officer	Mr.	Snyder	Dan		9712089848					dan.snyder@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Third Party Administrator (TPA) Liaison	Chief Operating Officer		Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	User Access Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	jordan.flynn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/20/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Utilization Management Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H5995	Utilization Review Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	HMO/HMOPOS		ATRIO Health Plans	5	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6018	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6018	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6018	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6018	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6018	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H6018	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6018	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H6018	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6018	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF PENNSYLVANIA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6019	Agent/Broker Compensation Data Contact	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Automated TrOOP Balance Transfer Contact	Medicare Front End Process Manager		Platts	Karen		8168435486					585HPSM@argushealth.com	423 W. 8th Street		Kansas City	MO	64105	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Backup User Access Contact	Chief Information Officer		Yong	Eben		6506162010					eben.yong@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Best Available Evidence Contact	CareAdvantage Manager		Barairo	Charlene		6506162183					CMSEnrollmentCenter@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Bid Audit Contact	Chief Financial Officer		Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Bid Audit Site Contact	Chief Financial Officer		Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Bid Primary Contact	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	CAP Report Contact for Public Website	Director of Compliance	Mrs.	Armenta	Brandy		6506161505					brandy.armenta@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	08/25/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	CEO - CMS Administrator Contact	CEO	Mr.	Curran	Patrick		6506165104					pat.curran@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	08/25/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	CEO - Senior Official for Contracting	CEO	Mr.	Curran	Patrick		6506165104					pat.curran@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	08/25/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Chief Financial Officer	Chief Financial Officer	Mr.	Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Chief Operating Officer	COO	Mrs.	Murphey	Colleen		6506162547					colleen.murphey@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	08/25/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Chief Information Officer	Chief Information Officer	Mr.	Yong	Eben		6506162010					eben.yong@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Chief Information Security Officer	Chief Information Officer	Mr.	Yong	Eben		6506162010					eben.yong@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	CMMI Model Point of Contact	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	CMS Casework Communication Contact	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Complaints Tracking Contact	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Contact for Fraud Investigations	Director of Compliance	Mrs	Armenta	Brandy		6506161505					brandy.armenta@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Coordination of Benefits Contact	Chief Information Officer	Mr.	Yong	Eben		6506162010					eben.yong@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Corporate Mailing						6506160050					info@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/15/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Pharmacy		Shen	Ming		6506162073					ming.shen@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Customer Service Operations Contact	CareAdvantage Manager		Barairo	Charlene		6506162183					CMSEnrollmentCenter@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	03/06/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	DIR Contact	Chief Financial Officer	Mr.	Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	DIR Contact (Secondary)	Director of Pharmacy		Shen	Ming		6506162073					ming.shen@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Emergency Part D Contact	Director of Pharmacy	Mr.	Shen	Ming		6506162073					ming.shen@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Emergency Part D Contact (Secondary)	Pharmacy Operations Supervisor		Cruz-McKernan	Karla		6506162075					karla.cruz-mckernan@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Encounter Data & Risk Adjustment Operations Contact	Medicare Risk Adjustment Director		Turner	KatieElyse		6506162565					katie-elyse.turner@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Enrollment Contact	CareAdvantage Manager		Barairo	Charlene		6506162183					CMSEnrollmentCenter@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/02/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	EOB Transfer Contact	Configuration Specialist		Gonzalez	Jesse		6506162023				6506160060	CMS.EOB@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Financial Audit Contact	Chief Financial Officer	Mr.	Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Financial Reporting Contact	Chief Financial Officer	Mr.	Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Formulary Contact	Director of Pharmacy	Mr.	Shen	Ming		6506162073					ming.shen@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Formulary Contact (Secondary)	Senior Formulary Strategy Specialist		Diallo	Issouf		8168435823					idiallo@dsthealth.com	SS&C Health	210 W. 10th Street	Kansas City	MO	64105	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	General Contact	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Government Relations Contact	Director of Compliance		Armenta	Brandy		6506161505					brandy.armenta@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	11/21/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	HIPAA Privacy Officer	Chief Government Affairs and Compliance Officer	Mr	Johansson	Ian	K	6506162151					ian.johansson@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	HIPAA Security Officer	Chief Information Officer	Mr.	Yong	Eben		6506162010					eben.yong@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Hospice Contact	CareAdvantage Manager		Barairo	Charlene		6506162183					CMSEnrollmentCenter@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Interoperability Contact	Chief Information Officer	Mr.	Yong	Eben		6506162010					eben.yong@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	MA Appeals/Grievances Contact	Chief Health Officer		Scribner	Amy		6506162151					CMSAppealsGrievances@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mr.	Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Marketing Contact	Manager of Marketing and Communications		Deinla	Joy		6506165036					Joy.Deinla@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	03/06/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Medical Director	Chief Medical Officer	Dr.	Esguerra	Chris		6506162540					chris.esguerra@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Medicare Compliance Officer	Chief Government Affairs and Compliance Officer	Mr	Johansson	Ian	K	6506162151					ian.johansson@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Medicare Coordinator	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Shen	Ming		6506162073					ming.shen@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/15/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Medication Therapy Management Contact	Director of Pharmacy		Shen	Ming		6506162073					ming.shen@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	OffShore Subcontractor Contact	Director of Compliance		Armenta	Brandy		6506161505					brandy.armenta@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	11/21/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Online Enrollment Center Contact (Back-up)	Enrollment/Disenrollment Supervisor		Bongolan	Sharon		6506162806					CMSEnrollmentCenter@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	01/25/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Online Enrollment Center Contact (Optional)	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Online Enrollment Center Contact (Primary)	CareAdvantage Manager		Barairo	Charlene		6506162183					CMSEnrollmentCenter@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Part C Application Contact	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Part C Reporting Contact	Director of Compliance		Armenta	Brandy		6506161505					brandy.armenta@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	11/21/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Part D Appeals	Director of Pharmacy		Shen	Ming							CMSAppealsGrievances@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active	6508292045				HMO - Health Maintenance Organization		C	San Francisco
H6019	Part D Appeals Contact (Secondary)	Pharmacy Operations Manager		Cruz-McKernan	Karla							CMSAppealsGrievances@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	03/06/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active	8885767227				HMO - Health Maintenance Organization		C	San Francisco
H6019	Part D Application Contact	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Part D Benefits Contact	Director of Pharmacy	Mr.	Shen	Ming		6506162073					ming.shen@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Part D Claims Submission Contact	Chief Information Officer	Mr.	Yong	Eben		6506162010					eben.yong@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Part D Exceptions Contact			Services	Pharmacy							PharmPA@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active	6506162088				HMO - Health Maintenance Organization		C	San Francisco
H6019	Part D Price File Contact (Back-up)	Director of Pharmacy		Shen	Ming		6506162073					ming.shen@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Part D Price File Contact (Optional)	Chief Information Officer	Mr.	Yong	Eben		6506162010					eben.yong@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Part D Price File Contact (Primary)			Joslin	Karen		8164352473					kjoslin@dsthealth.com	210 W. 10th Street		Kansas City	MO	64105	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Part D Quality Assurance Contact	Director of Pharmacy	Mr.	Shen	Ming		6506162073					ming.shen@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Part D Reporting Contact	Director of Compliance		Armenta	Brandy		6506161505					brandy.armenta@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	11/21/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Patient Safety Contact	Director of Pharmacy	Mr.	Shen	Ming		6506162073					ming.shen@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Payment Contact	Chief Financial Officer	Mr.	Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Pharmacy Director	Director of Pharmacy	Mr.	Shen	Ming		6506162073					ming.shen@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Pharmacy Network Management Contact	Credentialing Specialist		Dela Cruz	Paul		6506162107					CMSPharmacyNetwork@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Pharmacy Technical Help Desk Contact			Help Desk	Pharmacy						8162839785	help@argushealth.com	1300 Washington Street		Kansas City	MO	64105	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active	8886358362				HMO - Health Maintenance Organization		C	San Francisco
H6019	Physician Incentive Contact	Chief Financial Officer	Mr.	Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Plan Directory Contact for Public Website			Unit	Compliance		6506160050				6506160060	compliance@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Processor Contact	Sr. Client Relations Specialist		Evson	Freddie		8168451735					fdevson@dsthealth.com	210 W. 10th Street		Kansas City	MO	64105	02/10/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Quality Contact	Director, Quality		Ford	Nicole		6506162169					nicole.ford@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Reconciliation Contact	Chief Financial Officer	Mr.	Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Reconciliation Contact (Secondary)	Controller		Lester	Francine		6506162111					FrancineL@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Recovery Audit Contact	Chief Financial Officer	Mr.	Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	SNP Application Contact	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	SNP State Contact	Director of Medicare	Mr	Okonne	John		6506161521					john.okonne@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Surveillance Contact	Director of Compliance		Armenta	Brandy		6506161505					brandy.armenta@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	System Contact	Chief Information Officer	Mr.	Yong	Eben		6506162010					eben.yong@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mr.	Ehrgood	Trent		6506162171					trent.ehrgood@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	User Access Contact	Chief Government Affairs and Compliance Officer	Mr	Johansson	Ian	K	6506162151					ian.johansson@hpsm.org	801 Gateway Blvd,	Suite 100	South San Francisco	CA	94080	09/05/2023	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Utilization Management Contact	Chief Medical Officer	Dr.	Esguerra	Chris		6506162540					chris.esguerra@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6019	Utilization Review Contact	Chief Medical Officer	Dr.	Esguerra	Chris		6506162540					chris.esguerra@hpsm.org	801 Gateway Blvd	Suite 100	South San Francisco	CA	94080	02/03/2022	2023	SAN MATEO HEALTH COMMISSION	Local CCP	HEALTH PLAN OF SAN MATEO	HMO/HMOPOS		Health Plan of San Mateo	115	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6053	Backup User Access Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	CAP Report Contact for Public Website	CEO	Mr.	Philippi	Larry	D	6269673550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active	8779683550				HCPP		1	San Francisco
H6053	CEO - CMS Administrator Contact	Chairman	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	CEO - Senior Official for Contracting	Chairman	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Chief Financial Officer	Secretary/Treasurer	Mr.	Richardson	Don	C	6269673550				6269673161	morngold@yahoo.com	551 E. San Bernardino Road,		Covina	CA	91723	09/09/2009	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Chief Operating Officer	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Rd		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Chief Information Officer	Chief Information Officer	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Rd		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Chief Information Security Officer	Chief Information Security Officer	Mr	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Rd		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	CMS Casework Communication Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Complaints Tracking Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E San Bernardino Road		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Contact for Fraud Investigations	CMS Casework Communication Contact	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Rd		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Corporate Mailing						6269673550				6269673161	yvonneb@santafeha.com	551 E. San Bernardino Road,		Covina	CA	91723	03/13/2014	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Cost Report Contact	Cost Report Specialist	Ms	Bendig	Susan		8012984818					susanlynne48@comcast.net	232 Eagle Way		N. Salt Lake	UT	84054	10/28/2016	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Customer Service Operations Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Enrollment Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	General Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Government Relations Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	MA Appeals/Grievances Contact	Claims Manager	Ms.	Bagaman	Yvonne	R	6269673550				6269673161	yvonneb@santafeha.com	551 E. San Bernardino Road,		Covina	CA	91723	03/13/2014	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	MA Claims Processing Contact for Public Website	Claims Manager	Ms.	Bagaman	Yvonne	R	6269673550				6269673161	yvonneb@santafeha.com	551 E. San Bernardino Road,		Covina	CA	91723	03/13/2014	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Marketing Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Medical Director	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Medicare Compliance Officer	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Medicare Coordinator	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Part C Application Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Payment Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Plan Directory Contact for Public Website	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Quality Contact	Business Office Manager	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Surveillance Contact	Administrative Assistant	Ms	Vedolla	Haydee		6269673550				6269673161	haydeev@santafeha.com	551 E. San Bernardino Rd.		Covina	CA	91723	10/28/2016	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	System Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	User Access Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Utilization Management Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6053	Utilization Review Contact	CEO	Mr.	Philippi	Larry	D	8779683550				6269673161	larrydphilippi@gmail.com	551 E. San Bernardino Road,		Covina	CA	91723	09/27/2021	2023	SANTE FE EMPLOYEES HOSPITAL ASSOCIATION	HCPP - 1833 Cost	Santa Fe Employes Hospital Assn. - Coast Lines	HCPP - 1833 Cost		Sante Fe Employees Hospital Assn.	202	No	Active					HCPP		1	San Francisco
H6059	Automated TrOOP Balance Transfer Contact	Health Plan Specialist		Powell	Greg		3365504040					Greg.Powell@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Backup User Access Contact	President/CEO		Robinson	Ursula		3365504040					Ursula.Robinson@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Best Available Evidence Contact	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Bid Primary Contact	Health Plan Specialist		Powell	Greg		3365504040					Greg.Powell@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	CAP Report Contact for Public Website	Director of Quality, Compliance and Informatics	Mrs	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active	3365504040				PACE - Nat		C	Atlanta
H6059	CEO - CMS Administrator Contact	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	CEO - Senior Official for Contracting	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Chief Financial Officer	CFO	Mr	Nickerson	Kirby		7047548228				7049000766	Knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave		Salisbury	NC	28145	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Chief Operating Officer	Site Director	Mrs	Marrow	Lucillia		3365504040				3364642190	Lucillia.Marrow@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Chief Information Officer	Director of Quality, Compliance and Informatics	Mrs.	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Chief Information Security Officer	Director of Quality, Compliance and Informatics	Mrs.	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 E. Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	CMS Casework Communication Contact	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Complaints Tracking Contact	Director of Quality, Compliance and Informatics	Ms.	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Contact for Fraud Investigations	Director of Quality and Compliance		Smith	Adria		3365504051				3364585550	Adria.Smith@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Coordination of Benefits Contact	President/CEO		Robinson	Ursula		3365504040					Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Corporate Mailing						3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Coverage Gap Discount Program (CGDP) Payment Contact	Health Plan Specialist		Powell	Greg		3365504040					Greg.Powell@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/04/2021	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Customer Service Operations Contact	Director of Outreach and Marketing	Mrs.	Baldwin	Nedra		3365504040				3365504044	Nedra.Baldwin@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	DIR Contact	President/CEO		Robinson	Ursula		3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	DIR Contact (Secondary)	Health Plan Specialist	Mr	Powell	Greg		3365504040				3364642212	Greg.Powell@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Emergency Part D Contact	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Emergency Part D Contact (Secondary)	Health Plan Specialist		Powell	Greg		3365504040				3364642212	Greg.Powell@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Encounter Data & Risk Adjustment Operations Contact	President/CEO		Robinson	Ursula		3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Enrollment Contact	Director of Intake and Marketing	Mrs	Baldwin	Nedra		3365504040				3365504044	Nedra.Baldwin@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	EOB Transfer Contact	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Financial Audit Contact	CFO	Mr	Nickerson	Kirby		7047548228				7049000766	Knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave		Salisbury	NC	28145	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Financial Reporting Contact	CFO	Mr	Nickerson	Kirby		7047548228				7049000766	Knickerson@LSCarolinas.net	1416 S. Martin Luther King Jr. Ave		Salisbury	NC	28145	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Formulary Contact	Medical Director	Dr	Koehler	Robert		3365504040				3365504045	Robert.Koehler@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Formulary Contact (Secondary)	Health Plan Specialist		Powell	Greg		3365504040				3364642212	Greg.Powell@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	General Contact	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Government Relations Contact	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3365504044	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	HIPAA Privacy Officer	Director of Quality, Compliance and Informatics	Mrs	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	HIPAA Security Officer	Director of Quality, Compliance and Informatics	Mrs	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Interoperability Contact	Director of Quality, Compliance and Informatics	Mrs.	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	MA Appeals/Grievances Contact	Director of Quality, Compliance and Informatics	Ms	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	MA Claims Processing Contact for Public Website	Third Party Operations		Oakes	Jill	M	8562422110					Joakes@careventionhc.com	345 Marshal Ave Suite 101		St. Louis	MO	63119	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Marketing Contact	Director of Outreach and Marketing	Mrs	Baldwin	Nedra		3365504040				3365504044	Nedra.Baldwin@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Medical Director	Medical Director	Dr	Koehler	Robert		3365504040				3365504045	Robert.Koehler@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Medicare Compliance Officer	Director of Quality and Compliance	Mr.	Smith	Adria		3365504051				3364585550	Adria.Smith@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Medicare Coordinator	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Medicare Part D Opioid Overutilization Contact	Health Plan Specialist		Powell	Greg		3365504040				3365504045	Greg.Powell@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	08/10/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Medication Therapy Management Contact	Medical Director	Dr	Koehler	Robert		3365504040				3365504045	Robert.Koehler@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Online Enrollment Center Contact (Back-up)	Director of Intake and Marketing	Mrs	Baldwin	Nedra		3365504040				3364642212	Nedra.Baldwin@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Online Enrollment Center Contact (Optional)	Quality Coordinator		Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471` East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Online Enrollment Center Contact (Primary)	Marketing Coordinator	Mrs	Baldwin	Nedra		3365504040				3365504044	Nedra.Baldwin@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	05/12/2014	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Part C Application Contact	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Part D Appeals	Director of Quality, Compliance and Informatics	Mrs	Smith	Adria						3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active	3365504040				PACE - Nat		C	Atlanta
H6059	Part D Appeals Contact (Secondary)	President/CEO		Robinson	Ursula						3364642212	Ursula.Robinson@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active	3365504040				PACE - Nat		C	Atlanta
H6059	Part D Application Contact	President/CEO	Mrs	Robinson	Ursula		3365504040				3364642212	Ursula.Robinson@PaceTriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Part D Benefits Contact	Program Director	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Part D Claims Submission Contact	Health Plan Specialist	Mr	Powell	Greg		3365504040				3364642212	Greg.Powell@pacetriad.org	1471 E. Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Part D Exceptions Contact	President/CEO	Mrs	Robinson	Ursula	B					3365504044	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active	3365504040				PACE - Nat		C	Atlanta
H6059	Part D Exceptions Contact (Secondary)	Medical Director	Dr	Koehler	Robert						3365504045	Robert.Koehler@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active	3365504040				PACE - Nat		C	Atlanta
H6059	Part D Price File Contact (Back-up)	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Part D Price File Contact (Optional)	Health Plan Specialist		Powell	Greg		3365504070					Greg.Powell@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	06/17/2019	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Part D Price File Contact (Primary)	Medical Director	Dr	Koehler	Robert		3365504040				3365504045	Robert.Koehler@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Part D Quality Assurance Contact	Director of Quality, Compliance and Informatics	Mrs	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Part D Reporting Contact	President/CEO		Robinson	Ursula		3365504040					Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Patient Safety Contact	Clinical Coordinator	Mrs	Williams	Tina		3365504040				3365504045	Tina.Williams@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Payment Contact	President/CEO		Robinson	Ursula		3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 E. Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Personal Health Record Contact	Director of Quality, Compliance and Informatics	Mrs	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Pharmacy Director	Medical Director	Dr	Koehler	Robert		3365504056				3365504045	Robert.Koehler@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Pharmacy Network Management Contact	Medical Director	Dr	Koehler	Robert		3365504040				3365504045	Robert.Koehler@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Pharmacy Network Management Contact (Secondary)	Health Plan Specialist		Powell	Greg		3365504040				3364642212	Greg.Powell@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Pharmacy Technical Help Desk Contact	Clinical Coordinator	Mrs	Williams	Tina						3365504045	Tina.Williams@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active	3365504040				PACE - Nat		C	Atlanta
H6059	Pharmacy Technical Help Desk Contact (Secondary)	Clinic Supervisor		Williams	Jacque							Jacque.Williams@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active	3365504040				PACE - Nat		C	Atlanta
H6059	PHR Beneficiary Contact																	06/06/2013	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE	PACE of the Triad	Well-Spring Services, Inc.	641	Yes	Active	3365504040				PACE - Nat		C	Atlanta
H6059	Plan Directory Contact for Public Website	Director of Outreach and Marketing	Mrs	Baldwin	Nedra		3365504040				3365504044	Nedra.Baldwin@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Plan to Plan Reconciliation Contact	Health Plan Specialist		Powell	Greg		3365504040					Greg.Powell@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	12/27/2020	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Processor Contact	Program Director	Mrs	Robinson	Ursula	B	3365504056				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Quality Contact	Director of Quality, Compliance and Informatics	Mrs	Smith	Adria	C	3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Reconciliation Contact	President/CEO	Mrs	Robinson	Ursula		3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 E. Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Reconciliation Contact (Secondary)	Health Plan Specialist	Mr	Powell	Greg		3365504040				3364642212	Greg.Powell@pacetriad.org	1471 E Cone Blvd		Greensboro	NC	27405	03/02/2022	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Recovery Audit Contact	President/CEO	Mrs	Robinson	Ursula		3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd.		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Surveillance Contact	President/CEO	Mrs.	Robinson	Ursula		3365504040	4056			3364642212	Ursula.Robinson@pacetriad.org	1471 E. Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	System Contact	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Third Party Administrator (TPA) Liaison	Regulatory Manager	Ms	Green	Nicole		3144747831					ngreen@peakpacesolutions.com	345 Marshall Ave, Suite 101		St. Louis	MO	63119	05/10/2018	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	User Access Contact	President/CEO	Mrs	Robinson	Ursula	B	3365504040				3364642212	Ursula.Robinson@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Utilization Management Contact	Director of Quality, Compliance and Informatics	Mrs	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6059	Utilization Review Contact	Director of Quality, Compliance and Informatics	Mrs	Smith	Adria		3365504040				3364585550	Adria.Smith@pacetriad.org	1471 East Cone Blvd		Greensboro	NC	27405	02/24/2023	2023	PACE OF GUILFORD AND ROCKINGHAM COUNTIES, INC.	National PACE	PACE OF THE TRIAD	National PACE		Well-Spring Services, Inc.	641	Yes	Active					PACE - Nat		C	Atlanta
H6062	Agent/Broker Compensation Data Contact	VP, Government Business Strategy		Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Automated TrOOP Balance Transfer Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Backup User Access Contact	Compliance Manager		Vazquez	Cynthia		4052805680					cynthia.vazquez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/11/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Best Available Evidence Contact	Manager, Eligibility & Enrollment		Rhodes	Trent		4052805871					trent.rhodes@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Bid Audit Contact	VP, Government Business Strategy		Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Bid Audit Site Contact	VP, Government Business Strategy		Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Bid Primary Contact	VP, Government Business Strategy		Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	CAP Report Contact for Public Website	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract	7877582500	2040			HMO - Health Maintenance Organization		C	New York
H6062	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	O'Drobinak	Jim		7879998771					jim.odrobinak@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	O'Drobinak	Jim		7879998771					jim.odrobinak@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Chief Financial Officer	Chief Financial Officer	Mr.	Aponte	Jose		7877582500	5022				joseap@medicalcardsystem.com	210 Park Ave	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Chief Operating Officer	Chief Executive Officer	Mr.	O'Drobinak	Jim		7879998771					jim.odrobinak@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Chief Information Officer	Chief Information Officer	Mr.	Adhia	Kevin		4052805765					kevin.adhia@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	09/20/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Chief Information Security Officer	Chief Information Officer	Mr.	Adhia	Kevin		4052805765					kevin.adhia@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	09/20/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	CMS Casework Communication Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Complaints Tracking Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Contact for Fraud Investigations	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Coordination of Benefits Contact	Manager, Eligibility & Enrollment		Rhodes	Trent		4052805871					trent.rhodes@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Corporate Mailing						7877582500	2424				CSolis@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/12/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Coverage Gap Discount Program (CGDP) Payment Contact	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Customer Service Operations Contact	Director, Customer Care		Thomas	Daniel		4055261126					Daniel.Thomas@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	DIR Contact	VP, Government Business Strategy		Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	DIR Contact (Secondary)	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Electronic Health Record Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Emergency Part D Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Emergency Part D Contact (Secondary)	Manager, Clinical Pharmacy Operations		Adkins	Rene		9188787331				4052805613	rene.adkins@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Employer Waiver Contact	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Encounter Data & Risk Adjustment Operations Contact	Director, Medicare Risk Adjustment		Mody	Harshil		6307811675					harshil.mody@globalhealth.com	6120 South Yale Avenue	Suite 925	Tulsa	OK	74136	06/19/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Enrollment Contact	Manager, Eligibility & Enrollment		Rhodes	Trent		4052805871					trent.rhodes@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	EOB Transfer Contact	VP, Adjudication and Configurations		Thakkar	Rahul		4052805716				4055523098	rahul.thakkar@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Financial Audit Contact	VP, Government Business Strategy	Mr.	Patel	Sagar		9084003601					sagar.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Financial Reporting Contact	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Formulary Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Formulary Contact (Secondary)	Manager, Clinical Pharmacy Operations		Adkins	Rene		9188787331				4052805613	rene.adkins@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	General Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Government Relations Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	HIPAA Privacy Officer	Director Legal Services and Privacy		Ramirez	Alia		4052802988					alia.ramirez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	HIPAA Security Officer	Chief Information Officer		Adhia	Kevin		4052805765					kevin.adhia@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	09/20/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Hospice Contact	VP, Health Services		Stouffer	Kelly		4052805608					kelly.stouffer@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Interoperability Contact	Chief Information Officer	Mr.	Adhia	Kevin		4052805765					kevin.adhia@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	09/20/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	MA Appeals/Grievances Contact	VP, Health Services		Stouffer	Kelly		4052805608				4052805294	kelly.stouffer@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	MA Claims Processing Contact for Public Website	VP, Adjudication and Configurations		Thakkar	Rahul		4052805716				4055523098	rahul.thakkar@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Marketing Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Medical Director	Medical Director	Dr.	Agarwal	Pallavi		9187207689					pallavi.agarwal@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/10/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Medicare Compliance Officer	VP of Compliance and Medicare Compliance Officer	Mrs.	Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Medicare Coordinator	Manager, Medicare Compliance		Vazquez	Cynthia		4052805680					Cynthia.vazquez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Medicare Part D Opioid Overutilization Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Medication Therapy Management Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	OffShore Subcontractor Contact	Director Legal Services and Privacy		Ramirez	Alia		4052802988					alia.ramirez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Online Enrollment Center Contact (Primary)	Manager, Eligibility & Enrollment		Rhodes	Trent		4052805871					trent.rhodes@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Part C Application Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Part C Reporting Contact	Manager, Medicare Compliance		Vazquez	Cynthia		4052805680					Cynthia.vazquez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Part D Appeals	VP, Pharmacy		Patel	Monank							monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract	8444490360				HMO - Health Maintenance Organization		C	New York
H6062	Part D Appeals Contact (Secondary)	Manager, Clinical Pharmacy Operations		Adkins	Rene						4052805613	rene.adkins@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract	8444490360				HMO - Health Maintenance Organization		C	New York
H6062	Part D Application Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Part D Benefits Contact	Manager, Health Plan Benefits		Stavinoha	Rosalie		4052805637					rosalie.stavinoha@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025631	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Part D Claims Submission Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Part D Exceptions Contact	VP, Pharmacy		Patel	Monank							monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract	8444490360				HMO - Health Maintenance Organization		C	New York
H6062	Part D Exceptions Contact (Secondary)	Manager, Clinical Pharmacy Operations		Adkins	Rene						4052805613	rene.adkins@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract	8444490360				HMO - Health Maintenance Organization		C	New York
H6062	Part D Price File Contact (Back-up)	Manager, Clinical Pharmacy Operations		Adkins	Rene		9188787331					rene.adkins@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Part D Price File Contact (Primary)	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Part D Quality Assurance Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Part D Reporting Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Patient Safety Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Payment Contact	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Personal Health Record Contact	Director, Legal Services and Privacy		Ramirez	Alia		4052802988					alia.ramirez@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Pharmacy Director	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Pharmacy Network Management Contact	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Pharmacy Technical Help Desk Contact	VP, Pharmacy		Patel	Monank							monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract	8666934620				HMO - Health Maintenance Organization		C	New York
H6062	PHR Beneficiary Contact																	06/19/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS	GlobalHealth	MHH Healthcare, L.P.	669	Yes	Withdrawn Contract	8442805555				HMO - Health Maintenance Organization		C	New York
H6062	Physician Incentive Contact	VP Provider Contracting, Credentialing and Network		Echols	Patricia		2147636941					patricia.echols@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Plan Directory Contact for Public Website	Call Center Director		Thomas	Daniel		4055261126					daniel.thomas@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/17/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Plan to Plan Reconciliation Contact	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Processor Contact	Manager, Claims Processing		Schultz	Patricia		4052805338					patricia.schultz@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Quality Contact	VP, Health Services		Stouffer	Kelly		4052805608					kelly.stouffer@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Reconciliation Contact	VP, Finance		Harris	Tayla		4052805724					Tayla.Harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Reconciliation Contact (Secondary)	VP, Pharmacy		Patel	Monank		4052805761					monank.patel@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	06/29/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Recovery Audit Contact	VP of Compliance and Medicare Compliance Officer	Mrs.	Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	SNP Application Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Surveillance Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	System Contact	Chief Information Officer	Mr.	Adhia	Kevin		4052805765					kevin.adhia@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	09/20/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Third Party Administrator (TPA) Liaison	VP, Finance		Harris	Tayla		4052805724					tayla.harris@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	User Access Contact	VP of Compliance and Medicare Compliance Officer		Pastrana	Isis	C	7877582500	2040				isis.pastrana@medicalcardsystem.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	731025621	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Utilization Management Contact	VP, Health Services		Stouffer	Kelly		4052805608					kelly.stouffer@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6062	Utilization Review Contact	VP, Health Services		Stouffer	Kelly		4052805608					kelly.stouffer@globalhealth.com	210 Park Avenue	Suite 2900	Oklahoma City	OK	73102	07/07/2023	2023	GLOBALHEALTH OF TEXAS, INC.	Local CCP	GlobalHealth	HMO/HMOPOS		MHH Healthcare, L.P.	669	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H6067	Agent/Broker Compensation Data Contact	Director, Medicare Sales	Mr.	Trahan	Donald		4109987538					donald.trahan@carefirst.com	10455 Mill Run Circle	Mailstop OWML1	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Automated TrOOP Balance Transfer Contact	Sr. Business Analyst	Ms.	Doumas	Alicia		4109984655					Alicia.Doumas@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	08/15/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Backup User Access Contact	Sr. Regulatory Medicare Compliance Analyst	Ms.	Incorvati	Laura		4106052405					Laura.Incorvati@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Best Available Evidence Contact	Director, Medicare Operations	Ms.	Challis	Juanita		4109987534					CFGroupMA@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Bid Audit Contact	Product Manager	Ms.	Franklin	Lisa		4109985647					Lisa.Franklin@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Bid Audit Site Contact	Product Manager	Ms.	Franklin	Lisa		4109985647					Lisa.Franklin@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Bid Primary Contact	Product Manager	Ms.	Franklin	Lisa		4109985647					Lisa.Franklin@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	CAP Report Contact for Public Website	Health Plan CEO	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	CEO - CMS Administrator Contact	President and Chief Executive Officer	Mr.	Pieninck	Brian	D	4109985320					brian.pieninck@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	CEO - Senior Official for Contracting	President and Chief Executive Officer	Mr.	Pieninck	Brian	D	4109985320					brian.pieninck@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Chief Financial Officer	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Chief Operating Officer	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/20/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Chief Information Officer	VP, IT Ops and Infrastructure	Ms.	Henderson	Dori		4109985656					Dori.Henderson@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Chief Information Security Officer	Chief Information Security Officer	Mr.	Suarez	Roberto		4109985716					Roberto.Suarez@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/20/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	CMMI Model Point of Contact	Health Plan CEO	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	CMS Casework Communication Contact	Director, Medical Review & Appeals	Ms.	Faulkner	Pamela		4105287105					Pamela.Faulkner@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Complaints Tracking Contact	Director, Medical Review & Appeals	Ms.	Faulkner	Pamela		4105287105					Pamela.Faulkner@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Contact for Fraud Investigations	Director, SIU	Ms.	Kennedy	Elizabeth		4105287067					elizabeth.kennedy@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Coordination of Benefits Contact	Director, Medicare Operations	Ms.	Challis	Juanita		4109987534					CFGroupMA@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	05/31/2022	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Corporate Mailing						4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Financial Accountant	Ms.	Mitchell	Patrice		4109985273					patrice.mitchell@carefirst.com	10455 Mill Run Circle, MC 01-635		Owings Mills, MD 21117	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Customer Service Operations Contact	Manager, Operations	Ms.	Boer	Kelsey		4109985353					Kelsey.Boer@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	DIR Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	DIR Contact (Secondary)	Directory, Pharmacy Services	Mr.	Nardone	Mark		4109985675					Mark.Nardone@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/24/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Electronic Health Record Contact	Health Plan CEO	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Emergency Part D Contact	Director Pharmacy Government Programs	Mr.	Nardone	Mark		4109985675					Mark.Nardone@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Emergency Part D Contact (Secondary)	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					john.vellutato@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/24/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Employer Waiver Contact	Director of Operations	Ms.	Gonce	Angie		4109987561					angie.gonce@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Encounter Data & Risk Adjustment Operations Contact	VP, Quality & Risk Adjustment	Mr.	Ramalingam	Subbu		4106052605					Subbu.Ramalingam@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Enrollment Contact	Health Plan Chief Ops Officer	Ms.	Toland	Cheryl		4109985107					Cheryl.Toland@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	EOB Transfer Contact	Health Plan Chief Ops Officer	Ms.	Toland	Cheryl		4109985107				4109987534	Cheryl.Toland@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Financial Audit Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	10455 Run Mill Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Financial Reporting Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Formulary Contact	Director, Pharmacy Services	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Formulary Contact (Secondary)	Clinical Pharmacist	Ms.	Lee	Catherine		4105287033					Catherine.Lee@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	08/15/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	General Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Government Relations Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	HIPAA Privacy Officer	Dir, Privacy & Compliance	Ms.	Gregory	Lauren		4105285066					lauren.gregory@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	HIPAA Security Officer	Chief Information Security Officer	Mr.	Suarez	Roberto		4109985716					Roberto.Suarez@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Hospice Contact	Director, Utilization Management	Ms.	Westeburg	Sarah		4105287145					Sarah.Westburg@carefirst.com	10455 Mill Run Circle		Owing Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Interoperability Contact	VP, Enterprise Arch. & Integr.	Mr.	Heyl	Bob		2026806682					Bob.Heyl@carefirst.com	840 First Street, NE		Washington	DC	20065	02/16/2022	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	MA Appeals/Grievances Contact	Director, Medical Review & Appeals	Ms.	Faulkner	Pamela		4105287105					Pamela.Faulkner@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	01/12/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	MA Claims Processing Contact for Public Website			Services	Member		8552905744					Cheryl.Toland@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Marketing Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Medical Director	Medical Director	Dr.	Park	Kevin		4105287136					Kevin.Park@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/24/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Medicare Coordinator	Sr. Regulatory Compliance Analyst	Ms.	Incorvati	Laura		4106052405					laura.incorvati@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/24/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Medication Therapy Management Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	10455 Run Mill Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Online Enrollment Center Contact (Back-up)	Health Plan Chief Ops Officer	Ms.	Toland	Cheryl		4109985107					Cheryl.Toland@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Online Enrollment Center Contact (Primary)	Director, Medicare Operations	Ms.	Challis	Juanita		4109987534					CFGroupMA@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part C Application Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Appeals	Manager, Clinical Operations	Ms.	Beyda	Trista						7326914838	_REReconsideration@cvscaremark.com	3424 William Penn Hwy,		Pittsburg	PA	15235	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	8889700917				HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Appeals Contact (Secondary)	Medicare Appeals Analyst	Ms.	Gabor-Lyon	Pam						7326914838	Trista.Beyda@cvshealth.com	3424 William Penn Hwy		Pittsburgh	PA	15235	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	8889700917				HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Application Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Benefits Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Claims Submission Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Exceptions Contact	Sr. Dir., Pharm Eval & Oversight	Ms.	Poplawski	Mandi							Mandi.Poplawski@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	4105285053				HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Exceptions Contact (Secondary)	Clinical Pharmacist	Mr.	Vellutato	John							john.vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	4105722606				HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Price File Contact (Back-up)	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					john.vellutato@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Price File Contact (Optional)		Mr.	Loveland	Chet		4806064823					Chet.Loveland@cvshealth.com	9501 E. Shea Blvd.  MC 121		Scottsdale	AZ	85260	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Price File Contact (Primary)	Director Pharmacy Government Programs	Mr.	Nardone	Mark		4109985675					Mark.Nardone@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Quality Assurance Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105732602					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Part D Reporting Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Patient Safety Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105732602					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Payment Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Personal Health Record Contact	VP Medicare		Billman	Julie		4109987534					julie.billman@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	03/24/2021	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Pharmacy Director	Sr. Dir., Pharm Eval & Oversight	Ms.	Poplawski	Mandi		4105285053					Mandi.Poplawski@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Pharmacy Network Management Contact	Director Pharmacy Government Programs	Mr.	Nardone	Mark		4109985675					Mark.Nardone@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Pharmacy Network Management Contact (Secondary)	Sr. Dir., Pharm Eval & Oversight	Ms.	Poplawski	Mandi		4105285303					Mandi.Poplawski@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Pharmacy Technical Help Desk Contact	Director Pharmacy Government Programs	Mr.	Nardone	Mark							Mark.Nardone@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Philadelphia
H6067	Pharmacy Technical Help Desk Contact (Secondary)	Lead Business Analyst	Ms.	Ford	Michelle							Michelle.Ford@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	08/15/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	4437387978				HMO - Health Maintenance Organization		C	Philadelphia
H6067	PHR Beneficiary Contact																	03/24/2021	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS	CareFirst BlueCross Blue Shield Medicare Advantage	CareFirst, Inc.	45	Yes	Active	8552905744				HMO - Health Maintenance Organization		C	Philadelphia
H6067	Physician Incentive Contact	Manager, Payment Transformation	Mr.	Coffey	Nathan		4104692167					Nathan.Coffey@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Plan Directory Contact for Public Website			Services	Member		8552905744					Cheryl.Toland@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Plan to Plan Reconciliation Contact	Financial Analyst	Ms.	Rohsner	Lian		4109985710					Lian.Rohsner@Carefirst.com	P.O. Box 787172		Philadelphia	PA	191787172	02/17/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Processor Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Quality Contact	VP,Govt. Prg Star & Risk Adj	Mr.	Ramalingam	Subbu		4106052605					Subbu.Ramalingam@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	09/17/2022	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Reconciliation Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Reconciliation Contact (Secondary)	Director, Pharmacy Services	Mr.	Nardone	Mark		4109985675					Mark.Nardone@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	03/06/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Surveillance Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	System Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Third Party Administrator (TPA) Liaison	Lead Business Analyst	Ms.	Ford	Michelle	R	4437387978					Michelle.Ford@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	06/29/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	User Access Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Utilization Management Contact	Director, Utilization Management	Ms.	Westeburg	Sarah		4105287145					Sarah.Westburg@carefirst.com	10455 Mill Run Circle		Owing Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6067	Utilization Review Contact	Director, Utilization Management	Ms.	Westeburg	Sarah		4105287145					Sarah.Westburg@carefirst.com	10455 Mill Run Circle		Owing Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6078	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	02/10/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Bid Primary Contact	Director II Product Development		Kerin	Michele		5186050449					michele.kerin@anthem.com	46 Berkshire Drive		Colonie	NY	12205	10/27/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/10/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/10/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	02/10/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	02/10/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H6078	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				PPO - BBA		C	Chicago
H6078	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H6078	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				PPO - BBA		C	Chicago
H6078	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				PPO - BBA		C	Chicago
H6078	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				PPO - BBA		C	Chicago
H6078	PHR Beneficiary Contact																	02/10/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				PPO - BBA		C	Chicago
H6078	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	02/10/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6078	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	02/10/2020	2023	Group Retiree Health Solutions, Inc.	Local CCP	Blue Medicare Advantage	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H6079	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Backup User Access Contact	Chief Information Officer		Babachicos	Cara		7209746739					cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Best Available Evidence Contact	Finance and Compliance Analyst	Mr.	Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Bid Primary Contact	Finance and Compliance Analyst	Mr.	Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	CAP Report Contact for Public Website	VP Clinical Compliance Audit Management		Teter	Lezlie		7206829848				3039961600	Lteter@innovage.com	3870 Rosin Court		Sacremento	CA	95834	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	9096779517				PACE - Nat		C	San Francisco
H6079	CEO - CMS Administrator Contact	President & CEO	Mr.	Blair	Patrick		7209746704				3039961600	PBlair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	CEO - Senior Official for Contracting	President & CEO	Mr.	Blair	Patrick		7209746704				3039961600	PBlair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Chief Financial Officer	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Chief Operating Officer	COO	Ms.	Bent	Christine		7209742356				3039961600	cbent@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Chief Information Officer	CIO	Ms	Babachicos	Cara		3037202994					cbabachicos@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Chief Information Security Officer	Chief Information Security Officer	Mr	Smith	Alvin		7207896084				3039961600	ASmith2@innovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	CMS Casework Communication Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Complaints Tracking Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Contact for Fraud Investigations	Chief Legal Officer		D'Amato	Nicole		3038694664				3039961600	ndamato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Coordination of Benefits Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Corporate Mailing						3038694664				3039961600	bgutierrez@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Customer Service Operations Contact	Regional VP Operations COO	Mr.	Lohr	Clint		7209829868				3039961600	clohr@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	DIR Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Emergency Part D Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Encounter Data & Risk Adjustment Operations Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Enrollment Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	EOB Transfer Contact	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Financial Audit Contact	Director of Finance	Ms.	Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Financial Reporting Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Formulary Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	General Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Government Relations Contact	Executive VP Government Relations		Steckel	Carol		7207896157				3039961600	CSteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	HIPAA Privacy Officer	Associate General Counsel	Mr.	Moxon	Jeff		7206613727				3039961600	crobertson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	HIPAA Security Officer	Chief Information Security Officer		Smith	Alvin		7207896084					asmith2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Interoperability Contact	SVP, Application Systems		Zierolf	Kris		7209742380					kzierolf@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	MA Appeals/Grievances Contact	Regional Director of Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	MA Claims Processing Contact for Public Website	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Marketing Contact	SVP, Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Medical Director	Chief Medical Officer	Dr.	Feifer	Rich		7206827305				3039961600	RFeifer@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Medicare Compliance Officer	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Medicare Coordinator	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Medicare Part D Opioid Overutilization Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 E. Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Medication Therapy Management Contact	SVP of Clinical Strategic Partnerships	Mrs.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Part C Application Contact	Executive VP Government Relations	Ms.	Steckel	Carol		7207896157				3039961600	CSteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Part D Appeals	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	San Francisco
H6079	Part D Application Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Part D Benefits Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Part D Claims Submission Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Part D Exceptions Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	San Francisco
H6079	Part D Price File Contact (Back-up)	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Part D Price File Contact (Primary)	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Part D Quality Assurance Contact	SVP of Clinical Strategic Partnerships		Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Part D Reporting Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Patient Safety Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Payment Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Pharmacy Director	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Pharmacy Network Management Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Pharmacy Technical Help Desk Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active	7206663817				PACE - Nat		C	San Francisco
H6079	PHR Beneficiary Contact																	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE	Total Longterm Care, Inc.	Total Community Options, Inc.	230	Yes	Active	8772776163	732			PACE - Nat		C	San Francisco
H6079	Plan Directory Contact for Public Website	Director of Marketing		Stavros	Sarah		3033006904				3039961600	sstavros@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Plan to Plan Reconciliation Contact	Financial and Compliance Analyst		Kizewski	Alex		7207896171				7209173390	AKizewsk@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Processor Contact	CFO	Mr.	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Quality Contact	Vice President of Quality		Curry	Jill		2153782123					JCurry@innovage.com	2000 Market Street	Suite 780	Philadelphia	PA	19103	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Reconciliation Contact	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Recovery Audit Contact	SVP of Clinical Strategic Partnerships	Mr.	Cinque	Michael		7206663817					mcinque@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Surveillance Contact	SVP, Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	System Contact	Director, PACE Finance		Hewitt	Jessica		7209746767					jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Third Party Administrator (TPA) Liaison	Director, PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	User Access Contact	Corporate Director of Compliance		Dickerson	Anzio		7208687356					adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Utilization Management Contact	Chief Quality & Population Health Officer	Dr.	Wells	Ann		7206827305				3039961600	awells@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6079	Utilization Review Contact	Chief Quality & Population Health Officer	Dr.	Wells	Ann		7206827305				3039961600	awells@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/27/2023	2023	TOTAL LONGTERM CARE, INC.	National PACE	InnovAge California PACE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	San Francisco
H6080	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Chief Information Officer	SVP, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	01/24/2020	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	09/27/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Corporate Mailing						8132063091					william.winn@wellcare.com	P. O. Box 31386		Tampa	FL	33631	07/02/2019	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	09/27/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/27/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	02/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/03/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	09/27/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/25/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/25/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/03/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Medical Director	Chief Medical Officer	Dr.	Miskimmin	Renee		3133243700					renee.miskimmin@mhplan.com	1 Campus Martius	Suite 700	Detroit	MI	48226	07/19/2017	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	MMP Reporting Requirements Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	MMP Point of Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	09/27/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/24/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	09/27/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	09/27/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	PHR Beneficiary Contact																	09/27/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8555801689				Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Plan Directory Contact for Public Website			Services	Member		8553234578				8778582437	meridianmedicare@mhplan.com	1 Campus Martius	Suite 700	Detroit	MI	48226	07/19/2017	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/27/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	09/27/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6080	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	MERIDIAN HEALTH PLAN OF ILLINOIS, INC.	Demo	Meridian Medicare-Medicaid Plan (MMP)	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H6081	Automated TrOOP Balance Transfer Contact			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/22/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Backup User Access Contact			Magana	Vanessa		7604754753					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/22/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Best Available Evidence Contact			Magana	Vanessa		7604754753					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/22/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Bid Primary Contact			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/22/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	CAP Report Contact for Public Website			Nava	Janett		7606849547					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/22/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	CEO - CMS Administrator Contact		MD	Milani	Arash		8056982795					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/22/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	CEO - Senior Official for Contracting		MD	Milani	Arash		8056982795					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/22/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Chief Financial Officer		MD	Milani	Arash		8056982795					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/22/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Chief Operating Officer		MD	Milani	Arash		8056982795					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/22/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Chief Information Officer		MD	Ashtiani	Ramin		9173598164					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Chief Information Security Officer		MD	Ashtiani	Ramin		9173598164					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	CMS Casework Communication Contact			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/22/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Complaints Tracking Contact			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Contact for Fraud Investigations			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Coordination of Benefits Contact			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Corporate Mailing						9092283127					highdesertpace@gmail.com	12223 Highland Ave.		Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Coverage Gap Discount Program (CGDP) Payment Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Customer Service Operations Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	DIR Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Emergency Part D Contact			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Encounter Data & Risk Adjustment Operations Contact			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Enrollment Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	EOB Transfer Contact			Iglais	Jorge		7862878675				7602459448	highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Financial Audit Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Financial Reporting Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Formulary Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	General Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Government Relations Contact			Kraft	Sheila		7608811630					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	HIPAA Privacy Officer			Kraft	Sheila		7608811630					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	HIPAA Security Officer			Kraft	Sheila		7608811630					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Interoperability Contact			Kraft	Sheila		7608811630					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	MA Appeals/Grievances Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	MA Claims Processing Contact for Public Website			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Marketing Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Medical Director		MD	Choi	Johnny		9092283127					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Medicare Compliance Officer	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Medicare Coordinator	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Medicare Part D Opioid Overutilization Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Medication Therapy Management Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Online Enrollment Center Contact (Back-up)			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Online Enrollment Center Contact (Optional)			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Online Enrollment Center Contact (Primary)			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Part C Application Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	05/01/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Part D Appeals			Pleng	Wendy							highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending	7609818469				PACE - Nat		C	San Francisco
H6081	Part D Application Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	05/01/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Part D Benefits Contact			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Part D Claims Submission Contact			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Part D Exceptions Contact			Pleng	Wendy							highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending	7609818469				PACE - Nat		C	San Francisco
H6081	Part D Price File Contact (Back-up)			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Part D Price File Contact (Primary)			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Part D Quality Assurance Contact			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Part D Reporting Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Patient Safety Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Payment Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Pharmacy Director			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Pharmacy Network Management Contact			Avila	Valerie		9092604123					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Pharmacy Technical Help Desk Contact			Pleng	Wendy							highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending	7609818469				PACE - Nat		C	San Francisco
H6081	Plan Directory Contact for Public Website			Magana	Vanessa		7604754753					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Plan to Plan Reconciliation Contact			Magana	Vanessa		7604754753					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Processor Contact			Magana	Vanessa		7604754753					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Quality Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Reconciliation Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Recovery Audit Contact	NP	NP	Iglais	Jorge		7862878675					highdesertpace@gmail.com	11833 Amethyst Road		Victorville	CA	92392	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Surveillance Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	System Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Third Party Administrator (TPA) Liaison			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	User Access Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Utilization Management Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6081	Utilization Review Contact			Madrigal-Flynn	Brandy		9092283127					highdesertpace@gmail.com	12223 Highland Avenue	Suite 106-536	Rancho Cucamonga	CA	91739	06/23/2022	2023	HIGH DESERT PACE, INC,	National PACE	High Desert PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6142	CEO - CMS Administrator Contact	EXECUTIVE DIRECTOR	Ms.	Liu	Marsha		3124234200					mliu@unionhealth.org	1634 W POLK ST		CHICAGO	IL	60612	10/06/2022	2023	UNION HEALTH SERVICES, INC.	HCPP - 1833 Cost	Union Health Service, Inc.	HCPP - 1833 Cost		Union Health Services, Inc.	241	No	Active					HCPP		1	Chicago
H6142	CEO - Senior Official for Contracting	EXECUTIVE DIRECTOR	Ms.	Liu	Marsha		3124234200					mliu@unionhealth.org	1634 W POLK ST		CHICAGO	IL	60612	10/06/2022	2023	UNION HEALTH SERVICES, INC.	HCPP - 1833 Cost	Union Health Service, Inc.	HCPP - 1833 Cost		Union Health Services, Inc.	241	No	Active					HCPP		1	Chicago
H6142	Chief Financial Officer	CHIEF FINANCIAL OFFICER	Ms.	Vullmahn	Caroline		3124234200					cvullmahn@unionhealth.org	1634 W POLK ST		CHICAGO	IL	60612	10/06/2022	2023	UNION HEALTH SERVICES, INC.	HCPP - 1833 Cost	Union Health Service, Inc.	HCPP - 1833 Cost		Union Health Services, Inc.	241	No	Active					HCPP		1	Chicago
H6142	Chief Operating Officer	DIRECTOR OF OPERATIONS	MS.	Vullmahn	Caroline		3124234200					cvullmahn@unionhealth.org	1634 W POLK ST		CHICAGO	IL	60612	10/06/2022	2023	UNION HEALTH SERVICES, INC.	HCPP - 1833 Cost	Union Health Service, Inc.	HCPP - 1833 Cost		Union Health Services, Inc.	241	No	Active					HCPP		1	Chicago
H6142	Corporate Mailing						3124234200					MLIU@UNIONHEALTH.ORG	1634  W. POLK STREET		CHICAGO	IL	60612	02/06/2019	2023	UNION HEALTH SERVICES, INC.	HCPP - 1833 Cost	Union Health Service, Inc.	HCPP - 1833 Cost		Union Health Services, Inc.	241	No	Active					HCPP		1	Chicago
H6142	Cost Report Contact	Accounting Supervisor	Ms.	Childs	Sujuana		3124234200	3358				schilds@unionhealth.org	1634 W. POLK STREET		CHICAGO	IL	60612	10/06/2022	2023	UNION HEALTH SERVICES, INC.	HCPP - 1833 Cost	Union Health Service, Inc.	HCPP - 1833 Cost		Union Health Services, Inc.	241	No	Active					HCPP		1	Chicago
H6142	Enrollment Contact	SUPERVISOR, MEMBER SERVICE	MS.	CACCAVALE	DEANA		3124234200					DCACCAVALE@UNIONHEALTH.ORG	1634 W POLK ST		CHICAGO	IL	60612	06/28/2007	2023	UNION HEALTH SERVICES, INC.	HCPP - 1833 Cost	Union Health Service, Inc.	HCPP - 1833 Cost		Union Health Services, Inc.	241	No	Active					HCPP		1	Chicago
H6142	General Contact	Accounting Supervisor	Ms.	Childs	Sujuana		3124234200	3358				schilds@unionhealth.org	1634 W. POLK STREET		CHICAGO	IL	60612	10/06/2022	2023	UNION HEALTH SERVICES, INC.	HCPP - 1833 Cost	Union Health Service, Inc.	HCPP - 1833 Cost		Union Health Services, Inc.	241	No	Active					HCPP		1	Chicago
H6142	Medicare Compliance Officer		MS.	ROCK	JILL		3124234200	3222				JROCK@UNIONHEALTH.ORG	1634  W POLK STREET		CHICAGO	IL	60612	04/28/2021	2023	UNION HEALTH SERVICES, INC.	HCPP - 1833 Cost	Union Health Service, Inc.	HCPP - 1833 Cost		Union Health Services, Inc.	241	No	Active					HCPP		1	Chicago
H6142	System Contact	DIRECTOR OF OPERATIONS	MS.	LIU	MARSHA		3124234200					MLIU@UNIONHEALTH.ORG	1634 W POLK ST		CHICAGO	IL	60612	02/06/2019	2023	UNION HEALTH SERVICES, INC.	HCPP - 1833 Cost	Union Health Service, Inc.	HCPP - 1833 Cost		Union Health Services, Inc.	241	No	Active					HCPP		1	Chicago
H6147	Automated TrOOP Balance Transfer Contact	AVP, Pharmacy		Gobin	Antony		9095584000					AGobin@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Backup User Access Contact	AVP, Quality & Patient Safety		Bruneau	Brenda		9095584000					BBruneau@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Best Available Evidence Contact	VP, Financial Services		Mowery	Lew		9095584000					lmowery@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Bid Primary Contact	Chief Financial Officer and SVP Finance	Ms.	Lalas	Angela		9095584000					ALalas@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	CAP Report Contact for Public Website	AVP, Quality & Patient Safety		Bruneau	Brenda		9095584000					BBruneau@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	CEO - CMS Administrator Contact	Program Executive Director	Ms.	Von Esch	Leslie		9095587223					LVonEsch@llu.edu	1790 West Park Ave		Redlands	CA	92373	09/11/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	CEO - Senior Official for Contracting	Program Executive Director	Ms.	Von Esch	Leslie		9095587223					LVonEsch@llu.edu	1790 West Park Ave		Redlands	CA	92373	09/11/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Chief Financial Officer	Chief Financial Officer and SVP Finance	Ms.	Lalas	Angela		9095584000					ALalas@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Chief Operating Officer	COO	Mr.	Wright	Trevor		9095584000					TGWright@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Chief Information Officer	CIO	Mr.	Zirkelbach	Mark		9095584000					MZirkelbach@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Chief Information Security Officer	Exec Director, IS Security	Mr.	Voon	Patrick		9095584000					PVoon@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	CMS Casework Communication Contact	AVP, Care Coordination		Arias	Paul		9095584000					PArias@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Complaints Tracking Contact	Executive Director, Patient Experience		McDonald	Jennifer		9095584000					JMcdonald@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Contact for Fraud Investigations	AVP, Quality & Patient Safety		Bruneau	Brenda		9095584000					BBruneau@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Coordination of Benefits Contact	Director, Managed Care Finance		Rusovick	Heather		9095584000					HRusovick@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Corporate Mailing						9095587223					LVonEsch@llu.edu	1790 West Park Avenue		Redlands	CA	92373	09/11/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Coverage Gap Discount Program (CGDP) Payment Contact	Director-Pharmacy Outpatient, Pharmacy		Smith	Jenise		9095584000					JEDSmith@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Customer Service Operations Contact	Director-Patient Relations		Mikhail	Wagih		9095584000					WMikhail@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	DIR Contact	AVP, Pharmacy		Gobin	Antony		9095584000					AGobin@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	DIR Contact (Secondary)	Director-Pharmacy Outpatient, Pharmacy		Smith	Jenise		9095584000					JEDSmith@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Emergency Part D Contact	AVP, Pharmacy		Gobin	Antony		9095584000					AGobin@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Emergency Part D Contact (Secondary)	Director-Pharmacy Outpatient, Pharmacy		Smith	Jenise		9095584000					JEDSmith@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Encounter Data & Risk Adjustment Operations Contact	Executive Director, Managed Care		Everidge White	Gayle		9095584000					GEveridgewhite@llu.edu	1790 West Park Avenue	3421	Redlands	CA	92373	09/22/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Enrollment Contact	Director, Managed Care Finance		Rusovick	Heather		9095584000					HRusovick@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	EOB Transfer Contact	Operations Support Supervisor-Pharmastar		Biren	Alicia		8882987770				7158367683	jvang@pharmastarpbm.com	P.O. Box 3217		Eau Claire	WI	54702	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Financial Audit Contact	Chief Financial Officer and SVP Finance	Ms.	Lalas	Angela		9095584000					ALalas@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Financial Reporting Contact	Chief Financial Officer and SVP Finance	Ms.	Lalas	Angela		9095584000					ALalas@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Formulary Contact	AVP, Pharmacy		Gobin	Antony		9095584000					AGobin@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Formulary Contact (Secondary)	Director-Pharmacy Outpatient, Pharmacy		Smith	Jenise		9095584000					JEDSmith@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	General Contact	Program Executive Director	Ms.	Von Esch	Leslie		9095587223					LVonEsch@llu.edu	1790 West Park Ave		Redlands	CA	92373	09/11/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Government Relations Contact	Program Executive Director	Ms.	Von Esch	Leslie		9095587223					LVonEsch@llu.edu	1790 West Park Ave		Redlands	CA	92373	09/11/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	HIPAA Privacy Officer	AVP, Quality & Patient Safety		Bruneau	Brenda		9095584000					BBruneau@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	HIPAA Security Officer	Exec Director, IS Security	Mr.	Voon	Patrick		9095584000					PVoon@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Interoperability Contact	AVP, Quality & Patient Safety		Bruneau	Brenda		9095584000					BBruneau@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/11/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	MA Appeals/Grievances Contact	Director, Managed Care Finance		Rusovick	Heather		9095584000					HRusovick@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	MA Claims Processing Contact for Public Website	Director, Managed Care Finance		Rusovick	Heather		9095584000					HRusovick@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Marketing Contact	Program Executive Director	Ms.	Von Esch	Leslie		9095587223					LVonEsch@llu.edu	1790 West Park Ave		Redlands	CA	92373	09/11/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Medical Director	Geriatrics	Dr.	Labib	Wessam		9095584000					WLabib@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Medicare Compliance Officer	Program Executive Director	Ms.	Von Esch	Leslie		9095587223					LVonEsch@llu.edu	1790 West Park Ave		Redlands	CA	92373	09/28/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Medicare Coordinator	Director, Managed Care Finance		Rusovick	Heather		9095584000					HRusovick@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Medicare Part D Opioid Overutilization Contact	AVP, Pharmacy		Gobin	Antony		9095584000					AGobin@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/24/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Medication Therapy Management Contact	AVP, Pharmacy		Gobin	Antony		9095584000					AGobin@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Part C Application Contact	Program Executive Director	Ms.	Von Esch	Leslie		9095587223					LVonEsch@llu.edu	1790 West Park Avenue		Redlands	CA	92373	09/11/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Part D Appeals	Director, Managed Care Finance		Rusovick	Heather							HRusovick@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending	9095584000				PACE - Nat		C	San Francisco
H6147	Part D Application Contact	Program Executive Director	Ms.	Von Esch	Leslie		9095587223					LVonEsch@llu.edu	1790 West Park Ave		Redlands	CA	92373	09/11/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Part D Benefits Contact	Director-Pharmacy Outpatient, Pharmacy		Smith	Jenise		9095584000					JEDSmith@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Part D Claims Submission Contact	Client Support Supervisor-Pharmastar		Vang	Jane		8882987770					jvang@pharmastaronline.com	2503 N. Hillcrest Parkway		Altoona	WI	54720	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Part D Exceptions Contact	Director-Pharmacy Outpatient, Pharmacy		Smith	Jenise							JEDSmith@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending	9095584000				PACE - Nat		C	San Francisco
H6147	Part D Exceptions Contact (Secondary)	AVP, Pharmacy		Gobin	Antony							AGobin@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending	9095584000				PACE - Nat		C	San Francisco
H6147	Part D Price File Contact (Back-up)	Client Support Manager-Pharmastar		Slowiak	Andre		7158522983					asloiak@pharmastarpbm.com	P.O. Box 3217		Eau Claire	WI	54702	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Part D Price File Contact (Primary)	AVP, Pharmacy		Gobin	Antony		9095584000					AGobin@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Part D Quality Assurance Contact	Program Executive Director	Ms.	Von Esch	Leslie		9095587223					LVonEsch@llu.edu	1790 West Park Ave		Redlands	CA	92373	09/28/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Part D Reporting Contact	AVP, Quality & Patient Safety		Bruneau	Brenda		9095584000					BBruneau@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Patient Safety Contact	AVP, Quality & Patient Safety		Bruneau	Brenda		9095584000					BBruneau@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Payment Contact	VP, Financial Services		Mowery	Lew		9095584000					lmowery@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Pharmacy Director	AVP, Pharmacy		Gobin	Antony		9095584000					AGobin@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Pharmacy Network Management Contact	Director-Pharmacy Outpatient, Pharmacy		Smith	Jenise		9095584000					JEDSmith@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Pharmacy Network Management Contact (Secondary)	AVP, Pharmacy		Gobin	Antony		9095584000					AGobin@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Pharmacy Technical Help Desk Contact	Pharmastar		Service	Customer							jvang@pharmastaronline.com	2503 N. Hillcrest Parkway		Altoona	WI	54720	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending	8882987770				PACE - Nat		C	San Francisco
H6147	Plan Directory Contact for Public Website	Program Executive Director	Ms.	Von Esch	Leslie		9095587223					LVonEsch@llu.edu	1790 West Park Ave		Redlands	CA	92373	09/11/2023	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Plan to Plan Reconciliation Contact	Director, Managed Care Finance		Rusovick	Heather		9095584000					HRusovick@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Processor Contact	Client Support Supervisor-Pharmastar		Vang	Jane		8882987770					jvang@pharmastaronline.com	2503 N. Hillcrest Parkway		Altoona,	WI	54720	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Quality Contact	AVP, Quality & Patient Safety		Bruneau	Brenda		9095584000					BBruneau@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Reconciliation Contact	Director, Managed Care Finance		Rusovick	Heather		9095584000					HRusovick@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Reconciliation Contact (Secondary)	Executive Director, Managed Care		Everidge White	Gayle		9095584000					GEveridgewhite@llu.edu	1790 West Park Avenue	3421	Redlands	CA	92373	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Recovery Audit Contact	Director, Managed Care Finance	Ms.	Rusovick	Heather		9095584000					HRusovick@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Surveillance Contact	AVP, Quality & Patient Safety		Bruneau	Brenda		9095584000					BBruneau@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	System Contact	CIO	Mr.	Zirkelbach	Mark		9095584000					MZirkelbach@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Third Party Administrator (TPA) Liaison	AVP, Pharmacy		Gobin	Antony		9095584000					AGobin@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	User Access Contact	CIO	Mr.	Zirkelbach	Mark		9095584000					MZirkelbach@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Utilization Management Contact	Geriatrics	Dr.	Labib	Wessam		9095584000					WLabib@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6147	Utilization Review Contact	Geriatrics	Dr.	Labib	Wessam		9095584000					WLabib@llu.edu	11234 Anderson Street		Loma Linda	CA	92354	09/23/2021	2023	LOMA LINDA UNIVERSITY MEDICAL CENTER	National PACE	Loma Linda University Health PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6154	Agent/Broker Compensation Data Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Automated TrOOP Balance Transfer Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Backup User Access Contact			Berg	Lynnsey		6126326655					lynnsey.berg@optum.com	P.O. Box 9472		Minneapolis	MN	554409472	11/30/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Best Available Evidence Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Bid Audit Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Bid Audit Site Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Bid Primary Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	CAP Report Contact for Public Website			Jacobson	Marissa		9529922093					marissa.jacobson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	CEO - CMS Administrator Contact	Interm President & CFO	Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	CEO - Senior Official for Contracting		Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Chief Financial Officer		Ms	Quist	Mary		9529922058					mary.quist@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Chief Operating Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Chief Information Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Chief Information Security Officer		Mr	Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	CMMI Model Point of Contact			Schaefer	Jennifer		9529912803					jennifer.schaefer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	CMS Casework Communication Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Complaints Tracking Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Contact for Fraud Investigations			Monson	Peter		9529921149					peter.monson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/03/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Coordination of Benefits Contact			Vilendrer	Krista		9529923252					krista.vilendrer@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	04/22/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Corporate Mailing						9529922900					ann.kinsella@medica.com	401 Carlson Parkway	P.O. Box 9310 CP320	Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Coverage Gap Discount Program (CGDP) Payment Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Customer Service Operations Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	DIR Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	DIR Contact (Secondary)			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	03/13/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Emergency Part D Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Emergency Part D Contact (Secondary)			Janes	Kathy		9529928989					kathy.janes@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Employer Waiver Contact			Alness	Stacy		9529923825					stacy.alness@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/19/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Encounter Data & Risk Adjustment Operations Contact			Leth	Maria		9529928366					maria.leth@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/29/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Enrollment Contact			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/28/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	EOB Transfer Contact			Bourdages	Kathy		9529923653				9529923636	kathy.bourdages@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Financial Audit Contact	Director Finance & Strategy	Mr	Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/11/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Financial Reporting Contact			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Formulary Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Formulary Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	General Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Government Relations Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	HIPAA Privacy Officer			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/20/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	HIPAA Security Officer		Mr	Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Hospice Contact			Bourdages	Kathy		9529923653					PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/28/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Interoperability Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/14/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	MA Appeals/Grievances Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	MA Claims Processing Contact for Public Website			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Marketing Contact			Teff	Melissa		9529923972					melissa.teff@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Medical Director	Chief Clinical & Provider Strategy Officer		Webster	David		9529922801					david.webster@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/15/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Medicare Compliance Officer		Mrs	Koranteng	Milly		9529922090					mildred.koranteng@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/22/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Medicare Coordinator			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Medicare Part D Opioid Overutilization Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Medication Therapy Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	OffShore Subcontractor Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Online Enrollment Center Contact (Primary)			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Part C Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Part C Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/29/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Appeals			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529922353				HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Appeals Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529923448				HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Benefits Contact			Rodine	Bridget		9529922353					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/09/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Claims Submission Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Exceptions Contact			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529922353				HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Exceptions Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529923448				HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Price File Contact (Back-up)			Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Farifield	OH	45014	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Price File Contact (Optional)			Bourdages	Kathy		9529923653					PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/28/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Price File Contact (Primary)			Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Quality Assurance Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Part D Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/29/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Patient Safety Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Payment Contact			Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/11/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Pharmacy Director			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/10/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Pharmacy Network Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Pharmacy Network Management Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	La Tasha							LaTasha_Monroe@expressscripts.com	13051 N. Telecom Pkwy		Temple Terrace	FL	33637	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Kansas City
H6154	Pharmacy Technical Help Desk Contact (Secondary)			Bourdages	Kathy							PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/09/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Kansas City
H6154	Plan Directory Contact for Public Website			Service	Customer		8002348755					AskGovtPrograms@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Plan to Plan Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Processor Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Quality Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Reconciliation Contact (Secondary)			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	06/27/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Recovery Audit Contact	Manager Claims Operations	Mr	Foley	Steve		9529924160					steven.foley@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	SNP Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	SNP State Contact			Zillhardt	John		9529922290					John.Zillhardt@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Surveillance Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	System Contact			Schwartz	Pamela		9529922584					pamela.schwartz@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Third Party Administrator (TPA) Liaison			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	User Access Contact			Sherman	Autumn		9529923483					autumn.sherman@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	05/08/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Utilization Management Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6154	Utilization Review Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2017	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6158	Agent/Broker Compensation Data Contact	Manager, Individual Sales Agent		Creasman	Matthew		5013993923					mdcreasman@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Automated TrOOP Balance Transfer Contact	Eligibility Supervisor		White	William		6127776736					eobp2p@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Backup User Access Contact	Regulatory Compliance System Administrator		Coffman	Clay		5013782559					crcoffman@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Best Available Evidence Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Bid Audit Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 S Gaines St		Little Rock	AR	72201	06/12/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Bid Audit Site Contact	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Bid Primary Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	06/12/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	CAP Report Contact for Public Website	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	CEO - CMS Administrator Contact	Lead Executive, Senior Products	Ms.	Dixon	Laurin	E	9016063429					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	CEO - Senior Official for Contracting	Executive VP, Chief Operating Officer	Mr.	Dillard	Gray		5013782436					gddillard@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	05/20/2021	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Chief Financial Officer	CFO	Mr.	Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Chief Operating Officer	Executive VP, Chief Operating Officer	Mr.	Dillard	Gray		5013782436					gddillard@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Chief Information Officer	Chief Information Officer	Ms.	Ryan	Kathy		5013782017					koryan@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Chief Information Security Officer	Chief Information Officer	Ms.	Ryan	Kathy		5013782017					koryan@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	CMS Casework Communication Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Complaints Tracking Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Contact for Fraud Investigations	Director, Performance Mgt. & Investigations		Gunter	Debbie		5013786610					dsgunter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Coordination of Benefits Contact	Eligibility Supervisor		White	William		6127776736					cobmedd@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Corporate Mailing						5013785635					mdvannatta@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Customer Service Operations Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	DIR Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	DIR Contact (Secondary)	CFO		Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Emergency Part D Contact	Lead Executive, Senior Products		Dixon	Laurin	E	9016063429					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Emergency Part D Contact (Secondary)	Manager, Senior Products		Sherer	Michael		5013786341					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Encounter Data & Risk Adjustment Operations Contact	Director Medicare Risk Adjustment		Serrano	Kacey		5013714238					klserrano@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	03/19/2021	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Enrollment Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	EOB Transfer Contact	Eligibility Supervisor		White	William		6127776736				8776772730	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Financial Audit Contact	Medicare Compliance Officer	Mr.	Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	09/21/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Financial Reporting Contact	Financial Reporting Accountant		Russell	Holly		5013993954					hkrussell@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Formulary Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Formulary Contact (Secondary)			Wahl	Dan		6127776815					dwahl@primetherapeutics.com	Prime Therapeutics 1305 Corporate Drive		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	General Contact	Led Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Government Relations Contact	Sr Counsel Gov't Relation		Fenton	Janie		5013782103					jwfenton@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	HIPAA Privacy Officer	Sr Counsel Litigation		Roberts	Chet		5013782375					cxroberts@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	HIPAA Security Officer	Physical Security/Chief Security Officer		Shirley	Devin		5016880747					DMShirley@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	09/11/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Hospice Contact	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Interoperability Contact			Ritchey	Heather		5013782000					hrritchey@arkbluecross.com	601 South Gaines Street		Little Rock	AR	72201	02/11/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	MA Appeals/Grievances Contact	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	MA Claims Processing Contact for Public Website	Supervisor, Medicare Claims		Pilkington Ross	Amanda		5013013452					ampilkington@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Marketing Contact	VP Consumer and Retail Markets	Mr.	Vannatta	Matthew		5013785635					mdvannatta@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	05/20/2021	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Medical Director	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/10/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	09/21/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Medicare Coordinator	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Medicare Part D Opioid Overutilization Contact	Associate Medical Director	Dr.	Becker	Thomas		5013783100					tebecker@arkbluecross.com	601 S Gaines St.		Little Rock	AR	72201	06/12/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Medication Therapy Management Contact	Manager, Stars Pharmacy Lead		Walsh	Tyler		5013993975					trwalsh@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	06/07/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	OffShore Subcontractor Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	05/20/2021	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Online Enrollment Center Contact (Optional)	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 S Gaines		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Online Enrollment Center Contact (Primary)	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Part C Application Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Part C Reporting Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Appeals			Review Dept.	Clinical						8006936703	CRUMed@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Appeals Contact (Secondary)	Senior Counsel, Appeals		Phillips	Ashleigh						5013783366	adphillips@arkbluecross.com	PO Box 2181	Attn: Legal Appeals	Little Rock	AR	72203	01/11/2021	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active	5013782025				HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Application Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Benefits Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Claims Submission Contact			Brooke	Lance		4026862603				4029702545	lbrooke@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Exceptions Contact			Review Audit & Regul	Clinical						8006936703	clinicalreviewclientinquiries@primetherapeutics.co	Centennial Crossings - Clinical Review 4401 West 76th S		Edina	MN	55435	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Exceptions Contact (Secondary)			Review Dept Med D Au	Clinical						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Edina	MN	55435	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Price File Contact (Back-up)	Database Reporting Analyst		Xu	Jake		6127776830					jake.xu@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Price File Contact (Optional)	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Price File Contact (Primary)	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Quality Assurance Contact	Manager Metrics and Reporting		Luukkonen	Lynette		6127775574					lynette.luukkonen@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Part D Reporting Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Patient Safety Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Payment Contact	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Pharmacy Director	Associate Medical Director	Dr.	Becker	Thomas		5013783100					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Pharmacy Network Management Contact	Senior Director Network Provider Relations		Grindsteinner	Bretta		6127774021					bgrinsteinner@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Pharmacy Network Management Contact (Secondary)	Sr. Manager Pharmacy Provider Relations		Ecklund	Elisa		6127774308					eecklund@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Pharmacy Technical Help Desk Contact			Pharmacy Help Desk	Prime						8882852242	MGarzarodriguez@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active	8006933815				HMO - Health Maintenance Organization		C	Dallas
H6158	Plan Directory Contact for Public Website			Service	Customer		8442014934					MediPakAdvRx@arkbluecross.com	P O Box 3648		Little Rock	AR	72203	11/10/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Plan to Plan Reconciliation Contact	Financial Analyst		Holt	Susan		5013993958				5013783258	sbholt@arkbluecross.com	P O Box 8084		Little Rock	AR	72203	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Processor Contact	Director Business Service Ops - Govt Programs		Allie	Cindy		6127776772				6127776705	callie@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Quality Contact	Director Quality Programs		Griffin	Brandon		5013782208					jbgriffin@arkbluecross.com	320 W Capitol		Little Rock	AR	72201	03/17/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Reconciliation Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Reconciliation Contact (Secondary)	CFO		Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Recovery Audit Contact	Financial Analyst	Ms.	Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	SNP Application Contact			Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 South Gaines St		Little Rock	AR	72201	02/15/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	SNP State Contact			Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 South Gaines		Little Rock	AR	72201	02/15/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Surveillance Contact	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	System Contact	Manager, Configuration		Spicer	Derek		5013013425					bdspicer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Third Party Administrator (TPA) Liaison	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/05/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	User Access Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387				5013017306	wlbradford@arkbluecross.com	601 Gaines Street	10-South	Little Rock	AR	72201	05/20/2021	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Utilization Management Contact	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/10/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6158	Utilization Review Contact	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/10/2020	2023	USABLE HMO, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6188	Automated TrOOP Balance Transfer Contact	Director Financial Management	Mr.	Hamm	David		7247761100					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	05/23/2022	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Backup User Access Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	03/10/2020	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Best Available Evidence Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Bid Primary Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	CAP Report Contact for Public Website	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	03/10/2020	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	CEO - CMS Administrator Contact	CEO	Mr	Hamm	David	A	7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/19/2023	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	CEO - Senior Official for Contracting	CEO	Mr	Hamm	David	A	7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/19/2023	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Chief Financial Officer	CFO	Mr.	Carraway	Jeffrey		7247761100					jeffrey.carraway@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	02/02/2018	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Chief Operating Officer	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	04/19/2023	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Chief Information Officer	VP Technology and Quality	Mr	Lamb	Charles		7247209202					charles.lamb@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	09/16/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Chief Information Security Officer	VP Technology and Quality	Mr	Lamb	Charles		7247209202					charles.lamb@lutheranseniorlife.org	191 Scharberry lane		Mars	PA	16046	08/15/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	CMS Casework Communication Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Complaints Tracking Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Contact for Fraud Investigations	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Coordination of Benefits Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Corporate Mailing						4123561688					leslie.kisow@lutheranseniorlife.org	740 Blackburn Rd, Suite 300		Sewickley	PA	15143	06/07/2023	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Coverage Gap Discount Program (CGDP) Payment Contact	Director Financial Management		Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	05/21/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Customer Service Operations Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	DIR Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Emergency Part D Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Emergency Part D Contact (Secondary)	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Encounter Data & Risk Adjustment Operations Contact	Director Financial Management		Hamm	David		7247422226					daave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	03/10/2020	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Enrollment Contact	Accounting manager	Ms.	Cionni	Jane		7243022202				7247760811	maryjane.cionni@lutheranseniorlife.org	1323 Freedom Road		Cranberry Township	PA	16066	01/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	EOB Transfer Contact	Director Financial Management	Mr.	Hamm	David		7247422226				7247722960	dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Financial Audit Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Financial Reporting Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Formulary Contact	Medical Director	Dr.	Konitzky	Paul		7245458000				7245434370	paul.konitzky@lutheranseniorlife.org	115 Nolte Drive		Kittanning	PA	16201	03/10/2020	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	General Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Government Relations Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	HIPAA Privacy Officer	Compliance Officer	Ms.	Kaminski	Leean		7247422295				7247722960	leean.kaminski@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/08/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	HIPAA Security Officer	Director MIS	Mr.	Gilson	Dennis		7246254841					dennis.gilson@lutheranseniorlife.org	500 Wittenberg Way	P. O. Box 928	Mars	PA	16046	08/09/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Interoperability Contact			Hamm	David		7247761100					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	05/23/2022	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	MA Appeals/Grievances Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	MA Claims Processing Contact for Public Website	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Marketing Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Medical Director	Medical Director	Dr.	Konitzky	Paul		7245458000				7245434370	paul.konitzky@lutheranseniorlife.org	115 Nolte Drive		Kittanning	PA	16201	03/10/2020	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Medicare Compliance Officer	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Medicare Coordinator	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Konitzky	Paul		7245458000				7245434370	paul.konitzky@lutheranseniorlife.org	115 Nolte Drive		Kittanning	PA	16201	03/10/2020	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Medication Therapy Management Contact	Medical Director	Dr.	Konitzky	Paul		7245458000				7245434370	paul.konitzky@lutheranseniorlife.org	115 Nolte Drive		Kittanning	PA	16201	03/10/2020	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Part C Application Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Part D Appeals	Director Financial Management	Mr.	Hamm	David							dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active	7247422226				PACE - Nat		C	Philadelphia
H6188	Part D Appeals Contact (Secondary)	Accounting Manager	Ms.	Cionni	Jane							maryjane.cionni@lutheranseniorlife.org	1323 Freedom Road		Cranberry Township	PA	16066	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active	7247422202				PACE - Nat		C	Philadelphia
H6188	Part D Application Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Part D Benefits Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Part D Claims Submission Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Part D Exceptions Contact	Director Financial Management	Mr.	Hamm	David							dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active	7247422226				PACE - Nat		C	Philadelphia
H6188	Part D Exceptions Contact (Secondary)	Accounting Manager		Cionni	Jane							Maryjane.cionni@lutheranseniorlife.org	Lutheran SeniorLife	1323 Freedom Road	Cranberry Township	PA	16066	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active	7247422202				PACE - Nat		C	Philadelphia
H6188	Part D Price File Contact (Back-up)	Accounting Manager	Ms.	Cionni	Jane		7247422202					Maryjane.cionni@lutheranseniorlife.org	1323 Freedom Road		Cranberry Township	PA	16066	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Part D Price File Contact (Primary)	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Part D Quality Assurance Contact	Director, Quality Assurance & Education	Ms.	Hankey	Laura		7243022017				7242875430	laura.hankey@lutheranseniorlife.org	740 Balckburb Rd, Suite 300		Sewickley	PA	15143	04/08/2019	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Part D Reporting Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Patient Safety Contact	Medical Director	Dr.	Konitzky	Paul		7245458000				7245434370	paul.konitzky@lutheranseniorlife.org	115 Nolte Drive		Kittanning	PA	16201	03/10/2020	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Payment Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Personal Health Record Contact	Director Financial Management	Mr	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	01/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Pharmacy Director	Medical Director	Dr.	Konitzky	Paul		7245458000				7245434370	paul.konitzky@lutheranseniorlife.org	115 Nolte Drive		Kittanning	PA	16201	03/10/2020	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Pharmacy Network Management Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Pharmacy Technical Help Desk Contact	Medical Director	Dr.	Konitzky	Paul						7245434370	paul.konitzky@lutheranseniorlife.org	115 Nolte Drive		Kittanning	PA	16201	03/10/2020	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active	7245458000				PACE - Nat		C	Philadelphia
H6188	Pharmacy Technical Help Desk Contact (Secondary)	Dir Financial Management		Hamm	David							dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/08/2017	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active	7245458000				PACE - Nat		C	Philadelphia
H6188	PHR Beneficiary Contact																	01/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE	Lutheran SeniorLife	Lutheran SeniorLife	352	Yes	Active	7247421100				PACE - Nat		C	Philadelphia
H6188	Plan Directory Contact for Public Website	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Plan to Plan Reconciliation Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Processor Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Quality Contact	Director, Quality Assurance & Education	Ms.	Hankey	Laura		7243022017				7242875430	laura.hankey@lutheranseniorlife.org	740 Blackburn Rd, Suite 300		Sewickley	PA	15143	04/08/2019	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Reconciliation Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Recovery Audit Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Surveillance Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	System Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Third Party Administrator (TPA) Liaison	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	05/21/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	User Access Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Utilization Management Contact	Utilization Review Coordinator	Ms.	Nemec	Dawn		4123561653					dawn.nemec@lutheranseniorlife.org	740 Blackburn Rd, Suite 300	School of Nursing, Third Floor	Sewickley	PA	15143	04/08/2019	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6188	Utilization Review Contact	Utilization Review Coordinator	Ms.	Nemec	Dawn		4123561653					dawn.nemec@lutheranseniorlife.org	740 Blackburn Rd, Suite 300	School of Nursing, Third Floor	Sewickley	PA	15143	04/08/2019	2023	VIECARE ARMSTRONG, LLC	National PACE	LIFE Armstrong	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H6193	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H6193	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H6193	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H6193	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6193	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6200	Agent/Broker Compensation Data Contact	SVP Health Plan Operations		Cochran	Rick		4026306924					rcochran@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/18/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Automated TrOOP Balance Transfer Contact	Director Enrollment, Eligibility &B OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/05/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Backup User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Best Available Evidence Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Bid Audit Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Bid Audit Site Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Bid Primary Contact	ACTUARY	Mr.	Copeland	Joe		3142095834					jcopeland@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/24/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	CAP Report Contact for Public Website	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/18/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	CEO - CMS Administrator Contact	COO	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	CEO - Senior Official for Contracting	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Chief Financial Officer	Chief Financial Officer	Mr.	Grabski	Ben		7633007611					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Chief Operating Officer	Chief Operating Officer	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Chief Information Officer	Chief Information Officer	Mr.	Saghabini	JeanClaude		6173124659					jsaghbini@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Chief Information Security Officer	Chief Information Security Officer	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	CMMI Model Point of Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	CMS Casework Communication Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Complaints Tracking Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Contact for Fraud Investigations	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Coordination of Benefits Contact			Inquiries	COB		8665979560					COBInquiry@lumeris.com	P O BOX 5907		TROY	MI	48007	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Corporate Mailing						8665979560					customerservice@essencehealthcare.com	CUSTOMER SERIVCE	P O BOX 5907	TROY	MI	48007	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Coverage Gap Discount Program (CGDP) Payment Contact	Sr Manager, Health Plan Finance		Williams	Kliopatra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Customer Service Operations Contact	Vice President, Health Plan Operations	Ms.	Meyerhoffer	Linda		6366869682					rmeyerhoffer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	DIR Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	DIR Contact (Secondary)	Sr. Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly		3142092795					pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Emergency Part D Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		6307425966					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Emergency Part D Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Encounter Data & Risk Adjustment Operations Contact	VP Risk Adjustment Services	Mr.	Eschbach	Jason		6144397608					jeschbach@lumeris.com	13900 Riverport Drive		St. Louis	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Enrollment Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	EOB Transfer Contact	Director, Claims	Ms.	Wasserman	Rachelle		3147703520				3147706096	rwasserman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Financial Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Financial Reporting Contact	Corporate Accountng Director	Ms.	Pinkerton	Amanda		3145183519					apinkertaon@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Formulary Contact		Ms	Nyawabila	Christina		8447906297					FAS@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Formulary Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	General Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Government Relations Contact	Chief Legal Officer	Ms.	Halterman	Gail		3142092717					ghalterman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Davis	Amy		3142093945					adavis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	HIPAA Security Officer	CISO	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Hospice Contact	Vice President, Clinical Operations		Cruz	Jennifer		3147703556					pharmacy@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Interoperability Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Darnell	Erika		3144382410					ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/09/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	MA Claims Processing Contact for Public Website			Service	Customer		8665979560				8884802577	customerservice@essencehealthcare.com	P O BOX 5907		TROY	MI	48007	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Marketing Contact	Manager, Compliance Marketing	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Medical Director	Senior Medical Officer, UM	Dr.	Fusco	Michael		3147703770					mfusco@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Medicare Compliance Officer	VP Compliance, Medicare Compliance Officer	Mr,	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/18/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Medicare Coordinator	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Medicare Part D Opioid Overutilization Contact	Snr. Clinical Pharmacist	Ms.	Pasagic	Melita		3147703775					mpasagic@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/28/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Medication Therapy Management Contact	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	OffShore Subcontractor Contact	SVP Corporate Accounting & Chief Compliance Office	Ms.	Venable	Erin		3142093957					evenable@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Online Enrollment Center Contact (Back-up)	Manager, Compliance	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Online Enrollment Center Contact (Optional)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Online Enrollment Center Contact (Primary)	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	05/05/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Part C Application Contact	Sr. Director CMS Applications & PBP submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Part C Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Part D Appeals	Director, Appeals & Grievances	Ms.	Darnell	Erika							ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/09/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	3144382410				PPO - BBA		C	Kansas City
H6200	Part D Appeals Contact (Secondary)	Sr. Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly	M						pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	3142092795				PPO - BBA		C	Kansas City
H6200	Part D Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Part D Benefits Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Part D Claims Submission Contact		Ms.	Scherlippens	Carine		8587907415					Carine.Scherlippens@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Part D Exceptions Contact		Ms.	Byers	June							June.Byers@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				PPO - BBA		C	Kansas City
H6200	Part D Exceptions Contact (Secondary)		Mr	Elias	Jason							Jason.Elias@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				PPO - BBA		C	Kansas City
H6200	Part D Price File Contact (Back-up)	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Part D Price File Contact (Optional)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Part D Price File Contact (Primary)		Ms.	Finder	Plan		8445136003					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Part D Quality Assurance Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Part D Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Patient Safety Contact	Sr Manager, Clinical Pharmcist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Payment Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Pharmacy Director	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Pharmacy Network Management Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Pharmacy Network Management Contact (Secondary)			Operations	Pharmacy		8445136003					PharmacyOperationsSups@MedImpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services	Ms.	Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	8445136003				PPO - BBA		C	Kansas City
H6200	Pharmacy Technical Help Desk Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly							ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active	3147703788				PPO - BBA		C	Kansas City
H6200	Physician Incentive Contact	Sr. Manager, Health Plan Finance	Mr.	Privott	David		3147703732					dprivott@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Plan Directory Contact for Public Website			Service	Customer		8665979560					customerservice@essencehealthcare.com	1P O BOX 5907		TROY	MI	48007	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Plan to Plan Reconciliation Contact	Sr Manager, Health Plan Finance		Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Processor Contact		Ms.	Scott	Susan		8447906565					Susan.Scott@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Quality Contact	Snr. Director, Quality Improvement		Pattison	Lisa		5082728692					lpattison@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Reconciliation Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Reconciliation Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Recovery Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	SNP Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	SNP State Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	04/27/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Surveillance Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	System Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Third Party Administrator (TPA) Liaison	Client AP Specialist	Ms.	Brock	Letecea		3142548778					lbrock@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Utilization Management Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6200	Utilization Review Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/21/2023	2023	ESSENCE HEALTHCARE PPO, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Active					PPO - BBA		C	Kansas City
H6202	Agent/Broker Compensation Data Contact	Consumer Sales Manager		Nichol	James (JD)		7012772846					james.nichol@bcbsnd.com	4510 13th Ave S		Fargo	ND	58121	02/07/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Automated TrOOP Balance Transfer Contact	Manager, Business Process		Diaz	Mario		7143172628					OptumRx-SupportServices@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Backup User Access Contact	Manager Performance & Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	07/06/2021	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Best Available Evidence Contact	Manager, Enrollment and Billing		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road Suite 200		Glen Allen	VA	23060	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Bid Audit Contact	Director		Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Bid Audit Site Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/14/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Bid Primary Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	CAP Report Contact for Public Website	Managing Director		Pickens	Veronica		2483955887					vpickens@bcsbm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	CEO - CMS Administrator Contact	Plan President	Ms.	West	Beth		7012821593					BethAnn.West@NextBlueND.com	4510 13th Ave S		Fargo	ND	58121	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	CEO - Senior Official for Contracting	Plan President	Ms.	West	Beth		7012821593					BethAnn.West@NextBlueND.com	4510 13th Ave S		Fargo	ND	58121	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Chief Financial Officer	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/06/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Chief Operating Officer	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Chief Information Officer	IT Director II	Mrs.	Krause	Amy		3132256638					akrause@bcbsm.com	600 East Lafayette Blvd. MC 0506		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Cieszynski	Brent		3132258766					bcieszynski@bcbsm.com	600 Lafayette East		Detroit	MI	48226	08/22/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	CMMI Model Point of Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	CMS Casework Communication Contact	Compliance Consultant		White	Jasmin		2486654235					JWhite4@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/06/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Complaints Tracking Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Contact for Fraud Investigations	Manager		Zasadny	Brian		3132255956					bzasadny@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Coordination of Benefits Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	03/22/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Corporate Mailing						7012821593					BethAnn.West@NextBlueND.com	4510 13th Ave S		Fargo	ND	58121	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Supervisor		Cole	Terrence	A	5177086127					terrence.cole@emergentholdingsinc.com	200 North Grand Avenue, PO Box 40790		Lansing	MI	48901	12/28/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Customer Service Operations Contact	Director, Workforce Management, Analytics, & Supp		Weber	Julie		3132250555					jweber@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/11/2021	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	DIR Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	DIR Contact (Secondary)	Manager, Pharmacy Operations		Jones	Marini		3135706777					Marini.Jones@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Electronic Health Record Contact		Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Emergency Part D Contact	Manager		Zylstra	Jennifer		9544985880					jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Emergency Part D Contact (Secondary)	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Employer Waiver Contact	Manager, Functional Operations		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center	TC1505	Southfeld	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Encounter Data & Risk Adjustment Operations Contact	Director,RASubs &ElectronicSupp Data		Jensen	Robert		2486654115					robert.jenson@advantasure.com	1000 Town Center		Southfield	MI	48075	02/05/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Enrollment Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	EOB Transfer Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880				9528375607	Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/08/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Financial Audit Contact	Director	Mr.	Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Financial Reporting Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/06/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Formulary Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Formulary Contact (Secondary)	Manager, Functional Operations		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center	TC1505	Southfeld	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	General Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Government Relations Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	HIPAA Privacy Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	HIPAA Security Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Hospice Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/08/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Interoperability Contact	Manager, Functional Operations		Kingsley	Chris		2484444160					Christopher.kingsley@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	MA Appeals/Grievances Contact	Chief Operating Officer		Hower	Johanna		8048594034					Johanna.Hower@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	08/11/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	MA Claims Processing Contact for Public Website	Manager, Claims and Recovery Operations		Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	03/22/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Marketing Contact	Plan President		West	Beth		7012821593					BethAnn.West@NextBlueND.com	4510 13th Ave S		Fargo	ND	58121	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Medical Director	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Medicare Compliance Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/03/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Medicare Coordinator	Managing Director, Medicare Advantage Compliance		Pickens	Veronica		2483955887					vpickens@bcbsm.com	1000 Town Center		Southfield	MI	48075	11/15/2021	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Medicare Part D Opioid Overutilization Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/08/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Medication Therapy Management Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/08/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	OffShore Subcontractor Contact	Manager	Mrs.	Stretch	Kaitlin		2486654275					kstretch@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Online Enrollment Center Contact (Back-up)	Enrollment Business Lead		Schulz	Bryan		5084390769					Bryan.Schulz@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Online Enrollment Center Contact (Optional)	Manager		Woods	Cheyenne		2484173449					cheyenne.woods@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Online Enrollment Center Contact (Primary)	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Part C Application Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Part C Reporting Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Part D Appeals	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8558124306				PPO - BBA		C	Chicago
H6202	Part D Appeals Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8003443405	733326			PPO - BBA		C	Chicago
H6202	Part D Application Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Part D Benefits Contact	Senior		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Part D Claims Submission Contact	Manager, Business Process		Diaz	Mario		7143172628					OptumRx-SupportServices@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Part D Exceptions Contact	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8558124306				PPO - BBA		C	Chicago
H6202	Part D Exceptions Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	6143363326				PPO - BBA		C	Chicago
H6202	Part D Price File Contact (Back-up)	Vice President		Siuta	Lori		2242312298					lori.siuta@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Part D Price File Contact (Optional)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Part D Price File Contact (Primary)	Sr. Business Analyst, Medicare Operations		Vargas	Danielle		4437101262					danielle.wooten@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Part D Quality Assurance Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Part D Reporting Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Patient Safety Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Payment Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/06/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Personal Health Record Contact	Medical Director		Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Pharmacy Director	Medical Director		Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Pharmacy Network Management Contact	Sr. Account Manager, Network Account Management		Brown	Casey		6126427367					casey.brown@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Pharmacy Network Management Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Pharmacy Technical Help Desk Contact	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8558124306				PPO - BBA		C	Chicago
H6202	Pharmacy Technical Help Desk Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8009221557				PPO - BBA		C	Chicago
H6202	Physician Incentive Contact	Medical Director		Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Plan Directory Contact for Public Website	Work Track Project Manager		Nelson	Jessica		8447538039					Jessica.Nelson@emergient.com	4510 13th Ave S		Fargo	ND	58121	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Plan to Plan Reconciliation Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/06/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Processor Contact	Manager, Claims and Recovery Operations		Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	03/22/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Quality Contact	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Reconciliation Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Reconciliation Contact (Secondary)	Manager, Pharmacy Operations		Jones	Marini		3135706777					Marini.Jones@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Recovery Audit Contact	Manager, Performance and Oversight	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	SNP Application Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	SNP State Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Surveillance Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	07/06/2021	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	System Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Third Party Administrator (TPA) Liaison	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	200 North Grand Avenue	PO Box 40790	Lansing	MI	48901	12/28/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	User Access Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Utilization Management Contact	Managing Director, Medical Management	Dr.	Park	Gerald		2485047408					Gerald.Park@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	03/22/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6202	Utilization Review Contact	Managing Director, Medical Management	Dr.	Park	Gerald		2485047408					Gerald.Park@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	03/22/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	Local CCP	NextBlue of North Dakota	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6231	Automated TrOOP Balance Transfer Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Backup User Access Contact	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Best Available Evidence Contact	Franciscan PACE, Inc. Senior Director	Mrs.	Taylor	Wendy		2254900604	322			2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	11/19/2019	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Bid Primary Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	CAP Report Contact for Public Website	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	CEO - CMS Administrator Contact	VP, Chief Clinical Transformation Officer	Dr.	Miller	C. Bryan		2257652065				2254900354	c.bryanmiller@fmolhs.org	4200 Essen Lane		Baton Rouge	LA	70809	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	CEO - Senior Official for Contracting	VP, Chief Clinical Transformation Officer	Dr.	Miller	C. Bryan		2257652065				2254900354	c.bryanmiller@fmolhs.org	4200 Essen Lane		Baton Rouge	LA	70809	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Chief Financial Officer	Chief Financial Officer - FMOLHS	Mr.	Gleason	Mike		2259232701				2259264846	mike.gleason@fmolhs.org	4200 Essen Lane		Baton Rouge	LA	70808	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Chief Operating Officer	Chief Operations Officer - FMOLHS	xxx	Mullins	Mike		2259227469					mike.mullins@fmolhs.org	4200 Essen Lane		Baton Rouge	LA	70808	06/30/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Chief Information Officer	Chief Information Officer	Mr	Landry	Will		4433408915					will.landry@fmolhs.org	5959 S Sherwood Forest Blvd		Baton Rouge	LA	70816	06/30/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Chief Information Security Officer	SVP Chief Information Officer	Mr.	Landry	Will		4433408915					will.landry@fmolhs.org	5959 S Sherwood Forest Blvd		Baton Rouge	LA	70816	06/30/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	CMS Casework Communication Contact	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Complaints Tracking Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Contact for Fraud Investigations	Senior Director	Ms.	Taylor	Wendy		2254900322				2259264846	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive.	4200 Essen Lane	Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Coordination of Benefits Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Corporate Mailing						2254900604				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Customer Service Operations Contact	Franciscan PACE Inc. Senior Director	Mrs.	Taylor	Wendy		2254900604	322			2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	11/19/2019	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	DIR Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	DIR Contact (Secondary)	Senior Director	Ms.	Taylor	Wendy		2254900604					wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	01/05/2021	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Emergency Part D Contact	Director of Finance	Mr.	Blanchard	W. John		2254900604	324			2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Emergency Part D Contact (Secondary)	Senior Director	Ms.	Taylor	Wendy		2254900604				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive	4200  Essen Lane	Baton Rouge	LA	70806	01/05/2021	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Encounter Data & Risk Adjustment Operations Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324					whitney.blanchard@fmolhs.org	7436 Bishop Ott Dr		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Enrollment Contact		Ms.	Taylor	Wendy		2254900322				2254900355	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	EOB Transfer Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Financial Audit Contact	Director of Finance	Mr.	Blanchard	W. John		2254900604				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Financial Reporting Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Formulary Contact	Medical Director	Dr.	Green	Michael		2254900604	325			2254900354	michael.green@fmolhs.org	7436 Bishop Ott Drive	4200  Essen Lane	Baton Rouge	LA	70806	12/28/2018	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	General Contact	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Government Relations Contact	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	HIPAA Privacy Officer	Compliance Officer	Mr.	Leblanc	Philip		2257655216				2254900354	philip.leblanc@fmolhs.org	5000 Hennessy Blvd.		Baton Rouge	LA	70809	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	HIPAA Security Officer	Compliance Officer	Mr.	Leblanc	Philip		2257655216				2254900354	philip.leblanc@fmolhs.org	5000 Hennessy Blvd.		Baton Rouge	LA	70809	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Interoperability Contact	Sr. Director		Taylor	Wendy		2254900324					wendy.taylor@fmolhs.org	7436 Bishop Ott Dr		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	MA Appeals/Grievances Contact	Franciscan PACE Inc., Senior Director	Mrs.	Taylor	Wendy		2254900604	322			2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	11/19/2019	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	MA Claims Processing Contact for Public Website	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Marketing Contact	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900355	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Medical Director	Franciscan PACE Inc. Medical Director	Dr.	Green	Michael		2254900325				2254900354	michael.green@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	12/27/2018	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Medicare Compliance Officer	Compliance Officer	Mr.	Leblanc	Philip		2257655216				2254900354	philip.leblanc@fmolhs.org	5000 Hennessy Blvd.		Baton Rouge	LA	70809	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Medicare Coordinator	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Medicare Part D Opioid Overutilization Contact	PACE Baton Rouge Medical Director	Dr.	Green	Michael		2254900325				2254900354	michael.green@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Medication Therapy Management Contact	Medical Director	Mr.	Green	Michael		2254900324				2254900354	michael.green@fmolhs.org	7436 Bishop Ott Drive	4200  Essen Lane	Baton Rouge	LA	70806	12/27/2018	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Online Enrollment Center Contact (Back-up)	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Online Enrollment Center Contact (Primary)	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Part C Application Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Part D Appeals	Director of Finance	Mr.	Blanchard	W. John						2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active	8007892863				PACE - Nat		C	Denver
H6231	Part D Appeals Contact (Secondary)	Senior Director	Ms.	Taylor	Wendy						2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	01/05/2021	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active	2254900604				PACE - Nat		C	Denver
H6231	Part D Application Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Part D Benefits Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Part D Claims Submission Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Part D Exceptions Contact	Franciscan PACE Inc. Medical Director	Dr.	Green	Michael						2254900354	michael.green@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	12/27/2018	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active	8007892863				PACE - Nat		C	Denver
H6231	Part D Exceptions Contact (Secondary)	Director of Finance	Mr.	Blanchard	W. John						2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active	8007892863				PACE - Nat		C	Denver
H6231	Part D Price File Contact (Back-up)	Franciscan PACE Inc., Senior Director	Mrs.	Taylor	Wendy		2254900604	322			2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	11/19/2019	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Part D Price File Contact (Optional)	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Part D Price File Contact (Primary)	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Part D Quality Assurance Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Part D Reporting Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Patient Safety Contact	Franciscan PACE Inc., Senior Director	Mrs.	Taylor	Wendy		2254900604	322			2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	11/19/2019	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Payment Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Personal Health Record Contact	Office Manager	Ms.	Hooper	Jill		2254900604	327			2254900354	cynthia.hooper@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	03/25/2013	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Pharmacy Director	Franciscan PACE Inc., Senior Director	Mrs.	Taylor	Wendy		2254900604	322			2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	11/19/2019	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Pharmacy Network Management Contact	Franciscan PACE Inc. Senior Director	Mrs.	Taylor	Wendy		2254900604	322			2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	11/19/2019	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Pharmacy Network Management Contact (Secondary)	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Pharmacy Technical Help Desk Contact	Center Manager	Mrs.	Mitchell	Felicity						2254900354	felicity.mitchell@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	08/09/2022	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active	2254900604				PACE - Nat		C	Denver
H6231	Plan Directory Contact for Public Website	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Plan to Plan Reconciliation Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Processor Contact	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Quality Contact	PACE Quality Manager	Mrs.	LeJeune	Kelli		2254900604				2254900355	kelli.lejeune@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Reconciliation Contact	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Reconciliation Contact (Secondary)		Ms.	Taylor	Wendy		2254900604					wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	01/05/2021	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Recovery Audit Contact	Director of Finance	Mr.	Blanchard	W. John		2254900326					whitney.blanchard@fmolhs.org	7436 Bishop Ott		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Surveillance Contact	Compliance Officer	Mr.	Leblanc	Philip		2257655216				2254900354	Philip.leblanc@fmolhs.org	5000 Hennessy Blvd.		Baton Rouge	LA	70809	02/02/2015	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	System Contact	Senior Director	Ms.	Taylor	Wendy		2254900322				2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Third Party Administrator (TPA) Liaison	Director of Finance	Mr.	Blanchard	W. John		2254900324				2254900354	whitney.blanchard@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	04/18/2023	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	User Access Contact	Franciscan PACE Inc. Director	Mrs.	Taylor	Wendy		2254900604	326			2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	10/24/2019	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Utilization Management Contact	Franciscan PACE Inc. Senior Director	Mrs.	Taylor	Wendy		2254900604	322			2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	11/19/2019	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6231	Utilization Review Contact	Franciscan PACE Inc., Senior Director	Mrs.	Taylor	Wendy		2254900604	322			2254900354	wendy.taylor@fmolhs.org	7436 Bishop Ott Drive		Baton Rouge	LA	70806	11/19/2019	2023	FRANCISCAN PACE, INC.	National PACE	PACE Baton Rouge	National PACE		Franciscan Missionaries of Our Lady Health System	366	Yes	Active					PACE - Nat		C	Denver
H6237	Agent/Broker Compensation Data Contact	VP Medicare Sales	Mr.	Hess	Brent		8013336143					Brent.Hess@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	07/06/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Automated TrOOP Balance Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Backup User Access Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St.	MS:E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Best Available Evidence Contact	Membership Ambassador	Ms.	Neufeld	Jeri		8006621470	2526			8883352988	ORMEMMEDAmbassador@regence.com	PO Box 1827		Medford	OR	97501	02/16/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Bid Audit Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Bid Audit Site Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Bid Primary Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	CAP Report Contact for Public Website	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	CEO - CMS Administrator Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/04/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	CEO - Senior Official for Contracting	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/09/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Chief Financial Officer	SVP & CFO	Mr.	Rains	Mike		2063326521					Mike.Rains@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Chief Operating Officer	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Chief Information Officer	SVP STRATEGIC TECH SOL & CIO	Mr	Rotival	Laurent		2063325034					Laurent.Rotival@cambiahealth.com	200 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Chief Information Security Officer	VP & CHIEF INFO SEC OFFICER	Mr	Anderson	Kirk		5037251608					Kirk.Anderson@cambiahealth.com	100 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	CMMI Model Point of Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	CMS Casework Communication Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Complaints Tracking Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Contact for Fraud Investigations	Senior Audit Investigator	Ms.	Grimes-Burke	Jennifer		5035873355					Jennifer.Grimes-Burke@regence.com	100 SW Market St	M/S E12B	Portland	OR	97201	06/16/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Coordination of Benefits Contact	Manager, Member Services	Ms	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	PO Box 1827	MS: B32M	Medford	OR	97501	07/09/2016	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Corporate Mailing						5032206237				5035884350	Jennifer.DelVillar@regence.com	100 SW Market Street		Portland	OR	97201	01/07/2013	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Sr I	Mr.	Gerken	Matthew		2063324809					Matthew.Gerken@cambiahealth.com	1800 9th Ave		Seattle	WA	98101	04/19/2016	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Customer Service Operations Contact	Manager Member Services	Ms	Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	DIR Contact	Manager Pharmacy Informatics		Kidd	Vicki		2083957739				2083337874	vicki.kidd@regence.com	1211 West Myrtle, Suite 110		Boise	ID	83702	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	DIR Contact (Secondary)	Dir. Gov. Pro Compliance / Medicare Compliance Off	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street E10C		Portland	OR	97201	07/22/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Emergency Part D Contact	VP Pharm Ops & Compliance	Mr.	Weiss	Justin		5032256677					Justin.Weiss@cambiahealth.com	200 SW Market St		Portland	OR	97201	12/20/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Emergency Part D Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Employer Waiver Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment, Manager	Mr.	Moore	Jason		2087982318					Jason.Moore@cambiahealth.com	1602 21st Ave		Lewiston	ID	83501	10/18/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Enrollment Contact	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	EOB Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Financial Audit Contact	Government Programs Audit Consultant	Mr.	Hutt	Brian		5032206160					Brian.Hutt@regence.com	200 SW Market Street	MS: E10C	Portland	OR	97201	05/09/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Financial Reporting Contact	Fin Acctg & Reporting, Assistant Director	Mr	Striplin	Daniel	W	5032256069					Dan.Striplin@regence.com	200 SW Market		Portland	OR	97201	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Formulary Contact	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Ave		Portland	OR	97201	01/18/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	General Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Government Relations Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St.	MS:E10C	Portland	OR	97201	04/18/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	HIPAA Privacy Officer	VP Chief Compliance & Privacy Officer	Ms.	Erbes	Kristen		5035256533					kristen.erbes@regence.com	200 SW Market St	M/S: E14A	Portland	OR	97201	02/25/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	HIPAA Security Officer	Chief Information Security Officer	Mr.	Person	Steve		5037251654					Steve.Person@regence.com	1621 SW First Ave.		Portland	OR	97201	02/25/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Hospice Contact	Pharmacy Ops Oversight Specialist	Ms.	Pickens	Spring		5032255240					Spring.Pickens@regence.com	100 SW Market St	MS: WW5-56	Portland	OR	97201	02/05/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Interoperability Contact	VP Chief Tech Officer		Anderson	Kirk		5037251608					kirk.anderson@cambiahealth.com	Cambia Health Solutions	200 SW Market Street	Portland	OR	97201	02/09/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	MA Appeals/Grievances Contact	Manager, Appeals Operations	Mr.	Farber	Andy		5416181237					Andrew.Farber@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	975011827	04/18/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	MA Claims Processing Contact for Public Website	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Marketing Contact	Compliance Analyst		Meirose	Robyn		5033918668					robyn.meirose@regence.com	200 SW Market St  MS: E10C		Portland	OR	97201	09/15/2015	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Medical Director	SVP Chief Medical Officer	Ms.	Milavetz	Donna		8013336740					Donna.Milavetz@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	12/05/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Medicare Compliance Officer	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	07/14/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Medicare Coordinator	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827		Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Medicare Part D Opioid Overutilization Contact	Drug Management Program	Ms.	Anderson	Ally		8557297221					partdoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Medication Therapy Management Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Online Enrollment Center Contact (Back-up)	Dir Medicare Planning & Performance	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Online Enrollment Center Contact (Optional)	Manager Member Services	Ms.	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	2057 Commerce Dr		Medford	OR	97504	11/06/2017	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Online Enrollment Center Contact (Primary)	Spv Membership, GP OR Medicare Ops & Billing	Ms.	Cromwell	Krista		5416181286					Krista.Cromwell@regence.com	PO Box 1827	M/S: B32M	Medford	OR	97501	03/07/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Part C Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Part C Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossig Rd	Eagan	MN	55120	03/21/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Benefits Contact	Product Manager III	Ms.	Holliston	Danica		5032254871					Danica.Holliston@regence.com	200 SW Market St  M/S: E10M		Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Claims Submission Contact	Functional Business Consultant - Government Prgrms	Mr.	Brook	Lance		4026862603					LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	08/05/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Exceptions Contact (Secondary)	Asst Director Pharmacy Operations	Ms.	Yi	Edie							edie.yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	972071271	12/15/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	5032254801				HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Price File Contact (Back-up)	Database Reporting Analyst	Ms	Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Price File Contact (Optional)	QA Analyst Sr	Ms.	Tastad	Emily		6127772557					emily.tastad@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/03/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Price File Contact (Primary)	AD Pharmacy Informatics	Ms.	Kidd	Vicki		2083957739					Vicki.Kidd@regence.com	1211 West Myrtle		Boise	ID	83702	07/22/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Quality Assurance Contact	Assistant Dir Pharmacy Operations	Ms.	Yi	Edie		5032254801				2083957744	Edie. Yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	97201	07/06/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Part D Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Patient Safety Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Payment Contact	Asst Director Fin Acctg & Reporting	Mr.	Striplin	Dan		5032256069					Dan.Striplin@cambiahealth.com	100 SW Market St	M/S: C2A	Portland	OR	97201	01/14/2014	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Pharmacy Director	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Avenue, M/S PDX - WW3-33		Portland	OR	97201	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Pharmacy Network Management Contact	AVP, Network Mangement	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/18/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Management Relations		Lenhart	Alicia		6127773969				8778236373	Alicia.Lenhart@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	09/11/2020	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Pharmacy Technical Help Desk Contact	Director, Member Services Government Programs	Mr.	Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				HMO - Health Maintenance Organization		C	Seattle
H6237	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jon							jonathan.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				HMO - Health Maintenance Organization		C	Seattle
H6237	Plan Directory Contact for Public Website	Manager Member Services		Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Plan to Plan Reconciliation Contact	Pharmacy Operations Oversight Specialist, Sr.	Ms.	Manzer	Amy		5032255368					Amy.Manzer@regence.com	200 SW Market St	M/S: PDX-ZOF WW3-33	Portland	OR	97201	08/26/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing	Egan	MN	55121	04/19/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Quality Contact	Director, Quality Management	Mr.	Mcclure	Andy		5032206189					Andrew.Mcclure@regence.com	1621 SW First Ave	M/S WW5-52	Portland	OR	97201	04/12/2019	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Reconciliation Contact	VP Finance Controller		Vannoy	Anjie		5032761865					Anjie.Vannoy@cambiahealth.com	100 SW Market St.	MS:PDX-WW2-21	Portland	OR	97201	01/08/2018	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Reconciliation Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS:E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Recovery Audit Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Surveillance Contact	Government Programs Compliance Officer		Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St  M/S: E10C		Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	System Contact	Medicare Business Operations, Product Owner	Ms.	Fredinburg	Deana		5033754426					Deana.Fredinburg@regence.com	PO BOX 1827	M/S: B32AG	Medford	OR	97501	06/24/2022	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Third Party Administrator (TPA) Liaison	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St		Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	User Access Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Utilization Management Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6237	Utilization Review Contact	Director, Clinical Service Operations	Ms.	Adams	Lauren		2063325538					Lauren.Adams@cambiahealth.com	1800 Ninth Ave		Seattle	WA	98101	07/06/2023	2023	REGENCE BLUECROSS BLUESHIELD OF OREGON	Local CCP	Regence BlueCross BlueShield of Oregon	HMO/HMOPOS		Cambia Health Solutions, Inc.	227	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H6306	Agent/Broker Compensation Data Contact	Medicare Sales and Services Manager	Ms	Walston	Deborah		9106876559				9106876506	Deborah.Walston@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Automated TrOOP Balance Transfer Contact	VP, Chief Compliance Officer	Ms.	Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@Healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Backup User Access Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Best Available Evidence Contact	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Bid Audit Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Bid Audit Site Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Bid Primary Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	CAP Report Contact for Public Website	Director, Operations and Program Management	Ms.	Heckethorn	Erin	K	9106876582				9106876506	Erin.Heckethorn@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	CEO - CMS Administrator Contact	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	CEO - Senior Official for Contracting	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Chief Financial Officer	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/29/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Chief Operating Officer	President & COO	Mr	Humphrey	Craig		9106876585				9106876506	Craig.Humphrey@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Chief Information Officer	VP, Operations and IT	Ms.	Griffith	Kim		2179029004				2179029740	Kim.Griffith@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Chief Information Security Officer	Information Security Officer	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	CMS Casework Communication Contact	Manager of Regulatory and Medicare Compliance	Ms	Russell	Petrina		9106876560				9106876506	Petrina.Russell@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Complaints Tracking Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Contact for Fraud Investigations	Corporate Compliance and ERM Mgr		Adamson	Susan		2179029137					Susan.Adamson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Coordination of Benefits Contact	Medicare Operations Manager		Rentmeester	Kurt		9106876629				9106876506	Kurt.Rentmeester@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Corporate Mailing						9106876582				9106876506	Erin.Heckethorn@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Financial Analyst-Risk Adjustment		Boyce	Heather	R	2179029467					heather.boyce@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Customer Service Operations Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	DIR Contact	Director of Accounting		Deane	Laura		2179028322					laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	DIR Contact (Secondary)	Finance Manager-Risk Adjustment		Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Electronic Health Record Contact	Medical Director	Dr	Edgerton	Arthur		9107158194				9106876506	Art.Edgerton@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Emergency Part D Contact	Manager of Pharmacy Services	Ms	Lukow	Christine		9106876569					Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Encounter Data & Risk Adjustment Operations Contact	Director, System Config and Technical Services		Walsh	Pam		2179029449				2173657111	Pam.Walsh@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Enrollment Contact	Director, Operations and Program Management	Ms.	Heckethorn	Erin	K	9106876582				9106876506	Erin.Heckethorn@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	EOB Transfer Contact	Director, Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	jennifer.marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/27/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Financial Audit Contact	Executive Director of Finance	Mr.	Maxwell	Jamey		2179028321				2179029740	jamey.maxwell@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Financial Reporting Contact	Chief Financial Officer	Mr	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Formulary Contact	Manager of Pharmacy	Ms.	Lukow	Christine		2179028224				2179029794	christine.lukow@firstcarolinacare.com	42 Memorial Dr.		Pinehurst	NC	28374	01/27/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Formulary Contact (Secondary)	Managed Care Pharmacist	Ms	Deschler	Jena		2179029368				2179029798	jena.deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/27/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	General Contact	Director,  Operations and Program Management	Ms.	Heckethorn	Erin	K	9106876582				9106876506	Erin.Heckethorn@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Government Relations Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029740	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	HIPAA Privacy Officer	Director, Corporate Compliance and Privacy Officer		Jensen	Traci		2179029152				2179029794	traci.jensen@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	HIPAA Security Officer	Director of Information Security	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Hospice Contact	Manager of Pharmacy	Ms.	Lukow	Christine		2179028224				2179029794	christine.lukow@firstcarolinacare.com	42 Memorial Dr.		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Interoperability Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	MA Appeals/Grievances Contact	Member / Provider Relations Manager		Regal	Wendi		2179028017				2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	MA Claims Processing Contact for Public Website	Medicare Operations Manager	Mr.	Rentmeester	Kurt		9106876629				9106876506	Kurt.Rentmeester@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Marketing Contact	Manager of Regulatory and Medicare Compliance	Ms.	Russell	Petrina		9106876560				9106876506	Petrina.Russell@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Medical Director	Medical Director	Dr.	Edgerton	Arthur		9107158194				9106876506	Art.Edgerton@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Medicare Compliance Officer	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Medicare Coordinator	Medicare Operations Manager	Mr.	Rentmeester	Kurt		9106876629				9106876506	Kurt.Rentmeester@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Medicare Part D Opioid Overutilization Contact	Manager of Pharmacy Services	Ms	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Medication Therapy Management Contact	Manager of Pharmacy Services		Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	FirstCarolinaCare Insurance Company	42 Memorial Drive	Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	OffShore Subcontractor Contact	Manager, Medicare and Regulatory Compliance	Ms	Russell	Petrina	R	9106876560				9106876506	Petrina.Russell@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Online Enrollment Center Contact (Back-up)	Manager, Medicare and Regulatory Compliance	Ms	Russell	Petrina	R	9106876560				9106876506	Petrina.Russell@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Online Enrollment Center Contact (Optional)	Compliance Analyst		Pait	Russell	R	9106876593				9106876506	Russell.Pait@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Online Enrollment Center Contact (Primary)	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Part C Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Part C Reporting Contact	Compliance Analyst		Pait	Russell		9106876593				9106876506	Russell.Pait@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Part D Appeals	Lead Member Relations Coordinator	Ms	Lewis	Chelsea							Chelsea.Lewis@HealthAlliance.org	3510 Fields Drive South		Champaign	IL	61822	01/08/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8005003373				HMO - Health Maintenance Organization		C	Chicago
H6306	Part D Appeals Contact (Secondary)	Member/Provider Resolutions Manager		Regal	Wendi						2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8008513379				HMO - Health Maintenance Organization		C	Chicago
H6306	Part D Application Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Part D Benefits Contact	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Part D Claims Submission Contact	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Part D Exceptions Contact	Manager of Pharmacy Services	Ms.	Lukow	Christine						9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	9106876569				HMO - Health Maintenance Organization		C	Chicago
H6306	Part D Price File Contact (Back-up)	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Part D Price File Contact (Primary)	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Part D Quality Assurance Contact	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Part D Reporting Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Patient Safety Contact	Compliance Analyst		Pait	Russell		9106876593				9106876506	Russell.Pait@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Payment Contact	Director of BECS		Kleinert	Traci		2179029508				2179029797	Traci.Kleinert@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Personal Health Record Contact	Medical Director	Dr.	Edgerton	Arthur		9107158194				9106876506	Art.Edgerton@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Pharmacy Director	Director of Pharmacy		Buhr	Aimee		2179029366				2179029798	Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Pharmacy Network Management Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Pharmacy Network Management Contact (Secondary)	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Pharmacy Technical Help Desk Contact	Manager of Pharmacy	Ms.	Lukow	Christine						2179029794	christine.lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/18/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active	8008801188	2			HMO - Health Maintenance Organization		C	Chicago
H6306	Plan Directory Contact for Public Website	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Plan to Plan Reconciliation Contact	Finance Manager-Risk Adjustment		Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign,	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Processor Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029497	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Quality Contact	Medical Director	Dr.	Edgerton	Arthur		9107158194				9106876506	Art.Edgerton@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Reconciliation Contact	Director of Accounting		Deane	Laura		2179078322					laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Reconciliation Contact (Secondary)	Finance Manager-Risk Adjustment		Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Recovery Audit Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Surveillance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	System Contact	Director, Operations and Program Management	Ms.	Heckethorn	Erin	K	9106876582				9106876506	Erin.Heckethorn@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Third Party Administrator (TPA) Liaison	Senior Financial Analyst-Risk Adjustment		Johnson	Danica	J	2179028322					danica.johnson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	User Access Contact	Manager, Medicare and Regulatory Compliance	Ms	Russell	Petrina	R	9106876560				9106876506	Petrina.Russell@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Utilization Management Contact	Director of Health Services	Ms.	Taylor	Sharon		9106876580				9106876506	Sharon.Taylor@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6306	Utilization Review Contact	Director of Health Services	Ms.	Taylor	Sharon		9106876580				9106876506	Sharon.Taylor@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	HMO/HMOPOS		The Carle Foundation	583	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/25/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/25/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H6316	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H6316	PHR Beneficiary Contact																	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H6316	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6316	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	11/09/2020	2023	MISSOURI CARE, INCORPORATED	Local CCP	Healthy Blue	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Agent/Broker Compensation Data Contact	Finance Director		de los Reyes	Jamie		8107339657					jamie.delosreyes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	04/19/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Automated TrOOP Balance Transfer Contact	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Backup User Access Contact	Director, MIG Medicare Programs		Van Dusen	Kristin		9896273897					kristin.vandusen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/08/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Best Available Evidence Contact	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Bid Audit Contact	Vice President, Finance		Hairston	Rachel		8107339678					rachel.hairston@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Bid Audit Site Contact	Medicare Compliance Officer		Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Bid Primary Contact	Director, MIG Medicare Programs		Van Dusen	Kristin		9896273897					kristin.vandusen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	11/30/2020	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	CAP Report Contact for Public Website	Medicare Compliance Officer		Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	CEO - CMS Administrator Contact	President & CEO	Ms.	Jenkins	Nancy		8107339729					nancy.jenkins@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	12/29/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	CEO - Senior Official for Contracting	President & CEO	Ms.	Jenkins	Nancy		8107339702					nancy.jenkins@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	11/20/2020	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Chief Financial Officer	VP & Chief Financial Officer	Ms.	Diehl	Cheryl		9899923272					cheryl.diehl@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Chief Operating Officer	VP of BI and Operations	Ms.	Mavredes	Sara		8107339725					sara.mavredes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Chief Information Officer	VP of BI and Operations	Ms.	Mavredes	Sara		8107339725					sara.mavredes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Chief Information Security Officer	VP of BI and Operations	Ms.	Mavredes	Sara		8107339725					sara.mavredes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	CMMI Model Point of Contact	Director, MIG Medicare Programs		Van Dusen	Kristin		9896273897					kristin.vandusen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	CMS Casework Communication Contact	Director, MIG Customer & Provider Operations		Cuccia	Tami		8107339669					tami.cuccia@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Complaints Tracking Contact	Director, MIG Customer & Provider Operations		Cuccia	Tami		8107339669					tami.cuccia@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Contact for Fraud Investigations	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Coordination of Benefits Contact	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Corporate Mailing						8107339729					diab.rizk@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Director		de los Reyes	Jamie		8107339657					jamie.delosreyes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	04/19/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Customer Service Operations Contact	Director, Customer Service		Courtney	Brinley		2489044356					Courtney.Brinley@mclaren.org	G-3245 Beecher Rd	Ste 201	Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	DIR Contact	Vice President, Finance		Hairston	Rachel		8107339678					rachel.hairston@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	DIR Contact (Secondary)	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Electronic Health Record Contact	VP, Customer & Provider Services		Landon	Jody		8107339507					jody.landon@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8883270671				HMO - Health Maintenance Organization		C	Chicago
H6322	Emergency Part D Contact	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Emergency Part D Contact (Secondary)	Director of Pharmacy		Taylor	Randall		8102441658					randall.taylor@mclaren.org	G-3245 Beecher Rd.		Flint	MI	48532	12/29/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Employer Waiver Contact	Director, MIG Medicare Programs		Van Dusen	Kristin		9896273897					kristin.vandusen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Encounter Data & Risk Adjustment Operations Contact	Dir Business Information		Sergent	Maria		8107339526					maria.sergent@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	11/18/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Enrollment Contact	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	EOB Transfer Contact	Director, Customer Service		Brinley	Courtney		2489044356				8554175617	Courtney.Brinley@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Financial Audit Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Financial Reporting Contact	Vice President, Finance		Hairston	Rachel		8107339678					rachel.hairston@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Formulary Contact	Director of Pharmacy		Taylor	Randall		8102441658					randall.taylor@mclaren.org	G-3245 Beecher Rd.		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Formulary Contact (Secondary)	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	General Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Government Relations Contact	VP General Counsel		Ehrlich	Matthew		8107339681					matthew.ehrlich@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	HIPAA Privacy Officer	Compliance Officer		Rizk	Diab		8107339729					diab.rizk@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	HIPAA Security Officer	Compliance Officer		Rizk	Diab		8107339729					diab.rizk@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	10/15/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Hospice Contact	Pharmacy Project Coordinator		Slater	Angela		8106441660					angela.slater@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Interoperability Contact	Dir Business Information		Sergent	Maria		8107339526					maria.sergent@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	11/19/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	MA Appeals/Grievances Contact	Appeals Coordinator		Sweet	Melissa		8107339672				8106007984	medicareappeals@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	MA Claims Processing Contact for Public Website	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Marketing Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Medical Director	Medical Director	Dr.	Wheeler	Jeffrey		3178227300					jwheeler@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	10/26/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	07/25/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Medicare Coordinator	Director, MIG Medicare Programs		Van Dusen	Kristin		9896273897					kristin.vandusen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	11/30/2020	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Medicare Part D Opioid Overutilization Contact	Pharmacy Intake Specialist		Russell	Danielle		8107339783					danielle.russell@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Medication Therapy Management Contact	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Online Enrollment Center Contact (Back-up)	Director of Enrollment Operations		Garrison	Lori		3178227487					lgarrison@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	01/27/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Online Enrollment Center Contact (Primary)	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Part C Application Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Appeals	Pharmacy Project Coordinator		Slater	Angela							angela.slater@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8883270671				HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Appeals Contact (Secondary)	Pharmacy Intake Specialist		Jehnsen	Ashley							ashley.jehnsen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8883270671				HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Application Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Benefits Contact	Director of Pharmacy		Taylor	Randall		8102441658					randall.taylor@mclaren.org	G-3245 Beecher Rd.		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Claims Submission Contact	Software Developer		Vohwinkle	Jacob		8107339739					jacob.vohwinkle@mclaren.org	G-3245 Beecher Rd.		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Exceptions Contact	Pharmacy Project Coordinator		Slater	Angela							angela.slater@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8883270671				HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Exceptions Contact (Secondary)	Pharmacy Intake Specialist		Jehnsen	Ashley							ashley.jehnsen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8883270671				HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Price File Contact (Back-up)	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Price File Contact (Optional)	Pharmacy EDI Specialist		Ivancic	Matt		3178227391					mivancic@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	06/15/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Price File Contact (Primary)	Medicare Part D Project Manager		Keller	Shanon		8587907104					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	06/15/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Quality Assurance Contact	Pharmacy Project Coordinator		Slater	Angela		8102441660					angela.slater@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Part D Reporting Contact	Pharmacy Project Coordinator		Slater	Angela		8102441660					angela.slater@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Patient Safety Contact	Director of Pharmacy		Taylor	Randall		8102441658					randall.taylor@mclaren.org	G-3245 Beecher Rd.		Flint	MI	48532	03/02/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Payment Contact	Finance Director		de los Reyes	Jamie		8107339657					jamie.delosreyes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	04/19/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Personal Health Record Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Pharmacy Director	Director of Pharmacy		Taylor	Randall		8102441658					randall.taylor@mclaren.org	G-3245 Beecher Rd.		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Pharmacy Network Management Contact	Pharmacy Project Coordinator		Slater	Angela		8102441660					angela.slater@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy		Taylor	Randall		8102441658					randall.taylor@mclaren.org	G-3245 Beecher Rd.		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Pharmacy Technical Help Desk Contact	VP Contact Center Services		Battle	Dorry							customerservice@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	07/29/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8443362678				HMO - Health Maintenance Organization		C	Chicago
H6322	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Contact Services		Brewer	Kathy							customerservice@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	07/29/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8443362678				HMO - Health Maintenance Organization		C	Chicago
H6322	PHR Beneficiary Contact																	03/26/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS	McLaren Health Plan	McLaren Health Care Corporation	494	Yes	Active	8883270671				HMO - Health Maintenance Organization		C	Chicago
H6322	Plan Directory Contact for Public Website			Services	Member		8333582404					medicarememberservices@mclaren.org	PO Box 44092		Indianapolis	IN	46208	04/01/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Plan to Plan Reconciliation Contact	Finance Director		de los Reyes	Jamie		8107339657					jamie.delosreyes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	04/19/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Processor Contact	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Quality Contact	Director of Quality Programs		Wilson	Ashley		3178227239					awilson@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	11/11/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Reconciliation Contact	Finance Director		de los Reyes	Jamie		8107339657					jamie.delosreyes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	07/25/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Reconciliation Contact (Secondary)	Director of Pharmacy		Taylor	Randall		8102441658					randall.taylor@mclaren.org	G-3245 Beecher Rd.		Flint	MI	48532	02/10/2021	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Recovery Audit Contact	Finance Director	Ms.	de los Reyes	Jamie		8107339657					jamie.delosreyes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	04/19/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	SNP Application Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	SNP State Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Surveillance Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	System Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Third Party Administrator (TPA) Liaison	Finance Director		de los Reyes	Jamie		8107339657					jamie.delosreyes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	04/19/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	User Access Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Utilization Management Contact	VP of Health Services		Clark	Mary Lynn		8107339642					marylynn.clark@mclaren.org	G-3245 Beecher Rd	Ste 201	Flint	MI	48532	11/11/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6322	Utilization Review Contact	VP of Health Services		Clark	Mary Lynn		8107339642					marylynn.clark@mclaren.org	G-3245 Beecher Rd	Ste 201	Flint	MI	48532	11/11/2022	2023	MCLAREN HEALTH PLAN, INC.	Local CCP	McLaren Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6328	Agent/Broker Compensation Data Contact	Chief Sales Officer	Mr.	Ortiz	Jesus		2147076260				8178105214	jesus.ortiz@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Automated TrOOP Balance Transfer Contact	Account Manager	Mr.	Battaglia	James		3308886165				3308886015	jbattaglia@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Backup User Access Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Best Available Evidence Contact	Director, Pharmacy	Ms.	May	Amy		8176322128				8178105214	Amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Bid Audit Contact	Compliance Officer	Ms	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Bid Audit Site Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Bid Primary Contact	Compliance Officer	Ms	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	CAP Report Contact for Public Website	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY		Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	CEO - CMS Administrator Contact	Plan President and Chief Operating Officer	Mr.	Gadde	Kiran		8176323023					kiran.gadde@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	CEO - Senior Official for Contracting	Plan President and Chief Operating Officer	Mr.	Gadde	Kiran		8176323023					kiran.gadde@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Chief Financial Officer	Chief Financial Officer	Mr	Birch	Harvey		8176323023					harvey.birch@southwesternhealth.org	1601 LBJ FWY	Suite 200	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Chief Operating Officer	Chief Operating Officer	Mr.	Gadde	Kiran		8176321741					kiran.gadde@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Chief Information Officer	SVP, Chief Information Officer	Mr	Marlow	Mac		8176323023					mac.marlow@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Chief Information Security Officer	SVP, Chief Information Officer	Mr	Marlow	Mac		8176323023					mac.marlow@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	CMMI Model Point of Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	CMS Casework Communication Contact	Director, Compliance Officer	Ms.	Scott	Elizabeth		8176323023				8178105214	elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Complaints Tracking Contact	Director, Compliance Officer	Ms.	Scott	Elizabeth		8176323023				8178105214	elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Contact for Fraud Investigations	Compliance Officer	Ms	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Coordination of Benefits Contact	Sr Director, Strategic Operations	Mr.	Smith	Charles		8176323023				8178105214	charles.smith@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Corporate Mailing						8176323023				8178105214	elizabeth.scott@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant	Mr.	Liu	Robert		8176323023					robert.liu@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Customer Service Operations Contact	Sr Director, Operations	Mr.	Greene	Shane		8176874066				8176874103	Shane.greene@cnchealthplan.com	1603 Lyndon B. Johnson	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	DIR Contact	Senior Director, Government Programs	Mr.	Farmer	Jim		3308886098					jfarmer@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	DIR Contact (Secondary)	Analyst III, Government Programs	Mr.	Houchens	Logan		3308886095					lhouchens@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Emergency Part D Contact	Director, Pharmacy Services	Ms.	May	Amy		8176322128				8178105214	Amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Emergency Part D Contact (Secondary)	Director, Pharmacy Services	Mrs.	May	Amy		8176323023				8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Employer Waiver Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Encounter Data & Risk Adjustment Operations Contact	Finance	Ms.	Sheriff	Laura		8176323023					Laura.Sheriff@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Enrollment Contact	Sr Director, Strategic Operations	Mr	Smith	Charles		8176323023				8178105214	charles.smith@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	EOB Transfer Contact	Sr Director, Strategic Operations	Mr.	Smith	Charles		8176323023				8178105214	charles.smith@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Financial Audit Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Financial Reporting Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Formulary Contact	Clinical Formulary Pharmacist	Mr	Shick	Ryan		2342123614					rshick@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Formulary Contact (Secondary)	Director, Pharmacy	Ms.	May	Amy		8176322128				8178105214	Amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	General Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suit 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Government Relations Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	HIPAA Privacy Officer	Interim Privacy Officer and General Counsel	Mr.	Smith	Randall		4025993884					Randall.Smith@southwesternhealth.org	1601 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	HIPAA Security Officer	VP IT and Security	Mr.	Marlow	Mac		8176323023					mac.marlow@southwesternhealth.org	1601 Lyndon B. Johnson Freeway	Suite 200	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Hospice Contact	Clinical Pharmacy Services	Ms.	May  Pharm D	Amy		8176322128				8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Interoperability Contact	Sr Director, Operations	Mr.	Greene	Shane		8176321741					shane.greene@cnchealthplan.com	1603 LBJ FWY		Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	MA Appeals/Grievances Contact	Sr Director, Operations	Mr.	Greene	Shane		8176321741				8178105214	shane.greene@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	MA Claims Processing Contact for Public Website			Administration	Claims		8175298301					info@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Marketing Contact	Chief Sales Officer	Mr.	Ortiz	Jesus		2147076260					jesus.ortiz@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Medical Director	Chief Medical Officer, SWHR	Dr.	DeMartini	Robert		9726793982					robert.demartini@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Medicare Compliance Officer	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Medicare Coordinator	Manager Compliance Operations	Ms.	Geltman	Megan		8176323023				8178105214	megan.geltman@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy Services	Ms.	May	Amy		8176322128				8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Medication Therapy Management Contact	VP Pharmacy Solutions	Ms.	Miller	Holly		3302931916					hmiller@healthdialog.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	OffShore Subcontractor Contact	Manager Compliance Regulatory Oversight	Ms	Geltman	Megan		8176323023					megan.geltman@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Online Enrollment Center Contact (Back-up)	Sr Director, Operations	Mr.	Greene	Shane		8176321741				8176874103	shane.greene@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Online Enrollment Center Contact (Primary)	Sr Director, Strategic Operations	Mr.	Smith	Charles		8176323023				8178105214	charles.smith@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Part C Application Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Part C Reporting Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Part D Appeals	Director, Pharmacy Services	Ms	May	Amy						8174388483	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active	8773747993				PPO - BBA		C	Dallas
H6328	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations		Binegar	Sam						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active	3303449571	0409			PPO - BBA		C	Dallas
H6328	Part D Application Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Part D Benefits Contact	Account Manager	Mr.	Battaglia	James		3308886165				3308886015	jbattaglia@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Part D Claims Submission Contact	Senior Account Manager	Mr.	Battaglia	James		3308886165				3308886015	jbattaglia@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Part D Exceptions Contact	Director, Pharmacy Services	Ms.	May	Amy							amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active	8176322128				PPO - BBA		C	Dallas
H6328	Part D Exceptions Contact (Secondary)	Clinical Pharmacy Services	Ms.	May PharmD	Amy						8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active	8176322128				PPO - BBA		C	Dallas
H6328	Part D Price File Contact (Back-up)	Financial Analyst, Finance		Kessler	Cameron		2342123110				3304864801	ckessler@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Part D Price File Contact (Optional)	Director, Pharmacy Services	Ms.	May	Amy		8176322128				8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Part D Price File Contact (Primary)	Sr Financial Manager Reporting & Analytics	Mr.	Campbell	Tim		3308886988				3304864801	tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Part D Quality Assurance Contact	Director, Pharmacy Services	Ms.	May	Amy		8176322128				8178105214	amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Part D Reporting Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Patient Safety Contact	Director, Pharmacy Services	Ms.	May	Amy		8176322128					amy.may@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Payment Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Personal Health Record Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Pharmacy Director	Sr Director,  Pharmacy Services	Ms.	Flowers	Amy		8176323023				8178105214	amy.flowers@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Pharmacy Network Management Contact	Director Pharmacy Network Development	Ms.	Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active	8557915302				PPO - BBA		C	Dallas
H6328	PHR Beneficiary Contact																	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO	Care N Care	Texas Health Resources	709	Yes	Active	8557915302				PPO - BBA		C	Dallas
H6328	Physician Incentive Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Plan Directory Contact for Public Website			Concierge	Provider		8176874004					info@cnchealthplan.com	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Birch	Harvey		8176323023					harvey.birch@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Processor Contact	Sr Director, Strategic Operations	Mr.	Smith	Charles		8176323023				8178105214	charles.smith@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Quality Contact	Chief Medical Officer, SWHR	Dr.	DeMartini	Robert		9726793982					robert.demartini@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Reconciliation Contact	Chief Financial Officer	Mr.	Birch	Harvey		8176323023					harvey.birch@southwesternhealth.org	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Reconciliation Contact (Secondary)	Director Pharmacy Network Development	Ms.	May	Amy		8176323023				3304864801	amy.may@cnchealthplan.com	1603 LBJ FWY	Suite 201	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Recovery Audit Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Surveillance Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	System Contact	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Third Party Administrator (TPA) Liaison	Compliance Officer	Ms.	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	User Access Contact	Compliance Officer	Ms	Scott	Elizabeth		8176323023					elizabeth.scott@cnchealthplan.com	1603 LBJ FWY	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Utilization Management Contact	Chief Medical Officer, SWHR	Dr.	DeMartini	Robert		9726793982					robert.demartini@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6328	Utilization Review Contact	Chief Medical Officer, SWHR	Dr.	DeMartini	Robert		9726793982					robert.demartini@southwesternhealth.org	1603 Lyndon B. Johnson Freeway	Suite 300	Farmers Branch	TX	75234	08/09/2023	2023	CARE N' CARE INSURANCE COMPANY, INC.	Local CCP	Care N' Care Insurance Company	Local PPO		Texas Health Resources	709	Yes	Active					PPO - BBA		C	Dallas
H6334	CAP Report Contact for Public Website	Provider Relations Representative	Mr.	Enoe	Mark	S	2125866400	4288			2122373080	menoe@hotelfunds.org	NYHTC and HANYC, Inc. Employee Benefit Funds	305 West 44th Street	New York	NY	10036	08/29/2019	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	CEO - CMS Administrator Contact	Chief Executive Officer	Dr.	Jacobson	David		2125866400	3937			2122373063	djacobson@hotelfunds.org	NYHTC and HANYC, Inc. Employee Benefit Funds	305 West 44th Street	New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	CEO - Senior Official for Contracting	Chief Executive Officer	Dr.	Jacobson	David		2125866400	3937			2122373063	djacobson@hotelfunds.org	NYHTC and HANYC, Inc. Employee Benefit Funds	305 West 44th Street	New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Chief Financial Officer	Chief Financial Officer	Mr.	Heim	John		2125866400	4551			2125863596	jheim@hotelfunds.org	NYHTC and HANYC, Inc. Employee Benefit Funds	305 West 44th Street	New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Complaints Tracking Contact	Provider Relations Representative	Mr.	Enoe	Mark	S	2125866400	4288				menoe@hotelfunds.org	305 West 44th Street		New York	NY	10036	08/29/2019	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Corporate Mailing						2125866400					djacobson@hotelfunds.org	NYHTC and HANYC, Inc. Employee Benefit Funds	305 West 44th Street	New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Customer Service Operations Contact	Provider Relations Representative	Mr.	Enoe	Mark		2125866400	4288				menoe@hotelfunds.org	305 West 44th Street		New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	General Contact	Provider Relations Representative	Mr.	Enoe	Mark		2125866400	4288				menoe@hotelfunds.org	305 West 44th Street		New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Government Relations Contact	Provider Relations Representative	Mr.	Enoe	Mark		2125866400	4288			2122373080	menoe@hotelfunds.org	NYHTC and HANYC, Inc. Employee Benefit Funds	305 West 44th Street	New York	NY	10036	08/29/2019	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	MA Appeals/Grievances Contact	Provider Relations Representative		Enoe	Mark		2125866400	4288				menoe@hotelfunds.org	305 West 44th Street		New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Medical Director	Chief Executive Officer	Dr.	Jacobson	David		2125866400	3937			2122373063	djacobson@hotelfunds.org	NYHTC and HANYC, Inc. Employee Benefit Funds	305 West 44th Street	New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Medicare Compliance Officer	Chief External Affairs Officer	Mr.	Yang	Jordan	E	2125866400	4340			2122373080	jyang@hotelfunds.org	NYHTC and HANYC, Inc. Employee Benefit Funds	305 West 44th Street	New York	NY	10036	08/30/2019	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Medicare Coordinator	Provider Relations Representative	Mr.	Enoe	Mark		2125866400	4288			2122373080	menoe@hotelfunds.org	NYHTC and HANYC, Inc. Employee Benefit Funds	305 West 44th Street	New York	NY	10036	08/29/2019	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Plan Directory Contact for Public Website	Provider Relations Representative	Mr.	Enoe	Mark		2125866400					menoe@hotelfunds.org	305 West 44th Street		New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Quality Contact	Chief Executive Officer	Dr.	Jacobson	David		2125866400					djacobson@hotelfunds.org	305 West 44th Street		New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	User Access Contact	Provider Relations Representative	Mr.	Enoe	Mark		2125866400					menoe@hotelfunds.org	305 West 44th Street		New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Utilization Management Contact	Chief Executive Officer	Dr.	Jacobson	David		2125866400					djacobson@hotelfunds.org	305 West 44th Street		New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6334	Utilization Review Contact	Chief Executive Officer	Dr.	Jacobson	David		2125866400					djacobson@hotelfunds.org	305 West 44th Street		New York	NY	10036	11/17/2020	2023	NY HOTEL TRADES COUNCIL & HOTEL ASSOCIATION OF NYC	HCPP - 1833 Cost	NY Hotel Trades Council and Hotel Assn. of NYC	HCPP - 1833 Cost		NY Hotel Trades Council&Hotel Assn of NYC	167	No	Active					HCPP		1	New York
H6340	Automated TrOOP Balance Transfer Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Backup User Access Contact		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	05/10/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Best Available Evidence Contact			Cadena	Maria		6505022961					maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	05/10/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Bid Primary Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	CAP Report Contact for Public Website		Mr.	Tung	Yin		6462218525					yin.tung@welbehealth.com	570 Washington Ave		Plainview	NY	11803	09/28/2022	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	CEO - CMS Administrator Contact		Mr.	Tung	Yin		6462218525					yin.tung@welbehealth.com	570 Washington Ave		Plainview	NY	11803	05/24/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	CEO - Senior Official for Contracting		Mr.	Tung	Yin		6462218525					yin.tung@welbehealth.com	570 Washington Ave		Plainview	NY	11803	05/24/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Chief Financial Officer		Mr.	Epstein	Ethan		2036951178					ethan.epstein@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Chief Operating Officer		Mr.	Tung	Yin		6462218525					yin.tung@welbehealth.com	570 Washington Ave		Plainview	NY	11803	05/24/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Chief Information Officer		Ms.	O'Leary	Kate		9733031835					kate.oleary@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Chief Information Security Officer		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	CMS Casework Communication Contact	Compliance Director		Costigan	Bobbie		2192106392					Bobbie.Costigan@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	05/10/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Complaints Tracking Contact	Compliance Director		Costigan	Bobbie		2192106392					Bobbie.Costigan@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	05/10/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Contact for Fraud Investigations			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Coordination of Benefits Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Corporate Mailing						6508626371					matt.patterson@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Coverage Gap Discount Program (CGDP) Payment Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Customer Service Operations Contact		Mr.	Tung	Yin		6462218525					yin.tung@welbehealth.com	570 Washington Ave		Plainview	NY	11803	09/28/2022	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	DIR Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Emergency Part D Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Emergency Part D Contact (Secondary)			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Encounter Data & Risk Adjustment Operations Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Enrollment Contact			Cadena	Maria		6505022961					maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	05/10/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	EOB Transfer Contact			Cadena	Maria		6505022961				6263600082	maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	05/10/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Financial Audit Contact	Senior Accounting Manager	Ms.	Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Financial Reporting Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Formulary Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	General Contact		Mr.	Tung	Yin		6462218525					yin.tung@welbehealth.com	570 Washington Ave		Plainview	NY	11803	09/28/2022	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Government Relations Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	HIPAA Privacy Officer			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	HIPAA Security Officer		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Interoperability Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	MA Appeals/Grievances Contact			Simon	Jillian		3104296136					jillian.simon@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	05/10/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	MA Claims Processing Contact for Public Website			Grant	Alexsa		6503360300					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Marketing Contact			Castro	Marta		6509186233					marta.castro@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Medical Director	Chief Medical Officer		Le	Mike		7146086457					mike.le@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	05/10/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Medicare Compliance Officer		Ms.	Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Medicare Coordinator		Mr.	Tung	Yin		6462218525					yin.tung@welbehealth.com	570 Washington Ave		Plainview	NY	11803	09/28/2022	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Medicare Part D Opioid Overutilization Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Medication Therapy Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Part C Application Contact			Harden	Gabriele		3037754823					gabriele.harden@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Part D Appeals			Simon	Jillian							jillian.simon@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	05/10/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending	3104296136				PACE - Nat		C	New York
H6340	Part D Appeals Contact (Secondary)		Mr.	Tung	Yin							yin.tung@welbehealth.com	570 Washington Ave		Plainview	NY	11803	09/28/2022	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending	6462218525				PACE - Nat		C	New York
H6340	Part D Application Contact			Harden	Gabriele		3037754823					gabriele.harden@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Part D Benefits Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Part D Claims Submission Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Part D Exceptions Contact			Grant	Alexsa							alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending	8007348041				PACE - Nat		C	New York
H6340	Part D Price File Contact (Back-up)			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Part D Price File Contact (Primary)			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Part D Quality Assurance Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Part D Reporting Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Patient Safety Contact			Simon	Jillian		3104296136					jillian.simon@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	05/10/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Payment Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Pharmacy Director			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Pharmacy Network Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Pharmacy Technical Help Desk Contact			Grant	Alexsa							alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending	8007348041				PACE - Nat		C	New York
H6340	Plan Directory Contact for Public Website			Grant	Alexsa		6503360300					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Plan to Plan Reconciliation Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Processor Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Quality Contact			Simon	Jillian		3104296136					jillian.simon@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	05/10/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Reconciliation Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Recovery Audit Contact	VP Compliance	Ms.	Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Surveillance Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	System Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Third Party Administrator (TPA) Liaison			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	User Access Contact		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Utilization Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6340	Utilization Review Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/18/2023	2023	WELBEHEALTH ATLANTIC PACE, LLC	National PACE	WelbeHealth	National PACE				Yes	Pending					PACE - Nat		C	New York
H6342	Automated TrOOP Balance Transfer Contact	Exec Director		Williams	Sheila		5014418001					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Backup User Access Contact	QI Coordinator		Stoneman	Kimberly		5014418000					kimberly.stoneman@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/09/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Best Available Evidence Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/09/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Bid Primary Contact	Exec Director		Williams	Sheila		5014418001					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	CAP Report Contact for Public Website	Executive Director	Mrs	Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/09/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	CEO - CMS Administrator Contact	Executive Director	Mrs	Willias	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/09/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	CEO - Senior Official for Contracting	Executive Director	Mrs	Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/09/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Chief Financial Officer	CFO	Mr.	Beaulieu	Brent		5012022017					brent.beaulieu@baptist-health.org	9601 Baptist Health Drive		Little Rock	AR	72205	11/10/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Chief Operating Officer	Exec Dir	Mrs	Williams	Sheila		5014418001					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Chief Information Officer	QI Coordinator	Mrs	Stoneman	Kimberly		5014418000					kimberly.stoneman@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/09/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Chief Information Security Officer	VP Baptist Health	Mrs.	Matlock	Kourtney		5012021917					kourtney.matlock@baptist-health.org	10825 Financial Parkway		Little Rock	AR	72211	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	CMS Casework Communication Contact	Executive Director	Mrs	Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Complaints Tracking Contact	QI Coordinator		Stoneman	Kimberly		5014418000					kimberly.stoneman@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Contact for Fraud Investigations		Mrs.	Williams	Dana		5012026776					dana.williams@baptist-health.org	9601 Baptist Health Drive		Little Rock	AR	72205	11/06/2015	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Coordination of Benefits Contact	Exec Director		Williams	Sheila		5014418001					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Corporate Mailing						5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Coverage Gap Discount Program (CGDP) Payment Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Customer Service Operations Contact	QI Coordinator		Stoneman	Kimberly		5014418000					kimberly.stoneman@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	DIR Contact	Exec Director		Williams	Sheila		5014418001					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	DIR Contact (Secondary)			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Emergency Part D Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Emergency Part D Contact (Secondary)	Financial Services Manager	Mr	Gardner	Scott		5014418000					Scott.gardner@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Encounter Data & Risk Adjustment Operations Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Enrollment Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	EOB Transfer Contact	Executive Director	Mrs	Williams	Sheila		5014418000				5014418050	sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Financial Audit Contact	Executive Director	Mrs.	Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Financial Reporting Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Formulary Contact	Executive Director	Mrs	Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	General Contact	Executive Director	Mrs	Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Government Relations Contact	VP Baptist Health		Matlock	Kourtney		5012021917					kourtney.matlock@baptist-health.org	10825 Financial Centre Parkway	Suite 410	Little Rock	AR	72211	08/12/2021	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	HIPAA Privacy Officer		Mrs.	Williams	Dana		5012026776					dana.williams@baptist-health.org	9601 Baptist Health Drive		Little Rock	AR	72205	11/06/2015	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	HIPAA Security Officer		Mrs.	Williams	Dana		5012026776					dana.williams@baptist-health.org	9601 Baptist Health Drive		Little Rock	AR	72205	11/06/2015	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Interoperability Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	MA Appeals/Grievances Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	MA Claims Processing Contact for Public Website			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Marketing Contact	Marketing Coordinator	Ms.	Green	Patricia		5014418000					patricia.green@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Medical Director	Medical Director	Dr.	Prime	Jasmine		5014418000					jasmine.prime@practice-plus.com	3500 Springhill Drive		North Little Rock	AR	72117	06/28/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Medicare Compliance Officer	Executive Director	Mrs	Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/17/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Medicare Coordinator			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Prime	Jasmine		5014418000					jasmine.prime@practice-plus.com	3500 Springhill Drive		North Little Rock	AR	72117	06/28/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Medication Therapy Management Contact	Medical Director	Dr.	Prime	Jasmine		5014418000					jasmine.prime@practice-plus.com	3500 Springhill Drive		North Little Rock	AR	72117	06/28/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Part C Application Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Part D Appeals	Executive Director		Williams	Sheila							sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active	5014418000				PACE - Nat		C	Denver
H6342	Part D Appeals Contact (Secondary)	Financial Services Manager		Gardner	Scott							scott.gardner@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active	5014418000				PACE - Nat		C	Denver
H6342	Part D Application Contact	Executive Director	Mrs	Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Part D Benefits Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Part D Claims Submission Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Part D Exceptions Contact	Executive Director		Williams	Sheila							sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active	5014418000				PACE - Nat		C	Denver
H6342	Part D Price File Contact (Back-up)	Executive Director		Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Part D Price File Contact (Primary)			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Part D Quality Assurance Contact			Stoneman	Kimberly		5014418000					kimberly.stoneman@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/09/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Part D Reporting Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Patient Safety Contact	QI Coordinator		Stoneman	Kimberly		5014418000					kimberly.stoneman@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Payment Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Pharmacy Director	Medical Director	Dr.	Prime	Jasmine		5014418000					jasmine.prime@practice-plus.com	3500 Springhill Drive		North Little Rock	AR	72117	06/28/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Pharmacy Network Management Contact	Medical Director	Dr.	Prime	Jasmine		5014418000					jasmine.prime@practice-plus.com	3500 Springhill Drive		North Little Rock	AR	72117	06/28/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Pharmacy Technical Help Desk Contact	Executive Director		Williams	Sheila							sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active	5014418000				PACE - Nat		C	Denver
H6342	Plan Directory Contact for Public Website			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Plan to Plan Reconciliation Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Processor Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Quality Contact	QI Coordinator		Stoneman	Kimberly		5014418000					kimberly.stoneman@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Reconciliation Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Recovery Audit Contact	VP Baptist Health	Mrs.	Matlock	Kourtney		5012021917					kourtney.matlock@baptist-health.org	10825 Financial Parkway		Little Rock	AR	72211	08/12/2021	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Surveillance Contact	VP Baptist Health		Matlock	Kourtney		5012021917					kourtney.matlock@baptist-health.org	10825 Financial Centre Parkway	Suite 410	Little Rock	AR	72211	08/12/2021	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	System Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	08/15/2022	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Third Party Administrator (TPA) Liaison			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	User Access Contact	VP Baptist Health	Mrs	Matlock	Kourtney		5012021917					kourtney.matlock@baptist-health.org	10825 Financial Centre Parkway	Suite 410	Little Rock	AR	72211	08/12/2021	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Utilization Management Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6342	Utilization Review Contact			Williams	Sheila		5014418000					sheila.williams@baptist-health.org	3500 Springhill Drive		North Little Rock	AR	72117	02/21/2023	2023	COMPLETE HEALTH WITH PACE	National PACE	Baptist Health PACE	National PACE		Baptist Health (Arkansas)	629	Yes	Active					PACE - Nat		C	Denver
H6345	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	12/31/2019	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Backup User Access Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/01/2019	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Christopher	Laura	K	4046944897					compliance@pruitthealthpremier.com	1626 Jeurgens Court		Norcross	GA	30093	06/07/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	CEO - CMS Administrator Contact		Mr.	Pruitt	Neil		7708066893					npruitt@pruitthealth.com	1626 Jeurgens Court		Norcross	GA	30093	02/04/2019	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	CEO - Senior Official for Contracting		Mr.	Pruitt	Neil		7708066893					npruitt@pruitthealth.com	1626 Jeurgens Court		Norcross	GA	30093	02/04/2019	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Chief Financial Officer	CFO	Mr	Small	Phil		7702796200					PhSmall@pruitthealth.com	1626 Jeurgens Ct		Norcross	GA	30093	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Chief Operating Officer	Chief Operating Officer	Mr.	Beddingfield	Ryan		6785336300					rbeddingfield@pruitthealth.com	1626 jeurgens ct		norcross	GA	30093	09/08/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Contact for Fraud Investigations	Medicare Compliance Officer	Ms.	Christopher	Laura	K	4046944897					compliance@pruitthealthpremier.com	1626 Jeurgens COurt		Norcross	GA	30093	06/07/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/01/2019	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Corporate Mailing						8442243659					customerservice@pruitthealthpremier.com	P.O. Box 2190		Glen Allen	VA	230582190	12/29/2017	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Encounter Data & Risk Adjustment Operations Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/02/2019	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	EOB Transfer Contact			Lowry	Kristy		8448546883				8003756496	customerservice@pruitthealthpremier.com	P.O. Box 2190		Glen Allen	VA	230582190	01/15/2020	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Financial Audit Contact	CFO	Mr.	Small	Phil		7702796200					phsmall@pruitthealth.com	1626 Jeurgens Court		Norcross	GA	30093	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Financial Reporting Contact	CFO	Mr.	Small	Phil		7702796200					phsmall@pruitthealth.com	1626 Jeurgens Court		Norcross	GA	30093	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	12/31/2019	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	General Contact			Tolbert	Angie		7068367966					atolbert@pruitthealth.com	1626 jeurgens Court		Norcross	GA	30093	09/05/2018	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	HIPAA Privacy Officer	Medicare Compliance Officer	Ms.	Christopher	Laura	K	4046944897					compliance@pruitthealthpremier.com	1626 Jeurgens COurt		Norcross	GA	30093	06/07/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	HIPAA Security Officer	Medicare Compliance Officer	Ms.	Christopher	Laura	K	4046944897					compliance@pruitthealthpremier.com	1626 Jeurgens Court		Norcross	GA	30093	06/07/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Medical Director		Dr.	Stallings	Ravelle		6785336300					rstallings@pruitthealth.com	PruittHealth Premier	1626 Jeurgens Court	Norcross	GA	30093	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Christopher	laura	k	4046944897					kelly.christopher@pruitthealth.com	1626 jeurgens ct		norcross	GA	30093	07/11/2023	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Medicare Coordinator	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Part C Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Part C Reporting Contact			Rennie	Lynda		8043966383					lynda@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	12/31/2019	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Payment Contact	CFO	Mr.	Ragland	Robert		8042663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Atlanta
H6345	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Atlanta
H6345	Physician Incentive Contact			French	Kirk		8048402618					kirk.french@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Plan Directory Contact for Public Website			Sindlinger	Rocio		8558550668					rocio.sindlinger@allyalign.com	P.O. Box 2190		Glen Allen	VA	230582190	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Plan to Plan Reconciliation Contact	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	12/29/2017	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Quality Contact			Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/02/2019	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Reconciliation Contact		Mr.	Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/15/2020	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Reconciliation Contact (Secondary)	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Christopher	Laura	K	4046944897					compliance@pruitthealthpremier.com	1626 Jeurgens Court		Norcross	GA	30093	06/07/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Third Party Administrator (TPA) Liaison	CFO	Mr	Small	Phil		7702796200					PhSmall@pruitthealth.com	1626 Jeurgens Ct		Norcross	GA	30093	09/28/2022	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	User Access Contact	Medicare Compliance Officer	Ms.	Christopher	Kelly		4046944897					kelly.christopher@pruitthealth.com	1626 jeurgens ct		norcross	GA	30093	02/06/2023	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6345	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PRUITTHEALTH PREMIER NORTH CAROLINA, LLC	Local CCP	PruittHealth Premier	HMO/HMOPOS		UNICO Services, Inc.	622	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6348	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H6348	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/07/2018	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/15/2017	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Medical Director	Chief Medical Director	Dr.	Lucas	Brad		8662464356					blucas@centene.com	3700 Embassy Parkway, Suite 200		Akron	OH	44333	03/30/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H6348	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H6348	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H6348	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H6348	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H6348	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H6348	PHR Beneficiary Contact																	09/27/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8557661541				PPO - BBA		C	Dallas
H6348	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Plan Directory Contact for Public Website			Services	Provider		8557661541					CorporateMedicareComplianceDept@CENTENE.COM	550 N. Meridian Street	Suite 101	Indianapolis	IN	46204	03/31/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6348	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	COORDINATED CARE CORPORATION	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6351	Agent/Broker Compensation Data Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	12/31/2019	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Backup User Access Contact	Compliance Officer	Mr.	ORourke	David	A	9106222570					dorourke@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/12/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Best Available Evidence Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/05/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Bid Audit Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Bid Audit Site Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Bid Primary Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	CAP Report Contact for Public Website	Compliance Officer		ORourke	David	A	9106222570					dorourke@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/10/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	CEO - CMS Administrator Contact		Mr.	Oliver	David		9102632306					doliver@libertyhcare.com	2334 S. 41st Street		Wilmington	NC	28403	01/29/2017	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	CEO - Senior Official for Contracting		Mr.	Oliver	David		9102632306					doliver@libertyhcare.com	2334 S. 41st Street		Wilmington	NC	28403	01/29/2017	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Chief Financial Officer	CFO	Mr.	Calcutt	Joseph	V	9103321793					jcalcutt@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	03/08/2021	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Chief Operating Officer		Mr.	Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	08/17/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Chief Information Officer	Chief  Operating Officer	Ms.	Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/10/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Chief Information Security Officer	Chief Operating Officer	Ms.	Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/10/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	CMMI Model Point of Contact			Beittel	Timothy		9103252425					timothy.beittel@libertyadvantageplan.com	2334 South 41st		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	CMS Casework Communication Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Complaints Tracking Contact	Compliance Officer		ORourke	David	A	9106222570					dorourke@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/10/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Contact for Fraud Investigations	Compliance Officer		ORourke	David	A	9106222570					dorourke@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/10/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Coordination of Benefits Contact			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/27/2022	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Corporate Mailing						9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Coverage Gap Discount Program (CGDP) Payment Contact			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Customer Service Operations Contact	Compliance Officer		ORourke	David	A	9106222570					drourke@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/10/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	DIR Contact			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	DIR Contact (Secondary)			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Emergency Part D Contact			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Emergency Part D Contact (Secondary)			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Encounter Data & Risk Adjustment Operations Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Enrollment Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	EOB Transfer Contact			Oliver	David		9102632306				9102632306	doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Financial Audit Contact	Financial Manager	Mrs.	Fawson	Leesa		7062809154					lfawson@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	08/09/2022	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Financial Reporting Contact			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Formulary Contact			Paddock	Deanna		6087291628					Deanna.Paddock@navitus.com	361 Integrity Drive		Madison	WI	53717	01/12/2021	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Formulary Contact (Secondary)			Dede	Ledja		6087291690					Laura.Crain@navitus.com	361 Integrity Drive		Madison	WI	53717	01/12/2021	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	General Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 S. 41st Street		Wilmington	NC	28403	01/29/2017	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Government Relations Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	HIPAA Privacy Officer	Compliance Officer		ORourke	David	A	9106222570					dorourke@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/10/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	HIPAA Security Officer	Compliance Officer		ORourke	David	A	9106222570					dorourke@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/10/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Hospice Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Interoperability Contact			Oliver	David		9102632306					DOLIVER@LIBERTYHCARE.COM	2334 S. 41st St.		Wilmington	NC	28403	02/11/2022	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	MA Appeals/Grievances Contact	Operations		Troxler	Cynthia		9102632306					CTroxler@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	07/26/2022	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	MA Claims Processing Contact for Public Website			Fawson	Leesa		8448546884					LibertyProviderIVR@mirrahealthcare.com	2334 South 41st Street		Wilmington	NC	28403	10/04/2022	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Marketing Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Medical Director			Beittel	Timothy		9103252425					timothy.beittel@libertyadvantageplan.com	Liberty Advantage Plan	2324 S. 41st Street	Wilmington	NC	28403	12/01/2017	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Medicare Compliance Officer	Compliance Officer	Mr.	ORourke	David	A	9106222570					dorourke@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/10/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Medicare Coordinator			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Medicare Part D Opioid Overutilization Contact			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Medication Therapy Management Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Part C Application Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Part C Reporting Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						9202214649	Justin.LaCrosse@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Appeals Contact (Secondary)			Oliver	David							doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/05/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active	9102632306				HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Application Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Benefits Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	08/17/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Exceptions Contact			Fawson	Leesa							lfawson@libertyhcare.com	2334 South 41st		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active	9106604772				HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Exceptions Contact (Secondary)			Oliver	David							doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/05/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active	9102632306				HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Price File Contact (Back-up)			Rogeberg	Derek		6087291595				6087292584	Derek.Rogeberg@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	08/21/2019	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Price File Contact (Optional)			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/05/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	12/31/2019	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Quality Assurance Contact			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Part D Reporting Contact			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Patient Safety Contact			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Payment Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Pharmacy Director			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Pharmacy Network Management Contact	Associate Director, Provider Services, Operations		Burdick	Tammy		9202214089				9202214589	Tammy.Burdick@Navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/31/2019	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Pharmacy Network Management Contact (Secondary)			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/05/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Atlanta
H6351	Pharmacy Technical Help Desk Contact (Secondary)			Oliver	David							doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/05/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active	9102632306				HMO - Health Maintenance Organization		C	Atlanta
H6351	Physician Incentive Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Plan Directory Contact for Public Website	Compliance Officer		ORourke	David	A	8448546884					LibertyProviderIVR@mirrahealthcare.com	PO Box 3325		Spring Hill	FL	34611	04/10/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Plan to Plan Reconciliation Contact			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/29/2017	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Quality Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Reconciliation Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Reconciliation Contact (Secondary)			Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Recovery Audit Contact	Executive Director	Mr.	Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	SNP Application Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	SNP State Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Surveillance Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	System Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Third Party Administrator (TPA) Liaison	Financial Director		Fawson	Leesa		9106604772					lfawson@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	12/09/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	User Access Contact	Compliance Officer		ORourke	David	A	9106222570					dorourke@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	04/10/2023	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Utilization Management Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6351	Utilization Review Contact			Oliver	David		9102632306					doliver@libertyhcare.com	2334 South 41st Street		Wilmington	NC	28403	06/03/2020	2023	LIBERTY ADVANTAGE, LLC	Local CCP	Liberty Medicare Advantage	HMO/HMOPOS		Liberty Healthcare Insurance	668	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H6371	Automated TrOOP Balance Transfer Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Backup User Access Contact	CFO	Ms.	Richman	Jeannine		6093867171				6097477171	Jrichman@LSMNJ.ORG	3 Manhattan Drive		Burlington	NJ	08016	03/12/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Best Available Evidence Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Bid Primary Contact	CFO	Ms.	Richman	Jeannine		6097811379				6097474131	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	02/19/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	CAP Report Contact for Public Website	Director of Quality Assurance	Mrs.	Alvarado-Marin	Deanna		2014993900	3897			2017062092	dalvarado@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	01/11/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	CEO - CMS Administrator Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	CEO - Senior Official for Contracting	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Chief Financial Officer	CFO	Ms	Richman	Jeannine	M	6097811379				6097474140	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	09/02/2020	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Chief Operating Officer	Chief Operating Officer	Ms.	OUTTEN	SHERRY		6096941717				6097474101	SOUTTEN@LSMNJ.ORG	3 MANHATTAN DRIVE		BURLINGTON	NJ	08016	02/19/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Chief Information Officer	Senior Client Solutions Analyst	Mr.	Medlin	Dawsey		6096994150					dmedlin@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	06/22/2020	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Chief Information Security Officer	Senior Client Solutions Analyst	Mr.	Medlin	Dawsey		6096994150					dmedlin@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	06/22/2020	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	CMS Casework Communication Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Complaints Tracking Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Contact for Fraud Investigations	Compliance Officer	Ms.	Alvarado-Marin	Deanna		2014993900	3897			2017062092	dalvarado@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	01/11/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Coordination of Benefits Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Corporate Mailing						6097811379				6097474101	jrichman@lsmnj.org	3 MANHATTAN DRIVE		BURLINGTON	NJ	08016	02/19/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Coverage Gap Discount Program (CGDP) Payment Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Customer Service Operations Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	DIR Contact	CFO, FInance	Ms.	Richman	Jeannine		6096994131				6097474140	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	03/01/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	DIR Contact (Secondary)	Accounting Manager		Schultz	Steve		6096994128	4128			6097474128	sschultz@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	04/23/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Emergency Part D Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Emergency Part D Contact (Secondary)	CFO		Richman	Jeannine		6096994140				6097474140	Jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	03/12/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Encounter Data & Risk Adjustment Operations Contact	CFO		Richman	Jeannine		6097811379				6097474131	jrichman@lsmnj.org	3 MANHATTAN DRIVE		BURLINGTON	NJ	08016	04/23/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Enrollment Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	EOB Transfer Contact	CFO	Ms	Richman	Jeannine	M	6097811379				6097474140	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	09/02/2020	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Financial Audit Contact	CFO	Ms	Richman	Jeannine	M	6097811379				6097474140	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	09/02/2020	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Financial Reporting Contact	Chief Financial Officer	Ms	Richman	Jeannine		6093867171				6093862305	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	09/02/2020	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Formulary Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Formulary Contact (Secondary)	CFO		RICHMAN	JEANNINE		6097811379					jrichman@lsmnj.org	3 MANHATTAN DRIVE		BURLINGTON	NJ	08016	02/19/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	General Contact	Director of Assurance	Mrs.	Alvarado-Marin	Deanna		2014993900	3897			2017062092	dalvarado@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	01/11/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Government Relations Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	HIPAA Privacy Officer	Compliance Officer	Mrs.	Alvarado-Marin	Deanna		2014993900	3897			2017062092	dalvarado@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	01/11/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	HIPAA Security Officer	Compliance Officer	Ms.	Alvarado-Marin	Deanna		2014993900	3897			2017062092	dalvarado@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	01/11/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Interoperability Contact	CFO		Richman	Jeannine		6097811379				6097474131	jrichman@lsmnj.org	ATTN JEANNINE RICHMAN	3 MANHATTAN DR	Burlington	NJ	08016	04/23/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	MA Appeals/Grievances Contact	Director of Quality Assurance	Mrs.	Alvarado-Marin	Deanna		2014993900	3897			2017062092	dalvarado@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	01/11/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	MA Claims Processing Contact for Public Website	Client Services Rep	Ms.	Uhler	Laurie		3149449017					Luhler@peak.cpstn.com	345 Marshal Avenue	Suite 101	St. Louis	MO	63119	03/12/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Marketing Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Medical Director	Medical Director	Dr	SYED	AMER		2018902225				2015162577	ASYED@LSMNJ.ORG	377 Jersey Avenue	Suite 310	Jersey City	NJ	07302	02/19/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Medicare Compliance Officer	Compliance Officer	Mrs.	Alvarado-Marin	Deanna		2014993900	3897			2017062092	dalvarado@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	01/11/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Medicare Coordinator	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Medicare Part D Opioid Overutilization Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Medication Therapy Management Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Part C Application Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Part D Appeals	Executive Director	Ms.	Iavarone	Maria						2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active	2014993900	3879			PACE - Nat		C	New York
H6371	Part D Appeals Contact (Secondary)	Client Development Liaison		Quillen	Deb							dquillen@carekinesis.com	228 Strawbridge Drive		Moorestown	NJ	08057	03/12/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active	8566305218				PACE - Nat		C	New York
H6371	Part D Application Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Part D Benefits Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Part D Claims Submission Contact	Chief Financial Officer	Ms	Richman	Jeannine		6096994131				6097474131	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	09/02/2020	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Part D Exceptions Contact	Executive Director	Ms.	Iavarone	Maria						2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active	2014993900	3879			PACE - Nat		C	New York
H6371	Part D Exceptions Contact (Secondary)	CFO	Mrs.	Richman	Jeannine						6097474140	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	03/12/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active	6093867171				PACE - Nat		C	New York
H6371	Part D Price File Contact (Back-up)	Chief Financial Officer	Ms	Richman	Jeannine		6096994131				6097474131	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	09/02/2020	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Part D Price File Contact (Primary)	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Part D Quality Assurance Contact	Director of Quality Assurance	Mrs.	Alvarado-Marin	Deanna		2014993900	3897			2017062092	dalvarado@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	01/11/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Part D Reporting Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Patient Safety Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Payment Contact	CFO	Ms	Richman	Jeannine	M	6097811379				6097474140	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	09/02/2020	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Personal Health Record Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879				miavarone@lsmnj.org	377 Jersey AVenue	Suite 310	Jersey CIty	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Pharmacy Director	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Pharmacy Network Management Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Pharmacy Technical Help Desk Contact	Executive Director	Ms.	Iavarone	Maria						2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active	2014993900	3879			PACE - Nat		C	New York
H6371	PHR Beneficiary Contact																	03/12/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE	Lutheran Senior Life	Lutheran Social Ministries of New Jersey	427	Yes	Active	2014993900	3879			PACE - Nat		C	New York
H6371	Plan Directory Contact for Public Website	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Plan to Plan Reconciliation Contact	CFO	Ms	Richman	Jeannine	M	6097811379				6097474140	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	09/02/2020	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Processor Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Quality Contact	Director of Quality Assurance	Mrs.	Alvarado-Marin	Deanna		2014993900	3897			2017062092	dalvarado@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	01/11/2022	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Reconciliation Contact	CFO	Ms.	Richman	Jeannine		6093867171					jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	03/12/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Recovery Audit Contact	CFO	Ms	Richman	Jeannine	M	6097811379				6097474140	jrichman@lsmnj.org	3 Manhattan Drive		Burlington	NJ	08016	09/02/2020	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Surveillance Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	System Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Third Party Administrator (TPA) Liaison	Regulatory Manager	Ms.	Green	Nicole		3144747831					ngreen@peak.cpstn.com	345 Marshal Avenue	Suite 101	St. Louis	MO	63119	03/12/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	User Access Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Utilization Management Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6371	Utilization Review Contact	Executive Director	Ms.	Iavarone	Maria		2014993900	3879			2017062092	miavarone@lsmnj.org	377 Jersey Avenue	Suite   310	Jersey City	NJ	07302	12/03/2021	2023	LUTHERAN SENIOR HEALTHCARE, INC.	National PACE	Lutheran Senior LIFE	National PACE		Lutheran Social Ministries of New Jersey	427	Yes	Active					PACE - Nat		C	New York
H6378	Agent/Broker Compensation Data Contact	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Automated TrOOP Balance Transfer Contact	Manager, Technical Delivery & Oversight	Mr.	Gajarajan	Nivi		2678258648					ngajarajan2@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Backup User Access Contact	Medicare Compliance Sr Operations Analyst		Morris	Ms. Gail		2158178922					gpmorris@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	300 Stevens Drive, Suite 201	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Best Available Evidence Contact	Medicare Enrollment Manager	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Bid Audit Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Bid Audit Site Contact	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Bid Primary Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Lovin	Dan		2672985617					dlovin@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive, 2nd flr.	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	CEO - CMS Administrator Contact	President - Medicare Pennsylvania	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	04/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	CEO - Senior Official for Contracting	President, Medicare Pennjsylvania	Ms	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	04/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Chief Financial Officer	Chief Financial Officer	Mr.	Burgoyne	Michael		2159378875					mburgoyne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Chief Operating Officer	VP Medicare Integrated Health Plans	Mr.	McDade	Chris		4844971892					cmcdade@ameriHealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	07/26/2023	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Chief Information Officer	Chief Information Officer	Mr.	Dickson	Fred		2158636570					fdickson@amerihealthcaritas.com	Amerihealth Caritas, Inc.	1 International Plaza IP2-4009	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Chief Information Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive	Philadelphia, PA	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	CMMI Model Point of Contact	Director, Medical Management Medicare	Ms.	Becker	Nancy		4844971265					nbecker1@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	CMS Casework Communication Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Complaints Tracking Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Contact for Fraud Investigations	Director, SIU	Mr.	McCall	Trevor		4844971241					tmccall2@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr	Philadelphia	PA	19113	08/04/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Coordination of Benefits Contact	Manager, Provider Network Oversight	Ms.	Williams	Kathy		8437467499					kwilliams@firstchoicevipcareplus.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Corporate Mailing						8434143130					tmoody@amerihealthcaritas.com	Select Health of South Carolina	4390 Belle Oaks Drive	Charleston	SC	29405	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager	Ms.	Maheepathi	Geetha		4435279822					gmaheepathi@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	3875 West Chester Pike	Newtown Square	PA	19073	03/15/2023	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Customer Service Operations Contact	Director, Medicare Customer Service	Ms.	Veras	Helen		2672981794					hveras@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	08/04/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	DIR Contact	Director, Medicare Risk Adjustment and Performance	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	DIR Contact (Secondary)	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2824045991					AKindred@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Electronic Health Record Contact	Manager, Information Services		Drumming	Ms. Terri		2159378578					tdrumming@amerihealthcaritas.com	200 Stevens Drive Philadelphia		Philadephia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Emergency Part D Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Emergency Part D Contact (Secondary)	Director, Corporate Pharmacy		Cherian	Sheena		2158635768					scherian@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	12/28/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Employer Waiver Contact	Director, Medicare Medical Management	Ms	Becker	Nancy		4844971265					nbecker1@amerihealthcaritas.com	200 Stevens Drive Philadelphia		Philadephia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Encounter Data & Risk Adjustment Operations Contact	Director, Medicare ACA and Risk Adjustment	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Enrollment Contact	Manager Enrollment Operations,	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealtharitas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	EOB Transfer Contact	Director, Medicare Claims	Mr.	Boyer	Joseph		2158636668				2159375321	Jboyer@Amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Financial Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Financial Reporting Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Formulary Contact	Director of Clinical Services, Formulary/DUR	Ms.	Megargell	Lauren		2159374135					Lauren.megargell@performrx.com	PerformRx	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Formulary Contact (Secondary)	DIrector of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family	200 Stevens Drive	Philadephia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	General Contact	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philidelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Government Relations Contact	VP, Government Relations		Cozzo	Mr.Steven		2159378236					scozzo@Amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	HIPAA Privacy Officer	Director of Privacy	Ms.	Gustafson	Rebecca		2158636634					rgustafson@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr	Philadelphia	PA	19113	08/04/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	HIPAA Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Hospice Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadephia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Interoperability Contact	Director, Medicare Performance Management		Kindred	Amanda		2484045991					akindred@amerihealthcaritas.com	4000 Town Center	Suite 1300	Southfield	MI	48075	03/10/2023	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	MA Appeals/Grievances Contact	Director, Corporate Appeals	Ms.	Garber	Brenda		2158635585					bgarber@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	MA Claims Processing Contact for Public Website			Services	Provider		8889780862					VIPProviderComm@amerihealthcaritas.com	The AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Marketing Contact	Medicare Compliance Sr Operations Analyst	Ms.	Morris	Gail	P	2158635141					gpmorris@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	300 Stevens Dr, Suite 201	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Medical Director	Medicare Medical Director	Dr.	Busch	Gregory		8562174603					gbusch@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Medicare Compliance Officer	Medicare Compliance Officer	Ms	Solomon	Mary		2673004846					mlsolomon@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Drive, 2flr.	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Medicare Coordinator	Plan Lead	Ms.	Moody	Tonya		2158635700					tmoody@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philidelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	02/16/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Medication Therapy Management Contact	Director, Clinical Outcomes		Patel	Ms. Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	OffShore Subcontractor Contact	Performance Program Oversight Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	3785 Chester Pike	Newtown Square	PA	19073	01/05/2023	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Online Enrollment Center Contact (Back-up)	Sr Medicare Enrollment Processor	Ms.	Price	Jamilla		2158636355					jprice@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Online Enrollment Center Contact (Primary)	Medicare Enrollment Specialist	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part C Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part C Reporting Contact	Manager, Medicare Performance Management	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Appeals	Supvr, Quality Auditing	Ms.	Clark	Janine							jclark2@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	4844985214				HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Appeals Contact (Secondary)	Appeals & Grievance Admin		Christian	Ms.Yolanda							ychristian@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8552210045				HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Benefits Contact	Pharmacist II	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Claims Submission Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Bonko	Gerald						2158635100	gbonko@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636483				HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Utilization Management	Mr.	McHale	Shawn						2158635100	smchale@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636370				HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Price File Contact (Back-up)	Claims Processor Associate		Reed	Ms.Lindsay		8473466370					lindsay.reed@abarcahealth.com	Abarca Health	650 Ave Munoz Rivera, Suite 701	San Juan	PR	00918	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Price File Contact (Optional)	Medicare Financial Operations Analyst III	Ms	Weihe	Heather		7875231212	1444				heather.weihe@abarcahealth.com	650 Ave Munoz Rivera	Suite 701	San Juan	PR	00918	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Price File Contact (Primary)	Manager, Pharmacy Network Operations	Mr.	King	James		8435694845					jking@performrx.com	PerformRx	200 Stevens Drive,	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Quality Assurance Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Part D Reporting Contact	Quality Assurance Contract Account Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@keystonefirstpa.com	AmeriHealth Caritas Family of Companies	300 Stevens Dr. Suite 201	Philadelphia	PA	19113	03/10/2023	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Patient Safety Contact	Director, Clinical Outcomes		Patel	Ms. Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Payment Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Personal Health Record Contact	Manager, Information Services		Drumming	Ms. Terri		2159378578					tdrumming@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Pharmacy Director	Director of Pharmacy	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Pharmacy Network Management Contact	Manager, Pharmacy Network Operations	Mr.	King	James		8435694845					jking@performrx.com	PerformRx	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Pharmacy Network Management Contact (Secondary)	Director, Service Operations		Leal	Ms.Avelina		2158636540					aleal@peformrx.com	PerformRx	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Pharmacy Technical Help Desk Contact	Director, Service Operations	Ms.	Leal	Avelina							aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8553270511				HMO - Health Maintenance Organization		C	Philadelphia
H6378	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Care Center	Ms.	Lee	Pamela								PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8553270511				HMO - Health Maintenance Organization		C	Philadelphia
H6378	Physician Incentive Contact	Manager, Provider Relations	Ms.	Williams	Kathy		8437467499					kwilliams@firstchoicevipcareplus.com	4390 Belle Oak Drive,	Suite 400	Charletston	SC	29405	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Plan Directory Contact for Public Website			Services	Provider		8889780862					VIPProviderComm@amerihealthcaritas.com	The AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Plan to Plan Reconciliation Contact	Director, Finance	Ms	Sow	Oumou		4102584587					osow@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	P.O. 7137	London	KY	40742	06/15/2023	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Processor Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Quality Contact	Director Quality Management	Ms.	Trimble	Dorothea		6162507322					dtrimble@amerihealthcaritas.com	Amerihealth Michigan	4000 Town Center, Suite 1300	Southfield	MI	48075	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Reconciliation Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Reconciliation Contact (Secondary)	Business Analyst	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Recovery Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	SNP Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	07/04/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	SNP State Contact	Plan Lead		Moody	Ms. Tonya		2158635700					tmoody@amerihealthcaritas.com	200 Stevens Dr.		Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Surveillance Contact	Business Development Manager	Ms.	Kumagai	Naoko		2157563724					nkumagai@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/08/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	System Contact	Business Systems Analyst Lead	Ms.	Drumming	Terri		2159378578					tdrumming@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Third Party Administrator (TPA) Liaison	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	User Access Contact	Medicare Compliance Officer	Ms	Solomon	Mary		2673004846					mlsolomon@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Drive, 2flr.	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Utilization Management Contact	VP, Utilization Management Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6378	Utilization Review Contact	VP, Utilization Management Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	02/07/2022	2023	AMERIHEALTH CARITAS FLORIDA INC	Local CCP	AmeriHealth Caritas VIP Care (HMO-D-SNP)	HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6379	Agent/Broker Compensation Data Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/07/2023	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Automated TrOOP Balance Transfer Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Backup User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Best Available Evidence Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Bid Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Bid Audit Site Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/27/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Bid Primary Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	CAP Report Contact for Public Website	Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/28/2020	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8773841241				HMO - Health Maintenance Organization		C	Chicago
H6379	CEO - CMS Administrator Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	CEO - Senior Official for Contracting	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Chief Financial Officer	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Chief Operating Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Chief Information Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Chief Information Security Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	CMMI Model Point of Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	CMS Casework Communication Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Complaints Tracking Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Contact for Fraud Investigations	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Coordination of Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Corporate Mailing						8476968500					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway		Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	Thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Customer Service Operations Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	DIR Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	DIR Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Emergency Part D Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Emergency Part D Contact (Secondary)	CFO	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	01/20/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Encounter Data & Risk Adjustment Operations Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/18/2023	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Enrollment Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	EOB Transfer Contact	Claims Manager	Mr.	Salgado	Miguel		8476968578				8008861082	Miguel.Salgado@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	10/04/2021	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Financial Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Financial Reporting Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Formulary Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3308886015	Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Formulary Contact (Secondary)	Pharmacy Director		Lopez	Eduardo		7542085867					elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/07/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	General Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Government Relations Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	HIPAA Privacy Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	HIPAA Security Officer	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539				8555158166	Eric.Annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Hospice Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Interoperability Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	MA Appeals/Grievances Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	MA Claims Processing Contact for Public Website	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Marketing Contact	VP of Marketing	Ms.	Branco	Margaret		7187957495					margaret.branco@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/06/2023	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Medical Director		Dr	Butt	Tariq		3125458471					tariq.butt@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	11/09/2021	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Medicare Compliance Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Medicare Coordinator	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Medicare Part D Opioid Overutilization Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Medication Therapy Management Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3304058084	Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	OffShore Subcontractor Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Online Enrollment Center Contact (Primary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 302	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Part C Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Part C Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Part D Appeals			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy	Suite 450	Dublin	OH	43017	12/28/2020	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H6379	Part D Appeals Contact (Secondary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica							Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue		Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	7542085865				HMO - Health Maintenance Organization		C	Chicago
H6379	Part D Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Part D Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Part D Claims Submission Contact			Dovico	Rosario		2012696398					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	12/31/2020	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Part D Exceptions Contact			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	6143363326				HMO - Health Maintenance Organization		C	Chicago
H6379	Part D Price File Contact (Back-up)			Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Part D Price File Contact (Optional)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Part D Price File Contact (Primary)			Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	12/31/2020	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Part D Quality Assurance Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Part D Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Patient Safety Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Payment Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Pharmacy Director	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Pharmacy Network Management Contact			Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Pharmacy Network Management Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Pharmacy Technical Help Desk Contact			Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	08/04/2021	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H6379	Plan Directory Contact for Public Website	Vice President, Provider Operations	Ms.	Cuevas	Elizabeth		7542085880					Elizabeth.Cuevas@clearspringhealthcare.com	250 South Northwest Highway Suite 302	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Plan to Plan Reconciliation Contact	Senior Accountant	Ms.	Wrenn	Alisa		2249855588				3124290194	Alisa.Wrenn@Clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Processor Contact			Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Quality Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Reconciliation Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Recovery Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	SNP Application Contact	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	02/15/2023	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Surveillance Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	System Contact	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539					eric.annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Third Party Administrator (TPA) Liaison	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Utilization Management Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6379	Utilization Review Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (CO), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6396	Agent/Broker Compensation Data Contact	AVP, Sales Operations	Mr.	Handerhan	Bill		7328291160					bill.handerhan@caresource.com	230 N Main St		Dayton	OH	45402	07/15/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Backup User Access Contact	Regulatory Submission Specialist	Mr.	Houser	Aaron		9374874147					macompliance@CareSource.com	230 North Main St		Dayton	OH	45402	06/04/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Best Available Evidence Contact	Enrollment Team Lead	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 45401		Dayton	OH	45401	02/02/2016	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Bid Audit Contact	Senior Director, Actuarial Science	Mr.	Butz	Stephen		9376091705					stephen.butz@caresource.com	P. O. Box 8738		Dayton	OH	45401	02/17/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Bid Audit Site Contact	Senior Director, Actuarial Science	Mr.	Butz	Stephen		9376091705					stephen.butz@caresource.com	P. O. Box 8738		Dayton	OH	45401	02/17/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Bid Primary Contact	Senior Director, Actuarial Science	Mr.	Butz	Stephen		9376091705					stephen.butz@caresource.com	P. O. Box 8738		Dayton	OH	45401	02/17/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	CAP Report Contact for Public Website	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@caresource.com	230 N Main St		Dayton	OH	45402	05/04/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Preitauer	Erhardt		9375312455					Erhardt.Preitauer@caresource.com	P. O. Box 8738		Dayton	OH	45401	10/24/2018	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Preitauer	Erhardt		9375312455					Erhardt.Preitauer@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/21/2018	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Chief Financial Officer	Chief Financial Officer	Mr.	Smart	Lawrence		9375313335					Lawrence.Smart@caresource.com	P. O. Box 8738		Dayton	OH	45401	01/05/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Chief Operating Officer	(Interim) Chief Operating Officer	Mr.	Davidi	Isaac		9372715922					isaac.davidi@caresource.com	P. O. Box 8738		Dayton	OH	45401	04/12/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Chief Information Officer	Chief Information Officer	Ms.	Valencia	Devon		9375312552					devon.valencia@caresource.com	P.O. Box 8738		Dayton	OH	45401	07/11/2019	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Chief Information Security Officer	VP , Information Security and Privacy	Mrs.	Heckler	Lisa		9375313895					lisa.heckler@caresource.com	P.O. Box 8738		Dayton	OH	45401	01/03/2017	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	CMS Casework Communication Contact	Director, Grievance and Appeals	Ms.	Acuna	Celeste		4806406815					celeste.acuna@caresource.com	P.O. Box 1947		Dayton	OH	45401	01/20/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Complaints Tracking Contact	Director, Grievance and Appeals	Ms.	Acuna	Celeste		4806406815					celeste.acuna@caresource.com	P.O. Box 1947		Dayton	OH	45401	01/20/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Contact for Fraud Investigations	Program Integrity Analyst	Ms.	Johnson	Alexis	N	9372243300	2870			9373963876	SIUprogramintegrity@caresource.com	P. O. Box 8738		Dayton	OH	45401	02/02/2016	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Coordination of Benefits Contact	Manager, Enrollment Operations	Mr.	Spivey	Michael		9375313682				9374870643	COBInquiry@caresource.com	230 N. Main St.		Dayton	OH	45402	04/15/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Corporate Mailing						9372243300					macompliance@caresource.com	P. O. Box 8738		Dayton	OH	45401	08/31/2020	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	230 N. Main Street		Dayton	OH	45402	09/01/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Customer Service Operations Contact	Director, Customer Care		Cary	Lisa		9372326458					lisa.cary@caresource.com	40 W 2nd St		Dayton	OH	45402	10/04/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	DIR Contact	VP, Actuarial Science		Farmer	Nikki		9372863350					nikki.farmer@caresource.com	230 N. Main Street		Dayton	OH	45402	06/26/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	DIR Contact (Secondary)	Manager, Accounting	Ms.	Nelson	Megan		9374876597					megan.nelson@caresource.com	P. O. Box 8738		Dayton	OH	45401	09/23/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Emergency Part D Contact	Manager, Contact Center	Ms.	Davidson	Regina		7722362766					Regina_Davidson@express-scripts.com	10045 South Federal Highway		Port St. Lucie	FL	34952	07/01/2020	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Emergency Part D Contact (Secondary)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Encounter Data & Risk Adjustment Operations Contact	Director, Claims Encounter Data	Mr.	Shareef	Akbar		9374876640					MyCare-MA_EncounterRequests@caresource.com	220 E. Monument Ave.		Dayton	OH	45402	12/03/2019	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Enrollment Contact	Enrollment Team Lead	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 45401		Dayton	OH	45401	02/02/2016	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	EOB Transfer Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479				9374870359	rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Financial Audit Contact	AVP, Compliance	Ms.	Frazee	Margaux		9375313338					margaux.frazee@caresource.com	230 N. Main Street		Dayton	OH	45402	09/06/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Financial Reporting Contact	Chief Financial Officer	Mr.	Smart	Lawrence		9375313335					Lawrence.Smart@caresource.com	P. O. Box 8738		Dayton	OH	45401	02/15/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Formulary Contact	Director, Clinical Strategy	Ms.	Condon	Kelani		7373142944					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	09/26/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Formulary Contact (Secondary)	Pharmacist Formulary Strategy and Management		Cabrera	Lourdes		9374875477					maria.cabrera@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/04/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	General Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/20/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Government Relations Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@caresource.com	230 North Main Street		Dayton	OH	45402	05/04/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	HIPAA Privacy Officer	Privacy Officer	Ms.	Heckler	Lisa		9372243300	3895				Lisa.Heckler@caresource.com	P.O. Box 8738		Dayton	OH	45401	01/03/2017	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	HIPAA Security Officer	Chief Information Officer	Ms.	Valencia	Devon		9375312552					devon.valencia@caresource.com	P. O. Box 8738		Dayton	OH	45401	07/11/2019	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Hospice Contact	Director, Enrollment	Mr.	Castro	Armando		9375312291					armando.castro@caresource.com	230 N Main St		Dayton	OH	45402	05/29/2020	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Interoperability Contact	AVP, Enterprise Architecture		Hanley	Michael		8033721957					michael.hanley@caresource.com	230 N Main St		Dayton	OH	45402	06/01/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	MA Appeals/Grievances Contact	Director, Grievance and Appeals	Ms.	Acuna	Celeste		4806406815					celeste.acuna@caresource.com	P.O. Box 1947		Dayton	OH	45401	01/20/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	MA Claims Processing Contact for Public Website	VP of Claims and Configuration	Ms.	Hans	Holly		9375312750					Holly.Hans@caresource.com	P. O. Box 8738		Dayton	OH	45401	08/30/2018	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Marketing Contact	Regulatory Lead	Mr.	Houser	Aaron		9377891840					macompliance@CARESOURCE.COM	230 N Main St		Dayton	OH	45402	06/04/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Medical Director	Medical Director	Dr.	Mukunda	Beejadi		2166459092					beejadi.mukunda@caresource.com	5900 Landerbrook Drive	Ste 300	Mayfield Heights	OH	44124	10/29/2018	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Medicare Compliance Officer	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@caresource.com	230 N. Main St.		Dayton	OH	45402	05/04/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Medicare Coordinator	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/20/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Medicare Part D Opioid Overutilization Contact	Part D Diversion Specialist	Ms.	Wendell	Amy		9372243300	12543			9373963605	amy.wendell@caresource.com	P. O. Box 1940		Dayton	OH	45401	10/24/2018	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Medication Therapy Management Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Online Enrollment Center Contact (Optional)	Director, Enrollment	Mr.	Castro	Armando		9375312291					armando.castro@caresource.com	230 N Main Street		Dayton	OH	45402	05/29/2020	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Online Enrollment Center Contact (Primary)	Enrollment Team Lead	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 45401		Dayton	OH	45401	02/02/2016	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Part C Application Contact	Director, Medicare & Marketplace Filing		Gray	Melissa		9375312328					melissa.gray@caresource.com	230 N Main St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Part C Reporting Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/04/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Part D Appeals	Express Scripts, Sr. Pharmacy Manager		Schumm	Brian						8555858246	Brian_Schumm@express-scripts.com	5151 B		Dublin	OH	43017	06/08/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	New York
H6396	Part D Appeals Contact (Secondary)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol							rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	9378187479				HMO - Health Maintenance Organization		C	New York
H6396	Part D Application Contact	Director, Medicare & Marketplace Filing		Gray	Melissa		9375312328					melissa.gray@caresource.com	230 N Main St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Part D Benefits Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Part D Claims Submission Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	06/08/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	New York
H6396	Part D Exceptions Contact (Secondary)	Director. Pharmacy Operations	Ms.	Rattan	Sangeet							rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	9375911634				HMO - Health Maintenance Organization		C	New York
H6396	Part D Price File Contact (Back-up)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Part D Price File Contact (Optional)	Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	11/22/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Part D Price File Contact (Primary)	Sr Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/22/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Part D Quality Assurance Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Part D Reporting Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Patient Safety Contact	Director, Clinical Strategy	Ms.	Condon	Kelani		7373142944					rxcompliancerequest@caresource.com	140 N Jefferson St.		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Payment Contact	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	P. O. Box 8738		Dayton	OH	45401	03/07/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Pharmacy Director	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Pharmacy Network Management Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Pharmacy Network Management Contact (Secondary)	Network Account Director (ESI)		Kelly	Heather		8003579578					hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	01/19/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	11/22/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H6396	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol							rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	9378187479				HMO - Health Maintenance Organization		C	New York
H6396	Plan Directory Contact for Public Website	Manager HPLC Operations	Ms.	Smith	Allana		9296714107					allana.smith@caresource.com	P. O. Box 8378		Dayton	OH	45401	02/09/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Plan to Plan Reconciliation Contact	Manager, Accounting	Ms.	Nelson	Megan		9374876597					CareSourceP2P@caresource.com	CareSource Accounting	PO Box 2208	Dayton	OH	45401	03/07/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Processor Contact	VP Claims and Configuration		Hans	Holly		9372243300	12750				Holly.Hans@caresource.com	PO Box 8738		Dayton	OH	45401	09/28/2018	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Quality Contact	AVP, Medicare Quality	Mr.	Manetti	Thomas		3109358122					thomas.manetti@caresource.com	230 N Main St.		Dayton	OH	45502	03/05/2022	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Reconciliation Contact	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	P. O. Box 8738		Dayton	OH	45401	03/07/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Reconciliation Contact (Secondary)	Associate Director, Accounting	Ms.	North	Sara		9375312669					sara.north@caresource.com	PO Box 8738		Dayton	OH	45401	03/07/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Recovery Audit Contact	VP, Claims	Ms.	Hans	Holly		9375312750					holly.hans@caresource.com	P. O. Box 8738		Dayton	OH	45401	04/02/2019	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	SNP Application Contact	Director, Medicare & Marketplace Filing		Gray	Melissa		9375312328					melissa.gray@caresource.com	230 N Main St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Surveillance Contact	Manager Program Integrity	Ms.	Johnson	Alexis		9375312870					Alexis.Johnson@CareSource.com	230 North Main Street		Dayton	OH	45402	06/14/2017	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	System Contact	Chief Information Officer	Ms.	Valencia	Devon		9375312552					devon.valencia@caresource.com	P. O. Box 8738		Dayton	OH	45401	07/11/2019	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Third Party Administrator (TPA) Liaison	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	230 N. Main Street		Dayton	OH	45402	03/07/2023	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	User Access Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/20/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Utilization Management Contact	Director, Clinical Operations		Honig	Deronda		2162180296					Deronda.Honig@CareSource.com	P. O. Box 8738		Dayton	OH	45401	03/01/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6396	Utilization Review Contact	Director, Clinical Operations		Honig	Deronda		2162180296					Deronda.Honig@CareSource.com	P. O. Box 8738		Dayton	OH	45401	03/01/2021	2023	CARESOURCE OHIO, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6399	Agent/Broker Compensation Data Contact	National Sales Director Medicare		Swearingen	Matthew	C	6145800606					swearingenm@aetna.com	6589 Chanticleer Court		Westerville	OH	43082	12/28/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/16/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	05/04/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	CMS Casework Communication Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Complaints Tracking Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Coordination of Benefits Contact	Director of Pharmacy		Stekol	Ilona		3478806082					StekolI@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/29/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Corporate Mailing						4107525721				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/01/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Customer Service Operations Contact	Director, Service Operations		Phillips	Tish		8666002139					PhillipsL1@aetna.com	7400 Camous Road		New Albany	OH	43054	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Encounter Data & Risk Adjustment Operations Contact	Director, Informatics		Sevchik	Melissa		6026591404					sevchikm@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Enrollment Contact	Director Service Operations		Truitt	Michelle		7176716847					MLTruitt@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/05/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	General Contact	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/13/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Government Relations Contact	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/13/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Hospice Contact	Director, Service Operations		Truitt	Michelle		7176716847					MLTruitt@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	07/01/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	MA Appeals/Grievances Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	09/06/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	09/06/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Medical Director	Sr. Medical Director	Dr.	Khanna	Anisha		2012476013					khannaa@aetna.com	259 Beaufort Ave.		Livingston	NJ	07039	09/06/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Medicare Coordinator	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/13/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/22/2021	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part D Appeals	Supervisor, Clinical Pharmacy	Ms.	Spencer	Tiffane						8448142260	MedicareCoverageDeterminationMMP-SNP@AETNA.com	4500 E Cotton Center, Blvd	F829	Phoenix	AZ	85040	01/11/2021	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8609004579				HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part D Appeals Contact (Secondary)	Director, of Pharmacy	Ms.	Stekol	Ilona							StekolI@aetna.com	7400 West Campus Road	F829	New Albany	OH	43054	05/02/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	3478806082				HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/07/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part D Exceptions Contact	Director, Pharmacy		Stekol	Ilona							StekolI@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/05/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	3478806082				HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part D Exceptions Contact (Secondary)	Pharmacy Director		Vergil	Gina							Vergilg@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/13/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	4026997768				HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part D Quality Assurance Contact	Director, Pharmacy		Stekol	Ilona		3478806082					StekolI@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/17/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/24/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Pharmacy Technical Help Desk Contact	Director, Pharmacy		Stekol	Ilona							StekolI@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/29/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H6399	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Plan Directory Contact for Public Website	Senior Manager, Duals	Ms.	Brown	Anne Marie		7272720427					browna36@aetna.com	3482 Maclaren Dr.		Palm Harbor	FL	34684	09/08/2023	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Processor Contact	Vice President, Duals Markets	Mr.	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/13/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	02/15/2021	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	System Contact	Director Business Information Magement	Ms.	Tanzillo	Hollie	M	7407398501					tanzilloh@aetna.com	7400 Campus Road		New Albany	OH	43054	07/07/2021	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	User Access Contact	Senior Administrative Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	07/15/2020	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Utilization Management Contact	Sr. Director Straregic Programs, AMA COE Clinical		Hawkins	Erin		8175288743					hawkinse@aetna.com	4300 Centreway Place		Arlington	TX	76018	07/07/2021	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6399	Utilization Review Contact	Sr. Director Straregic Programs, AMA COE Clinical		Hawkins	Erin		8175288743					hawkinse@aetna.com	4300 Centreway Place		Arlington	TX	76018	07/07/2021	2023	AETNA BETTER HEALTH INC. (NJ)	Local CCP	Aetna Better Health of New Jersey	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6408	Agent/Broker Compensation Data Contact	Director of Sales		Dues	Travis		6145463157				6145463131	Travis.Dues@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Automated TrOOP Balance Transfer Contact	Part D Analyst		Houk	Kim		6145463183				6145463131	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Backup User Access Contact	Sr. Application Specialist		Crawford	Carl		6145463215				6145463144	ccrawford@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Best Available Evidence Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Bid Audit Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463211	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Bid Audit Site Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Bid Primary Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	CAP Report Contact for Public Website	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	CEO - CMS Administrator Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	Jack.Randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	CEO - Senior Official for Contracting	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Chief Financial Officer	Chief Financial Officer	Mr	Vis	David		6145463211				6145463131	david.vis@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Chief Operating Officer	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Chief Information Officer	VP Service Optimization	Mr.	Trimmer	Matt		3017547190					matt.trimmer@trinity-health.org	3100 Easton Square Place		Columbus	OH	43219	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Chief Information Security Officer	Sr Security Manager, Enterprise Information Securi	Mr.	Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	CMS Casework Communication Contact	Compliance Specialist	Mr.	Jordan	David	A	6147068474				6142348372	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Complaints Tracking Contact	Compliance Specialist	Mr	Jordan	David	A	6147068474					djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Contact for Fraud Investigations	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Coordination of Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Corporate Mailing						4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Customer Service Operations Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	DIR Contact	CEO		Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square  Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	DIR Contact (Secondary)	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Electronic Health Record Contact	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Emergency Part D Contact	Chief Compliance Officer		Suffern	Patricia		4124780244				6145463132	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	12/23/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Emergency Part D Contact (Secondary)	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Employer Waiver Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Reconciliation Analyst		Sloan	Mike		6145463134					mike.sloan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Enrollment Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	EOB Transfer Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Financial Audit Contact	Chief Administration Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Financial Reporting Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Formulary Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Formulary Contact (Secondary)	Director, Pharmacy		Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	General Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Government Relations Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	HIPAA Privacy Officer	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	HIPAA Security Officer	Sr Security Manager, Enterprise Information Securi		Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Hospice Contact	Senior Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Interoperability Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	MA Appeals/Grievances Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	MA Claims Processing Contact for Public Website	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Marketing Contact	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Medical Director	MD	Dr.	Wise	Greg		6145463151				6145463131	gwise@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Medicare Compliance Officer	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Medicare Coordinator	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Medicare Part D Opioid Overutilization Contact	Pharmacy Data Analyst	Ms.	Houk	Kimberly		6145463183					kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Medication Therapy Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	OffShore Subcontractor Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment	Ms	Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Online Enrollment Center Contact (Optional)	Director, Enrollment and Premium Billing		Caudle	Jeff		6145463224				6145463148	jcaudle@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Online Enrollment Center Contact (Primary)	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Part C Application Contact	Director, Product Management and Business Devlpt		Mauck	Brandon		6145955681					brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Part C Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Part D Appeals	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H6408	Part D Appeals Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H6408	Part D Application Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Part D Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Part D Claims Submission Contact	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Part D Exceptions Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H6408	Part D Exceptions Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H6408	Part D Price File Contact (Back-up)	Formulary Consultant		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea		Scottsdale	AZ	85260	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Part D Price File Contact (Primary)	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Part D Quality Assurance Contact	Director of Pharmacy, Health Plans		Turoff	Chris		6144030394				6142346481	chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Part D Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Patient Safety Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Payment Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Pharmacy Director	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Pharmacy Network Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Pharmacy Network Management Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Pharmacy Technical Help Desk Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H6408	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Data Analyst	Mrs	Miller	Kim							kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H6408	PHR Beneficiary Contact																	02/02/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS	MediGold	Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H6408	Physician Incentive Contact	Interim VP, Health Services	Ms	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Plan Directory Contact for Public Website	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Plan to Plan Reconciliation Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Processor Contact	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Quality Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Reconciliation Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Reconciliation Contact (Secondary)	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Recovery Audit Contact	Chief Administrative Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Surveillance Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	System Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Third Party Administrator (TPA) Liaison	Sr Finance Analyst		Fountain	Lisa		6145463220					lfountain@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	User Access Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Utilization Management Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6408	Utilization Review Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6425	Automated TrOOP Balance Transfer Contact	Business Office	Ms.	Carter	Tessa		4794636609				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	03/03/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Backup User Access Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Best Available Evidence Contact	Marketing and Intake	Ms	Carter	Tessa		4794636619				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	05/29/2020	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Bid Primary Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	CAP Report Contact for Public Website	Executive Director	Mr	Morris	Jack	M	4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	CEO - CMS Administrator Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	CEO - Senior Official for Contracting	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Chief Financial Officer	Controller	Mr	Burrows	DJ		4794631120					dburrows@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	01/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Chief Operating Officer	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Chief Information Officer	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Chief Information Security Officer	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	CMS Casework Communication Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Complaints Tracking Contact	Quality Improvement Coordinator	Mr	Harmon	Martin		4794636610				4794636601	mharmon@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	08/16/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Contact for Fraud Investigations	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Coordination of Benefits Contact	Business Office	Ms	Carter	Tessa		4794636609				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	03/03/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Corporate Mailing						4794636600					paceoftheozarks@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	09/27/2018	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Coverage Gap Discount Program (CGDP) Payment Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Customer Service Operations Contact	Business Office Coordinator	Ms	Carter	Tessa		4794636609				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	03/03/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	DIR Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	DIR Contact (Secondary)	Controller	Mr	Burrows	DJ		4794631120					dburrows@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	02/18/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Emergency Part D Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Emergency Part D Contact (Secondary)	Business Office	Ms.	Carter	Tessa		4794636609				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	03/16/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Encounter Data & Risk Adjustment Operations Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Dr E		Springdale	AR	72761	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Enrollment Contact	Intake and Enrollment	Ms.	Carter	Tessa		4794636619				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	02/17/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	EOB Transfer Contact	Business Office Coordinator	Ms.	Carter	Tessa		4794636609				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	03/03/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Financial Audit Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Financial Reporting Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Formulary Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	General Contact	Executive Director	Mr	Morris	Jack		4794636609				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Government Relations Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	HIPAA Privacy Officer	Executive Director	Mr	Morris	Jack		4794636611					jmorris@wregional.com	813 Founders Park Dr E	Suite 107	Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	HIPAA Security Officer	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Interoperability Contact		Mr	Morris	Jack		4794636600					jmorris@wregional.com	813 Founders Park Dr E		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	MA Appeals/Grievances Contact	Executive Director	Mr	Morris	Jack		4794636611					jmorris@wregional.com	813 Founders Park Dr E	Suite 107	Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	MA Claims Processing Contact for Public Website	Executive Director	Mr	Morris	Jack		4794636609				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Marketing Contact	Marketing and Intake	Ms	Carter	Tessa		4794636619				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	05/29/2020	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Medical Director	Medical Director	Mr	Martin	Alan		4794636600				4794636616	amartin@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	02/18/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Medicare Compliance Officer	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Medicare Coordinator	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr	Martin	Alan		4794636618				4794636601	amartin@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	02/06/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Medication Therapy Management Contact	Medical Director	Mr	Martin	Alan		4794636600				4794636616	amartin@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	02/18/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Part C Application Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Part D Appeals	Executive Director	Mr	Morris	Jack						4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active	4794636611				PACE - Nat		C	Denver
H6425	Part D Application Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Part D Benefits Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Part D Claims Submission Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Part D Exceptions Contact	Executive Director	Mr	Morris	Jack						4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active	4794636611				PACE - Nat		C	Denver
H6425	Part D Price File Contact (Back-up)	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Part D Price File Contact (Primary)	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Part D Quality Assurance Contact	Quality Coordinator	Mr	Harmon	Martin		4794636600				4794636601	mharmon@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	08/01/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Part D Reporting Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Patient Safety Contact	Quality Coordinator	Mr	Harmon	Martin		4794636600	6610			4794636601	mharmon@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	08/08/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Payment Contact	Business Office Coordinator	Ms.	Carter	Tessa		4794636609				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	03/03/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Pharmacy Director	Medical Director	Mr	Martin	Alan		4794636600				4794636616	amartin@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	02/18/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Pharmacy Network Management Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Pharmacy Technical Help Desk Contact	Executive Director	Mr	Morris	Jack						4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active	4794636600				PACE - Nat		C	Denver
H6425	Plan Directory Contact for Public Website	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Plan to Plan Reconciliation Contact	Business Office Coordinator	Ms.	Carter	Tessa		4794636609				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	03/03/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Processor Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Quality Contact	Quality Coordinator	Mr	Harmon	Martin		4794636610					mharmon@wregional.com	813 Founders Park Dr E	Suite 107	Springdale	AR	72762	03/16/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Reconciliation Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Reconciliation Contact (Secondary)	Controller	Mr	Burrows	DJ		4794631120				4794636601	dburrows@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	02/16/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Recovery Audit Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Surveillance Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	System Contact	Business Office Coordinator	Ms	Carter	Tessa		4794636609				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	03/03/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Third Party Administrator (TPA) Liaison	Business Office Coordinator	Ms	Carter	Tessa		4794636609				4794636601	tcarter@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	03/03/2023	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	User Access Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Utilization Management Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6425	Utilization Review Contact	Executive Director	Mr	Morris	Jack		4794636611				4794636601	jmorris@wregional.com	813 Founders Park Drive East, Suite 107		Springdale	AR	72762	12/07/2022	2023	WASHINGTON REGIONAL MEDICORP	National PACE	PACE of the Ozarks	National PACE		Washington Regional Medical System	686	Yes	Active					PACE - Nat		C	Denver
H6446	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H6446	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Medical Director	Sr. VP, Medical Affairs	Dr.	Nelson	Vincent		3145056872					vincent.nelson@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/17/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		5869804867					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		5869804867					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H6446	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H6446	PHR Beneficiary Contact																	09/27/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8338544766				HMO - Health Maintenance Organization		C	Dallas
H6446	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Plan Directory Contact for Public Website			Services	Provider		8665498289					CorporateMedicareComplianceDept@Centene.com	2500 N. Buffalo Drive	Suite 250	Las Vegas	NV	89128	03/31/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		5869804867					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6446	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6453	Agent/Broker Compensation Data Contact	Chief Financial Officer	Mr.	Short	Adam		2252952189					Adam.Short@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/07/2022	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Automated TrOOP Balance Transfer Contact	Controller	Ms.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 Desiard Street	#300	Monroe	LA	71201	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Backup User Access Contact	Manager, Medicare Compliance Programs	Mr.	Guillot	Mark	J	2252987040					Mark.Guillot@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	06/05/2015	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Best Available Evidence Contact	Medicare Enrollment Supervisor	Ms.	Brasher	Michele		3189983083					mbrasher@vhpla.com	130 Desiard Street	#300	Monroe	LA	71201	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Bid Audit Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Bid Audit Site Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Bid Primary Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	CAP Report Contact for Public Website	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	05/06/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	CEO - CMS Administrator Contact	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	CEO - Senior Official for Contracting	President and CEO	Dr.	Udvarhelyi	Steven		2252952548					Steven.Udvarhelyi@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/09/2016	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Chief Financial Officer	Chief Financial Officer	Mr.	Short	Adam		2252952189					adam.short@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/07/2022	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Chief Operating Officer	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Chief Information Officer	SVP, CIO & Security Officer	Ms.	Kozik	Sue		2252983307					Sue.Kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Chief Information Security Officer	SVP, CIO & Security Officer	Ms.	Kozik	Sue		2252953307					Sue.Kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	CMS Casework Communication Contact	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Complaints Tracking Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					wesley.miller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/07/2022	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Contact for Fraud Investigations	Manager, Federal Investigations	Mrs.	Cowart	Kandyce		2252952073					Kandyce.Cowart@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2015	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Coordination of Benefits Contact	Medicare Enrollment Supervisor	Ms.	Brasher	Michele		3189983083					mbrasher@vhpla.com	130 Desiard Street		Monroe	LA	71201	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Corporate Mailing						2252952589					Robbin.Calhoun@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant, Financial Reporting	Ms.	Brown	Leigh Ann		2259533055					Leigh-Ann.Brown@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/23/2021	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Customer Service Operations Contact	Director of Member Services	Ms.	Trichel	Amy		3189982870					atrichel@vhpla.com	130 Desiard Street		Monroe	LA	71201	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	DIR Contact	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	DIR Contact (Secondary)	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Emergency Part D Contact	Clinical Pharmacist I		Pennington	Hannah		2252987485					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	11/09/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Emergency Part D Contact (Secondary)	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					wesley.miller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Employer Waiver Contact	State Director, Individual and Senior Sales	Mr.	Wagner	Dan		5048325831					Dan.Wagner@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	04/29/2015	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Encounter Data & Risk Adjustment Operations Contact	VP, Analytics and Quality Improvement		Vicidomina	Benjamin		2252952471					Benjamin.Vicidomina@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/23/2019	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Enrollment Contact	Medicare Enrollment Supervisor	Ms.	Brasher	Michele		3189983083					mbrasher@vhpla.com	130 Desiard Street		Monroe	LA	71201	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	EOB Transfer Contact	Controller	Ms.	Cupit	Chelle		3189983076				3188129987	ccupit@vhpla.com	130 Desiard Street		Monroe	LA	71201	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Financial Audit Contact	VP, Internal Audit, Compliance & Privacy	Ms.	Saporito	Mary		2252981742					Mary.Saporito@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Financial Reporting Contact	SVP Finance & Controller	Mr.	Short	Adam		2252952189					Adam.Short@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Formulary Contact	Clinical Pharmacist I		Pennington	Hannah		2252001752					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Formulary Contact (Secondary)	Clinical Pharmacist	Mr.	Seggerman	Wade		2252981972					wade.seggerman@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	General Contact	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Government Relations Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	05/06/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	HIPAA Privacy Officer	VP, Internal Audit, Compliance & Privacy	Ms.	Saporito	Mary		2252981742					Mary.Saporito@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	HIPAA Security Officer	Interim Head of Information Security	Mr.	Sotnikov	Slava		2252987036					Slava.Sotnikov@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Hospice Contact	Account Manager - Express Scripts	Ms.	Morgan	Stacy		4802818763					slmorgan@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Interoperability Contact	SVP, COO	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	5525 Re1tz Ave		Baton Route	LA	70809	02/15/2022	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	MA Appeals/Grievances Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					wesley.miller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	MA Claims Processing Contact for Public Website	Controller	Ms.	Cupit	Chelle		3189983076				8665087145	customerservice@blueadvantage.bcbsla.com	130 Desiard Street		Monroe	LA	71201	01/04/2021	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Marketing Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Medical Director	Lead Medical Director	Ms.	Barfield	Deirdre	Y	2252981978					deirdre.barfield@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/14/2019	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Medicare Compliance Officer	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					wesley.miller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	05/06/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Medicare Coordinator	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Dearman	Clyde		3189982710					clyde.dearman@bcbsla.com	130 DeSaird Street	Ste 300	Monroe	LA	71201	02/14/2023	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Medication Therapy Management Contact	Director, Clinical Programs		Muralidharan	Adrienne		3146846625					AMuralidharan@express-scripts.com	One Express Way		St. Louis	MO	63121	05/03/2019	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	OffShore Subcontractor Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Online Enrollment Center Contact (Back-up)	Medicare Advantage Marketing Manager	Mrs.	Booth	Ann		2252982180					Ann.Booth@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	01/14/2016	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor	Ms.	Brasher	Michele		3189983083					mbrasher@vhpla.com	130 Desiard Street		Monroe	LA	71201	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Part C Application Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	05/06/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Part C Reporting Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	05/06/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Part D Appeals	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@Express-Scripts.com	5151 Blazer Memorial Parkway		Dublin	OH	43017	02/03/2016	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Denver
H6453	Part D Appeals Contact (Secondary)	Clinical Pharamcist I		Pennington	Hannah							Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	2252001752				HMO - Health Maintenance Organization		C	Denver
H6453	Part D Application Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	05/06/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Part D Benefits Contact	Clinical Pharamcist I		Pennington	Hannah		2252001752					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Part D Claims Submission Contact	Director Product Management	Mr.	Etherton	Jim		5133163889					jbetherton@express-scripts.com	8990 Duke Drive		Mason	OH	45040	10/12/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Part D Exceptions Contact	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@Express-Scripts.com	5151 Blazer Memorial Parkway		Dublin	OH	43017	02/03/2016	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Denver
H6453	Part D Exceptions Contact (Secondary)	Clinical Pharamcist I		Pennington	Hannah							Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	2252001752				HMO - Health Maintenance Organization		C	Denver
H6453	Part D Price File Contact (Back-up)	Sr. Manager - Government Relations	Mrs.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	01/14/2016	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Part D Price File Contact (Optional)	Clinical Pharamcist I		Pennington	Hannah		2252001752					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Part D Price File Contact (Primary)	Director-Government Programs	Mr.	Westrum	Josh		4807363132	433132				jwestrum@express-scripts.com	7909 S. Hardy Drive, Suite 106		Tempe	AZ	85284	01/14/2016	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Part D Quality Assurance Contact	Clinical Pharmacist I	Ms.	Pennington	Hannah		2252001752					hannah.pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Part D Reporting Contact	Clinical Pharmacist I		Pennington	Hannah		2252987485					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	11/09/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Patient Safety Contact	Lead Medical Director	Dr.	Barfield	Deirdre	Y	2252981978					Deirdre.barfield@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/14/2019	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Payment Contact	SVP Finance & Controller	Mr.	Short	Adam		2252952189					Adam.Short@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Pharmacy Director	VP, Pharmacy Services	Mr.	Ford	Milam		2252981850					Milam.Ford@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/05/2015	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Pharmacy Network Management Contact	Network Account Dir, Retail Strategy & Contracting	Ms.	Kelly	Heather		3146921866					Hakelly@express-scripts.com	One Express Way		St Louis	MO	63121	10/24/2016	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist I		Pennington	Hannah		2252001752					Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Pharmacy Technical Help Desk Contact	Sr. Manager - Memeber Services Contact Center		McVey	Darcheena							Darcheena_McVey@express-scripts.com	1640 Century Center Pkwy		Memphis	TN	38134	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Denver
H6453	Pharmacy Technical Help Desk Contact (Secondary)	Clinical Pharmacist I		Pennington	Hannah							Hannah.Pennington@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/30/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	2252001752				HMO - Health Maintenance Organization		C	Denver
H6453	Physician Incentive Contact	Controller	Ms.	Cupit	Chelle		8665087145					customerservice@blueadvantage.bcbsla.com	130 Desiard Street		Monroe	LA	71201	01/04/2021	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Plan Directory Contact for Public Website			Service	Customer		8665087145					customerservice@blueadvantage.bcbsla.com	130 Desiard Street		Monroe	LA	71201	01/04/2021	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Plan to Plan Reconciliation Contact	Senior Accountant, Financial Reporting	Ms.	Brown	Leigh Ann		2259533055					Leigh-Ann.Brown@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/23/2021	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Processor Contact	Senior Director, Government Programs, Medicare	Ms.	Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	10/12/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Quality Contact	Dir, Clinical Informatics & Gov Program Performanc	Mr.	Vicidomina	Benjamin	V	2252952471					Benjamin.Vicidomina@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Reconciliation Contact	SVP Finance & Controller	Mr.	Short	Adam		2252952189					Adam.Short@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Reconciliation Contact (Secondary)	Director, Financial Strategic Planning	Mr.	Prescott	Clinton		2252981931					Clinton.Prescott@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	08/07/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Recovery Audit Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	05/06/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	SNP Application Contact	Government Programs Manager		Suire	Monica		2254399354					monica.suire@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/14/2023	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Surveillance Contact	Medicare Advantage Sales Director	Mr.	Whittemore	John	E	2252004836					John.Whittemore@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	01/25/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	System Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Third Party Administrator (TPA) Liaison	Senior Accountant, Financial Reporting	Ms.	Brown	Leigh Ann		2259533055					Leigh-Ann.Brown@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	02/23/2021	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	User Access Contact	Director, Medicare Advantage Compliance Officer	Mr.	Miller	Wesley		2252987965					macompliance@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	708093809	05/06/2020	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Utilization Management Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6453	Utilization Review Contact	Director, Medicare Advantage Operations	Mr.	Gray	Paul		2252987015					paul.gray@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	09/05/2018	2023	HMO LOUISIANA, INC.	Local CCP	Blue Cross and Blue Shield of Louisiana	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H6502	Agent/Broker Compensation Data Contact			Ray	Miles		8163952906					Miles.Ray@BlueKC.com	2301 Main St		Kansas City	MO	64108	05/10/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Automated TrOOP Balance Transfer Contact	Manager, Business Process		Diaz	Mario		7143172628					mario.diaz@optum.com	2300 Main St.		Irvine	CA	92614	04/03/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Backup User Access Contact			Muncy	Angela		8163953648					angela.muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	01/04/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Best Available Evidence Contact	Director of Operations		Power	Donna		8163953259					Donna.Power@bluekc.com	2301 Main St		Kansas City	MO	64108	10/01/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Bid Audit Contact			Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Bid Audit Site Contact			Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Bid Primary Contact			Muncy	Angela		8163953648					angela.muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	CAP Report Contact for Public Website			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	CEO - CMS Administrator Contact		Dr	Sweat	Greg		8163601040					greg.sweat@bluekc.com	2301 Main St		Kansas City	MO	64108	02/07/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	CEO - Senior Official for Contracting		Dr	Sweat	Greg		8163601040					greg.sweat@bluekc.com	2301 Main Street		Kansas City	MO	64108	02/07/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Chief Financial Officer		Mr.	Bowling	Philip		8163953885					Philip.Bowling@BlueKC.com	2301 Main Street		Kansas City	MO	64108	04/04/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Chief Operating Officer		Mrs.	Rund	Lori		8163952748					Lori.Rund@BlueKC.com	2301 Main Street		Kansas City	MO	64108	11/27/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Chief Information Officer		Mr.	Chowdhury	Bhaskar		8163953137					Bhaskar.Chowdhury@bluekc.com	2301 Main Street		Kansas City	MO	64108	08/11/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Chief Information Security Officer		Mr.	McAdams	Scott		8163953650					Scott.McAdams@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/15/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	CMS Casework Communication Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Complaints Tracking Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Contact for Fraud Investigations			Heath	Ashlee		8163953443					Ashlee.Heath@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Coordination of Benefits Contact			Phillips	Denise		8163952032					_MSP_COB@BlueKC.com	2301 Main Street		Kansas City	MO	64108	05/10/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Corporate Mailing						8889898842					customerservice@bluekcma.com	2301 Main Street		Kansas City	MO	64108	04/22/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant, Lead		Bresee	Mickey		8163953145					mickey.bresee@bluekc.com	2301 Main Street	ATTN: Finance	Kansas City	MO	64108	01/25/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Customer Service Operations Contact	Director of Operations		Power	Donna		8163953259					Donna.Power@bluekc.com	2301 Main St		Kansas City	MO	64108	10/01/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	DIR Contact			McMeen	Kera		8163952269					MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	08/02/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	DIR Contact (Secondary)			Muncy	Angela		8163953648					angela.muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Electronic Health Record Contact			Haynes	Elizabeth		8163952170					elizabeth.haynes@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/24/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Emergency Part D Contact		Mrs.	Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	08/02/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Emergency Part D Contact (Secondary)			McMenus	Cindy		8163952226					Cindy.McMenus@BlueKC.com	2301 Main Street		Kansas City	MO	64108	08/11/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Employer Waiver Contact			Muncy	Angela		8163953648					angela.muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Encounter Data & Risk Adjustment Operations Contact			Haynes	Elizabeth		8163952170					Elizabeth.Haynes@bluekc.com	2301 Main Street		Kansas City	MO	64108	08/29/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Enrollment Contact	Director of Operations		Power	Donna		8163953259					Donna.Power@bluekc.com	2301 Main St		Kansas City	MO	64108	10/01/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	EOB Transfer Contact	DVP, Operations		McComb	Michael		8163952751				8775491746	michael.mccomb@bluekc.com	2301 Main Street		Kansas City	MO	64108	12/31/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Financial Audit Contact	Medicare Advantage Compliance Officer	Mrs.	Muncy	Angela		8163953648					angela.muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	01/04/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Financial Reporting Contact			Smith	Jenny		8163952635					Jenny.Smith@bluekc.com	2301 Main Street		Kansas City	MO	64108	04/26/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Formulary Contact			Maloney	Julia		2242312718					Julia.Maloney@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/11/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Formulary Contact (Secondary)			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	08/24/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	General Contact		Mrs.	Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/03/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Government Relations Contact			Hoey	Yen		8163953664					yen.hoey@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/03/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	HIPAA Privacy Officer		Mr.	McAdams	Scott		8163953650					Scott.McAdams@BlueKC.com	2301 Main Street		Kansas City	MO	64108	01/05/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	HIPAA Security Officer		Mr.	McAdams	Scott		8163953650					Scott.McAdams@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/15/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Hospice Contact			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Interoperability Contact	Director, Information Governance		Grace	Karen		8163952008					Karen.Grace@bluekc.com	2301 Main Street		Kansas City	MO	64108	11/03/2021	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	MA Appeals/Grievances Contact	Medicare Advantage Compliance Officer		Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	05/10/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	MA Claims Processing Contact for Public Website			McComb	Michael		8163952751					customerservice@bluekcma.com	2301 Main Street		Kansas City	MO	64108	12/31/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Marketing Contact	Manager, Government Programs Marketing	Mrs.	Sutton	Angie		8163952160					Angie.Sutton@bluekc.com	2301 Main Street		Kansas City	MO	64108	05/10/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Medical Director		Dr.	Barbour	Linda		8163952884					Linda.Barbour@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/27/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Medicare Compliance Officer		Mrs.	Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	01/04/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Medicare Coordinator		Mrs.	Rund	Lori		8163952748					Lori.Rund@BlueKC.com	2301 Main Street		Kansas City	MO	64108	01/06/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Medicare Part D Opioid Overutilization Contact			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Medication Therapy Management Contact			Liaqat	Tazeen		2242312290					tazeen.liaqat@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/03/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	OffShore Subcontractor Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Online Enrollment Center Contact (Back-up)			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Online Enrollment Center Contact (Optional)			Hoey	Yen		8163953664					yen.hoey@bluekc.com	2301 Main Street		Kansas City	MO	64108	10/01/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Online Enrollment Center Contact (Primary)	Director of Operations		Power	Donna		8163953259					Donna.Power@bluekc.com	2301 Main St		Kansas City	MO	64108	10/01/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Part C Application Contact			Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Part C Reporting Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Part D Appeals	Manager, Prior Authorization		Bricker	Bryce							bryce.m.bricker@optum.com	9040 S. Rita Rd		Tucson	AZ	85747	08/11/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active	8445694142				PPO - BBA		C	Kansas City
H6502	Part D Appeals Contact (Secondary)			McMenus	Cindy							_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active	8665087140				PPO - BBA		C	Kansas City
H6502	Part D Application Contact			Muncy	Angela		8163953648					Angela.Muncy@bluekc.com	2301 Main Street		Kansas City	MO	64108	09/23/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Part D Benefits Contact			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Part D Claims Submission Contact			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Part D Exceptions Contact			Bricker	Bryce							bryce.m.bricker@optum.com	9040 S. Rita Rd		Tucson	AZ	85747	12/31/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active	6126326838				PPO - BBA		C	Kansas City
H6502	Part D Exceptions Contact (Secondary)			Campbell	Anna							Anna.Campbell@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/03/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active	4079276161				PPO - BBA		C	Kansas City
H6502	Part D Price File Contact (Back-up)			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Part D Price File Contact (Primary)			Kim	Kevin		7633617996					medops_planfinder@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/03/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Part D Quality Assurance Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Part D Reporting Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Patient Safety Contact			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Payment Contact		Mrs.	Rund	Lori		8163952748					Lori.Rund@BlueKC.com	2301 Main Street		Kansas City	MO	64108	02/15/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Pharmacy Director			McMenus	Cindy		8163952226					Cindy.McMenus@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/27/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Pharmacy Network Management Contact			Hagan	Kyle		3039895828					kyle.hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	12/31/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Pharmacy Network Management Contact (Secondary)			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk		Summers	Todd							todd.summers@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	06/23/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active	8445694142				PPO - BBA		C	Kansas City
H6502	Plan Directory Contact for Public Website			Service	Customer		8665087140					customerservice@bluekcma.com	2301 Main St		Kansas City	MO	64108	12/31/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Plan to Plan Reconciliation Contact	Accountant, Lead		Bresee	Mickey		8163953145					_P2P_Report@bluekc.com	2301 Main Street	ATTN: P2P Department	Kansas City	MO	64108	08/22/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Processor Contact			Cassata	Mercedes		6307809152					mercedes.cassata@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	12/31/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Quality Contact			Haynes	Elizabeth		8163952170					Elizabeth.Haynes@bluekc.com	2301 Main Street		Kansas City	MO	64108	08/11/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Reconciliation Contact		Mrs.	Rund	Lori		8163952748					Lori.Rund@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/31/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Reconciliation Contact (Secondary)			Galande	Anant		8163952507					Anant.Galande@bluekc.com	2301 Main Street		Kansas City	MO	64108	03/09/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Recovery Audit Contact	Medicare Advantage Compliance Officer	Mrs.	Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	01/04/2019	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Surveillance Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	System Contact		Mr.	Chowdhury	Bhaskar		8163953137					Bhaskar.Chowdhury@bluekc.com	2301 Main Street		Kansas City	MO	64108	08/11/2022	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Third Party Administrator (TPA) Liaison			McMenus	Cindy		8163952226					_MA_PartD@BlueKC.com	2301 Main Street		Kansas City	MO	64108	09/20/2023	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	User Access Contact			Muncy	Angela		8163953648					Angela.Muncy@BlueKC.com	2301 Main Street		Kansas City	MO	64108	07/23/2018	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Utilization Management Contact		Dr.	Barbour	Linda		8163952884					Linda.Barbour@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/27/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6502	Utilization Review Contact		Dr.	Barbour	Linda		8163952884					Linda.Barbour@BlueKC.com	2301 Main Street		Kansas City	MO	64108	12/27/2020	2023	MISSOURI VALLEY LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Blue Medicare Advantage	Local PPO		Blue Cross and Blue Shield of Kansas City	614	Yes	Active					PPO - BBA		C	Kansas City
H6517	Automated TrOOP Balance Transfer Contact	CFO	Mr	Diaz	Javier		5597374786					javdiaz@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Backup User Access Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Best Available Evidence Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Bid Primary Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	CAP Report Contact for Public Website	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	CEO - CMS Administrator Contact	President and CEO	Mrs	Hydash	Kerry		5597374700					khydash@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	CEO - Senior Official for Contracting	President and CEO	Mrs	Hydash	Kerry		5597374700					khydash@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Chief Financial Officer	CFO	Mr	Diaz	Javier		5597374786					javdiaz@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Chief Operating Officer	COO	Mrs	Verduzzo	Norma		5597374700					nverduzzo@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Chief Information Officer	CIO	Mr	Kelley	Jay		5597374700					jkelley@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Chief Information Security Officer	CIO	Mr	Kelley	Jay		5597374700					jkelley@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	CMS Casework Communication Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Complaints Tracking Contact	COO	Mrs	Verduzzo	Norma		5597374700					nverduzzo@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Contact for Fraud Investigations	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Coordination of Benefits Contact	CFO	Mr	Diaz	Javier		5597374786					javdiaz@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Corporate Mailing						5597374700					khydash@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr	Diaz	Javier		5597374786					javdiaz@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Customer Service Operations Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	DIR Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	DIR Contact (Secondary)	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Emergency Part D Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Emergency Part D Contact (Secondary)	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Encounter Data & Risk Adjustment Operations Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Enrollment Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	EOB Transfer Contact	Deputy CEO	Mr	Vawter	Chad		5597374907				5597374907	cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Financial Audit Contact	CFO	Mr	Diaz	Javier		5597374786					javdiaz@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Financial Reporting Contact	CFO	Mr	Diaz	Javier		5597374786					javdiaz@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Formulary Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Formulary Contact (Secondary)	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	General Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Government Relations Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	HIPAA Privacy Officer	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	HIPAA Security Officer	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Interoperability Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	MA Appeals/Grievances Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	MA Claims Processing Contact for Public Website	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Marketing Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Medical Director	Chief Clinical Officer	Mrs	Sidhu	Paramvir		5597374700					psidhu@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Medicare Compliance Officer	Deputy CEO	Mr	Vawter	Chad		5597374907				5597374907	cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Medicare Coordinator	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Medicare Part D Opioid Overutilization Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Medication Therapy Management Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	OffShore Subcontractor Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Online Enrollment Center Contact (Back-up)	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Online Enrollment Center Contact (Optional)	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Online Enrollment Center Contact (Primary)	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Part C Application Contact			Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Avenue		Visalia	CA	93291	07/20/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Part D Appeals	Deputy CEO	Mr	Vawter	Chad							cvwater@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending	5597374907				PACE - Nat		C	San Francisco
H6517	Part D Appeals Contact (Secondary)	Deputy CEO	Mr	Vawter	Chad							cvwater@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending	5597374907				PACE - Nat		C	San Francisco
H6517	Part D Application Contact			Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Avenue		Visalia	CA	93291	07/20/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Part D Benefits Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Part D Claims Submission Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Part D Exceptions Contact	Deputy CEO	Mr	Vawter	Chad							cvwater@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending	5597374907				PACE - Nat		C	San Francisco
H6517	Part D Exceptions Contact (Secondary)	Deputy CEO	Mr	Vawter	Chad							cvwater@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending	5597374907				PACE - Nat		C	San Francisco
H6517	Part D Price File Contact (Back-up)	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Part D Price File Contact (Optional)	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Part D Price File Contact (Primary)	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Part D Quality Assurance Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Part D Reporting Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Patient Safety Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Payment Contact	CFO	Mr	Diaz	Javier		5597374786					javdiaz@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Personal Health Record Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Pharmacy Director	Director of Pharmacy		Mahal	Pargat		5597374907					pmahal@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Pharmacy Network Management Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Pharmacy Network Management Contact (Secondary)	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Pharmacy Technical Help Desk Contact	Deputy CEO	Mr	Vawter	Chad							cvwater@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending	5597374907				PACE - Nat		C	San Francisco
H6517	Pharmacy Technical Help Desk Contact (Secondary)	Deputy CEO	Mr	Vawter	Chad							cvwater@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending	5597374907				PACE - Nat		C	San Francisco
H6517	Plan Directory Contact for Public Website	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Plan to Plan Reconciliation Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Processor Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Quality Contact	Director of Quality Improvement	Mr	Goddard	Mitch		5597374907					mgoddard@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Reconciliation Contact	CFO	Mr	Diaz	Javier		5597374786					javdiaz@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Reconciliation Contact (Secondary)	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Recovery Audit Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Surveillance Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	System Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Third Party Administrator (TPA) Liaison	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	User Access Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Utilization Management Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6517	Utilization Review Contact	Deputy CEO	Mr	Vawter	Chad		5597374907					cvawter@fhcn.org	305 E Center Ave		Visalia	CA	93291	09/29/2022	2023	FAMILY HEALTHCARE NETWORK	National PACE	Family HealthCare Network PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6526	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H6526	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H6526	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H6526	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H6526	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6526	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF NEW MEXICO, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6528	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	6126562187				PPO - BBA		C	San Francisco
H6528	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	7632832653				PPO - BBA		C	San Francisco
H6528	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	8005959532				PPO - BBA		C	San Francisco
H6528	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation	8007887871				PPO - BBA		C	San Francisco
H6528	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6528	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Consolidation					PPO - BBA		C	San Francisco
H6529	Agent/Broker Compensation Data Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Automated TrOOP Balance Transfer Contact	Director of Data Integration & Development	Mr.	Katheeder	Tim		8123787066					Tim.Katheeder@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Backup User Access Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Best Available Evidence Contact	Member and Provider Services		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Bid Audit Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@MyTruAdvantage.com	417 Washington Street		Columbus	IN	472021787	09/01/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Bid Primary Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	CAP Report Contact for Public Website	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	10/22/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	CEO - CMS Administrator Contact	President & CEO	Mr.	Sadtler	John		8123738714					John.Sadtler@siho.org	PO Box 1787		Columbus	IN	472021787	01/17/2020	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	CEO - Senior Official for Contracting	President & CEO	Mr.	Sadtler	John		8123738714					John.Sadtler@siho.org	PO Box 1787		Columbus	IN	472021787	01/17/2020	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Chief Financial Officer	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington Street		Columbus	IN	47201	08/20/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Chief Operating Officer	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington St		Columbus	IN	47201	04/07/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Chief Information Officer	Vice President, Information Technology	Mr.	Clancy	Mike		8123787052					Mike.Clancy@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Chief Information Security Officer	Director of Technology Services	Mr.	Taylor	Rob		8123787046					Rob.Taylor@siho.org	PO Box 1787		Columbus	IN	472021787	01/17/2020	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	CMS Casework Communication Contact	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.do@siho.org	417 Washington Street		Columbus	IN	47201	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Complaints Tracking Contact	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.do@siho.org	417 Washington Street		Columbus	IN	47201	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Contact for Fraud Investigations	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.do@siho.org	417 Washington Street		Columbus	IN	47201	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Coordination of Benefits Contact	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.do@siho.org	417 Washington Street		Columbus	IN	47201	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Corporate Mailing						8123787000					Hannah.Hauser@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington Street		Columbus	IN	47201	08/20/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Customer Service Operations Contact	Director of Customer Service		Diedrich	Bridget		8123142500	1073				Bridget.Diedrich@siho.org	PO Box 1787		Columbus	IN	472021787	10/05/2020	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	DIR Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington Street		Columbus	IN	47202	08/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	DIR Contact (Secondary)	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington Street		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Electronic Health Record Contact	Member and Provider Services		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active	8444254280				HMO - Health Maintenance Organization		C	Chicago
H6529	Emergency Part D Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Emergency Part D Contact (Secondary)	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Encounter Data & Risk Adjustment Operations Contact	VP Operations	Mr.	Massard	Gary		8123787083					Gary.Massard@siho.org	PO Box 1787		Columbus	IN	472021787	06/18/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Enrollment Contact	Director of Data Integration & Development	Mr.	Katheeder	Tim		8123787066					Tim.Katheeder@siho.org	PO Box 1787		Columbus	IN	472021787	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	EOB Transfer Contact	Member and Provider Services		Services	Member		8444254280				3178603632	memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Financial Audit Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington Street		Columbus	IN	47201	08/20/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Financial Reporting Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 W. Washington Street		Columbus	IN	472021787	10/22/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Formulary Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Formulary Contact (Secondary)			Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	03/25/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	General Contact	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington Street		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Government Relations Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	HIPAA Privacy Officer	Administration and PHO Lead		Prabhune	Sheetal		8123787097	3003				sprabhune@inspirehealthpartners.com	PO Box 1787		Columbus	IN	472021787	01/30/2020	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	HIPAA Security Officer	Director Technology Services	Mr.	Taylor	Rob		8123787046					Rob.Taylor@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Hospice Contact	Member and Provider Services		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	47201	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Interoperability Contact	Director of Provider Relations		Jones	Michelle		8123787107					Michelle.Jones@siho.org	417 Washington Street		Columbus	IN	47201	12/17/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	MA Appeals/Grievances Contact	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.do@siho.org	417 Washington Street		Columbus	IN	47201	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	MA Claims Processing Contact for Public Website	Member and Provider Service		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/24/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Marketing Contact	Reports Specialist	Ms.	Gottman	Melissa		8123142500	1107				Melissa.Gottman@MyTruAdvantage.com	417 Washington Street		Columbus	IN	472021787	09/01/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Medical Director	Medical Director	Dr.	Goode	Roy		8123430967					Roy.Goode@siho.org	PO Box 1787		Columbus	IN	472021787	08/23/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Medicare Compliance Officer	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington Street		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Medicare Coordinator	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Medicare Part D Opioid Overutilization Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Medication Therapy Management Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	OffShore Subcontractor Contact	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington St		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Online Enrollment Center Contact (Back-up)	Manager of Quality Assurance, G&A, FWA & RA		Do	Nicole		8123142500	1102				Nicole.Do@siho.org	417 Washington Street		Columbus	IN	47201	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Online Enrollment Center Contact (Optional)	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington Street		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Online Enrollment Center Contact (Primary)	Director of Data Integration & Development	Mr.	Katheeder	Tim		8123787066					Tim.Katheeder@siho.org	PO Box 1787		Columbus	IN	472021787	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Part C Application Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Part C Reporting Contact	Reports Specialist		Gottman	Melissa		8123142500	1107				Melissa.Gottman@SIHO.org	417 Washington Street		Columbus	IN	47201	09/22/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Appeals	Member and Provider Services		Services	Member							memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active	8444254280				HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Appeals Contact (Secondary)	Member and Provider Services		Services	Member							memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	47202	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active	8444254280				HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Application Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Benefits Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Claims Submission Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Exceptions Contact	Member and Provider Services		Services	Member							memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active	8444254280				HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Exceptions Contact (Secondary)	Member and Provider Services		Services	Member							memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active	8444254280				HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Price File Contact (Back-up)	General Consultant User		Keller	Sharon		8587907104					PlanFinderCommunications@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	09/19/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Price File Contact (Optional)	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@SIHO.org	417 Washington St		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Price File Contact (Primary)	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Quality Assurance Contact	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington St.		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Part D Reporting Contact	Reports Specialist		Gottman	Melissa		8123142500	1107				Melissa.Gottman@SIHO.org	417 Washington Street		Columbus	IN	47201	09/22/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Patient Safety Contact	Reports Specialist		Gottman	Melissa		8123142500	1107				Melissa.Gottman@SIHO.org	417 Washington Street		Columbus	IN	47201	09/22/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Payment Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington Street		Columbus	IN	47202	08/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Personal Health Record Contact	Member and Provider Service		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/24/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Pharmacy Director	Medical Director	Dr.	Goode	Roy		8123430967					Roy.Goode@siho.org	PO Box 1878		Columbus	IN	472021787	08/23/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Pharmacy Network Management Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Pharmacy Network Management Contact (Secondary)	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	08/20/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Pharmacy Technical Help Desk Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly							Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H6529	Pharmacy Technical Help Desk Contact (Secondary)	COO	Mr.	McConnell	Roy							Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	08/20/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H6529	PHR Beneficiary Contact																	02/24/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS	Southeastern Indiana Health Organization Inc	SIHO Holding, Inc.	761	Yes	Active	8444254280				HMO - Health Maintenance Organization		C	Chicago
H6529	Physician Incentive Contact	Director of Provider Relations		Jones	Michelle		8123787107					Michelle.Jones@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Plan Directory Contact for Public Website	Member and Provider Service		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/18/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Plan to Plan Reconciliation Contact	Staff Accountant I		Dobbs	Rachel		8123142500	1202				rachel.dobbs@siho.org	417 Washington Street		Columbus	IN	47201	05/12/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Processor Contact	Senior Executive	Mr.	Massard	Gary		8123787083					Gary.Massard@siho.org	PO Box 1787		Columbus	IN	472021787	02/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Quality Contact	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.Do@siho.org	PO Box 1787		Columbus	IN	472021787	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Reconciliation Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington St		Columbus	IN	47201	08/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Reconciliation Contact (Secondary)	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@SIHO.org	417 Washington St		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Recovery Audit Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington St		Columbus	IN	47201	08/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Surveillance Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	10/22/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	System Contact	Vice President Information Technology	Mr.	Clancy	Mike		8123787052					Mike.Clancy@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Third Party Administrator (TPA) Liaison	Staff Accountant I		Dobbs	Rachel		8123142500	1202				rachel.dobbs@siho.org	417 Washington Street		Columbus	IN	47201	05/12/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	User Access Contact	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington Street		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Utilization Management Contact	Member and Provider Services		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6529	Utilization Review Contact	Member and Provider Services		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	HMO/HMOPOS		SIHO Holding, Inc.	761	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6541	Automated TrOOP Balance Transfer Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Backup User Access Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Best Available Evidence Contact			Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Drive		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Bid Primary Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	CAP Report Contact for Public Website			Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Drive		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	CEO - CMS Administrator Contact	CEO	Mr.	Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	CEO - Senior Official for Contracting	CEO	Mr.	Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Chief Financial Officer	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Chief Operating Officer	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Chief Information Officer	CEO	Mr.	Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Chief Information Security Officer	CEO	Mr.	Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	CMS Casework Communication Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Complaints Tracking Contact	Quality improvement director	Ms.	Reece	Jennifer		8593147284					jreece@forhorizon.com	178 Broadway Street		Irvine	KY	40336	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Contact for Fraud Investigations	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Coordination of Benefits Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/07/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Corporate Mailing						8596234080					kellyupchurch@forhorizon.com	PO Box 572		Richmond	KY	40476	02/20/2023	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Customer Service Operations Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	DIR Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	DIR Contact (Secondary)	Ex Director	Ms.	Hickman	Stacey		6066881549					shickmam@forhorizon.com	PO Box 135		Albany	KY	42602	02/20/2023	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Emergency Part D Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Emergency Part D Contact (Secondary)	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Encounter Data & Risk Adjustment Operations Contact	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Enrollment Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	EOB Transfer Contact	CFO	Mr.	Jones	Kevin		8596234080				8596245771	kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Financial Audit Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Drive		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Financial Reporting Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Formulary Contact	Ex Director	Ms	Hickman	Stacey		6066881549					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	02/20/2023	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Formulary Contact (Secondary)	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	General Contact	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Government Relations Contact	CEO	Mr.	Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	HIPAA Privacy Officer	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	HIPAA Security Officer	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Interoperability Contact	COO		Burchett	Melinda		6063873376					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	11/08/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	MA Appeals/Grievances Contact	Quality improvement director	Ms.	Reece	Jennifer		8593147284					jreece@forhorizon.com	178 Broadway Street		Irvine	KY	40336	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	MA Claims Processing Contact for Public Website	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Marketing Contact			Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Drive		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Medical Director	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Medicare Compliance Officer	Compliance officer	Ms.	Reece	Jennifer		8593147284					jreece@forhorizon.com	178 Broadway Street		Irvine	KY	40336	06/07/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Medicare Coordinator	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Medicare Part D Opioid Overutilization Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Medication Therapy Management Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	OffShore Subcontractor Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Online Enrollment Center Contact (Back-up)	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/07/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Online Enrollment Center Contact (Optional)	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/07/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Online Enrollment Center Contact (Primary)	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/07/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Part C Application Contact			Upchurch	Kelly		8596234080					kellyupchurch.com@forhorizon.com	2028 Merrick Drive		Richmond	KY	40475	01/25/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Part D Appeals	CEO	Mr.	Upchurch	Kelly						8596245771	kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active	8596234080				PACE - Nat		C	Atlanta
H6541	Part D Appeals Contact (Secondary)	CEO	Mr.	Upchurch	Kelly						8596245771	kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active	8596234080				PACE - Nat		C	Atlanta
H6541	Part D Application Contact			Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Drive		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Part D Benefits Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Part D Claims Submission Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Part D Exceptions Contact	CEO	Mr.	Upchurch	Kelly						8596245771	kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active	8596234080				PACE - Nat		C	Atlanta
H6541	Part D Exceptions Contact (Secondary)	CEO	Mr.	Upchurch	Kelly						8596245771	kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active	8596234080				PACE - Nat		C	Atlanta
H6541	Part D Price File Contact (Back-up)	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Part D Price File Contact (Optional)	CEO	Mr.	Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Part D Price File Contact (Primary)	CEO	Mr.	Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Part D Quality Assurance Contact	Quality improvement director	Ms.	Reece	Jennifer		8593147284					jreece@forhorizon.com	178 Broadway Street		Irvine	KY	40336	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Part D Reporting Contact	CEO	Mr.	Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Patient Safety Contact	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Payment Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Personal Health Record Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/07/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Pharmacy Director	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Pharmacy Network Management Contact	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Pharmacy Network Management Contact (Secondary)	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Pharmacy Technical Help Desk Contact	CEO	Mr.	Upchurch	Kelly						8596245771	kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active	8596234080				PACE - Nat		C	Atlanta
H6541	Pharmacy Technical Help Desk Contact (Secondary)	CEO	Mr.	Upchurch	Kelly						8596245771	kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active	8596234080				PACE - Nat		C	Atlanta
H6541	Plan Directory Contact for Public Website	CEO	Mr.	Upchurch	Kelly		8596234080					kellyupchurch@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Plan to Plan Reconciliation Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Processor Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Quality Contact	Quality improvement director	Ms.	Reece	Jennifer		8593147284					jreece@forhorizon.com	178 Broadway Street		Irvine	KY	40336	06/07/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Reconciliation Contact	CFO	Mr.	Jones	Kevin		8596234080	1104				kjones@forhorizon.com	PO Box 572		Richmond	KY	40476	02/20/2023	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Reconciliation Contact (Secondary)	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Drive		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Recovery Audit Contact	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Drive		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Surveillance Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	System Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Third Party Administrator (TPA) Liaison	CFO	Mr.	Jones	Kevin		8596234080					kjones@forhorizon.com	2028 Merrick Dr		Richmond	KY	40475	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	User Access Contact	Executive Director		Hickman	Stacey		6063099068					shickman@forhorizon.com	PO Box 135		Albany	KY	42602	06/08/2022	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Utilization Management Contact	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6541	Utilization Review Contact	COO	Ms.	Burchett	Melinda		6063053028					mburchett@forhorizon.com	PO Box 135		Albany	KY	42602	02/09/2021	2023	HORIZON-PACE, LLC	National PACE	Horizon - PACE	National PACE		American Health Management, Inc.	783	Yes	Active					PACE - Nat		C	Atlanta
H6545	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6545	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6545	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6545	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6545	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H6545	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6545	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H6545	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6545	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ILLINOIS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6550	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H6550	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/07/2018	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/15/2017	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Medical Director	Sr. VP, Medical Affairs	Dr.	Nelson	Vincent		3145056872					vincent.nelson@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/17/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H6550	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H6550	PHR Beneficiary Contact																	09/27/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8555659519				HMO - Health Maintenance Organization		C	Dallas
H6550	Physician Incentive Contact	Sr. Director, Contracting & Network Development	Mr.	Figueroa	Jaime	J	3145056543					Jaime.J.Figueroa@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Plan Directory Contact for Public Website			Services	Provider		8555659519					CorporateMedicareComplianceDept@CENTENE.COM	8325 Lenexa Drive	Suite 200	Lenexa	KS	66214	03/31/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Recovery Audit Contact	Director, Payment Integrity	Ms.	Dunlap	Tara		3146408333					Tara.L.Dunlap@CENTENE.COM	7700 Forsyth Boulevard		St. Louis	MO	63105	09/17/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6550	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6551	Automated TrOOP Balance Transfer Contact	Regional Finance Director		Schmotzer	David		2153394533				6102719530	David.Schmotzer@Trinity-Health.org	1930 South Broad Street	Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Backup User Access Contact	Executive Director	Mr.	Moore	Daniel		2679917660					Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Best Available Evidence Contact	Executive Director	Mr.	Moore	Daniel		2679917660				2679917618	Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Bid Primary Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	CAP Report Contact for Public Website	Executive Director	Mr	Moore	Daniel		2679917660				2679917618	Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	CEO - CMS Administrator Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	CEO - Senior Official for Contracting	Executive Director	Mr.	Moore	Daniel		2679917660				2679917618	Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Chief Financial Officer	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Chief Operating Officer	COO	Ms.	Lewis	Anne		4066472980					anne.lewis@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	04/28/2022	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Chief Information Officer	Director Enterprise IT Operations	Mr	Gillespie	Jeff		6142348636					gillespj@trinity-health.org	1201 Langhorne-Newtown Road		Langhorne	PA	19047	09/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Chief Information Security Officer	VP Information Security	Ms.	Jennings	Preston		6105503183					Preston.Jennings@trinity-health.org	1201 Langhorne-Newtown Road		Langhorne	PA	19047	09/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	CMS Casework Communication Contact	Executive Director	Mr.	Moore	Daniel		2679917660				2679917618	Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Complaints Tracking Contact	Director, Quality and Compliance		Michel	Katie		2679917660					Katie.Michel@trinity-health.org	2500 Northgate Rd	Suite 1	Trevose	PA	19053	09/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Contact for Fraud Investigations	Director, Quality and Compliance	Ms	Michel	Katie		2679917660					Katie.Michel@trinity-health.org	2500 Northgate Rd		Trevose	PA	19053	09/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Coordination of Benefits Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Corporate Mailing						2679917660				2679917618	Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Coverage Gap Discount Program (CGDP) Payment Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Customer Service Operations Contact	Executive Director	Mr	Moore	Daniel		2679917660					Dmoore2@trinity-health.org	2500 Northgate Rd		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	DIR Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	DIR Contact (Secondary)	Accounting Specialist	Ms	Kassimu	Gabrielle		2679917634					Gabrielle.Kassimu@stmaryhealthcare.org	St. Mary Medical Center	1201 Langhorne-Newtown Rd.	Langhorne	PA	19057	03/25/2017	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Emergency Part D Contact	Regional Finance Director	Mr	Schmotzer	David		2153394533				6102719530	David.Schmotzer@Trinity-Health.org	1930 South Broad Street	Unit 3	Philadelphia	PA	19145	08/02/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Emergency Part D Contact (Secondary)	Manager Part D Compliance	Dr.	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	1930 South Broad Street		Philadelphia	PA	19145	09/03/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Encounter Data & Risk Adjustment Operations Contact	Director of Coding and Documentation		Creaney	Emy		7343431939					creaneye@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	10/25/2019	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Enrollment Contact	Outreach/Enrollment Specialist/Community Liaison	Ms	Leib	Margaret		2679917622				2679917618	MLeib@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/09/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	EOB Transfer Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533				2679917618	David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Financial Audit Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Financial Reporting Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Formulary Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2679917601				2679917618	joseph.garbarino@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/03/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	General Contact	Executive Director	Mr	Moore	Daniel		2679917660				2679917618	Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Government Relations Contact	Executive Director	Mr.	Moore	Daniel		2679917660				2679917618	Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	HIPAA Privacy Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	HIPAA Security Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Interoperability Contact	Regional Director IT Operations		Latimer	Mike		7343433079					mike.latimer@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	04/20/2022	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	MA Appeals/Grievances Contact	Director, Quality and Compliance	Mr	Michel	Katie		2679917660					Katie.Michel@trinity-health.org	2500 Northgate		Trevose	PA	19053	09/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	MA Claims Processing Contact for Public Website	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Marketing Contact	Director Marketing & Communications	Ms	Lark	Azia		9735182754					azia.lark@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	02/03/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Medical Director	Medical Director	Dr	Sojan	Antonia		2679917601				2679917618	antonia.sojan@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/03/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Medicare Compliance Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Medicare Coordinator	Executive Director	Mr.	Moore	Daniel		2679917660				2679917618	Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2679917601				2679917618	joseph.Garbarino@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/03/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362				4134932024	joseph.garbarino@mercyhealth.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	07/27/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Online Enrollment Center Contact (Back-up)	Outreach/Enrollment Specialist/Community Liaison	Ms	Leib	Margaret		2679917622				2679917618	MLeib@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/09/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Online Enrollment Center Contact (Primary)	Accounting Specialist	Ms	Kassimu	Gabrielle		2679917634					Gabrielle.Kassimu@trinity-health.org	St. Mary Medical Center	1201 Langhorne-Newtown Rd.	Langhorne	PA	19057	09/09/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Part C Application Contact	Executive Director	Mr.	Moore	Daniel		2679917660				2679917618	Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Part D Appeals	Manager Part D Compliance	Mr	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad St	Unit 3	Philadelphia	PA	19145	09/09/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H6551	Part D Appeals Contact (Secondary)	Director Quality & Compliance		Trotter	Lorraine							LTrotter@trinity-health.org	2500 Northgate Rd		Trevose	PA	19053	09/03/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active	2679917626				PACE - Nat		C	Philadelphia
H6551	Part D Application Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Part D Benefits Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Part D Claims Submission Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Part D Exceptions Contact	Manager Part D Compliance	Mr.	Garbarino	Joseph							Joseph.Garbarino@trinity-health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	09/03/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H6551	Part D Exceptions Contact (Secondary)	Director Quality & Compliance		Trotter	Lorraine							LTrotter@trinity-health.org	2500 Northgate Rd		Trevose	PA	19053	09/03/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active	2679917626				PACE - Nat		C	Philadelphia
H6551	Part D Price File Contact (Back-up)	Executive Director	Mr.	Moore	Daniel		2679917620				2679917618	Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Part D Price File Contact (Primary)	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Part D Quality Assurance Contact	Director, Quality and Compliance	Mr	Michel	Katie		2679917660					Katie.Michel@trinity-health.org	2500 Northgate Rd		Trevose	PA	19053	09/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Part D Reporting Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Patient Safety Contact	Director, Quality and Compliance	Ms	Michel	Katie		2679917660					Katie.Michel@trinity-health.org	2500 Northgate Rd		Trevose	PA	19053	09/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Payment Contact	Regional Finance Director	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Personal Health Record Contact	Health Information Management Coordinator	Ms	Groff	Kira		2679917641				2679917618	Kira.Groff@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/09/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Pharmacy Director	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@mercyhealth.org	1930 South Broad Street		Philadelphia	PA	19145	08/02/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Pharmacy Network Management Contact	Manager Part D Compliance		Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/09/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Pharmacy Network Management Contact (Secondary)	Regional Finance Director	Mr.	Schmotzer	David		2679917625				2156451036	david.schmotzer@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/09/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Pharmacy Technical Help Desk Contact	Manager Part D Compliance		Garbarino	Joseph							joseph.garbarino@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/09/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Philadelphia
H6551	PHR Beneficiary Contact																	06/26/2015	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE	LIFE St.Mary	Trinity Health Corporation	234	Yes	Active	8009999999				PACE - Nat		C	Philadelphia
H6551	Plan Directory Contact for Public Website	Executive Director	Mrs.	Moore	Daniel		2679917660				2679917618	Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Plan to Plan Reconciliation Contact	Director of Finance	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Processor Contact	Director of Finance	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Quality Contact	Director QI/Compliance	Ms	Michel	Katie		2679917626					katie.michel@trinity-health.org	2500 Northgate Rd		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Reconciliation Contact	Director of Finance	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Reconciliation Contact (Secondary)	Accounting Specialist	Ms	Kassimu	Gabrielle		2679917634					Gabrielle.Kassimu@trinity-health.org	St. Mary Medical Center	1201 Langhorne-Newtown Rd.	Langhorne	PA	19057	09/09/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Recovery Audit Contact	Director of Finance	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Surveillance Contact	Executive Director	Mr	Moore	Daniel		2679917660					Dmoore2@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/13/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	System Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Third Party Administrator (TPA) Liaison	Director of Finance	Mr.	Schmotzer	David	P	2153394533					David.Schmotzer@Trinity-Health.org	1930 South Broad Street, Unit 3		Philadelphia	PA	19145	08/13/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	User Access Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Utilization Management Contact	Medical Director	Dr	Sojan	Antonia		2679917601				2679917618	antonia.sojan@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/03/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6551	Utilization Review Contact	Medical Director	Dr	Sojan	Antonia		2679917601				2679917618	antonia.sojan@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	09/03/2021	2023	LIFE ST. MARY	National PACE	LIFE St. Mary	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Philadelphia
H6586	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6586	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6586	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6586	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6586	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H6586	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6586	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H6586	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6586	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ARIZONA, INC.	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6594	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H6594	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H6594	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H6594	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H6594	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H6594	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H6594	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H6594	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6594	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH PLANS OF VERMONT, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6595	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H6595	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H6595	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H6595	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H6595	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/16/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6595	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6596	Automated TrOOP Balance Transfer Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Backup User Access Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689722					Keith.Greiner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	11/06/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Best Available Evidence Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Bid Primary Contact	Actuary	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/01/2021	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	CAP Report Contact for Public Website	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/20/2020	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	CEO - CMS Administrator Contact	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/20/2020	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	CEO - Senior Official for Contracting	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/20/2020	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Chief Financial Officer	Chief Financial Officer	Mr.	Bailey	Todd		5083689097				5087914332	Todd.Bailey@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/27/2019	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Chief Operating Officer	Senior Vice President & Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Chief Information Officer	Senior Vice President & Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/10/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Chief Information Security Officer	Senior Vice President & Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/10/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	CMS Casework Communication Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Ulfves.Heather@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/07/2018	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Complaints Tracking Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Ulfves.Heather@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/07/2018	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Contact for Fraud Investigations	Director Internal Audit	Ms.	Brown	Velinda		5083689016				5083689111	Velinda.Brown@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Coordination of Benefits Contact	Senior Director, Claims Administration	Ms	Straitiff	Kirsten		5083689047					kirsten.straitiff@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/20/2022	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Corporate Mailing						7168101843					Mary.Vause@fallonweinberg.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/26/2018	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Manager Accounting	Mr.	McNamara	Shawn		5083689085					Shawn.McNamara@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Customer Service Operations Contact	VP, Customer Service	Mr.	Perron	Donald		5083689701					Donald.Perron@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	DIR Contact	Actuarial Associate	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/05/2021	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	DIR Contact (Secondary)	Director and Senior Actuary, Government Programs	Mr.	Leung	Hang		5083689258					Hang.Leung@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/15/2022	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Emergency Part D Contact	Manager, Customer Service	Mr.	Fregeau	Andrew		9784347996					Andrew.Fregeau@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/07/2018	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Emergency Part D Contact (Secondary)	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Encounter Data & Risk Adjustment Operations Contact	Manager, Business Service Delivery	Ms.	Ernst	Alicia		5083689369					Alicia.Ernst@fallonhealth.org	One Chestnut Place	10 Chestnut St	Worcester	MA	01608	07/13/2020	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Enrollment Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	EOB Transfer Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089			5088311136	Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Financial Audit Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Financial Reporting Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Formulary Contact	Director, Pharmacy Therapeutics	Ms.	Kendall	Kate		5087992100	79169				Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	08/09/2018	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Formulary Contact (Secondary)	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	General Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Government Relations Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	HIPAA Privacy Officer	Privacy Officer	Ms.	Sanford	Katrin		5083689838					Kartin.Sanford@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/14/2019	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	HIPAA Security Officer	VP IT Operations	Mr.	Petisce	Tony		5083689300					Tony.Petisce@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Interoperability Contact	VP, Enterprise Technology Officer		Budaj	John		5083689362					john.budaj@fallonhealth.org	10 Chestnut Street		Worcester	MA	01608	12/29/2021	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	MA Appeals/Grievances Contact	Director, Care Services Support	Ms.	Ryan	Patricia		5083689771					Patricia.Ryan@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/04/2019	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	MA Claims Processing Contact for Public Website			Service	Customer		7168101892					contactcustomerservice@fallonweinberg.org	461 John James Audubon Parkway		Amherst	NY	14228	11/07/2014	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Marketing Contact	Manager, Medicare Marketing Materials	Ms.	Kudron	Julie		5083689581					Julie.Kudron@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Medical Director	PACE Primary Care Physician Fallon Health Weinberg	Dr.	Thurairajah, MD	Arunan		7162897815					Arunan.Thurairajah@fallonweinberg.org	461 John James Audubon Pkwy.		Amherst	NY	14228	09/29/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Medicare Compliance Officer	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Medicare Coordinator	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Medicare Part D Opioid Overutilization Contact	Supervisor, Pharmacy Technician Team	Ms.	Kendall	Kate		8003332535	79169				Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/04/2018	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Medication Therapy Management Contact	Manager, Pharmacy Ops & Clinical Programs	Mr.	Sartini	David		5083689790					David.Sartini@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/26/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	OffShore Subcontractor Contact	Medicare Compliance & Regulatory Affairs Associate	Ms.	DeMarco	Kristie		5083689514					Kristie.DeMarco@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/02/2020	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Part C Application Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Part D Appeals	Director, Care Services Support	Ms.	Ryan	Patricia							Patricia.Ryan@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/04/2019	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689771				PACE - Nat		C	New York
H6596	Part D Appeals Contact (Secondary)	Manager, Member Appeals and Grievances	Ms.	Foulkes	Christina							Christina.Foulkes@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/08/2021	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689447				PACE - Nat		C	New York
H6596	Part D Application Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Part D Benefits Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Part D Claims Submission Contact	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Part D Exceptions Contact	Manager, Pharmacy Ops & Clinical Programs	Mr.	Sartini	David							David.Sartini@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/26/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689790				PACE - Nat		C	New York
H6596	Part D Exceptions Contact (Secondary)	Director, Pharmacy Therapeutics	Ms.	Kendall	Kate							Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	08/09/2018	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	5087992100	79169			PACE - Nat		C	New York
H6596	Part D Price File Contact (Back-up)	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Part D Price File Contact (Optional)	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Part D Price File Contact (Primary)	Govt Programs and Quality Clinical Pharmacist	Mr.	Huynh	Jayce		5087992100	69212				Jayce.Huynh@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	07/08/2020	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Part D Quality Assurance Contact	Gov't Programs & Quality Clinical Pharmacist	Mr.	Huynh	Jayce		5083689212					Jayce.Huynh@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	08/27/2019	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Part D Reporting Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689772					Keith.Greiner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	10/16/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Patient Safety Contact	PACE Primary Care Physician Fallon Health Weinberg	Dr.	Thurairajah, MD	Arunan		7162897815					Arunan.Thurairajah@fallonweinberg.org	461 John James Audubon Pkwy.		Amherst	NY	14228	09/29/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Payment Contact	Senior Manager Accounting	Mr.	McNamara	Shawn		5083689085					Shawn.McNamara@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Pharmacy Director	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Pharmacy Network Management Contact	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Ops and Clinical Programs	Mr.	Sartini	David		5083689790					David.Sartini@fallonhealth.org	One Chestnut Place,	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Pharmacy Technical Help Desk Contact			Help Desk	OptumRx								1600 McConnor Parkway		Schaumburg	IL	60173	12/29/2021	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	8443688734				PACE - Nat		C	New York
H6596	Pharmacy Technical Help Desk Contact (Secondary)			Summers	Todd								OptumRx	755 Research Pkwy, Suite 300	Oklahoma City	OK	73104	12/29/2021	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active	8664431095				PACE - Nat		C	New York
H6596	Plan Directory Contact for Public Website	Chief Executive, Fallon Health Weinberg	Ms.	Bostek	Kristine		5083689923					Kristine.Bostek@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2023	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Plan to Plan Reconciliation Contact	Director, Medical Accounting	Mr.	Beaulieu	Michael		5083689020					Michael.Beaulieu@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/07/2023	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Processor Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Ulfves.Heather@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/07/2018	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Quality Contact	Director of Quality and Risk, SE & FHW	Ms.	Malkoski	Michelle		8003332535	49979				Michelle.Malkoski@fallonhealth.org	One Chestnut Place	10 Chestnust Steet	Worcester	MA	01608	09/29/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Reconciliation Contact	Actuarial Associate	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/05/2021	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Reconciliation Contact (Secondary)	Director and Senior Actuary, Government Programs	Mr.	Leung	Hang		5083689258					Hang.Leung@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/15/2022	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Recovery Audit Contact	Senior Director, Claims Administration	Ms	Straitiff	Kirsten		5083689047					kirsten.straitiff@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/08/2022	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Surveillance Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	System Contact	Senior Vice President & Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/10/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Third Party Administrator (TPA) Liaison	Financial Accounting & Reporting Sr. Analyst	Ms.	Maesto	Alison		5083689486					Alison.Maesto@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/27/2019	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	User Access Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Utilization Management Contact	PACE Primary Care Physician Fallon Health Weinberg	Dr.	Thurairajah, MD	Arunan		7162897815					Arunan.Thurairajah@fallonweinberg.org	461 John James Audubon Pkwy.		Amherst	NY	14228	09/29/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6596	Utilization Review Contact	PACE Primary Care Physician Fallon Health Weinberg	Dr.	Thurairajah, MD	Arunan		7162897815					Arunan.Thurairajah@fallonweinberg.org	461 John James Audubon Pkwy.		Amherst	NY	14228	09/29/2017	2023	FALLON HEALTH WEINBERG, INC.	National PACE	Fallon Health Weinberg	National PACE		Fallon Community Health Plan, Inc.	88	Yes	Active					PACE - Nat		C	New York
H6605	Agent/Broker Compensation Data Contact	Director, Broker Commission		Wooddell	Gregory		8132066381					Gregory.Wooddell@wellcare.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Marketing Contact	Director, Compliance		Destino	JoAnna	L	7164627230					jdestino@centene.com	7700 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H6605	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H6605	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H6605	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H6605	Part D Price File Contact (Back-up)	Sr Manager, Provider Network Management Operations	Ms.	Drelick	Dana		2256635738					dana.drelick@centene.com	5 River Park Pl E #210		Fresno	CA	93750	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H6605	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H6605	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8774577621				PPO - BBA		C	Dallas
H6605	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6605	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF HAWAII, INC.	Local CCP	Wellcare by Ohana Health Plan	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6622	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H6622	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H6622	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6622	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA WI HEALTH ORGANIZATION INSURANCE CORP	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H6652	Agent/Broker Compensation Data Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Automated TrOOP Balance Transfer Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Backup User Access Contact	Compliance Analyst	Mrs.	Geter	Stefani		4059240627				8442805360	sgeter@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Best Available Evidence Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Bid Audit Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Bid Audit Site Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Bid Primary Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	CAP Report Contact for Public Website	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	CEO - CMS Administrator Contact	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	CEO - Senior Official for Contracting	CEO	Mr.	Bailey	Michael	D	6157518131				8442805360	mbailey@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Chief Financial Officer	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Chief Operating Officer	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Chief Information Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Chief Information Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	CMMI Model Point of Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	CMS Casework Communication Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Complaints Tracking Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Contact for Fraud Investigations	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Coordination of Benefits Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Corporate Mailing						6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Customer Service Operations Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		8555210626				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	DIR Contact	VP Formulary & Rebate Economics		Ellermeir	Nicole		9133875120					nellermeir@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	DIR Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Electronic Health Record Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Emergency Part D Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Emergency Part D Contact (Secondary)	Pharmacy Operations	Mrs.	Sanchez	Lynn		4056014429				8442805360	lsanchez@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Encounter Data & Risk Adjustment Operations Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Enrollment Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	EOB Transfer Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Financial Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Financial Reporting Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Formulary Contact	Pharmacy Manager Formulary	Mr.	Rossi	David		3304866311				3308886015	drossi@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Formulary Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	General Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Government Relations Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	HIPAA Privacy Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	HIPAA Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Hospice Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Interoperability Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	05/16/2022	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	MA Appeals/Grievances Contact	A&G Team Lead	Mrs.	Henderson	Maya		6156268442				8442805360	mhenderson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	MA Claims Processing Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Marketing Contact	Compliance Analyst	Mrs.	Geter	Stefani		4059240627				8442805360	sgeter@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Medical Director	Medical Director	Dr.	Misra	Sumathi		6156365478					SMisra@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/17/2022	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Medicare Compliance Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Medicare Coordinator	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Medicare Part D Opioid Overutilization Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Medication Therapy Management Contact	Director of Clinical Product Development and Strat	Ms.	Miller	Holly		3304866457				3304058094	hrmiller@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	OffShore Subcontractor Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Online Enrollment Center Contact (Back-up)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Online Enrollment Center Contact (Primary)	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Part C Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Part C Reporting Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Appeals	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8555210626				HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Appeals Contact (Secondary)	Clinical Operations Supervisor	Ms	Dozier	Rhea						3304058081	appeals@ElixirSolutions.com	2181 E Aurora Road	Building B, Suite 201	Twinsburg	OH	44087	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8555210626				HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Benefits Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Claims Submission Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Exceptions Contact	Associate VP of Clinical Operations	Ms.	Lavignette	Amanda						3304864801	alavignette@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Exceptions Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8555210626				HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Price File Contact (Back-up)	Manager Rebates		Davis	Erin		3304866375				3304864801	edavidson@EnvisionRx.com	8957 Canyon Falls	Suite 100	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Price File Contact (Optional)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Price File Contact (Primary)	Senior Director Rebates, Trade Relations	Mr.	Bonus	Jason		3304864841				3304864801	jbonus@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Quality Assurance Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Part D Reporting Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Patient Safety Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Pharmacy Director	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Pharmacy Network Management Contact	Director of Pharmacy Network Contracting		Dyer	Tim		3308884812				3304058094	tdyer@EnvisionRx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Pharmacy Network Management Contact (Secondary)	R.Ph, Pharmacy and Part D Director	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	09/07/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8336746202				HMO - Health Maintenance Organization		C	Dallas
H6652	Pharmacy Technical Help Desk Contact (Secondary)			Sanchez	Lynn						4056015627	lsanchez@amhealthplans.com	909 S. Meridian Ave. Ste 425		Oklahoma City	OK	73108	02/10/2020	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8334786370				HMO - Health Maintenance Organization		C	Dallas
H6652	Plan Directory Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Plan to Plan Reconciliation Contact	Sr. Manager,  Financial Accounting	Ms.	Tilley	Stephanie		9312420499					stilley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	08/30/2023	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Processor Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Quality Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Reconciliation Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Reconciliation Contact (Secondary)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Recovery Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	SNP Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	SNP State Contact	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Surveillance Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	System Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Third Party Administrator (TPA) Liaison	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	User Access Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Utilization Management Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6652	Utilization Review Contact	Director , Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF FL, INC.	Local CCP	American Health Advantage of Florida	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6672	Agent/Broker Compensation Data Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/07/2023	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Automated TrOOP Balance Transfer Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Backup User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Best Available Evidence Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Bid Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Bid Audit Site Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/27/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Bid Primary Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	CAP Report Contact for Public Website	Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/28/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8773841241				HMO - Health Maintenance Organization		C	Chicago
H6672	CEO - CMS Administrator Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	CEO - Senior Official for Contracting	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Chief Financial Officer	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Chief Operating Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Chief Information Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Chief Information Security Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	CMMI Model Point of Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	CMS Casework Communication Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Complaints Tracking Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Contact for Fraud Investigations	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Coordination of Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Corporate Mailing						8476968500					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway		Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	Thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Customer Service Operations Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	DIR Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	DIR Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Electronic Health Record Contact		Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/07/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Emergency Part D Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Emergency Part D Contact (Secondary)	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Encounter Data & Risk Adjustment Operations Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/18/2023	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Enrollment Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	EOB Transfer Contact	Claims Manager	Mr.	Salgado	Miguel		8476968578				8008861082	Miguel.Salgado@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	10/04/2021	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Financial Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Financial Reporting Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Formulary Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3308886015	Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	General Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Government Relations Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	HIPAA Privacy Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	HIPAA Security Officer	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539				8555158166	Eric.Annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Hospice Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Interoperability Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	MA Appeals/Grievances Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	MA Claims Processing Contact for Public Website	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Marketing Contact	VP of Marketing	Ms.	Branco	Margaret		7187957495					margaret.branco@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/06/2023	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Medical Director		Dr	Butt	Tariq		3125458471					tariq.butt@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	11/09/2021	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Medicare Compliance Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Medicare Coordinator	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Medicare Part D Opioid Overutilization Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Medication Therapy Management Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3304058084	Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	OffShore Subcontractor Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Online Enrollment Center Contact (Primary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 302	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Part C Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Part C Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Part D Appeals			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy	Suite 450	Dublin	OH	43017	12/28/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H6672	Part D Appeals Contact (Secondary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica							Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue		Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	7542085865				HMO - Health Maintenance Organization		C	Chicago
H6672	Part D Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Part D Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Part D Claims Submission Contact			Dovico	Rosario		2012696398					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Part D Exceptions Contact			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	6143363326				HMO - Health Maintenance Organization		C	Chicago
H6672	Part D Price File Contact (Back-up)			Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Part D Price File Contact (Optional)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Part D Price File Contact (Primary)			Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Part D Quality Assurance Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Part D Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Patient Safety Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Payment Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Pharmacy Director	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Pharmacy Network Management Contact			Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Pharmacy Network Management Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Pharmacy Technical Help Desk Contact			Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	08/04/2021	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H6672	Plan Directory Contact for Public Website	Vice President, Provider Operations	Ms.	Cuevas	Elizabeth		7542085880					Elizabeth.Cuevas@clearspringhealthcare.com	250 South Northwest Highway Suite 302	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Plan to Plan Reconciliation Contact	Senior Accountant	Ms.	Wrenn	Alisa		2249855588				3124290194	Alisa.Wrenn@Clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Processor Contact			Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Quality Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Reconciliation Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Recovery Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	SNP Application Contact	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	07/06/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Surveillance Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	System Contact	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539					eric.annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Third Party Administrator (TPA) Liaison	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Utilization Management Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6672	Utilization Review Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6678	Agent/Broker Compensation Data Contact	Mgr, Broker Commission	Mr.	Furman	Benjamin	D	3143493212					Benjamine.D.Furman@Wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H6678	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Medical Director	Medical Director	Mr	Wilson	Keith		5125966469					Robert.Wilson@SuperiorHealthPlan.com	77 West Wacker Drive, 14th Floor		Chicago	IL	60601	03/30/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H6678	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H6678	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8337051358				HMO - Health Maintenance Organization		C	Dallas
H6678	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Plan Directory Contact for Public Website			Services	Provider		8555659519					CorporateMedicareComplianceDept@CENTENE.COM	8325 Lenexa Drive	Suite 200	Lenexa	KS	66214	03/31/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road, Ren 1, 2nd Floor	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6678	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6706	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H6706	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H6706	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H6706	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H6706	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6706	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UnitedHealthcare Benefits of Texas, Inc.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H6713	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H6713	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H6713	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H6713	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H6713	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H6713	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H6713	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H6713	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6713	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF ILLINOIS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6723	Agent/Broker Compensation Data Contact	Manager, Broker Administration		Chilia	Tony		2166871948					tony.chilia@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Automated TrOOP Balance Transfer Contact	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					Katherine.Goff@medmutual.com	100 American ROad		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Backup User Access Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Best Available Evidence Contact	Medicare Operations Analyst II		Crowley	Lauren		2166876585					BAEdocs@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Bid Audit Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Bid Audit Site Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Bid Primary Contact	Lead Medicare Products Analyst		Kotecki	Bradley		2166872762					bradley.kotecki@medmutual.com	100 American Road		Cleveland	OH	44144	06/09/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	CAP Report Contact for Public Website	Medicare Compliance Officer		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	CEO - CMS Administrator Contact	President and CEO	Mr.	Glass	Steve		2166876223					steve.glass@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	CEO - Senior Official for Contracting	President and CEO	Mr.	Glass	Steve		2166876223					steve.glass@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Chief Financial Officer	Chief Financial Officer	Mr.	Helton	Tony		2166877828					Anthony.Helton@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Chief Operating Officer	Director, Medicare Compliance	Ms.	Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Chief Information Officer	Chief Information Officer	Mr.	Donovan	Chris		4408786450					chris.donovan@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Chief Information Security Officer	Chief Data & Information Officer	Mr.	Donovan	Chris		4408786450					chris.donovan@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	CMS Casework Communication Contact	Director, Customer Care		Glaspie	Anissa		2166877059					anissa.glaspie@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Complaints Tracking Contact	Director, Customer Care		Glaspie	Anissa		2166877059					anissa.glaspie@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Contact for Fraud Investigations	Director, Financial Investigations		Shoemaker	John		2166877245					john.shoemaker@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Coordination of Benefits Contact	Manager, COB and Workers Comp		Njaim	Stephanie		4194737733					Stephanie.Njaim@medmutual.com	100 American  Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Corporate Mailing						2166877000					victoria.kressler@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Reporting and Data Analytics		Stepic	Michelle		2166877151					michelle.stepic@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Customer Service Operations Contact	Director, Customer Care		Glaspie	Anissa		2166877059					anissa.glaspie@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	DIR Contact	Manager, Financial Reporting and Data Analytics		Stepic	Michelle		2166877151					michelle.stepic@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	DIR Contact (Secondary)	Director, Corporate Financial Reporting		Fallon	Pembroke		2166877181					pembroke.fallon@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Electronic Health Record Contact	Director, HIPAA and Vendor Contract Compliance		Mayock	Julie		2166877769					julie.mayock@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Emergency Part D Contact	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Emergency Part D Contact (Secondary)	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Employer Waiver Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Encounter Data & Risk Adjustment Operations Contact	Manager, Risk Adjustment Information Services		Shaner	Donald		2166877159					donald.shaner@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Enrollment Contact	Director, Membership Services		Miller	Sue		2166877454					sue.miller@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	EOB Transfer Contact	Sr. Project Manager		Rush	Jamie		5132347613	617613			2166877675	ESITrOOPTransfer@express-scripts.com	8990 Duke Drive		Mason	OH	45040	12/14/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Financial Audit Contact	Lead Financial Analyst	Mr.	Long	David		2166876309					david.long@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Financial Reporting Contact	VP, Corporate Controller		Hanawalt	Cory		2166872790					Cory.Hanawalt@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Formulary Contact	Director, Pharmacy		Blagojevic	Marko		2166876239					marko.blagojevic@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Formulary Contact (Secondary)	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	General Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Government Relations Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	HIPAA Privacy Officer	VP, Corporate Compliance Officer		Mancino	Paul		2166872675					paul.mancino@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	HIPAA Security Officer	EVP, Chief Data and Information Officer		Donovan	Chris		2166876450					chris.donovan@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Hospice Contact	Director Pharmacy - Medicare and Information		Goff	Katherine		2166877344					katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Interoperability Contact	Director, HIPAA and Vendor Contract Compliance		Mayock	Julie		2166877769					julie.mayock@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	MA Appeals/Grievances Contact	Director, Customer Care		Glaspie	Anissa		2166877059					anissa.glaspie@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	MA Claims Processing Contact for Public Website	Director, Claims Operations		Rittner	Kim		2166874377					kim.rittner@medmutual.com	100 American Rd.		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Marketing Contact	Manager, Acquisition Marketing		Schultz	Melissa		6143130506					melissa.schultz@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Medical Director	Sr. Medical Officer	Dr.	Muzina	David		2166876480					david.muzina@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Medicare Compliance Officer	Director, Medicare Compliance	Ms.	Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Medicare Coordinator	Manager, Medicare Compliance		Trost	Lisa		2166877830					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Ivec	Carl		2166876017					carl.ivec@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Medication Therapy Management Contact	Clinical Pharmacist		Ivec	Carl		2166876017					carl.ivec@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	OffShore Subcontractor Contact	Manager, Medicare Compliance		Trost	Lisa		2166877830					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Online Enrollment Center Contact (Back-up)	Manager, Member Services & System Administration		Bartholomai	Diane		2166877357					diane.bartholomai@medmutual.com	100 American Rd		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Online Enrollment Center Contact (Optional)	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American  Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Online Enrollment Center Contact (Primary)	Director, Membership Services		Miller	Sue		2166877454					sue.miller@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Part C Application Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Part C Reporting Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Appeals	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/14/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Appeals Contact (Secondary)	Director, Pharmacy - Medicare and Information		Goff	Katherine							katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active	2166877344				HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Application Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Benefits Contact	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive.		Franklin Lakes	NJ	07417	05/19/2021	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Exceptions Contact	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/14/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active	6143363326				HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Exceptions Contact (Secondary)	Director, Pharmacy - Medicare and Information		Goff	Katherine							katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active	2166877344				HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Price File Contact (Back-up)	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Price File Contact (Optional)	Sr. Manager Government Programs		Dolfi	Amanda		6147613606				2166872623	amanda_dolfi@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/14/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Price File Contact (Primary)			Westrum	Joshua		4807363132	433132				Medicarewebsitefiles@express-scripts.com	7909 S. Hardy Dr.	#106	Tempe	AZ	85284	12/14/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Quality Assurance Contact	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Part D Reporting Contact	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Patient Safety Contact	Director, Pharmacy		Blagojevic	Marko		2166876239					marko.blagojevic@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Payment Contact	VP, Corporate Controller	Mr.	Hanawalt	Cory		2166872790					Cory.Hanawalt@medmutual.com	100 American Road		Cleveland	OH	44144	09/15/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Personal Health Record Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Pharmacy Director	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Pharmacy Network Management Contact			Kelly	Heather		3146921866					hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	02/02/2015	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy - Medicare and Information		Goff	Katherine		2166877344					katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	4700 North Hanley		St. Louis	MO	63134	12/23/2021	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H6723	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy - Medicare and Information		Goff	Katherine							katherine.goff@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active	2166877344				HMO - Health Maintenance Organization		C	Chicago
H6723	Physician Incentive Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Plan Directory Contact for Public Website	Director, Provider Experience		Subsinsky	Shirra		8003621279					ProviderInformation@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Plan to Plan Reconciliation Contact	Manager, Financial Reporting and Data Analytics		Stepic	Michelle		2166877151					michelle.stepic@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Processor Contact	Sr. Director, Government Programs Medicare		Gibson	Sharon		8057779130					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	11/29/2016	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Quality Contact	Director, Clinical Quality Improvement		Sullivan	Suzanne		4408786481					suzanne.sullivan@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Reconciliation Contact	Manager, Financial Reporting and Data Analytics		Stepic	Michelle		2166877151					Michelle.Stepic@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Reconciliation Contact (Secondary)	Director, Corporate Financial Reporting		Fallon	Pembroke		2166877181					pembroke.fallon@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Recovery Audit Contact	Director, Financial Payment and Review	Mr.	Palace	Ted		2166872807					Ted.Palace@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	SNP Application Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	SNP State Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Surveillance Contact	Dir, Individual Sales and Compliance		Coyne	Jaime		2166872676					MASalesCompliance@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	System Contact	VP, Chief Technology Officer		Stein	Matt		4408786460					matt.stein@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Third Party Administrator (TPA) Liaison	Manager, Financial Reporting and Data Analytics	Ms.	Stepic	Michelle		2166877151					Michelle.Stepic@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	User Access Contact	Director, Medicare Compliance		Slee	Nicole		6143066271					MACompliance@medmutual.com	100 American Road		Cleveland	OH	44144	09/14/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Utilization Management Contact	VP, Clinical Care Management		Nadzam	Victoria		2166877824					victoria.nadzam@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6723	Utilization Review Contact	VP, Clinical Care Management		Nadzam	Victoria		2166877824					victoria.nadzam@medmutual.com	100 American Road		Cleveland	OH	44144	05/26/2023	2023	MEDICAL MUTUAL OF OHIO	Local CCP	Medical Mutual of Ohio	HMO/HMOPOS		MEDICAL MUTUAL OF OHIO	289	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6743	Agent/Broker Compensation Data Contact	VP Sales Operations		Hohenberg	Brandon		5058600441					brandon.hohenberg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Esp	Bryan		8587906445					PartDCAT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/04/2015	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Backup User Access Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Best Available Evidence Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Bid Audit Contact	Chief Compliance Officer	Mrs.	Flynn	Jordan		6026924381					jordan.flynn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Bid Audit Site Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Bid Primary Contact	VP of Product		Viveiros	Matt		9175826324					matt.viveiros@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	CAP Report Contact for Public Website	Chief Compliance Officer		Flynn	Jordan		9713040068				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	6026924381				PPO - BBA		C	Seattle
H6743	CEO - CMS Administrator Contact	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	CEO - Senior Official for Contracting	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Chief Financial Officer	Chief Financial Officer	Mr.	Stewart	Mark		4012848679					mark.stewart@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Chief Operating Officer	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Chief Information Officer	Chief Information Officer	Mr.	Snyder	Dan		9712089848					dan.snyder@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Chief Information Security Officer	Information Security Officer	Mr.	Rohver	Eric		5414922164					eric.rohveri@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	CMS Casework Communication Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Complaints Tracking Contact	Director of Appeals and Grievances		Vaughn	Sara		9712094307				5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	09/19/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Contact for Fraud Investigations	HIPAA Privacy Officer/FWA Program Manager		Saunders Ricks	Rhonda		9713040043				5035841772	rhonda.saundersricks@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	09/19/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Coordination of Benefits Contact	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Corporate Mailing						8776728620				5035841772	compliance@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/20/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Controller		Kirkpatrick	James		5034285602					james.kirkpatrick@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/17/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Customer Service Operations Contact	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	DIR Contact	Vice President of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	DIR Contact (Secondary)	Director of Actuarial Services		Guest IV	William		5039677386					william.guestIV@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	09/19/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Emergency Part D Contact	VP Pharmacy Operations	Ms.	Liu	Helen		9707129377					helen.liu@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Emergency Part D Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Encounter Data & Risk Adjustment Operations Contact	CFO		Stewart	Mark		4012848679					mark.stewart@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Enrollment Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	EOB Transfer Contact	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441				9512067316	jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Financial Audit Contact	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Financial Reporting Contact	CFO		Stewart	Mark		4012848679				5416728670	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Formulary Contact	Director of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	02/17/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Formulary Contact (Secondary)	Supervisor, Formulary Services		Nyawabila	Christina		8587906297					FMT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/04/2015	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	General Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Government Relations Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	HIPAA Privacy Officer	HIPAA Privacy Officer/FWA Program Manager		Saunders Ricks	Rhonda		9713040043				5035841772	rhonda.saundersricks@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	09/19/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	HIPAA Security Officer	ISO	Mr.	Rohver	Eric		5414922164					eric.rohveri@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Hospice Contact	VP of Pharmacy Operations	Ms.	Liu	Helen		9707129377					helen.liu@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Interoperability Contact	Chief Technology Officer		Snyder	Dan		9712089848					dan.snyder@atriohp.com	1965 Ryan Dr. SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	MA Appeals/Grievances Contact	Director of Appeals and Grievances		Vaughn	Sara		9712094307				5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	09/19/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	MA Claims Processing Contact for Public Website	customer service		Service	Customer		8776728620				5416728670	customerservice@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	10/05/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Marketing Contact	Compliance Manager	Mr.	Allotta	Tony		8303090299					tony.allotta@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	06/09/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Medical Director	Chief Medical Director		Wethers	Darren		3143782525					darren.wethers@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Medicare Coordinator	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Medicare Part D Opioid Overutilization Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	01/19/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Medication Therapy Management Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	OffShore Subcontractor Contact	Chief Legal Officer, General Counsel		Wilson	Charles		5039677387				5035841772	charles.wilson@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	05/18/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Online Enrollment Center Contact (Optional)	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Online Enrollment Center Contact (Primary)	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Part C Application Contact	Chief Legal Officer		Wilson	Charles		5039677387				8662569002	charles.wilson@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	02/15/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Part C Reporting Contact	Compliance Manager	Mrs.	Luma	Yoleine		9172080084					yoleine.luma@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/09/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Part D Appeals	Director of Appeals and Grievances		Vaughn	Sara						5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	09/19/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	8776728620	3			PPO - BBA		C	Seattle
H6743	Part D Appeals Contact (Secondary)	VP of Pharmacy Operationss		Liu	Helen						5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	9707129377				PPO - BBA		C	Seattle
H6743	Part D Application Contact	Chief Legal Officer		Wilson	Charles		5039677387				8662569002	charles.wilson@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	02/15/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Part D Benefits Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Part D Claims Submission Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Part D Exceptions Contact	Director of Appeals and Grievances		Vaughn	Sara						5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	11/11/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	8776728620	3			PPO - BBA		C	Seattle
H6743	Part D Exceptions Contact (Secondary)	VP of Pharmacy Operations	Ms.	Liu	Helen						5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	9717129377				PPO - BBA		C	Seattle
H6743	Part D Price File Contact (Back-up)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Part D Price File Contact (Optional)	Medicare Part D Project Manager		Maldonado	Cheryl		8587906397					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct,		San Diego	CA	92131	04/09/2014	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Part D Price File Contact (Primary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Part D Quality Assurance Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Part D Reporting Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Patient Safety Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Payment Contact	President & CEO		Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Personal Health Record Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Pharmacy Director	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Pharmacy Network Management Contact	Supervisor, Pharmacy Network Support		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	03/13/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Pharmacy Network Management Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Pharmacy Technical Help Desk Contact	Director, Contact Center Services		Brewer	Kathy							Customerservice@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/08/2018	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	8006819571				PPO - BBA		C	Seattle
H6743	Pharmacy Technical Help Desk Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen							helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	9707129377				PPO - BBA		C	Seattle
H6743	PHR Beneficiary Contact																	05/09/2018	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO	ATRIO Health Plans	ATRIO Health Plans	5	Yes	Active	8776728620				PPO - BBA		C	Seattle
H6743	Plan Directory Contact for Public Website	Customer Service		Service	Customer		8776728620				5416728670	customerservice@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	10/05/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Plan to Plan Reconciliation Contact	Chief Financial Officer		Stewart	Mark		4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Processor Contact	Director, Medicare Programs		Scherlippens	Carine		8587907415					Carine.Scherlippens@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	04/09/2014	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Quality Contact	Chief Medical Director		Wethers	Darren		3143782525					darren.wethers@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Reconciliation Contact	Chief Financial Officer		Stewart	Mark		4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Reconciliation Contact (Secondary)	Director of Actuarial Services		Guest IV	William		5039677386					william.guestIV@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	02/17/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Recovery Audit Contact	CFO	Mrs.	Stewart	Mark	I	4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	SNP Application Contact	Director of SNP Programs		Yaun	Caroline		9526886695					caroline.yaun@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	09/08/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	SNP State Contact	Director of SNP Programs		Yaun	Caroline		9526886695					caroline.yaun@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	09/08/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Surveillance Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	System Contact	Chief Technology Officer	Mr.	Snyder	Dan		9712089848					dan.snyder@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Third Party Administrator (TPA) Liaison	Chief Operating Officer		Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	User Access Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	jordan.flynn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/20/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Utilization Management Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6743	Utilization Review Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H6750	Agent/Broker Compensation Data Contact	Vice President, Medicare Sales & Marketing	Ms.	McManus	Marie		6179729400	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Automated TrOOP Balance Transfer Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Backup User Access Contact	Medicare Compliance Program Manager		Tran	Brenda		7816121000	85880				brenda.tran@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Best Available Evidence Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Bid Audit Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Bid Audit Site Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Bid Primary Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852	84759				taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Chief Financial Officer	SVP Chief Financial Officer	Mr.	Walker	Scott		7816126840					r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Chief Operating Officer	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Chief Information Officer	SVP and Chief Information Officer	Ms.	Ferhatbegovic	Selma		7816121000	84633				Selma.Ferhatbegovic@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	CMS Casework Communication Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Complaints Tracking Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Contact for Fraud Investigations	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Coordination of Benefits Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Corporate Mailing						7816121000					Cain.Hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Customer Service Operations Contact	Manager, Member Services	Ms.	Villatoro	Yesly		7816121000	54152				yesly.villatoro@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	DIR Contact	Senior Manager, Pharmacy reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	DIR Contact (Secondary)	Pharmacy Analyst Senior	Ms.	Santino	Cristina		7816121000	82560				cristina.santino@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Emergency Part D Contact	Director, Pharmacy Operations		Bonica	Joseph		7816123342					joseph.bonica@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Emergency Part D Contact (Secondary)	Manager, Pharmacy Compliance		Lake	Matthew		7816123976					matthew.lake@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Employer Waiver Contact	Manager, Client Service	Ms.	Bartkiewicz	Mary		7816121000	83937				mary.bartkiewicz@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Data Analyst Lead	Ms.	Quinlan	Judith		7816121000	83377				judith.quinlan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Enrollment Contact	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	EOB Transfer Contact	Manager, Business Implementation		Nesmith	Tanisha		7816124861				6176730286	tanisha.nesmith@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Financial Audit Contact	Chief Financial Officer	Mr.	Walker	Scott		7816121000	86840				r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Financial Reporting Contact	SVP Finance & Chief Accounting Officer	Mr.	Porter	Mark		6179729400	85536				mark.porter@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Formulary Contact	Clinical Pharmacist Senior	Mr.	Kowalski	Alec		7816121000	82045				alec.kowalski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Formulary Contact (Secondary)	Clinical Pharmacist Senior		Shafir	Frances		7816122897					frances.shafir@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	General Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Government Relations Contact	Chief Government Affairs Officer	Ms.	Lewis	Kristin		7816121000	83621				kristin.lewis@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	HIPAA Privacy Officer	VP Privacy & Special Investigation	Mr.	Walsh	Chris		7816121000	82508				Christopher.walsh@point32health.org	1600 Crown Colony Drive		Quincy	MA	02169	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	HIPAA Security Officer	VP Chief  Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Hospice Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Interoperability Contact	Vice President & Chief Technology Officer		Querusio	David		7816122629					david.querusio@point32health.org	One Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	MA Claims Processing Contact for Public Website	Vice President, Claims	Mr.	Fernandez	David		6175844884					david.fernandez@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Marketing Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Medical Director	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Medicare Compliance Officer	Medicaid Compliance Officer	Mrs	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Medicare Coordinator	SVP, President Medicare	Ms.	Blake	Patty		7816124287					Patty.Blake@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Dohan	David		7816121000	82615				David.Dohan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Medication Therapy Management Contact	Sr Pharmacy Program Manager		Burns	Ashlyn		7816122239					ashlyn.burns@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	OffShore Subcontractor Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Online Enrollment Center Contact (Back-up)	Director, Enrollment & Payment - Senior Products	Ms.	Bullock	Jennifer		7816121000	83183				jennifer.bullock@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Online Enrollment Center Contact (Optional)	Supervisor, Enrollment	Ms.	Van De Mortel	Migdalia		7816121000	84104				Migdalia.Van.De.Mortel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Online Enrollment Center Contact (Primary)	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Part C Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Part C Reporting Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Part D Appeals	Director, Appeals & Grievances		Evans	Kathleen							Kathleen.Evans@point32health.org	1 Wellness Way		Canton	MA	02021	09/20/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	6179729400	87204			HMO - Health Maintenance Organization		C	Boston
H6750	Part D Appeals Contact (Secondary)	Program Manager Senior	Ms.	Mello	Sheri							sheri.mello@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	84862			HMO - Health Maintenance Organization		C	Boston
H6750	Part D Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Part D Benefits Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Part D Claims Submission Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Chan	Bryan							bryan.chan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	82370			HMO - Health Maintenance Organization		C	Boston
H6750	Part D Exceptions Contact (Secondary)	Supervisor, Pharmacy Utilization Management	Ms.	Griffith	Samantha							samantha.griffith@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	84551			HMO - Health Maintenance Organization		C	Boston
H6750	Part D Price File Contact (Back-up)	Advisor, Medicare Operations		Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Part D Price File Contact (Optional)	Sr. Pharmacy Implementation Specialist		Sullivan	Tim		7816124922					tim.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Part D Price File Contact (Primary)	Sr Business Analyst		Moore-Elliott	Shalandria		7637974305					shalandria.moore-elliott@optum.com	1600 McConnor Pwy.		Schaumburg	IL	60173	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Part D Quality Assurance Contact	Vice President, Behavioral Health	Ms.	Borrelli	Jill		6179729400	85397				jill.borrelli@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Part D Reporting Contact	Director, Pharmacy Financial & Reporting	Mr.	Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Patient Safety Contact	Sr Pharmacy Implementation Specialist		von Fritzinger	Lisa		7816123778					lisa.vonfritzinger@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Payment Contact	Program Manager III	Ms.	Cook	Tiffany		7816121000	84908				Tiffany.Cook@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Pharmacy Director	Vice President, Pharmacy	Ms.	Sullivan	Miriam		7816121000	84116				miriam.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations		Ashby	JoLynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Pharmacy Technical Help Desk Contact	Sr. Manager		Villaneuva	Juan							Juan.Villanueva@optum.com	3515 S Harbor Blvd.		Costa Mesa	CA	92626	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7148253761				HMO - Health Maintenance Organization		C	Boston
H6750	Pharmacy Technical Help Desk Contact (Secondary)	Associate Director, Pharmacy Help Desk		Betten	Brad							bradley.betten@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	8555240380				HMO - Health Maintenance Organization		C	Boston
H6750	PHR Beneficiary Contact																	12/02/2016	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS	Harvard Pilgrim HealthCare	Point32Health, Inc.	398	Yes	Active	8883334742				HMO - Health Maintenance Organization		C	Boston
H6750	Physician Incentive Contact	Senior Manager, Contracting Operations and Strateg		Trotman	Yvette		7816126102					yvette.trotman@point32health.org	1600 Crown Colony		Quincy	MA	02169	01/20/2022	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Plan Directory Contact for Public Website	Supervisor, Marketing Materials Production	Mr.	Kayser	Kenneth		7816121000	83518				kenneth.kayser@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Plan to Plan Reconciliation Contact	Manager, Finance Operations	Ms.	Olson	Rachel		7816121000	84360				rachel.olson@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Processor Contact	Director, Claims	Ms.	Patel	Monal		7816121000	88187				monal.patel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Quality Contact	Senior Manager, Quality Informatics	Ms.	McCoy	Kelly		7816121000	83515				kelly.mccoy@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Reconciliation Contact	Senior Manager, Pharmacy Reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Reconciliation Contact (Secondary)	Director, Pharmacy Financial & Reporting		Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	09/11/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Recovery Audit Contact	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	SNP Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	SNP State Contact	Director Business Implementation		Chukwu	Matthew		7816123967					matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Surveillance Contact	Director, Sales Operations		McManus	Marie		6117972940	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	System Contact	Senior Manager, Business Account Management	Mr.	Allen	Jeffrey		7816121000	83167			6179729008	Jeffrey.Allen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Third Party Administrator (TPA) Liaison	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	User Access Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Utilization Management Contact	Director, Care Management	Ms.	Menery	Maureen		7816121000	83994				maureen.menery@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6750	Utilization Review Contact	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	HARVARD PILGRIM HEALTH CARE OF NEW ENGLAND, INC.	Local CCP	Harvard Pilgrim Health Care of New England, Inc.	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6759	Automated TrOOP Balance Transfer Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Backup User Access Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Best Available Evidence Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Bid Primary Contact	Business Office Manager		Cox	Terra		9709643500	3556			9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	CAP Report Contact for Public Website	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	CEO - CMS Administrator Contact	Chief of Community Healthcare	Mr	Soczynski	Paul		4144068843				9529417097	psoczynski@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/28/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	CEO - Senior Official for Contracting	Chief of Community Healthcare	Mr	Soczynski	Paul		4144068843				9529417097	psoczynski@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/16/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Chief Financial Officer	Sr. Director, Health Plan Operations	Mr.	Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/16/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Chief Operating Officer	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Chief Information Officer	Chief Information & Technology Officer	Mr	Osborne	David		6124287900				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Chief Information Security Officer	Chief Information & Technology Officer	Mr	Osborne	David		6124287900				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	CMS Casework Communication Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Complaints Tracking Contact	Director Program Integrity/Compliance		Linnell	Kathryn	R	9708352910				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Contact for Fraud Investigations	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Coordination of Benefits Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Corporate Mailing						9529410305				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/16/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Customer Service Operations Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	DIR Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	DIR Contact (Secondary)	Finance Manager	Mr	Raynor	Eddy		9194253053					eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	02/21/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Emergency Part D Contact	Executive Director		Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th Street		Louisville	KY	40203	03/09/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Emergency Part D Contact (Secondary)	Director Program Integrity/Compliance	Ms	Linnell	Kathryn		9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/09/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Encounter Data & Risk Adjustment Operations Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	11485 Highway 65		Eckert	CO	81418	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Enrollment Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	EOB Transfer Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Financial Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Financial Reporting Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Formulary Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	General Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Government Relations Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	HIPAA Privacy Officer	Chief Information & Technology Officer	Mr	Osborne	David		6124287900				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/20/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	HIPAA Security Officer	Chief Information & Technology Officer	Mr	Osborne	David		6124287900				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/20/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Interoperability Contact	Director of Program Integrity/Compliance		Linnell	Kathryn		9705087757				9702520166	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	MA Appeals/Grievances Contact	Director of Quality		Peterson	Nora		9709643500				9702520166	npeterson@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	MA Claims Processing Contact for Public Website	Claims Administrator		Ford	Jill		9705087711				9707971984	jford@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Marketing Contact	Marketing&Communication Relations		Rincon	Michelle		5173190740				5173190650	mrincon@voa.org	1921 E Miller Road		Lansing	MI	48911	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Medical Director	Medical Director	Dr.	Speedie	Douglas		9708358500				9702520166	DSpeedie@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Medicare Compliance Officer	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Medicare Coordinator	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	4022 Stirrup Creek Drive Suite 315		Durham	NC	27703	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Medicare Part D Opioid Overutilization Contact	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9705087757				9702520166	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Medication Therapy Management Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Part C Application Contact	Executive Director		Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th Street		Louisville	KY	40203	03/08/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Part D Appeals	Director Program Integrity/Compliance	Ms	Linnell	Kathryn	R					8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	02/20/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active	9705087757				PACE - Nat		C	Atlanta
H6759	Part D Application Contact	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/16/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Part D Benefits Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Part D Claims Submission Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Part D Exceptions Contact	Finance Manager		Raynor	Eddy						9194253001	eraynor@voa.org	5400 S. Miami Blvd. Ste 150		Durham	NC	27703	03/08/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active	9194253053				PACE - Nat		C	Atlanta
H6759	Part D Exceptions Contact (Secondary)	Director Program Integrity/Compliance	Ms	Linnell	Kathryn						8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active	9705087757				PACE - Nat		C	Atlanta
H6759	Part D Price File Contact (Back-up)	Executive Director		Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th Street		Louisville	KY	40203	03/09/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Part D Price File Contact (Primary)	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/16/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Part D Quality Assurance Contact	Director Program Integrity/Compliance	Ms	Linnell	Kathryn		9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Part D Reporting Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Patient Safety Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Payment Contact	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	4022 Stirrup Creek Drive Suite 315		Durham	NC	27703	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Pharmacy Director	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Pharmacy Network Management Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Pharmacy Technical Help Desk Contact	Executive Director		Howell	Keith						9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active	9709643500				PACE - Nat		C	Atlanta
H6759	Plan Directory Contact for Public Website	Executive Director		Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th Street		Louisville	KY	40203	03/08/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Plan to Plan Reconciliation Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Processor Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Quality Contact	Quality Assurance Manager		Peterson	Nora		9708352960				9708352902	npeterson@voa.org	11485 Hwy 65		Eckert	CO	81418	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Reconciliation Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Reconciliation Contact (Secondary)	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/16/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Recovery Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Surveillance Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	System Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Third Party Administrator (TPA) Liaison	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/16/2023	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	User Access Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Utilization Management Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6759	Utilization Review Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	06/15/2022	2023	Senior CommUnity Care Of Kentucky	National PACE	Senior CommUnity Care of Kentucky	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Atlanta
H6765	Agent/Broker Compensation Data Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Automated TrOOP Balance Transfer Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Backup User Access Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Best Available Evidence Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Bid Audit Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Bid Audit Site Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Bid Primary Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	CAP Report Contact for Public Website	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	CEO - CMS Administrator Contact	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	CEO - Senior Official for Contracting	CEO	Mr.	Bailey	Michael	D	6157518131				8442805360	mbailey@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Chief Financial Officer	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Chief Operating Officer	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Chief Information Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Chief Information Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	CMMI Model Point of Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	CMS Casework Communication Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Complaints Tracking Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Contact for Fraud Investigations	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Coordination of Benefits Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Corporate Mailing						6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Customer Service Operations Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	DIR Contact	VP Formulary & Rebate Economics		Ellermeir	Nicole		9133875120					nellermeir@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	DIR Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Electronic Health Record Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Emergency Part D Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Emergency Part D Contact (Secondary)	Pharmacy Operations	Mrs.	Sanchez	Lynn		4056014429				8442805360	lsanchez@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Encounter Data & Risk Adjustment Operations Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Enrollment Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	EOB Transfer Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Financial Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Financial Reporting Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Formulary Contact	Clinical Formulary Pharmacist	Ms.	Quinn	Kelsey		3304864954					kquinn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Formulary Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	General Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Government Relations Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	HIPAA Privacy Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	HIPAA Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Hospice Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Interoperability Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	MA Appeals/Grievances Contact	Sr Director, Health Plan Administration	Mrs.	Brimm	Angie		8665834649				8442805360	abrimm@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	07/25/2023	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	MA Claims Processing Contact for Public Website	Sr. Director, Health Plan Administration	Mrs.	Brimm	Angie		8665834649				8442805360	abrimm@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	07/25/2023	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Marketing Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Medical Director	Medical Director	Dr.	Misra	Sumathi		6156365478					SMisra@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/17/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Medicare Compliance Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Medicare Coordinator	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Medicare Part D Opioid Overutilization Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Medication Therapy Management Contact	Director of Clinical Product Development and Strat	Ms.	Miller	Holly		3304866457				3304058094	hrmiller@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	OffShore Subcontractor Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Online Enrollment Center Contact (Back-up)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Online Enrollment Center Contact (Primary)	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Part C Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Part C Reporting Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Appeals	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations	Mr	Binegar	Sam						3304058081	appeals@ElixirSolutions.com	2181 E Aurora Road	Building B, Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8003997524				HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Benefits Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Claims Submission Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Exceptions Contact	Associate VP of Clinical Operations	Ms.	Lavignette	Amanda						3304864801	alavignette@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Exceptions Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Price File Contact (Back-up)	Sr Financial Manager Reporting & Analytics	Mr	Campbell	Tim		3308886988					tcampbell@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Price File Contact (Optional)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Price File Contact (Primary)	Senior Director Rebates, Trade Relations	Mr.	Bonus	Jason		3304864841				3304864801	jbonus@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Quality Assurance Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Part D Reporting Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Patient Safety Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Pharmacy Director	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Pharmacy Network Management Contact	Director of Pharmacy Network Development and Ops	Ms	Profio	Lauren		3304864864				3304058094	lprofio@ElixirSolutions.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/17/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Pharmacy Network Management Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8335026757				HMO - Health Maintenance Organization		C	Dallas
H6765	Pharmacy Technical Help Desk Contact (Secondary)			Sanchez	Lynn						4056015627	lsanchez@amhealthplans.com	909 S. Meridian Ave. Ste 425		Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8555210627				HMO - Health Maintenance Organization		C	Dallas
H6765	Plan Directory Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Plan to Plan Reconciliation Contact	Sr. Manager,  Financial Accounting	Ms.	Tilley	Stephanie		9312420499					stilley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	08/30/2023	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Processor Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Quality Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Reconciliation Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Reconciliation Contact (Secondary)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Recovery Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	SNP Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	SNP State Contact	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Surveillance Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	System Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Third Party Administrator (TPA) Liaison	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	User Access Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Utilization Management Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6765	Utilization Review Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF IOWA INC	Local CCP	Iowa Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6776	Agent/Broker Compensation Data Contact	SVP of Finance		Kehoe	John		3478423503					John.Kehoe@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Automated TrOOP Balance Transfer Contact	VP of ITS		Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	04/25/2018	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Backup User Access Contact	SVP of Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Best Available Evidence Contact	VP of Operational Support		Rosen	Richard		3478423684					richard.rosen@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	07/17/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Bid Audit Contact	SVP of Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Bid Primary Contact	SVP of Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	CAP Report Contact for Public Website	SVP of Quality		Konrad	Marcia		9142688418					marcia.konrad@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active	8009509000				HMO - Health Maintenance Organization		C	New York
H6776	CEO - CMS Administrator Contact	Executive Vice President	Ms.	Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	CEO - Senior Official for Contracting	Executive Vice President	Ms.	Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	07/17/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Chief Financial Officer	SVP of Finance	Mr.	Kehoe	John		3478423503					john.kehoe@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Chief Operating Officer	SVP Clinical Operations	Ms.	Lau	Julieanne		3478423554					julieanne.lau@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Chief Information Officer	VP of ITS	Mr.	Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	04/25/2018	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Chief Information Security Officer	VP of ITS	Mr.	Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	04/25/2018	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	CMS Casework Communication Contact	Executive Vice President		Aldrich	Susan	Y	9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	07/17/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Complaints Tracking Contact	Director of Contracts and Compliance		Wong	Diana		3478423666					diana.wong@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/19/2021	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Contact for Fraud Investigations	SVP of Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Coordination of Benefits Contact	SVP of Finance		Kehoe	John		3478423503					John.Kehoe@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Corporate Mailing						8009509000					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	04/25/2018	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Coverage Gap Discount Program (CGDP) Payment Contact	AVP of Finance		Lugo	Michelle		3478423557					michelle.lugo@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/19/2021	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Customer Service Operations Contact	VP of Member Services		Hron	Patty		3478423541					patty.hron@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	DIR Contact	AVP of Compliance		Khassanov	Yana		3478423509					yana.khassanov@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	07/17/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	DIR Contact (Secondary)	Director of Medicare		Williams	Sadirah		9292436197					Sadirah.Williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/16/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Emergency Part D Contact	Account Manager		Mazzone	Amanda		8136526685					Amanda_Mazzone@express-scripts.com	Express Scripts	one Express Way	St. Louis	MO	63121	11/01/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Emergency Part D Contact (Secondary)	Medicare Strategist		Miller	Wayne		5702446859					Wmiller2@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	11/01/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Encounter Data & Risk Adjustment Operations Contact	VP of ITS	Mr.	Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	10/18/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Enrollment Contact	Executive Vice President		Aldrich	Susan	Y	9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	07/17/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	EOB Transfer Contact	SVP of Finance		Kehoe	John		3478423503				8666907596	John.Kehoe@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Financial Audit Contact	SVP of Finance	Mr.	Kehoe	John		3478423503					john.kehoe@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Financial Reporting Contact	SVP of Finance		Kehoe	John		3478423503					John.Kehoe@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Formulary Contact	Director of Medicare		Williams	Sadirah		3477787881					sadirah.williams@elderservehealth.org	80 West 225th St.		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Formulary Contact (Secondary)	AVP of Compliance		Khassanov	Yana		3478423509				8887778279	yana.khassanov@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/19/2021	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	General Contact	Executive Vice President		Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	07/17/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Government Relations Contact	Executive Vice President		Aldrich	Susan	Y	9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	07/17/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	HIPAA Privacy Officer	SVP of Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	HIPAA Security Officer	VP of ITS		Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	04/25/2018	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Hospice Contact	SVP Clinical Operations	Ms.	Lau	Julieanne		3478423554					julieanne.lau@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Interoperability Contact	VP Technology		Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th street		Bronx	NY	10463	02/11/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	MA Appeals/Grievances Contact	SVP of Quality		Konrad	Marcia		9142688418					marcia.konrad@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	MA Claims Processing Contact for Public Website	AVP of Claims		Flanagan	Fiona		3478423526					fiona.flanagan@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/19/2021	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Marketing Contact	Executive Vice President		Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	07/17/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Medical Director	Medical Director	Dr.	Davidson	Peter		3478423546					peter.davidson@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Medicare Compliance Officer	SVP of Regulatory Affairs	Esq.	Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Medicare Coordinator	AVP of Compliance		Khassanov	Yana		3478423509					yana.khassanov@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	07/17/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Medicare Part D Opioid Overutilization Contact	Director, Clinical & Trend Solutions		Muralidharan	Adrienne		3143131932					amuralidharan@express-scripts.com	ESI	One Express Way	St. Louis	MO	63121	10/28/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Medication Therapy Management Contact	AVP of Compliance		Khassanov	Yana		3478423509					Yana.Khassanov@elderservehealth.org	80 West 225th St.		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Part C Application Contact	SVP of Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Part C Reporting Contact	SVP of Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Part D Appeals	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	ESI	5151 Blazer Pkwy	Dublin	OH	43017	11/07/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	New York
H6776	Part D Appeals Contact (Secondary)	Director of Medicare		Williams	Sadirah							sadirah.williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	03/15/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active	8007710088				HMO - Health Maintenance Organization		C	New York
H6776	Part D Application Contact	SVP of Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Part D Benefits Contact	AVP of Compliance		Khassanov	Yana		3478423509					Yana.Khassanov@elderservehealth.org	80 West 225th St.		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	ESI	1 Express Way	St. Louis	MO	63121	10/28/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Part D Exceptions Contact	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	ESI	5151 Blazer Pkwy	Dublin	OH	43017	11/07/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	New York
H6776	Part D Exceptions Contact (Secondary)	Director of Medicare		Williams	Sadirah							sadirah.williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	03/13/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active	9292436197				HMO - Health Maintenance Organization		C	New York
H6776	Part D Price File Contact (Back-up)	Manager Regulated Markets Product		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	ESI	4865 Dixie Hway	Fairfield	OH	45014	04/12/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Part D Price File Contact (Optional)	Director of Medicare		Williams	Sadirah		9292436197					sadirah.williams@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	03/15/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Part D Price File Contact (Primary)	Sr. Manager, Regulated Markets		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	ESI	5151 Blazer Pkwy	Dublin	OH	43017	04/12/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Part D Quality Assurance Contact	Director of Medicare		Williams	Sadirah		9292436197					Sadirah.Williams@elderservehealth.org	80 West 225th St.		Bronx	NY	10463	03/02/2021	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Part D Reporting Contact	SVP of Regulatory Affairs		Ling	Jenny		3478423528					jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Patient Safety Contact	SVP Clinical Operations		Lau	Julieanne		3478423554					julieanne.lau@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Payment Contact	SVPof Finance		Kehoe	John		3478423503					John.Kehoe@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Pharmacy Director	AVP of Compliance		Khassanov	Yana		3478423509					Yana.Khassanov@elderservehealth.org	80 West 225th St.		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Pharmacy Network Management Contact	Network Account, Director, Retail Strategy Network		Kelly	Heather		3146921866					hakelly@express-scripts.com	ESI	1 Express Way	St. Louis	MO	63121	10/28/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Pharmacy Network Management Contact (Secondary)	AVP of Network Development		Altamirano	Bolivar		3478423527					bolivar.altamirano@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/16/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	ESI	13051 N Telecom Pkwy Ste 150	Temple Terrace	FL	33637	11/07/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H6776	Plan Directory Contact for Public Website	AVP of Network Development		Altamirano	Bolivar		3478423527					bolivar.altamirano@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/16/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Plan to Plan Reconciliation Contact	AVP of Finance		Lugo	Michelle		3478423557					michelle.lugo@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/19/2021	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Processor Contact	VP of Claims		Flanagan	Fiona		3478423526					fiona.flanagan@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/16/2022	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Quality Contact	AVP of Quality		Konrad	Marcia		9142688418					marcia.konrad@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Reconciliation Contact	SVP of Finance		Kehoe	John		3478423503					John.Kehoe@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Reconciliation Contact (Secondary)	AVP of Finance		Lugo	Michelle		3478423557					michelle.lugo@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/19/2021	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Recovery Audit Contact	SVP of Finance	Mr.	Kehoe	John		3478423503					john.kehoe@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	SNP Application Contact	SVP of Regulatory Affairs		Ling	Jenny		3478423528				8887778279	jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	SNP State Contact	Senior Vice President of Regulatory Affairs		Ling	Jenny		3478423528				8887778279	jenny.ling@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	04/25/2018	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Surveillance Contact	Executive Vice President		Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	07/17/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	System Contact	VP of ITS		Ramaglia	Damon		3478423584					damon.ramaglia@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	04/25/2018	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Third Party Administrator (TPA) Liaison	AVP of Finance		Lugo	Michelle		3478423557					michelle.lugo@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/19/2021	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	User Access Contact	AVP of Compliance		Khassanov	Yana		3478423509				8887778279	Yana.Khassanov@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/19/2021	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Utilization Management Contact	Executive Vice President		Aldrich	Susan		9149604407					susan.aldrich@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	07/17/2019	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6776	Utilization Review Contact	Medical Director	Dr.	Davidson	Peter		3478423546					peter.davidson@elderservehealth.org	80 West 225th Street		Bronx	NY	10463	02/22/2023	2023	ELDERSERVE HEALTH, INC.	Local CCP	RiverSpring Health Plans	HMO/HMOPOS		RiverSpring Living Holding Corp.	524	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6787	Automated TrOOP Balance Transfer Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Backup User Access Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Best Available Evidence Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Bid Primary Contact	Business Office Manager		Cox	Terra		9709643500	3556			9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	CAP Report Contact for Public Website	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	CEO - CMS Administrator Contact	Chief of Community Healthcare	Mr.	Soczynski	Paul		4144068843				9529417097	PSoczynski@voa.org	7485 Office Ridge circle		Eden Prairie	MN	55344	02/27/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	CEO - Senior Official for Contracting	Chief of Community Healthcare	Mr.	Soczynski	Paul		4144068843				9529417097	PSoczynski@voa.org	7485 Offie Ridge Circle		Eden Prairie	MN	55344	02/27/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Chief Financial Officer	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124287858				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Chief Operating Officer	Executive DIrector	Mr.	Robbins	Ken		5173190700					krobbins@voa.org	1921 E. Miller Road		Lansing	MI	48911	05/03/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Chief Information Officer	Vice President of Information Technologies	Mr	Osborne	David		9529410305				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/03/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Chief Information Security Officer	Vice President of Information Technologies	Mr	Osborne	David		9529410305				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/03/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	CMS Casework Communication Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Complaints Tracking Contact	Director of Program Integrity/Compliance		Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	02/27/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Contact for Fraud Investigations	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	02/27/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Coordination of Benefits Contact	Business office Manager	Ms	Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/27/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Corporate Mailing						9529410305				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director, Health Plan Operations	Mr.	Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Customer Service Operations Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	DIR Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	DIR Contact (Secondary)	Finance Manger	Mr	Raynor	Eddy		9194253053					eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	02/20/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Emergency Part D Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Emergency Part D Contact (Secondary)	Director of Program Integrity	Ms.	Linnell	Kathryn	R	9709643500				9702520166	klinnell@voa.org	2377Robins Way		Montrose	CO	81401	02/21/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Encounter Data & Risk Adjustment Operations Contact	Business office Manager	Ms.	Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/27/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Enrollment Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	EOB Transfer Contact	Business Office Manager	Ms.	Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/27/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Financial Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Financial Reporting Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Formulary Contact	Pace Regional Executive	Mr.	Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	02/27/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	General Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Government Relations Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	HIPAA Privacy Officer	Vice President of Information Technology	Mr.	Osborne	David		9529410305				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/03/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	HIPAA Security Officer	Vice President of Information Technology	Mr.	Osborne	David		9529410305				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	03/03/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Interoperability Contact	Director Program Integrity/Compliance	Ms.	Linnell	Kathryn		9705087757				8668299949	klinnell@voa.org	2377 Robins Ways		Montrose	CO	81401	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	MA Appeals/Grievances Contact	Director of Quality	Ms.	Peterson	Nora		9709643500				9702520166	npeterson@voa.org	2377 Robins Way		Montrose	CO	81401	02/27/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	MA Claims Processing Contact for Public Website	Claims Administrator	Ms	Ford	Jill		9705087711				9707971984	jford@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Marketing Contact	Marketing Coordinator		Rincon	Michelle		5173190700				5173190650	mrincon@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Medical Director	Medical Director	Dr.	Hengstebeck	Elizabeth		5173190700				5173190717	ehengstebeck@voa.org	1921 East Miller Road		Lansing	MI	48911	07/02/2018	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Medicare Compliance Officer	PACE Director of Program Integrity/Compliance	Ms.	Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	12/28/2021	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Medicare Coordinator	Finance Manager	Mr.	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	5400 S Miami Blvd., Ste 150		Durham	NC	27703	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Medicare Part D Opioid Overutilization Contact	Director Program Integrity/Compliance	Ms	Linnell	Kathryn		9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Medication Therapy Management Contact	Medical Director	Dr.	Hengstebeck	Elizabeth		5173190700				5179135991	ehengstebeck@voa.org	1921 East Miller Road		Lansing	MI	48911	07/02/2018	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Part C Application Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Part D Appeals	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn						8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active	9705087757				PACE - Nat		C	Chicago
H6787	Part D Appeals Contact (Secondary)	Executive Director		Robbins	Ken	S						krobbins@vova.org	1921 East Miller Road		Lansing	MI	48911	01/11/2021	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active	2316383079				PACE - Nat		C	Chicago
H6787	Part D Application Contact	Sr. Director, Health Plan Operations	Mr.	Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Part D Benefits Contact	Business Office Manager	Ms	Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Part D Claims Submission Contact	Business office Manager	Ms.	Cox	Terra		9705087757				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Part D Exceptions Contact	Finance Manager	Mr.	Raynor	Eddy						9194253001	eraynor@voa.org	5400 S. Miami Blvd. Ste 150		Durham	NC	27703	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active	9194253053				PACE - Nat		C	Chicago
H6787	Part D Exceptions Contact (Secondary)	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn						8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active	9705087757				PACE - Nat		C	Chicago
H6787	Part D Price File Contact (Back-up)	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 E Miller Rd		Lansing	MI	48911	03/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Part D Price File Contact (Primary)	Sr. Director, Health Plan Operations	Mr.	Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Part D Quality Assurance Contact	Director Program Integrity/Compliance	Ms	Linnell	Kathryn		9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Part D Reporting Contact	Finance Manager	Mr.	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	5400 S. Miami Blvd., Ste 150		Durham	NC	27703	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Patient Safety Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Payment Contact	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	4022 Stirrup Creek Drive Suite 315		Durham	NC	27703	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Pharmacy Director	Regional Executive Director	Mr	Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Pharmacy Network Management Contact	Executive Director	Mr.	Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Pharmacy Technical Help Desk Contact	Executive Director	Mr.	Howell	Keith						9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active	9709643500				PACE - Nat		C	Chicago
H6787	Plan Directory Contact for Public Website	Executive Director		Robbins	Ken		5173190700				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Plan to Plan Reconciliation Contact	Business Office Manager	Ms.	Cox	Terra		9705077737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/27/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Processor Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Quality Contact	Director of Quality		Peterson	Nora		9709643500				9702520166	npeterson@voa.org	2377 Robins Way		Montrose	CO	81401	03/08/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Reconciliation Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Reconciliation Contact (Secondary)	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Praire	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Recovery Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/15/2022	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Surveillance Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	System Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Third Party Administrator (TPA) Liaison	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	User Access Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Utilization Management Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6787	Utilization Review Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	03/11/2020	2023	VOANS SENIOR COMMUNITY CARE OF MICHIGAN, INC.	National PACE	Senior Community Care of Michigan	National PACE		Volunteers of America National Services	367	Yes	Active					PACE - Nat		C	Chicago
H6796	Automated TrOOP Balance Transfer Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Backup User Access Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Best Available Evidence Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Bid Primary Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	CAP Report Contact for Public Website			Sander	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	CEO - CMS Administrator Contact		Ms.	Bell	Yvonne		7603449951					yvonneb@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	CEO - Senior Official for Contracting		Ms.	Bell	Yvonne		7603449951					yvonneb@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Chief Financial Officer		Ms.	Rizzo	Marlene		7603449951					marlener@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Chief Operating Officer		Ms.	Bell	Yvonne		7603449951					yvonneb@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Chief Information Officer		Ms.	Bell	Yvonne		7603449951					yvonneb@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Chief Information Security Officer		Ms.	Bell	Yvonne		7603449951					yvonneb@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	CMS Casework Communication Contact		Ms.	Bell	Yvonne		7603449951					yvonneb@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Complaints Tracking Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Contact for Fraud Investigations			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Coordination of Benefits Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Corporate Mailing						7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Coverage Gap Discount Program (CGDP) Payment Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Customer Service Operations Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	DIR Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Emergency Part D Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Encounter Data & Risk Adjustment Operations Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Enrollment Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	EOB Transfer Contact			Sanders	Sara		7603449951				7603449951	saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Financial Audit Contact	CFO	Ms.	Rizzo	Marlene		7603449951					marlener@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Financial Reporting Contact		Ms.	Rizzo	Marlene		7603449951					marlener@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Formulary Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	General Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Government Relations Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	HIPAA Privacy Officer			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	HIPAA Security Officer			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Interoperability Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	MA Appeals/Grievances Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	MA Claims Processing Contact for Public Website			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Marketing Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Medical Director			Slone	Jonathan		7603449951					jonathans@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Medicare Compliance Officer		Ms.	Bell	Yvonne		7603449951					yvonneb@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Medicare Coordinator		Ms.	Bell	Yvonne		7603449951					yvonneb@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Medicare Part D Opioid Overutilization Contact			Slone	Jonathan		7603449951					jonathans@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Medication Therapy Management Contact			Slone	Jonathan		7603449951					jonathans@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Part C Application Contact			Sanders	Sara		7603449951	10106				saras@innercare.org	852 E. Danenberg Drive		El Centro	CA	92243	10/19/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Part D Appeals			Sanders	Sara							saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending	8004653203				PACE - Nat		C	San Francisco
H6796	Part D Application Contact			Sanders	Sara		7603449951	10106				saras@innercare.org	852 E. Danenberg Drive		El Centro	CA	92243	10/19/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Part D Benefits Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Part D Claims Submission Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Part D Exceptions Contact			Sanders	Sara							saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending	8004653203				PACE - Nat		C	San Francisco
H6796	Part D Price File Contact (Back-up)			Slone	Jonathan		7603449951					jonathans@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Part D Price File Contact (Primary)			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Part D Quality Assurance Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Part D Reporting Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Patient Safety Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Payment Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Pharmacy Director			Slone	Jonathan		7603449951					jonathans@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Pharmacy Network Management Contact			Slone	Jonathan		7603449951					jonathans@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Pharmacy Technical Help Desk Contact			Sanders	Sara							saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending	8004653203				PACE - Nat		C	San Francisco
H6796	Plan Directory Contact for Public Website			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Plan to Plan Reconciliation Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Processor Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Quality Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Reconciliation Contact	CFO	Ms.	Rizzo	Marlene		7603449951					marlener@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Recovery Audit Contact	CFO	Ms.	Rizzo	Marlene		7603449951					marlener@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Surveillance Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	System Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Third Party Administrator (TPA) Liaison			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	User Access Contact		Ms.	Bell	Yvonne		7603449951					yvonneb@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Utilization Management Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6796	Utilization Review Contact			Sanders	Sara		7603449951					saras@innercare.org	852 East Danenberg Drive		El Centro	CA	92243	12/28/2022	2023	CLINICAS DE SALUD DEL PUEBLO, INC.	National PACE	Innercare PACE	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H6813	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6813	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6813	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6813	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6813	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H6813	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H6813	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H6813	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6813	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TEXAS INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H6815	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Rd		Tampa	FL	33436	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H6815	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2020	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/07/2018	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/10/2017	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/10/2017	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/10/2017	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Medical Director	Chief Medical Officer	Dr.	Chen	Alex		8186766564					alex.y.chen@healthnet.com	21281 Burbank Blvd		Woodland Hills	CA	91367	03/30/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Rd.		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/10/2017	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2020	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H6815	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H6815	PHR Beneficiary Contact																	09/27/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8445825177				HMO - Health Maintenance Organization		C	Dallas
H6815	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Plan Directory Contact for Public Website			Services	Provider		8884458913					CorporateMedicareComplianceDept@Centene.com	1321 SW 68th Parkway		Tigard	OR	97223	03/31/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/17/2023	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6815	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET HEALTH PLAN OF OREGON, INC.	Local CCP	Wellcare by Health Net	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6830	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H6830	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	01/31/2020	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	01/31/2020	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	01/31/2020	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Medical Director	Sr. VP, Medical Affairs	Dr.	Nelson	Vincent		3145056872					vincent.nelson@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/17/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H6830	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H6830	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H6830	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H6830	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/31/2020	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H6830	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H6830	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8338166623				PPO - BBA		C	Dallas
H6830	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Plan Directory Contact for Public Website			Services	Provider		8555659519					CorporateMedicareComplianceDept@CENTENE.COM	8325 Lenexa Drive	Suite 200	Lenexa	KS	66214	03/31/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6830	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY KANSAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H6832	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	12/31/2019	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Backup User Access Contact	Medicare Compliance Officer, Plan Partner Support	Ms.	Bouyer	Valorie		6159161254					valorie.bouyer@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/23/2019	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	CEO - CMS Administrator Contact	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	CEO - Senior Official for Contracting	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Chief Financial Officer	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Chief Operating Officer	Chief Operating Officer/General Manager	Mr.	Emami	John		7038837508					john.emami@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Contact for Fraud Investigations	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/23/2019	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Corporate Mailing						8558550336					customerservice@alignseniorcare.com	PO BOX 4440		Glen Allen	VA	23058	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Coverage Gap Discount Program (CGDP) Payment Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment	Mr.	Hassenstab	Mark		5072697711					Mark.Hassenstab@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/23/2019	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	EOB Transfer Contact			Lowry	Kristy		8558550336				8336102390	kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Financial Audit Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Financial Reporting Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	12/31/2019	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	General Contact	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	HIPAA Privacy Officer	Chief Compliance Officer and HIPAA Privacy Officer	Ms.	Crowe	Melanie		4049330409					melanie.crowe@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	HIPAA Security Officer	Sr. Director Cybersecurity	Mr	Brogdon	Clevelen		6158094476					Clevelen.Brogdon@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	MA Claims Processing Contact for Public Website	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Medical Director	VP Medical Affairs		Dahlgren	Andrew		8042968288					Andrew.Dahlgren@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	06/14/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Medicare Coordinator	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/14/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	03/09/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part C Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	12/31/2019	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Payment Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Philadelphia
H6832	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H6832	Physician Incentive Contact	Executive Director	Mr.	Bryant	Greg	L	6154804567					greg.bryant@alignseniorcare.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Plan Directory Contact for Public Website			Sindlinger	Rocio		8558550336					rocio.sindlinger@allyalign.com	PO BOX 4440		Glen Allen	VA	23058	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Plan to Plan Reconciliation Contact	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/23/2019	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Quality Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	03/09/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Reconciliation Contact		Mr.	Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/08/2019	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Reconciliation Contact (Secondary)	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Recovery Audit Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	System Contact	VP Systems and Interim Security Officer	Ms.	Carino	Lea		8042209287					lea.carino@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	03/31/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Third Party Administrator (TPA) Liaison	Manager of Regulatory Accounting	Ms.	Weis	Katelyn		6073294042					kate.weis@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	User Access Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6832	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/20/2021	2023	ALIGN SENIOR CARE MI, LLC	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6846	Automated TrOOP Balance Transfer Contact	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Backup User Access Contact	Program Director	Ms.	Cone	Kirsten		8282138440					Kirsten.cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	12/23/2022	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Best Available Evidence Contact	Program Director	Ms.	Cone	Kirsten		8282138440					Kirsten.cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	12/23/2022	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Bid Primary Contact	Program Director	Ms.	Cone	Kirsten		8282138442					Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	CAP Report Contact for Public Website	Program Director	Ms.	Cone	Kirsten		8282138442				8286818913	kirsten.cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	CEO - CMS Administrator Contact	CEO	Mrs	Buchanan	Tracy		8282746185					tracy.buchanan@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	01/27/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	CEO - Senior Official for Contracting	Program Director	Ms.	Cone	Kirsten		8282138442					Kirsten.Cone@hcahealthcare.com	286 Overlook Rd		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Chief Financial Officer	CFO	Mr.	Groesser	Tyler		8282774818					tyler.groesser@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	08/13/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Chief Operating Officer	Program Director	Ms.	Cone	Kirsten		8282138442				8286818913	Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Chief Information Officer	Chief Information Officer	Mr.	Brown	Jon		8282130422					jon.brown3@hcahealthcare.com	980 Hendersonville Road		Asheville	NC	28803	02/18/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Chief Information Security Officer	Information Security Officer	Mr.	Kelly	Jim		8282130330					Jim.Kelly@hcahealthcare.com	980 Hendersonville Road		Asheville	NC	28803	02/18/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	CMS Casework Communication Contact	Program Director	Ms.	Cone	Kirsten		8282138440					Kirsten.cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	12/23/2022	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Complaints Tracking Contact	Quality and Compliance Director	Mrs.	Hanson	Teresa		8282138440	1021047				teresa.hanson1@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	04/04/2022	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Contact for Fraud Investigations	Ethis and Compliance Officer & Privacy	Ms.	Davis	Bailey		8287778191					Bailey.Davis3@HCAHealthcare.com	68 Sweeten Creek Road		Asheville	NC	28803	09/20/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Coordination of Benefits Contact	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Corporate Mailing						8282138442				8286818913	Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	02/18/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager	Mr	Earley	Trey		8282138442					trey.earley@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	09/29/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Customer Service Operations Contact	Program Director	Ms.	Cone	Kirsten		8282138442				8286818913	kirsten.cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	DIR Contact	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	DIR Contact (Secondary)	CFO	Mr	Groesser	Tyler		9415397329					tyler.groesser@hcahealthcare.com	68 Sweeten Creek		Asheville	NC	28803	09/09/2022	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Emergency Part D Contact	Program Director	Ms.	Cone	Kirsten		8282138442					Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Emergency Part D Contact (Secondary)	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Encounter Data & Risk Adjustment Operations Contact	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	10/31/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Enrollment Contact	Finance Manager	Mr	Earley	Trey		8282138442					trey.earley@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	09/29/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	EOB Transfer Contact	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Financial Audit Contact	Finance Manager	Mr.	Earley	Trey		8282138442					trey.earley@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	09/20/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Financial Reporting Contact	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Formulary Contact	Manager - Retail Pharmacy Operations	Ms.	Lamm	Meredith		8282130050					Meredith.Lamm@HCAHealthcare.com	2 Medical Park Drive		Asheville	NC	28803	06/15/2020	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Formulary Contact (Secondary)	Finance Manager	Mr	Earley	Trey		8282138442					trey.earley@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	09/29/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	General Contact	Program Director	Ms.	Cone	Kirsten		8282138442					kirsten.cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Government Relations Contact	Program Director	Ms.	Cone	Kirsten		8282138440					Kirsten.cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	12/23/2022	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	HIPAA Privacy Officer	Ethis and Compliance Officer & Privacy	Ms.	Davis	Bailey		8287778191					Bailey.Davis3@HCAHealthcare.com	68 Sweeten Creek Road		Asheville	NC	28803	09/20/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	HIPAA Security Officer	Ethis and Compliance Officer & Privacy	Ms.	Davis	Bailey		8287778191					Bailey.Davis3@HCAHealthcare.com	68 Sweeten Creek Road		Asheville	NC	28803	09/20/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Interoperability Contact	Program Director		Cone	Kirsten	L	8282138440					kirsten.cone@hcahealthcare.com	286 Overlook Rd		Asheville	NC	28803	09/29/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	MA Appeals/Grievances Contact	Program Director	Ms.	Cone	Kirsten		8282138440					Kirsten.cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	12/23/2022	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	MA Claims Processing Contact for Public Website	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Marketing Contact	Program Director	Ms.	Cone	Kirsten		8282138442					Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Medical Director	Medical Director	Dr.	Patterson	Christophe		8282138441				8286818913	christopher.patterson@msj.org	286 Overlook Road		Asheville	NC	28803	12/24/2018	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Medicare Compliance Officer	Program Director	Ms.	Cone	Kirsten		8282138440				8286818913	kirsten.cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Medicare Coordinator	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	09/29/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Patterson	Christophe		8282138442				8286818913	Christopher.patterson@msj.org	286 Overlook Road		Asheville	NC	28803	12/24/2018	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Medication Therapy Management Contact	Clinical Nurse Coordinator	Ms.	Tolley	Stephanie		8282138442				8286818913	Stephanie.tolley1@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	09/20/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Online Enrollment Center Contact (Primary)	Finance Manager	Mr	Earley	Trey		8282138442					trey.earley@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	09/29/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Part C Application Contact	Program Director	Ms.	Cone	Kirsten		8282138442				8286818913	Kirsten.Cone@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Part D Appeals	Finance Manager	Mr	Earley	Trey							trey.earley@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	01/08/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active	8282138442				PACE - Nat		C	Atlanta
H6846	Part D Appeals Contact (Secondary)	Program Director	Ms.	Cone	Kirsten						8286818913	Kirsten.cone@hcahealthcare.com	286 Overlook Rd		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active	8282138442				PACE - Nat		C	Atlanta
H6846	Part D Application Contact	Program Director	Ms.	Cone	Kirsten		8282138442					Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Part D Benefits Contact	Finance Manager	Mr	Earley	Trey		8282138442					trey.earley@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	01/08/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Part D Claims Submission Contact	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Part D Exceptions Contact	Finance Manager	Mr.	Earley	Trey						8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	03/18/2020	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active	8282138442				PACE - Nat		C	Atlanta
H6846	Part D Exceptions Contact (Secondary)	Program Director	Ms.	Cone	Kirsten							Kirsten.Cone@hcahealthcare.com	286 Overlook Rd		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active	8282138442				PACE - Nat		C	Atlanta
H6846	Part D Price File Contact (Back-up)	Finance Manager	Mr	Earley	Trey		8282138442					Trey.Earley@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	02/18/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Part D Price File Contact (Primary)	Program Director	Ms.	Cone	Kirsten		8282138442					Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Part D Quality Assurance Contact	Ethics and Compliance Officer	Ms.	Davis	Bailey		8287778191				8286818913	Bailey.Davis3@HCAHealthcare.com	68 Sweeten Creek		Asheville	NC	28803	09/20/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Part D Reporting Contact	Finance Manager	Mr	Earley	Trey		8282138442					trey.earley@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	01/08/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Patient Safety Contact	Quality and Compliance Manager	Ms.	Hanson	Teresa		8282138442					Teresa.Hanson1@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	12/23/2022	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Payment Contact	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Personal Health Record Contact	Quality and Compliance Manager		Hanson	Teresa		8282138442					Teresa.Hanson1@hcahealthcare.com	286 Overlook Rd		Asheville	NC	28803	12/23/2022	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Pharmacy Director	Manager - Retail Pharmacy Operations	Ms.	Lamm	Meredith		8282130050					Meredith.Lamm@HCAHealthcare.com	2 Medical Park Drive		Asheville	NC	28803	06/15/2020	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Pharmacy Network Management Contact	Clinical RN Coord	Ms.	Tolley	Stephanie		8282138442				8286818913	Stephanie.tolley1@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	09/20/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Pharmacy Network Management Contact (Secondary)	Program Director	Ms.	Cone	Kirsten		8282138442					Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Pharmacy Technical Help Desk Contact	Clinical Nurse Coordinator	Ms.	Tolley	Stephanie						8286818913	Stephanie.tolley1@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	09/20/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active	8001112222				PACE - Nat		C	Atlanta
H6846	Pharmacy Technical Help Desk Contact (Secondary)	Program Director	Ms.	Cone	Kirsten							Kirsten.Cone@hcahealthcare.com	286 Overlook Rd.		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active	8282138442				PACE - Nat		C	Atlanta
H6846	Plan Directory Contact for Public Website	Program Director	Ms.	Cone	Kirsten		8282138442					Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Plan to Plan Reconciliation Contact	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Processor Contact	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Quality Contact	Quality and Compliance Manager	Ms.	Hanson	Teresa		8282138442					Teresa.Hanson1@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	12/23/2022	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Reconciliation Contact	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Road		Asheville	NC	28803	02/18/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Reconciliation Contact (Secondary)	Program Director	Ms.	Cone	Kirsten		8282138442					Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Recovery Audit Contact	Program Director	Ms.	Cone	Kirsten		8282138440				8286818913	Kirsten.cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Surveillance Contact	Ethis and Compliance Officer & Privacy	Mr	Davis	Bailey		8287778191					bailey.davis3@HCAHealthcare.com	68 Sweeten Creek Road		Asheville	NC	28803	09/29/2023	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	System Contact	Program Director	Ms	Cone	Kirsten		8282138442					Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Third Party Administrator (TPA) Liaison	Finance Manager	Mr.	Earley	Trey		8282138442				8286818913	Trey.Earley@HCAHealthcare.com	286 Overlook Rd		Asheville	NC	28803	08/07/2019	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	User Access Contact	Program Director	Ms.	Cone	Kirsten		8282138442					Kirsten.Cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	05/04/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Utilization Management Contact	Program Director	Ms.	Cone	Kirsten		8282138440					Kirsten.cone@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	12/23/2022	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6846	Utilization Review Contact	Medical Director	Dr.	Patterson	Christophe		8282138440				8286818913	Christopher.Patterson@hcahealthcare.com	286 Overlook Road		Asheville	NC	28803	02/18/2021	2023	CAREPARTNERS REHABILITATION HOSPITAL, LLLP	National PACE	CarePartners PACE	National PACE		HCA Healthcare, Inc.	606	Yes	Active					PACE - Nat		C	Atlanta
H6847	Agent/Broker Compensation Data Contact	Manager, Broker Relations		Hamel	Tom		8572827469					thamel@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Automated TrOOP Balance Transfer Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Backup User Access Contact	Director, Regulatory Affairs & Compliance		Richardson	Stephanie		5087760489					srichardson@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Best Available Evidence Contact	Director, Enrollment		Fishkin	Carly		8572822762					cfishkin@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	08/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Bid Audit Contact	Chief Actuary		Sanghvi	Sujata		8572827525					ssanghvi@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Bid Primary Contact	Manager, Medicare Product		Cassidy	Cheryl		8572823348					CCassidy@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	01701	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	CAP Report Contact for Public Website	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	12/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active	8558333668				HMO - Health Maintenance Organization		C	Boston
H6847	CEO - CMS Administrator Contact	President	Mr	Tringale	Steve		2079394468					stringale@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	12/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	CEO - Senior Official for Contracting	President	Mr	Tringale	Steve		2079394468					stringale@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	12/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Chief Financial Officer	CFO	Ms	Silva	Lucy		2079394468					lsilva@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	12/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Chief Operating Officer	COO	Mr	Mcormick	Mark		2079394468					mmcormick@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	12/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Chief Information Officer	CIO	Mr	Bundela	Yogi		8572822863					ybundela@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Chief Information Security Officer	Chief Information Security and Privacy Officer	Mr	Kadakia	Jigar		8572827121					jkadakia@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	CMS Casework Communication Contact	Director, Quality		Sahar	Maurice		8572829076					msahar@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	07/06/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Complaints Tracking Contact	Director, Quality		Sahar	Maurice		8572829076					msahar@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	07/06/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Contact for Fraud Investigations	Director, Provider		Sargent	Marlene		8572823205					msargent@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Coordination of Benefits Contact	Manager, Recoveries		Ryan	Cathy		8572829131					cryan@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Corporate Mailing						8572823348					BBowen@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Customer Service Operations Contact	Director, Customer Services		Biron	Jonathan		8572829082					jbiron@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	DIR Contact	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Emergency Part D Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Emergency Part D Contact (Secondary)	Manager Pharmacy Operations Medicare		Hart	Maegen		8572825333					MHart@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	08/16/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Encounter Data & Risk Adjustment Operations Contact	Director, Risk Score Management and Medical Econom		Keefe	kevin		8572826420					kkeefe@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Enrollment Contact	Director, Enrollment		Fishkin	Carly		8572822762					cfishkin@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	EOB Transfer Contact	Director, Pharmacy		Gallagher	Angela		8572822493				8572823348	agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Financial Audit Contact	Controller	Mr	Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Financial Reporting Contact	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Formulary Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Formulary Contact (Secondary)	Manager Pharmacy Operations Medicare		Hart	Maegen		8572825333					MHart@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	08/16/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	General Contact	Manager, Medicare Product Development		Cassidy	Cheryl		8572823348					CCassidy@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	06/08/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Government Relations Contact	Director, Government Affairs		Sullivan	John		8572823376					jsullivan@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	HIPAA Privacy Officer	SVP, Legal, Regulatory Affairs and Compliance		Moore	ALice		8572826589					amoore@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	HIPAA Security Officer	SVP, Legal, Regulatory Affairs and Compliance		Moore	ALice		8572826589					amoore@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Hospice Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Interoperability Contact	Director, Regulatory Affairs & Compliance		Richardson	Stephanie		5087760489					srichardson@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	08/31/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	MA Appeals/Grievances Contact	Director, Quality		Sahar	Maurice		8572829076					msahar@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	07/06/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	MA Claims Processing Contact for Public Website	Director, Claims		Noel	Leticia		8572826499					lnoel@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Marketing Contact	Director, Customer Engagement Marketing		Miller	Chris		8572823360					cmiller@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	07/06/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Medical Director	Chief Medical Officer	Dr	Jubelt	Lindsay		8572821234					ljubelt@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Medicare Compliance Officer	Medicare Compliance Officer	Ms	Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Medicare Coordinator	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Drive		Somerville	MA	02145	11/08/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Gallagher	Angela		8572823348					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Medication Therapy Management Contact	Director, Pharmacy		Gallagher	Angela		8572822645					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Part C Application Contact			Cassidy	Cheryl		8572823348					CCassidy@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	11/15/2021	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Part C Reporting Contact	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Part D Appeals	Director, Quality		Sahar	Maurice							msahar@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	07/06/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active	8572829076				HMO - Health Maintenance Organization		C	Boston
H6847	Part D Application Contact			Cassidy	Cheryl		8572823348					CCassidy@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	11/15/2021	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Part D Benefits Contact	Manager, Medicare Product		Cassidy	Cheryl		8572823348					ccassidy@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Part D Claims Submission Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Part D Exceptions Contact	Director, Pharmacy		Gallagher	Angela							agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active	8572822493				HMO - Health Maintenance Organization		C	Boston
H6847	Part D Price File Contact (Back-up)	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Part D Price File Contact (Optional)	Manager Pharmacy Operations Medicare		Hart	Maegen		8572825333					MHart@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	08/16/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Part D Price File Contact (Primary)	Deputy Chief Medical Officer	Dr	Shafi	Farah		8572828040					fshafi@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Part D Quality Assurance Contact	Director, Pharmacy		Gallagher	Angela		8572822438					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Part D Reporting Contact	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Patient Safety Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Payment Contact	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Pharmacy Director	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Pharmacy Network Management Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Pharmacy Technical Help Desk Contact	Director, Pharmacy		Gallagher	Angela							agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Boston
H6847	Pharmacy Technical Help Desk Contact (Secondary)	Manager Pharmacy Operations Medicare		Hart	Maegen							MHart@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	08/16/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active	8572825333				HMO - Health Maintenance Organization		C	Boston
H6847	Plan Directory Contact for Public Website	Director, Customer Services		Biron	Jonathan		8572829082					jbiron@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Plan to Plan Reconciliation Contact	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Processor Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Quality Contact	Director, Quality		Sahar	Maurice		8572822728					msahar@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Reconciliation Contact	Chief Actuary		Sanghvi	Sujata		8572827525					ssanghvi@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Reconciliation Contact (Secondary)	VP, Actuarial & Underwriting		Liang	Marybeth		8572820150					mliang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Recovery Audit Contact	Medicare Compliance Officer	Ms	Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Surveillance Contact	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	System Contact	Director, Business Systems Configuration		Malvo	Donovan		8572823015					dmalvo@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Third Party Administrator (TPA) Liaison	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	User Access Contact	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Utilization Management Contact	VP, Clinical Operations		Scott	Joy		8572828039					jscott@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6847	Utilization Review Contact	VP, Clinical Operations		Scott	Joy		8572828039					jscott@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	HMO/HMOPOS		Mass General Brigham Incorporated	784	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Agent/Broker Compensation Data Contact	Director, Sales Operations and Oversight		Hunt	Bae		2163751430					Bae.Hunt@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Automated TrOOP Balance Transfer Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					ashley.smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Backup User Access Contact	Medicare Compliance Manager		Johnson	Teressa		7733974408					teressa.johnson@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Best Available Evidence Contact	Sr Enrollment & Reconciliation Analyst		Cason	Joseph		6177486356					joseph.cason@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Bid Audit Contact	VP, Medicare Products		Fintz	Jennifer		6174783879					Jennifer.Fintz@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Bid Audit Site Contact	VP, Medicare Products		Fintz	Jennifer		6174783879					Jennifer.Fintz@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Bid Primary Contact	VP, Medicare Products		Fintz	Jennifer		6174783879					Jennifer.Fintz@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	CAP Report Contact for Public Website	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	CEO - CMS Administrator Contact	President	Ms.	Thiltgen	Heather		6177486060					Heather.Thiltgen@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	CEO - Senior Official for Contracting	President	Ms.	Thiltgen	Heather		6177486060					Heather.Thiltgen@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Chief Financial Officer	Chief Financial Officer	Mr.	Collins	James		6177486384					James.Collins@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Chief Operating Officer	Chief Operating Officer	Ms.	Cruz	Diana		4235030063					Diana.Cruz@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Chief Information Officer	Acting WellSense Chief Information Officer	Mr	Harvey	Arthur		6176388505					arthur.harvey@bmc.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Chief Information Security Officer	Sr. Director - Chief Information Security Officer	Mr	Cullivan	Lee		6179010454					lee.cullivan@bmc.org	529 Main Street	Suite 500	Charlestown	MA	02129	02/15/2021	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	CMS Casework Communication Contact	Director, Appeals & Grievances		Bigbee	Jacqueline		7746446922					jacqueline.bigbee@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Complaints Tracking Contact	Director, Appeals & Grievances		Bigbee	Jacqueline		7746446922					jacqueline.bigbee@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Contact for Fraud Investigations	Senior Manager, Special Investigations Unit		Boutin	Katherine		6032633044					Katherine.Boutin@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Coordination of Benefits Contact	Manager of Claims Audit & OPL		Taylor	Judy		6177486235					Judy.Taylor@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Corporate Mailing						6174783654					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President of Finance & Corporate Controller		Goguen	Janice		6177486215					Janice.Goguen@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Customer Service Operations Contact	Ops Mgr, Member & Provider Services		Mendez	Keyssir		6177483867					Keyssir.Mendez@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	DIR Contact	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	DIR Contact (Secondary)	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Emergency Part D Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Emergency Part D Contact (Secondary)	Sr. Director of Pharmacy Services		Pham	Phuong		6174783707					phuong.pham@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Encounter Data & Risk Adjustment Operations Contact	Senior Director of Pricing and Reserving		Tuan	Blesilda		6174783790					Blesilda.Tuan@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Enrollment Contact	Sr Enrollment & Reconciliation Analyst		Cason	Joseph		6177486356					joseph.cason@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	EOB Transfer Contact	Director, Claims, Enrollment & Provider Appeals		Hinderman	Emily		6174783614				6178970884	emily.hinderman@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Financial Audit Contact	Medicare Compliance Officer	Mr.	Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Financial Reporting Contact	Vice President of Finance & Corporate Controller		Goguen	Janice		6177486215					Janice.Goguen@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Formulary Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Formulary Contact (Secondary)	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	General Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Government Relations Contact	Director of Government Affairs	Mr.	Krintzman	Josh		6177486490					Josh.Krintzman@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	HIPAA Privacy Officer	Associate General & Privacy Officer Counsel		da Costa	Luis		6177486079					Luis.DaCosta@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	HIPAA Security Officer	Information Security Officer		Tavares	Heather		6177486221					Heather.Tavares@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Hospice Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Interoperability Contact	Sr. Director, IT Solutions		Ellis	Ezren		6177486381					ezren.ellis@wellsense.org	529 Main Street, Suite 500		Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	MA Appeals/Grievances Contact	Director, Appeals & Grievances		Bigbee	Jacqueline		7746446922					jacqueline.bigbee@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	MA Claims Processing Contact for Public Website	Director, Claims, Enrollment & Provider Appeals		Hinderman	Emily		6174783614					emily.hinderman@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Marketing Contact	Director of Medicare Marketing		Chrzanowski	Kelly		2166950332					Kelly.Chrzanowski@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	09/08/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Medical Director	Senior Medical Director	Dr.	Rubenstein	Jessica		8573010164					Jessica.Rubenstein@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Medicare Coordinator	Medicare Compliance Manager		Johnson	Teressa		7733974408					teressa.johnson@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Medicare Part D Opioid Overutilization Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					ashley.smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Medication Therapy Management Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	OffShore Subcontractor Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Online Enrollment Center Contact (Back-up)	Programmer Analyst II		Lapaix	Anord		7865415843					anord.lapaix@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Online Enrollment Center Contact (Optional)	Programmer Analyst II		Gray	Kevin		6174783636					kevin.gray@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Online Enrollment Center Contact (Primary)	EDI Analyst II		MacMillan	Sheba		6174783538					Sheba.MacMillan@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Part C Application Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Part C Reporting Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Part D Appeals	Director, Appeals & Grievances		Bigbee	Jacqueline							jacqueline.bigbee@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	8558338125				HMO - Health Maintenance Organization		C	Boston
H6851	Part D Appeals Contact (Secondary)	Manager, Appeals & Grievances		DiSciscio	Felicia							Felicia.DiSciscio@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	09/19/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	6174783556				HMO - Health Maintenance Organization		C	Boston
H6851	Part D Application Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Part D Benefits Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Part D Claims Submission Contact	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@bmchp-wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	09/09/2021	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Part D Exceptions Contact	Director of Clinical Pharmacy		Smith	Ashley							Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	8558338125				HMO - Health Maintenance Organization		C	Boston
H6851	Part D Exceptions Contact (Secondary)	Senior Director of Pharmacy Services		Pham	Phuong							Phuong.Pham@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	8558338125				HMO - Health Maintenance Organization		C	Boston
H6851	Part D Price File Contact (Back-up)	Manager of Pharmacy Services, SCO		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Part D Price File Contact (Optional)	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/23/2021	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Part D Quality Assurance Contact	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Part D Reporting Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@bmchp-wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	06/14/2022	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Patient Safety Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Payment Contact	VP, Finance & Corporate Controller		Goguen	Janice		6177486215					Janice.Goguen@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Pharmacy Director	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Pharmacy Network Management Contact	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Pharmacy Network Management Contact (Secondary)	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Pharmacy Technical Help Desk Contact	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie							Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Boston
H6851	Pharmacy Technical Help Desk Contact (Secondary)	Director of Clinical Pharmacy		Smith	Ashley							medicareD@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Boston
H6851	Plan Directory Contact for Public Website	Director Provider Data Integrity		de Medeiros	Sherri-Ann		8885660008					providerinfo@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Plan to Plan Reconciliation Contact	Staff Accountant		McGinnis	Kathleen		7819752780					Kathleen.McGinnis@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Processor Contact	Director, Claims, Enrollment & Provider Appeals		Hinderman	Emily		6174783614					emily.hinderman@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Quality Contact	VP, Quality & Clinical Programs		Valdez-Shipp	Kyra		3146081622					Kyra.Shipp@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Reconciliation Contact	Director, Actuarial Services		Nadler	Benjamin		6174783858					benjamin.nadler@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	09/08/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Reconciliation Contact (Secondary)	Chief Actuary		Li	Bo		7817889988					Bo.Li@Wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Recovery Audit Contact	Medicare Compliance Officer	Mr.	Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	SNP Application Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Surveillance Contact	Medicare Compliance Officer		Comerford	Michael		7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	System Contact	Director of IT Solutions		Ellis	Ezren		6177486381					ezren.ellis@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Third Party Administrator (TPA) Liaison	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	User Access Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Utilization Management Contact	Director of Utilization Management		Costello	Barbara		6174783648					Barbara.Costello@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6851	Utilization Review Contact	Director of Utilization Management		Costello	Barbara		6174783648					Barbara.Costello@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	03/24/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H6852	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H6852	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H6852	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H6852	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H6852	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H6852	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H6852	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H6852	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6852	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF PENNSYLVANIA INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6868	Automated TrOOP Balance Transfer Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Backup User Access Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Best Available Evidence Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Bid Primary Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	CAP Report Contact for Public Website	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	CEO - CMS Administrator Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	CEO - Senior Official for Contracting	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Chief Financial Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Chief Operating Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Chief Information Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Chief Information Security Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	CMS Casework Communication Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Complaints Tracking Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Contact for Fraud Investigations	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Coordination of Benefits Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Corporate Mailing						2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Customer Service Operations Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	DIR Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	DIR Contact (Secondary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Emergency Part D Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Emergency Part D Contact (Secondary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Encounter Data & Risk Adjustment Operations Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Enrollment Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	EOB Transfer Contact	CFO	Mrs	Prentis	Kristin		7328063224				7328063224	kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Financial Audit Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Financial Reporting Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Formulary Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Formulary Contact (Secondary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	General Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Government Relations Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	HIPAA Privacy Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	HIPAA Security Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Interoperability Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	MA Appeals/Grievances Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	MA Claims Processing Contact for Public Website	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Marketing Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Medical Director	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Medicare Compliance Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Medicare Coordinator	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Medicare Part D Opioid Overutilization Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Medication Therapy Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	OffShore Subcontractor Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Online Enrollment Center Contact (Back-up)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Online Enrollment Center Contact (Primary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Part C Application Contact	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenix	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Part D Appeals	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Atlanta
H6868	Part D Appeals Contact (Secondary)	Executive Director	Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H6868	Part D Application Contact	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenix	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Part D Benefits Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Part D Claims Submission Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Part D Exceptions Contact	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Atlanta
H6868	Part D Exceptions Contact (Secondary)		Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H6868	Part D Price File Contact (Back-up)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Part D Price File Contact (Primary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Part D Quality Assurance Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Part D Reporting Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Patient Safety Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Payment Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Personal Health Record Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Pharmacy Director	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Pharmacy Network Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Pharmacy Network Management Contact (Secondary)	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Pharmacy Technical Help Desk Contact	Executive Director	Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H6868	Pharmacy Technical Help Desk Contact (Secondary)	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Atlanta
H6868	PHR Beneficiary Contact																	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE	Beacon of Life SC			Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H6868	Plan Directory Contact for Public Website	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Plan to Plan Reconciliation Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Processor Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Quality Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Reconciliation Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Reconciliation Contact (Secondary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Recovery Audit Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Surveillance Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	System Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Third Party Administrator (TPA) Liaison	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	User Access Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Utilization Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6868	Utilization Review Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	BOLDAGE PACE KENTUCKY, LLC	National PACE	BoldAge PACE Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H6870	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	CAP Report Contact for Public Website	Vice President, Regulatory Compliance	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	12/07/2018	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/10/2017	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	10/29/2019	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Medical Director	Chief Medical Director	Mr.	Harmon	David		5124163782	22182				dharmon@centene.com	5900 E. Ben White Blvd.		Austin	TX	78741	03/30/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	MMP Reporting Requirements Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/30/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	MMP Point of Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/30/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132061716				Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	PHR Beneficiary Contact																	09/27/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8668961844				Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Plan Directory Contact for Public Website			Services	Provider		8773915921					CorporateMedicareComplianceDept@CENTENE.COM	5900 E. Ben White Blvd.		Austin	TX	78741	03/31/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/24/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6870	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUPERIOR HEALTHPLAN, INC.	Demo	Superior HealthPlan	Medicare-Medicaid Plan HMO/HMOPOS		Centene Corporation	351	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H6874	Agent/Broker Compensation Data Contact	Associate Vice President Sales		Eck	Brian		6126763380					beck@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Automated TrOOP Balance Transfer Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					FIR_Transactions@ucare.org	500 Stinson Boulevard NE		Minnneapolis	MN	55413	08/16/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Backup User Access Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Best Available Evidence Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Bid Audit Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Bid Audit Site Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Bid Primary Contact	Corporate Actuary		Uding	Chris		6126763372					bids@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	CAP Report Contact for Public Website	Senior Regulatory  Auditor		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/14/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	CEO - CMS Administrator Contact	President	Mr.	Brua	Kyle		7158470080					kyle.brua@aspirushealthplan.com	3000 Westhill Drive, Suite 303		Wausau	WI	54401	02/03/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	CEO - Senior Official for Contracting	President	Mr.	Brua	Kyle		7158470080					kyle.brua@aspirushealthplan.com	3000 Westhill Drive, Suite 303		Wausau	WI	54401	02/03/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Chief Financial Officer	SVP and Chief Financial Officer	Mr.	Sczygelski	Sidney		7158472603					sid.sczygelski@aspirus.org	2200 Westwood Drive, 3rd Floor		Wausau	WI	54401	07/24/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Chief Operating Officer	Director of Corporate Treasury and Aspirus Health	Mr.	Nemeth	James		7158431387					james.nemeth@aspirushealthplan.com	3000 Westhill Drive, Suite 303		Wausau	WI	54401	02/03/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Chief Information Officer	SVP and Chief Information Officer	Mr	Richardson	Todd		7158472122					todd.richardson@aspirus.org	2200 Westwood Drive, 3rd Floor		Wausau	WI	54401	02/05/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Chief Information Security Officer	VP Information Security	Mr	Berryman	Glenn		7158431444					glenn.berryman@aspirus.org	2800 Westhill Drive	Suite 206	Wausau	WI	54401	10/04/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	CMS Casework Communication Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Complaints Tracking Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Contact for Fraud Investigations	Manager SIU		Weidemann	Angie		6128171655					aweidemann@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Coordination of Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Corporate Mailing						6126766500				6126766501	sschwartz@ucare.org	UCare	500 Stinson Boulevard NE	Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Senior		Ly	Tong		6126277157					tly@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/17/2021	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Customer Service Operations Contact	CS Support Services Sr Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	DIR Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	DIR Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Emergency Part D Contact	Customer Service Workforce Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Emergency Part D Contact (Secondary)	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	600 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Encounter Data & Risk Adjustment Operations Contact			Olberding	Milissia		6126763205					molberding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Enrollment Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	EOB Transfer Contact	Customer Service Workforce Manager		Vang	Pakou		6126763585				6128842145	pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Financial Audit Contact	Controller	Mr.	Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Financial Reporting Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Formulary Contact	Pharmacy Supervisor		Merk	Zachariah		6126763483					zmerk@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	07/29/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Formulary Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	General Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Government Relations Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	HIPAA Privacy Officer	Director of Compliance and Operations		Armstrong	Tina		6122817262					Tina.Armstrong@aspirus.org	3000 Westhill Drive, Suite 303		Wausau	WI	54401	02/03/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	HIPAA Security Officer	Director of Compliance and Operations		Armstrong	Tina		6122817262					Tina.Armstrong@aspirus.org	3000 Westhill Drive, Suite 303		Wausau	WI	54401	02/03/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Hospice Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Interoperability Contact	VP, Deputy General Counsel		Owen	Elizabeth		6513992800					eowen@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	04/17/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	MA Appeals/Grievances Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	MA Claims Processing Contact for Public Website	CCO Audit & Compliance Manager		Tenhoff	Reed		6126763664					rtenhoff@ucare.og	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/11/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Marketing Contact	Government Relations Materials Coordinator		Morales	Ana Sophia		6122945641					amorales@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/22/2021	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Medical Director	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Medicare Compliance Officer	Director of Gov and Pharm Programs/Compliance	Mrs.	Scholze	Amanda		6084611105					Amanda.Scholze@aspirushealthplan.com	3000 Westhill Drive, Suite 303		Wausau	WI	54401	08/31/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Medicare Coordinator	Federal Government Relations Manager		Mitchell	Milonda		6122945143					mmitchell1@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/12/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030					anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Medication Therapy Management Contact	Pharmacy Quality Manager		Bower	Erika		6122945800				6128842321	ebower@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/10/2021	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	OffShore Subcontractor Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Online Enrollment Center Contact (Back-up)	MBE Operations Manager		Rooney	Courtney		6126763468					crooney@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	11/12/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/16/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Part C Application Contact	Director of Corporate Treasury and Aspirus Health	Mr.	Nemeth	James		7158431387					bpomedicare@ucare.org	3000 Westhill Drive, Suite 303		Wausau	WI	54401	02/03/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Part C Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/13/2021	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Part D Appeals	A&G Regulatory and Compliance Specialist		Wood	Nakia							cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active	6122945668				PPO - BBA		C	Chicago
H6874	Part D Appeals Contact (Secondary)	Manager Appeals & Grievances		Paciorek	Joshua							jpaciorek@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active	6122945225				PPO - BBA		C	Chicago
H6874	Part D Application Contact	Director of Corporate Treasury and Aspirus Health	Mr.	Nemeth	James		7158431387					bpomedicare@ucare.org	3000 Westhill Drive, Suite 303		Wausau	WI	54401	02/03/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Part D Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Part D Claims Submission Contact	Data Analyst Sr.		Krishnan	Kamali		6122945146					kkrishnan@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Part D Exceptions Contact	Vice President Pharmacy Management		Mitsch	Patrick						6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active	6122945051				PPO - BBA		C	Chicago
H6874	Part D Exceptions Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam						6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active	6122945030				PPO - BBA		C	Chicago
H6874	Part D Price File Contact (Back-up)	Pharmacy Operations Manager Sr.		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Part D Price File Contact (Optional)	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Part D Price File Contact (Primary)	Sr Manager, Government Programs		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	01/18/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Part D Quality Assurance Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Part D Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Patient Safety Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Payment Contact	Chief Financial Officer		Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Pharmacy Director	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	patmitsch@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Pharmacy Network Management Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Pharmacy Technical Help Desk Contact	Director, Customer Service		Moore	LaTasha							LaTasha_Monroe@expressscripts.com	13051 N Telecom Parkway	Suite 150	Temple Terrace	FL	33637	01/18/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active	8009221557				PPO - BBA		C	Chicago
H6874	PHR Beneficiary Contact																	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO	UCare	Aspirus, Inc.	747	Yes	Active	8775231515				PPO - BBA		C	Chicago
H6874	Physician Incentive Contact	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/06/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Plan Directory Contact for Public Website	Customer Service Workforce Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Plan to Plan Reconciliation Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Processor Contact	Pharmacy Operations Manager Sr		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Quality Contact	Vice President Quality Management		Hanley	Greg		6122945296					ghanley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/15/2020	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Reconciliation Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Reconciliation Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Recovery Audit Contact	Audit Director	Mr.	Schach	Steve		6126763562					sschach@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	554132615	04/17/2023	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	SNP State Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Surveillance Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	System Contact	Chief Information Security Officer, Director		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Third Party Administrator (TPA) Liaison	Accountant		Zator	Chris		6126763563					czator@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/15/2021	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	User Access Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/19/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Utilization Management Contact	VP Clinical Services		Wickman	Amy		6126763418					awickman@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6874	Utilization Review Contact	Clinical Regulatory Specialist		Brown	Julie	B	6126763433					jbbrown@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	ASPIRUS HEALTH PLAN, INC.	Local CCP	Aspirus Health Plan	Local PPO		Aspirus, Inc.	747	Yes	Active					PPO - BBA		C	Chicago
H6887	Automated TrOOP Balance Transfer Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S. Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Backup User Access Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Best Available Evidence Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Bid Primary Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	CAP Report Contact for Public Website	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	CEO - CMS Administrator Contact	CEO	Mrs.	Mansue	Amy		8566416610					mansuea@ihn.org	165 Bridgeton Pike		Mullica Hill	NJ	08062	05/04/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	CEO - Senior Official for Contracting	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Chief Financial Officer	Senior VP of Finance and CFO	Mr.	Pelino	William	D	8566416605					pelinow@ihn.org	165 Bridgeton Pike		Mullica Hill	NJ	08062	03/09/2023	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Chief Operating Officer	Chief Operating Officer	Mr.	Moore	Warren	E	8566416602					mooreew@ihn.org	165 Bridgeton Pike		Mullica Hill	NJ	08062	06/01/2022	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Chief Information Officer	Information Systems Analyst	Mr.	Coyle	David		8565078551				8565754929	CoyleD@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Chief Information Security Officer	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	CMS Casework Communication Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Complaints Tracking Contact	Quality Director		Powell	Al'Asia		8563624517					powella@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Contact for Fraud Investigations	Quality Director		Powell	Al'Asia		8563624517					powella@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Coordination of Benefits Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Corporate Mailing						8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Customer Service Operations Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	DIR Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Emergency Part D Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Emergency Part D Contact (Secondary)	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Encounter Data & Risk Adjustment Operations Contact	Finance Director	Ms.	Stevenson	Gail		8563624516				8564975250	stevensong@ihn.org	2445 S. Delsea Drive		Vineland	NJ	08360	10/21/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Enrollment Contact	Center Director	Ms.	Rossi	Alicia		8563624510					RossiA@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	EOB Transfer Contact	Finance Director	Ms.	Stevenson	Gail		8563624516				8565754982	stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Financial Audit Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Financial Reporting Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Formulary Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	General Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Government Relations Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	HIPAA Privacy Officer	Quality Director	Mrs.	Powell	Al'Asia		8563624517					powella@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	HIPAA Security Officer	Quality Director	Mrs.	Powell	Al'Asia		8563624517					powella@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Interoperability Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S. Delsea Drive		Vineland	NJ	08360	06/01/2022	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	MA Appeals/Grievances Contact	Quality Director		Wallace	Al'Asia		8563624517					powella@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	MA Claims Processing Contact for Public Website	Liason		Uhler	PeakTPA		8663864447					inquiry@peak.cpstn.com	P.O. Box 21631		Eagan	MN	55121	02/21/2022	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Marketing Contact	Manager of Client Services	Mr.	Clendaniel	Brett		8565754330				8566964216	clendanielb@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	03/09/2023	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Medical Director	Medical Director	Dr	Raziano	Donna		8564185433					Razianod@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	11/29/2022	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Medicare Compliance Officer	Quality Director	Ms.	Powell	Al'Asia		8563624517					powella@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Medicare Coordinator	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Medicare Part D Opioid Overutilization Contact	Quality Director	Ms.	Powell	Al'Asia		8563624517					powella@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	11/29/2022	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Medication Therapy Management Contact	Medical Director	Dr	Raziano	Donna		8564185433					razianod@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	11/29/2022	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Online Enrollment Center Contact (Primary)	Manager of Intake & Enrollment	Mrs.	Hymer	Anna		8564185433					hymera@ihn.org	2445 S. Delsea Drive		Vineland	NJ	08360	11/29/2022	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Part C Application Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Part D Appeals	Quality Director	Mrs.	Powell	Al'Asia							powella@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active	8563624517				PACE - Nat		C	New York
H6887	Part D Appeals Contact (Secondary)	Executive Director	Mrs.	DempseyStahl	Mia							dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/08/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active	8563624515				PACE - Nat		C	New York
H6887	Part D Application Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Part D Benefits Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Part D Claims Submission Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Part D Exceptions Contact	Finance Director	Ms.	Stevenson	Gail							stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active	8552955433				PACE - Nat		C	New York
H6887	Part D Price File Contact (Back-up)	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Part D Price File Contact (Primary)	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Part D Quality Assurance Contact	Quality Director		Powell	Al'Asia		8563624517					powella@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Part D Reporting Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Patient Safety Contact	Quality Director		Powell	Al'Asia		8563624517					powella@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Payment Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S. Delsea Drive		Vineland	NJ	08360	05/17/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Personal Health Record Contact	Health Information Management Specialist	Ms.	LaBoy	Susan		8564185433	67115			8565755045	laboys@ihn.org	2445 S. Delsea Drive		Vineland	NJ	08360	05/17/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Pharmacy Director	Medical Director	Dr	Raziano	Donna		8564185433					razianod@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	11/29/2022	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Pharmacy Network Management Contact	Medical Director	Dr	Raziano	Donna		8564185433					razianod@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	11/29/2022	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Pharmacy Technical Help Desk Contact	Executive Director	Mrs.	DempseyStahl	Mia							dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active	8563624515				PACE - Nat		C	New York
H6887	Pharmacy Technical Help Desk Contact (Secondary)	Client Support Specialist	Ms.	Hladilek	Kayla							khladilek@pharmastar.com	2445 S. Delsea Drive		Vineland	NJ	08360	05/17/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active	8882987770				PACE - Nat		C	New York
H6887	Plan Directory Contact for Public Website	Executive Director	Mrs.	DempseyStahl	Mia		8564185433					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Plan to Plan Reconciliation Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Processor Contact	Liasion	Ms.	Uhler	Laurie		8663864447					inquiry@peak.cpstn.com	P.O. Box 21631		Eagan	MN	55121	02/21/2022	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Quality Contact	Quality Director		Powell	Al'Asia		8563624517					powella@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Reconciliation Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Recovery Audit Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Surveillance Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	System Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Third Party Administrator (TPA) Liaison	Inspira LIFE Program Liaison	Ms.	Uhler	Laurie		8663864447					inquiry@peak.cpstn.com	P.O. Box 21631		Eagan	MN	55121	02/21/2022	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	User Access Contact	Executive Director	Mrs.	DempseyStahl	Mia		8563624515					dempseystahlm@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/10/2021	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Utilization Management Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6887	Utilization Review Contact	Finance Director	Ms.	Stevenson	Gail		8563624516					stevensong@ihn.org	2445 S Delsea Drive		Vineland	NJ	08360	01/23/2019	2023	INSPIRA HEALTH NETWORK LIFE, INC.	National PACE	Inspira Health Network LIFE	National PACE		Inspira Health Network, Inc.	454	Yes	Active					PACE - Nat		C	New York
H6891	Agent/Broker Compensation Data Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Automated TrOOP Balance Transfer Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Backup User Access Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Best Available Evidence Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Bid Audit Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Bid Audit Site Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Bid Primary Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	CAP Report Contact for Public Website	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	CEO - CMS Administrator Contact	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	CEO - Senior Official for Contracting	CEO	Mr.	Bailey	Michael	D	6157518131				8442805360	mbailey@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Chief Financial Officer	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Chief Operating Officer	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Chief Information Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Chief Information Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	CMMI Model Point of Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	CMS Casework Communication Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Complaints Tracking Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Contact for Fraud Investigations	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Coordination of Benefits Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Corporate Mailing						6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Customer Service Operations Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	05/18/2020	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	DIR Contact	VP Formulary & Rebate Economics		Ellermeir	Nicole		9133875120					nellermeir@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	DIR Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Electronic Health Record Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Emergency Part D Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Emergency Part D Contact (Secondary)	Pharmacy Operations	Mrs.	Sanchez	Lynn		4056014429				8442805360	lsanchez@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Encounter Data & Risk Adjustment Operations Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Enrollment Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	EOB Transfer Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Financial Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Financial Reporting Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Formulary Contact	Clinical Formulary Pharmacist	Ms.	Quinn	Kelsey		3304864954					kquinn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Formulary Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	General Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Government Relations Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	HIPAA Privacy Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	HIPAA Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Hospice Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Interoperability Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	MA Appeals/Grievances Contact	A&G Team Lead	Mrs.	Henderson	Maya		6156268442				8442805360	mhenderson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	MA Claims Processing Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		8003997524				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Marketing Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Medical Director	Medical Director	Dr.	Misra	Sumathi		6156365478					SMisra@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/17/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Medicare Compliance Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Medicare Coordinator	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Medicare Part D Opioid Overutilization Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Medication Therapy Management Contact	Director of Clinical Product Development and Strat	Ms.	Miller	Holly		3304866457				3304058094	hrmiller@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	OffShore Subcontractor Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Online Enrollment Center Contact (Back-up)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Online Enrollment Center Contact (Primary)	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Part C Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Part C Reporting Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Appeals	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations	Mr	Binegar	Sam						3304058081	appeals@ElixirSolutions.com	2181 E Aurora Road	Building B, Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8003997524				HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Benefits Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Claims Submission Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Exceptions Contact	Associate VP of Clinical Operations	Ms.	Lavignette	Amanda						3304864801	alavignette@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Exceptions Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Price File Contact (Back-up)	Sr Financial Manager Reporting & Analytics	Mr	Campbell	Tim		3308886988					tcampbell@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Price File Contact (Optional)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Price File Contact (Primary)	Senior Director Rebates, Trade Relations	Mr.	Bonus	Jason		3304864841				3304864801	jbonus@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Quality Assurance Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Part D Reporting Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Patient Safety Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Pharmacy Director	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Pharmacy Network Management Contact	Director of Pharmacy Network Development and Ops	Ms	Profio	Lauren		3304864864				3304058094	lprofio@EnvisionRx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Pharmacy Network Management Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8336746201				HMO - Health Maintenance Organization		C	Dallas
H6891	Pharmacy Technical Help Desk Contact (Secondary)			Sanchez	Lynn						4056015627	lsanchez@amhealthplans.com	909 S. Meridian Ave. Ste 425		Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8555210627				HMO - Health Maintenance Organization		C	Dallas
H6891	Plan Directory Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Plan to Plan Reconciliation Contact	Sr. Manager,  Financial Accounting	Ms.	Tilley	Stephanie		9312420499					stilley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	08/30/2023	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Processor Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Quality Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Reconciliation Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Reconciliation Contact (Secondary)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Recovery Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	SNP Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	SNP State Contact	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Surveillance Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	System Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Third Party Administrator (TPA) Liaison	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	User Access Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Utilization Management Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6891	Utilization Review Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF TX, INC.	Local CCP	American Health Advantage of Texas	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6898	Agent/Broker Compensation Data Contact	Product Coordinator		Armstrong	Chris		8023713250					carmstrong@bcbsvt.com	P.O. Box 186		Montpelier	VT	05601	02/07/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Automated TrOOP Balance Transfer Contact	Manager, Business Process		Diaz	Mario		7143172628					OptumRx-SupportServices@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Backup User Access Contact	Manager, Performance & Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	07/06/2021	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Best Available Evidence Contact	Manager, Enrollment and Billing		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road Suite 200		Glen Allen	VA	23060	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Bid Audit Contact	Director		Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Bid Audit Site Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/14/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Bid Primary Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	05/10/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	CAP Report Contact for Public Website	Director		Pickens	Veronica		2483955887					vpickens@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	CEO - CMS Administrator Contact	Plan President	Ms.	Getsie	Pamela		8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	CEO - Senior Official for Contracting	Plan President	Ms.	Getsie	Pamela		8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Chief Financial Officer	SVP, Controller	Mr.	Pisarik	Jason		2486654348					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	VT	05601	02/07/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Chief Operating Officer	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	05/10/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Chief Information Officer	IT Director II	Mrs.	Krause	Amy		3132256638					akrause@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Cieszynski	Brent		3132258766					bcieszynski@bcbsm.com	600 Lafayette East		Detroit	MI	48226	08/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	CMMI Model Point of Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	05/10/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	CMS Casework Communication Contact	Compliance Consultant		White	Jasmin		2486654235					JWhite4@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Complaints Tracking Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Contact for Fraud Investigations	Manager		Zasadny	Brian		3132255956					bzasadny@bcbsm.com	600 East Lafayette		Detroit	MI	48226	12/28/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Coordination of Benefits Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	03/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Corporate Mailing						8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	200 North Grand Avenue	PO Box 40790	Lansing	MI	48901	12/28/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Customer Service Operations Contact	Director, Workforce Management, Analytics, & Supp		Weber	Julie		3132250555					jweber@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/11/2021	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	DIR Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	DIR Contact (Secondary)	Manager, Pharmacy Operations		Jones	Marini		3135706777					Marini.Jones@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Electronic Health Record Contact	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/10/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Emergency Part D Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Emergency Part D Contact (Secondary)	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Employer Waiver Contact	Manager		Nelson	Jessica		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	05/10/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Encounter Data & Risk Adjustment Operations Contact	Director		Jensen	Robert		2486654115					robert.jenson@advantasure.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Enrollment Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	05/10/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	EOB Transfer Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880				9528375607	Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/08/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Financial Audit Contact	Director	Mr.	Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Financial Reporting Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Formulary Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Formulary Contact (Secondary)	Manager		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center		Southfield	MI	48075	05/10/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	General Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Government Relations Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	HIPAA Privacy Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	HIPAA Security Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Hospice Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/08/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Interoperability Contact	Manager, Functional Operations		Kingsley	Chris		2484444160					Christopher.kingsley@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	MA Appeals/Grievances Contact	Chief Operating Officer		Hower	Johanna		8048594034					Johanna.Hower@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	08/11/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	MA Claims Processing Contact for Public Website	Manager, Claims and Recovery Operations		Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	03/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Marketing Contact	Plan President	Ms.	Getsie	Pamela		8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Medical Director	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Medicare Compliance Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/03/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Medicare Coordinator	Managing Director, Medicare Advantage Compliance		Pickens	Veronica		2483955887					vpickens@bcbsm.com	1000 Town Center		Southfield	MI	48075	11/15/2021	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Medicare Part D Opioid Overutilization Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/02/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Medication Therapy Management Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/02/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	OffShore Subcontractor Contact	Manager	Mrs.	Stretch	Kaitlin		2486654275					kstretch@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Online Enrollment Center Contact (Back-up)	Enrollment Business Lead		Schulz	Bryan		5084390769					Bryan.Schulz@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Online Enrollment Center Contact (Optional)	Manager		Woods	Cheyenne		2484173449					cheyenne.woods@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Online Enrollment Center Contact (Primary)	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Part C Application Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Part C Reporting Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Part D Appeals	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8554890646				PPO - BBA		C	Chicago
H6898	Part D Appeals Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8003443405	733326			PPO - BBA		C	Chicago
H6898	Part D Application Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Part D Benefits Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Part D Claims Submission Contact	Manager, Business Process		Diaz	Mario		7143172628					OptumRx-SupportServices@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Part D Exceptions Contact	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8554890646				PPO - BBA		C	Chicago
H6898	Part D Exceptions Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	9544985880				PPO - BBA		C	Chicago
H6898	Part D Price File Contact (Back-up)	Vice President		Siuta	Lori		2242312298					lori.siuta@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Part D Price File Contact (Optional)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Part D Price File Contact (Primary)	Sr. Business Analyst, Medicare Operations		Vargas	Danielle		4437101262	433132				danielle.wooten@optum.com	11000 Optum Circle	Suite 106	Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Part D Quality Assurance Contact	Managing Director, Operations		Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	06/01/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Part D Reporting Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Patient Safety Contact	Managing Director, Operations		Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Payment Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Personal Health Record Contact	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Pharmacy Director	Managing Director, Operations		Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Pharmacy Network Management Contact	Sr. Account Manager, Network Account Management		Brown	Casey		6126427367					casey.brown@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Pharmacy Network Management Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Pharmacy Technical Help Desk Contact	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8554890646				PPO - BBA		C	Chicago
H6898	Pharmacy Technical Help Desk Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8009221557				PPO - BBA		C	Chicago
H6898	Physician Incentive Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Plan Directory Contact for Public Website	Work Track Project Manager		Nelson	Jessica		8448395122					Jessica.Nelson@emergient.com	P.O. Box 186		Montpelier	VT	05601	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Plan to Plan Reconciliation Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Processor Contact	Manager, Claims and Recovery Operations		Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	03/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Quality Contact	Corporate Medical Director		Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Reconciliation Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Reconciliation Contact (Secondary)	Manager, Pharmacy Operations		Jones	Marini		3135706777					Marini.Jones@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Recovery Audit Contact	Manager, Performance and Oversight	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Surveillance Contact	Manger, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	07/06/2021	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	System Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Third Party Administrator (TPA) Liaison	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	200 North Grand Avenue	PO Box 40790	Lansing	MI	48901	12/28/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	User Access Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Utilization Management Contact	Managing Director, Medical Management	Dr.	Park	Gerald		2485047408					Gerald.Park@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	03/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6898	Utilization Review Contact	Managing Director, Medical Management	Dr.	Park	Gerald		2485047408					Gerald.Park@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	03/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H6910	Agent/Broker Compensation Data Contact	Director of Sales		Dues	Travis		6145463157				6145463131	Travis.Dues@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Automated TrOOP Balance Transfer Contact	Part D Analyst		Houk	Kim		6145463183				6145463131	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Backup User Access Contact	Sr. Application Specialist		Crawford	Carl		6145463215				6145463144	ccrawford@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Best Available Evidence Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Bid Audit Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463211	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Bid Audit Site Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Bid Primary Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	CAP Report Contact for Public Website	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	CEO - CMS Administrator Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	Jack.Randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	CEO - Senior Official for Contracting	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Chief Financial Officer	Chief Financial Officer	Mr	Vis	David		6145463211				6145463131	david.vis@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Chief Operating Officer	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Chief Information Officer	VP Service Optimization	Mr.	Trimmer	Matt		3017547190					matt.trimmer@trinity-health.org	3100 Easton Square Place		Columbus	OH	43219	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Chief Information Security Officer	Sr Security Manager, Enterprise Information Securi	Mr.	Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	CMS Casework Communication Contact	Compliance Specialist	Mr.	Jordan	David	A	6147068474				6142348372	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Complaints Tracking Contact	Compliance Specialist	Mr	Jordan	David	A	6147068474					djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Contact for Fraud Investigations	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Coordination of Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Corporate Mailing						4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Customer Service Operations Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	DIR Contact	CEO		Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square  Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	DIR Contact (Secondary)	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Electronic Health Record Contact	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Emergency Part D Contact	Chief Compliance Officer		Suffern	Patricia		4124780244				6145463132	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	12/23/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Emergency Part D Contact (Secondary)	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Employer Waiver Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Reconciliation Analyst		Sloan	Mike		6145463134					mike.sloan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Enrollment Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	EOB Transfer Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Financial Audit Contact	Chief Administration Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Financial Reporting Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Formulary Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Formulary Contact (Secondary)	Director, Pharmacy		Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	General Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Government Relations Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	HIPAA Privacy Officer	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	HIPAA Security Officer	Sr Security Manager, Enterprise Information Securi		Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Hospice Contact	Senior Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Interoperability Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	MA Appeals/Grievances Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	MA Claims Processing Contact for Public Website	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Marketing Contact	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Medical Director	MD	Dr.	Wise	Greg		6145463151				6145463131	gwise@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Medicare Compliance Officer	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Medicare Coordinator	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Medicare Part D Opioid Overutilization Contact	Pharmacy Data Analyst	Ms.	Houk	Kimberly		6145463183					kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Medication Therapy Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	OffShore Subcontractor Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment	Ms	Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Online Enrollment Center Contact (Optional)	Director, Enrollment and Premium Billing		Caudle	Jeff		6145463224				6145463148	jcaudle@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Online Enrollment Center Contact (Primary)	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Part C Application Contact	Director, Product Management and Business Devlpt		Mauck	Brandon		6145955681					brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Part C Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Part D Appeals	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H6910	Part D Appeals Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H6910	Part D Application Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Part D Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Part D Claims Submission Contact	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Part D Exceptions Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H6910	Part D Exceptions Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H6910	Part D Price File Contact (Back-up)	Formulary Consultant		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea		Scottsdale	AZ	85260	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Part D Price File Contact (Primary)	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Part D Quality Assurance Contact	Director of Pharmacy, Health Plans		Turoff	Chris		6144030394				6142346481	chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Part D Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Patient Safety Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Payment Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Pharmacy Director	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Pharmacy Network Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Pharmacy Network Management Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Pharmacy Technical Help Desk Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H6910	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Data Analyst	Mrs	Miller	Kim							kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H6910	PHR Beneficiary Contact																	01/16/2019	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS	MediGold	Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H6910	Physician Incentive Contact	Interim VP, Health Services	Ms	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Plan Directory Contact for Public Website	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Plan to Plan Reconciliation Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Processor Contact	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Quality Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Reconciliation Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Reconciliation Contact (Secondary)	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Recovery Audit Contact	Chief Administrative Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Surveillance Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	System Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Third Party Administrator (TPA) Liaison	Sr Finance Analyst		Fountain	Lisa		6145463220					lfountain@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	User Access Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Utilization Management Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6910	Utilization Review Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF IDAHO, INC.	Local CCP	Saint Alphonsus Health Plan	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H6936	Agent/Broker Compensation Data Contact	Medicare Sales Compliance & Audit Oversight Specia	Ms.	Aguayo	Nancy		6029168515					nancy.aguayo@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Automated TrOOP Balance Transfer Contact			Esp	Brian		8587906445					partdcat@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Backup User Access Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Best Available Evidence Contact	Mgr- Medicare Enrollment		Ramirez	Michelle		6029168404					michelle.ramirez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Bid Audit Contact	Director, Corporate & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		PHOENIX	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Bid Primary Contact	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	CAP Report Contact for Public Website			Services	Member		4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Ph	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	CEO - CMS Administrator Contact	President and CEO	Ms.	Kehaly	Pam		6028644610					pam.kehaly@azblue.com	8220 N. 23rd Ave.		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	CEO - Senior Official for Contracting	President and CEO	Ms.	Kehaly	Pam		6028644610					pam.kehaly@azblue.com	8220 N. 23rd Ave.		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Chief Financial Officer	Chief Financial Officer	Mr.	El-Tawil	Mark		6028645700					mark.el-tawil@azblue.com	8220 N 23rd Ave	MS C410	Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Chief Operating Officer	Chief Operating Officer	Mr.	Greenberg	Joe		6029166930					joe.greenberg@azblue.com	8220 N. 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Chief Information Officer	VP- CIO	Mr.	Pencek	Michael		6029166728					michael.pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Chief Information Security Officer	Director, Chief Information Security Officer	Mr.	Pencek	Michael		6029166728					Michael.Pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	CMS Casework Communication Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Complaints Tracking Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Contact for Fraud Investigations	Staff Vice President, Corp & Medicare Compliance	Ms.	Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Coordination of Benefits Contact	Mgr- Medicare Finance		Nguyen	Peter		6029168506					peter.nguyen@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Corporate Mailing						4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst/Accountant	Mr.	Westphal	Robert		6029168503					robert.westphal@azblue.com	8220 N 23rd Ave.		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Customer Service Operations Contact	Staff VP, MA Ops & FEP Progs		Langum	Becca	S	6029166742					rebecca.langum@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	DIR Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	DIR Contact (Secondary)	Mgr- Medicare Finance		Nguyen	Peter		6029168506					peter.nguyen@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Emergency Part D Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Emergency Part D Contact (Secondary)	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N. 23rd Ave.		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Encounter Data & Risk Adjustment Operations Contact	Sr. Manager, Risk Adjustment Operations		Hubler	Jamee		6029168220					Jamee.Hubler@azblue.com	8220 N. 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Enrollment Contact	Mgr- Medicare Enrollment		Ramirez	Michelle		6029168404					michelle.ramirez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	EOB Transfer Contact	Director, PDP Operations		Weideman	Stacy		6028644391				8583572494	stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Financial Audit Contact	Chief Audit Executive	Mrs.	Lohse	Deepa		6028644452					deepa.lohse@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	09/20/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Financial Reporting Contact	Director, Financial Reporting	Ms.	Acquafredda	Brandy		6028644683					brandy.acquafredda@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Formulary Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Formulary Contact (Secondary)	Director, Formulary Services		Zele	Carolyn		8587905737				8006833053	FMT@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	General Contact	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Government Relations Contact	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	HIPAA Privacy Officer	Director of Legal and Privacy Officer		Schrock	Anne		6028644315					anne.schrock@azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	HIPAA Security Officer	Director, Chief Information Security Officer	Mr.	Pencek	Michael		6029166728					Michael.Pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Hospice Contact	Sr Health Plan Rx Specialist		Norman	Laci		6029168577					laci.norman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Interoperability Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	MA Appeals/Grievances Contact			Services	Member		4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	MA Claims Processing Contact for Public Website	VP & General Manager Medicare & FEP		Bowers	Krista		8182197755					krista.bowers@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Marketing Contact	Marketing Manager		Johnson	Nichelle		6028645215					MedSalesHPMSMaterial@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Medical Director	Medical Director	Dr	Raja	Rubina		6028642176					rubina.raja@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Medicare Compliance Officer	Director, Corporate and Medicare Compliance	Mrs.	Moore	Veronica		6023367600				6028643152	veronica.moore@azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Medicare Coordinator	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Medicare Part D Opioid Overutilization Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Medication Therapy Management Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Online Enrollment Center Contact (Primary)	Mgr- Medicare Enrollment		Ramirez	Michelle		6029168404					michelle.ramirez@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Part C Application Contact	Director, Corporate & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		PHOENIX	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Part C Reporting Contact	Director, Corporate & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		PHOENIX	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Part D Appeals			Services	Member							contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract	8004468331				HMO - Health Maintenance Organization		C	San Francisco
H6936	Part D Appeals Contact (Secondary)	Manager Disputes and Appeals Department		Angel	Clarissa							GrievanceAppeals@Azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract	6029168073				HMO - Health Maintenance Organization		C	San Francisco
H6936	Part D Application Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Part D Benefits Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Part D Claims Submission Contact			Scherlippens	Carine		8587907415					MedicarePartDProjectManagers@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Part D Exceptions Contact	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy							Stacy.Weideman@azblue.com	10835 N 25th Ave. Ste 108		Phoenix	AZ	85029	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract	6028644391				HMO - Health Maintenance Organization		C	San Francisco
H6936	Part D Price File Contact (Back-up)	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Part D Price File Contact (Primary)			Jordan	Felicia		8587906416					planfindercommunications@medimpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Part D Quality Assurance Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Part D Reporting Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Patient Safety Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Payment Contact	Finance Manager	Mr.	Nguyen	Peter		6029168506					peter.nguyen@azblue.com	8220 N 23rd Ave.		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Pharmacy Director	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Pharmacy Network Management Contact	Supervisor, Pharmacy Network Support		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Pharmacy Network Management Contact (Secondary)	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics		Weideman	Stacy		6028644391					Stacy.Weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services		Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct .		San Diego	CA	92131	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract	8774036038				HMO - Health Maintenance Organization		C	San Francisco
H6936	Pharmacy Technical Help Desk Contact (Secondary)	Dir-Clinical Pharmacy Prgm, Clinical Therapeutics	Mr.	Weideman	Stacy							stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract	6028644391				HMO - Health Maintenance Organization		C	San Francisco
H6936	Plan Directory Contact for Public Website			Services	Member		4809370409					contact.advantage@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Plan to Plan Reconciliation Contact	Director, Financial Reporting		Acquafredda	Brandy		6028644683				6028645308	brandy.acquafredda@azblue.com	PO Box 81049		Phoenix	AZ	85069	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Processor Contact			Scherlippens	Carine		8587907415					MedicarePartDProjectManagers@MedImpact.com	MedImpact	10181 Scripps Gateway Ct .	San Diego	CA	92131	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Quality Contact	VP Medicare Performance		Cash	Gerri		6028644668					gerrilin.cash@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Reconciliation Contact	Mgr- Medicare Finance		Nguyen	Peter		6024272128					peter.nguyen@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Reconciliation Contact (Secondary)	Director, Financial Reporting		Acquafredda	Brandy		6028644683					brandy.acquafredda@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Recovery Audit Contact	Director, Corporate and Medicare Compliance	Ms.	Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Surveillance Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					Veronica.Moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	System Contact	Informatn Security Svcs- Lead	Ms.	O'Brien	Debi		6029167939					debi.o'brien@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Third Party Administrator (TPA) Liaison	Finacial Analyst/Accountant	Mr.	Westphal	Robert		6029168503					robert.westphal@azblue.com	8220 N 23rd Ave.		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	User Access Contact	Informatn Security Svcs- Lead	Ms.	O'Brien	Debi		6029167939					debi.o'brien@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Utilization Management Contact	Mgr- Utilization Management		Guddendorf	Kelly		6028644358					kelly.guddendorf@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6936	Utilization Review Contact	Mgr- Utilization Management		Guddendorf	Kelly		6028644358					kelly.guddendorf@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/26/2023	2023	BLUE CROSS & BLUE SHIELD OF ARIZONA, INC.	Local CCP	Blue Cross Blue Shield of Arizona	HMO/HMOPOS		Blue Cross Blue Shield of Arizona	447	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	San Francisco
H6941	Automated TrOOP Balance Transfer Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Backup User Access Contact	Senior Director	Mrs.	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Best Available Evidence Contact	Senior Director	Mrs.	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Bid Primary Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	CAP Report Contact for Public Website	PACE Program Director	Ms	Blue	Samantha		9186649000	1224				sblue@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	CEO - CMS Administrator Contact	Chief Executive Officer	Ms	Bradshaw	Eileen		9186649000				9186649922	eileen.bradshaw@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	09/28/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	CEO - Senior Official for Contracting	PACE Program Director	Ms	Blue	Samantha		9186649000	1224				sblue@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	09/28/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Chief Financial Officer	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Chief Operating Officer	Chief Executive Officer	Mrs.	Bradshaw	Eileen		9186649000					eileen.bradshaw@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Chief Information Officer	Senior Director	Mrs	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Chief Information Security Officer	Compliance Officer	Mrs.	Crow	Mary		9186649000					mcrow@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	CMS Casework Communication Contact	PACE Program Director	Ms	Blue	Samantha		9186649000	1224				sblue@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Complaints Tracking Contact	PACE Program Director	Ms	Blue	Samantha		9186649000	1224				sblue@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Contact for Fraud Investigations	Senior Director	Mrs.	Blue	Samanthani		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Coordination of Benefits Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Corporate Mailing						9186649000	1224				sblue@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Customer Service Operations Contact	PACE Program Director	Ms	Blue	Samantha		9186649000	1224				sblue@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	DIR Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	DIR Contact (Secondary)	Senior Director	Mrs.	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Emergency Part D Contact	Senior Director of PACE	Ms	Blue	Samantha		9186649000	1224			9186649922	sblue@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	09/28/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Emergency Part D Contact (Secondary)	Chief Financial Officer	Mr.	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	01/06/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Encounter Data & Risk Adjustment Operations Contact	Sr. Director LIFE PACE		Blue	Samantha		9189499969					sblue@lifeseniorservices.org	5330 E. 31st St. Suite 800		Tulsa	OK	74135	02/24/2023	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Enrollment Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	EOB Transfer Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Financial Audit Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Financial Reporting Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Formulary Contact	COO		Greenhalgh	Michael		8889742763				8562730135	mgreenhalgh@trhc.com	CareKinesis, Inc.	228 Strawbridge Drive	Moorestown	NJ	08057	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	General Contact	PACE Program Director	Ms	Blue	Samantha		9186649000	1224				sblue@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Government Relations Contact	Senior Director	Mrs.	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	HIPAA Privacy Officer	Compliance Officer	Mrs.	Crow	Mary		9186649000					mcrow@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	HIPAA Security Officer	Compliance Officer	Mrs.	Crow	Mary		9186649000					mcrow@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Interoperability Contact	Senior Director	Mrs.	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	MA Appeals/Grievances Contact	Senior Director	Mrs.	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Marketing Contact	Marketing Director	Ms	Kirchhoff	Kelly		9186649000				9186649922	kkirchhoff@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Medical Director	Medical Director	Dr.	Arney	Lori		9189499969				9186649922	larney@lifeseniorservices.org	902 E. Pine Street		Tulsa	OK	74106	06/01/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Medicare Compliance Officer	Compliance Officer	Mrs,	Crow	Mary		9186649000					mcrow@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Medicare Coordinator	PACE Program Director	Ms	Blue	Samantha		9186649000					sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	09/28/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Arney	Lori		9189499969					larney@lifeseniorservices.org	902 E Pine St		Tulsa	OK	74106	09/28/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Medication Therapy Management Contact	Medical Director	Dr.	Arney	Lori		9189499969				9186649922	larney@lifeseniorservices.org	902 E. Pine Street		Tulsa	OK	74106	06/01/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Part C Application Contact	Senior Director	Mrs.	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Part D Appeals	PACE Program Director	Ms	Blue	Samantha						9186649922	sblue@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	09/28/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active	8666649009				PACE - Nat		C	Dallas
H6941	Part D Appeals Contact (Secondary)	Chief Financial Officer	Mr.	Copeland	Bill						9186649922	bcopeland@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	01/06/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active	8666649009	6649000			PACE - Nat		C	Dallas
H6941	Part D Application Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Part D Benefits Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Part D Claims Submission Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Part D Exceptions Contact	Chief Financial Officer	Mr	Copeland	Bill						9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active	8666649009				PACE - Nat		C	Dallas
H6941	Part D Exceptions Contact (Secondary)	Senior Director	Mrs.	Blue	Samantha							sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active	9186649000	1124			PACE - Nat		C	Dallas
H6941	Part D Price File Contact (Back-up)	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Part D Price File Contact (Primary)	COO		Greenhalgh	Michael		8889742763				8562730135	mgreenhalgh@trhc.com	CareKinesis, Inc.	228 Strawbridge Drive	Moorestown	NJ	08057	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Part D Quality Assurance Contact	PACE Program Director	Ms	Blue	Samantha		9186649000	1224				sblue@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Part D Reporting Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Patient Safety Contact	Medical Director	Dr.	Arney	Lori		9189499969				9186649922	larney@lifeseniorservices.org	902 E. Pine Street		Tulsa	OK	74106	02/18/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Payment Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000	1211			9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Pharmacy Director	COO		Greenhalgh	Michael		8889742763				8562730135	mgreenhalgh@trhc.com	CareKinesis, Inc.	228 Strawbridge Drive	Moorestown	NJ	08057	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Pharmacy Network Management Contact	COO		Greenhalgh	Michael		8889742763				8562730135	mgreenhalgh@trhc.com	CareKinesis, Inc.	228 Strawbridge Drive	Moorestown	NJ	08057	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Pharmacy Technical Help Desk Contact	COO		Greenhalgh	Michael						8562730135	mgreenhalgh@trhc.com	CareKinesis, Inc.	228 Strawbridge Drive	Moorestown	NJ	08057	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active	8889742763				PACE - Nat		C	Dallas
H6941	Plan Directory Contact for Public Website	PACE Program Director	Ms	Blue	Samatha		9186649000					sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	09/28/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Processor Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Quality Contact	PACE Program Director	Ms	Blue	Samantha		9186649000	1224				sblue@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Reconciliation Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Reconciliation Contact (Secondary)	Senior Director	Mrs.	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Recovery Audit Contact	Chief Financial Officer	Mr	Copeland	Bill		9186649000				9186649922	bcopeland@lifeseniorservices.org	5330 East 31st Street, Suite 800		Tulsa	OK	74135	02/27/2019	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Surveillance Contact	Senior Director	Mrs.	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	System Contact	Senior Director	Mrs.	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mr.	Copeland	Bill		9186649000					bcopeland@lifeseniorservices.org	5330 E 31st Street, Suite 800		Tulsa	OK	74135	02/17/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	User Access Contact	Senior Director	Mrs.	Blue	Samantha		9186649000	1124				sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	12/09/2022	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Utilization Management Contact	PACE Program Director	Ms	Blue	Samantha		9186649000					sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	09/28/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6941	Utilization Review Contact	PACE Program Director	Ms	Blue	Samantha		9186649000					sblue@lifeseniorservices.org	5330 E. 31st Street, Suite 800		Tulsa	OK	74135	09/28/2021	2023	LIFE PACE	National PACE	LIFE PACE, INC.	National PACE		LIFE Senior Services, Inc.	601	Yes	Active					PACE - Nat		C	Dallas
H6959	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	12/31/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Backup User Access Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/24/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	CAP Report Contact for Public Website	Chief Compliance Officer, ISNP Ventures, LLC		O'Shea	Holly		4107661995					compliance@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	02/02/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	CEO - CMS Administrator Contact	President, ISNP Ventures, LLC	Mr.	Attman	Gary		4108028073	114				gattman@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	12/31/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	CEO - Senior Official for Contracting	President, ISNP Ventures, LLC	Mr.	Attman	Gary		4107661995	114				gattman@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	03/25/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Chief Financial Officer	CFO, ISNP Ventures, LLC	Mr.	Finglass	Brian		4107661995	114			4105051525	finglassb@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	03/26/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Chief Operating Officer	COO	Mr	Attman	Gary	L	4107661995	99510				gattman@futurecare.com	8028 Ritchie Hwy	Suite 210	Pasadena	MD	21122	02/10/2020	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Contact for Fraud Investigations	Chief Compliance Officer, ISNP Ventures, LLC		O'Shea	Holly		4107661995	114				compliance@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	02/02/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/24/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Corporate Mailing						8442061205					keycarecustomerservice@allyalign.com	P.O. Box 6510		Glen Allen	VA	230586510	02/16/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/13/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/13/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Encounter Data & Risk Adjustment Operations Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/24/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	EOB Transfer Contact			Lowry	Kristy		8448546883				8003756496	kristy.lowry@allyalign.com	P.O. Box 2190		Glen Allen	VA	230582190	01/15/2020	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Financial Audit Contact	CFO, ISNP Ventures LLC	Mr.	Finglass	Brian		4107661995	114				finglassb@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Financial Reporting Contact	CFO, ISNP Ventures, LLC	Mr.	Finglass	Brian		4107661995	114			4105051525	finglassb@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	12/31/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	General Contact	Chief Compliance Officer, ISNP Ventures, LLC		O'Shea	Holly		4107661995	114				compliance@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	02/02/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	HIPAA Privacy Officer		Ms.	O'Shea	Holly		4107661995	114				osheah@futurecarehealth.com	8028 Ritchie Highway		Pasadena	MD	21122	03/22/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	HIPAA Security Officer		Ms.	O'Shea	Holly		4107661995	114				osheah@futurecarehealth.com	8028 Ritchie Highway		Pasadena	MD	21122	03/22/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Medical Director	Chief Medical Officer, ISNP Ventures, LLC	Dr.	Sheikh	Fatima		4107661995					sheikhf@futurecare.com	8028 Ritchie Highway		Pasadena	MD	21122	04/02/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Medicare Compliance Officer	Chief Compliance Officer, ISNP Ventures, LLC	Ms.	O'Shea	Holly		4107661995	114				compliance@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	10/08/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Medicare Coordinator			O'Shea	Holly		4107661995	114				osheah@futurecarehealth.com	8028 Ritchie Highway		Pasadena	MD	21122	10/07/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/07/2023	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part C Application Contact	Chief Financial Officer, ISNP Ventures, LLC	Mr.	Finglass	Brian		4107661995	114			4105051525	finglassb@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	02/02/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part C Reporting Contact			Rennie	Lynda		8043966383					lynda@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/24/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Application Contact	Chief Financial Officer, ISNP Ventures, LLC	Mr.	Finglass	Brian		4107661995	114			4105051525	finglassb@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	02/02/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/15/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/13/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	03/19/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	12/31/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Payment Contact	CFO, ISNP Ventures, LLC	Mr.	Finglass	Brian		4107661995	114			4105051525	finglassb@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/13/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	12/31/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Philadelphia
H6959	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H6959	Physician Incentive Contact			Howells	Heather		8049215196					heather.howells@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Plan Directory Contact for Public Website			Sindlinger	Rocio		8442061205					rocio.sindlinger@allyalign.com	P.O. Box 2190		Glen Allen	VA	230582190	12/15/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Plan to Plan Reconciliation Contact	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/24/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Quality Contact			Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/24/2019	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Reconciliation Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/15/2020	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Reconciliation Contact (Secondary)	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Recovery Audit Contact	Chief Compliance Officer, ISNP Ventures, LLC	Ms.	O'Shea	Holly		4107661995					compliance@keycareadvantage.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	02/02/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Third Party Administrator (TPA) Liaison	CFO, ISNP Ventures, LLC	Mr.	Finglass	Brian		4107661995	114			4105051525	finglassb@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	09/28/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	User Access Contact	Chief Compliance Officer, ISNP Ventures, LLC	Ms.	O'Shea	Holly		4107661995	114				compliance@keycareadvantage.com	8028 Ritchie Highway		Pasadena	MD	21122	02/24/2022	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6959	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/13/2021	2023	ISNP VENTURES, LLC	Local CCP	KeyCare Advantage	HMO/HMOPOS		ISNP Holdings, LLC	732	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H6975	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H6975	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H6975	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449089				HMO - Health Maintenance Organization		C	Dallas
H6975	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6975	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE OF ALABAMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H6988	Agent/Broker Compensation Data Contact	Chief Financial Officer		Stender	Steven		7182157000	3202				sstender@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	12/06/2017	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Zlotkus	Steve		8587906250				8587906052	PartDCAT@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	04/29/2020	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Backup User Access Contact	Senior Director of Operational Compliance and SIU		Walfish	Moshe		7182157000	3123				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Best Available Evidence Contact	Medicare Enrollment Manager		Thompkins	Alicia		7182157000	3750			7185815552	AThompkins@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Bid Audit Contact	Chief Financial Officer		Stender	Steven		7182157000	3102				sstender@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Bid Audit Site Contact	Chief Compliance Officer		Faust	Lois		7182157000	3104				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Bid Primary Contact	Chief Financial Officer		Stender	Steven		7182157000	3102				sstender@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	CAP Report Contact for Public Website	Chief Compliance Officer		Faust	Lois		7182157000	3104				lfaust@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Bloom	Mark		9178313187					mbloom@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	01/19/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	CEO - Senior Official for Contracting	Chief Executive Officer		Bloom	Mark		9178313187					mbloom@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Chief Financial Officer	Chief Financial Officer		Stender	Steven		9178313102					sstender@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Chief Operating Officer	Chief Executive Officer		Bloom	Mark		9178313187					mbloom@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Chief Information Officer	Chief Information Officer		Hirsch	Steven		9179936631					shirsch@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Chief Information Security Officer	AVP of Information Systems	Mr.	Shonk	Brian		9177895360					bshonk@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	CMS Casework Communication Contact	Director of Regulatory Compliance		Ng	Wendy		9179936647					compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	09/27/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Complaints Tracking Contact	Director of Regulatory Compliance		Ng	Wendy		9179936647					compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	09/27/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Contact for Fraud Investigations	Senior Director of Operational Compliance and SIU		Walfish	Moshe		7182157000	3123				moshew@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Coordination of Benefits Contact	Senior Director of Finance		Engelberg	Gila		7182157000	3301				GEngelberg@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	04/16/2022	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Corporate Mailing						7182157000					compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	04/15/2020	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Director of Finance		Engelberg	Gila		7182157000	3301				GEngelberg@centersplan.com	75 Vanderbilt Ave.	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Customer Service Operations Contact	VP of Business Operations		Kalatsky	Shlomo		9172017947					skalatsky@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	DIR Contact	Compliance Reporting Manager		Shtern	Gennady		7182157000	3414				gshtern@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	03/09/2022	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	DIR Contact (Secondary)	Senior Director of Operational Compliance and SIU		Walfish	Moshe		7182157000	3123				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	03/09/2022	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Electronic Health Record Contact	Chief Compliance Officer		Faust	Lois		7182157000	3104				compliance@centersplan.com	75 Vanderbilt Ave.	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Emergency Part D Contact	Chief Medical Officer	Dr.	Michelson	Marco		7182157000	3254				mmichelson@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	01/19/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Emergency Part D Contact (Secondary)	Director of Pharmacy Management	Ms.	Segal	Penina		7182157000	3221				psegal@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	01/19/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Encounter Data & Risk Adjustment Operations Contact	Director of System Configuration		Koegel	Adam		9177895320					adamkoegel@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	03/09/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Enrollment Contact	Medicare Enrollment Manager		Thompkins	Alicia		9176365717					AThompkins@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	EOB Transfer Contact	VP of Business Operations		Kalatsky	Shlomo		9172017947				9292553257	skalatsky@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Financial Audit Contact	Chief Financial Officer		Stender	Steven		9178313102					sstender@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Financial Reporting Contact	Chief Financial Officer		Stender	Steven		9178313102					sstender@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Formulary Contact	Manager, Formulary Administration and Maintenance		Nyawabila	Christina		8587907009					FAS@Medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Formulary Contact (Secondary)	Director of Pharmacy Management		Segal	Penina		7182157000	3221				psegal@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	General Contact	Chief Compliance Officer		Faust	Lois		7182157000	3104				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Government Relations Contact	Chief Compliance Officer		Faust	Lois		7182157000	3104				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	HIPAA Privacy Officer	Chief Compliance Officer		Faust	Lois		7182157000	3104				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	HIPAA Security Officer	Chief Information Officer		Hirsch	Steve		7182157000	3261				shirsch@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Hospice Contact	Director of Pharmacy Management		Segal	Penina		7182157000	3221				psegal@centersplan.com	75 Vanderbilt Avenue	Ste. 700	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Interoperability Contact	AVP of Information Systems		Shonk	Brian		7182157000	3247				bshonk@centersplan.com	75 Vanderbilt Avenue	7th floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	MA Appeals/Grievances Contact	Associate Director of Grievance and Appeals		Rolffot	Julia		9179936661					jrolffot@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	MA Claims Processing Contact for Public Website	Assistant Director of Claims		Montalvo	Crystal		6468594039					cmontalvo@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Marketing Contact	AVP of Compliance		Fernandes	Natalie		7182157000	3142			3476201885	nfernandes@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/12/2022	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Medical Director	Chief Medical Officer	Dr.	Michelson	Marco		9179244971					mmichelson@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	08/14/2020	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Medicare Compliance Officer	Chief Compliance Officer		Faust	Lois		9178313104					compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Medicare Coordinator	AVP of Compliance		Fernandes	Natalie		7182157000	3142			3476201885	compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/12/2022	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy Management		Segal	Penina		7182157000	3221				psegal@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Medication Therapy Management Contact	Director of Pharmacy Management		Segal	Penina		7182157000	3221				psegal@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Online Enrollment Center Contact (Back-up)	Asst. Director of Clinical Intake & Enrollment		Sharma	Manu		6469333371					msharma@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Online Enrollment Center Contact (Optional)	Senior Director of Intake & Enrollment		Mejia	Serena		9179936665					smejia@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Online Enrollment Center Contact (Primary)	Medicare Enrollment Manager		Thompkins	Alicia		9176365717					AThompkins@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Part C Application Contact	Senior Director of Operational Compliance and SIU		Walfish	Moshe		7182157000	3123				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Part C Reporting Contact	Senior Director of Operational Compliance and SIU		Walfish	Moshe		7182157000	3123				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Part D Appeals	Director of Pharmacy Management		Segal	Penina							psegal@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active	7182157000	3221			HMO - Health Maintenance Organization		C	New York
H6988	Part D Appeals Contact (Secondary)	Associate Director of Grievance and Appeals		Rolffot	Julia							jrolffot@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active	9179936661				HMO - Health Maintenance Organization		C	New York
H6988	Part D Application Contact	Senior Director of Operational Compliance and SIU		Walfish	Moshe		7182157000	3123				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Part D Benefits Contact	Director of Pharmacy Management		Segal	Penina		7182157000	3221				psegal@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Part D Claims Submission Contact	Assistant Director of Claims		Montalvo	Crystal		6468594039					cmontalvo@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Part D Exceptions Contact	Director of Pharmacy Management		Segal	Penina							psegal@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active	7182157000	3221			HMO - Health Maintenance Organization		C	New York
H6988	Part D Exceptions Contact (Secondary)	Assistant Director of Pharmacy		Vysotski	Sora							svysotski@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active	7182157000	3220			HMO - Health Maintenance Organization		C	New York
H6988	Part D Price File Contact (Back-up)	Medicare Part D Project Manager I		Niemi	Kirstin		8587906455					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	07/27/2020	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Part D Price File Contact (Optional)	Director of Pharmacy Management		Segal	Penina		7182157000	3221				psegal@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Part D Price File Contact (Primary)	Chief Medical Officer	Dr.	Michelson	Marco		7182157000	3254				mmichelson@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	03/13/2017	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Part D Quality Assurance Contact	Director of Quality		Seifert	Julie		7182157000	3126				jseifert@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Part D Reporting Contact	Manager, Medicare Programs and Services		Scott	Susan		8587906565					MedicarePartDProjectManagers@Medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Patient Safety Contact	Chief Medical Officer	Dr.	Michelson	Marco		7182157000	3254				mmichelson@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	03/13/2017	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Payment Contact	Chief Financial Officer		Stender	Steven		7182157000	3102				sstender@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Pharmacy Director	Director of Pharmacy Management		Segal	Penina		7182157000	3221				psegal@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Pharmacy Network Management Contact	Director of Configuration Services		Moe	Kathlene		8587907437					kathlene.moe@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	08/05/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Pharmacy Network Management Contact (Secondary)	Assistant Director of Pharmacy		Vysotski	Sora		7182157000	3220				svysotski@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Pharmacy Technical Help Desk Contact	VP, Customer Contact Services		Battle	Dorry						8587906075	Customerservice@Medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	10/27/2016	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active	8888075717				HMO - Health Maintenance Organization		C	New York
H6988	Pharmacy Technical Help Desk Contact (Secondary)	Director of Pharmacy Management		Segal	Penina							psegal@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active	8442745227	3221			HMO - Health Maintenance Organization		C	New York
H6988	Plan Directory Contact for Public Website	AVP of Compliance		Fernandes	Natalie		7182157000	3142			3476201885	compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/12/2022	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Plan to Plan Reconciliation Contact	Senior Director of Finance		Engelberg	Gila		7182157000	3301				GEngelberg@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Processor Contact	Manager, Medicare Programs and Services		Scott	Susan		8587906565					Susan.Scott@Medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Quality Contact	Director of Quality		Seifert	Julie		7182157000	3126				jseifert@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Reconciliation Contact	Chief Financial Officer		Stender	Steven		7182157000	3102				sstender@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Reconciliation Contact (Secondary)	Chief Compliance Officer		Faust	Lois		7182157000	3104				compliance@centersplan.com	75 Vanderbilt Ave	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Recovery Audit Contact	Senior Director of Operational Compliance and SIU		Walfish	Moshe		7182157000	3123				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	SNP Application Contact	Chief Compliance Officer		Faust	Lois		7182157000	3104				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	SNP State Contact	Chief Compliance Officer		Faust	Lois		7182157000	3104				compliance@centersplan.com	75 Vanderbilt Ave	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Surveillance Contact	Chief Compliance Officer		Faust	Lois		7182157000	3104				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	System Contact	AVP of Information Systems		Shonk	Brian		7182157000	3247				bshonk@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	05/30/2023	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Third Party Administrator (TPA) Liaison	Senior Director of Finance		Engelberg	Gila		7182157000	3301				GEngelberg@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	User Access Contact	Senior Director of Operational Compliance and SIU		Walfish	Moshe		7182157000	3123				compliance@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	07/07/2021	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Utilization Management Contact	Director of Utilization Management		Mavrinac	Peggy		7182157000	3582				PMavrinac@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	12/05/2018	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H6988	Utilization Review Contact	Director of Utilization Management		Mavrinac	Peggy		7182157000	3582				PMavrinac@centersplan.com	75 Vanderbilt Avenue	7th Floor	Staten Island	NY	10304	04/15/2020	2023	CENTERS PLAN FOR HEALTHY LIVING, LLC	Local CCP	Centers Plan for Healthy Living	HMO/HMOPOS		Centers Plan for Healthy Living, LLC	514	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7003	Automated TrOOP Balance Transfer Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Backup User Access Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Best Available Evidence Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Bid Primary Contact	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	CAP Report Contact for Public Website	VP of PACE Operations	Mrs	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	CEO - CMS Administrator Contact	CEO	Mr	Gurley	Eric		4028292950				4028292939	egurley@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	CEO - Senior Official for Contracting	CEO	Mr	Gurley	Eric		4028292950				4028292939	egurley@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Chief Financial Officer	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Chief Operating Officer	Senior VP & COO	Mrs	Kaminski	Julie		4028292954				4028292939	Jkaminski@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Chief Information Officer	CFO	Mr	Bear	Scott		4028292922					sbear@immanuel.com	1044 North 115th Street Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Chief Information Security Officer	CFO	Mr.	Bear	Scott		4028292922					sbear@immanuel.com	1044 North 115th Street Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	CMS Casework Communication Contact	VP of PACE Operations	Mrs	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Complaints Tracking Contact	VP of PACE Operations	Mrs	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Contact for Fraud Investigations	Corporate Compliance Officer	Mrs	Durbin	Tracy		4028292968				4028292939	TDurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Coordination of Benefits Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Corporate Mailing						4028292999				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Coverage Gap Discount Program (CGDP) Payment Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Customer Service Operations Contact	VP of PACE Operations	Mrs	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	DIR Contact	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	DIR Contact (Secondary)	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Emergency Part D Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Emergency Part D Contact (Secondary)	Health Plan Analyst	Mrs.	Battaglia	Trisha		4028296951					tbattaglia@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	09/21/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Encounter Data & Risk Adjustment Operations Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Enrollment Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	EOB Transfer Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Financial Audit Contact	Dir of Health Plan Managment	Mrs	Boyle	Amanda		4028292933					aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	09/21/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Financial Reporting Contact	Dir of Health Plan Management	Mrs	Boyle	Amanda		4028292933					aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	09/21/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Formulary Contact	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	General Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Government Relations Contact	Corporate Compliance Officer	Mr	Sigmond	John		4028292910					jsigmond@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	HIPAA Privacy Officer	Corporate Compliance Officer	Mrs	Durbin	Tracy		4028292968				4028292939	Tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	HIPAA Security Officer	CFO	Mr	Bear	Scott		4028292922					sbear@immanuel.com	1044 North 115th Street Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Interoperability Contact	CFO	Mr	Bear	Scott		4028292922					sbear@immanuel.com	1044 N 115th Street		Omaha	NE	68135	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	MA Appeals/Grievances Contact	Director of PACE Clinical Operations	Mrs	Grasz	Liza		4028292967					LGrasz@immanuel.com	1044 N 115th Street	Suite 500	Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	MA Claims Processing Contact for Public Website	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292943				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Marketing Contact	VP of PACE Operations	Mrs.	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Medical Director	VP of Clinical Operations	Mr	Fox	Devin		4028293278					DFox@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Medicare Compliance Officer	Corp Compliance Officer	Mrs.	Durbin	Tracy		4028292968					tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	09/21/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Medicare Coordinator	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Medicare Part D Opioid Overutilization Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 N 115th Street		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Medication Therapy Management Contact	Vice President of Clinic Operations	Mr	Fox	Devin		4028293278					DFox@immanuel.com	1044 North 115th Street		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Part C Application Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Part D Appeals	Corporate Compliance Officer	Mrs	Durbin	Tracy						4028292939	tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active	4028292968				PACE - Nat		C	Kansas City
H7003	Part D Appeals Contact (Secondary)	Dir. Health Plan Management	Mrs.	Boyle	Amanda						4028292939	aboyle@immanuel.com	1044 N 115th Street		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active	4028292993				PACE - Nat		C	Kansas City
H7003	Part D Application Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Part D Benefits Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Part D Claims Submission Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Part D Exceptions Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda						4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active	0000000000				PACE - Nat		C	Kansas City
H7003	Part D Exceptions Contact (Secondary)	Corporate Compliance Officer	Mrs	Durbin	Tracy						4028292939	tdurbin@immanuel.com	1044 N Street		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active	4028292968				PACE - Nat		C	Kansas City
H7003	Part D Price File Contact (Back-up)	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Part D Price File Contact (Primary)	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Part D Quality Assurance Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 N 115th Street		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Part D Reporting Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Patient Safety Contact	Corporate Compliance Officer	Mrs	Durbin	Tracy		4028292968				4028292939	tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Payment Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Personal Health Record Contact	VP of PACE Operations	Mrs	Butterfield	April		4028292900				4028292998	abutterfield@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Pharmacy Director	VP of Clinical Operations	Mr	Fox	Devin		4028293278					DFox@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Pharmacy Network Management Contact	VP of Clincial Operations	Mr	Fox	Devin		4028293278					DFox@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Pharmacy Technical Help Desk Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda						4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active	0000000000				PACE - Nat		C	Kansas City
H7003	Plan Directory Contact for Public Website	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Plan to Plan Reconciliation Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Processor Contact	Dir. Health Plan Management	Mrs	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Quality Contact	Director of Clincial Operations	Mrs	Grasz	Liza		5155182403					LGrasz@immanuel.com	1044 N 115th Street		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Reconciliation Contact	CFO	Mr	Bear	Scott		4028292922				4028292939	sbear@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Recovery Audit Contact	Corporate Compliance Officer	Mrs	Durbin	Tracy		4028292968				4028292939	tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Surveillance Contact	Corporate Compliance Officer	Ms	Durbin	Tracy		4028292968				4028292939	tdurbin@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	System Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Third Party Administrator (TPA) Liaison	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	User Access Contact	Dir. Health Plan Management	Mrs.	Boyle	Amanda		4028292993				4028292998	aboyle@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Utilization Management Contact	Director of Clinical Operations	Mrs	Grasz	Liza		4028292967					LGrasz@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7003	Utilization Review Contact	Director of Clinical Operations	Mrs	Grasz	Liza		4028292697					LGrasz@immanuel.com	1044 North 115th Street, Suite 500		Omaha	NE	68154	07/14/2023	2023	PACE NEBRASKA	National PACE	Immanuel Pathways Omaha	National PACE		Immanuel	460	Yes	Active					PACE - Nat		C	Kansas City
H7006	Agent/Broker Compensation Data Contact	VP Sales Operations		Hohenberg	Brandon		5058600441					brandon.hohenberg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Esp	Bryan		8587906445					PartDCAT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/04/2015	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Backup User Access Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Best Available Evidence Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Bid Audit Contact	Chief Compliance Officer	Mrs.	Flynn	Jordan		6026924381					jordan.flynn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Bid Audit Site Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Bid Primary Contact	VP of Product		Viveiros	Matt		9175826324					matt.viveiros@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	CAP Report Contact for Public Website	Chief Compliance Officer		Flynn	Jordan		9713040068				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	6026924381				PPO - BBA		C	Seattle
H7006	CEO - CMS Administrator Contact	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	CEO - Senior Official for Contracting	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Chief Financial Officer	Chief Financial Officer	Mr.	Stewart	Mark		4012848679					mark.stewart@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Chief Operating Officer	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Chief Information Officer	Chief Information Officer	Mr.	Snyder	Dan		9712089848					dan.snyder@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Chief Information Security Officer	Information Security Officer	Mr.	Rohver	Eric		5414922164					eric.rohveri@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	CMS Casework Communication Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Complaints Tracking Contact	Director of Appeals and Grievances		Vaughn	Sara		9712094307				5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Contact for Fraud Investigations	HIPAA Privacy Officer/FWA Program Manager		Saunders Ricks	Rhonda		9713040043				5035841772	rhonda.saundersricks@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Coordination of Benefits Contact	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Corporate Mailing						8776728620				5035841772	compliance@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/20/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Controller		Kirkpatrick	James		5034285602					james.kirkpatrick@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/17/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Customer Service Operations Contact	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	DIR Contact	Vice President of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	DIR Contact (Secondary)	Director of Actuarial Services		Guest IV	William		5039677386					william.guestIV@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Emergency Part D Contact	VP Pharmacy Operations	Ms.	Liu	Helen		9707129377					helen.liu@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/04/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Emergency Part D Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Encounter Data & Risk Adjustment Operations Contact	CFO		Stewart	Mark		4012848679					mark.stewart@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Enrollment Contact	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	EOB Transfer Contact	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441				9512067316	jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Financial Audit Contact	President & CEO	Mr.	Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Financial Reporting Contact	CFO		Stewart	Mark		4012848679				5416728670	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Formulary Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Formulary Contact (Secondary)	Supervisor, Formulary Services		Nyawabila	Christina		8587906297					FMT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/04/2015	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	General Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Government Relations Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	HIPAA Privacy Officer	HIPAA Privacy Officer/FWA Program Manager		Saunders Ricks	Rhonda		9713040043				5035841772	rhonda.saundersricks@atriohp.com	2965 Ryan Dr. SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	HIPAA Security Officer	ISO	Mr.	Rohver	Eric		5414922164					eric.rohveri@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Hospice Contact	VP of Pharmacy Operations	Ms.	Liu	Helen		9707129377					helen.liu@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Interoperability Contact	Chief Technology Officer		Snyder	Dan		9712089848					dan.snyder@atriohp.com	1965 Ryan Dr. SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	MA Appeals/Grievances Contact	Director of Appeals and Grievances		Vaughn	Sara		9712094307				5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	MA Claims Processing Contact for Public Website	customer service		Service	Customer		8776728620				5416728670	customerservice@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	10/05/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Marketing Contact	Compliance Manager	Mr.	Allotta	Tony		8303090299					tony.allotta@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	06/09/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Medical Director	Chief Medical Director		Wethers	Darren		3143782525					darren.wethers@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Medicare Coordinator	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Medicare Part D Opioid Overutilization Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Medication Therapy Management Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	OffShore Subcontractor Contact	Chief Legal Officer, General Counsel		Wilson	Charles		5039677387				5035841772	charles.wilson@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	05/18/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Online Enrollment Center Contact (Optional)	Chief Operations Officer	Mrs.	Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	01/05/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Online Enrollment Center Contact (Primary)	Enrollment Manager		Vredenburg	Cristi		5414925119					Cristi.vredenburg@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/04/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Part C Application Contact	Chief Legal Officer		Wilson	Charles		5039677387				8662569002	charles.wilson@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	02/15/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Part C Reporting Contact	Compliance Manager	Mrs.	Luma	Yoleine		9172080084					yoleine.luma@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/09/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Part D Appeals	Director of Appeals and Grievances		Vaughn	Sara						5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/20/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	8776728620	3			PPO - BBA		C	Seattle
H7006	Part D Appeals Contact (Secondary)	VP of Pharmacy Operationss		Liu	Helen						5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	9707129377				PPO - BBA		C	Seattle
H7006	Part D Application Contact	Chief Legal Officer		Wilson	Charles		5039677387				8662569002	charles.wilson@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	02/15/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Part D Benefits Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Part D Claims Submission Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Part D Exceptions Contact	Director of Appeals and Grievances		Vaughn	Sara						5416728670	sara.vaughn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	11/11/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	8776728620	3			PPO - BBA		C	Seattle
H7006	Part D Exceptions Contact (Secondary)	VP of Pharmacy Operations	Ms.	Liu	Helen						5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	9717129377				PPO - BBA		C	Seattle
H7006	Part D Price File Contact (Back-up)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Part D Price File Contact (Optional)	Medicare Part D Project Manager		Maldonado	Cheryl		8587906397					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct,		San Diego	CA	92131	04/09/2014	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Part D Price File Contact (Primary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Part D Quality Assurance Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Part D Reporting Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Patient Safety Contact	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Payment Contact	President & CEO		Kimmer	Gregg		3128772850					Gregg.kimmer@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	08/02/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Personal Health Record Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Pharmacy Director	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Pharmacy Network Management Contact	Supervisor, Pharmacy Network Support		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	03/13/2019	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Pharmacy Network Management Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen		9707129377				5035841772	helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Pharmacy Technical Help Desk Contact	Director, Contact Center Services		Brewer	Kathy							Customerservice@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/13/2018	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	8006819571				PPO - BBA		C	Seattle
H7006	Pharmacy Technical Help Desk Contact (Secondary)	VP of Pharmacy Operations	Dr.	Liu	Helen							helen.liu@atriohp.com	2965 Ryan Dr SE		salem	OR	97301	12/08/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active	9707129377				PPO - BBA		C	Seattle
H7006	PHR Beneficiary Contact																	05/09/2018	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO	ATRIO Health Plans	ATRIO Health Plans	5	Yes	Active	8776728620				PPO - BBA		C	Seattle
H7006	Plan Directory Contact for Public Website	Customer Service		Service	Customer		8776728620				5416728670	customerservice@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	10/05/2020	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Plan to Plan Reconciliation Contact	Chief Financial Officer		Stewart	Mark		4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Processor Contact	Director, Medicare Programs		Scherlippens	Carine		8587907415					Carine.Scherlippens@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	04/09/2014	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Quality Contact	Chief Medical Director		Wethers	Darren		3143782525					darren.wethers@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Reconciliation Contact	Chief Financial Officer		Stewart	Mark		4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Reconciliation Contact (Secondary)	Director of Actuarial Services		Guest IV	William		5039677386					william.guestIV@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	02/17/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Recovery Audit Contact	CFO	Mr.	Stewart	Mark		4012848679				5035841772	mark.stewart@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	SNP Application Contact	Director of SNP Programs		Yaun	Caroline		9526886695					caroline.yaun@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	09/08/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	SNP State Contact	Director of SNP Programs		Yaun	Caroline		9526886695					caroline.yaun@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	09/08/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Surveillance Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	Jordan.flynn@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/08/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	System Contact	Chief Technology Officer	Mr.	Snyder	Dan		9712089848					dan.snyder@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	03/28/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Third Party Administrator (TPA) Liaison	Chief Operating Officer		Callahan	Jennifer		9715992441					jennifer.callahan@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	07/31/2023	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	User Access Contact	Chief Compliance Officer		Flynn	Jordan		6026924381				5035841772	jordan.flynn@atriohp.com	2965 Ryan Drive SE		Salem	OR	97301	07/20/2021	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Utilization Management Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7006	Utilization Review Contact	Director of Medical Management		Walker	Kait		5414921704					Kait.walker@atriohp.com	2965 Ryan Dr SE		Salem	OR	97301	06/07/2022	2023	ATRIO HEALTH PLANS	Local CCP	ATRIO Health Plans	Local PPO		ATRIO Health Plans	5	Yes	Active					PPO - BBA		C	Seattle
H7020	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H7020	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H7020	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H7020	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H7020	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H7020	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H7020	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7020	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF SOUTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7027	Automated TrOOP Balance Transfer Contact	Chief Financial Officer		Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Backup User Access Contact	Director of Foundation and Government Relations		Hayford	Justin		7738288270					jhayford@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Best Available Evidence Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Bid Primary Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	CAP Report Contact for Public Website	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	CEO - CMS Administrator Contact	President and CEO	Mr.	Fulwiler	Daniel		7735846130					dfulwiler@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	CEO - Senior Official for Contracting	President and CEO	Mr.	Fulwiler	Daniel		7735846130					dfulwiler@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Chief Financial Officer	Chief Financial Officer	Mr.	Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Chief Operating Officer	Chief Operations Officer	Ms.	Vergara	Carmen		8727623106					cvergara@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Chief Information Officer	VP of Information Technology	Mr.	Shivnani	Nish		7734821969					nshivnani@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/29/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Chief Information Security Officer	VP of Information Technology	Mr.	Shivnani	Nish		7734821969					nshivnani@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/29/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	CMS Casework Communication Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Complaints Tracking Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Contact for Fraud Investigations	Chief Financial Officer		Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Coordination of Benefits Contact	Chief Financial Officer		Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Corporate Mailing						7735846200					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/23/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Coverage Gap Discount Program (CGDP) Payment Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Customer Service Operations Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	DIR Contact	Director of Finance		Spreitzer	Zachary		7734821966					zspreitzer@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	DIR Contact (Secondary)	Chief Financial Officer		Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Emergency Part D Contact	Director of Finance		Spreitzer	Zachary		7734821966					zspreitzer@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Emergency Part D Contact (Secondary)	Chief Financial Officer		Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Encounter Data & Risk Adjustment Operations Contact	Chief Financial Officer		Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Enrollment Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	EOB Transfer Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786				7738234224	hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Financial Audit Contact	Chief Financial Officer	Mr.	Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Financial Reporting Contact	Chief Financial Officer		Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Formulary Contact	Director of Finance		Spreitzer	Zachary		7734821966					zspreitzer@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	General Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Government Relations Contact	Director of Foundation and Government Relations		Hayford	Justin		7738288270					jhayford@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	HIPAA Privacy Officer	Chief Operations Officer		Vergara	Carmen		8727623106					cvergara@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	HIPAA Security Officer	Chief Operations Officer		Vergara	Carmen		8727623106					cvergara@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Interoperability Contact	VP of Information Technology		Shivnani	Nish		7734821969					nshivnani@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	MA Appeals/Grievances Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	MA Claims Processing Contact for Public Website	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Marketing Contact	VP of External Affairs		Cifuentes	Ricardo		7739321015					rcifuentes@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Medical Director	Chief Medical Officer		Kim	Thomas		7735846200					tkim@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Medicare Compliance Officer	Chief Financial Officer	Mr.	Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Medicare Coordinator	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Medicare Part D Opioid Overutilization Contact	Director of Finance		Spreitzer	Zachary		7734821966					zspreitzer@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Medication Therapy Management Contact	Chief Medical Officer		Kim	Thomas		7735846200					tkim@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Part C Application Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S. Western Avenue, Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Part D Appeals	Chief Financial Officer		Gadia	Ryan							rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending	7735846200				PACE - Nat		C	Chicago
H7027	Part D Application Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S. Western Avenue, Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Part D Benefits Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Part D Claims Submission Contact	Director of Finance		Spreitzer	Zachary		7734821966					zspreitzer@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Part D Exceptions Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi							hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending	7735846200				PACE - Nat		C	Chicago
H7027	Part D Price File Contact (Back-up)	Director of Finance		Spreitzer	Zachary		7734821966					zspreitzer@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Part D Price File Contact (Primary)	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Part D Quality Assurance Contact	Director of Finance		Spreitzer	Zachary		7734821966					zspreitzer@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Part D Reporting Contact	Director of Finance		Spreitzer	Zachary		7734821966					zspreitzer@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Patient Safety Contact	Director of Quality		Ross	Samuel		7735846206					sross@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Payment Contact	Chief Financial Officer		Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Personal Health Record Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Pharmacy Director	Chief Medical Officer		Kim	Thomas		7735846200					tkim@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Pharmacy Network Management Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Pharmacy Technical Help Desk Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi							hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending	7735846200				PACE - Nat		C	Chicago
H7027	Plan Directory Contact for Public Website	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Plan to Plan Reconciliation Contact	Chief Financial Officer		Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Processor Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Quality Contact	Director of Quality		Ross	Samuel		7735846206					sross@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Reconciliation Contact	Chief Financial Officer		Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Recovery Audit Contact	Chief Financial Officer	Mr.	Gadia	Ryan		7736405792					rgadia@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/23/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Surveillance Contact	Chief Operations Officer		Vergara	Carmen		8727623106					cvergara@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	System Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Third Party Administrator (TPA) Liaison	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	User Access Contact	VP of Strategy and Business Development		Ortolaza-Alvear	Heidi		7736405786					hortolaza@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Utilization Management Contact	Chief Medical Officer		Kim	Thomas		7735846200					tkim@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7027	Utilization Review Contact	Chief Medical Officer		Kim	Thomas		7735846200					tkim@esperanzachicago.org	1940 S Western Ave. Suite 205		Chicago	IL	60608	12/28/2022	2023	ESPERANZA HEALTH CENTERS	National PACE	Esperanza Health Centers	National PACE		Esperanza Health Centers	814	Yes	Pending					PACE - Nat		C	Chicago
H7028	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H7028	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H7028	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H7028	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H7028	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H7028	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H7028	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H7028	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7028	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF SOUTH CAROLINA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7059	Automated TrOOP Balance Transfer Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204				7273241866	jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Backup User Access Contact	VP of IT		Clark	Arthur		7275234050				7275234006	ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Best Available Evidence Contact	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Bid Primary Contact	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	CAP Report Contact for Public Website	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	CEO - CMS Administrator Contact	CEO	Mr.	Fleece	Jonathan		9415527525					JFleece@stratumhealthsystem.org	5955 Rand Blvd.		Sarasota	FL	34238	03/22/2021	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	CEO - Senior Official for Contracting	CEO	Mr.	Fleece	Jonathan		9415527525					JFleece@stratumhealthsystem.org	5955 Rand Blvd.		Sarasota	FL	34238	03/22/2021	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Chief Financial Officer	CFO	Ms.	Bouhamid	Saida		9415527599					SaidaBouhamid@EmpathHealth.org	5955 Rand Blvd.		Sarasota	FL	34238	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Chief Operating Officer	CEO/President	Mr.	Fleece	Jonathan		9415527525					jonathanfleece@empathhealth.org	5955 Rand Blvd.		Sarasota	FL	34238	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Chief Information Officer	VP of IT	Mr.	Clark	Arthur		7275234050				7275234006	ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Chief Information Security Officer	VP of IT	Mr.	Clark	Arthur		7275234050				7275234006	ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	CMS Casework Communication Contact	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Complaints Tracking Contact	Quality Coordinator		McNeill	Lisa		7273241827					lisamcneill@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Contact for Fraud Investigations	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Coordination of Benefits Contact	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Corporate Mailing						7273241858					ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Coverage Gap Discount Program (CGDP) Payment Contact	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Customer Service Operations Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	DIR Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	DIR Contact (Secondary)	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Emergency Part D Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Sarasota	FL	34238	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Emergency Part D Contact (Secondary)	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Encounter Data & Risk Adjustment Operations Contact	Health Plan Operations Manager	Ms.	Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6744 102nd. Ave/		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Enrollment Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	EOB Transfer Contact	health		Crevier	Jeanne		7272599204				7273241866	jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Financial Audit Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Financial Reporting Contact	CFO/COO	Ms.	Bouhamid	Saida		9415527599					SaidaBouhamid@EmpathHealth.org	5955 Rand Blvd.		Sarasota	FL	34238	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Formulary Contact	Executive Director		m	c		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Formulary Contact (Secondary)			Jolly	Donna		9415527571					djolly@tidewell.org	5955 Rand Blvd		Sarasota	FL	34238	03/22/2021	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	General Contact	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Government Relations Contact	SVP		Reiter	Thomas		7205304082					thomasreiter@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	HIPAA Privacy Officer	CEO/President		Fleece	Jonathan		9415527525				9415565800	jonathanfleece@empathhealth.org	5955 Rand Blvd		Sarasota	FL	34238	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	HIPAA Security Officer	VP of Compliance		Mosby	Laura		7275232106					LauraMosby@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Interoperability Contact	SVP		Reiter	Thomas		7205304082					thomasreiter@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	MA Appeals/Grievances Contact	Quality Coordinator		McNeill	Lisa		7273241827					lisamcneill@empathhealth.org	6744 102nd. Ave/		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	MA Claims Processing Contact for Public Website	Health Plan Operations Manager	Ms.	Crevier	Jeanne		7272599034					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Marketing Contact	VP of Marketing and Communications		Allen	Kelly		7275233395					kellyallen@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Medical Director	Medical Director		Burt	William		7272890062					williamburt@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Medicare Compliance Officer	VP of Compliance	Ms.	Mosby	Laura		7275232106				7275232122	LauraMosby@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Medicare Coordinator	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Medicare Part D Opioid Overutilization Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Medication Therapy Management Contact	Medical Director		Burt	William		7272890062					williamburt@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	OffShore Subcontractor Contact	CFO/COO	Ms.	Bouhamid	Saida		9415527599					sbouhamid@tidewell.org	5955 Rand Blvd.		Sarasota	FL	34238	03/22/2021	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Online Enrollment Center Contact (Back-up)	CFO/COO	Ms.	Bouhamid	Saida		9415527599					sbouhamid@tidewell.org	5955 Rand Blvd.		Sarasota	FL	34238	03/22/2021	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Online Enrollment Center Contact (Primary)	Program Director		Coseo	Robert		9415867353					rcoseo@stratumhealthsystem.org	5955 Rand Boulevard		Sarasota	FL	34238	03/26/2021	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Part C Application Contact	Executive Director		Messersmith	Christophe		7273241858				7273241866	ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Part D Appeals	Health Plan Operations Manager	Ms.	Crevier	Jeanne							jeannecrevier@empathhealth.org	6744 102nd. Ave/		p	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending	7272599204				PACE - Nat		C	Atlanta
H7059	Part D Appeals Contact (Secondary)	Executive Director		m	Christophe							ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending	7273241858				PACE - Nat		C	Atlanta
H7059	Part D Application Contact	Executive Director		Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Part D Benefits Contact	Executive Director		Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Part D Claims Submission Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Part D Exceptions Contact	Health Plan Operations Manager		Crevier	Jeanne							jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending	7272599204				PACE - Nat		C	Atlanta
H7059	Part D Exceptions Contact (Secondary)	Executive Director		Messersmith	Christophe							ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending	7273241858				PACE - Nat		C	Atlanta
H7059	Part D Price File Contact (Back-up)	Health Plan Operations Manager	Ms.	Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Part D Price File Contact (Primary)	Executive Director		Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Part D Quality Assurance Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Part D Reporting Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Patient Safety Contact	Executive Director		Messersmith	Christophe		7273241858					christophermessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Payment Contact	Health Plan Operations Manager	Ms.	Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Personal Health Record Contact	Program Director		Coseo	Robert		9415867353					rcoseo@stratumhealthsystem.org	5955 Rand Boulevard		Sarasota	FL	34238	03/26/2021	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Pharmacy Director	Pharmacy Director		Rigali	Aaron		7275232550					aaronrigali@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Pharmacy Network Management Contact	Pharmacy Director		Rigali	Aaron		7275232550					aaronrigali@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Pharmacy Network Management Contact (Secondary)			Brown	Jenifer		9415527571					jbrown@tidewell.org	5955 Rand Blvd		Sarasota	FL	34238	03/22/2021	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Pharmacy Technical Help Desk Contact	Pharmacy Director		Rigali	Aaron							aaronrigali@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending	7275232550				PACE - Nat		C	Atlanta
H7059	Pharmacy Technical Help Desk Contact (Secondary)			LaRue	Denise								5955 Rand Blvd		Sarasota	FL	34238	03/22/2021	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending	8557878655				PACE - Nat		C	Atlanta
H7059	PHR Beneficiary Contact																	03/22/2021	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE	Stratum LIFE LLC			Yes	Pending	8557878655				PACE - Nat		C	Atlanta
H7059	Plan Directory Contact for Public Website	Executive Director		Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Plan to Plan Reconciliation Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Processor Contact	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	34238	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Quality Contact	Quality Coordinator		McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Reconciliation Contact	Executive Director	Mr.	Messersmith	Christophe		7273241858					ChristopherMessersmith@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Reconciliation Contact (Secondary)	CFO/COO	Ms.	Bouhamid	Saida		9415527599					sbouhamid@tidewell.org	5955 Rand Blvd.		Sarasota	FL	34238	03/22/2021	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Recovery Audit Contact	VP of Compliance	Mr.	Mosby	Laura		7275232106					LauraMosby@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Surveillance Contact	VP of Compliance		Mosby	Laura		7275232106					LauraMosby@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	System Contact	VP of IT		Clark	Arthur		7275234050				7275234006	ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Third Party Administrator (TPA) Liaison	Health Plan Operations Manager		Crevier	Jeanne		7272599204					jeannecrevier@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	User Access Contact	VP of IT		Clark	Arthur		7275234050				7275234006	ArthurClark@empathhealth.org	5771 Roosevelt Blvd.		Clearwater	FL	33760	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Utilization Management Contact	Quality Coordinator		McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7059	Utilization Review Contact	Quality Coordinator		McNeill	Lisa		7273241827				7273241866	lisamcneill@empathhealth.org	6774 102nd Ave. No.		Pinellas Park	FL	33782	09/06/2023	2023	STRATUM LIFE, LLC	National PACE	Stratum LIFE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7063	Agent/Broker Compensation Data Contact	Director Medicare Advantage		Nolte	Erin		7852916589				7852900783	erin.nolte@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	01/28/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Automated TrOOP Balance Transfer Contact	Manager PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/10/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Backup User Access Contact	Compliance Officer		Pewe	Michelle		7852916947					Compliance@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Best Available Evidence Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592					janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Bid Audit Contact	Compliance Officer		English	Chris		7852918078					compliance@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Bid Audit Site Contact	Compliance Officer		English	Chris		7852918078					compliance@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Bid Primary Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	CAP Report Contact for Public Website	Manager Government Programs Operations		Gilmer-Gentry	Janice		8002400577					janice-gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	CEO - CMS Administrator Contact	President and CEO	Mr.	All	Matt		7852917631					matt.all@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	01/04/2021	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	CEO - Senior Official for Contracting	President and CEO	Mr.	All	Matt		7852917631					matt.all@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	01/04/2021	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Chief Financial Officer	Chief Financial Officer	Mr	Bergman	Jeff		7852917263				7852918465	jeff.bergman@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	06/01/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Chief Operating Officer	Chief Operating Officer	Mrs.	Graves	Holly		7852917953					holly.graves@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	09/26/2023	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Chief Information Officer	VP Information Technology/CIO	Mr	Langdon	Matt		7852918426					matt.langdon@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/28/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Chief Information Security Officer	Chief Information Security Officer	Mr.	Allphin	Matt		7852916781					matt.allphin@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	01/28/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	CMS Casework Communication Contact	Compliance Officer		English	Chris		7852918078					compliance@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Complaints Tracking Contact	Compliance Officer		English	Chris		7852916589				7852900783	medicareadvantage.ctm@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	01/31/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Contact for Fraud Investigations	Manager SIU		Zimmerman	Tina		7852917693					tina.zimmerman@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	01/12/2021	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Coordination of Benefits Contact	Manager PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	COBmedd@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/10/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Corporate Mailing						7852916589				7852900783	erin.nolte@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	01/28/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Coverage Gap Discount Program (CGDP) Payment Contact	Staff Accountant		Zen	Kayla-Ann		7852918208				7852900783	kayla-ann.zen@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	07/06/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Customer Service Operations Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	DIR Contact	Staff Accountant		Zen	Kayla-Ann		7852918208				7852900805	Kayla-ann.zen@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	07/06/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	DIR Contact (Secondary)	Manager General Accounting		Droge	Jason		7852918171				7852900728	jason.droge@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	66629	12/15/2021	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Emergency Part D Contact	Manager of Enrollment		Ware	Anita		5083309500					anita.ware@advantasure.com	4121 Cox Rd	Suite 200	Glen Allen	VA	23060	12/09/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Emergency Part D Contact (Secondary)	Operations Enrollment Supervisor		LaMontagne	Amanda		2489436684					amanda.lamontagne@advantasure.com	4121 Cox Rd	Suite 200	Glen Allen	VA	23060	12/05/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Employer Waiver Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Encounter Data & Risk Adjustment Operations Contact	Manager, Revenue Management		Herber	Matthew		7852918095					matthew.herber@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	66629	03/31/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Enrollment Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	EOB Transfer Contact	Manager PBM Operations	Ms	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/10/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Financial Audit Contact	Chief Financial Officer	Mrs.	Shelton	Ann		7852918262					ann.shelton@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Financial Reporting Contact	Chief Financial Officer		Bergman	Jeff		7852917263				7852918465	jeff.bergman@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	06/01/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Formulary Contact	Corporate Pharmacist		Poell	Shannon		7852916910				7852900734	shannon.poell@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	06/28/2023	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Formulary Contact (Secondary)	Supervisor Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	10/15/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	General Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Government Relations Contact	VP Government & Community Relations		Mickle	Sunee		7852917194					sunee.mickle@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	04/17/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	HIPAA Privacy Officer	Chief Compliance Officer		Roehler	Dan		7852918607					Compliance@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	04/17/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	HIPAA Security Officer	Chief Information Security Officer		Allphin	Matt		7852916781					matt.allphin@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	01/28/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Hospice Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Interoperability Contact	Manager IS Services		Carver	Brian		7852918148					brian.carver@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	66629	03/31/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	MA Appeals/Grievances Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	MA Claims Processing Contact for Public Website	Manager Government Programs Operations		Gilmer-Gentry	Janice		8002400577					janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Marketing Contact	Product Marketing Coordinator		Ezerendu	Keshia		7852918220					keshia.ezerendu@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	03/31/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Medical Director	VP Medical Affairs & CMO	Dr.	Fong	John		7852918742				7852900809	john.fong@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Medicare Compliance Officer	Compliance Officer	Mr.	English	Chris		7852131767					chris.english@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	11/10/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Medicare Coordinator	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms	Anderson	Ally		8554570763				8557297271	partdoverutil@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	04/04/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Medication Therapy Management Contact	Manager MTM Care Management		Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	12/23/2021	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Online Enrollment Center Contact (Back-up)	Director of Medicare Advantage		Nolte	Erin		7852916589					erin.nolte@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	66629	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Online Enrollment Center Contact (Primary)	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Part C Application Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Part C Reporting Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Part D Appeals	Director Regulatory and Audit Response	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/15/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active	8772775449	3			PPO - BBA		C	Kansas City
H7063	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing		Eagan	MN	55121	04/04/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active	8006936651	3			PPO - BBA		C	Kansas City
H7063	Part D Application Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Part D Benefits Contact	Manager, PBM Operations	Ms.`	McCambridge	Danielle		6127772978					Danielle.McCambridge@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/02/2021	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Part D Claims Submission Contact	Consultant Government Programs	Mr.	Brooke	Lance		4026862603					lbrooke@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/15/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Part D Exceptions Contact	Director Regulatory and Audit Response	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/15/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active	8772775449	3			PPO - BBA		C	Kansas City
H7063	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	04/04/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active	8006936651	3			PPO - BBA		C	Kansas City
H7063	Part D Price File Contact (Back-up)	Business Solutions Analyst	Mr.	Bushman	John		6134599623					john.bushman@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/10/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Part D Price File Contact (Optional)	QA Analyst		Ly	Martin		6127776931					martin.ly@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/23/2021	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Part D Price File Contact (Primary)	Pharmacist		Poell	Shannon		7852916910				7852900774	shannon.poell@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	66629	06/28/2023	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Part D Quality Assurance Contact	Corporate Pharmacist		Poell	Shannon		7852916910				7852900734	shannon.poell@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	06/28/2023	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Part D Reporting Contact	Corporate Pharmacist		Poell	Shannon		7852916910				7852900734	shannon.poell@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	06/28/2023	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Patient Safety Contact	Senior Director		Puckett	Reese		6127775037					rpuckett@primetherapeutics.com	8400 Normandale Lake Blvd	Suite 700	Bloomington	MN	55437	12/16/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Payment Contact	Manager General Accounting		Droge	Jason		7852918171				7852900728	jason.droge@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	12/15/2021	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Pharmacy Director	Corporate Pharmacist		Liesmann	Tiffany		7852918296					tiffany.liesmann@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	06/28/2023	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Pharmacy Network Management Contact	AVP Network Management	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/15/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Pharmacy Network Management Contact (Secondary)	Sr. Director Network Management	Ms	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/04/2021	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Pharmacy Technical Help Desk Contact	Manager Member Services, Prime		Garza-Rodriguez	Melissa							MGarzarodriguez@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	01/22/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active	8663255231				PPO - BBA		C	Kansas City
H7063	Pharmacy Technical Help Desk Contact (Secondary)	Director Member Services Gov Programs, Prime		Bunch	Jonathon							jonathon.bunch@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	01/22/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active	8663255231				PPO - BBA		C	Kansas City
H7063	Plan Directory Contact for Public Website	Manager Government Programs Operations		Gilmer-Gentry	Janice		8002400577					janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Plan to Plan Reconciliation Contact	Staff Accountant		Zen	Kayla-Ann		7852918208				7852900733	Kayla-ann.zen@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	07/06/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Processor Contact	Director Government Programs & Ops	Ms.	Allie	Cindy		6127776722					medicareclaimresearch@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/10/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Quality Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Reconciliation Contact	Staff Accountant		Zen	Kayla-Ann		7852918208				7852900733	kayla-ann.zen@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	07/06/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Reconciliation Contact (Secondary)	Manager Accounting Systems		Droge	Jason		7852918171				7852900733	jason.droge@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	66629	04/06/2022	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Recovery Audit Contact	Compliance Officer	Mr	English	Chris		7852918078					chris.english@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	06/28/2023	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Surveillance Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900783	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	System Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900783	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Third Party Administrator (TPA) Liaison	Manager General Accounting		Droge	Jason		7852918171				7852900783	jason.droge@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	12/15/2021	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	User Access Contact	Compliance Officer		English	Chris		7852918078					chris.english@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	02/03/2020	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Utilization Management Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7063	Utilization Review Contact	Manager Government Programs Operations		Gilmer-Gentry	Janice		7852918592				7852900733	janice.gilmer-gentry@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	10/25/2019	2023	BLUECROSS BLUESHIELD KANSAS SOLUTIONS, INC.	Local CCP	Blue Cross and Blue Shield of Kansas	Local PPO		Blue Cross Blue Shield of Kansas	310	Yes	Active					PPO - BBA		C	Kansas City
H7074	Agent/Broker Compensation Data Contact	VP, Sales		Simonds	Kristina		6572187635					KSimonds@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Automated TrOOP Balance Transfer Contact	PBM - Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Backup User Access Contact	Compliance Director		Spitzer	Chandra		6572745530					CSpitzer@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Best Available Evidence Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Bid Audit Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Bid Audit Site Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Bid Primary Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	CAP Report Contact for Public Website	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	CEO - CMS Administrator Contact	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	CEO - Senior Official for Contracting	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Chief Financial Officer	Chief Financial Officer	Mr.	Freeman	Thomas		6572187604					TFreeman@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Chief Operating Officer	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Kardes	Hakan		6572187772					hkardes@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	03/29/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Chief Information Security Officer	VP, Technology & CISO	Mr.	MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	CMMI Model Point of Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	CMS Casework Communication Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Complaints Tracking Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Contact for Fraud Investigations	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Coordination of Benefits Contact	AVP, Membership & Eligibility		Torres	Carrie		6572187409	2109				CArreola@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Corporate Mailing						6572187713				8443202247	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/15/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122			5622074634	adelatorre@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Customer Service Operations Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	DIR Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	DIR Contact (Secondary)	AVP, Pharmacy		Liu	Ruby		3237287232	2316				RLiu@AHCUSA.com	1100 W. Town & Country Rd., Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Electronic Health Record Contact	AVP, Platform Product		Brown Hayes	Michael		7144979628					MBrown-Hayes@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	04/01/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Emergency Part D Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Emergency Part D Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		3108667966				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Employer Waiver Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment		Bogdanov	Eyosef		5623666179					ebogdanov@ahcusa.com	1100 W. Town and Country Rd.	Suite 1600	Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Enrollment Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	EOB Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Financial Audit Contact	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Financial Reporting Contact	Sr. Director, Accounting & Reporting		Tran	Sue Anne		6572187673	7673				stran@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Formulary Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Formulary Contact (Secondary)	PBM - Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	General Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Government Relations Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	HIPAA Privacy Officer	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	HIPAA Security Officer	VP, Technology & CISO		MacLeod	David		3033967531					DMacleod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Hospice Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Interoperability Contact	VP, Data Engineering & BI CTO Data and Al		Sam	Georgie		8188807212					gsam@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	MA Appeals/Grievances Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	MA Claims Processing Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Marketing Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Medical Director	SVP Market Management WCR	Dr.	Kim	John		6572187640				5622074617	JKim@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Medicare Compliance Officer	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy	B	6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Medicare Coordinator	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Medicare Part D Opioid Overutilization Contact	PBM - Supv Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Medication Therapy Management Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	OffShore Subcontractor Contact	VP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	CLynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/09/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Online Enrollment Center Contact (Back-up)	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Online Enrollment Center Contact (Optional)	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Online Enrollment Center Contact (Primary)	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Part C Application Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Part C Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Part D Appeals	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6127775393				PPO - BBA		C	San Francisco
H7074	Part D Appeals Contact (Secondary)	Sr. Manager, Appeals & Grievance		Jimenez	Gudelia							GJimenez@ahcusa.com	1100 W. Town and Country Road, Suite #300		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6572187488	2188			PPO - BBA		C	San Francisco
H7074	Part D Application Contact	CEO		Maroney	Dawn		5623346192				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Part D Benefits Contact	PBM - Director, Benefit Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Part D Claims Submission Contact	PBM - Functional Business Consultant Govt Programs		Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Part D Exceptions Contact	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8006936651				PPO - BBA		C	San Francisco
H7074	Part D Exceptions Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali							AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6572187709				PPO - BBA		C	San Francisco
H7074	Part D Price File Contact (Back-up)	PBM - Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Part D Price File Contact (Optional)	PBM - QA Analyst		Tastad	Emily		6127776931					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Part D Price File Contact (Primary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Part D Quality Assurance Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Part D Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Patient Safety Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Payment Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Personal Health Record Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Pharmacy Director	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Pharmacy Network Management Contact	PBM - AVP, Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	03/31/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Pharmacy Network Management Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/21/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				PPO - BBA		C	San Francisco
H7074	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	07/09/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				PPO - BBA		C	San Francisco
H7074	PHR Beneficiary Contact																	02/15/2021	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO	Alignment Health Plan	Alignment Healthcare USA, LLC	612	Yes	Active	8666342247				PPO - BBA		C	San Francisco
H7074	Physician Incentive Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Plan Directory Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Plan to Plan Reconciliation Contact	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122			5622074266	adelatorre@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Processor Contact	Manager, PBM Operations		Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Quality Contact	Sr. Director, Quality Management/Credentialing		Lacock	Lisa		6572187638					LLacock@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Reconciliation Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Reconciliation Contact (Secondary)	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122				adelatorre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Recovery Audit Contact	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	SNP Application Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	SNP State Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Surveillance Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	System Contact	VP, AVA Health Plan Systems & Operations		Bates	Patrick		6572187636	7636				PBates@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Third Party Administrator (TPA) Liaison	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122				adelatorre@ahcusa.com	1100 W. Town and Country Rd, Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	User Access Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Utilization Management Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7074	Utilization Review Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NORTH CAROLINA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H7076	Agent/Broker Compensation Data Contact	AVP, Sales Operations	Mr.	Handerhan	Bill		7328291160					bill.handerhan@caresource.com	230 N Main St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Backup User Access Contact	Regulatory Submission Specialist	Mr.	Houser	Aaron		9374874147					macompliance@CareSource.com	230 North Main St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Best Available Evidence Contact	Enrollment Team Lead	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 45401		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Bid Audit Contact	Senior Director, Actuarial Science	Mr.	Butz	Stephen		9376091705					stephen.butz@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Bid Audit Site Contact	Senior Director, Actuarial Science	Mr.	Butz	Stephen		9376091705					stephen.butz@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Bid Primary Contact	Senior Director, Actuarial Science	Mr.	Butz	Stephen		9376091705					stephen.butz@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	CAP Report Contact for Public Website	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@caresource.com	230 N Main St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Preitauer	Erhardt		9375312455					Erhardt.Preitauer@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Preitauer	Erhardt		9375312455					Erhardt.Preitauer@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Chief Financial Officer	Chief Financial Officer	Mr.	Smart	Lawrence		9375313335					Lawrence.Smart@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Chief Operating Officer	(Interim) Chief Operating Officer	Mr.	Davidi	Isaac		9372715922					isaac.davidi@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Chief Information Officer	Chief Information Officer	Ms.	Valencia	Devon		9375312552					devon.valencia@caresource.com	P.O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Chief Information Security Officer	VP , Information Security and Privacy	Mrs.	Heckler	Lisa		9375313895					lisa.heckler@caresource.com	P.O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	CMS Casework Communication Contact	Director, Grievance and Appeals	Ms.	Acuna	Celeste		4806406815					celeste.acuna@caresource.com	P.O. Box 1947		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Complaints Tracking Contact	Director, Grievance and Appeals	Ms.	Acuna	Celeste		4806406815					celeste.acuna@caresource.com	P.O. Box 1947		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Contact for Fraud Investigations	Program Integrity Analyst	Ms.	Johnson	Alexis	N	9372243300	2870			9373963876	SIUprogramintegrity@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Coordination of Benefits Contact	Manager, Enrollment Operations	Mr.	Spivey	Michael		9375313682				9374870643	COBInquiry@caresource.com	230 N. Main St.		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Corporate Mailing						9372243300					macompliance@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	230 N. Main Street		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Customer Service Operations Contact	Director, Customer Care		Cary	Lisa		9372326458					lisa.cary@caresource.com	40 W 2nd St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	DIR Contact	VP, Actuarial Science		Farmer	Nikki		9372863350					nikki.farmer@caresource.com	230 N. Main Street		Dayton	OH	45402	06/26/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	DIR Contact (Secondary)																	06/26/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Emergency Part D Contact	Manager, Contact Center	Ms.	Davidson	Regina		7722362766					Regina_Davidson@express-scripts.com	10045 South Federal Highway		Port St. Lucie	FL	34952	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Emergency Part D Contact (Secondary)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Encounter Data & Risk Adjustment Operations Contact	Director, Claims Encounter Data	Mr.	Shareef	Akbar		9374876640					MyCare-MA_EncounterRequests@caresource.com	220 E. Monument Ave.		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Enrollment Contact	Enrollment Team Lead	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 45401		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	EOB Transfer Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479				9374870359	rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Financial Audit Contact	AVP, Compliance	Ms.	Frazee	Margaux		9375313338					margaux.frazee@caresource.com	230 N. Main Street		Dayton	OH	45402	09/06/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Financial Reporting Contact	Chief Financial Officer	Mr.	Smart	Lawrence		9375313335					Lawrence.Smart@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Formulary Contact	Director, Clinical Strategy	Ms.	Condon	Kelani		7373142944					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Formulary Contact (Secondary)	Pharmacist Formulary Strategy and Management		Cabrera	Lourdes		9374875477					maria.cabrera@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	General Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Government Relations Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@caresource.com	230 North Main Street		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	HIPAA Privacy Officer	Privacy Officer	Ms.	Heckler	Lisa		9372243300	3895				Lisa.Heckler@caresource.com	P.O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	HIPAA Security Officer	Chief Information Officer	Ms.	Valencia	Devon		9375312552					devon.valencia@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Hospice Contact	Director, Enrollment	Mr.	Castro	Armando		9375312291					armando.castro@caresource.com	230 N Main St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Interoperability Contact	AVP, Enterprise Architecture		Hanley	Michael		8033721957					michael.hanley@caresource.com	230 N Main St		Dayton	OH	45402	06/01/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	MA Appeals/Grievances Contact	Director, Grievance and Appeals	Ms.	Acuna	Celeste		4806406815					celeste.acuna@caresource.com	P.O. Box 1947		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	MA Claims Processing Contact for Public Website	VP of Claims and Configuration	Ms.	Hans	Holly		9375312750					Holly.Hans@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Marketing Contact	Regulatory Lead	Mr.	Houser	Aaron		9377891840					macompliance@CARESOURCE.COM	230 N Main St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Medical Director	Medical Director	Dr.	Mukunda	Beejadi		2166459092					beejadi.mukunda@caresource.com	5900 Landerbrook Drive	Ste 300	Mayfield Heights	OH	44124	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Medicare Compliance Officer	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@caresource.com	230 N. Main St.		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Medicare Coordinator	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Medicare Part D Opioid Overutilization Contact	Part D Diversion Specialist	Ms.	Wendell	Amy		9372243300	12543			9373963605	amy.wendell@caresource.com	P. O. Box 1940		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Medication Therapy Management Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Online Enrollment Center Contact (Optional)	Director, Enrollment	Mr.	Castro	Armando		9375312291					armando.castro@caresource.com	230 N Main Street		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Online Enrollment Center Contact (Primary)	Enrollment Team Lead	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 45401		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Part C Application Contact	Director, Medicare & Marketplace Filing		Gray	Melissa		9375312328					melissa.gray@caresource.com	230 N Main St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Part C Reporting Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Part D Appeals	Express Scripts, Sr. Pharmacy Manager		Schumm	Brian						8555858246	Brian_Schumm@express-scripts.com	5151 B		Dublin	OH	43017	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract	8003443405	733326			HMO - Health Maintenance Organization		C	New York
H7076	Part D Appeals Contact (Secondary)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol							rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract	9378187479				HMO - Health Maintenance Organization		C	New York
H7076	Part D Application Contact	Director, Medicare & Marketplace Filing		Gray	Melissa		9375312328					melissa.gray@caresource.com	230 N Main St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Part D Benefits Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Part D Claims Submission Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract	8003443405	733326			HMO - Health Maintenance Organization		C	New York
H7076	Part D Exceptions Contact (Secondary)	Director. Pharmacy Operations	Ms.	Rattan	Sangeet							rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract	9375911634				HMO - Health Maintenance Organization		C	New York
H7076	Part D Price File Contact (Back-up)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Part D Price File Contact (Optional)	Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Part D Price File Contact (Primary)	Sr Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Part D Quality Assurance Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Part D Reporting Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Patient Safety Contact	Director, Clinical Strategy	Ms.	Condon	Kelani		7373142944					rxcompliancerequest@caresource.com	140 N Jefferson St.		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Payment Contact	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Pharmacy Director	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Pharmacy Network Management Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Pharmacy Network Management Contact (Secondary)	Network Account Director (ESI)		Kelly	Heather		8003579578					hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract	8009221557				HMO - Health Maintenance Organization		C	New York
H7076	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol							rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract	9378187479				HMO - Health Maintenance Organization		C	New York
H7076	Plan Directory Contact for Public Website	Manager HPLC Operations	Ms.	Smith	Allana		9296714107					allana.smith@caresource.com	P. O. Box 8378		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Plan to Plan Reconciliation Contact	Manager, Accounting	Ms.	Nelson	Megan		9374876597					CareSourceP2P@caresource.com	CareSource Accounting	PO Box 2208	Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Processor Contact	VP Claims and Configuration		Hans	Holly		9372243300	12750				Holly.Hans@caresource.com	PO Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Quality Contact	AVP, Medicare Quality	Mr.	Manetti	Thomas		3109358122					thomas.manetti@caresource.com	230 N Main St.		Dayton	OH	45502	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Reconciliation Contact	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Reconciliation Contact (Secondary)	Associate Director, Accounting	Ms.	North	Sara		9375312669					sara.north@caresource.com	PO Box 8738		Dayton	OH	45401	03/07/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Recovery Audit Contact	VP, Claims	Ms.	Hans	Holly		9375312750					holly.hans@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	SNP Application Contact	Director, Medicare & Marketplace Filing		Gray	Melissa		9375312328					melissa.gray@caresource.com	230 N Main St		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Surveillance Contact	Manager Program Integrity	Ms.	Johnson	Alexis		9375312870					Alexis.Johnson@CareSource.com	230 North Main Street		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	System Contact	Chief Information Officer	Ms.	Valencia	Devon		9375312552					devon.valencia@caresource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Third Party Administrator (TPA) Liaison	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	230 N. Main Street		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	User Access Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Utilization Management Contact	Director, Clinical Operations		Honig	Deronda		2162180296					Deronda.Honig@CareSource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7076	Utilization Review Contact	Director, Clinical Operations		Honig	Deronda		2162180296					Deronda.Honig@CareSource.com	P. O. Box 8738		Dayton	OH	45401	05/02/2023	2023	CARESOURCE INDIANA, INC.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H7093	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Bid Primary Contact	Product Management Director		Gray	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	02/15/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/15/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/15/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	4553 La Tienda Drive	Mail Drop CAT102-C001	Thousand Oaks	CA	91362	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Part D Appeals	Medical Director, MD Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H7093	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				PPO - BBA		C	Chicago
H7093	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Part D Exceptions Contact	Medical Director, MD Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H7093	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				PPO - BBA		C	Chicago
H7093	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	05/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				PPO - BBA		C	Chicago
H7093	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				PPO - BBA		C	Chicago
H7093	PHR Beneficiary Contact																	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				PPO - BBA		C	Chicago
H7093	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7093	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/21/2021	2023	COMMUNITY INSURANCE COMPANY	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7114	Automated TrOOP Balance Transfer Contact	PACE Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Backup User Access Contact	PACE Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Best Available Evidence Contact	PACE Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Bid Primary Contact	PACE Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	CAP Report Contact for Public Website	PACE Director		Tilford	Christina		4056093682					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active	4056093688				PACE - Nat		C	Dallas
H7114	CEO - CMS Administrator Contact	PACE President	Mr.	Brownlow	Jake		4056093688					jake.brownlow@valir.com	7021 NW 6th St		Oklahoma City	OK	73102	08/16/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	CEO - Senior Official for Contracting	PACE President	Mr.	Brownlow	Jake		4056093688					jake.brownlow@valir.com	721 NW 6th St		Oklahoma City	OK	73102	08/16/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Chief Financial Officer		Mr	Cummings	Chris		4056093688					chris.cummings@valir.com	700 NW 7th St		Oklahoma City	OK	73102	09/20/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Chief Operating Officer	PACE President	Mr.	Brownlow	Jake		4056093688					jake.brownlow@valir.com	721 NW 6th St		Oklahoma City	OK	73102	08/16/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Chief Information Officer	Site Director	Mrs	Tilford	Christina		4056093688					Christina Tilford@valir.com	721 NW 6th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Chief Information Security Officer	Site Director	Mrs	Tilford	Christina		4056093688					christina.tilford@valir.com	721 NW 6th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	CMS Casework Communication Contact	PACE President	Mr.	Brownlow	Jake		4056093688					jake.brownlow@valir.com	700 NW 7th St		Oklahoma City	OK	73102	08/16/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Complaints Tracking Contact	Director of QI and Compliance	Mrs	Coleman	Monica		4056093688					monica.coleman@valir.com	721 NW 6th		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Contact for Fraud Investigations	Site Director	Mrs	Tilford	Christina		4056093688					christina.tilford@valir.com	721 NW 6th ST		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Coordination of Benefits Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	721 NW 6th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Corporate Mailing						4056093682					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Coverage Gap Discount Program (CGDP) Payment Contact	Site Director	Mrs	Tilford	Christina		4056093688					christina.tilford@valir.com	721 NW 6th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Customer Service Operations Contact	Director of QI and Compliance	Mrs	Coleman	Monica		4056093688					monica.coleman@valir.com	721 NW 6th		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	DIR Contact	Site Director		Tilford	Christina		4056093682					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	DIR Contact (Secondary)	PACE President	Mr.	Brownlow	Jake		4056093688					jake.brownlow@valir.com	721 NW 6th Street		Oklahoma City	OK	73102	08/16/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Emergency Part D Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Emergency Part D Contact (Secondary)	PACE President	Mr.	Brownlow	Jake		4056093688					jake.brownlow@valir.com	721 NW 6th Street		Oklahoma City	OK	73102	08/16/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Encounter Data & Risk Adjustment Operations Contact	Site Director		Tilford	Christina		4056093688				8778875107	christina.tilford@valir.com	721 NW 6th Street		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Enrollment Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	EOB Transfer Contact	Site Director		Tilford	Christina		4056093688				4055531188	christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Financial Audit Contact	Site Director	Mrs	Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Financial Reporting Contact	Site Director		Tilford	Chirstina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Formulary Contact	Medical Director	Dr	Minor	Sarah		4056093688					ctilford@valir.com	721 NW 6th		Oklahoma City	OK	73102	08/14/2023	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Formulary Contact (Secondary)	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	General Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Government Relations Contact	Director of QI and Compliance	Mrs	Coleman	Monica		4056093688					monica.coleman@valir.com	721 NW 6th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	HIPAA Privacy Officer	Director of QI and Compliance		Coleman	Monica		4056093688					monica.coleman@valir.com	721 NW 6th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	HIPAA Security Officer	Director of QI and Compliance		Coleman	Monica		4056093688					monica.coleman@valir.com	721 NW 6th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Interoperability Contact	Site Director		Tilford	Christina		4059245836					christina.tilford@valir.com	721 nw 6th street		oklahoma city	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	MA Appeals/Grievances Contact	Director of QI and Compliance		Coleman	Monica		4056093688					monica.coleman@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	MA Claims Processing Contact for Public Website	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Marketing Contact	President		Brownlow	Jake		4056093688					jake.brownlow@valir.com	700 NW 7th St		Oklahoma City	OK	73102	09/20/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Medical Director	Medical Director	Dr	Minor	Sarah		4056093688					ctilford@valir.com	721 NW 6th		Oklahoma City	OK	73102	08/14/2023	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Medicare Compliance Officer	Director of QI and Compliance	Mrs	Coleman	Monica		4056093688					monica.coleman@valir.com	721 NW 6th		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Medicare Coordinator	Site Director	Mrs.	Tilford	Christina		4056093688					christina.tilford@valir.com	721 NW 6th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Medicare Part D Opioid Overutilization Contact	Director of QI and Compliance	Mrs	Coleman	Monica		4056093688					monica.coleman@valir.com	721 NW 6th		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Medication Therapy Management Contact	Medical Director	Dr	Minor	Sarah		4056093688					christina.tilford@valir.com	721 NW 6th		Oklahoma City	OK	73102	08/14/2023	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Part C Application Contact	Site Director		Tilford	Christina		4056093688				8778875107	christina.tilford@valir.com	721 NW 6th Street		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Part D Appeals	Site Director		Tilford	Christina							christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active	4056093688				PACE - Nat		C	Dallas
H7114	Part D Appeals Contact (Secondary)	Director of QI and Compliance		Coleman	Monica							monica.coleman@valir.com	721 NW 6th Street		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active	4056093688				PACE - Nat		C	Dallas
H7114	Part D Application Contact	Site Director		Tilford	Christina		4056093688				8778875107	christina.tilford@valir.com	700 NW 7th Street		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Part D Benefits Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Part D Claims Submission Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Part D Exceptions Contact	Site Director		Tilford	Christina							christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active	4056093688				PACE - Nat		C	Dallas
H7114	Part D Exceptions Contact (Secondary)	PACE President	Mr.	Brownlow	Jake							jake.brownlow@valir.com	721 NW 6th Street		Oklahoma City	OK	73102	08/16/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active	4056093688				PACE - Nat		C	Dallas
H7114	Part D Price File Contact (Back-up)	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Part D Price File Contact (Optional)	PACE President	Mr.	Brownlow	Jake		4056093688					jake.brownlow@valir.com	721 NW 6th Street		Oklahoma City	OK	73102	08/16/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Part D Price File Contact (Primary)	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Part D Quality Assurance Contact	Director of QI and Compliance	Mrs	Coleman	Monica		4056093688					monica.coleman@valir.com	721 NW 6th		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Part D Reporting Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Patient Safety Contact	Director of QI and Compliance	Mrs	Coleman	Monica		4056093688					monica.coleman@valir.com	721 NW 6th ST		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Payment Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Pharmacy Director	Medical Director	Dr	Minor	Sarah		4056093688					ctilford@valir.com	721 NW 6th		Oklahoma City	OK	73102	08/14/2023	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Pharmacy Network Management Contact	Medical Director	Dr	Minor	Sarah		4056093688					ctilford@valir.com	721 NW 6th		Oklahoma City	OK	73102	08/14/2023	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Pharmacy Network Management Contact (Secondary)	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	721 NW 6th Street		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Pharmacy Technical Help Desk Contact	Site Director		Tilford	Christina							christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active	4056093688				PACE - Nat		C	Dallas
H7114	Plan Directory Contact for Public Website	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Plan to Plan Reconciliation Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Processor Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Quality Contact	Director of QI and Compliance	Mrs	Coleman	Monica		4056093688					monica.coleman@valir.com	721 NW 6th ST		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Reconciliation Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Reconciliation Contact (Secondary)	PACE President	Mr.	Brownlow	Jake		4056093688					jake.brownlow@valir.com	721 NW 6th Street		Oklahoma City	OK	73102	08/16/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Recovery Audit Contact	Director of QI and Compliance	Mrs	Tilford	Christina		4056093688					christina.tilford@valir.com	721 NW 6th ST		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Surveillance Contact	Director of Qi and Compliance	Mrs	Coleman	Monica		4056093688					monica.coleman@valir.com	721 NW 6th ST		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	System Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Third Party Administrator (TPA) Liaison	Site Director	Mrs	Tilford	Christina		4056093688					christina.tilford@valir.com	721 NW 6th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	User Access Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Utilization Management Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7114	Utilization Review Contact	Site Director		Tilford	Christina		4056093688					christina.tilford@valir.com	700 NW 7th St		Oklahoma City	OK	73102	07/11/2022	2023	VALIR PACE	National PACE	Valir PACE	National PACE		Valir PACE, LLC.	716	Yes	Active					PACE - Nat		C	Dallas
H7115	Agent/Broker Compensation Data Contact	VP, Marketing & Brand		Tinsey	Mark		6152182867					mark.tinsey@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment and Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	1025 West Navitus Dr		Appleton	WI	54913	06/08/2021	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Backup User Access Contact	VP, Compliance		Clark	Robert		7133386429					Robert.clark@memorialhermann.org	11740 Katy Hwy, Building III		Houston	TX	77079	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Best Available Evidence Contact	VP, Marketing & Brand		Tinsey	Mark		6152182867					mark.tinsey@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Bid Audit Contact	Vice President, Finance	Ms.	De Moya	Cindy		7133384314					Cindy.DeMoya@memorialhermann.org	929 Gessner, Suite 1900		Houston	TX	77024	07/01/2019	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Bid Audit Site Contact	Vice President, Finance	Ms.	De Moya	Cindy		7133384314					Cindy.DeMoya@memorialhermann.org	929 Gessner, Suite 1900		Houston	TX	77024	07/01/2019	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Bid Primary Contact	Vice President, Finance	Ms.	De Moya	Cindy		7133384314					Cindy.DeMoya@memorialhermann.org	929 Gessner, Suite 1900		Houston	TX	77024	07/01/2019	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	CAP Report Contact for Public Website	VP, Marketing & Brand		Tinsey	Mark		6152182867					mark.tinsey@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	CEO - CMS Administrator Contact	CEO	Mr.	Hurt	Jay		7135972523	1107				Jay.Hurt2@memorialhermann.org	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	CEO - Senior Official for Contracting	CEO	Mr	Hurt	Jay		7135972523	1107				Jay.Hurt2@memorialhermann.org	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Chief Financial Officer	Chief Financial Officer	Ms.	Petersen	Heather		7133386429					heather.petersen@apex4health.com	929 Gessner, Suite 1900		Houston	TX	77024	08/18/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Chief Operating Officer	COO	Mr.	Hurt	Jay		7135972523	1107				Jay.Hurt@memorialhermann.org	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Chief Information Officer		Ms.	Hammel	Amanda		7133385755					amanda.hammel@memorialhermann.org	920 Frostwood		Houston	TX	77024	06/12/2018	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Chief Information Security Officer		Mr.	Yates	Randy		7133386050					Randy.yates@memorialhermann.org	920 Frostwood, Suite 2.500.16		Houston	TX	77024	03/11/2016	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	CMMI Model Point of Contact	SVP Health Services		Douds	Claudia		7133386357					claudia.douds@apex4health.com	929 Gessner Rd	Suite 1500	Houston	TX	77024	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	CMS Casework Communication Contact	VP, Marketing & Brand		Tinsey	Mark		6152182867					mark.tinsey@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Complaints Tracking Contact	A&G Manager		Reuter	Megan		6605371821					megan.reuter@apex4health.com	929 Gessner, Suite 1500		Houston	TX	77024	08/18/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Contact for Fraud Investigations	VP, Compliance		Clark	Robert		7133386429					robert.clark@memorialherman.org	11740 Katy Hwy, Building III		Houston	TX	77079	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Coordination of Benefits Contact	Manager, Eligibility & Enrollment		Ray	Trevor		3183550478					trevor.ray@apex4health.com	929 Gessner, Suite 1500		Houston	TX	77024	08/18/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Corporate Mailing						7133385252					MHHealthCustomerService@memorialhermann.org	Memorial Hermann Health Plan	929 Gessner Suite 1500	Houston	TX	77024	09/19/2018	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance		Powell	John		7139060870					john.powell@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Customer Service Operations Contact	VP, Health Plan Operations		Ward	Lindsay		7249723130					lindsay.ward@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	DIR Contact	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					hector.ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	DIR Contact (Secondary)	DIR Team		Plan Finder	Navitus		8775717500					Plan.Finder@Navitus.com	1025 W Navitus Dr		Appleton	WI	54913	09/08/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Emergency Part D Contact	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					hector.ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Emergency Part D Contact (Secondary)	VP of Compliance	Mr.	Clark	Robert		7133386429					robert.clark@memorialhermann.org	11740 Katy Hwy, Building III		Houston	TX	77079	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Employer Waiver Contact	Vice President, Finance	Ms.	De Moya	Cindy		7133384314					Cindy.DeMoya@memorialhermann.org	929 Gessner, Suite 1900		Houston	TX	77024	07/05/2019	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Encounter Data & Risk Adjustment Operations Contact	MGR,  RISK ADJUSTMENT OPS		Alajbegovic	Malgorzata		7133386527					Malgorzata.Alajbegovic@memorialhermann.org	929 Gessner Rd	Suite 1500	Houston	TX	77024	04/16/2020	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Enrollment Contact	Manager, Eligibility & Enrollment		Ray	Trevor		3183550478					trevor.ray@apex4health.com	929 Gessner, Suite 1500		Houston	TX	77024	08/18/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	EOB Transfer Contact	V.P. of Health Plan Operations		Johnson	Jill		6155400894				7133386487	jill.johnson@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Financial Audit Contact	Director of Finance	Mr.	Powell	John		7139060870					john.powell@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Financial Reporting Contact	Director of Finance		Powell	John		7139060870					john.powell@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Formulary Contact	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					hector.ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Formulary Contact (Secondary)	Pharmacy Manager Formulary		Paddock	Deanna		8775717500					Deanna.Paddock@Navitus.com	1025 W Navitus Dr		Appleton	WI	54913	01/12/2021	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	General Contact	Chief Executive Officer		Hurt	Jay		7135972523	1107				Jay.Hurt2@memorialhermann.org	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Government Relations Contact	Chief Executive Officer		Hurt	Jay		7135972523	1107				Jay.Hurt2@memorialhermann.org	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	HIPAA Privacy Officer	Chief Community Benefit Officer IT		Allen	Monique		7133385983					monique.allen@memorialhermann.org	929 Gessner		Houston	TX	77024	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	HIPAA Security Officer	Chief Community Benefit Officer IT		Allen	Monique		7133385983					monique.allen@memorialhermann.org	929 Gessner		Houston	TX	77024	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Hospice Contact	VP of Health Services	Ms.	Douds	Claudia		7133386492					claudia.douds@apex4health.com	929 Gessner Suite 1500		Houston	TX	77024	08/18/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Interoperability Contact	V.P. of Health Plan Compliance	Mr.	Clark	Robert	L	7133386429					robert.clark@memorialhermann.org	11740 Katy Hwy, Building III		Houston	TX	77079	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	MA Appeals/Grievances Contact	VP Health Services		Douds	Claudia		7133386492					claudia.douds@apex4health.com	929 Gessner, Suite 1500		Houston	TX	77024	08/18/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	MA Claims Processing Contact for Public Website	V.P. of Health Plan Operations		Johnson	Jill		6155400894					Jill.Johnson@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Marketing Contact	VP, Marketing & Brand		Tinsey	Mark		6152182867					mark.tinsey@apex4health.com	24 Greenway Plaza	1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Medical Director	Chief Medical Officer	Dr	Bates	Karmen		7135972523					karmen.bates@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Medicare Compliance Officer	VP, Compliance	Mr.	Clark	Robert		7133386429					robert.clark@memorialhermann.org	11740 Katy Hwy, Building III		Houston	TX	77079	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Medicare Coordinator	CEO		Hurt	Jay		7135972523	1107				Jay.Hurt2@memorialhermann.org	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Medicare Part D Opioid Overutilization Contact	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					hector.ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Medication Therapy Management Contact	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					hector.ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	OffShore Subcontractor Contact	V.P. of Health Plan Operations		Ward	Lindsay		7249723130					Lindsay.ward@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Online Enrollment Center Contact (Back-up)	Manager, Eligibility & Enrollment		Ray	Trevor		3183550478					trevor.ray@apex4health.com	929 Gessner, Suite 1500		Houston	TX	77024	08/18/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Online Enrollment Center Contact (Optional)	VP, Compliance		Clark	Robert		7133386429					Robert.clark@memorialhermann.org	11740 Katy Hwy, Building III		Houston	TX	77079	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Online Enrollment Center Contact (Primary)	VP, Marketing & Brand		Tinsey	Mark		6152182867					mark.tinsey@apex4health.com	24 Greenway Plaza	1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Part C Application Contact	VP, Compliance	Mr.	Clark	Robert		7133386429					robert.clark@memorialhermann.org	11740 Katy Hwy, Building III		Houston	TX	77079	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Part C Reporting Contact	VP, Compliance		Clark	Robert		7133386429					Robert.clark@memorialhermann.org	11740 Katy Hwy, Building III		Houston	TX	77079	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						9202214649	justin.lacrosse@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/08/2021	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Denver
H7115	Part D Appeals Contact (Secondary)	AVP, Pharmacy Operations		Ramirez	Hector	W						Hector.Ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active	7135972523				HMO - Health Maintenance Organization		C	Denver
H7115	Part D Application Contact	VP, Compliance	Mr.	Clark	Robert		7133386429					robert.clark@memorialhermann.org	11740 Katy Hwy, Building III		Houston	TX	77079	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Part D Benefits Contact	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					hector.ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Part D Claims Submission Contact	Manager, Technical Operations		Dirks	Bob		9202214404					DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/17/2021	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Part D Exceptions Contact	Sr. Manager, Clinical Prior Authorization		LeClair	Christophe							Christopher.LeClair@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/08/2021	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Denver
H7115	Part D Exceptions Contact (Secondary)	AVP, Pharmacy Operations		Ramirez	Hector	W						Hector.Ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active	7135972523				HMO - Health Maintenance Organization		C	Denver
H7115	Part D Price File Contact (Back-up)	MPF Team		Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	1025 W Navitus Dr		Appleton	WI	54913	09/08/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Part D Price File Contact (Optional)	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					hector.ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Part D Price File Contact (Primary)	Plan Finder Manager		Plan Finder	Navitus		6087291578					Plan.Finder@navitus.com	361 Integrity Drive		Madison	WI	53713	02/17/2021	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Part D Quality Assurance Contact	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					hector.ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Part D Reporting Contact	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					hector.ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Patient Safety Contact	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					hector.ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Payment Contact	Director of Finance		Powell	John		7139060870					John.Powell@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Pharmacy Director	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					hector.ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688					Jan.Robinson@navitus.com	361 Integrity Drive		Madison	WI	53713	02/17/2021	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Pharmacy Network Management Contact (Secondary)	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					Hector.Ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Pharmacy Technical Help Desk Contact	Sr Manager, Cust Svce Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/08/2021	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Denver
H7115	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Pharmacy Operations		Ramirez	Hector	W						Hector.Ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active	7135972523				HMO - Health Maintenance Organization		C	Denver
H7115	Physician Incentive Contact	CEO		Hurt	Jay		7135972523	1107				Jay.Hurt2@memorialhermann.org	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Plan Directory Contact for Public Website	Chief Executive Officer		Hurt	Jay		7135972523	1107				Jay.Hurt2@memorialhermann.org	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Plan to Plan Reconciliation Contact	Director, Finance		Powell	John		7139060870					john.powell@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Processor Contact	V.P. of Health Plan Operations		Johnson	Jill		6155400894					Jill.Johnson@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Quality Contact	Director, Quality and Case Management		McClure	Joi		7133386322					joi.mcclure@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Reconciliation Contact	SVP Chief Accounting Officer		DeMoya	Cindy		7133384314					cindy.demoya@memorialhermann.org	929 Gessner Suite 1500		Houston	TX	77024	03/17/2020	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Reconciliation Contact (Secondary)	Director Financial Services		Powell	John		7139060870					john.powell@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Recovery Audit Contact	CFO	Ms.	Petersen	Heather		6154917490					Heather.Petersen@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	SNP Application Contact	VP Health Services		Douds	Claudia		7133386357					claudia.douds@apex4health.com	929 Gessner Rd	Suite 1500	Houston	TX	77024	08/18/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	SNP State Contact	Director	Ms.	McClure	Joi		7133386322					joi.mcclure@apex4health.com	24 Greenway Plaza	Suite 1150	Houston	TX	77046	09/22/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Surveillance Contact	VP  Compliance		Clark	Robert		7133386429					robert.clark@memorialhermann.org	11740 Katy Hwy, Building III		Houston	TX	77079	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	System Contact	Manager, Business Solutions		Perez	Michael		7133384206					R.Michael.Perez@memorialhermann.org	929 Gessner #1500		Houston	TX	77024	07/05/2019	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Third Party Administrator (TPA) Liaison	AVP, Pharmacy Operations		Ramirez	Hector	W	7135972523					Hector.Ramirez@apex4health.com	24 Greenway Plaza, Suite 1150		Houston	TX	77046	09/25/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	User Access Contact	VP, Compliance		Clark	Robert		7133386429					Robert.clark@memorialhermann.org	11740 Katy Hwy, Building III		Houston	TX	77079	09/12/2023	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Utilization Management Contact	VP of Health Services		Douds	Claudia		7133386429					claudia.douds@apex4health.com	929 Gessner Suite1500		Houston	TX	77024	10/25/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7115	Utilization Review Contact	VP of Health Services		Douds	Claudia		7133386429					claudia.douds@apex4health.com	929 Gessner Suite1500		Houston	TX	77024	10/25/2022	2023	MEMORIAL HERMANN HEALTH PLAN	Local CCP	Memorial Hermann Health Plan	HMO/HMOPOS		Memorial Hermann Health System	578	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7123	Agent/Broker Compensation Data Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Automated TrOOP Balance Transfer Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2021	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Backup User Access Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Best Available Evidence Contact	Customer Service		Health Plan	UPMC		8006068648					upmchp@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	03/17/2023	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Bid Audit Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Bid Audit Site Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Bid Primary Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	CAP Report Contact for Public Website	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	CEO - CMS Administrator Contact	President	Ms.	Holder	Diane	P	4124547640				4124547750	holderd@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/04/2023	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	CEO - Senior Official for Contracting	President	Ms.	Holder	Diane	P	4124547640				4124547750	holderd@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/04/2023	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Chief Financial Officer	Chief Financial Officer	Mr.	Gebbens	Gordon		4124545559					gebbgx@UPMC.EDU	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Chief Operating Officer	Chief Operating Officer	Ms.	Jenkins	Mary Beth	L	4124547764					jenkinsml@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Chief Information Officer	Chief Information Officer	Mr	McCallister	Ed		4124547711					mccallisterew@upmc.edu	600 Grant St, 60th Floor		Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Chief Information Security Officer	VP, ISD	Mr	Haas	Scott		4124546162					haassm@upmc.edu	600 Grant St., 55th Floor		Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	CMS Casework Communication Contact	Sr. Administrator, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Complaints Tracking Contact	Sr. Administrator, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Contact for Fraud Investigations	Sr. Director Fraud & Abuse		Workman	Craig		4124545524					workmanc@upmc.edu	USX Tower, 47th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Coordination of Benefits Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Corporate Mailing						4124547500					upmchp@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst		Kelly	Alexis		4124547856				4124542110	medicarereporting@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	12/02/2021	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Customer Service Operations Contact	Customer Service		Health Plan	UPMC		8006068648					upmchp@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	03/17/2023	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	DIR Contact	Director, Pharmacy Finance		Bovier	Jacqueline		4124547584					bovierjd@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	DIR Contact (Secondary)	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Emergency Part D Contact	Vice President, Customer Engagement & Enrollment		Palmerine	Anne		4129777828					palmerineac3@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Operations		Kienzle	Paul		7242070388					kienzlepa@upmc.edu	600 Grant Street		Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Encounter Data & Risk Adjustment Operations Contact	Director, Government Revenue		Plank	Tim		4124547747					planktm@upmc.edu	USX Tower, 36th Floor	600 Grant Street	Pittsburgh	PA	15219	10/28/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Enrollment Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	EOB Transfer Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Financial Audit Contact	Sr. Director, Medicare Operations	Mr.	Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Financial Reporting Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Formulary Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Formulary Contact (Secondary)	Specialist, Pharmacy Operations	Ms.	Lindemuth	Nicole		4124548589					lindemuthnl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	General Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Government Relations Contact	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Grumbine	Megan		7034021772					grumbinem@upmc.edu	USX Tower, 41st Floor	600 Grant St.	Pittsburgh	PA	15219	11/03/2020	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	HIPAA Security Officer	Chief Privacy Officer	Ms.	Grumbine	Megan		7034021772					grumbinem@upmc.edu	USX Tower, 41st Floor	600 Grant St.	Pittsburgh	PA	15219	11/03/2020	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Hospice Contact	Pharmacy Coordinator	Ms.	Lindemuth	Nicole		4124548589					lindemuthnl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	06/24/2020	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Interoperability Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	02/16/2022	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	MA Appeals/Grievances Contact	Sr. Administrator, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	MA Claims Processing Contact for Public Website	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Marketing Contact	Director, Medicare Marketing		McVey	Alicia		4124545525					mcveyal@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Medical Director	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Medicare Coordinator	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Medicare Part D Opioid Overutilization Contact	Sr. Manager, Clinical Pharmacy		Zandier	Lauren		4124542950				4124545295	craigl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Medication Therapy Management Contact	Sr. Manager Clinical Pharmacy		Zandier	Lauren		4124542950				4124545295	craigl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Online Enrollment Center Contact (Back-up)	Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Online Enrollment Center Contact (Optional)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Online Enrollment Center Contact (Primary)	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part C Application Contact	Project Manager	Mr.	Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/18/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part C Reporting Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part D Appeals	Manager, C&G		Richards	Rebecca						4124547920	richardsr3@upmc.edu	USX Tower, 42nd Floor	600 Grant Street	Pittsburgh	PA	15219	02/25/2021	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active	4124540116				HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part D Appeals Contact (Secondary)	Manager, Pharmacy Compliance		Chaussinand	Matt							chaussinand@upmc.edu	600 Grant St., USX, 12th Floor		Pittsburgh	PA	15219	02/25/2021	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active	4124545914				HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part D Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/18/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part D Benefits Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part D Claims Submission Contact	Director, Product Management		Etherton	Jim		5133163889					jbetherton@express-scripts.com	8990 Duke Drive		Mason	OH	45040	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part D Exceptions Contact			Services	Pharmacy							upmchp@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active	8003964139				HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part D Price File Contact (Back-up)	Sr. Manager, Government Programs		Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	USX Tower, 9th Floor	5151 Blazer Pkwy	Dublin	OH	43017	01/18/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part D Price File Contact (Optional)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/18/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part D Price File Contact (Primary)	Director, Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107 St. #11202		Overland	KS	66207	07/28/2020	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part D Quality Assurance Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Part D Reporting Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Patient Safety Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Payment Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Personal Health Record Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/18/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Pharmacy Director	Sr. Director, Pharmacy Operations		Kienzle	Paul		7242070388					kienzlepa@upmc.edu	600 Grant Street		Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Pharmacy Network Management Contact	Network Account Director		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Pharmacy Technical Help Desk Contact	DIrector, Customer Service		Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	07/29/2021	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Philadelphia
H7123	PHR Beneficiary Contact																	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS	MyHealth	UPMC Health System	249	Yes	Active	4128032065				HMO - Health Maintenance Organization		C	Philadelphia
H7123	Physician Incentive Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Plan Directory Contact for Public Website			Marketing	Medicare		8773813765					upmchp@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Plan to Plan Reconciliation Contact	Business Analyst II		Michalski	Jeff		4124545715				4124542110	medicarereporting@upmc.edu	c/o UPMC Health Plan Attn: Dave Soltesz P2P	US Steel Tower, 600 Grant Street, 21st Floor	Pittsburgh	PA	15219	10/03/2022	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Processor Contact	Sr Director - Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Quality Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Reconciliation Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Reconciliation Contact (Secondary)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Recovery Audit Contact	Sr. Director, Medicare Operations	Mr.	Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	SNP Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	SNP State Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Surveillance Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	System Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Third Party Administrator (TPA) Liaison	Business Analyst II		Kelly	Alexis		4124547856				4124542110	medicarereporting@upmc.edu	c/o UPMC Health Plan Attn: Alexis Kelly P2P	US Steel Tower, 600 Grant Street, 9th Floor	Pittsburgh	PA	15219	02/08/2022	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	User Access Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Utilization Management Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7123	Utilization Review Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	01/16/2019	2023	UPMC HEALTH COVERAGE, INC.	Local CCP	UPMC for Life Complete Care	HMO/HMOPOS		UPMC Health System	249	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7147	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7147	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7147	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7147	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7147	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H7147	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7147	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H7147	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7147	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF COLORADO INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7149	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8887369118				8885547668	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/03/2018	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/05/2017	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H7149	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Plan Directory Contact for Public Website			Customer Service	Aetna		8669014692					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	11/26/2014	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7149	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH INC. (PA)	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H7151	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7812272122					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		7812272123					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7812272124					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		7812272127					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Chief Information Security Officer	Security Officer	Mr.	Careless	Jason		6025764139					Jason.careless@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Contact for Fraud Investigations	Head of SIU		Bowman	John		3144732898					john.bowman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	General Contact	Compliance Manager	Ms.	Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		7812272122					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	HIPAA Privacy Officer	Privacy Officer		Reilly	Emily		4043049090					Emily.reilly@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	HIPAA Security Officer	Information Security Officer		Careless	Jason		6025764139					Jason.careless@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Marketing Contact	Marketing Manager		Lord	Austin		5085964196					Austin.lord@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Medicare Coordinator	Compliance Manager	Ms.	Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7151	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7151	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7151	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7151	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Payment Contact	CFO	Mr.	Yale	Brad		7812272124					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H7151	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7151	PHR Beneficiary Contact																	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H7151	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Processor Contact	Chief Operating Officer		Henry	Larry		7812272127					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Surveillance Contact	Chief Compliance Officer		OKane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	User Access Contact	Chief Compliance Officer	Ms.	OKane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7151	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7163	Agent/Broker Compensation Data Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Automated TrOOP Balance Transfer Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Backup User Access Contact	Medicare Advantage Compliance Program Manager	Mrs.	Rainer	Sally		3183720214					Sally.Rainer@bcbsla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Best Available Evidence Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Bid Audit Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccpuit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Bid Audit Site Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Bid Primary Contact	Vice President, Monroe Operations	Mrs.	Self	Jessica		3189982853					jself@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	CEO - CMS Administrator Contact	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	130 DeSiard Street, Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	CEO - Senior Official for Contracting	CEO	Mr.	Camerlinck	Bryan		2252952537					Bryan.Camerlinck@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	03/23/2023	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Chief Financial Officer	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Chief Operating Officer	SVP and COO, Government Business	Mr.	Faulk	Sheldon		2252952079					sheldon.faulk@bcbsla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Chief Information Officer	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Chief Information Security Officer	Chief Information Security Officer	Mr.	Sotnikov	Slava		2252987036					slava.sotnikov@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	CMS Casework Communication Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Complaints Tracking Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Contact for Fraud Investigations	Manager, Special Investigations	Mrs.	Cowart	Kandyce		2252952073					kandyce.cowart@bcbsla.com	5525 Reitz Avnue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Coordination of Benefits Contact	Medicare Enrollment Supervisor	Mrs.	Drake	Michele		3189983083					mdrake@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Corporate Mailing						3183610900					jself@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St. Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Customer Service Operations Contact	Director of Member Services	Mrs.	Trichel	Amy		3189982870					atrichel@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	DIR Contact	Chief Financial Officer	Mrs	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	DIR Contact (Secondary)	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Electronic Health Record Contact	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Emergency Part D Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3185372903					cdearman@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Emergency Part D Contact (Secondary)	Medicare Compliance Officer	Mr.	Miller	Wesley		2252522096					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Employer Waiver Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Encounter Data & Risk Adjustment Operations Contact	Director of Quality Improvement		Murphy	Paul		3189983098					pmurphy@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Enrollment Contact	Medicare Enrollment Supervisor	Mrs.	Drake	Michele		3189983083					mdrake@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	EOB Transfer Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076				3188129987	ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Financial Audit Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Financial Reporting Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076				3188129987	ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Formulary Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Formulary Contact (Secondary)	Medicare Team Lead, Formulary Services		Paddock	Deanna		6087292628					Deanna.Paddock@Navitus.com	2601 W. Beltline Highway, Suite 600		Madison	WI	53713	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	General Contact	VP of MA Operations and Plan Performance	Mr.	Gray	Paul		2253549898					paul.gray@bcbsla.com	225 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Government Relations Contact	Deputy General Counsel	Mrs.	Harvey	Korey		2252972762					korey.harvey@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	HIPAA Privacy Officer	VP Internal Audit, Compliance & Privacy	Mrs.	Saporito	Mary		2252981742					mary.saporito@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	HIPAA Security Officer	VP of Internal Audit, Compliance & Privacy	Mrs.	Saporito	Mary		2252981742					mary.saporito@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Hospice Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Interoperability Contact	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	MA Appeals/Grievances Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	MA Claims Processing Contact for Public Website	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076				3188129987	ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Marketing Contact	SVP and Marketing Officer	Mr.	Keller	Brian		2252981582					brian.keller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Medical Director	Chief Medical Director	Dr.	Raulerson	Robert		3189983701					rraulerson@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Medicare Coordinator	Medicare Advantage Compliance Program Manager	Mrs.	Rainer	Sally		3183720214					Sally.Rainer@bcbsla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	02/15/2023	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Medication Therapy Management Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	OffShore Subcontractor Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Online Enrollment Center Contact (Back-up)	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Online Enrollment Center Contact (Optional)	Medicare Advantage Compliance Program Manager	Mrs.	Rainer	Sally		3183720214					Sally.Rainer@bcbsla.com	130 DeSiard St	Suite 30	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor	Mrs.	Drake	Michele		3189983083				3188071115	mdrake@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Part C Application Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Part C Reporting Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Part D Appeals	Appeals Supervisor	Mrs.	Olivo	Cassidy							cmolivo@vhpla.com	130 DeSiard Street, Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	3189982859				HMO - Health Maintenance Organization		C	Denver
H7163	Part D Appeals Contact (Secondary)	Senior Appeals Specialist	Mrs.	Stowe	Emily							edstowe@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	3189983193				HMO - Health Maintenance Organization		C	Denver
H7163	Part D Application Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Part D Benefits Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Part D Claims Submission Contact	Supervisor		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Part D Exceptions Contact	Director of Pharmacy	Mr.	Dearman	Clyde							cdearman@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	3189982710				HMO - Health Maintenance Organization		C	Denver
H7163	Part D Exceptions Contact (Secondary)	Medicare Compliance Officer	Mr.	Miller	Wesley							Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	2252987965				HMO - Health Maintenance Organization		C	Denver
H7163	Part D Price File Contact (Back-up)			Dahlke	Nicole		9202214162					plan.finder@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Part D Price File Contact (Optional)	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard St  Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Part D Price File Contact (Primary)			Finder	Plan		6087291578					plan.finder@navitus.com	361 Integrity Drive		Madison	WI	53714	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Part D Quality Assurance Contact	Director of Pharmacy	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Part D Reporting Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Patient Safety Contact	Clinical Pharmacist	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Payment Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Personal Health Record Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Pharmacy Director	Pharmacy Director	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 Desiard St., Ste 130		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Pharmacy Network Management Contact	Associate Director Pharmacy Network Management		Burdick	Tammy		9202214089					Tammy.Burdick@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Pharmacy Network Management Contact (Secondary)	Pharmacy Director	Mr.	Dearman	Clyde		3189982710					cdearman@vhpla.com	130 DeSiard St Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Pharmacy Technical Help Desk Contact	Pharmacy Director	Mr.	Dearman	Clyde							cdearman@vhpla.com	130 DeSiard St Suite 300		monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	8667040109				HMO - Health Maintenance Organization		C	Denver
H7163	Pharmacy Technical Help Desk Contact (Secondary)	Medicare Compliance Officer	Mr.	Miller	Wesley							Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active	2252987965				HMO - Health Maintenance Organization		C	Denver
H7163	PHR Beneficiary Contact																	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS	Vantage Health Plan, Inc	Louisiana Health Service & Indemnity Company	617	Yes	Active	8667040109				HMO - Health Maintenance Organization		C	Denver
H7163	Physician Incentive Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard Street	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Plan Directory Contact for Public Website	Director of Member Service	Mrs.	Trichel	Amy		8888231910					atrichel@vhpla.com	130 DeSiard Street, Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Processor Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Quality Contact	Director of Quality Improvement	Mr.	Murphy	Paul		3189983098					pmurphy@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Reconciliation Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Reconciliation Contact (Secondary)	Chief Financial Officer		Haygood	Rhonda		3189983900					rhaygood@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	07/13/2020	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Recovery Audit Contact	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	SNP Application Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	SNP State Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Reitz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Surveillance Contact	SVP and Chief Marketing Officer	Mr.	Keller	Brian		2252981582					brian.keller@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	System Contact	Chief Information Officer	Mrs.	Kozik	Sue		2252981689					sue.kozik@bcbsla.com	5525 Reitz Avenue		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mrs.	Cupit	Chelle		3189983076					ccupit@vhpla.com	130 DeSiard St. Suite 300		Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	User Access Contact	Medicare Compliance Officer	Mr.	Miller	Wesley		2252987965					Wesley.Miller@bcbsla.com	5525 Retiz Ave		Baton Rouge	LA	70809	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Utilization Management Contact	Chief Medical Director	Dr.	Raulerson	Robert		3189983701					rraulerson@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7163	Utilization Review Contact	Chief Medical Director	Dr.	Raulerson	Robert		3189983701					rraulerson@vhpla.com	130 DeSiard St	Suite 300	Monroe	LA	71201	12/22/2022	2023	PRIMEWELL HEALTH SERVICES OF MISSISSIPPI, INC.	Local CCP	Primewell Health Services	HMO/HMOPOS		Louisiana Health Service & Indemnity Company	617	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H7165	Agent/Broker Compensation Data Contact	VP -  Medicare Advantage Operations Marketing		Edwards	Don		8032649482					Don.Edwards@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Automated TrOOP Balance Transfer Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Backup User Access Contact	Director of Medicare Advantage Operations Services		Morris	Charles		8032641799					charles.morris@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Best Available Evidence Contact	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Bid Audit Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Bid Audit Site Contact	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Bid Primary Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	CAP Report Contact for Public Website	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	CEO - CMS Administrator Contact	CEO	Mr.	Mizeur	Michael	J	8032646000					CEO@BCBSSC.com	I-20 at Alpine Road	AA-X01	Columbia	SC	29219	01/03/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	CEO - Senior Official for Contracting	CEO	Mr.	Mizeur	Michael	J	8032646000					CEO@BCBSSC.com	I-20 at Alpine Road	AA-X01	Columbia	SC	29219	01/03/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Chief Financial Officer	VP & CFO, BCBS Div	Mrs.	Srulevich	Heather		8032649488					Heather.Srulevich@BCBSSC.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	10/26/2017	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Chief Operating Officer	President, BlueCross BlueShield of SC	Mr	Graves	Scott		8033825114					SCOTT.GRAVES@bcbssc.com	I-20 Apline Road	AA-X18	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Chief Information Officer	Senior VP, CIO	Mrs.	McCormick	Renee		8032642369					Renee.McCormick@bcbssc.com	1-20 Alpine Road	AA-X01	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Chief Information Security Officer	Senior VP, CIO	Mrs.	McCormick	Renee		8032642369					Renee.McCormick@bcbssc.com	1-20 Alpine Road	AA-X01	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	CMS Casework Communication Contact	Manager - Medicare Advantage Operations		Dewitt	Tanika		8032641103					Tanika.Dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Complaints Tracking Contact	Manager - Medicare Advantage Operations		Dewitt	Tanika		8032641103					Tanika.Dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Contact for Fraud Investigations	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Coordination of Benefits Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/23/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Corporate Mailing						8032642944				8032649581	katrina.gesh-wilson@bcbssc.com	PO Box 100191		Columbia	SC	29202	11/15/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Coverage Gap Discount Program (CGDP) Payment Contact	Director - Private Business Accounting		Campbell	Newt		8032640357					CGDP_REPORTING@bcbssc.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Customer Service Operations Contact	Director Operations		Rodillo-Fowler	Ellen		8032640965					ellen.rodillo-fowler@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	DIR Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris		8032644347				8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	DIR Contact (Secondary)	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Electronic Health Record Contact	VP- Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/23/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Emergency Part D Contact	VP - Medicare Advantage Operations		Boggero	Laurin		8034224440				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/23/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Emergency Part D Contact (Secondary)	VP Medicare Advantage		Gesh-Wilson	Kat		2816841626					kat.gesh-wilson@bcbssc.com	I-20 at Alpine Road	AG-770	Columbia	SC	29219	12/13/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Employer Waiver Contact	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Encounter Data & Risk Adjustment Operations Contact	Director Statistics and Research		Kosnosky	Brenda		8032642744					brenda.kosnosky@bcbssc.com	I-20 at Alpine Rd.	AX-555	Columbia	SC	29219	10/22/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Enrollment Contact	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	EOB Transfer Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/23/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Financial Audit Contact	Compliance Officer	Mr.	Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Financial Reporting Contact	Director - Financial Reporting		Haile	Karin		8032642089					Karin.Haile@bcbssc.com	1-20 at Alpine Road	AX-200	Columbia	SC	29219	08/09/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Formulary Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris		8032644347				8038708162	Chris.Puffenbarger@bcbssc.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Formulary Contact (Secondary)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	I-20 @ Alpine Rd	Mailcode AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	General Contact	VP - Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	Laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/23/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Government Relations Contact	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	HIPAA Privacy Officer	Privacy Compliance Officer		Weeks	Linda		8032643562					linda.weeks@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	10/05/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	HIPAA Security Officer	AVP, I/S Goverance		Hubbard	Elizabeth		8032646146					Elizabeth.Hubbard@bcbssc.com	I-20 at Alpine Road	AA-225	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Hospice Contact	Supervisor - Medicare Advantage Operations		DeWitt	Tanika		8032641103					tanika.dewitt@bcbssc.com	1-20 @ Alpine Rd.	AG-780	Columbia	SC	29223	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Interoperability Contact	VP Medicare Operations		Boggero	Laurin		8032646635					laurin.boggero@bcbssc.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/27/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	MA Appeals/Grievances Contact	Manager - Medicare Advantage Operations		Dewitt	Tanika		8032641103					tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	MA Claims Processing Contact for Public Website	Director Operations		Morris	Charles		8032641799					charles.morris@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Marketing Contact	VP -  Medicare Advantage Operations Marketing		Edwards	Don		8032649482					Don.Edwards@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Medical Director	Chief Medical Officer		Sungurov	Max		8032645729					max.sungurov@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	05/18/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Medicare Compliance Officer	Compliance Officer	Mr.	Pierstorff	Joel		8036062211				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 @ Alpine Rd, Mailcode AC-200	AC-200	Columbia	SC	29219	01/05/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Medicare Coordinator	Manager - Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	tanika.dewitt@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Medicare Part D Opioid Overutilization Contact	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Medication Therapy Management Contact	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	OffShore Subcontractor Contact	VP-Medicare Advantage Operations	Ms.	Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Online Enrollment Center Contact (Back-up)	VP Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Online Enrollment Center Contact (Optional)	Manager Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Online Enrollment Center Contact (Primary)	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Part C Application Contact	VP Medicare Advantage		Gesh-Wilson	Katrina		8032642944					kat.gesh-wilson@bcbssc.com	I-20 @ Alpine Rd	AG-770	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Part C Reporting Contact	AVP - Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Part D Appeals	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris						8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/31/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032645355				HMO - Health Maintenance Organization		C	Atlanta
H7165	Part D Appeals Contact (Secondary)	Supervisor - Medicare Advantage Operations		Dewitt	Tanika						8032649581	tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032641103				HMO - Health Maintenance Organization		C	Atlanta
H7165	Part D Application Contact	VP Medicare Advantage		Gesh-Wilson	Katrina		8032642944					kat.gesh-wilson@bcbssc.com	I-20 @ Alpine Rd	AG-770	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Part D Benefits Contact	Sr. Director - Medicare Pharmacy		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	I-20 at Alpine Road	AG-770	Columbia	SC	29219	07/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Part D Claims Submission Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Part D Exceptions Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris						8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032644347				HMO - Health Maintenance Organization		C	Atlanta
H7165	Part D Exceptions Contact (Secondary)	Supervisor - Medicare Advantage Operations		Dewitt	Tanika							tankia.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032641103				HMO - Health Maintenance Organization		C	Atlanta
H7165	Part D Price File Contact (Back-up)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Part D Price File Contact (Primary)	Manager, MA Pharmacy Management		Puffenbarger	Chris		8032644347					Chris.Puffenbarger@bcbssc.com	1-20 Alpine Road	AX-740	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Part D Quality Assurance Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Part D Reporting Contact	Corporate Compliance Manager		Ramsey	Ryan		8032642735					BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	01/02/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Patient Safety Contact	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Payment Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Personal Health Record Contact	VP, Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Pharmacy Director	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Pharmacy Network Management Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris		8032644347				8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Pharmacy Network Management Contact (Secondary)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Pharmacy Technical Help Desk Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris							Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/31/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8555405951				HMO - Health Maintenance Organization		C	Atlanta
H7165	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica							terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8555405951				HMO - Health Maintenance Organization		C	Atlanta
H7165	PHR Beneficiary Contact																	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS	BlueCross BlueShield of South Carolina, Medicare Advantage	BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8886456025				HMO - Health Maintenance Organization		C	Atlanta
H7165	Plan Directory Contact for Public Website			Services	Provider		8003342583					Provider.Education@BCBSSC.com	I-20 at Alpine Road	AX-624	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Plan to Plan Reconciliation Contact	Director, Accounting		Campbell	Newt		8032640357				8038708623	Newt.Campbell@bcbssc.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	04/13/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Processor Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Quality Contact	Medicare Stars Performance Officer		Sloan	Jason		8032647645					Jason.Sloan@bcbssc.com	1-20 at Alpine Road	AG-A10	Columbia	SC	29219	03/17/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Reconciliation Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Reconciliation Contact (Secondary)	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Recovery Audit Contact	VP-Medicare Advantage Operations	Ms.	Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Surveillance Contact	VP -  Medicare Advantage Operations Marketing		Edwards	Don		8032649482					Don.Edwards@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	System Contact	Assistant Vice President - Information Systems		Aldinger	Eugenia		8032645410					Eugenia.Aldinger@bcbssc.com	I-20 at Alpine Road	AF-123	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Third Party Administrator (TPA) Liaison	Director - Private Business Accounting		Campbell	Newt		8032640357					CGDP_REPORTING@bcbssc.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	User Access Contact	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Utilization Management Contact	VP - Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7165	Utilization Review Contact	VP - Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	HMO/HMOPOS		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H7169	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H7169	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/02/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/02/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Medical Director	Chief Medical Director	Dr.	Lucas	Brad		8662464356					blucas@centene.com	3700 Embassy Parkway, Suite 200		Akron	OH	44333	03/30/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/30/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132061716				PPO - BBA		C	Dallas
H7169	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H7169	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H7169	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H7169	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H7169	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H7169	PHR Beneficiary Contact																	09/27/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8557661851				PPO - BBA		C	Dallas
H7169	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	03/31/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7169	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	BUCKEYE HEALTH PLAN COMMUNITY SOLUTIONS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7172	Agent/Broker Compensation Data Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	07/15/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Best Available Evidence Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	07/15/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	12/19/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	12/19/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Bid Primary Contact	Sr. Manager, Project Program Mgmnt		Fahrner	Melanie		6186061189					mafahrner@aetna.com	7400 W. Campus Road		New Albany	OH	43054	06/20/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	05/04/2020	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	CMS Casework Communication Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Complaints Tracking Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Coordination of Benefits Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/12/2017	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Corporate Mailing						4107525721				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/01/2020	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant	Mrs.	Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/18/2019	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Customer Service Operations Contact	Director, Service Operations		Phillips	Tish		8666002139					PhillipsL1@aetna.com	7400 Camous Road		New Albany	OH	43054	01/21/2020	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Emergency Part D Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/12/2017	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Emergency Part D Contact (Secondary)	Director, Pharmacy		Stekol	Ilona		3478806082					stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Employer Waiver Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	07/15/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Encounter Data & Risk Adjustment Operations Contact	Director, Informatics		Sevchik	Melissa		6026591404					sevchikm@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	12/12/2019	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Enrollment Contact	Director, Service Operations		Truitt	Michelle		7176716847					MLTruitt@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	07/01/2020	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Formulary Contact	Pharmacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/11/2018	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Formulary Contact (Secondary)	Director, Pharmacy		Stekol	Ilona		3478806082					stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	General Contact	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/14/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Government Relations Contact	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/14/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	HIPAA Privacy Officer	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	07/15/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Hospice Contact	Director, Service Operations		Truitt	Michelle		7176716847					MLTruitt@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	07/01/2020	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	MA Appeals/Grievances Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	09/06/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	09/06/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Medical Director	Sr.  Medical Director		Hudson, MD	Karla		7739324873					hudsonk2@aetna.com	3200 Highland Ave.	MC F661	Downers Grove	IL	60515	09/06/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Medicare Coordinator	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/14/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Medicare Part D Opioid Overutilization Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	10/17/2018	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Medication Therapy Management Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/12/2017	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	MMP Reporting Requirements Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	07/15/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	MMP Point of Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	07/15/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	OffShore Subcontractor Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	07/15/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part C Application Contact	Exec Dir, Business Operations		Washington	Chaz		3854993702					washingtonc3@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/29/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part D Appeals	Supervisor, Clinical Pharmacy	Ms.	Spencer	Tiffane						8553658108	MedicareCoverageDeterminationMMP-SNP@AETNA.com	4500 E Cotton Center, Blvd	F829	Phoenix	AZ	85040	01/11/2021	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8609004579				Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part D Appeals Contact (Secondary)	Pharmacy Director	Ms.	Vergil	Gina						8553658108	VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/05/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	4026997768				Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	06/24/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part D Benefits Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/12/2017	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part D Claims Submission Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/12/2017	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part D Exceptions Contact	Phamacy Director		Vergil	Gina							VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/12/2017	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	4026997768				Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part D Exceptions Contact (Secondary)	Director, Pharmacy		Stekol	Ilona							stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/05/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	3478806082				Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part D Price File Contact (Back-up)	Pharmacy Director		Vergil	Gina		4026997768					Vergilg@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part D Quality Assurance Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/12/2017	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Patient Safety Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	04/12/2017	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Payment Contact	Lead Director, FP&A		Stefanich	Anita		3129283105					StefanichA@cvshealth.com	333 West Wacker Drive	Suite 2100	Chicago	IL	60606	12/05/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Personal Health Record Contact	Senior Medical Director		Chand	David		3303882849					ChandD@aetna.com	3526 Torey Pine Drive		Fairlawn	OH	44333	09/06/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Pharmacy Director	Pharmacy Director		Nkurunziza	Natalie		8609006247					NkurunzizaN@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	09/20/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Pharmacy Network Management Contact	Pharmacy Director		Nkurunziza	Natalie		8609006247					NkurunzizaN@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	09/20/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy		Stekol	Ilona		3478806082					Stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Pharmacy Technical Help Desk Contact	Phamacy Director		Nkurunziza	Natalie							NkurunzizaN@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	07/11/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8553642975				Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Physician Incentive Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	07/15/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Plan Directory Contact for Public Website	Senior Manager, Duals	Ms.	Brown	Anne Marie		7272720427					browna36@aetna.com	3482 Maclaren Dr.		Palm Harbor	FL	34684	09/08/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Processor Contact	Vice President, Duals Markets	Mr.	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/14/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Quality Contact	Sr. Manager, Health Care Quality		Wanish	Michelle		3368017218					wanishm@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Reconciliation Contact (Secondary)	Lead Director, FP&A	Ms.	Stefanich	Anita		3129283105					StefanichA@cvshealth.com	333 W. Wacker Drive	Suite 2100	Chicago	IL	60606	12/05/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	01/31/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Surveillance Contact	Lead Director, Compliance		Brown	Kristen	J	6144395370					brownk5@aetna.com	7400 West Campus Road, Mail Code F494		New Albany	OH	43054	07/15/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	System Contact	Director Business Information Magement	Ms.	Tanzillo	Hollie	M	7407398501					tanzilloh@aetna.com	7400 Campus Road		New Albany	OH	43054	07/07/2021	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Utilization Management Contact	Sr. Director Straregic Programs, AMA COE Clinical		Hawkins	Erin		8175288743					hawkinse@aetna.com	4300 Centreway Place		Arlington	TX	76018	07/07/2021	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7172	Utilization Review Contact	Duals Utilization Mgmt Principal Clinical Leader		Jones	Leslye		8606870283					JonesL12@cvshealth.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/19/2022	2023	AETNA BETTER HEALTH INC. (OH)	Demo	Aetna Better Health of Ohio, MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7175	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H7175	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H7175	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H7175	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H7175	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H7175	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H7175	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H7175	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7175	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE OF NORTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7195	Automated TrOOP Balance Transfer Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Backup User Access Contact	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	04/25/2017	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Best Available Evidence Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Bid Primary Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	CAP Report Contact for Public Website	CEO	Mrs.	Grimm	Lynn	M	7012500709	102			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	CEO - CMS Administrator Contact	CEO	Mrs.	Grimm	Lynn	M	7012500709	102			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	CEO - Senior Official for Contracting	CEO	Mrs.	Grimm	Lynn	M	7012500709	102			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Chief Financial Officer	CEO	Mrs.	Grimm	Lynn	M	7012500709	102			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Chief Operating Officer	CEO	Mrs.	Grimm	Lynn	M	7012500709	102			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Chief Information Officer	Systems Security Officer	Mr.	Vasicek	Jeff		7012500709	114			7012500709	jvasicek@northlandhealth.com	2223 East Rosser		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Chief Information Security Officer	Systems Security Officer	Mr.	Vasicek	Jeff		7012500709	114			7012500709	jvasicek@northlandhealth.com	2223 East Rosser		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	CMS Casework Communication Contact	CEO	Mrs.	Grimm	Lynn	M	7012500709	102			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Complaints Tracking Contact	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Contact for Fraud Investigations	Compliance Officer	Mrs.	Harrison	Marlys		7017513050	103			7012500739	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Coordination of Benefits Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Corporate Mailing						7012500709				7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Coverage Gap Discount Program (CGDP) Payment Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Customer Service Operations Contact	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	DIR Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	DIR Contact (Secondary)	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Emergency Part D Contact	Compliance Officer	Mrs.	Harrison	Marlys		7017513050	103			7012500739	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Emergency Part D Contact (Secondary)	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	12/14/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Encounter Data & Risk Adjustment Operations Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Enrollment Contact	Marketing/Outreach Director	Mrs.	Simon	Theresa		7017513050	103			7012500739	tsimon@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	EOB Transfer Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Financial Audit Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Financial Reporting Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Formulary Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Formulary Contact (Secondary)	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	General Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Government Relations Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	HIPAA Privacy Officer	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	HIPAA Security Officer	Systems Security Officer	Mr.	Vasicek	Jeff		7012500709	114			7012500739	jvasicek@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Interoperability Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	04/19/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	MA Appeals/Grievances Contact	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	MA Claims Processing Contact for Public Website	Marketing/Outreach Director	Mrs.	Simon	Theresa		7017513050	103			7012500739	tsimon@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Marketing Contact	Marketing/Outreach Director	Mrs.	Simon	Theresa		7017513050	103			7012500739	tsimon@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Medical Director	Medical Director	Dr.	Datz	Kurt		7012500709					kdatz@northlandhealth.com	2223 East Rosser Ave.		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Medicare Compliance Officer	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Medicare Coordinator	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Datz	Kurt		7012500709					kdatz@northlandhealth.com	2223 East Rosser Ave.		Bismarck	ND	58501	04/19/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Medication Therapy Management Contact	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Online Enrollment Center Contact (Primary)	Marketing/Outreach Director	Mrs.	Simon	Theresa		7012500709	103			7012500739	tsimon@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Part C Application Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Part D Appeals	Compliance Officer	Mrs.	Harrison	Marlys						7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active	8888838959	121			PACE - Nat		C	Denver
H7195	Part D Appeals Contact (Secondary)	Compliance Officer	Mrs.	Harrison	Marlys						7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active	8888838959	121			PACE - Nat		C	Denver
H7195	Part D Application Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Part D Benefits Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Part D Claims Submission Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Part D Exceptions Contact	Compliance Manager	Mrs.	Harrison	Marlys						7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active	8888838959	121			PACE - Nat		C	Denver
H7195	Part D Price File Contact (Back-up)	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Part D Price File Contact (Primary)	CEO	Mrs.	Grimm	Lynn	M	7012500709					lgrimm@northlandhealth.com	2223 East Rosser Ave.		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Part D Quality Assurance Contact	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Part D Reporting Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Patient Safety Contact	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Payment Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Personal Health Record Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Pharmacy Director	Medical Director	Dr.	Datz	Kurt		7012500709					kdatz@northlandhealth.com	2223 East Rosser Ave.		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Pharmacy Network Management Contact	Compliance Manager	Mrs.	Harrison	Marlys		7017513050	121			7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Pharmacy Technical Help Desk Contact	Compliance Manager	Mrs.	Harrison	Marlys						7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	05/03/2016	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active	8888838959	121			PACE - Nat		C	Denver
H7195	Pharmacy Technical Help Desk Contact (Secondary)	Compliance Manager	Mrs.	Harrison	Marlys						7017513053	mharrison@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active	8888838959	121			PACE - Nat		C	Denver
H7195	PHR Beneficiary Contact																	01/07/2014	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE	Northland PACE Senior Care Services	Northland Healthcare Alliance	369	Yes	Active	8888838959				PACE - Nat		C	Denver
H7195	Plan Directory Contact for Public Website	Marketing/Outreach Director	Mrs.	Simon	Theresa		7017513050	103			7012500739	tsimon@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Plan to Plan Reconciliation Contact	CEO	Mrs.	Grimm	Lynn	M	7012500709					lgrimm@northlandhealth.com	2223 East Rosser Ave.		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Processor Contact	CEO	Mrs.	Grimm	Lynn	M	7012500709					lgrimm@northlandhealth.com	2223 East Rosser Ave.		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Quality Contact	Quality Director	Ms.	Leno	Susan		7017513050				7012500739	sleno@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	12/14/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Reconciliation Contact	CEO	Mrs.	Grimm	Lynn	M	7012500709					lgrimm@northlandhealth.com	2223 East Rosser Ave.		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Recovery Audit Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Surveillance Contact	Systems Security Officer	Mr.	Vasicek	Jeff		7012500709	114			7012500709	jvasicek@northlandhealth.com	2223 East Rosser		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	System Contact	Systems Security Officer	Mr.	Vasicek	Jeff		7012500709	114			7012500709	jvasicek@northlandhealth.com	2223 East Rosser		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Third Party Administrator (TPA) Liaison	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	User Access Contact	CEO	Mrs.	Grimm	Lynn	M	7012500709					lgrimm@northlandhealth.com	2223 East Rosser Ave.		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Utilization Management Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7195	Utilization Review Contact	CEO	Mrs.	Grimm	Lynn		7012500709	103			7012500739	lgrimm@northlandhealth.com	2223 East Rosser Avenue		Bismarck	ND	58501	02/16/2022	2023	NORTHLAND PACE PROGRAM	National PACE	Northland PACE Senior Care Services	National PACE		Northland Healthcare Alliance	369	Yes	Active					PACE - Nat		C	Denver
H7199	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H7199	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H7199	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H7199	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H7199	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H7199	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H7199	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H7199	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7199	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH  PLAN OF OREGON	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H7220	Agent/Broker Compensation Data Contact	Director, Medicare Risk		Rau	Todd		3179632590				3179639800	trau@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Automated TrOOP Balance Transfer Contact	Executive Director -Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Backup User Access Contact	Manager, Information Systems		Smith	Rachel		3174329357					rsmith55@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Best Available Evidence Contact	Member Services Director		Barrow	Nina		3179632591					nbarrow1@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Bid Audit Contact	Compliance Program Manager		Chadd	Tammy		3179631915					tchadd@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Bid Audit Site Contact	Compliance Program Manager		Chadd	Tammy		3179631915					tchadd@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Bid Primary Contact	Medicare Advantage Product Leader	Mr	Lee	Ed		3179639773					elee3@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	08/22/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	CAP Report Contact for Public Website	Vice President of Legal and Compliance	Ms.	Korty	Tina		3179637830				3179639800	tkorty@iuhealth.org	950 N. Meridian S	Suite 400	Indianapolis	IN	46204	12/21/2021	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	CEO - CMS Administrator Contact	President	Ms.	Motter	Stephanie		4632301807					smotter@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	CEO - Senior Official for Contracting	President	Ms.	Motter	Stephanie		4632301807					smotter@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	08/31/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Chief Financial Officer	Chief Financial Officer		Black	Scott		3179621022					sblack@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	08/17/2021	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Chief Operating Officer	Executive Director of Operations		Johnson	Renea		3179634988					rjohnson37@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/29/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Chief Information Officer	IS Director	Mr	Berbeco	Robert		3179371343					rberbeco@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Chief Information Security Officer	IS Director	Mr	Berbeco	Robert		3173713436					rberbeco@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	CMMI Model Point of Contact	Compliance Manager		Chadd	Tammy		3179631915					tchadd@iuhealth.org	950 N Meridian St, 4th floor		Indianapolis	IN	46204	04/29/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	CMS Casework Communication Contact	Compliance Consultant		Roach	Denise		3179639832					dbogardus@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Complaints Tracking Contact	Compliance Consultant		Roach	Denise		3179639832					dbogardus@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Contact for Fraud Investigations	Compliance Officer		Korty	Tina		3173195701					tkorty@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/21/2021	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Coordination of Benefits Contact	Member Services Director		Barrow	Nina		3179622591					nbarrow1@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Corporate Mailing						3179639797				3179639800	tkorty@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager		Manship	Lisa		3179628898					lmanship1@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	05/17/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Customer Service Operations Contact	Executive Director		Johnson	Renea		3179634988					rjohnson37@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	DIR Contact	Manager - Pharmacy Government Programs		Scarpino	Christine		5713853936					CScarpino@evolenthealth.com	800 N Glebe Rd	Suite 500	Arlington	VA	22203	12/29/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	DIR Contact (Secondary)	Executive Director - Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Electronic Health Record Contact	Financial Senior Analyst		Uribe Mantilla	Silvia		3179624048					suribemantil@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	08/18/2021	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Emergency Part D Contact	Executive Director -Pharmacy		Johnson	H Chris		3177194934					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Emergency Part D Contact (Secondary)	Manager - Pharmacy Government Programs		Scarpino	Christine		5713853936					CScarpino@evolenthealth.com	800 N Glebe Rd	Suite 500	Arlington	VA	22203	12/29/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Encounter Data & Risk Adjustment Operations Contact	Exec Dir Healthcare Economics Outcomes		Lee	Ed		3179639773					elee3@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Enrollment Contact	Member Services Director		Barrow	Nina		3179632591					nbarrow1@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	EOB Transfer Contact	Claims Manager		McLaughlin	Allison		3179621652				3179681233	amclaughlin4@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	05/31/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Financial Audit Contact	Compliance Manager	Ms	Chadd	Tammy		3179631915					tchadd@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	02/15/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Financial Reporting Contact	Finance Manager		Sandusky	Amy	L	3179196575					asandusky@iuhealth.org	950 N Meridian St, 4th Floor	Suite 400	INDIANAPOLIS, IN	IN	46204	08/02/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Formulary Contact	Executive Director -Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Formulary Contact (Secondary)			Etmoed	Lora		5718954913					lertmoed@evolenthealth.com	800 N Glebe Rd	Suite 500	Arlington	VA	22203	05/31/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	General Contact	Compliance Manager		Chadd	Tammy		3179631915					tchadd@iuhealth.org	950 N Meridian St, 4th floor	Suite 400	Indianapolis	IN	46204	04/29/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Government Relations Contact	Vice President of Legal, Compliance and Regulatory		Korty	Tina		3173195701					tkorty@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/21/2021	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	HIPAA Privacy Officer	VP, Chief Privacy Officer		Altobella	Michelle		3179631940					HIPAA@iuhealth.org	340 W 10th St		Indianapolis	IN	46202	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	HIPAA Security Officer	Executive Director, IS		Parker	Mitch		3179631940					HIPAA@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Hospice Contact	Compliance Consultant		Chadd	Tammy		3179631915					tchadd@iuhealth.org	950 N Meridian St, 4th floor		Indianapolis	IN	46204	04/29/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Interoperability Contact	IS Director		Smith	Rachel		3174329357					rsmith55@iuhealth.org	950 N Meridian St, 4th Floor		INDIANAPOLIS, IN	IN	46204	05/31/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	MA Appeals/Grievances Contact	Supervisor, Customer Solutions		Watson	Deborah		3179639785					dwatson3@iuhealth.org	950 N Meridian St	Suite 200	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	MA Claims Processing Contact for Public Website	Manager Claims		McLaughlin	Allison		3179621652					amclaughlin4@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	03/01/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Marketing Contact	Compliance Consultant		Roach	Denise		3173314656					dbogardus@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	03/01/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Medical Director	Medical Director	Dr.	Bernhardt	Richard		3179639700					rbernhar@iuhealth.org	950 N Meridian St, Suite 600		Indianapolis	IN	46204	08/22/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Medicare Compliance Officer	Vice President of Legal and Compliance	.	Korty	Tina		3173195701				3179639800	tkorty@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	04/05/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Medicare Coordinator	Medicare Advantage Product Leader		Lee	Ed		3179639773					elee3@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	08/22/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Medicare Part D Opioid Overutilization Contact			Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Medication Therapy Management Contact	Executive Director -Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	OffShore Subcontractor Contact	Compliance Manager		Chadd	Tammy		3179631915					tchadd@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Online Enrollment Center Contact (Back-up)	Enrollment & Billing Manager		Porter	Asha		3179639801					aporter1@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Online Enrollment Center Contact (Optional)	Member Services Director		Barrow	Nina		3179632591					nbarrow1@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46208	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Online Enrollment Center Contact (Primary)	Director, Medicare Risk		Rau	Todd		3179632590				3179639800	trau@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Part C Application Contact	Product Manager, Innovation		Alexander	Kate		3179628719					kalexander5@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	08/22/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Part C Reporting Contact	Compliance Consultant		Roach	Denise		3173314656					dbogardus@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	05/31/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Appeals	Manager - Pharmacy Government Programs		Scarpino	Christine							CScarpino@evolenthealth.com	800 N Glebe Rd	Suite 500	Arlington	VA	22203	12/29/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active	8668231016				HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Appeals Contact (Secondary)			Johnson	H Chris							hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active	5713853711				HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Application Contact	Product Manager, Innovation		Alexander	Kate		3179628719					kalexander5@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	08/22/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Benefits Contact	Executive Director -Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Claims Submission Contact	Executive Director -Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Exceptions Contact	Manager - Pharmacy Government Programs		Scarpino	Christine							PartDOps@evolenthealth.com	800 N Glebe Rd	Suite 500	Arlington	VA	22203	12/29/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active	8668231016				HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Exceptions Contact (Secondary)			Johnson	H. Chris							PartDOps@evolenthealth.com	950 North Meridian St.	Suite 600	Indianapolis	IN	46204	09/27/2018	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active	5713853711				HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Price File Contact (Back-up)	Manager - Pharmacy Government Programs		Scarpino	Christine		5713853936					CScarpino@evolenthealth.com	800 N Glebe Rd Suite 500		Arlington	VA	22203	12/29/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Price File Contact (Optional)	Compliance Manager		Chadd	Tammy		3179631915					tchadd@iuhealth.org	950 N Meridian St, 4th floor		Indianapolis	IN	46204	04/29/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Price File Contact (Primary)	Executive Director -Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Quality Assurance Contact	Executive Director -Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Part D Reporting Contact	Compliance Manager		Chadd	Tammy		3179631915					tchadd@iuhealth.org	950 N Meridian St, 4th floor		Indianapolis	IN	46204	04/29/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Patient Safety Contact	Executive Director -Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Payment Contact	Manager - Financial Reporting & Budgeting		Manship	Lisa		3179628898				3179639800	lmanship1@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	03/08/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Personal Health Record Contact	Compliance Manager		Walsh	Erin		3179639748					ewalsh1@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	05/31/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Pharmacy Director	Executive Director -Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Pharmacy Network Management Contact	Executive Director -Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Pharmacy Network Management Contact (Secondary)			Rolland	Karen		5713851457					KRolland@evolenthealth.com	800 N Glebe Rd	Suite 500	Arlington	VA	22203	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Pharmacy Technical Help Desk Contact			Rolland	Karen							KRolland@evolenthealth.com	800 N Glebe Rd	Suite 500	Arlington	VA	22203	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H7220	Pharmacy Technical Help Desk Contact (Secondary)	Manager - Pharmacy Government Programs		Scarpino	Christine							CScarpino@evolenthealth.com	800 N Glebe Rd	Suite 500	Arlington	VA	22203	12/29/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active	8668231016				HMO - Health Maintenance Organization		C	Chicago
H7220	PHR Beneficiary Contact																	11/05/2019	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS	Indiana University Health Plans	Indiana University Health	379	Yes	Active	3179639748				HMO - Health Maintenance Organization		C	Chicago
H7220	Physician Incentive Contact	Director - Claims Operations		Knotts	Dustin		3179632579					dknotts@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	06/10/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Plan Directory Contact for Public Website	Member Services Director		Barrow	Nina		8004559776					nbarrow1@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	10/27/2021	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Plan to Plan Reconciliation Contact	Finance Manager		Sandusky	Amy	L	3179196575				3179639800	asandusky@iuhealth.org	950 N Meridian St, 4th Floor	Suite 400	INDIANAPOLIS, IN	IN	46204	08/02/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Processor Contact	Claims Manager		McLaughlin	Allison		3179621652					amclaughlin4@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	05/31/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Quality Contact	Executive Director - Care Mgmt and Utilization		Foster	Deb		3179632537					dfoster16@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	04/26/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Reconciliation Contact	Financial Services Manager		Sandusky	Amy	L	3179196575					asandusky@iuhealth.org	950 N Meridian St, 4th Floor	Suite 400	INDIANAPOLIS, IN	IN	46204	08/02/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Reconciliation Contact (Secondary)	Manager - Pharmacy Government Programs		Scarpino	Christine		5713853936					CScarpino@evolenthealth.com	800 N Glebe Rd	Suite 500	Arlington	VA	22203	12/29/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Recovery Audit Contact	Compliance Consultant	Ms	Chadd	Tammy		3179631915				3179639800	tchadd@iuhealth.org	950 N Meridian St, 4th floor	Suite 400	Indianapolis	IN	46204	02/15/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Surveillance Contact	Compliance Officer		Korty	Tina		3173195701					tkorty@iuhealth.org	950 N Meridian St	Ste 400	Indianapolis	IN	46204	05/31/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	System Contact	Product Leader		Lee	Ed		3174070510				3179639800	elee3@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	08/15/2023	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Third Party Administrator (TPA) Liaison	Executive Director -Pharmacy		Johnson	H Chris		3179634844					hjohnson10@iuhealth.org	950 N Meridian St	Suite 600	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	User Access Contact	Manager IS Security		Naffziger	Joan		3179639760					jnaffzig@iuhealth.org	950 N Meridian St	Suite 400	Indianapolis	IN	46204	12/14/2020	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Utilization Management Contact	Utilization Management		Hartigan	Melissa		3174432438				3179639802	mhartigan@evolenthealth.com	950 N Meridian St	Suite 600	Indianapolis	IN	46204	05/26/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7220	Utilization Review Contact	Utilization Management		Hartigan	Melissa		3174432438				3179639802	mhartigan@evolenthealth.com	950 N Meridian St	Suite 600	Indianapolis	IN	46204	05/26/2022	2023	INDIANA UNIVERSITY HEALTH PLANS NFP, INC.	Local CCP	Indiana University Health Plans	HMO/HMOPOS		Indiana University Health	379	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7245	Agent/Broker Compensation Data Contact	Senior Markets Producer Analyst	Ms.	Garfield	Bambee		4259184121					Bambee.Garfield@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Automated TrOOP Balance Transfer Contact	Director PBM Operations	Ms.	Barnhart	Lisa		5133176662					lisa.barnhart@advantasure.com	Advantasure, Inc.	134 Turnpike Road	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Backup User Access Contact	Med Adv Compliance Program Adm		Burruss	Amanda		4259187772				4259184163	amanda.burruss@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Best Available Evidence Contact	Senior Manager, Medicare Operations	Ms.	Browne	Kris		4259184213					kris.browne@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Bid Audit Contact	Senior Actuary	Mr.	Wang	Chunnan		4259185156					chunnan.wang@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Bid Audit Site Contact	Senior Actuary	Mr	Wang	Chunnan		4259185156					chunnan.wang@premera.com	7001 220th Street S.W.		Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Bid Primary Contact	Senior Product Manager	Ms	Elasky	Rachele		2244897372					rachele.elasky@premera.com	7001 220th Street S.W.		Mountlake Terrace	WA	98043	05/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	CEO - CMS Administrator Contact	CEO	Mr.	Roe	Jeff		4259186239					jeffrey.roe@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	CEO - Senior Official for Contracting	President and CEO	Mr.	Roe	Jeff		4259186239					jeffrey.roe@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Chief Financial Officer	EVP, Chief Financial Officer	Mr.	Risse	Thomas		4259183926					thomas.risse@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Chief Operating Officer	EVP for Sales and Marketing	Mr.	Akers	Bill		5098682562					bill.akers@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Chief Information Officer	Chief Information Officer	Mr.	Katare	Brajesh		4259185055					brajesh.katare@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Chief Information Security Officer	VP, Chief Information Security Officer	Dr.	Mayers	Adrian		4259186416					Adrian.Mayers@PREMERA.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	CMMI Model Point of Contact	Sr Medicare Compliance Officer	Ms.	Connolly	Shawnna		4259183867				4259184163	shawnna.connolly@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	CMS Casework Communication Contact	Sr. Med Adv Compliance Program Adm	Ms.	Webster	Noni		4259188283				4259184163	Noni.Webster@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Complaints Tracking Contact	Sr. Med Adv Compliance Program Adm	Ms	Webster	Noni		4259188283				4259184163	Noni.Webster@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Contact for Fraud Investigations	Director, Special Investigations Unit	Ms.	Seifert	Christine		4259184073					Christine.Seifert@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Coordination of Benefits Contact	Enrollment and COB Manager	Ms.	LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	Advantasure,Inc.	1000 Town Center, 15th floor	Southfield	MI	48073	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Corporate Mailing						4259185400					jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Coverage Gap Discount Program (CGDP) Payment Contact	Actuary - FSA	Ms.	Harney	Suzie		4259186211					suzanne.harney@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Customer Service Operations Contact	Manager	Ms.	Woods	Remy		3132257369					rwoods2@bcbsm.com	Advantasure, Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	DIR Contact	Director Finance, Controller	Ms.	Bowen	Juli		4259185438					juli.bowen@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	DIR Contact (Secondary)	Senior Actuary	Mr.	Wang	Chunnan		4259185156					chunnan.wang@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Electronic Health Record Contact	Senior Manager, Medicare Operations	Ms.	Browne	Kris		4259184213					kris.browne@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Emergency Part D Contact	Director PBM Operations	Ms.	Barnhardt	Lisa		2483785273					lisa.barnhardt@advantasure.com	Advantasure, Inc.	7001	Glen Allen	VA	23060	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Emergency Part D Contact (Secondary)	Clinical Lead, PBM Operations	Mr.	Wiff	Roy		6144399079					roy.wiff@advantasure.com	Advantasure, Inc.	7001	Glen Allen	VA	23060	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Encounter Data & Risk Adjustment Operations Contact	Senior Manager Risk Adjustment Program Operations	Ms.	Landro	Karen		4259184858					karen.landro@premera.com	Premera Blue Cross	7001 220th St SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Enrollment Contact	Enrollment and Billing Manager	Ms.	Ware	Anita		5082514855					Anita.Ware@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	EOB Transfer Contact	Enrollment and Billing Manager	Ms.	Ware	Anita		5082514855				0000000000	Anita.Ware@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Financial Audit Contact	Director of Finance, Controller	Ms.	Bowen	Juli		4259185438					juli.bowen@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Financial Reporting Contact	Director Finance, Controller	Ms.	Bowen	Juli		4259184213					Juli.Bowen@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Formulary Contact	Clinical Pharmacist	Mr.	Wiff	Roy	W	7408336136					Roy.Wiff@advantasure.com	Advantasure,Inc.	118 Turnpike Rd	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Formulary Contact (Secondary)	Pharmacy Manager	Ms.	Polzin	Jennifer		4259186350					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	General Contact	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Government Relations Contact	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	HIPAA Privacy Officer	Privacy Senior Manager	Mr.	Brandt	Chris		4259185531					christopher.brandt@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	HIPAA Security Officer	Vice President, Chief Information Security Officer	Dr.	Mayers	Adrian		4259186416					Adrian.Mayers@PREMERA.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Hospice Contact	Pharmacy Manager, Clinical Programs	Ms.	Polzin	Jennifer		4253818236					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Interoperability Contact	Manager, Provider Programs	Ms.	Jain	Sakshi		4259183428					Sakshi.Jain@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	MA Appeals/Grievances Contact	Manager, Appeals and Grievances	Ms.	Price	Candace		8048963553					candace.price@advantasure.com	Advantasure,Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	MA Claims Processing Contact for Public Website	Claims Operations Manager	Ms.	Griffin	Suzanne		2486212356					Suzanne.Griffin@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Marketing Contact	Sr. MA Risk Adjustment Compliance Administrator	Ms	McLean	Lisa		4259792887				4259184163	lisa.mclean@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Medical Director	Medical Director, Government Programs	Dr.	Jacobson, MD MHA CPC	Steven		4259186471					steven.jacobson@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Medicare Coordinator	Senior Manager, Medicare Operations	Ms.	Browne	Kris		4259184213					kris.browne@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Medicare Part D Opioid Overutilization Contact	Pharmacy Manager	Ms.	Polzin	Jennifer		4259186350					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Medication Therapy Management Contact	Pharmacy Manager	Ms.	Polzin	Jennifer		4259186350					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Online Enrollment Center Contact (Back-up)	Senior Enrollment Specialist	Ms	Izzi	Jodi		2032145825					jodi.izzi@advantasure.com	Advantasure, Inc.	134 Turnpike Road	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Online Enrollment Center Contact (Primary)	Appeals and Grievances Manager	Ms.	LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	Advantasure, Inc.	134 Turnpike Road	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Part C Application Contact	VP & GM Senior Markets	Ms.	Bos	Tracy		4259184479					tracy.bos@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Part C Reporting Contact	Sr. Med Adv Compliance Program Adm	Ms	Webster	Noni		4259188283				4259184163	noni.webster@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Appeals	Clinical Pharmacist	Mr	Wiff	Roy	W						roy.wiff@advantasure.com	Advantasure, Inc.	118 Turnpike Rd	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active	7408336136				HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Appeals Contact (Secondary)	Director PBM Operations	Ms.	Barnhart	Lisa							lisa.barnhart@advantasure.com	Advantasure,Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active	7657202775				HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Application Contact	VP & GM Senior Markets	Ms.	Bos	Tracy		4259184479					tracy.bos@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Benefits Contact	Manager, Pharm Ops & PBM Oversight	Ms.	Phothirath	Pari		5592607700					pari.phothirath@advantasure.com	Advantasure, Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Claims Submission Contact	Director PBM Operations	Ms.	Phothirath	Pari		5592607700					pari.phothirath@advantasure.com	Advantasure,Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Exceptions Contact	Clnical Pharmacist	Mr.	Wiff	Roy							roy.wiff@advantasure.com	Advantasure,Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active	6144399079				HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Exceptions Contact (Secondary)	Pharmacy Manager	Ms	Polzin	Jennifer							jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active	4259186350				HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Price File Contact (Back-up)	Sr. Consultant	Mr.	Loveland	Chet		4806064865					Chet.Loveland@CVSHealth.com	CVS Health	8801 East Raintree Drive	Scottsdale	AZ	85260	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Price File Contact (Optional)	Senior ManagerManager, MedD Finance	Ms.	Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	CVS Health	9501 E. Shea Blvd., MC 121	Scottsdale	AZ	85260	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Price File Contact (Primary)	Manger, Pharm Ops & PBM Oversight	Ms.	Phothirath	Pari		5592607700					pair.phothirath@advantasure.com	Advantasure,Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Quality Assurance Contact	Clinical Pharmacist	Mr.	Wiff	Roy		7408336136					roy.wiff@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Part D Reporting Contact	Clinical Pharmacist	Mr.	Wiff	Roy		7408336136					roy.wiff@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Patient Safety Contact	Expert IT/BI Analyst	Mr.	Mandadi	Sharath		2486654322					sharath.mandadi@advantasure.com	Advantasure, Inc.	1000 Town Center, Suite 1500	Southfield	MI	48075	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Payment Contact	Director Finance, Controller	Ms.	Bowen	Juli		4259185438					juli.bowen@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Personal Health Record Contact	Senior Manager, Medicare Operations	Ms.	Browne	Kris		4259184213					kris.browne@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Pharmacy Director	Manager Pharmacy Consulting	Ms.	Polzin	Jennifer		4259186350					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Pharmacy Network Management Contact	Pharmacy Manager	Ms.	Polzin	Jennifer		4259186350					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist	Mr.	Wiff	Roy		8888508526					roy.wiff@advantasure.com	Advantasure, Inc.	118 Turnpike Rd	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Pharmacy Technical Help Desk Contact			Help Desk	Pharmacy								CVS Health	9501 E. Shea Blvd.	Scottsdale	AZ	85260	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Seattle
H7245	Pharmacy Technical Help Desk Contact (Secondary)	Clinical Pharmacist	Mr.	Wiff	Roy							roy.wiff@advantasure.com	Advantasure, Inc.	118 Turnpike Rd.	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Seattle
H7245	PHR Beneficiary Contact																	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS	Premera Blue Cross	Premera	537	Yes	Active	8888508526				HMO - Health Maintenance Organization		C	Seattle
H7245	Physician Incentive Contact	Strategic Initiatives Manager	Ms.	Evans	Camille		4259185462					camille.evans@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Plan Directory Contact for Public Website	Senior Manager, Medicare Operations	Ms.	Browne	Kris		4259184213					kris.browne@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Plan to Plan Reconciliation Contact	Senior Actuary	Mr.	Wang	Chunnan		4259185156					chunnan.wang@premera.com	Premera Blue Cross Attn: P2P	P.O. Box 91060	Seattle	WA	98111	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Processor Contact	Claims Operations Mgr - MA Claims Only	Ms.	Griffin	Suzanne		2486212356					Suzanne.Griffin@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Quality Contact	Director, Medicare Advantage Star Ratings	Ms.	Delostrinos	Wilhelmina		4259187782					wilhelmina.delostrinos@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Reconciliation Contact	Director Finance, Controller	Ms.	Bowen	Juli		4259185438					juli.bowen@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Reconciliation Contact (Secondary)	Senior Actuary	Mr.	Wang	Chunnan		4259185156					chunnan.wang@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Surveillance Contact	Sr. MA Compliance Program Adm	Ms	Connolly	Shawnna		4259183867					Shawnna.Connolly@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	System Contact	Med Adv Compliance Program Adm	Ms.	Burruss	Amanda		4259187772					amanda.burruss@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Third Party Administrator (TPA) Liaison	Actuary - FSA		Harney	Suzie		4259186211					suzanne.harney@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	User Access Contact	Med Adv Compliance Program Adm	Ms.	Burruss	Amanda		4259187772				4259184163	amanda.burruss@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Utilization Management Contact	Medical Director, Government Programs	Dr.	Jacobson, MD MHA CPC	Steven		4259186471					steven.jacobson@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7245	Utilization Review Contact	Medical Director, Government Programs	Dr.	Jacobson, MD MHA CPC	Steven		4259186471					steven.jacobson@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	04/24/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H7262	Automated TrOOP Balance Transfer Contact	PACE Community Relations Director	Ms.	Morelli	Selina		3036045356					SelinaMorelli@trucare.org	2593 Park Lane		Lafayette	CO	80026	07/26/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Backup User Access Contact	PACE Executive Director	Ms.	BLACK	SAMANTHA		3036045233					samanthablack@trucare.org	2594 Trailridge Dr East		Lafayette	CO	80026	07/26/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Best Available Evidence Contact	PACE Executive Director	Ms.	Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	06/18/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Bid Primary Contact	CEO TRU Community Care		Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	07/26/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	CAP Report Contact for Public Website	PACE Community Relations Director	Ms	Morelli	Selina		3036045356					SelinaMorelli@trucare.org	2593 Park Lane		Lafayette	CO	80026	07/26/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	CEO - CMS Administrator Contact	PACE Executive Director	Ms.	Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	06/18/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	CEO - Senior Official for Contracting	CEO TRU Community Care	Mr	Gresser	Scott		3036045241					scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Chief Financial Officer	Chief Financial Officer	Mr.	Gresser	Scott		3036045241				3036045392	ScottGresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	03/22/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Chief Operating Officer	Chief Operating Officer	Ms.	Black	Samantha		3036045233					SamanthaBlack@trucare.org	2593 Park Lane		Lafayette	CO	80026	09/03/2020	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Chief Information Officer	Interim Director of Technology and Facilities	Ms.	Sliger	Sally		3034497740					SallySliger@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	09/13/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Chief Information Security Officer	Interim Director of Technology and Facilities	Ms.	Sliger	Sally		3034497740					SallySliger@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	09/13/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	CMS Casework Communication Contact	PACE Executive Director		Black	Samantha		3036650115	223				SamanthaBlack@trucare.org	2593 Park Lane		Lafayette	CO	80026	08/17/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Complaints Tracking Contact	PACE Quality/Compliance Manager		Salinas	Laura		3033059387					LauraSalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Contact for Fraud Investigations	PACE Quality/Compliance Manager		Salinas	Laura		3033059387					LauraSalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Coordination of Benefits Contact	PACE Community Relations Manager	Ms.	Morelli	Selina		3036045356				3034153451	SelinaMorelli@trucare.org	2593 Park Lane		Lafayette	CO	80026	09/03/2020	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Corporate Mailing						3036045241					ScottGresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	07/26/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Coverage Gap Discount Program (CGDP) Payment Contact	CEO TRU Community Care		Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	07/26/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Customer Service Operations Contact	PACE Executive Director		Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	01/29/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	DIR Contact	VP/Chief Financial Officer		Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	02/14/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Emergency Part D Contact	VP/Chief Financial Officer	Mr.	Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	11/27/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Emergency Part D Contact (Secondary)	PACE Quality/Compliance Manager		Salinas	Laura		3033059387					laurasalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Encounter Data & Risk Adjustment Operations Contact	Executive Director		Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	04/27/2020	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Enrollment Contact	PACE Community Relations Director	Ms.	Morelli	Selina		3036045356					SelinaMorelli@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/22/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	EOB Transfer Contact	VP/Chief Financial Officer		Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	02/14/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Financial Audit Contact	PACE Executive Director	Ms.	Black	Samantha		3036650115	223			3034153451	SamanthaBlack@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	08/18/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Financial Reporting Contact	VP/Chief Financial Officer		Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	02/14/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Formulary Contact	CMO	Dr.	Wensel	David		3039264733					DavidWensel@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/12/2021	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	General Contact	PACE Executive Director	Ms.	Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	06/18/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Government Relations Contact	PACE Executive Director		Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	01/29/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	HIPAA Privacy Officer	PACE Quality/Compliance Manager		Salinas	Laura		3033059387					laurasalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	HIPAA Security Officer	PACE Quality/Compliance Manager		Salinas	Laura		3033059387					laurasalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Interoperability Contact	Director of Quality and Compliance		Salinas	Laura		3033059387					laurasalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	MA Appeals/Grievances Contact	PACE Quality/Compliance Manager		Salinas	Laura		3033059387					laurasalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	MA Claims Processing Contact for Public Website	PACE Community Relations Manager	Ms	Morelli	Selina		3036045356					SelinaMorelli@trucare.org	2593 Park Lane		Lafayette	CO	80026	09/03/2020	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Marketing Contact	PACE Community Relations Manager	Ms.	Morelli	Selina		3036045356					SelinaMorelli@trucare.org	2593 Park Lane		Lafayette	CO	80026	09/03/2020	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Medical Director	PACE Medical Director	Dr.	Grushan	Marc		3034153471					MarcGrushan@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/12/2021	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Medicare Compliance Officer	QA/Compliance Manager	Ms.	Salinas	Laura		3039264757					laurasalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	08/31/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Medicare Coordinator	VP/Chief Financial Officer	Mr.	Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	11/27/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Medicare Part D Opioid Overutilization Contact	PACE Q/A Director		Salinas	Laura		3033059387					laurasalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Medication Therapy Management Contact	PACE Medical Director	Dr.	Grushan	Marc		3036650115					MarcGrushan@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/22/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Part C Application Contact	PACE Executive Director		Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	01/29/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Part D Appeals	VP/Chief Financial Officer		Gresser	Scott						3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	06/18/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active	8443507223				PACE - Nat		C	Denver
H7262	Part D Appeals Contact (Secondary)	PACE Executive Director	Ms.	Black	Samantha	L					3034153451	SamanthaBlack@trucare.org	2593 Park Lane		Lafayette	CO	80026	01/12/2021	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active	8443507223				PACE - Nat		C	Denver
H7262	Part D Application Contact	PACE Executive Director		Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	01/29/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Part D Benefits Contact	VP/Chief Financial Officer		Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	11/27/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Part D Claims Submission Contact	VP/Chief Financial Officer		Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	11/27/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Part D Exceptions Contact	VP/Chief Financial Officer		Gresser	Scott							scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	11/27/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active	3036045241				PACE - Nat		C	Denver
H7262	Part D Price File Contact (Back-up)	PACE Executive Director		Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	01/29/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Part D Price File Contact (Primary)	VP/Chief Financial Officer	Mr.	Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	02/14/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Part D Quality Assurance Contact	PACE Executive Director	Ms.	Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	11/13/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Part D Reporting Contact	PACE Executive Director	Ms.	Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	11/13/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Patient Safety Contact	PACE Quality/Compliance Manager		Salinas	Laura		3033059387					laurasalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Payment Contact	VP/Chief Financial Officer	Mr.	Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	02/14/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Personal Health Record Contact	PACE Quality/Compliance Manager		Salinas	Laura		3033059387					laurasalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Pharmacy Director	CMO	Dr.	Wensel	David		3039264733					DavidWensel@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/12/2021	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Pharmacy Network Management Contact	CMO	Dr.	Wensel	David		3039264733					DavidWensel@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/12/2021	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Pharmacy Technical Help Desk Contact	PACE Medical Director	Dr.	Grushan	Marc							MarcGrushan@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/12/2021	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active	3034153471				PACE - Nat		C	Denver
H7262	PHR Beneficiary Contact																	06/18/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE	TRU Community Care	TRU Community Care	655	Yes	Active	3036650115				PACE - Nat		C	Denver
H7262	Plan Directory Contact for Public Website	PACE Community Relations Manager	Ms.	Morelli	Selina		3036045356					SelinaMorelli@trucare.org	2593 Park Lane		Lafayette	CO	80026	09/03/2020	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Plan to Plan Reconciliation Contact	VP/Chief Financial Officer		Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	02/14/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Processor Contact	PACE Executive Director		Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	01/29/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Quality Contact	PACE Quality/Compliance Manager		Salinas	Laura		3033059387					laurasalinas@trucare.org	2593 Park Lane		Lafayette	CO	80026	03/01/2023	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Reconciliation Contact	VP/Chief Financial Officer		Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	02/14/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Recovery Audit Contact	PACE Executive Director	Ms.	Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	11/13/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Surveillance Contact	PACE Executive Director		Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	01/29/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	System Contact	PACE Executive Director		Black	Samantha		3036045233					samanthablack@trucare.org	2593 Park Lane		Lafayette	CO	80026	01/29/2018	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Third Party Administrator (TPA) Liaison	VP/Chief Financial Officer		Gresser	Scott		3036045241				3036045392	scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	02/14/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	User Access Contact	Chief Financial Officer		Gresser	Scott		3036045241					scottgresser@trucare.org	2594 Trailridge Drive East		Lafayette	CO	80026	01/19/2017	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Utilization Management Contact	PACE Executive Director		Black	Samantha		3036650115	223				SamanthaBlack@trucare.org	2593 Park Lane		Lafayette	CO	80026	08/17/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7262	Utilization Review Contact	PACE Executive Director		Black	Samantha		3036650115	223				SamanthaBlack@trucare.org	2593 Park Lane		Lafayette	CO	80026	08/17/2022	2023	TRU COMMUNITY CARE	National PACE	TRU PACE	National PACE		TRU Community Care	655	Yes	Active					PACE - Nat		C	Denver
H7273	Agent/Broker Compensation Data Contact	Medicare Sales Operations Director	Ms	Perry	Danielle		6024004768					Danielle.Perry@bannerhealth.com	2901 N Central Ave	Ste. 160	Phoenix	AZ	85012	03/29/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Automated TrOOP Balance Transfer Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N. Central Ave Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Backup User Access Contact	Compliance Senior Director	Ms	Corlette	Kristina		6027472431					BMAComplianceOfficer@BannerHealth.com	2901 N Central Ave., Ste 160		Phoenix	AZ	85012	12/05/2022	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Best Available Evidence Contact	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Bid Audit Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Bid Audit Site Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Bid Primary Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	CAP Report Contact for Public Website	Chief Operations Officer	Mrs	Spiekermeier	Sarah		5208745520				5208747083	Sarah.Spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Stringham	James		6025684179				5208747083	James.Stringham2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Stringham	James		6025684179				5208747083	James.Stringham2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Chief Financial Officer	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Chief Operating Officer	Chief Operations Officer	Mrs	Spiekermeier	Sarah		5208745520				5208747083	Sarah.Spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Chief Information Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Chief Information Security Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	CMS Casework Communication Contact	Director, Grievance and Appeals	Mr	Maccioli	James		5208743247				5208747083	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Complaints Tracking Contact	Director, Grievance and Appeals	Mr	Maccioli	James		5208743247				5208747083	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Contact for Fraud Investigations	Director of Compliance	Ms	Dorazio	Terri		5208742847				5208747072	Theresa.Dorazio@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Coordination of Benefits Contact	Director Reimbursement Services		Groves	Lori		6024692249					Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Corporate Mailing						5208745550				5208747083	silvia.parra@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant		Cosentino	Rebekah		5208502776					Rebekah.Cosentino@bannerhealth.com	2901 N Central Ave. Ste 160		Phoenix	AZ	85012	01/12/2022	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Customer Service Operations Contact	Customer Care Director	Mrs	Carrillo	Veronica		5208745349				5208747083	Veronica.Carrillo@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	DIR Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	DIR Contact (Secondary)	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave. Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Electronic Health Record Contact	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Emergency Part D Contact	Pharmacy On Call Cell Phone		On Call	Pharmacy		5202601860				5208747083	BUHPgovernmentprograms@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Emergency Part D Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Encounter Data & Risk Adjustment Operations Contact	Sr. Director Payment Integrity & Reimbursement	Mr.	Horton	Tanner		4806845016					Tanner.Horton2@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	03/09/2022	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Enrollment Contact	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	EOB Transfer Contact	Director Reimbursement Services		Groves	Lori		6024692254				5208747083	Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Financial Audit Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Financial Reporting Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Formulary Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Formulary Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	General Contact	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	03/22/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Government Relations Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	HIPAA Privacy Officer	Director of Compliance	Ms	Dorazio	Terri		5208742847				5208747072	Theresa.Dorazio@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	HIPAA Security Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/01/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Hospice Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Interoperability Contact	Interoperability Healthcare Leader	Mr	Mathew	Rakesh		6027277420					Rakesh.Mathew@bannerhealth.com	2901 N Central Ave. Ste 160		Phoenix	AZ	85012	12/20/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	MA Appeals/Grievances Contact	Director, Grievance and Appeals	Mr	Maccioli	James		5208743247				5208747083	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	MA Claims Processing Contact for Public Website	Director Reimbursement Services		Groves	Lori		6024692249					Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Marketing Contact	Marketing Manager	Ms	Medina	AnaMaria		5208745082				5208747083	AnaMaria.Medina@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Medical Director	Chief Medical Officer	Dr	Stein	Sandra		5209040346					Sandra.Stein@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	09/05/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Medicare Compliance Officer	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	03/22/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Medicare Coordinator	Senior Manager Government Programs	Ms	Flores	Vanessa		5208745781				5208747083	buhpgovernmentprograms@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Medicare Part D Opioid Overutilization Contact	Express Scripts Director Clinical & Trend Solution		Muralidharan	Adrienne		3143131932					amuralidharan@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	12/21/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Medication Therapy Management Contact	Director (Clinical & Trend Solutions)		Muralidharan	Adrienne		3143131932				8587906052	amuralidharan@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	12/21/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	OffShore Subcontractor Contact	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	03/22/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Online Enrollment Center Contact (Back-up)	Medicare Sales Operations Director	Ms	Perry	Danielle		6024004768					Danielle.Perry@bannerhealth.com	2901 N Central Ave	Ste. 160	Phoenix	AZ	85012	01/26/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Online Enrollment Center Contact (Optional)	Enrollment Supervisor	Ms	Espinoza	Brianna		5208744192				5205855252	Brianna.Espinoza@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Online Enrollment Center Contact (Primary)	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Part C Application Contact	Chief Operations Officer	Mrs	Spiekermeier	Sarah		6237554652					sarah.spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Part C Reporting Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Part D Appeals	Director, Grievance and Appeals	Mr	Maccioli	James						8664658340	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active	8778743930				PPO - BBA		C	San Francisco
H7273	Part D Appeals Contact (Secondary)	Associate Director, Grievance & Appeals	Mrs	Garcia	Renee						5208743462	Renee.Garcia2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active	8778743930				PPO - BBA		C	San Francisco
H7273	Part D Application Contact	Chief Operations Officer	Mrs	Spiekermeier	Sarah		6237554652					sarah.spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Part D Benefits Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Part D Claims Submission Contact	Director Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	Express Scripts	One Express Way	St Louis	MO	63121	01/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Part D Exceptions Contact	Express Scripts Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	Express Scripts	5151 Blazer Pkwy	Dublin	OH	43017	12/21/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active	8003443405	733326			PPO - BBA		C	San Francisco
H7273	Part D Exceptions Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael							Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active	8888075695				PPO - BBA		C	San Francisco
H7273	Part D Price File Contact (Back-up)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Part D Price File Contact (Optional)	Express Scripts Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	Express Scripts	4865 Dixie Hwy	Fairfield	OH	45014	02/01/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Part D Price File Contact (Primary)	Express Scripts Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	Express Scripts	5151 Blazer Pkwy	Dublin	OH	43017	02/01/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Part D Quality Assurance Contact	Sr. Director Quality Management	Mrs	Robles Caraveo	Sandra		6233266425					sandra.roblescaraveo@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	02/16/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Part D Reporting Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Patient Safety Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Payment Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Personal Health Record Contact	Sr. Director Quality Management	Mrs	Robles Caraveo	Sandra		6233266425					sandra.roblescaraveo@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	02/16/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Pharmacy Director	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Pharmacy Network Management Contact	Express Scripts Network Accountant Director		Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	01/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Pharmacy Network Management Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 360		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Pharmacy Technical Help Desk Contact	Express Scripts (Director, Customer Services)		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	Express Scripts	13051 N Telecom PKWY STE 150	Temple Terrace	FL	33637	08/02/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active	8009036215				PPO - BBA		C	San Francisco
H7273	Pharmacy Technical Help Desk Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael							Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active	8888075695				PPO - BBA		C	San Francisco
H7273	PHR Beneficiary Contact																	06/14/2022	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO	Express Scripts	Banner Health	389	Yes	Active	3143131932				PPO - BBA		C	San Francisco
H7273	Physician Incentive Contact	Payer Account Program Sr. Manager	Ms	Ruiz	Marcela		5208745215				5208747083	Marcela.Ruiz@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Plan Directory Contact for Public Website	BMA Customer Care		Care	Customer		5208743930				5208743434	memberservicesinquiries@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Plan to Plan Reconciliation Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Processor Contact	Director Reimbursement Services		Groves	Lori		6024692249					Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	11/30/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Quality Contact	Sr. Director Quality Management	Mrs	Robles Caraveo	Sandra		6233266425					sandra.roblescaraveo@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	02/16/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Reconciliation Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Reconciliation Contact (Secondary)	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave. Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Recovery Audit Contact	Finance CRU Director	Mr	Schreiber	Thomas		5208745240				5208747083	thomas.schreiber@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	SNP Application Contact	Chief Operations Officer	Mrs	Spiekermeier	Sarah		6237554652					sarah.spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	SNP State Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Surveillance Contact	Marketing Associate Director	Ms.	Medina	AnaMaria		5208745082					AnaMaria.Medina@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	System Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Third Party Administrator (TPA) Liaison	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	User Access Contact	Chief Operations Officer	Mrs	Spiekermeier	Sarah		6237554652					sarah.spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Utilization Management Contact	RN Director Utilization Management	Ms	Messing	Carla		6026171632					carla.messing@bannerhealth.com	525 W Brown Rd		Mesa	AZ	85201	09/14/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7273	Utilization Review Contact	Medical Management Associate Director	Ms	Wilson	Traci	R	4802702342					Traci.Wilson@bannerhealth.com	525 W Brown Rd		Mesa	AZ	85201	09/14/2021	2023	BANNER HEALTH INSURANCE GROUP	Local CCP	Banner Medicare Advantage	Local PPO		Banner Health	389	Yes	Active					PPO - BBA		C	San Francisco
H7284	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H7284	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025807929				PPO - BBA		C	Kansas City
H7284	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H7284	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5024682494				PPO - BBA		C	Kansas City
H7284	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	8008658715				PPO - BBA		C	Kansas City
H7284	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025800475				PPO - BBA		C	Kansas City
H7284	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7284	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC.	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7301	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/01/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8887369118				8885547668	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	12/03/2018	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8042966237				PPO - BBA		C	Philadelphia
H7301	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	7132085765				PPO - BBA		C	Philadelphia
H7301	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/05/2017	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6026183945				PPO - BBA		C	Philadelphia
H7301	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6122633491				PPO - BBA		C	Philadelphia
H7301	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8002386279				PPO - BBA		C	Philadelphia
H7301	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Plan Directory Contact for Public Website			Customer Service	Aetna		8667844916					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	11/26/2014	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7301	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	COVENTRY HEALTH CARE OF ILLINOIS, INC.	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H7323	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	DIR Contact	VP, Data Analytics & Reporting		Xiong	Yan		8132065163				8134648450	Yan.Xiong@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/15/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/15/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/15/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	11/10/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H7323	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H7323	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/15/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H7323	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H7323	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H7323	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/15/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H7323	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H7323	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/15/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/27/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7323	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE NATIONAL HEALTH INSURANCE COMPANY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H7326	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H7326	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H7326	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H7326	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H7326	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H7326	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8668928340				PPO - BBA		C	Dallas
H7326	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/08/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7326	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE OF SOUTH CAROLINA, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7330	Agent/Broker Compensation Data Contact	Chief Growth Officer	Mr.	Miller	Benjamin		3124297117	111				ben.miller@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Automated TrOOP Balance Transfer Contact			Montgomery	Nakisha		5124579422					nmontgomery@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	02/13/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Backup User Access Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Best Available Evidence Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Bid Audit Contact	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Bid Primary Contact	V.P. Product Development	Ms.	Pamanian	Lily		3127763356	325				lily.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	CAP Report Contact for Public Website	Chief Information Officer	Mr.	Shah	Vrajesh		3122057948	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	CEO - CMS Administrator Contact	CEO	Mr.	Clifton	Andrew		3128588400					andrew.clifton@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	12/15/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	CEO - Senior Official for Contracting	CEO	Mr.	Clifton	Andrew		3128588400					andrew.clifton@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	12/15/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Chief Financial Officer	CFO	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Chief Operating Officer	COO	Mr.	Collins	GARFIELD		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Chief Information Officer	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Chief Information Security Officer	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	CMS Casework Communication Contact	Director, Compliance Audit and Monitoring		Gordon	Reneatha		3128097947					reneatha.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	05/22/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Complaints Tracking Contact	Director, Compliance Audit and Monitoring	Ms.	Gordon	Reneatha		3128097947					compliance@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Contact for Fraud Investigations	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Coordination of Benefits Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Corporate Mailing						6126077433					reneatha.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Customer Service Operations Contact	COO	Mr.	Collins	Garfield		3123195468	101				garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	DIR Contact	CMO	Dr.	Fessenden	Michael		3123003495	196				michael.fessenden@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	DIR Contact (Secondary)	Pharmacy Project Manager	Mr.	Santaya	Carlos		3124770778					carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450	Suite 450	Chicago	IL	60606	05/19/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Emergency Part D Contact	Chief Medical Officer	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Emergency Part D Contact (Secondary)	Pharmacy Project Manager	Mr.	Santaya	Carlos		3124770778					carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	02/15/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Employer Waiver Contact	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Encounter Data & Risk Adjustment Operations Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Enrollment Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	EOB Transfer Contact	CFO	Mr.	Sahin	Mete		7032825955				3122398304	mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Financial Audit Contact	CFO	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Financial Reporting Contact	CFO	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Formulary Contact	Formulary Operations Clinical Pharmacist, Elixir		Shick	Ryan		2342123614					rshick@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Formulary Contact (Secondary)	CMO	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	General Contact	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Government Relations Contact	Communication	Mr.	Martin	Stephen		3122057948	138				stephen.martin@myzing.com	225 West Washington Street	Suite 450	Chicago	IL	60606	02/15/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	HIPAA Privacy Officer	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	HIPAA Security Officer	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Hospice Contact	V.P. Clinical Operations		Wohkittel	Karen		3128585770					karen.wohkittel@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	05/22/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Interoperability Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	02/15/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	MA Appeals/Grievances Contact	V.P. Health Plan Operations	Mr.	Smith	Mark		3125858846	165				mark.smith@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	MA Claims Processing Contact for Public Website	COO	Mr.	Collins	Garfield		3122057948					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	02/15/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Marketing Contact	Chief Growth Officer	Ms.	Miller	Benjamin		3124297117					ben.miller@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Medical Director	Interim CMO	Dr	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	05/31/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Medicare Compliance Officer	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Medicare Coordinator	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Medicare Part D Opioid Overutilization Contact	Pharmacy Project Manager	Mr.	Santaya	Carlos		3124770778					carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450	Suite 450	Chicago	IL	60606	05/19/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Medication Therapy Management Contact	Pharmacy Project Manager	Mr.	Santaya	Carlos		3124770778					carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	05/19/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	OffShore Subcontractor Contact	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Part C Application Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Part C Reporting Contact	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Part D Appeals	Pharmacy Project Manager	Mr.	Santaya	Carlos							carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	02/15/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	3124770778				HMO - Health Maintenance Organization		C	Chicago
H7330	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations		Binegar	Sam						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Chicago
H7330	Part D Application Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Part D Benefits Contact	CMO	Dr.	Fessenden	Michael		3123003495	186			3127762135	michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Part D Claims Submission Contact	CMO	Dr.	Fessenden	Michael		3123003495				3127575109	michael.fessenden@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Part D Exceptions Contact	Pharmacy Project Manager	Mr.	Santaya	Carlos							carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	02/15/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	3124770778				HMO - Health Maintenance Organization		C	Chicago
H7330	Part D Exceptions Contact (Secondary)	Appeals Supervisor, Clinical Operations		Binegar	Sam						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	3303449571				HMO - Health Maintenance Organization		C	Chicago
H7330	Part D Price File Contact (Back-up)	CMO	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Part D Price File Contact (Primary)	Sr Financial Manager Reporting & Analytics		Campbell	Tim		3308886988					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Part D Quality Assurance Contact	CMO	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Part D Reporting Contact	CMO	Dr.	Fessenden	Michael		3123003495	186			3127762135	michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Patient Safety Contact	CMO	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 W. Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Payment Contact	CFO	Mr.	Sahin	Mete		7032825955					mete.sahin@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Pharmacy Director	CMO	Dr.	Fessenden	Michael		3123003495					michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Pharmacy Network Management Contact	Director Pharmacy Network Development and Operatio		Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Pharmacy Network Management Contact (Secondary)	Pharmacy Project Manager	Mr.	Santaya	Carlos		3124770778					carlos.santaya@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Pharmacy Technical Help Desk Contact	V.P. Operations		Conn	Todd							tconn@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/01/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	8554766993				HMO - Health Maintenance Organization		C	Chicago
H7330	Pharmacy Technical Help Desk Contact (Secondary)	CMO	Dr.	Fessenden	Michael							michael.fessenden@myzinghealth.com	225 West Washington Street, Suite 450		Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active	3123003495				HMO - Health Maintenance Organization		C	Chicago
H7330	Plan Directory Contact for Public Website	COO	Mr.	Collins	Garfield		8669464458					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	02/15/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Plan to Plan Reconciliation Contact	Comptroller	Ms.	Jackson	Amy		3128833465					accountspayable@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	05/31/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Processor Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Quality Contact	Sr. V.P.  Stars & Quality	Mr.	Weaver	Daniel		3126615667					daniel.weaver@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	09/25/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Reconciliation Contact	COO	Mr.	Collins	Garfield		3123195468					garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Reconciliation Contact (Secondary)	Manager, Medicare Operations	Ms.	Wright	Wanda		3122057948	126				wanda.wright@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Recovery Audit Contact	Director, Compliance Audit and Monitoring	Ms.	Gordon	Reneatha		3128097947					reneatha.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	SNP Application Contact	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	SNP State Contact	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Surveillance Contact	Chief Compliance Officer	Mr.	Matuszak	Russell		3128326676	292				russell.matuszak@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	System Contact	Chief Information Officer	Mr.	Shah	Vrajesh		3127763435	140				vrajesh.shah@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Third Party Administrator (TPA) Liaison	COO	Mr.	Collins	Garfield		3123195468				3122398304	garfield.collins@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	07/17/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	User Access Contact	Director of Compliance Audit and Monitoring	Ms.	Gordon	Reneatha		3122057948	121				reneatha.gordon@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	08/23/2022	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Utilization Management Contact	V.P. Clinical Operations		Wohkittel	Karen		3128585770					karen.wohkittel@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	05/22/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7330	Utilization Review Contact	V.P. Clinical Operations		Wohkittel	Karen		3128585770					karen.wohkittel@myzinghealth.com	225 West Washington Street	Suite 450	Chicago	IL	60606	05/22/2023	2023	ZING HEALTH, INC.	Local CCP	Zing Health	HMO/HMOPOS		Zing Health Consolidator, Inc	730	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7360	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H7360	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	02/02/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	02/02/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/02/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Medical Director	Chief Medical Officer	Dr.	Chen	Alex		8186766564					alex.y.chen@healthnet.com	21281 Burbank Blvd		Woodland Hills	CA	91367	03/30/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H7360	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H7360	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Part D Benefits Contact	Supervisor, Clinical Audit (Pharmacy)	Mr.	Mantella	Jason		4084574913					giacinto.mantella@centene.com	1850 W. Rio Salado Pkwy. Suite 211		Tempe	AZ	85281	04/02/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H7360	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H7360	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	02/02/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H7360	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H7360	PHR Beneficiary Contact																	09/27/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8002754737				PPO - BBA		C	Dallas
H7360	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Plan Directory Contact for Public Website			Services	Provider		8002754737					CorporateMedicareComplianceDept@CENTENE.COM	PO Box 10198		Van Nuys	CA	91410	03/31/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7360	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	HEALTH NET OF CALIFORNIA, INC.	Local CCP	Wellcare by Health Net	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7366	Automated TrOOP Balance Transfer Contact	Director of Finance		Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Backup User Access Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Best Available Evidence Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Bid Primary Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	CAP Report Contact for Public Website	Executive Director		Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	07/25/2022	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	CEO - CMS Administrator Contact	Chief Executive Officer	Dr.	Harris	Julian		9179230744					Julian.Harris@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	01/25/2023	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	CEO - Senior Official for Contracting		Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		los Angles	CA	90018	07/25/2022	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Chief Financial Officer	Chief Financial Officer	Mr	Ganesan	Dinesh		8604915789					Dinesh.Ganesan@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	01/25/2023	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Chief Operating Officer	Chief Operating Officer	Ms	Kerns	Kristen		9122705723					Kristen.Kerns@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	01/25/2023	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Chief Information Officer	Chief Information Officer	Mr.	Alam	Shahid		7243168323					Shahid.Alam@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/01/2023	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Chief Information Security Officer	Chief Information Officer	Mr	Alam	Shahid		7243168323					Shahid.Alam@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/01/2023	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	CMS Casework Communication Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Complaints Tracking Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Contact for Fraud Investigations	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Coordination of Benefits Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Corporate Mailing						2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	07/25/2022	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Customer Service Operations Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	DIR Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Emergency Part D Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Encounter Data & Risk Adjustment Operations Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Enrollment Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	EOB Transfer Contact	Director of Finance	Mr	Cordeau	Bryan		2026039602				9495356405	bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Financial Audit Contact	Director of Finance	Mr	Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Financial Reporting Contact	Director of Finance		Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Formulary Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	General Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Government Relations Contact		Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		los Angles	CA	90018	07/25/2022	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Bryant	Jennifer		9496899526					jennifer.bryant@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/01/2023	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	HIPAA Security Officer	Chief Privacy Officer	Ms.	Bryant	Jennifer		9496899526					jennifer.bryant@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/01/2023	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Interoperability Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	01/28/2022	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	MA Appeals/Grievances Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	MA Claims Processing Contact for Public Website	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Marketing Contact	Executive Director	Mr.	Murphy	Grady		2133289666					Grady.Murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/01/2023	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Medical Director	Associate Chief Medical Officer	MD	Gyurmey	Tsewang		3235334477					Tsewang.Gyurmey@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	01/25/2023	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Medicare Compliance Officer	Senior Director, Compliance	Ms	Dey	Anna		7204423926					Anna.Dey@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	01/25/2023	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Medicare Coordinator	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Medicare Part D Opioid Overutilization Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	03/28/2022	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Medication Therapy Management Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Part C Application Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Part D Appeals	Director of Finance		Cordeau	Bryan							bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active	2026039602				PACE - Nat		C	San Francisco
H7366	Part D Application Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Part D Benefits Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Part D Claims Submission Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Part D Exceptions Contact	Director of Finance		Cordeau	Bryan							bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active	2026039602				PACE - Nat		C	San Francisco
H7366	Part D Price File Contact (Back-up)	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Part D Price File Contact (Primary)	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Part D Quality Assurance Contact	Director of Finance		Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Part D Reporting Contact	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Patient Safety Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Payment Contact	Director of Finance		Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Pharmacy Director	Executive Director		Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Pharmacy Network Management Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Pharmacy Technical Help Desk Contact	Director of Finance		Cordeau	Bryan							bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active	2026039602				PACE - Nat		C	San Francisco
H7366	Plan Directory Contact for Public Website	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Plan to Plan Reconciliation Contact	Director of Finance		Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Processor Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Quality Contact	Sr. Dir.  of Quality & Clinical Performance	Ms.	Quimby	Shyra		9592346419					shyra.quimby@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/22/2023	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Reconciliation Contact	Director of Finance	Mr	Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Recovery Audit Contact	Director of Finance	Mr	Cordeau	Bryan		2026039602					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Surveillance Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	System Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Third Party Administrator (TPA) Liaison	Director of Finance		Cordeau	Bryan		9495356405					bryan.cordeau@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	User Access Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Utilization Management Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7366	Utilization Review Contact	Executive Director	Mr	Murphy	Grady		2133289666					grady.murphy@concertocare.com	3670 Degnan Blvd		Los Angeles	CA	90018	06/02/2021	2023	CONCERTOHEALTH PACE OF LOS ANGELES, LLC	National PACE	ConcertoHealth PACE of Los Angeles	National PACE		Perfect Health, Inc.	779	Yes	Active					PACE - Nat		C	San Francisco
H7379	Agent/Broker Compensation Data Contact	Director, Medicare Sales	Mr.	Trahan	Donald		4109987538					donald.trahan@carefirst.com	10455 Mill Run Circle	Mailstop OWML1	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Automated TrOOP Balance Transfer Contact	Sr. Business Analyst	Ms.	Doumas	Alicia		4109984655					Alicia.Doumas@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	08/15/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Backup User Access Contact	Sr. Regulatory Medicare Compliance Analyst	Ms.	Incorvati	Laura		4106052405					Laura.Incorvati@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Best Available Evidence Contact	Director, Medicare Operations	Ms.	Challis	Juanita		4109987534					CFGroupMA@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Bid Audit Contact	Product Manager	Ms.	Franklin	Lisa		4109985647					Lisa.Franklin@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Bid Audit Site Contact	Product Manager	Ms.	Franklin	Lisa		4109985647					Lisa.Franklin@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Bid Primary Contact	Product Manager	Ms.	Franklin	Lisa		4109985647					Lisa.Franklin@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	CAP Report Contact for Public Website	Health Plan CEO	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	CEO - CMS Administrator Contact	President and Chief Executive Officer	Mr.	Pieninck	Brian	D	4109985320					brian.pieninck@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	CEO - Senior Official for Contracting	President and Chief Executive Officer	Mr.	Pieninck	Brian	D	4109985320					brian.pieninck@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Chief Financial Officer	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Chief Operating Officer	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Chief Information Officer	VP, IT Ops and Infrastructure	Ms.	Henderson	Dori		4109985656					Dori.Henderson@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Chief Information Security Officer	Chief Information Security Officer	Mr.	Suarez	Roberto		4109985716					Roberto.Suarez@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	CMMI Model Point of Contact	Health Plan CEO	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	CMS Casework Communication Contact	Director, Medical Review & Appeals	Ms.	Faulkner	Pamela		4105287105					Pamela.Faulkner@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Complaints Tracking Contact	Director, Medical Review & Appeals	Ms.	Faulkner	Pamela		4105287105					Pamela.Faulkner@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Contact for Fraud Investigations	Director, SIU	Ms.	Kennedy	Elizabeth		4105287067					elizabeth.kennedy@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Coordination of Benefits Contact	Director, Medicare Operations	Ms.	Challis	Juanita		4109987534					CFGroupMA@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Corporate Mailing						4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Financial Accountant	Ms.	Mitchell	Patrice		4109985273					patrice.mitchell@carefirst.com	10455 Mill Run Circle, MC 01-635		Owings Mills, MD 21117	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Customer Service Operations Contact	Manager, Operations	Ms.	Boer	Kelsey		4109985353					Kelsey.Boer@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	DIR Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	DIR Contact (Secondary)	Directory, Pharmacy Services	Mr.	Nardone	Mark		4109985675					Mark.Nardone@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/24/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Electronic Health Record Contact	Health Plan CEO	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Emergency Part D Contact	Director Pharmacy Government Programs	Mr.	Nardone	Mark		4109985675					Mark.Nardone@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Emergency Part D Contact (Secondary)	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					john.vellutato@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/24/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Employer Waiver Contact	Director of Operations	Ms.	Gonce	Angie		4109987561					angie.gonce@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Encounter Data & Risk Adjustment Operations Contact	VP, Quality & Risk Adjustment	Mr.	Ramalingam	Subbu		4106052605					Subbu.Ramalingam@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Enrollment Contact	Health Plan Chief Ops Officer	Ms.	Toland	Cheryl		4109985107					Cheryl.Toland@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	EOB Transfer Contact	Health Plan Chief Ops Officer	Ms.	Toland	Cheryl		4109985107				4109987534	Cheryl.Toland@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Financial Audit Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	10455 Run Mill Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Financial Reporting Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Formulary Contact	Director, Pharmacy Services	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Formulary Contact (Secondary)	Clinical Pharmacist	Ms.	Lee	Catherine		4105287033					Catherine.Lee@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	08/15/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	General Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Government Relations Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	HIPAA Privacy Officer	Dir, Privacy & Compliance	Ms.	Gregory	Lauren		4105285066					lauren.gregory@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	HIPAA Security Officer	Chief Information Security Officer	Mr.	Suarez	Roberto		4109985716					Roberto.Suarez@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Hospice Contact	Director, Utilization Management	Ms.	Westeburg	Sarah		4105287145					Sarah.Westburg@carefirst.com	10455 Mill Run Circle		Owing Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Interoperability Contact	VP, Enterprise Arch. & Integr.	Mr.	Heyl	Bob		2026806682					Bob.Heyl@carefirst.com	840 First Street, NE		Washington	DC	20065	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	MA Appeals/Grievances Contact	Director, Medical Review & Appeals	Ms.	Faulkner	Pamela		4105287105					Pamela.Faulkner@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	MA Claims Processing Contact for Public Website			Services	Member		8552905744					Cheryl.Toland@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Marketing Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Medical Director	Medical Director	Dr.	Park	Kevin		4105287136					Kevin.Park@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/24/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Medicare Coordinator	Sr. Regulatory Compliance Analyst	Ms.	Incorvati	Laura		4106052405					laura.incorvati@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/24/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Medication Therapy Management Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	10455 Run Mill Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Online Enrollment Center Contact (Back-up)	Health Plan Chief Ops Officer	Ms.	Toland	Cheryl		4109985107					Cheryl.Toland@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Online Enrollment Center Contact (Optional)	Manager Enrollment		Threat	Drew		4109984740					drew.threat@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	03/24/2021	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Online Enrollment Center Contact (Primary)	Director, Medicare Operations	Ms.	Challis	Juanita		4109987534					CFGroupMA@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Part C Application Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Part D Appeals	Manager, Clinical Operations	Ms.	Beyda	Trista						7326914838	_REReconsideration@cvscaremark.com	3424 William Penn Hwy,		Pittsburg	PA	15235	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active	8889700917				PPO - BBA		C	Philadelphia
H7379	Part D Appeals Contact (Secondary)	Medicare Appeals Analyst	Ms.	Gabor-Lyon	Pam						7326914838	Trista.Beyda@cvshealth.com	3424 William Penn Hwy		Pittsburgh	PA	15235	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active	8889700917				PPO - BBA		C	Philadelphia
H7379	Part D Application Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Part D Benefits Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Part D Claims Submission Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Part D Exceptions Contact	Sr. Dir., Pharm Eval & Oversight	Ms.	Poplawski	Mandi							Mandi.Poplawski@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active	4105285053				PPO - BBA		C	Philadelphia
H7379	Part D Exceptions Contact (Secondary)	Clinical Pharmacist	Mr.	Vellutato	John							john.vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active	4105722606				PPO - BBA		C	Philadelphia
H7379	Part D Price File Contact (Back-up)	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					john.vellutato@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Part D Price File Contact (Optional)		Mr.	Loveland	Chet		4806064823					Chet.Loveland@cvshealth.com	9501 E. Shea Blvd.  MC 121		Scottsdale	AZ	85260	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Part D Price File Contact (Primary)	Director Pharmacy Government Programs	Mr.	Nardone	Mark		4109985675					Mark.Nardone@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Part D Quality Assurance Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105732602					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Part D Reporting Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Patient Safety Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105732602					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Payment Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Personal Health Record Contact	VP Medicare		Billman	Julie		4109987534					julie.billman@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	03/24/2021	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Pharmacy Director	Sr. Dir., Pharm Eval & Oversight	Ms.	Poplawski	Mandi		4105285053					Mandi.Poplawski@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Pharmacy Network Management Contact	Director Pharmacy Government Programs	Mr.	Nardone	Mark		4109985675					Mark.Nardone@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Pharmacy Network Management Contact (Secondary)	Sr. Dir., Pharm Eval & Oversight	Ms.	Poplawski	Mandi		4105285303					Mandi.Poplawski@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Pharmacy Technical Help Desk Contact	Director Pharmacy Government Programs	Mr.	Nardone	Mark							Mark.Nardone@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	08/15/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active	8666934620				PPO - BBA		C	Philadelphia
H7379	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Dir. , Pharm Eval & Oversight	Ms.	Poplawski	Mandi							Mandi.Poplawski@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active	8666934620				PPO - BBA		C	Philadelphia
H7379	PHR Beneficiary Contact																	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO	CareFirst BlueCross Blue Shield Medicare Advantage	CareFirst, Inc.	45	Yes	Active	8552905744				PPO - BBA		C	Philadelphia
H7379	Physician Incentive Contact	Manager, Payment Transformation	Mr.	Coffey	Nathan		4104692167					Nathan.Coffey@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Plan Directory Contact for Public Website			Services	Member		8552905744					Cheryl.Toland@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Plan to Plan Reconciliation Contact	Financial Analyst	Ms.	Rohsner	Lian		4109985710					Lian.Rohsner@Carefirst.com	P.O. Box 787172		Philadelphia	PA	191787172	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Processor Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Quality Contact	VP,Govt. Prg Star & Risk Adj	Mr.	Ramalingam	Subbu		4106052605					Subbu.Ramalingam@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Reconciliation Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Reconciliation Contact (Secondary)	Director, Pharmacy Services	Mr.	Nardone	Mark		4109985675					Mark.Nardone@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	SNP Application Contact	VP Medicare		Billman	Julie		4109987534					julie.billman@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	03/24/2021	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	SNP State Contact	VP Medicare		Billman	Julie		4109987534					julie.billman@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	03/24/2021	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Surveillance Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	System Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Third Party Administrator (TPA) Liaison	Lead Business Analyst	Ms.	Ford	Michelle	R	4437387978					Michelle.Ford@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	User Access Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Utilization Management Contact	Director, Utilization Management	Ms.	Westeburg	Sarah		4105287145					Sarah.Westburg@carefirst.com	10455 Mill Run Circle		Owing Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7379	Utilization Review Contact	Director, Utilization Management	Ms.	Westeburg	Sarah		4105287145					Sarah.Westburg@carefirst.com	10455 Mill Run Circle		Owing Mills	MD	21117	07/22/2023	2023	CAREFIRST ADVANTAGE PPO, INC.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage	Local PPO		CareFirst, Inc.	45	Yes	Active					PPO - BBA		C	Philadelphia
H7389	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H7389	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H7389	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H7389	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H7389	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H7389	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H7389	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7389	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7399	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H7399	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	01/24/2019	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Medical Director	Chief Medical Director	Dr.	Lucas	Brad		8662464356					blucas@centene.com	3700 Embassy Parkway, Suite 200		Akron	OH	44333	03/30/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H7399	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H7399	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8332935966				HMO - Health Maintenance Organization		C	Dallas
H7399	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	03/31/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7399	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY ILLINOIS	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7404	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/04/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H7404	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H7404	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H7404	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H7404	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7404	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H7419	Agent/Broker Compensation Data Contact	Vice President, Public Plans Business Performance	Mr.	Margiotta	Mark		7816121000	83911				mark.margiotta@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Automated TrOOP Balance Transfer Contact	Senior Manager, Operations	Mr.	Mahoney	Thomas		7816121000	84897				thomas.mahoney@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Backup User Access Contact	Compliance Officer, Medicaid and Dual Products		Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Best Available Evidence Contact	Manager, Member Experience	Ms.	Stoesser	Dorothy		7816121000	82751				dorothy.stoesser@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Bid Audit Contact	Director, Business Implementation	Ms.	Kitayama	Julie		7816121000	83392				julie.kitayama@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Bid Audit Site Contact	Director, Business Implementation	Ms.	Kitayama	Julie		7816121000	83392				julie.kitayama@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Bid Primary Contact	Director, Business Implementation	Ms.	Kitayama	Julie		7816121000	83392				julie.kitayama@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	CAP Report Contact for Public Website	Director, Business Implementation	Ms.	Kitayama	Julie		7816121000	83392				julie.kitayama@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	09/11/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Chief Financial Officer	SVP Chief Financial Officer	Mr.	Walker	Scott		7816126840					r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	07/25/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Chief Operating Officer	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	06/12/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Chief Information Officer	SVP and Chief Information Officer	Ms.	Ferhatbegovic	Selma		7816121000	84633				Selma.Ferhatbegovic@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	07/28/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	CMS Casework Communication Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Complaints Tracking Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Contact for Fraud Investigations	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Coordination of Benefits Contact	Vice President, Claims	Mr.	Fernandez	David		6175844884					david.fernandez@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Corporate Mailing						7816121000					cain_hayes@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@tpoint32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Customer Service Operations Contact	Manager, Member Experience	Ms.	Stoesser	Dorothy		7816121000	82751				dorothy.stoesser@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	DIR Contact	Senior manager, Pharmacy Reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	03/08/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	DIR Contact (Secondary)	Pharmacy Analyst Senior		Santino	Cristina		7816121000	82560				cristina.santino@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Electronic Health Record Contact	Director, Core Administration System Application	Mr.	Pavao	Joseph		7816121000	83289				Joseph.Pavao@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Emergency Part D Contact	Director, Pharmacy Operations		Bonica	Joseph		7816123342					joseph.bonica@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Emergency Part D Contact (Secondary)	Manager, Pharmacy Compliance		Lake	Matthew		7816123976					matthew.lake@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Data Analyst Lead	Ms.	Quinlan	Judith		7816121000	83377				judith.quinlan@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Enrollment Contact	Senior Manager, Operations	Mr.	Mahoney	Thomas		7816121000	84897				thomas.mahoney@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	EOB Transfer Contact	Manager, Business Implementation		Nesmith	Tanisha		7816124861				6176730286	tanisha.nesmith@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Financial Audit Contact	Chief Financial Officer	Mr.	Kurpad	Umesh		7816121000	84968				Umesh.Kurpad@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Financial Reporting Contact	Chief Financial Officer	Mr.	Kurpad	Umesh		7816121000	84968				Umesh.Kurpad@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Formulary Contact	Clinical Pharmacist Senior	Mr.	Kowalski	Alec		7816121000	82045				alec.kowalski@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Formulary Contact (Secondary)	Clinical Pharmacist Senior		Shafir	Frances		7816122897					frances.shafir@point32health.org	1 Wellness Way		Canton	MA	02021	07/19/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	General Contact	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Government Relations Contact	Chief Government Affairs Officer	Ms.	Lewis	Kristin		7816121000	83621				kristin.lewis@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	HIPAA Privacy Officer	VP Privacy & Special Investigation	Mr.	Walsh	Chris		7816121000	82508				Christopher.walsh@point32health.org	1600 Crown Colony Drive		Quincy	MA	02169	01/18/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	HIPAA Security Officer	VP Chief  Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	07/28/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Hospice Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Interoperability Contact	Vice President & Chief Technology Officer		Querusio	David		7816122629					david.querusio@point32health.org	One Wellness Way		Canton	MA	02021	02/10/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	MA Claims Processing Contact for Public Website	Director, Claims	Ms.	Patel	Monal		7816121000	88187				monal.patel@point32health.org	1 Wellness Way		Canton	MA	02021	04/26/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Marketing Contact	Director, Community Relations & Marketing	Mr.	Bosaz	Rudy		7816121000	82319				rudy.bosaz@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Medical Director	Medical Director	Dr.	Dufresne	Duke		7816121000	82757				duke.dufresne@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Medicare Compliance Officer	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Medicare Coordinator	Vice President, Public Plans Business Performance	Mr.	Margiotta	Mark		7816121000	83911				mark.margiotta@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Dohan	David		7816121000	82615				David.Dohan@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Medication Therapy Management Contact	Sr Pharmacy Program Manager		Burns	Ashlyn		7816122239					ashlyn.burns@point32health.org	1 Wellness Way		Canton	MA	02021	07/19/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	MMP Reporting Requirements Contact	Director, Business Implementation	Ms.	Kitayama	Julie		7816121000	83392				julie.kitayama@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	MMP Point of Contact	Director, Business Implementation	Ms.	Kitayama	Julie		7816121000	83392				julie.kitayama@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	OffShore Subcontractor Contact	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Online Enrollment Center Contact (Primary)	Senior Manager, Operations	Mr.	Mahoney	Thomas		7816121000	84897				thomas.mahoney@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part C Application Contact	Director, Business Implementation	Ms.	Kitayama	Julie		7816121000	83392				julie.kitayama@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part C Reporting Contact	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part D Appeals	Director, Appeals & Grievances		Evans	Kathleen							Kathleen.Evans@point32health.org	1 Wellness Way		Canton	MA	02021	09/20/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	6179729400	87204			Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part D Appeals Contact (Secondary)	Program Manager Senior	Ms.	Mello	Sheri							sheri.mello@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	84862			Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part D Application Contact	Director, Business Implementation	Ms.	Kitayama	Julie		7816121000	83392				julie.kitayama@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part D Benefits Contact	Director, Business Implementation	Ms.	Kitayama	Julie		7816121000	83392				julie.kitayama@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part D Claims Submission Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Chan	Bryan							bryan.chan@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	82370			Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part D Price File Contact (Back-up)	Advisor, Medicare Operations		Vargas	Danille		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	60173	07/19/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part D Price File Contact (Optional)	Sr. Pharmacy Implementation Specialist		Sullivan	Tim		7816124922					tim.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	07/19/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part D Price File Contact (Primary)	Sr Business Analyst		Moore-Elliott	Shalandria		7637974305					shalandria.moore-elliott@optum.com	1600 McConnor Pwy.		Schaumburg	IL	60173	07/19/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part D Quality Assurance Contact	Vice President, Behavioral Health	Ms.	Borrelli	Jill		6179729400	85397				jill.borrelli@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Part D Reporting Contact	Director, Pharmacy Financial & Reporting	Mr.	Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Patient Safety Contact	Sr Pharmacy Implementation Specialist		von Fritzinger	Lisa		7816123778					lisa.vonfritzinger@point32health.org	1 Wellness Way		Canton	MA	02021	07/19/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Payment Contact	Chief Financial Officer	Mr.	Walker	Scott		7816121000	86840				R.Scott.Walker@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Pharmacy Director	Vice President, Pharmacy	Ms.	Sullivan	Miriam		7816121000	84116				miriam.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Pharmacy Network Management Contact	Manager, Retail Network Operations		Hagan	Kyle		3039895828					Kyle.hagan@optum.com	7120 W Iowa Ave		lakewood	CO	80232	12/08/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations		Ashby	JoLynn		7637326364					JAshby@castiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	12/08/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Pharmacy Technical Help Desk Contact	Sr. Manager		Villanueva	Juan							Juan.Villanueva@optum.com	3515 S Harbor Blvd.		Costa Mesa	CA	92626	07/19/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7148253761				Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Pharmacy Technical Help Desk Contact (Secondary)	Associate Director, Pharmacy Help Desk		Betten	Brad							bradley.betten@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	12/08/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	8555240380				Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Plan Directory Contact for Public Website	Vice President, Public Plans Product Strategy  Act	Ms.	Hague	Ashley		6176787905					ashley.hague@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Plan to Plan Reconciliation Contact	Manager, Finance Operations	Ms.	Olson	Rachel		7816121000	84360				rachel.olson@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Processor Contact	Director, Claims	Ms.	Patel	Monal		7816121000	88187				monal.patel@point32health.org	1 Wellness Way		Canton	MA	02021	04/26/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Quality Contact	Manager, Quality Measurement & Reporting	Ms.	Angelson-Welch	Danielle		7816121000	82587				danielle.angelson-welch@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Reconciliation Contact	Senior Manager, Pharmacy Reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	03/08/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Reconciliation Contact (Secondary)	Director, Pharmacy Financial & Reporting		Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	09/11/2023	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Recovery Audit Contact	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Surveillance Contact	Product Reporting Analyst Senior	Mr.	Houston	Nathan		7816121000	84174				nathan.houston@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	System Contact	Director, Core Administration System Application	Mr.	Pavao	Joseph		7816121000	83289				joseph.pavao@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Third Party Administrator (TPA) Liaison	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@tpoint32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	User Access Contact	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@tpoint32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Utilization Management Contact	Program Director	Ms.	Markert	Kerry		7816121000	85225				kerry.markert@point32health.org	1 Wellness Way		Canton	MA	02021	04/26/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7419	Utilization Review Contact	Medical Director	Dr.	Dufresne	Duke		7816121000	82757				duke.dufresne@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS HEALTH PUBLIC PLANS, INC.	Demo	Tufts Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H7445	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H7445	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H7445	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H7445	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H7445	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7445	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF WISCONSIN, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H7464	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	San Francisco
H7464	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	San Francisco
H7464	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H7464	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	San Francisco
H7464	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/27/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7464	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF THE MID-ATLANTIC, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7469	Automated TrOOP Balance Transfer Contact	Financial Medicare Part D Manager	Mrs	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Backup User Access Contact	Quality Manager	Mrs.	Sharpe	Bridget		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Best Available Evidence Contact	Quality Manager	Mrs.	SHARPE	BRIDGET		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Bid Primary Contact	Financial Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	CAP Report Contact for Public Website	Quality Manager	Mrs.	SHARPE	BRIDGET		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	CEO - CMS Administrator Contact	Executive Director	Mrs.	Bretz	Amy		9044280400				9044280404	abretz@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	09/06/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	CEO - Senior Official for Contracting	Executive Director	Mrs	Bretz	Amy		9044280400				9044280404	abretz@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Chief Financial Officer	Financial Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Chief Operating Officer	Executive Director	Mrs.	Bretz	Amy		9044280400				9044280404	abretz@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Chief Information Officer	Chief Information Officer	Mr.	Helinsky	Michael		9042685200					michael.helinsky@aliviacare.com	4266 Sunbeam Road		Jacksonville	FL	32257	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Chief Information Security Officer		Mr.	Helinsky	Michael		9042685200					michael.helinsky@aliviacare.com	4266 Sunbeam Road		Jacksonville	FL	32257	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	CMS Casework Communication Contact	Quality Manager	Mrs.	Sharpe	Bridget		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Complaints Tracking Contact	Quality Improvement		Sharpe	Bridget		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Contact for Fraud Investigations	Financial Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Coordination of Benefits Contact	Financial Medicare Part D Manager	Ms.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Corporate Mailing						9044280400				9044280404	abretz@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Coverage Gap Discount Program (CGDP) Payment Contact	Health Plan Manager	Ms.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Customer Service Operations Contact	Program Director	Mrs.	SHARPE	BRIDGET		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	DIR Contact	Financial Medicare Part D Manager		Thomas	Dawn	D	9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	DIR Contact (Secondary)	Executive Director		Bretz	Amy		9044280400					abretz@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Emergency Part D Contact	Health Plan Manager		Thomas	Dawn		9044280400					dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Emergency Part D Contact (Secondary)	Executive Director		Bretz	Amy		9044280400					abretz@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	09/06/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Encounter Data & Risk Adjustment Operations Contact	Finance Medicare Part D Manager		Thomas	Dawn	D	9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Enrollment Contact	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	EOB Transfer Contact	Business Office Coordinator	Mr.	Wilder	William		9044280400				9044280404	wwilder@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Financial Audit Contact	Director of Finance	Ms.	Mount	Chaka		9042685200					chaka.mount@aliviacare.com	4266 Sunbeam Road		Jacksonville	FL	32257	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Financial Reporting Contact	Finance Medicare Part D Manager		Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Formulary Contact	Medical Director		Sanchez	Ana		9044125134				9044280404	ASanchez@communityhospice.com	5450 Ramona Boulevard		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	General Contact	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Government Relations Contact	Executive Director	Mrs.	Bretz	Amy		9044280400				9044280404	abretz@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	09/06/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	HIPAA Privacy Officer	Quality Manager		SHARPE	BRIDGET		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	HIPAA Security Officer	Quality Manager		SHARPE	BRIDGET		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Interoperability Contact	Quality Manager		SHARPE	BRIDGET		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	MA Appeals/Grievances Contact	Quality Improvement		Sharpe	Bridget		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	MA Claims Processing Contact for Public Website	Finance Medicare Part D Manager	Ms.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	09/06/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Marketing Contact	Enrollment Manager	Mrs.	Owens	Regina		9044280400				9044280404	rowens2@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Medical Director	Medical Director	Dr	Sanchez	Ana		9044125134				9044280404	ASanchez@communityhospice.com	5450 Ramona Boulevard		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Medicare Compliance Officer	QI Manager	Mr.	SHARPE	BRIDGET		9044280400					bsharpe1@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Medicare Coordinator	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr	Sanchez	Ana		9044125134				9044280404	ASanchez@communityhospice.com	5450 Ramona Boulevard		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Medication Therapy Management Contact	Medical Director	Dr	Sanchez	Ana		9044125134				9044280404	ASanchez@communityhospice.com	5450 Ramona Boulevard		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Online Enrollment Center Contact (Back-up)	Executive Director		Bretz	Amy		9044280400				9044280404	abretz@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Online Enrollment Center Contact (Primary)	Finance Medicare Part D Manager		Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Part C Application Contact	Executive Director	Mrs.	Bretz	Amy		9044280400				9044280404	abretz@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	09/06/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Part D Appeals	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn						9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active	9044280400				PACE - Nat		C	Atlanta
H7469	Part D Application Contact	Executive Director	Mrs.	Bretz	Amy		9044280400					abretz@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	09/06/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Part D Benefits Contact	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Part D Claims Submission Contact	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Part D Exceptions Contact	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn	D					9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active	9044280400				PACE - Nat		C	Atlanta
H7469	Part D Price File Contact (Back-up)	Executive Director	Mrs.	Bretz	Amy		9044280400				9044280404	abretz@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Part D Price File Contact (Primary)	Finance Medicare Part D Manager		Thomas	Dawn	D	9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Part D Quality Assurance Contact	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Part D Reporting Contact	Finance Medicare Part D Manager		Thomas	Dawn	D	9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Patient Safety Contact	Medical Director	Dr	Sanchez	Ana		9044125134				9044280404	ASanchez@communityhospice.com	5450 Ramona Boulevard		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Payment Contact	Finance Medicare Part D Manager		Thomas	Dawn	D	9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Pharmacy Director	Medical Director	MD	Sanchez	Ana		9044125134					ASanchez@communityhospice.com	5450 Ramona Boulevard		Jacksonville	FL	32205	09/06/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Pharmacy Network Management Contact	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	09/06/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Pharmacy Technical Help Desk Contact	Medical Director	Mrs.	Silva	Joseph						9044280404	jsilva@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active	9044280400				PACE - Nat		C	Atlanta
H7469	Plan Directory Contact for Public Website	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Plan to Plan Reconciliation Contact	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Processor Contact	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Quality Contact	Quality Improvement		Sharpe	Bridget		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Reconciliation Contact	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Recovery Audit Contact	Compliance	Ms	Sharpe	Bridget		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Surveillance Contact	Enrollment Manager	Mrs.	Owens	Regina		9044280400				9044280404	rowens2@thepaceplace.org	5450 Ramona Boulevard		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	System Contact	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Third Party Administrator (TPA) Liaison	Finance Medicare Part D Manager	Mrs.	Thomas	Dawn		9044280400				9044280404	dthomas2@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	06/26/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	User Access Contact	Quality Manager	Ms.	SHARPE	BRIDGET		9044280400				9044280404	bsharpe1@thepaceplace.org	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Utilization Management Contact	Medical Director	Dr	Sanchez	Ana		9044125134				9044280404	ASanchez@communityhospice.com	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7469	Utilization Review Contact	Medical Director	Dr	Sanchez	Ana		9044125134					ASanchez@communityhospice.com	5450 Ramona Blvd		Jacksonville	FL	32205	08/16/2023	2023	PACE PARTNERS OF NORTHEAST FLORIDA, INC.	National PACE	PACE Partners of Northeast Florida	National PACE		Community Hospice of Northeast Florida, Inc.	720	Yes	Active					PACE - Nat		C	Atlanta
H7501	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Zlotkus	Steve		8587906250				8587906052	PartDCAT@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Backup User Access Contact	Manager		Gomez	Gisela		7142468757					ggomez@caloptima.org	505 City Parkway West		Orange	CA	92868	02/24/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Best Available Evidence Contact	Director of PACE	Ms.	Macias-Garcia	Monica		7144681077					monica.macias@caloptima.org	13300 Garden Grove Boulevard		Garden Grove	CA	92843	04/27/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Bid Primary Contact	Manager	Ms.	Gomez	Gisela		7142468757					ggomez@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	CAP Report Contact for Public Website	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Hunn	Michael		9493380005					michael.hunn@caloptima.org	505 City Parkway West		Orange	CA	92868	12/14/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Hunn	Michael		6579001481					michael.hunn@caloptima.org	505 City Parkway West		Orange	CA	92868	03/08/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Chief Financial Officer	Chief Financial Officer	Ms.	Huang	Nancy		6572356935					nhuang@caloptima.org	505 City Parkway West		Orange	CA	92868	12/10/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Chief Operating Officer	Chief Operating Officer	Ms.	Kim	Yunkyung		7142468408					yunkyung.kim@caloptima.org	505 City Parkway West		Orange	CA	92868	11/30/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Chief Information Officer	Chief Information Officer	Mr.	Younan	Wael		6579001154					wael.younan@caloptima.org	505 City Parkway West		Orange	CA	92868	04/25/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Chief Information Security Officer	Chief Information Security Officer	Mr.	Younan	Wael		6579001154					wael.younan@caloptima.org	505 City Parkway West		Orange	CA	92868	04/25/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	CMS Casework Communication Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Complaints Tracking Contact	QI Manager	Ms.	Robinson	Jennifer		7142468693					jennifer.robinson@caloptima.org	13300 Garden Grove Boulevard		Garden Grove	CA	92843	12/28/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Contact for Fraud Investigations	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Coordination of Benefits Contact			Cardenas	Albert		7142468878					COBinquiries@caloptima.org	505 City Parkway West		Orange	CA	92868	04/21/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Corporate Mailing						6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Coverage Gap Discount Program (CGDP) Payment Contact	Controller	Mr.	Kaing	Jason		6579001373					jason.kaing@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Customer Service Operations Contact	Director of PACE	Ms.	Macias-Garcia	Monica		7144681077					monica.macias@caloptima.org	13300 Garden Grove Boulevard		Garden Grove	CA	92843	04/27/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	DIR Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	DIR Contact (Secondary)	Program Specialist		Kurth	Jennifer		7142468767					jkurth@caloptima.org	505 City Parkway West		Orange	CA	92868	03/08/2016	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Emergency Part D Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7148150329					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Emergency Part D Contact (Secondary)	Manager		Li	Tina		6579001173					tina.li@caloptima.org	505 City Parkway West		Orange	CA	92868	01/05/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Encounter Data & Risk Adjustment Operations Contact	Manager, Encounters		Dabu	Lorena		7142468486					ldabu@caloptima.org	505 City Parkway West		Orange	CA	92868	12/10/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Enrollment Contact		Mr.	Zuniga	Noe		7144681027					nzuniga@caloptima.org	13300 Garden Grove Boulevard		Garden Grove	CA	92843	01/03/2018	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	EOB Transfer Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Financial Audit Contact	Director, Regulatory Affairs & Compliance Medicare	Ms.	Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Financial Reporting Contact	Controller	Mr,	Kaing	Jason		6579001373					jason.kaing@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Formulary Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	General Contact	Director, Regulatory Affairs & Compliance		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	06/06/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Government Relations Contact	Manager	Ms.	Gomez	Gisela		7142468757					ggomez@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	HIPAA Privacy Officer	Director, Privacy		Ho	Fay		7142468892					fho@caloptima.org	505 City Parkway West		Orange	CA	92868	09/08/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	HIPAA Security Officer	Director, Privacy		Ho	Fay		7142468892					fho@caloptima.org	505 City Parkway West		Orange	CA	92868	09/08/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Interoperability Contact	IT Project Manager, Sr	Mr.	DeFrain	Phil		7142468477					pdefrain@caloptima.org	505 City Parkway West		Orange	CA	92868	05/12/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	MA Appeals/Grievances Contact	QI Manager	Ms.	Robinson	Jennifer		7142468693					jennifer.robinson@caloptima.org	505 City Parkway West	13300 Garden Grove Boulevard	Orange	CA	92843	12/28/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	MA Claims Processing Contact for Public Website	Director, Claims Administration		Tungol	Cesar		7147966141					ctungol@caloptima.org	505 City Parkway West		Orange	CA	92868	12/10/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Marketing Contact		Mr.	Zuniga	Noe		7144681027					nzuniga@caloptima.org	505 City Parkway West		Orange	CA	92868	01/03/2018	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Medical Director	Medical Director	Dr.	Frisch	Donna		7147148974					donna.frisch@caloptima.org	505 City Parkway West		Orange	CA	92868	04/27/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Medicare Compliance Officer	Director of Regulatory Affairs and Compliance	Ms.	Phillips	Annie		6572356994					medicarecomplianceofficer@caloptima.org	505 City Parkway West		Orange	CA	92868	07/21/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Medicare Coordinator	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Medicare Part D Opioid Overutilization Contact	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/31/2018	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Medication Therapy Management Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	OffShore Subcontractor Contact	Director, Regulatory Affairs & Compliance Medicare		Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Part C Application Contact	Director of PACE	Ms.	Macias-Garcia	Monica		7144681077					monica.macias@caloptima.org	13300 Garden Grove Boulevard		Garden Grove	CA	92843	04/27/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Part D Appeals	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin						7144816459	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	03/24/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active	7142468460				PACE - Nat		C	San Francisco
H7501	Part D Appeals Contact (Secondary)	Manager		Li	Tina							tina.li@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active	6579001173				PACE - Nat		C	San Francisco
H7501	Part D Application Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Part D Benefits Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Part D Claims Submission Contact			Rivera-Aquino	Denisse		8582915269					PDE@Medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Part D Exceptions Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin							kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active	8885878088				PACE - Nat		C	San Francisco
H7501	Part D Price File Contact (Back-up)	Medicare Part D Manager		Keller	Shanon		8587906455				8587906038	planfindercommunications@medImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	04/16/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Part D Price File Contact (Optional)	Medicare Part D Manager		Keller	Shanon		8587906455				8587906038	planfindercommunications@medImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	04/16/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Part D Price File Contact (Primary)	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Part D Quality Assurance Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Part D Reporting Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Patient Safety Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Payment Contact	Controller	Mr.	Kaing	Jason		6579001373					jason.kaing@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Personal Health Record Contact	Director of PACE	Ms.	Macias-Garcia	Monica		7144681077					monica.macias@caloptima.org	13300 Garden Grove Boulevard		Garden Grove	CA	92843	04/27/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Pharmacy Director	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Pharmacy Network Management Contact	Manager, PNS & Claims Operations		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Pharmacy Network Management Contact (Secondary)	Director, Clinical Pharmacy Management		Gericke	Kristin		7142468460				7142468649	kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services		Brewer	Kathy							customerservice@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active	8008100554				PACE - Nat		C	San Francisco
H7501	Pharmacy Technical Help Desk Contact (Secondary)	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin							kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active	8885878088				PACE - Nat		C	San Francisco
H7501	Plan Directory Contact for Public Website	Director of PACE	Ms.	Macias-Garcia	Monica		7144681077					monica.macias@caloptima.org	13300 Garden Grove Boulevard		Garden Grove	CA	92843	04/27/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Plan to Plan Reconciliation Contact	Controller	Mr.	Kaing	Jason		6579001373					p2p@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Processor Contact	Director, Medicare Programs		Davis-Jones	De'Lona	M	8587906229					DeLona.Davis-Jones@Medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Quality Contact	QI Manager	Ms.	Robinson	Jennifer		7142468693					jennifer.robinson@caloptima.org	13300 Garden Grove Boulevard		Garden Grove	CA	92843	12/28/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Reconciliation Contact	Director, Clinical Pharmacy Management	Ms.	Gericke	Kristin		7142468471					kgericke@caloptima.org	505 City Parkway West		Orange	CA	92868	12/24/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Reconciliation Contact (Secondary)	Controller	Mr.	Kaing	Jason		6579001373					jason.kaing@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Recovery Audit Contact	Director, Regulatory Affairs & Compliance Medicare	Ms.	Phillips	Annie		6572356994					aphillips@caloptima.org	505 City Parkway West		Orange	CA	92868	05/06/2021	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Surveillance Contact	Director of PACE	Ms.	Macias-Garcia	Monica		7144681077					monica.macias@caloptima.org	13300 Garden Grove Boulevard		Garden Grove	CA	92843	04/27/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	System Contact	Director of PACE	Ms.	Macias-Garcia	Monica		7144681077					monica.macias@caloptima.org	13300 Garden Grove Boulevard		Garden Grove	CA	92843	04/27/2023	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Third Party Administrator (TPA) Liaison	Controller	Mr.	Kaing	Jason		6579001373					jason.kaing@caloptima.org	505 City Parkway West		Orange	CA	92868	04/30/2020	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	User Access Contact	Manager		Gomez	Gisela		7142468757					ggomez@caloptima.org	505 City Parkway West		Orange	CA	92868	02/13/2019	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Utilization Management Contact	Executive Director		Giardina	Kelly		6579001013					kelly.giardina@caloptima.org	505 City Parkway West		Orange	CA	92868	09/08/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7501	Utilization Review Contact	Executive Director		Giardina	Kelly		6579001013					kelly.giardina@caloptima.org	505 City Parkway West		Orange	CA	92868	09/08/2022	2023	ORANGE COUNTY HEALTH AUTHORITY	National PACE	CalOptima PACE	National PACE		Orange County Health Authority	39	Yes	Active					PACE - Nat		C	San Francisco
H7511	Agent/Broker Compensation Data Contact	Director of Product Development	Ms.	Meyer	Courtney		6053122613					Courtney.Meyer@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Automated TrOOP Balance Transfer Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Backup User Access Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Best Available Evidence Contact	Director of Billing & Enrollment	Mr.	Reichelt	Daniel		6053122624					daniel.reichelt@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Bid Audit Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Bid Audit Site Contact	Director of Acturial Services	Mr.	Pence	Gregory		4156018550					gregory.pence@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Bid Primary Contact	Director of Actuarial Services	Mr.	Pence	Gregory		4156018550					gregory.pence@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	CAP Report Contact for Public Website	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	6053286806				HMO - Health Maintenance Organization		C	Dallas
H7511	CEO - CMS Administrator Contact	President	Mr.	Snyder	John		6053122750					john.snyder@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	CEO - Senior Official for Contracting	President	Mr.	Snyder	John		6053122750					john.snyder@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Chief Financial Officer	Vice President of Finance	Mr.	Maude	Brian		6053286801					Brian.Maude@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Chief Operating Officer	Chief Operating Officer	Ms.	Griese	Emily		6053287020					Emily.Griese@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Chief Information Officer	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Chief Information Security Officer	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	CMMI Model Point of Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	CMS Casework Communication Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 Cherapa place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Complaints Tracking Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Contact for Fraud Investigations	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Coordination of Benefits Contact	Director of Payment Integrity	Ms.	Lieser	Mesa		6053287024					mesa.lieser@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Corporate Mailing						8005354831					sanfordhealthplan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Customer Service Operations Contact	Director of Customer Service	Mr.	Ling	Ryan		6053127459					ryan.ling@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	DIR Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	DIR Contact (Secondary)	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Electronic Health Record Contact	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Emergency Part D Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Emergency Part D Contact (Secondary)	Senior Director of Goverment Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Employer Waiver Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Encounter Data & Risk Adjustment Operations Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Enrollment Contact	Director of Product Development	Ms.	Meyer	Courtney		6053122613					courtney.meyer@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	EOB Transfer Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182				6053286811	aleesa.jansick@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Financial Audit Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Financial Reporting Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Formulary Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Formulary Contact (Secondary)	Principal Pharmacy Benefits Specialist		Chen	Honghua		2242312740					Christine.Chen2@optum.com	1600  McConnor Parkway	Suite 201	Schaumburg	IL	601736801	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	General Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Government Relations Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	HIPAA Privacy Officer	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	HIPAA Security Officer	Systems Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Hospice Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Interoperability Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	MA Appeals/Grievances Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	MA Claims Processing Contact for Public Website	Executive Director Operations	Ms.	Guggisberg	Stacey		6053286802					stacey.guggisberg@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Marketing Contact	Director of Marketing	Ms.	McCloskey	Diana		6053122762					diana.mccloskey@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Medical Director	Vice President, Medical Officer	Dr.	Faber	Kevin		6053287192					kevin.faber@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Medicare Compliance Officer	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Medicare Coordinator	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Medication Therapy Management Contact	Clinical Program Manager	Ms.	Liaqat	Tazeen		6305440541					Tazeen.liaqat@optum.com	1240 South Pine Island Rd.		Plantation	FL	33324	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	OffShore Subcontractor Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Online Enrollment Center Contact (Back-up)	Director of Medicare Programs	Mr.	Ovenden	Nathan		6053122606					nathan.ovenden@sanfordhealth.org	300 Cherapa Place, Suite 201		Sioux Falss	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Online Enrollment Center Contact (Optional)	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Online Enrollment Center Contact (Primary)	Senior Director of Development and Distribution	Ms.	Meyer	Courtney		6053122613					courtney.meyer@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Part C Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Part C Reporting Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Appeals	Manager, Prior Authorization Appeals	Ms.	Le	Christina						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Appeals Contact (Secondary)	Pharmacy Technician, PA Appeals		Chavez	Kelly						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Benefits Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Claims Submission Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Exceptions Contact	Manager, Prior Authorization	Ms.	Le	Christina						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Exceptions Contact (Secondary)	Pharmacy Technician, PA		Chavez	Kelly						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Price File Contact (Back-up)	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615				6053286811	timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Price File Contact (Optional)	Senior Director of Government Program	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Price File Contact (Primary)	Senior Business Analyst	Ms.	Lyman	Dorothy		6514955369					Dorothy.Lyman@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Quality Assurance Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007				6053286811	rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Part D Reporting Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Patient Safety Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Payment Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Personal Health Record Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Pharmacy Director	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615				6053286811	timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations	Ms.	Ashby	Jolynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk	Mr.	Summers	Todd							Todd.Summers@optum.com	1600 McConnor Parkway	Suite 200	Schaumburg	IL	601736801	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8446429090				HMO - Health Maintenance Organization		C	Dallas
H7511	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Service	Mr.	Juarez	Ethan							ethan.juarez@optum.com	3515 Harbor Blvd		Costa Mesaa	CA	92626	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	7148256891				HMO - Health Maintenance Organization		C	Dallas
H7511	PHR Beneficiary Contact																	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS	Sanford Health Plan	Sanford Health	740	Yes	Active	8885354831				HMO - Health Maintenance Organization		C	Dallas
H7511	Physician Incentive Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Plan Directory Contact for Public Website	Senior Director of Risk & Regulation	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Plan to Plan Reconciliation Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Processor Contact	Senior Manager, Benefit Administration	Ms.	Lievanos	Cassandra		7637974205					cassandra.lievanos@optum.com	5701 Katella Ave		Cypress	CA	90630	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Quality Contact	Senior Director of Risk & Regulation	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Reconciliation Contact	Director of Billing & Enrollment	Mr.	Reichelt	Daniel		6053122624					daniel.reichelt@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Reconciliation Contact (Secondary)	Executive Director of Opertions	Ms.	Guggisberg	Stacey		6053286802					stacey.guggisberg@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Recovery Audit Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	SNP Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	SNP State Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Surveillance Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	System Contact	Systems Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Third Party Administrator (TPA) Liaison	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	User Access Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Utilization Management Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7511	Utilization Review Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	GOOD SAMARITAN INSURANCE PLAN OF NEBRASKA, INC.	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7512	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H7512	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	02/02/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/02/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Medical Director	Medical Director	Mr	Haake	Karl		9132951245					karl.haake@sunflowerhealthplan.com	77 West Wacker Drive, 14th Floor		Chicago	IL	60601	03/30/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H7512	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H7512	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H7512	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H7512	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H7512	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H7512	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334311356				PPO - BBA		C	Dallas
H7512	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	03/31/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7512	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY MICHIGAN	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/09/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/09/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/27/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H7518	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H7518	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H7518	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/09/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H7518	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H7518	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Lugge	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H7518	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H7518	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/09/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7518	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF MISSOURI HEALTH INSURANCE COMPANY, INC	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H7522	Agent/Broker Compensation Data Contact	CFO	Mr.	Vivaldi	Carlos		7873069135				7873004886	carlos.vivaldi@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Automated TrOOP Balance Transfer Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Backup User Access Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Best Available Evidence Contact	AVP Enrollment and Membership Accounting	Ms.	Suarez	Yamile		7874069767				7879992199	Yamile.Suarez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Bid Audit Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Bid Audit Site Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Bid Primary Contact	Product Development Manager	Ms	Martinez	Viviana		7874849559				7876253356	viviana.martinez-lanza@mmmhc.com	PO Box 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	CAP Report Contact for Public Website	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active	8663335470	52259			PPO - BBA		C	Chicago
H7522	CEO - CMS Administrator Contact	President of MMM	Mr.	Rivera Cardona	Ricardo		7876330707				7873004886	ricardo.rivera-cardona@mmmhc.com	350 Avenida Chardon	Torre Chardon Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	CEO - Senior Official for Contracting	President Medicare Programs	Mr.	Gonzalez Rivera	Orlando		7872070700				7873004886	Orlando.Gonzalez@mmmhc.com	350 Avenida Chardon	Torre Chardon Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Chief Financial Officer	Chief Financial Officer	Mr.	Vivaldi	Carlos		7873069135				7873004886	Carlos.Vivaldi@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Chief Operating Officer	COO	Ms	Garcia	Vilmari		7874478131				7873004886	vilmari.garcia@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Chief Information Officer	CIO	Mr.	Molinary	Rachid		7872496365				9395451239	rachid.molinary@mmmhc.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Chief Information Security Officer	Vice President IT Department	Mr.	Arill	Juan		7875016127				7879991726	juan.arill@mmmhc.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	CMMI Model Point of Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	CMS Casework Communication Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Complaints Tracking Contact	A&G Director	Ms.	Rodriguez	Janice		9397173509	2537			7876202390	janice.rodriguez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Contact for Fraud Investigations	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Coordination of Benefits Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Corporate Mailing						7876223000	52259			7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Coverage Gap Discount Program (CGDP) Payment Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Customer Service Operations Contact	Vice President of Operations	Ms.	Iglesias	Morayma		7876002047					morayma.iglesias-sustache@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	DIR Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	DIR Contact (Secondary)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Electronic Health Record Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active	8663335470	52259			PPO - BBA		C	Chicago
H7522	Emergency Part D Contact	Pharmacy VP	Ms	Morant	Iris		7873797592				7873005503	iris.morant-rodriguez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Emergency Part D Contact (Secondary)	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Employer Waiver Contact	Chief Sales and Marketing Officer	Ms.	Montilla	Lara		7875065320					lara.montilla-byrne@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Encounter Data & Risk Adjustment Operations Contact	Director Risk and Quality Data Analytics	Mr	Kaplun	Alex		2015663591					akaplun@mmmhc.com	350 Avenida Chardon Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Enrollment Contact	AVP Enrollment and Membership Accounting	Ms.	Suarez	Yamile		7874069767				7879992199	Yamile.Suarez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	EOB Transfer Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Financial Audit Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Financial Reporting Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Formulary Contact	Director of Formulary and Utilization Management	Dr.	Lazaro	Maria	I	7876756858	8617			7873005503	maria.lazaro@mmmhc.com	PO BOX 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Formulary Contact (Secondary)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	General Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Government Relations Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	HIPAA Privacy Officer	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	HIPAA Security Officer	Vice President IT Department	Mr.	Arill	Juan		7875016127				7879991726	juan.arill@mmmhc.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Hospice Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Interoperability Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	MA Appeals/Grievances Contact	A&G Director	Ms.	Rodriguez	Janice		9397173509	2537			7876202390	janice.rodriguez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	MA Claims Processing Contact for Public Website	Chief of Clinical Operations	Mr	Salinas	Gonzalo		7873832706	2033			7879992177	Gonzalo.Salinas@mso-pr.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Marketing Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Medical Director	Chief Medical Officer	Dr.	Rosso	Diego		7874478148				7873005523	diego.rosso@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Medicare Compliance Officer	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Medicare Coordinator	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Medicare Part D Opioid Overutilization Contact	Pharmacy AVP	Ms	Ramos	Sara		7874132083				7873005503	sara.ramos-gonzalez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Medication Therapy Management Contact	Pharmacy AVP	Ms	Ramos	Sara		7874132083				7873005503	sara.ramos-gonzalez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	OffShore Subcontractor Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Online Enrollment Center Contact (Back-up)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Online Enrollment Center Contact (Optional)	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Online Enrollment Center Contact (Primary)	AVP Enrollment and Membership Accounting	Ms.	Suarez	Yamile		7874069767				7879992199	Yamile.Suarez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Part C Application Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Part C Reporting Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Part D Appeals	A&G Director	Ms.	Rodriguez	Janice						7876202390	janice.rodriguez@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active	8663335470	2537			PPO - BBA		C	Chicago
H7522	Part D Appeals Contact (Secondary)	Chief Medical Officer	Dr.	Rosso	Diego						7873005523	Diego.Rosso@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active	8663335470	58722			PPO - BBA		C	Chicago
H7522	Part D Application Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Part D Benefits Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Part D Claims Submission Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Part D Exceptions Contact	Pharmacy Operation Director	Ms	Rivera	Erika						7873005503	erika.rivera@mmmhc.com	PO BOX 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active	8663335470	58633			PPO - BBA		C	Chicago
H7522	Part D Exceptions Contact (Secondary)	Pharmacy VP	Ms.	Morant	Iris						7873005503	iris.morant-rodriguez@mso-pr.com	PO BOX 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active	8663335470	58660			PPO - BBA		C	Chicago
H7522	Part D Price File Contact (Back-up)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Part D Price File Contact (Optional)		Ms	Forty	Mario		4806064865					Mario.Forty@cvshealth.com	9501 E. Shea Blvd,		Scorrsdale	AZ	85260	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Part D Price File Contact (Primary)	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Part D Quality Assurance Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Part D Reporting Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Patient Safety Contact	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Payment Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Personal Health Record Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Pharmacy Director	Pharmacy VP	Ms	Morant	Iris		7873797592				7873005503	iris.morant-rodriguez@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Pharmacy Network Management Contact	Pharmacy Services Manager	Ms	Rodriguez	Isis		7876532814				7872866032	irodriguezp@mc-21.com	MC-21 Corporation	Call Box 4908	Caguas	PR	00726	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Pharmacy Network Management Contact (Secondary)	Pharmacy Operations Support and Quality Assurance	Mr	Mercado Toro	Jose		7879257029	58679			7873005503	jose.mercado-toro@mso-pr.com	350 Avenida Chardon, Torre Chardon, Suite 500		San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Pharmacy Technical Help Desk Contact	Pharmacy VP	Ms.	Morant	Iris						7873005503	iris.morant-rodriguez@mso-pr.com	PO BOX 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active	8777767706	58660			PPO - BBA		C	Chicago
H7522	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Operation Director	Ms	Rivera	Erika						7873005503	erika.rivera@mmmhc.com	PO BOX 71114		San Juan	PR	009368014	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active	8663335470	58633			PPO - BBA		C	Chicago
H7522	PHR Beneficiary Contact																	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO	MMM Healthcare, Inc.	Elevance Health, Inc.	1	Yes	Active	8663335470				PPO - BBA		C	Chicago
H7522	Physician Incentive Contact	Finance Director	Ms.	Perez	Mireya		7874484061				7873005502	Mireya.perez@mso-pr.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Plan Directory Contact for Public Website	AVP Member Services	Ms.	Quinones	Janice		8666766060					janice.quinones@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Plan to Plan Reconciliation Contact	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Processor Contact	CVS VP Medicare Program Services	Ms.	Merlino	Melanie		4802152151				4803146881	Melanie.Merlino@caremark.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Quality Contact	AVP of Quality Management	Ms.	Miranda	Ana	B	7872218738				7873005510	ana.miranda-mercado@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Reconciliation Contact	AVP Finance	Mr.	Gonzalez Cuadrado	Agustin		7876089270				7873004886	agustin.gonzalez-cuadrado@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Reconciliation Contact (Secondary)	Regulatory Compliance Director	Ms.	Falcon	Cynthia		7876002822				7876253356	Cynthia.Falcon-Mejias@mmmhc.com	350 Ave Chardon, Torre Chardon	Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Recovery Audit Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	SNP Application Contact	Chief Sales and Marketing Officer	Ms.	Montilla	Lara		7875065320					lara.montilla-byrne@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	SNP State Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Surveillance Contact	Corporate Compliance Officer	Ms.	Plumey	Myra		7873793327				7876253356	myra.plumey@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	System Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Third Party Administrator (TPA) Liaison	Revenue and Med Cost Accounting Supervisor	Mr.	Serrano Figueroa	Juan		7873987704					Juan.Serrano@mmmhc.com	PO Box 71114		San Juan	PR	00936	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	User Access Contact	Compliance Operations AVP	Ms	Hiraldo	Marieva		7872231672				7876253356	marieva.hiraldo@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Utilization Management Contact	Chief of Clinical Operations	Mr	Salinas	Gonzalo		7873832706	2033			7879992177	Gonzalo.Salinas@mso-pr.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	009182137	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7522	Utilization Review Contact	Chief Medical Officer	Dr.	Rosso	Diego		7874478148				7873005523	diego.rosso@mmmhc.com	350 Avenida Chardon	Torre Chardon, Suite 500	San Juan	PR	00918	04/19/2023	2023	MMM HEALTHCARE, LLC	Local CCP	Medicare y Mucho Mas	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H7524	Agent/Broker Compensation Data Contact	Manager, Broker Administration and Operations		McBride	Kelly		5857396683					Kelly.McBride@Excellus.com	165 Court Street		Rochester	NY	14647	04/18/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Automated TrOOP Balance Transfer Contact	Medicare Product Operations Specialist		Laird	Jennifer		5853397717					Jennifer.Laird@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Backup User Access Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court Street		Rochester	NY	14647	11/02/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Best Available Evidence Contact	Supervisor Medicare Operations		Piershalski	Dana		7168574435					Dana.Piershalski@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Bid Audit Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Bid Audit Site Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Bid Primary Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	5853397745				HMO - Health Maintenance Organization		C	New York
H7524	CEO - CMS Administrator Contact	Executive Vice President & Chief Financial Officer	Mr.	Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	CEO - Senior Official for Contracting	President and Chief Executive Officer	Mr.	Reed	Jim		3156716406					Jim.Reed@excellus.com	333 Butternut Drive		Syracuse	NY	13214	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Chief Financial Officer	Executive Vice President & Chief Financial Officer	Mr.	Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Chief Operating Officer	President and Chief Executive Officer	Mr.	Reed	Jim		3156716406					Jim.Reed@excellus.com	333 Butternut Drive		Syracuse	NY	13214	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Chief Information Officer	Vice President, IT Finance and Corporate Systems	Ms.	Walker	Angela		5853276529					Angela.Walker@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Chief Information Security Officer	Vice President, Chief Information Security Officer	Mr.	Pickup	Jason		5853397620	25511				Jason.Pickup@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	CMS Casework Communication Contact	Medicare Compliance Program Administrator		Gomez	Rafael		7168576226					Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Complaints Tracking Contact	Medicare Compliance Program Administrator		Gomez	Rafael		7168576226					Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Contact for Fraud Investigations	Corporate Director of Special Investigations		Paris	Meg		5852384425				5854536346	Meg.Paris@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Coordination of Benefits Contact	Manager, Analysis and Recovery		May	Mary		3157928873					Mary.May@excellus.com	12 Rhoads Dr.		Utica	NY	13502	07/17/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Corporate Mailing						5852384505					CCiardi@excellus.com	165 Court Street		Rochester	NY	14647	02/07/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Coverage Gap Discount Program (CGDP) Payment Contact	Director Treasury Business Process Management		Weiser	Heidi		5853397791					Heidi.Weiser@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Customer Service Operations Contact	Vice President, Customer Care		Levi	Alexander		5853996683					Alexander.Levi@excellus.com	300 Main St.		E. Rochester	NY	14445	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	DIR Contact	Actuarial Analyst		LaMantia	John		8726007942					John.LaMantia@excellus.com	165 Court Street		Rochester	NY	14647	02/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	DIR Contact (Secondary)	Manager, Actuarial Services		Khaper	Susan		3156716451					Susan.Khaper@excellus.com	333 Butternut Drive		Syracuse	NY	13214	02/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Emergency Part D Contact	Executive Vice President & Chief Financial Officer		Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Emergency Part D Contact (Secondary)	Director, Pharmacy Operations		Rocco	Darlene		5852613857				8778125306	Darlene.Rocco@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Encounter Data & Risk Adjustment Operations Contact	Manager, Health Plan Risk Adjustment		Palmer	Benjamin		3156717270					Benjamin.Palmer@excellus.com	333 Butternut Drive		Dewitt	NY	13214	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Enrollment Contact	Director, Medicare Enrollment and Reconciliation		Della Rocco	Kimberly		5853393876					Kimberly.DellaRocco@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	EOB Transfer Contact	Pharmacy Product Ops Specialist		Ammons	Andrea		5853397986				8778125306	Andrea.Ammons@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Financial Audit Contact	Manager Financial Compliance	Mr.	Mau	Ahren		5854785535					Ahren.Mau@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Financial Reporting Contact	Manager, Medicare and SN Finance		Stalzer	Virginia		5852384428					Virginia.Stalzer@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Formulary Contact	Medicare Part D Formulary Manager		Eric	Woodruff		7167832740					Eric.Woodruff@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Formulary Contact (Secondary)	Medicare Part D Formulary Manager		Banaszak	Danielle		7166145704					Danielle.Banaszak@excellus.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	General Contact	VP Retail Markets Operations		Bodley	Karen		5854559038					Karen.Bodley@excellus.com	165 Court Street		Rochester	NY	14647	08/05/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Government Relations Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	HIPAA Privacy Officer	VP, Ethics & Privacy Officer		Hill	Timothy	J	3156716663					Timothy.Hill@excellus.com	333 Butternut Drive		Dewitt	NY	13214	08/01/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	HIPAA Security Officer	Vice President, Chief Information Security Officer		Pickup	Jason		5853397620					Jason.Pickup@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Hospice Contact	Manager, Pharmacy Utilization Management		Khan	Joe		7168437881					Joe.Khan@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Interoperability Contact	Program Manager		Ozminkowski	David		5855305532					David.Ozminkowski@excellus.com	165 Court Street		Rochester	NY	14647	02/07/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	MA Appeals/Grievances Contact	Medicare Compliance Program Administrator		Gomez	Rafael		7168576226					Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	MA Claims Processing Contact for Public Website	Manager, Customer Operations		Amato	Heather		7162505162					Heather.Amato@Univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	08/24/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Marketing Contact	Marketing Manager		Reardon	Elizabeth		5853276504					Elizabeth.Reardon@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Medical Director	Senior VP and Corporate Medical Director		Cohen	Stephen		5854536366					Stephen.Cohen@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Medicare Coordinator	VP Retail Markets Operations		Bodley	Karen		5854559038					Karen.Bodley@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Medicare Part D Opioid Overutilization Contact	Quality Improvement Clinical Pharmacist		Morano	Melissa		7166145705					melissa.morano@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Medication Therapy Management Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Online Enrollment Center Contact (Back-up)	Enrollment Operation Project Manager II		Abiusi	Amy		7166145787					Amy.Abiusi@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Online Enrollment Center Contact (Optional)	Manager, EDI & Enrollment Governance		Field	Eric		3154360215					Eric.Field@excellus.com	333 Butternut Drive		Syracuse	NY	13214	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Online Enrollment Center Contact (Primary)	Enrollment Operations Analyst II		Conway	Michael		7165045512					Michael.Conway@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Part C Application Contact	Product Implementation and Operations Project Mgr		McParlane	Kelli		7164910233					Kelli.McParlane@univerahealthcare.com	209 Woodshire Court		Getzville	NY	14068	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Part C Reporting Contact	Medicare Compliance Program Administrator		Dewa	Renate		3155732791					Renate.Dewa@excellus.com	165 Court Street		Rochester	NY	14647	01/04/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Part D Appeals	Compliance Program Administrator III		Gomez	Rafael							Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	7168576226				HMO - Health Maintenance Organization		C	New York
H7524	Part D Appeals Contact (Secondary)	Manager of Advocacy and Compliance Ops		Jobe	Jessica							Jessica.Jobe@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	7162902570				HMO - Health Maintenance Organization		C	New York
H7524	Part D Application Contact	Product Implementation and Operations Project Mgr		McParlane	Kelli		7164910233					Kelli.McParlane@univerahealthcare.com	209 Woodshire Court		Getzville	NY	14068	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Part D Benefits Contact	Medicare Product Operations Specialist		Laird	Jennifer		5853397717					Jennifer.Laird@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Part D Claims Submission Contact	Medicare Product Operations Specialist		Kohlmeier	Charity		5853277540				8778125306	Charity.Kohlmeier@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Part D Exceptions Contact	Manager, Pharmacy Utilization Management		Khan	Joe							Joe.Khan@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	7168437881				HMO - Health Maintenance Organization		C	New York
H7524	Part D Exceptions Contact (Secondary)	Clinical Pharmacist		Murajda	Lauren							Lauren.Murajda@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	5853397607				HMO - Health Maintenance Organization		C	New York
H7524	Part D Price File Contact (Back-up)	Pharmacy Product Ops Specialist		Kohlmeier	charity		5854536463					Charity.Kohlmeier@excellus.com	165 Court Street		Rochester	NY	14647	07/05/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Part D Price File Contact (Optional)	Director of Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Part D Price File Contact (Primary)	Medicare Product Operations Specilist		Ciaramaglia	Shannon		5852384506					shannon.ciaramaglia@excellus.com	165 Court Street		Rocheser	NY	14647	05/03/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Part D Quality Assurance Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Part D Reporting Contact	Medicare Compliance Program Administrator		Dewa	Renate		3155732791					Renate.Dewa@excellus.com	165 Court Street		Rochester	NY	14647	01/04/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Patient Safety Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Payment Contact	Director, Medicare Enrollment and Reconciliation		Della Rocco	Kimberly		5853393876					Kimberly.DellaRocco@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Pharmacy Director	Director, Pharmacy Operations		Rocco	Darlene		5853277544					Darlene.Rocco@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Pharmacy Network Management Contact	Pharmacy Operations Support		Brown	Burt		5853277530				5853396640	Burt.Brown@excellus.com	165 Court Street		Rochester	NY	14647	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Pharmacy Network Management Contact (Secondary)	Network Account Directory Retail Strategy and Cont		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkwy	Ste 150	Temple Terrace	FL	33637	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H7524	Pharmacy Technical Help Desk Contact (Secondary)	SR Director Goverment Programs, Medicare		Gibson	Sharon							SGGibson@Express-scripts.com	One Express Way		St. Louis	MO	63121	01/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H7524	Physician Incentive Contact	VBP Clinical Programs Manager		Ferris	Laura		3156717134				3156716752	Laura.Ferris@excellus.com	333 Butternut Drive		Syracuse	NY	13214	01/18/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Plan Directory Contact for Public Website	Manager, Customer Operations		Myrto	Colleen		3156718498					Colleen.Myrto@Excellus.com	333 Butternut Drive		Dewitt	NY	13214	08/24/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Plan to Plan Reconciliation Contact	Manager, Finance Operations		Simmons	Jennifer		5852316874					Jennifer.Simmons@excellus.com	165 Court Street		Rochester	NY	14647	12/08/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Processor Contact	SR Directory Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	01/18/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Quality Contact	Director, Accreditation and Quality Programs		Walters	Michele		3154012582					Michele.Walters@excellus.com	333 Butternut Drive		Syracuse	NY	13214	01/18/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Reconciliation Contact	Actuarial Analyst		LaMantia	John		8726007942					John.LaMantia@excellus.com	165 Court Street		Rochester	NY	14647	02/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Khaper	Susan		3156716451					Susan.Khaper@excellus.com	333 Butternut Drive		Syracuse	NY	13214	02/17/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Recovery Audit Contact	Manager Financial Compliance	Mr.	Mau	Ahren		5854785535					Ahren.Mau@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	SNP Application Contact	Product Implementation and Operations Project Mgr		McParlane	Kelli		7164910233					kelli.mcparlane@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/21/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Surveillance Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	System Contact	VP Information Technology		Leondard	LaRhonda		5854142258					LaRhonda.Leonard@Excellus.Com	300 Main St.		E. Rochester	NY	14445	01/18/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Third Party Administrator (TPA) Liaison	Financial Analyst		McManus	Michael		5853397789					Michael.Mcmanus@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	User Access Contact	Medicare Compliance Program Administrator		Conte	Elva		7163168569					Elva.Conte@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Utilization Management Contact	UM Accreditation & Compliance Administrator		Burnop	Elizabeth		3152721088					Elizabeth.Burnop@excellus.com	12 Rhoads Drive		Utica	NY	13502	08/02/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7524	Utilization Review Contact	UM Accreditation & Compliance Administrator		Burnop	Elizabeth		3152721088					Elizabeth.Burnop@excellus.com	12 Rhoads Drive		Utica	NY	13502	08/02/2023	2023	EXCELLUS HEALTH PLAN COMMUNITY CARE LLC	Local CCP	Excellus Health Plan Community Care LLC	HMO/HMOPOS		Lifetime Healthcare, Inc.	87	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7556	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8735 Henderson Rd.		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8735 Henderson Rd		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8735 Henderson Rd		Tampa	FL	33436	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8735 Henderson Rd		Tampa	FL	33436	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8735 Henderson Rd		Tampa	FL	33436	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract	8778937277				PPO - BBA		C	Dallas
H7556	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8735 Henderson Road		Tampa	FL	33624	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Coordination of Benefits Contact	Director, Pharmacy Operations		Borowiecki	Jeff		3143493212					cob@centene.com	8735 Henderson Rd		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	DIR Contact (Secondary)	Vice President, Data Analytics & Reporting		Xiong	Yan		8132065163					Yan.Xiong@wellcare.com	8715 Henderson Rd.		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8735 Henderson Rd		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8735 Henderson Road, Ren 1, 3rd Floor		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Medical Director	Medical Director	Mr	Haake	Karl		9132951245					karl.haake@sunflowerhealthplan.com	77 West Wacker Drive, 14th Floor		Chicago	IL	60601	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Part D Appeals	Sr Manager, Pharmacy Operations	Ms.	Hatchman	Erika							erika.hatchman@wellcare.com	8735 Henderson Rd		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract	8132061716				PPO - BBA		C	Dallas
H7556	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8715 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract	8132066534				PPO - BBA		C	Dallas
H7556	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract	8132067152				PPO - BBA		C	Dallas
H7556	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract	6023080218				PPO - BBA		C	Dallas
H7556	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8735 Henderson Road Tampa,FL 33634		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8715 Henderson Rd.		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8735 Henderson Road		Tampa	FL	33624	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract	8888656567				PPO - BBA		C	Dallas
H7556	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract	8888656567				PPO - BBA		C	Dallas
H7556	PHR Beneficiary Contact																	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO	Member Services	Centene Corporation	351	Yes	Withdrawn Contract	8336230771				PPO - BBA		C	Dallas
H7556	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Plan Directory Contact for Public Website			Services	Provider		8667960530					CorporateMedicareComplianceDept@Centene.com	1301 International Parkway,	Suite 400	Sunrise	FL	33323	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Plan to Plan Reconciliation Contact	Manager, Reporting and Analytics		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8735 Henderson Road, Ren 1, 2nd Floor	Attn: P2P Department	Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8735 Henderson Road		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8735 Henderson Road	Attn: P2P Department	Tampa	FL	33634	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7556	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	05/26/2023	2023	CENTENE VENTURE COMPANY ALABAMA HEALTH PLAN, INC.	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Withdrawn Contract					PPO - BBA		C	Dallas
H7557	Agent/Broker Compensation Data Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Automated TrOOP Balance Transfer Contact			Rush	Jamie		5616901134					ESITroopTransfer@express-scripts.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Backup User Access Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1, Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Best Available Evidence Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N 107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Bid Audit Contact			Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Bid Audit Site Contact			Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Bid Primary Contact		Mr.	Granow	Les		5614440709					Les.Granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	CAP Report Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	CEO - CMS Administrator Contact		Dr.	Lerer	Rene		5614440780					rene.lerer@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	CEO - Senior Official for Contracting		Ms.	Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Chief Financial Officer		Mr.	Granow	Les		5614440709					les.granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Chief Operating Officer		Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Chief Information Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Chief Information Security Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	CMS Casework Communication Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Complaints Tracking Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Contact for Fraud Investigations			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Coordination of Benefits Contact		Ms.	Burdelik	Dawn		5618153729					dawn.burdelik@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Corporate Mailing						5616901134					compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Coverage Gap Discount Program (CGDP) Payment Contact		Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	Longevity Health Plan	485 Madison Avenue Suite 202	New York	NY	10022	03/11/2021	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Customer Service Operations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	DIR Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	DIR Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Electronic Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Emergency Part D Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Emergency Part D Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Encounter Data & Risk Adjustment Operations Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Enrollment Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	EOB Transfer Contact		Ms.	Socoski	Beth		5616901134				5616901134	Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Financial Audit Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Financial Reporting Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Formulary Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Formulary Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	General Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Government Relations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	HIPAA Privacy Officer		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	HIPAA Security Officer		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Hospice Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Interoperability Contact	CIO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	MA Appeals/Grievances Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	MA Claims Processing Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Marketing Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Medical Director		Mr.	Orgain	Javette		3127206656					javette.orgain@longevityhealthplan.com	Longevity Health Plan	1611 Church Street	Evanston	IL	60201	02/15/2021	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Medicare Compliance Officer		Ms.	Lacey	Jennifer		8133677169					Jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Medicare Coordinator	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Medicare Part D Opioid Overutilization Contact	Director, Clinical & Trend Solutions	Ms.	Muralidharan	Adrienne		5616901134					amuralidharan@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	02/15/2023	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Medication Therapy Management Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	OffShore Subcontractor Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Part C Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Part C Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Part D Appeals	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H7557	Part D Appeals Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H7557	Part D Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Part D Benefits Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		8002040016					Rosario_dovico@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H7557	Part D Exceptions Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H7557	Part D Price File Contact (Back-up)	Product Manager Advisor	Ms.	Williams	Stephanie		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Part D Price File Contact (Optional)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Part D Price File Contact (Primary)	sr mgr, Government Programs		Dolfi	Amanda		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Part D Quality Assurance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Part D Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Patient Safety Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Payment Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Personal Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Pharmacy Director	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra	Ms.	Kelly	Heather		8002040016					hakelly@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Pharmacy Network Management Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Pharmacy Technical Help Desk Contact	Director, Customer Service	Ms.	Moore	LaTasha						8882358551	LaTasha_Monroe@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H7557	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Account Manager	Ms.	Kolesar	Bhrena							Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H7557	Physician Incentive Contact		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Plan Directory Contact for Public Website	Medicare Compliance Director	Ms.	Socoski	Beth		8883133609					Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Plan to Plan Reconciliation Contact		Ms.	Zhai	Vicky		5616328915					Vicky.Zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Processor Contact		Ms.	Gibson	Sharon		6143766614					SGGibson@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Quality Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Reconciliation Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Reconciliation Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Recovery Audit Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	SNP Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	SNP State Contact		Ms.	Lacey	Jennifer		5614440706					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Surveillance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	System Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Third Party Administrator (TPA) Liaison	COO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	User Access Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Utilization Management Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7557	Utilization Review Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MICHIGAN, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	CAP Report Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	12/14/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	09/16/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	MA Claims Processing Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H7559	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H7559	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H7559	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H7559	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	09/16/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	09/16/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	09/16/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H7559	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H7559	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Plan Directory Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7559	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	Molina Healthcare of Virginia, LLC	Local CCP	Molina Healthcare of Virginia	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7598	Agent/Broker Compensation Data Contact	Underwriting Manager		McHugh	Faye		7158522630					fmchugh@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Automated TrOOP Balance Transfer Contact	Clinical Pharmacy Manager		Hofer	Alissa		7158522096					ahofer@pharmastar.com	2411 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Backup User Access Contact	Compliance & Government Programs Manager		McConaughey	Christina		7158522039					cmcconaughey@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Best Available Evidence Contact	Chief Financial Officer	Mr.	Tanner	Robert		7158522064					btanner@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Bid Audit Contact	Chief Financial Officer	Mr.	Tanner	Robert		7158522064					btanner@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Bid Primary Contact	Chief Financial Officer	Mr.	Tanner	Robert		7158522064					btanner@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	CAP Report Contact for Public Website	Chief Information Officer		Pichler	Doug		7158522024					dpichler@group-health.com	2503 N Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	CEO - CMS Administrator Contact	CEO and General Manager	Ms.	North	Sarah		7158522090					snorth@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	CEO - Senior Official for Contracting	CEO and General Manager	Ms.	North	Sarah		7158522090					snorth@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Chief Financial Officer	Chief Financial Officer	Mr.	Tanner	Robert		7158522064					btanner@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Chief Operating Officer	CEO and General Manager	Ms.	North	Sarah		7158522090					snorth@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Chief Information Officer	Chief Information Officer	Mr.	Pichler	Doug		7158522024					dpichler@group-health.com	2503 N Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Chief Information Security Officer	Chief Information Officer	Mr.	Pichler	Doug		7158522024					dpichler@group-health.com	2503 N Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	CMS Casework Communication Contact	Chief Medical Officer		Bauer	Michele		7158525721					mbauer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Complaints Tracking Contact	Director of Compliance		Hernandez	Terri		7158522086					thernandez@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	04/11/2023	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Contact for Fraud Investigations	Audit Supervisor		Harmer	Tina		7158525797					tharmer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	04/11/2023	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Coordination of Benefits Contact	Service Manager		Spurlock	Dual		7158522618					dspurlock@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Corporate Mailing						7158522618				7158367683	dspurlock@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mr.	Tanner	Robert		7158522064					btanner@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Customer Service Operations Contact	Service Manager		Spurlock	Dual		7158522618				7158367683	dspurlock@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	DIR Contact	Chief Financial Officer	Mr.	Tanner	Robert		7158522064					btanner@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Electronic Health Record Contact	Chief Information Officer		Pichler	Doug		7158522024					dpichler@group-health.com	2503 N. Hillcrest Parkway		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Emergency Part D Contact	Chief Medical Officer	Dr.	Bauer	Michele		7158525725					mbauer@group-health.com	2503 N. Hillcrest Parkway		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Encounter Data & Risk Adjustment Operations Contact	Software Development Manager		Wergeland	Cindy		7158522033					cwergela@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Enrollment Contact	Enrollment Coordinator/COB Specialist		Spurlock	Dual		7158522618					dspurlock@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	04/11/2023	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	EOB Transfer Contact	Service Manager		Spurlock	Dual		7158522618				7158367683	dspurlock@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Financial Audit Contact	Accounting Manager	Ms.	Monpas	Theresa		7158525764					tmonpas@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Financial Reporting Contact	Chief Financial Officer	Mr.	Tanner	Robert		7158522064					btanner@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Formulary Contact	Clinical Pharmacy Manager	Ms.	Hofer	Alissa		7158522096					ahofer@pharmastar.com	2411 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Formulary Contact (Secondary)	Clinical Pharmacist		Rau	Dakota		7158525783					drau@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	General Contact	Compliance & Government Programs Manager		McConaughey	Christina		7158522039					cmcconaughey@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Government Relations Contact	CEO and General Manager		North	Sarah		7158522090					snorth@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	HIPAA Privacy Officer	Executive Director of Compliance		McCracken	Sarah		7158525725					smccracken@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	HIPAA Security Officer	Executive Director of Compliance		McCracken	Sarah		7158525725					smccracken@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Hospice Contact	Chief Medical Officer		Bauer	Michele		7158525721					mbauer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Interoperability Contact	CIO		Pichler	Doug		7158522024					DPICHLER@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	MA Appeals/Grievances Contact	Appeals Specialist		Hatleli	Laura		7158522082					lhatleli@grouphealth.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	04/11/2023	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	MA Claims Processing Contact for Public Website	Claims and Product Quality Manager		Polzer	Tera		7158522616					tpolzer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Marketing Contact	Director of Marketing		Yang	Adam		7158522984					ayang@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Medical Director	Chief Medical Officer		Bauer	Michele		7158525721					mbauer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Medicare Compliance Officer	Executive Director of Compliance	Mrs.	McCracken	Sarah		7158525725					smccracken@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Medicare Coordinator	Medicare and Medicaid Specialist		Starck	Sara		7158522083					sstarck@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Medicare Part D Opioid Overutilization Contact	Chief Medical Officer		Bauer	Michele		7158525721					mbauer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Medication Therapy Management Contact	Chief Medical Officer		Bauer	Michele		7158525721					mbauer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Part C Application Contact	Executive Director of Compliance		McCracken	Sarah		7158525725					smccracken@group-health.com	2503 N Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Part C Reporting Contact	Compliance and Government Programs Manager		McConaughey	Christina		7158522039					cmcconaughey@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	04/11/2023	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Part D Appeals	Appeals Specialist		Hatleli	Laura							lhatleli@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	04/11/2023	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active	7158522082				HMO - Health Maintenance Organization		C	Chicago
H7598	Part D Appeals Contact (Secondary)	Director of Compliance		Hernandez	Terri						7158367683	thernandez@group-health.com	2503 N. Hillcrest Parkway		Altoona	WI	54720	04/11/2023	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active	7158522086	5725			HMO - Health Maintenance Organization		C	Chicago
H7598	Part D Application Contact	Executive Director of Compliance		McCracken	Sarah		7158525725					smccracken@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Part D Benefits Contact	Service Manager		Spurlock	Dual		7158522618				7158367683	dspurlock@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Part D Claims Submission Contact	Claims and Product Quality Manager		Polzer	Tera		7158522616					tpolzer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Part D Exceptions Contact	Chief Medical Officer		Bauer	Michele							mbauer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active	8882037770				HMO - Health Maintenance Organization		C	Chicago
H7598	Part D Price File Contact (Back-up)	Clinical Pharmacy Manager	Ms.	Hofer	Alissa		7158522096					ahofer@pharmastar.com	2411 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Part D Price File Contact (Primary)	Chief Financial Officer	Mr.	Tanner	Robert		7158522064					btanner@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Part D Quality Assurance Contact	Quality Improvement Manager		Hanson	Taylor		7158522994					thanson@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Part D Reporting Contact	Compliance and Government Programs Manager		McConaughey	Christina		7158522039					cmcconaughey@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	04/11/2023	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Patient Safety Contact	Chief Medical Officer		Bauer	Michele		7158525721					mbauer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Payment Contact	Accounting Manager		Monpas	Theresa		7158525764					tmonpas@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Pharmacy Director	Clinical Pharmacy Manager	Ms.	Hofer	Alissa		7158522096					ahofer@pharmastar.com	2411 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Pharmacy Network Management Contact	Clinical Pharmacy Manager	Ms.	Hofer	Alissa		7158522096					ahofer@pharmastar.com	2411 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Pharmacy Technical Help Desk Contact	Service Manager		Spurlock	Dual						7158522618	dspurlock@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active	8882037770				HMO - Health Maintenance Organization		C	Chicago
H7598	Plan Directory Contact for Public Website	Director of Marketing		Yang	Adam		7158522984					ayang@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Tanner	Robert		7158522064					btanner@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Processor Contact	Claims and Product Quality Manager		Polzer	Tera		7158522616					tpolzer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Quality Contact	Quality Improvement Manager		Hanson	Taylor		7158522994					thanson@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Reconciliation Contact	Chief Financial Officer	Mr.	Tanner	Robert		7158522064				7158367683	btanner@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Recovery Audit Contact	Chief Financial Officer	Mr.	Tanner	Robert		7158522064					btanner@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	SNP Application Contact	Executive Director of Compliance		McCracken	Sarah		7158525725					smccracken@group-health.com	2503 N. Hillcrest Parkway		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Surveillance Contact	Chief Information Officer		Pichler	Doug		7158522024					dpichler@group-health.com	2503 N Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	System Contact	Chief Information Officer		Pichler	Doug		7158522024					dpichler@group-health.com	2503 N Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Third Party Administrator (TPA) Liaison	CEO and General Manager		North	Sarah		7158522090					snorth@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	User Access Contact	Executive Director of Compliance		McCracken	Sarah		7158525725					smccracken@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	10/20/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Utilization Management Contact	Chief Medical Officer		Bauer	Michele		7158525721					mbauer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7598	Utilization Review Contact	Chief Medical Officer		Bauer	Michele		7158525721					mbauer@group-health.com	2503 N. Hillcrest Pkwy		Altoona	WI	54720	05/04/2022	2023	GROUP HEALTH COOPERATIVE OF EAU CLAIRE	Local CCP	Group Health Cooperative of Eau Claire	HMO/HMOPOS		Group Health Cooperative of Eau Claire	754	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7605	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7605	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7605	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7605	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7605	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H7605	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7605	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H7605	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7605	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH PLAN OF TENNESSEE INC	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7607	Agent/Broker Compensation Data Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	05/10/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Automated TrOOP Balance Transfer Contact		Mr.	Zlotkus	Steve		8587906250					Steve.Zlotkus@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/11/2020	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Backup User Access Contact	CISO	Mr.	Nabours	John		7146508689					john.nabours@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Best Available Evidence Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Bid Audit Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave.	Suite 100	Huntington Beach	CA	92647	03/29/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Bid Audit Site Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Bid Primary Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	CAP Report Contact for Public Website	SVP of Operations	Mrs.	Ramsey	Erin	R	9492911387					Erin.Ramsey@CCMAPD.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	CEO - CMS Administrator Contact	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	CEO - Senior Official for Contracting	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Chief Financial Officer	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave.	Suite 100	Huntington Beach	CA	92647	03/29/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Chief Operating Officer	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Chief Information Officer	CIO	Mr.	Srivastava	Unmesh		6265149143					unmesh.srivastava@ccmapd.com	660 W. Huntington Dr	Suite 200	Arcadia	CA	91007	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Chief Information Security Officer	CISO	Mr.	Nabours	John		7146508689					john.nabours@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	CMMI Model Point of Contact	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	CMS Casework Communication Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Complaints Tracking Contact	Manager, A&G	Ms.	Sprague	Ashlee		7146508768					ashlee.sprague@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Contact for Fraud Investigations	Director, SIU	Mr.	Barlahan	Andrei		7146508691					andrei.barlahan@ccmapd.com	660 W. Huntington Dr	Suite 200	Arcadia	CA	91007	10/11/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Coordination of Benefits Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	07/27/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Corporate Mailing						9492911387					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/15/2023	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave.	Suite 100	Huntington Beach	CA	92647	03/29/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Customer Service Operations Contact	Manager, A&G	Ms.	Sprague	Ashlee		7146508768					ashlee.sprague@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	DIR Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	DIR Contact (Secondary)	SVP of Operations	Mrs.	Ramsey	Erin	R	9492911387					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Electronic Health Record Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	07/27/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Emergency Part D Contact	Compliance Officer	Ms.	Coleman	Sabrina	M	6265149140					sabrina.coleman@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	02/03/2023	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Emergency Part D Contact (Secondary)	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Employer Waiver Contact	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Encounter Data & Risk Adjustment Operations Contact	Senior Director, Risk Adjustment & Encounter Data	Ms.	Naithani	Pooja		7146508771					pooja.naithani@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Enrollment Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	07/27/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	EOB Transfer Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742				6572764714	erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	07/27/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Financial Audit Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Financial Reporting Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Formulary Contact			Nyawablia	Christina		8587906297					Christina.Nyawabila@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/11/2020	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Formulary Contact (Secondary)	VP, Audit & Compliance	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	General Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	9492911387					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Government Relations Contact	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	HIPAA Privacy Officer	Compliance Officer	Ms.	Coleman	Sabrina	M	6265149140					sabrina.coleman@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	02/03/2023	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	HIPAA Security Officer	CISO	Mr.	Nabours	John		7146508689					john.nabours@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Hospice Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	07/27/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Interoperability Contact			Srivastava	Unmesh		6265149143					unmesh.srivastava@ccmapd.com	660 W. Huntington Dr	Suite 200	Arcadia	CA	91007	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	MA Appeals/Grievances Contact	Manager, A&G	Ms.	Sprague	Ashlee		7146508768					ashlee.sprague@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	MA Claims Processing Contact for Public Website	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	07/27/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Marketing Contact	Compliance Analyst	Mrs.	To	Julie		7142009991					julie.to@ccmapd.com	660 W. Huntington Dr.	Suite 200	Arcadia	CA	91007	08/24/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Medical Director	Chief Clinical Officer	Dr.	Siddiq	Khalid		6265149123					khaliq.siddiq@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	02/03/2023	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Medicare Compliance Officer	VP, Audit & Compliance Officer	Mrs.	Coleman	Sabrina		6265149140					sabrina.coleman@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	10/14/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Medicare Coordinator	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	07/27/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Medicare Part D Opioid Overutilization Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	07/27/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Medication Therapy Management Contact	Compliance Analyst	Mrs.	To	Julie		7142009991					julie.to@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	OffShore Subcontractor Contact	Compliance Officer	Mrs.	Coleman	Sabrina	M	6265149140					sabrina.coleman@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	02/03/2023	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Online Enrollment Center Contact (Back-up)	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@ccmapd.com	7711 Center Ave.	Suite 100	Huntington Beach	CA	92647	03/29/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Online Enrollment Center Contact (Optional)	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave.	Suite 100	Huntington Beach	CA	92647	03/29/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Online Enrollment Center Contact (Primary)	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742				6572764714	erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	07/27/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Part C Application Contact	Compliance Officer	Mrs.	Coleman	Sabrina	M	6265149140					sabrina.coleman@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	02/03/2023	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Part C Reporting Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave.	Suite 100	Huntington Beach	CA	92647	03/29/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Appeals			Martin	Dawn							AppealGrievancesManagement@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/03/2020	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active	8587907118				HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Appeals Contact (Secondary)	Manager, A&G	Ms.	Sprague	Ashlee						6572764715	ashlee.sprague@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active	8332839888				HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Application Contact	Compliance Officer	Ms.	Coleman	Sabrina	M	6265149140					sabrina.coleman@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	02/03/2023	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Benefits Contact	Compliance Officer	Ms.	Coleman	Sabrina	M	6265149140					sabrina.coleman@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	02/03/2023	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Claims Submission Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave.	Suite 100	Huntington Beach	CA	92647	03/29/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Exceptions Contact			Martin	Dawn							AppealGrievancesManagement@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/03/2020	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active	8587907118				HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Exceptions Contact (Secondary)	COO	Mr.	Lee	Myong	S						myong.lee@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active	8334099463				HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Price File Contact (Back-up)			Niemi	Kirstin		8587906455					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/11/2020	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Price File Contact (Optional)	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Price File Contact (Primary)	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Quality Assurance Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Part D Reporting Contact			MacLochlainn	Tine		8587907031					MedicarePartDProjectManagers@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/11/2020	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Patient Safety Contact	Compliance Analyst	Mrs.	To	Julie		7142009991					julie.to@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Payment Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Personal Health Record Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	07/27/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Pharmacy Director	Chief Clinical Officer	Dr.	Siddiq	Khaliq		6265149123					kaliq.siddiq@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Pharmacy Network Management Contact			Burke	Sharon	S	8587907148					Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/11/2020	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Pharmacy Network Management Contact (Secondary)	Compliance Analyst	Mrs.	To	Julie		7142009991					julie.to@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services.		Brewer	Kathy							CustomerService@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	11/15/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active	8009263004				HMO - Health Maintenance Organization		C	San Francisco
H7607	Pharmacy Technical Help Desk Contact (Secondary)	COO	Mr.	Lee	Myong	S						Myong.Lee@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active	8334099463				HMO - Health Maintenance Organization		C	San Francisco
H7607	Physician Incentive Contact	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Plan Directory Contact for Public Website	Customer Service		Service	Customer		8333888162					csr@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Plan to Plan Reconciliation Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Processor Contact		Mr.	Davis-Jones	DeLona	S	8587906229					MedicarePartDProjectManagers@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	02/11/2020	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Quality Contact	Director of Quality and Stars Program	Ms.	Encarnacion	Eden Anne	V	8189238299				6572764714	eden.encarnacion@ccmapd.com	660 W Huntington Dr	Suite 200	Arcadia	CA	91007	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Reconciliation Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Reconciliation Contact (Secondary)	SVP of Operations	Mrs.	Ramsey	Erin	R	9492911387					Erin.Ramsey@CCMAPD.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Recovery Audit Contact	CFO	Mr.	Pham	Hiep	D	7144225089					Hiep.Pham@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	SNP Application Contact	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@clevercarehealthplan.com	7711 Center Ave.	Suite 100	Huntington Beach	CA	92647	04/19/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	SNP State Contact	COO	Mr.	Lee	Myong	S	9179239858					myong.lee@clevercarehealthplan.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Surveillance Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742					erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	System Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	7146508742				6572764714	erin.ramsey@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	07/27/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Third Party Administrator (TPA) Liaison	Mgr, Financial Planning & Analysis	Mr.	Hoang	Tom		7144675689					tom.hoang@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	User Access Contact	SVP of Operations	Mrs.	Ramsey	Erin	R	9492911387					erin.ramsey@ccmapd.com	7711 Center Ave.	Suite 100	Huntington Beach	CA	92647	08/12/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Utilization Management Contact	Director, Utilization Management	Ms.	Clarke	Terry		7146508766					terry.clarke@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7607	Utilization Review Contact	Director, Utilization Management	Ms.	Clarke	Terry		7146508766					terry.clarke@ccmapd.com	7711 Center Ave	Suite 100	Huntington Beach	CA	92647	04/18/2022	2023	CLEVER CARE OF GOLDEN STATE, INC.	Local CCP	Clever Care Health Plan	HMO/HMOPOS		Clever Care Health Plan, Inc.	750	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7617	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H7617	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025807929				PPO - BBA		C	Kansas City
H7617	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025809138				PPO - BBA		C	Kansas City
H7617	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5024682494				PPO - BBA		C	Kansas City
H7617	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	8008658715				PPO - BBA		C	Kansas City
H7617	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active	5025800475				PPO - BBA		C	Kansas City
H7617	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7617	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	EMPHESYS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Active					PPO - BBA		C	Kansas City
H7619	Automated TrOOP Balance Transfer Contact	Health Plan Operations	Ms.	Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Backup User Access Contact	Quality Assurance and Enrollment Director		Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Best Available Evidence Contact	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Bid Primary Contact	Health Plan Operations		Alvarado	Kathleen		6095728588					kathleen.alvarado@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	06/02/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	CAP Report Contact for Public Website	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	CEO - CMS Administrator Contact	Interim Executive Director	Ms.	Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	CEO - Senior Official for Contracting	Interim Executive Director	Ms.	Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite  1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Chief Financial Officer	CFO	Mr.	Kim	Hak		6095697031					hak.kim@atlanticare.org	2500 English Creek Avenue	Building 500	Egg Harbor Township	NJ	08234	08/16/2021	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Chief Operating Officer	Interim Executive Director	Ms.	Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08226	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Chief Information Officer	Interim Executive Director	Ms.	Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08226	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Chief Information Security Officer	Quality Assurance Director	Ms.	Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	11/21/2018	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	CMS Casework Communication Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Complaints Tracking Contact	Quality Assurance Director	Ms.	Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	11/21/2018	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Contact for Fraud Investigations	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Coordination of Benefits Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Corporate Mailing						6095728588					Sandra.Festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Coverage Gap Discount Program (CGDP) Payment Contact	Health Plan Operations	Ms.	Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Customer Service Operations Contact	Quality Assurance Director	Ms.	Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	11/21/2018	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	DIR Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	DIR Contact (Secondary)	Health Plan Operations	Ms.	Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Emergency Part D Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Emergency Part D Contact (Secondary)	Health Plan Operations	Ms.	Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Encounter Data & Risk Adjustment Operations Contact	Health Plan Operations	Ms.	Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Enrollment Contact			Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	EOB Transfer Contact	Manager of Health Plan Operations		Alvarado	Kathleen		6095728588				6095728589	Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Financial Audit Contact	Health Plan Operations Manager	Ms.	Alvarado	Kathleen		6095728588					kathleen.alvarado@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	12/16/2022	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Financial Reporting Contact			Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Formulary Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Formulary Contact (Secondary)	Manager of Health Plan Operations		Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	General Contact	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Government Relations Contact	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	HIPAA Privacy Officer	Quality Assurance Director	Ms.	Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	11/21/2018	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	HIPAA Security Officer	Quality Assurance Director	Ms.	Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	11/21/2018	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Interoperability Contact	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave	Ste 1400	Atlantic CIty	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	MA Appeals/Grievances Contact	Quality Assurance Director	Ms.	Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	11/21/2018	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	MA Claims Processing Contact for Public Website	Health Plan Operations Manager		Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Marketing Contact	Quality Assurance and Enrollment Director		Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Medical Director	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Medicare Compliance Officer	Quality Assurance Director	Ms.	Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	11/21/2018	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Medicare Coordinator	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Medication Therapy Management Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Part C Application Contact	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Part D Appeals	Medical Director	Dr.	Mazur	Kimberly							Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active	6095728588				PACE - Nat		C	New York
H7619	Part D Appeals Contact (Secondary)	Health Plan Operations Manager		Alvarado	Kathleen							Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave	Ste 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active	6095728588				PACE - Nat		C	New York
H7619	Part D Application Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Part D Benefits Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Part D Claims Submission Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Part D Exceptions Contact	Medical Director	Dr.	Mazur	Kimberly							Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active	6095728588				PACE - Nat		C	New York
H7619	Part D Price File Contact (Back-up)	Health Plan Operations Manager		Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Part D Price File Contact (Primary)	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Part D Quality Assurance Contact	Quality Assurance Director		Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Avenue	Suite 1400	Atlantic City	NJ	08401	04/09/2019	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Part D Reporting Contact	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Patient Safety Contact	Quality Assurance Director		Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Avenue	Suite 1400	Atlantic City	NJ	08401	04/09/2019	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Payment Contact	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Pharmacy Director	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Pharmacy Network Management Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Pharmacy Technical Help Desk Contact	Medical Director	Dr.	Mazur	Kimberly							Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active	6095728588				PACE - Nat		C	New York
H7619	Plan Directory Contact for Public Website	Quality Assurance and Enrollment Director		Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Plan to Plan Reconciliation Contact	Health Plan Operations Manager		Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Processor Contact	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Quality Contact	Quality Assurance Director	Ms.	Williams	Erin		6095728588					erin.williams@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	11/21/2018	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Reconciliation Contact	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Recovery Audit Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Surveillance Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	System Contact	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Third Party Administrator (TPA) Liaison	Health Plan Operations Manager		Alvarado	Kathleen		6095728588					Kathleen.Alvarado@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/20/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	User Access Contact	Interim Executive Director		Festa	Sandra		6095728588					sandra.festa@atlanticare.org	1401 Atlantic Ave.	Suite 1400	Atlantic City	NJ	08401	05/19/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Utilization Management Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7619	Utilization Review Contact	Medical Director	Dr.	Mazur	Kimberly		6095728588					Kimberly.Mazur@atlanticare.org	1401 Atlantic Ave	Suite 1400	Atlantic City	NJ	08401	01/03/2023	2023	ATLANTICARE HEALTH SERVICES, INC.	National PACE	AtlantiCare LIFE Connection	National PACE		AtlantiCare Health Services, Inc.	683	Yes	Active					PACE - Nat		C	New York
H7621	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H7621	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H7621	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7621	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA HEALTH PLAN OF CALIFORNIA, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H7646	Agent/Broker Compensation Data Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	12/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Automated TrOOP Balance Transfer Contact	Director Enrollment, Eligibility & OHI	Mrs.	Meyer	Jennell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/26/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Backup User Access Contact	Sr Analyst, Medicare Compliance	Ms.	Richardson	Heather		5174907128					heather.richardson@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	01/08/2021	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Best Available Evidence Contact	Director Enrollment, Eligibility & OHI	Mr.	Meyer	Jennell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/10/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Bid Audit Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	12/27/2019	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Bid Audit Site Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	12/27/2019	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Bid Primary Contact	Actuary	Mr.	Copeland	Joe		3142095834					jcopeland@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/10/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	CAP Report Contact for Public Website	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	12/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	CEO - CMS Administrator Contact	President & CEO	Mr.	Reese	Dennis		5175992256					dennis.reese@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	12/31/2019	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	CEO - Senior Official for Contracting	President & CEO	Mr.	Reese	Dennis		5175992256					dennis.reese@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	12/14/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Chief Financial Officer	Chief Financial Officer	Ms.	Werner	Nicole		5174496213					Nicole.Werner@PHPMM.org	1400 E. Michigan Ave.		Lansing	MI	489122107	03/21/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Chief Operating Officer	COO/CIO	Mr.	Dengel	Jonathan		5172901508					PHP-Medicare_Compliance@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	08/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Chief Information Officer	COO/CIO	Mr.	Dengel	Jonathan		5172901508					PHP-Medicare_Compliance@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	08/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Chief Information Security Officer	Chief Information Security Officer	Mr.	Carpenter	Trent		5173646440					PHP-Medicare_Compliance@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	08/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	CMMI Model Point of Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	12/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	CMS Casework Communication Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Complaints Tracking Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Contact for Fraud Investigations	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Coordination of Benefits Contact			Inquiries	COB		8445293757					COBInquiry@lumeris.com	P O BOX 7119		Troy	MI	48007	06/26/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Corporate Mailing						5173648400					customerservice@phpmedicare.com	1400 E. Michigan Ave.		Lansing	MI	489122107	03/10/2020	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Customer Service Operations Contact	Vice President, Health Plan Operations	Ms.	Meyerhoeffer	Linda		6366869682					rmeyerhoeffer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	DIR Contact	Chief Financial Officer	Ms.	Werner	Nicole		5173648315					nicole.werner@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	03/21/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	DIR Contact (Secondary)	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E Michigan Ave		Lansing	MI	489122107	02/27/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Electronic Health Record Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	12/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Emergency Part D Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Emergency Part D Contact (Secondary)	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	12/27/2019	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Employer Waiver Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment SErvices	Mr.	Eschbach	Jason		6144397608					jeschbach@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/14/2021	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Enrollment Contact	Director Enrollment, Eligibility & OHI	Mr.	Meyer	Jennell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/10/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	EOB Transfer Contact	Director, Claims	Ms.	Wasserman	Rachelle		3147703520				3147706096	rwasserman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/14/2021	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Financial Audit Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Financial Reporting Contact	Senior Accountant	Ms.	Whelan	Grace		5173648288					Grace.Whelan@PHPMM.org	1400 E. Michigan Ave.		Lansing	MI	489122107	05/01/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Formulary Contact	Sr  Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Formulary Contact (Secondary)	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan		Lansin	MI	48912	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	General Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Government Relations Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	12/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	HIPAA Privacy Officer	Mgr, Compliance	Ms.	Adams	Trisha		5173648486					PHP-Medicare_Compliance@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	08/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	HIPAA Security Officer	Manager, Compliance	Ms.	Adams	Trisha		5173648486					PHP-Medicare_Compliance@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	08/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Hospice Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Interoperability Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E Michigan Ave		Lansing	MI	48912	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Darnell	Erika		3144382410					ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/10/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	MA Claims Processing Contact for Public Website			CustomerService	PHP		8445293757					customerservice@phpmedicare.com	PO BOX 7119		Troy	MI	48007	12/22/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Marketing Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Medical Director	Chief Medical Officer	Dr.	Thompson	Kenneth		2693529564					Kenneth.Thompson@sparrow.org	1400 E. Michigan Ave.		Lansing	MI	489122107	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Medicare Compliance Officer	Director Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	12/27/2019	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Medicare Coordinator	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Medicare Part D Opioid Overutilization Contact	Snr. Clinical Pharmacist	Ms.	Pasagic	Melita		3147703775					mpasagic@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	01/19/2021	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Medication Therapy Management Contact	Sr  Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	OffShore Subcontractor Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Online Enrollment Center Contact (Back-up)	Manager, Compliance	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	11/11/2021	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Online Enrollment Center Contact (Optional)	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Online Enrollment Center Contact (Primary)	Director Enrollment, Eligibility & OHI	Mr.	Meyer	Jennell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/10/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Part C Application Contact	Sr Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/14/2021	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Part C Reporting Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Appeals	Director, Appeals & Grievances	Ms.	Darnell	Erika							ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	05/10/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active	3144382410				HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Appeals Contact (Secondary)	Manager, Compliance	Ms	Young	Polly							pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	08/11/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active	3142092795				HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Application Contact	Sr Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/14/2021	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Benefits Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		9145896300					rosario_dovico@express-scripts.com	One Express Way		St Louis	MO	63121	10/14/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian							brian_schumm@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active	8003343405	73326			HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Exceptions Contact (Secondary)	Director, Medicare Compliance	Ms.	Coberly	Michelle							michelle.coberly@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active	2693529564				HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Price File Contact (Back-up)	Manager, Regulated Markets Product	Ms.	Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	04/17/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Price File Contact (Optional)	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Price File Contact (Primary)	Sr Manager, Regulated Markets	Ms.	Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	04/17/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Quality Assurance Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Part D Reporting Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Patient Safety Contact	Sr  Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Payment Contact	Chief Financial Officer	Ms.	Werner	Nicole		5173648315					nicole.werner@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	03/21/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Personal Health Record Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Pharmacy Director	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Pharmacy Network Management Contact	Network Account Director	Ms.	Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		Saint Louis	MO	63121	01/12/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Pharmacy Network Management Contact (Secondary)	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Pharmacy Technical Help Desk Contact	Director Customer Service	Ms.	Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkwy Suite 150		Temple Terrace	FL	33637	11/18/2021	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H7646	Pharmacy Technical Help Desk Contact (Secondary)	Sr  Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly							ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active	3147703788				HMO - Health Maintenance Organization		C	Chicago
H7646	Physician Incentive Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Plan Directory Contact for Public Website			CustomerService	PHP		8445293757					customerservice@phpmedicare.com	PO BOX 7119		Troy	MI	48007	12/22/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Plan to Plan Reconciliation Contact	Sr. Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Processor Contact	Sr. Director, Government Programs, Medicare	Ms.	Gibson	Sharon		8052361175					sggibson@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	02/01/2019	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Quality Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Reconciliation Contact	Chief Financial Officer	Ms.	Werner	Nicole		5173648315					nicole.werner@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	03/21/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Reconciliation Contact (Secondary)	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Recovery Audit Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	SNP Application Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Avenue		Lansing	MI	48912	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Surveillance Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	System Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Third Party Administrator (TPA) Liaison	Client AP Specialist	Ms.	Brock	Letecea		3142548778					lbrock@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	12/20/2021	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	User Access Contact	Director, Medicare Compliance	Ms.	Coberly	Michelle		2693529564					michelle.coberly@phpmm.org	1400 E. Michigan Ave.		Lansing	MI	489122107	04/01/2022	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Utilization Management Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7646	Utilization Review Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	03/22/2023	2023	PHP MEDICARE	Local CCP	PHP Medicare	HMO/HMOPOS		University of Michigan Health	727	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7656	Automated TrOOP Balance Transfer Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Backup User Access Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Best Available Evidence Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Bid Primary Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	CAP Report Contact for Public Website	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	CEO - CMS Administrator Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	CEO - Senior Official for Contracting	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Chief Financial Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Chief Operating Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Chief Information Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Chief Information Security Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	CMS Casework Communication Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Complaints Tracking Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Contact for Fraud Investigations	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Coordination of Benefits Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Corporate Mailing						2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Customer Service Operations Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	DIR Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	DIR Contact (Secondary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Emergency Part D Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Emergency Part D Contact (Secondary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Encounter Data & Risk Adjustment Operations Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Enrollment Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	EOB Transfer Contact	CFO	Mrs	Prentis	Kristin		7328063224				7328063224	kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Financial Audit Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Financial Reporting Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Formulary Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Formulary Contact (Secondary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	General Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Government Relations Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	HIPAA Privacy Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	HIPAA Security Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Interoperability Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	MA Appeals/Grievances Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	MA Claims Processing Contact for Public Website	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Marketing Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Medical Director	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Medicare Compliance Officer	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Medicare Coordinator	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Medicare Part D Opioid Overutilization Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Medication Therapy Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	OffShore Subcontractor Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Online Enrollment Center Contact (Back-up)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Online Enrollment Center Contact (Primary)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Part C Application Contact	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenix	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Part D Appeals	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	San Francisco
H7656	Part D Appeals Contact (Secondary)	Executive Director	Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	San Francisco
H7656	Part D Application Contact	CEO		Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenix	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Part D Benefits Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Part D Claims Submission Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Part D Exceptions Contact	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	San Francisco
H7656	Part D Exceptions Contact (Secondary)		Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	San Francisco
H7656	Part D Price File Contact (Back-up)	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Part D Price File Contact (Primary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Part D Quality Assurance Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Part D Reporting Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Patient Safety Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Payment Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Personal Health Record Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Pharmacy Director	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Pharmacy Network Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Pharmacy Network Management Contact (Secondary)	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Pharmacy Technical Help Desk Contact	Executive Director	Mrs	Runyon	Bobbi							brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	San Francisco
H7656	Pharmacy Technical Help Desk Contact (Secondary)	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	San Francisco
H7656	PHR Beneficiary Contact																	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE	Beacon of Life SC			Yes	Pending	7325923400				PACE - Nat		C	San Francisco
H7656	Plan Directory Contact for Public Website	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Plan to Plan Reconciliation Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Processor Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Quality Contact	CEO	Mrs	Austin	Mary		2156098714					maustin@boldagepace.com	134 Mary Hill Road		Phoenixville	PA	19460	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Reconciliation Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Reconciliation Contact (Secondary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Recovery Audit Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Surveillance Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	System Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Third Party Administrator (TPA) Liaison	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	User Access Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Utilization Management Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7656	Utilization Review Contact	Executive Director	Mrs	Runyon	Bobbi		7325923400					brunyon@beaconpace.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	09/15/2023	2023	VALLEY PACE, LLC	National PACE	Valley PACE, LLC	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H7660	Automated TrOOP Balance Transfer Contact	Director Financial Management	Mr.	Hamm	David		7247761100					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	05/23/2022	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Backup User Access Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	03/10/2020	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Best Available Evidence Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Bid Primary Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	CAP Report Contact for Public Website	Director Quality Assurance and education	Mr.	Hankey	Laura		4123561668				7243022091	laura.hankey@lutheranseniorlife.org	740 Blackburn Rd, Suite 300		Sewickley	PA	15143	08/04/2020	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	CEO - CMS Administrator Contact	CEO	Mr	Hamm	David	A	7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/19/2023	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	CEO - Senior Official for Contracting	CEO	Mr	Hamm	David	A	7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/19/2023	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Chief Financial Officer	CFO	Mr.	Carraway	Jeffrey		7247761100					jeffrey.carraway@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	02/02/2018	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Chief Operating Officer	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	04/19/2023	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Chief Information Officer	VP Technology and Quality	Mr	Lamb	Charles		7247209202					charles.lamb@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	11/06/2017	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Chief Information Security Officer	VP Technology and Quality	Mr	Lamb	Charles		7247209202					charles.lamb@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/08/2019	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	CMS Casework Communication Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Complaints Tracking Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Contact for Fraud Investigations	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Coordination of Benefits Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Corporate Mailing						4123561668					leslie.kisow@lutheranseniorlife.org	740 Blackburn Rd, Suite 300		Sewickley	PA	15143	06/07/2023	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Coverage Gap Discount Program (CGDP) Payment Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	05/21/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Customer Service Operations Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	DIR Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	DIR Contact (Secondary)	Accounting Manager		Cionni	Jane		7247422202					maryjane.cionni@lutheranseniorlife.org	1323 Freedom Rd		Cranberry Township	PA	16066	01/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Emergency Part D Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Emergency Part D Contact (Secondary)	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Encounter Data & Risk Adjustment Operations Contact	Director Financial Management		Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	03/10/2020	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Enrollment Contact	Accounting Manager	Ms.	Cionni	Jane		7247422202					maryjane.cionni@lutheranseniorlife.org	1323 Freedom Road		Cranberry Township	PA	16066	01/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	EOB Transfer Contact	Director Financial Management	Mr.	Hamm	David		7247422226				7247722960	dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/21/2017	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Financial Audit Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/21/2017	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Financial Reporting Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/21/2017	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Formulary Contact	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	10/03/2022	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	General Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Government Relations Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	HIPAA Privacy Officer	Compliance Officer	Ms.	Kaminski	Leean		7247422295					leean.kaminski@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/16/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	HIPAA Security Officer	Director MIS	Mr.	Gilson	Dennis		7246254841					dennis.gilson@lutheranseniorlife.org	500 Wittenberg Way	P. O. Box 928	Mars	PA	16046	08/09/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Interoperability Contact			Hamm	David		7247761100					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	05/23/2022	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	MA Appeals/Grievances Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	MA Claims Processing Contact for Public Website	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/21/2017	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Marketing Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Medical Director	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	10/03/2022	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Medicare Compliance Officer	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/21/2017	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Medicare Coordinator	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	10/23/2022	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Medication Therapy Management Contact	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	10/03/2022	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Part C Application Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Part D Appeals	Director Financial Management	Mr.	Hamm	David							dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/21/2017	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active	7247422226				PACE - Nat		C	Philadelphia
H7660	Part D Application Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	04/21/2017	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Part D Benefits Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/16/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Part D Claims Submission Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/16/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Part D Exceptions Contact	Director Financial Management	Mr.	Hamm	David							dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/16/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active	7247422226				PACE - Nat		C	Philadelphia
H7660	Part D Price File Contact (Back-up)	Accounting Manager	Ms.	Cionni	Jane		7247422202					Maryjane.cionni@lutheranseniorlife.org	1323 Freedom Road		Cranberry Township	PA	16066	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Part D Price File Contact (Primary)	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/16/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Part D Quality Assurance Contact	Director Quality Assurance and education	Mr.	Hankey	Laura		4123561668					laura.hankey@lutheranseniorlife.org	740 Blackburn Rd, Suite 300		Sewickley	PA	15143	04/08/2019	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Part D Reporting Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/16/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Patient Safety Contact	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	10/03/2022	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Payment Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Pharmacy Director	Medical Director	Dr.	Hanna	Abeer		7242875433					abeer.hanna@lutheranseniorlife.org	231 Diamond St		Butler	PA	16001	10/03/2022	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Pharmacy Network Management Contact	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Pharmacy Technical Help Desk Contact	Medical Director	Dr.	Hanna	Abeer							abeer.hanna@lutheranseniorlife.org	LIFE-Beaver County Center Place	131 Pleasant Drive Suite 1	Aliquippa	PA	15001	10/03/2022	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active	7243785400				PACE - Nat		C	Philadelphia
H7660	Plan Directory Contact for Public Website	Executive Director	Ms	Kisow	Leslie		7247761100					leslie.kisow@lutheranseniorlife.org	740 Blackburn Road		Sewickley	PA	15143	11/22/2021	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Plan to Plan Reconciliation Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Processor Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Quality Contact	Director Quality Assurance and education	Mr.	Hankey	Laura		4123561668					laura.hankey@lutheranseniorlife.org	740 Blackburn Rd, Suite 300		Sewickley	PA	15143	04/08/2019	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Reconciliation Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Recovery Audit Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Surveillance Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	System Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	08/10/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Third Party Administrator (TPA) Liaison	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	191 Scharberry Lane		Mars	PA	16046	05/21/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	User Access Contact	Director Financial Management	Mr.	Hamm	David		7247422226					dave.hamm@lutheranseniorlife.org	Lutheran SeniorLife	191 Scharberry Lane	Mars	PA	16046	08/09/2016	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Utilization Management Contact	Utilization Review Coordinator	Ms.	Nemec	Dawn		4123561653					dawn.nemec@lutheranseniorlife.org	740 Blackburn Road, Suite 300		Sewickley	PA	15143	04/08/2019	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7660	Utilization Review Contact	Utilization Review Coordinator	Ms.	Nemec	Dawn		4123561653					dawn.nemec@lutheranseniorlife.org	740 Blackburn Road, Suite 300		Sewickley	PA	15143	04/08/2019	2023	VIECARE BEAVER, LLC	National PACE	LIFE Beaver and Lawrence Counties	National PACE		Lutheran SeniorLife	352	Yes	Active					PACE - Nat		C	Philadelphia
H7670	Agent/Broker Compensation Data Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Automated TrOOP Balance Transfer Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Backup User Access Contact	Medicare Compliance Officer		Perritt	Maggie		7747011601					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Best Available Evidence Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Bid Audit Contact	CFO	Mr.	Beerman	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Bid Audit Site Contact	CFO	Mr.	Beerman	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Bid Primary Contact	CFO	Mr.	Beerman	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	CEO - CMS Administrator Contact	President	Ms.	Trafton	Heather		7747011213					Heather.Trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	CEO - Senior Official for Contracting	President	Ms.	Trafton	Heather		7747011213					Heather.Trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Chief Financial Officer	CFO	Mr.	Beerman	James		7747011437					james.beermann@massadvantage.com	365 Plantation St	3rd Floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Chief Operating Officer	President	Ms.	Trafton	Heather		7747011213					heather.trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Chief Information Officer	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					Maggie.Perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Chief Information Security Officer	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					Maggie.Perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	CMMI Model Point of Contact	President	Ms.	Trafton	Heather		7747011213					Heather.Trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	CMS Casework Communication Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Complaints Tracking Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Contact for Fraud Investigations	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Coordination of Benefits Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Corporate Mailing						7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Beerman	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Customer Service Operations Contact	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	DIR Contact	CFO	Mr.	Beerman	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	DIR Contact (Secondary)	President	Ms.	Trafton	Heather		7747011213					Heather.Trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Electronic Health Record Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Emergency Part D Contact	Medicare Pharmacy Program Director	Ms.	Hursey	Erica		7747011626					erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	12/21/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Emergency Part D Contact (Secondary)	Pharmacy Manager, Part D		Jones	Susan		7747011720					Susan.Jones@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	12/28/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Employer Waiver Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Encounter Data & Risk Adjustment Operations Contact	Director, Business Systems Analysis		Pedigo	Anne		6157723229					anne.pedigo@sscinc.com	210 W. 10th Street		Kansas CIty	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Enrollment Contact	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	EOB Transfer Contact	Vice President		Velten	Steve		8164357408				3607211381	svelten@dsthealth.com	210 W. 10th Street		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Financial Audit Contact	CFO	Mr.	Beerman	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Financial Reporting Contact	CFO	Mr.	Beerman	James		7747011437					james.beermann@massadvantage.com	365 Plantation St	3rd Floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Formulary Contact	Pharmacy Manager, Part D		Jones	Susan		7747011720					susan.jones@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	12/21/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Formulary Contact (Secondary)	Medicare Pharmacy Program Director		Hursey	Erica		7747011626					erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	05/16/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	General Contact	Senior Vice President, Operations	Ms.	Turbett	Catherine		7747011724					Catherine.Turbett@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Government Relations Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	HIPAA Privacy Officer	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					Maggie.Perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	HIPAA Security Officer	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					Maggie.Perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Hospice Contact	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Interoperability Contact	IT Director		Carey	Cameron		9789356216					cam.carey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	05/16/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	MA Appeals/Grievances Contact	President	Ms.	Trafton	Heather		7747011213					heather.trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	MA Claims Processing Contact for Public Website	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W. 10th Street		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Marketing Contact	VP of Sales and Marketing	Ms.	Mood	Margaret		7747011181					margaret.mood@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Medical Director	Chief Medical Officer	Dr.	Wang	David		5083341000					david.wang@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Medicare Coordinator	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Medicare Part D Opioid Overutilization Contact	Medicare Pharmacy Program Director		Hursey	Erica		7747011626					erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	05/16/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Medication Therapy Management Contact	Medicare Pharmacy Program Director		Hursey	Erica		7747011626					erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	05/16/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Online Enrollment Center Contact (Back-up)	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Online Enrollment Center Contact (Optional)	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Online Enrollment Center Contact (Primary)	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Part C Application Contact	Sr Manager Network Management		McWilliams	Leach		7747011735					leah.mcwilliams@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	02/13/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Part C Reporting Contact	Senior Director, Government Programs		LeVecque	Lynn		5083340569					lynn.levecque@umassmemorial.org	365 Plantation Street	3rd floor	Worcester	MA	01605	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Part D Appeals	Sr Manager of Pharmacy Part D	Ms.	Jones	Susan							susan.jones@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	10/24/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active	7747011720				HMO - Health Maintenance Organization		C	New York
H7670	Part D Appeals Contact (Secondary)	Medicare Pharmacy Program Director	Ms	Hursey	Erica							erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	10/24/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active	7747011626				HMO - Health Maintenance Organization		C	New York
H7670	Part D Application Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Part D Benefits Contact	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Part D Claims Submission Contact	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Part D Exceptions Contact	Vice President, Compliance & Contracting		Cone	Mark							mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active	8168436461				HMO - Health Maintenance Organization		C	New York
H7670	Part D Exceptions Contact (Secondary)	Vice President, Compliance & Contracting		Cone	Mark							mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active	8168436461				HMO - Health Maintenance Organization		C	New York
H7670	Part D Price File Contact (Back-up)	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Part D Price File Contact (Optional)	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Part D Price File Contact (Primary)	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Part D Quality Assurance Contact	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Part D Reporting Contact	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Patient Safety Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Payment Contact	CFO	Mr.	Beerman	James		7747011437					james.beermann@massadvantage.com	365 Plantation St	3rd Floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Personal Health Record Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Pharmacy Director	Sr Director Pharmacy Network Analytics and Pricing		Huffman	Gregg		8164352471					ghuffman@sscinc.com	210 W 10th St		Kansas City	MO	64105	10/18/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Pharmacy Network Management Contact	Sr Director Pharmacy Network Analytics and Pricing		Huffman	Gregg		8164352471					ghuffman@sscinc.com	210 W 10th St		Kansas City	MO	64105	10/18/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Pharmacy Network Management Contact (Secondary)	Sr Director Pharmacy Network Analytics and Pricing		Huffman	Gregg		8164352471					ghuffman@dsthealth.com	210 W 10th St		Kansas City	MO	64105	10/18/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Pharmacy Technical Help Desk Contact	Sr Director Pharmacy Network Analytics and Pricing		Huffman	Greg							ghuffman@sscinc.com	210 W 10th St		Kansas City	MO	64105	10/24/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active	8449180114				HMO - Health Maintenance Organization		C	New York
H7670	Pharmacy Technical Help Desk Contact (Secondary)	Sr Director Pharmacy Network Analytics and Pricing		Huffman	Greg							ghuffman@sscinc.com	210 W 10th St		Kansas City	MO	64105	10/24/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active	8449180114				HMO - Health Maintenance Organization		C	New York
H7670	PHR Beneficiary Contact																	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS	Central Mass Health Holding LLC	Central Mass Health Holding LLC	773	Yes	Active	8164352412				HMO - Health Maintenance Organization		C	New York
H7670	Physician Incentive Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Plan Directory Contact for Public Website	President	Ms.	Trafton	Heather		7747011213					heather.trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Plan to Plan Reconciliation Contact	Medicare Pharmacy Program Director		Hursey	Erica		7747011626					erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	06/21/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Processor Contact	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W. 10th Street		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Quality Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Reconciliation Contact	CFO	MR.	Beerman	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Reconciliation Contact (Secondary)	Comptroller		Natarajan	Gayatri		7747011731					gayatri.natarajan@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	02/16/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	SNP Application Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	SNP State Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Surveillance Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	System Contact	President	Ms.	Trafton	Heather		7747011213					Heather.Trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Third Party Administrator (TPA) Liaison	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	User Access Contact	Medicare Compliance Officer		Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	05/16/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Utilization Management Contact	President	Ms.	Trafton	Heather		7747011213					heather.trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7670	Utilization Review Contact	Chief Medical Officer		Wang	David		7747011441					david.wang@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	HMO/HMOPOS		Central Mass Health Holding LLC	773	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	CAP Report Contact for Public Website			Services	Member		8664400012					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	MA Claims Processing Contact for Public Website			Services	Member		8664400012					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/12/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H7678	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H7678	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H7678	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H7678	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H7678	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H7678	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Plan Directory Contact for Public Website			Services	Member		8664400012					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Processor Contact	MHI-Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/06/2020	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7678	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Local CCP	Molina Healthcare of Texas, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7680	Agent/Broker Compensation Data Contact	Vice President of Medicare Sales	Mr.	Tolle	Rob		4699997675					Rob.Tolle@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Manosca	Nova		8587905873					PartDCAT@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Backup User Access Contact			Rassmussen	Eric		7754204825					eric.rassmussen@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Best Available Evidence Contact	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Bid Audit Contact	Chief Compliance Officer	Mr	Ramirez	Philip		7757709348				7757709360	philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Bid Audit Site Contact	Sr. Program Manager	Mr	Cahill	Eric		7757709245				7757709360	eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Bid Primary Contact	Sr. Program Manager	Mr	Cahill	Eric		7757709245				7757709360	eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	CAP Report Contact for Public Website	Marketing Director		Belli	Libby		7757709450					libby.belli@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	CEO - CMS Administrator Contact	CEO	Mr	Jemmoua	Kamal		7757709325					kamal.jemmoua@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	CEO - Senior Official for Contracting	CEO	Mr.	Jemmoua	Kamal		7757709325					kamal.jemmoua@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Chief Financial Officer	Chief Financial Officer	Mr.	Hsieh	David		6103823300					david.hsieh@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Chief Operating Officer	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Chief Information Officer	Vice President of IT	Mr.	Rasmussen	Eric		7757709234				7757709060	eric.rasmussen@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89510	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Chief Information Security Officer	CISO - UHS	Mrs.	Sassaman	Kim		6103824858					kim.sassaman@uhsinc.com	367 S Gulph RD		King of Prussia	PA	19406	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	CMMI Model Point of Contact	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	CMS Casework Communication Contact	Chief Compliance Officer	Mr.	Ramirez	Philip	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Complaints Tracking Contact	Director of Operations		Revada	Liz		7757709207					liz.revada@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Contact for Fraud Investigations	SIU Investigator	Mrs.	Kast	Shannon		7754204840					Shannon.Kast@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Coordination of Benefits Contact	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Corporate Mailing						7757709245					eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Coverage Gap Discount Program (CGDP) Payment Contact	Pharmacy Director		Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89052	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Customer Service Operations Contact	Chief Operating Officer		Koltz	Patrick		7757709240					patrick.koltz@uhsinc.com	1510 Meadow Wood Ln		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	DIR Contact	CEO	Mr	Jemmoua	Kamal		6109924579				7757709360	kamal.jemmoua@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	DIR Contact (Secondary)	Director Pharmacy	Mr.	Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Electronic Health Record Contact	Director Health Services		Estipona	Steve		7757709462					steve.estipona@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Emergency Part D Contact	Director Pharmacy	Mr.	Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Emergency Part D Contact (Secondary)	Manager of Pharmacy Services	.	Holybee	Jonni		7757373028					jonni.holybee@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Employer Waiver Contact	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Encounter Data & Risk Adjustment Operations Contact	Chief Development Officer		Henriques	Dominic		7757709282					dominic.henriques@uhsinc.com	1510 Meadow Wood Ln		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Enrollment Contact	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	EOB Transfer Contact	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240				9999999999	Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Financial Audit Contact	Manager of Finance	Mr.	Lopez	Robert		7757709374					Robert.lopez3@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Financial Reporting Contact	Manager of Finance	Mr.	Lopez	Robert		7757709374					Robert.lopez3@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Formulary Contact	Sup Formulary Operations		Nyawabila	Christina		8587906297					FMT@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Formulary Contact (Secondary)	Pharmacy Director		Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	General Contact	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Government Relations Contact	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	HIPAA Privacy Officer	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	HIPAA Security Officer	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Hospice Contact	Health Services Director		Estipona	Steve		7757709462					Steve.Estipona@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Interoperability Contact	VP Information Technology	Mr.	Rassmussen	Eric		7754204825					eric.rassmussen@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	MA Appeals/Grievances Contact	Director of Operations		Revada	Liz		7757709207					liz.revada@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Marketing Contact	Chief Compliance Officer	Mr.	Ramirez	Philip	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Medical Director	Chief Medical Director	Dr.	Biondi	Traci		7757701510					traci.biondi@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Medicare Coordinator	Chief Compliance Officer	Mr.	Ramirez	Philip	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Medicare Part D Opioid Overutilization Contact	Medicare Part D Opioid Overutilization Contact		Emoto	Julianne		8587905846					julianne.emoto@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/29/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Medication Therapy Management Contact	Clinical Solutions Mgr II		Nguyen	Linh		8587906627					MTMP@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	OffShore Subcontractor Contact	Strategic Services Manager	Mrs.	Evans	Ilene		7757709245					ilene.evans@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Online Enrollment Center Contact (Back-up)	Director of Medicare Sales	Ms.	Saintil	Adrienne		7757701564					Adrienne.Saintil@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Online Enrollment Center Contact (Optional)	Chief Operating Officer	Mr.	Koltz	Patrick		7757709240					Patrick.Koltz@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Online Enrollment Center Contact (Primary)	Vice President of Medicare Sales	Mr.	Tolle	Rob		4699997675					Rob.Tolle@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Part C Application Contact	Sr. Program Manager	Mr.	Cahill	Eric		7757709245					eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Part C Reporting Contact	Chief Compliance Officer	Mr.	Ramirez	Philip	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Part D Appeals	Part D Appeals 1	Ms.	Redd Guinto	Karen							karen.reddguinto@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8587906584				HMO - Health Maintenance Organization		C	San Francisco
H7680	Part D Appeals Contact (Secondary)	Part D Appeals 2		Redd Guinto	Karen							karen.reddguinto@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8587906584				HMO - Health Maintenance Organization		C	San Francisco
H7680	Part D Application Contact	Sr Program Manager	Mr	Cahill	Eric	J	7754204835					eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Part D Benefits Contact	Director of Pharmacy	Mr	Huang	David		3177528432					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Part D Claims Submission Contact	Sup Medicare PDE Operations		Blansfield	John		8582915304					PDE@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Part D Exceptions Contact	Manager, QA & Client Services		Nguyen	Quan							Quan.nguyen@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8587907151				HMO - Health Maintenance Organization		C	San Francisco
H7680	Part D Exceptions Contact (Secondary)	Dir PA Clinical Programs		McGurran	Shawn							Shawn.McGurran@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8587906682				HMO - Health Maintenance Organization		C	San Francisco
H7680	Part D Price File Contact (Back-up)	Medicare Part D Program MGR I		Niemi	Kristin		8587906455					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Part D Price File Contact (Primary)	Medicare D Program MGR I		Niemi	Kristin		8587906455					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Part D Quality Assurance Contact	Director Pharmacy		Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Part D Reporting Contact	Medicare Part D Project Manager		Scott	Susan		8587906565					MedicarePartDProjectManagers@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Patient Safety Contact	Pharmacy Services Manager	.	Holybee	Jonni		7757709244					jonni.holybee@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Payment Contact	Manager of Finance	Mr.	Lopez	Robert		7757709374					Robert.lopez3@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Pharmacy Director	Pharmacy Director	Mr.	Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Ren	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Pharmacy Network Management Contact	Director, Configuration Services		Lujan	Jennifer		8587906565					jennifer.lujan@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Pharmacy Network Management Contact (Secondary)	Manager, PNS & Claims Operations		Burke	Sharon		8587907148					Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Pharmacy Technical Help Desk Contact	Direct Contact Center Services		Battle	Dorry							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8445877389				HMO - Health Maintenance Organization		C	San Francisco
H7680	Pharmacy Technical Help Desk Contact (Secondary)	Direct Contact Center Services		Battle	Dorry							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active	8445877389				HMO - Health Maintenance Organization		C	San Francisco
H7680	Physician Incentive Contact	Director of Network Management	Jr	Maronde	James		7757709300					james.marondejr@uhsinc.com	639 Isbell Road Ste. 400		Reno	NV	89509	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Plan Directory Contact for Public Website	Marketing Director		Belli	Libby		7757709450					libby.belli@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Plan to Plan Reconciliation Contact	Manager of Finance	Mr.	Lopez	Robert		7757709374					Robert.lopez3@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Processor Contact	Director, Medicare Programs		Davis-Jones	DeLona		8587906229					DeLona.Davis-Jones@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Quality Contact	Director of Quality Improvement		Martinez	Johanna		7757709524					johanna.martinez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Reconciliation Contact	Manager of Finance	Mr.	Lopez	Robert		7757709374					Robert.lopez3@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Reconciliation Contact (Secondary)	Chief Finance Officer	Mr.	Hsieh	David		6103824858					david.hsieh@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Recovery Audit Contact	Chief Compliance Officer	Mr.	Ramirez	phil	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	SNP Application Contact	Sr Program Manager	Mr.	Cahill	Eric	J	7754204835					eric.cahill@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	SNP State Contact	Chief Compliance Officer	Mr.	Ramirez	Philip		7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Surveillance Contact	Director of Operations	Ms.	Revada	Liz		7757709207					liz.revada@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	System Contact	VP Information Technology		Rassmussen	Eric		7754204825					eric.rassmussen@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Third Party Administrator (TPA) Liaison	Pharmacy Director		Huang	David		7757709229					david.huang@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89052	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	User Access Contact	Chief Compliance Officer	Mr.	Ramirez	Philip	D	7757709348					philip.ramirez@uhsinc.com	1510 Meadow Wood Lane		Reno	NV	89502	05/22/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Utilization Management Contact	Manager, QA & Client Services		Nguyen	Quan		8587907151					Quan.nguyen@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7680	Utilization Review Contact	Dir PA Clinical Programs		McGurran	Shawn		8587906682					Shawn.McGurran@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	03/06/2023	2023	PROMINENCE HEALTHFIRST OF TEXAS	Local CCP	Prominence Health Plan	HMO/HMOPOS		Universal Health Services, Inc.	587	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H7725	Automated TrOOP Balance Transfer Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Backup User Access Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Best Available Evidence Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Bid Primary Contact	Business Office Manager		Cox	Terra		9709643500	3556			9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	CAP Report Contact for Public Website	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	CEO - CMS Administrator Contact	Chief of Community Healthcare	Mr	Soczynski	Paul	F	4144068843				9529410428	psoczynski@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	CEO - Senior Official for Contracting	Chief of Community Healthcare	Mr	Soczynski	Paul	F	4144068843				9529410428	psoczynski@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Chief Financial Officer	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124287858				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Chief Operating Officer	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Chief Information Officer	Chief Information & Technology Officer	Mr	Osborne	David		6124287900				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Chief Information Security Officer	Chief Information & Technology Officer	Mr	Osborne	David		6124287900				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	CMS Casework Communication Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Complaints Tracking Contact	Director Program Integrity/Compliance		Linnell	Kathryn	R	9708352910				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Contact for Fraud Investigations	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Coordination of Benefits Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Corporate Mailing						9529410305				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Customer Service Operations Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	DIR Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	DIR Contact (Secondary)	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Emergency Part D Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Emergency Part D Contact (Secondary)	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Encounter Data & Risk Adjustment Operations Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	11485 Highway 65		Eckert	CO	81418	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Enrollment Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	EOB Transfer Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Financial Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Financial Reporting Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Formulary Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	General Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Government Relations Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	HIPAA Privacy Officer	Chief Information & Technology Officer	Mr	Osborne	David		6124287900				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	HIPAA Security Officer	Chief Information & Technology Officer	Mr	Osborne	David		6124287900				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Interoperability Contact	Director of Program Integrity/Compliance		Linnell	Kathryn		9705087757				9702520166	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	MA Appeals/Grievances Contact	Director of Quality		Peterson	Nora		9709643500				9702520166	npeterson@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	MA Claims Processing Contact for Public Website	Business Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Marketing Contact	Marketing&Communication Relations		Rincon	Michelle		5173190740				5173190650	mrincon@voa.org	1921 E Miller Road		Lansing	MI	48911	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Medical Director	Medical Director	Dr.	Speedie	Douglas		9708358500				9702520166	DSpeedie@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Medicare Compliance Officer	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Medicare Coordinator	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	4022 Stirrup Creek Drive Suite 315		Durham	NC	27703	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Medicare Part D Opioid Overutilization Contact	Director of Program Integrity/Compliance	Ms	Linnell	Kathryn	R	9705087757				9702520166	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Medication Therapy Management Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Part C Application Contact	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Part D Appeals	Director Program Integrity/Compliance	Ms	Linnell	Kathryn	R					8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending	9705087757				PACE - Nat		C	Atlanta
H7725	Part D Appeals Contact (Secondary)	Executive Director	Ms	Booker	Chiquita						9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending	9529410305				PACE - Nat		C	Atlanta
H7725	Part D Application Contact	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Part D Benefits Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Part D Claims Submission Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Part D Exceptions Contact	Business Manager		Cox	Terra						9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending	9705087737				PACE - Nat		C	Atlanta
H7725	Part D Exceptions Contact (Secondary)	Executive Director	Ms	Booker	Chiquita						9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending	9529410305				PACE - Nat		C	Atlanta
H7725	Part D Price File Contact (Back-up)	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Part D Price File Contact (Optional)	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Part D Price File Contact (Primary)	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Part D Quality Assurance Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Part D Reporting Contact	Business Office Manager		Cox	Terra		9709643556				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Patient Safety Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Payment Contact	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	4022 Stirrup Creek Drive Suite 315		Durham	NC	27703	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Personal Health Record Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Pharmacy Director	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Pharmacy Network Management Contact	Executive Director		Howell	Keith		9709643500				9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Pharmacy Technical Help Desk Contact	Executive Director		Howell	Keith						9702520166	kehowell@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending	9709643500				PACE - Nat		C	Atlanta
H7725	Plan Directory Contact for Public Website	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Plan to Plan Reconciliation Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Processor Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Quality Contact	Quality Assurance Manager		Peterson	Nora		9708352960				9708352902	npeterson@voa.org	11485 Hwy 65		Eckert	CO	81418	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Reconciliation Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Reconciliation Contact (Secondary)	Business Office Manager	Ms.	Cox	Terra		9709643500				9702496956	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Recovery Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Surveillance Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	System Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Third Party Administrator (TPA) Liaison	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	User Access Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Utilization Management Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7725	Utilization Review Contact	Executive Director	Ms	Booker	Chiquita		9529410305				9529410428	cbooker@voa.org	960 S. 4th St.		Louisville	KY	40203	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF JEFFERSON COUNTY	National PACE	Senior CommUnity Care of Jefferson County	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H7728	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Bid Primary Contact	Product Management Director		Gray	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation	5133167654				PPO - BBA		C	Chicago
H7728	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation	8144498744				PPO - BBA		C	Chicago
H7728	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation	5133167654				PPO - BBA		C	Chicago
H7728	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation	5407984087				PPO - BBA		C	Chicago
H7728	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation	8333774266				PPO - BBA		C	Chicago
H7728	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation	3135973173				PPO - BBA		C	Chicago
H7728	PHR Beneficiary Contact																	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Consolidation	8004671199				PPO - BBA		C	Chicago
H7728	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7728	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	05/26/2023	2023	ANTHEM HEALTH PLANS OF NEW HAMPSHIRE, INC.	Local CCP	Anthem Blue Cross and Blue Shield	Local PPO		Elevance Health, Inc.	1	Yes	Consolidation					PPO - BBA		C	Chicago
H7746	Agent/Broker Compensation Data Contact	Finance Director		de los Reyes	Jamie		8107339657					jamie.delosreyes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	04/19/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Automated TrOOP Balance Transfer Contact	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Backup User Access Contact	Director, MIG Medicare Programs		Van Dusen	Kristin		9896273897					kristin.vandusen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/08/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Best Available Evidence Contact	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Bid Audit Contact	VP & Chief Financial Officer		Diehl	Cheryl		8107339723					cheryl.diehl@mclaren.org	G-3245 Beecher Rd	Ste 201	Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Bid Audit Site Contact	Medicare Compliance Officer		Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Bid Primary Contact	Director, MIG Medicare Programs		Van Dusen	Kristin		9896273897					kristin.vandusen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	11/30/2020	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	CAP Report Contact for Public Website	Medicare Compliance Officer		Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	CEO - CMS Administrator Contact	President & CEO	Ms.	Cromer	Jessica		8107339729					jcromer@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	12/29/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	CEO - Senior Official for Contracting	President & CEO	Ms.	Cromer	Jessica		3178227119					jcromer@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	11/24/2020	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Chief Financial Officer	VP & Chief Financial Officer	Ms.	Diehl	Cheryl		9899923272					cheryl.diehl@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Chief Operating Officer	VP of BI and Operations	Ms.	Mavredes	Sara		8107339725					sara.mavredes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Chief Information Officer	VP of BI and Operations	Ms.	Mavredes	Sara		8107339725					sara.mavredes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Chief Information Security Officer	VP of BI and Operations	Ms.	Mavredes	Sara		8107339725					sara.mavredes@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	CMMI Model Point of Contact	Director, MIG Medicare Programs		Van Dusen	Kristin		9896273897					kristin.vandusen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	CMS Casework Communication Contact	Director, MIG Customer & Provider Operations		Cuccia	Tami		8107339669					tami.cuccia@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Complaints Tracking Contact	Director, MIG Customer & Provider Operations		Cuccia	Tami		8107339669					tami.cuccia@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Contact for Fraud Investigations	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Coordination of Benefits Contact	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Corporate Mailing						3178227306					phebenstreit@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	02/10/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance		Brown	Kristine		3178227398					krbrown@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	03/23/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Customer Service Operations Contact	VP, Health Plan Operations		Everett	Torriaun		3178227439					teverett@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	DIR Contact	VP & Chief Financial Officer		Diehl	Cheryl		8107339723					cheryl.diehl@mclaren.org	G-3245 Beecher Rd	Ste 201	Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	DIR Contact (Secondary)	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Electronic Health Record Contact	VP, Health Plan Operations		Everett	Torriaun		3178227439					teverett@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	10/15/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8333582140				HMO - Health Maintenance Organization		C	Chicago
H7746	Emergency Part D Contact	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Emergency Part D Contact (Secondary)	Director of Pharmacy		Taylor	Randall		8102441658					randall.taylor@mclaren.org	G-3245 Beecher Rd.		Flint	MI	48532	12/29/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Employer Waiver Contact	Director, MIG Medicare Programs		Van Dusen	Kristin		9896273897					kristin.vandusen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Encounter Data & Risk Adjustment Operations Contact	Dir Business Information		Sergent	Maria		8107339526					maria.sergent@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	11/11/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Enrollment Contact	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	EOB Transfer Contact	VP, Health Plan Operations		Everett	Torriaun		3178227439				3178227439	teverett@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Financial Audit Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Financial Reporting Contact	VP & Chief Financial Officer		Diehl	Cheryl		8107339723					cheryl.diehl@mclaren.org	G-3245 Beecher Rd	Ste 201	Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Formulary Contact	Director of Clinical Pharmacy		Powell	Wendi		3178227376					wpowell@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	07/26/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Formulary Contact (Secondary)	Clinical Pharmacist		Mattingly	Marissa		3179837249					mmattingly@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	02/10/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	General Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Government Relations Contact	VP General Counsel		Ehrlich	Matthew		8107339681					matthew.ehrlich@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	HIPAA Privacy Officer	Dir Legal Affairs		Matthews	Jim		3173087354					jmatthews@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	HIPAA Security Officer	Dir Business Technology		Goerges	John		3178227454					jgoerges@mdwise.og	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Hospice Contact	Pharmacy Business Analyst		Farley	Lisa		3179837822					lfarley@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	02/10/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Interoperability Contact	Dir Business Information		Sergent	Maria		8107339526					maria.sergent@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	11/11/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	MA Appeals/Grievances Contact	Appeals Coordinator		Sweet	Melissa		8107339672				8106007984	medicareappeals@mdwise.org	G-3245 Beecher Rd		Flint	MI	48532	01/25/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	MA Claims Processing Contact for Public Website	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Marketing Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Medical Director	Medical Director	Dr.	Wheeler	Jeffrey		3178227300					jwheeler@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	02/08/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	07/25/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Medicare Coordinator	Director, MIG Medicare Programs		Van Dusen	Kristin		9896273897					kristin.vandusen@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	11/30/2020	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Medicare Part D Opioid Overutilization Contact	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	07/26/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Medication Therapy Management Contact	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Online Enrollment Center Contact (Back-up)	Director of Enrollment Operations		Garrison	Lori		3178227487					lgarrison@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Online Enrollment Center Contact (Primary)	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Part C Application Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Appeals	Pharmacy Clinical Review Technician		Truelove	Brittany							btruelove@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	07/26/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8003561204				HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Appeals Contact (Secondary)	Director of Clinical Pharmacy		Powell	Wendi							wpowell@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	11/11/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8003561204				HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Application Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Benefits Contact	Director of Clinical Pharmacy		Powell	Wendi		3178227376					wpowell@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	07/26/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Claims Submission Contact	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	07/26/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Exceptions Contact	Director of Clinical Pharmacy		Powell	Wendi							wpowell@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	11/11/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8003561204				HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Exceptions Contact (Secondary)	Pharmacy Clinical Review Technician		Truelove	Brittany							btruelove@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	02/10/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8003561204				HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Price File Contact (Back-up)	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Price File Contact (Optional)	Pharmacy EDI Specialist		Ivancic	Matt		3178227391					mivancic@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	06/15/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Price File Contact (Primary)	Medicare Part D Project Manager		Keller	Shanon		8587907104					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	06/15/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Quality Assurance Contact	Director of Clinical Pharmacy		Powell	Wendi		3178227376					wpowell@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	11/11/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Part D Reporting Contact	Pharmacy Business Analyst		Farley	Lisa		3179837822					lfarley@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	02/10/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Patient Safety Contact	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Payment Contact	Director of Finance		Brown	Kristine		3178227398					krbrown@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	03/29/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Personal Health Record Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Pharmacy Director	Director of Clinical Pharmacy		Powell	Wendi		3178227376					wpowell@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	07/26/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Pharmacy Network Management Contact	Pharmacy Business Analyst		Farley	Lisa		3179837822					lfarley@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	02/10/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Pharmacy Network Management Contact (Secondary)	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Pharmacy Technical Help Desk Contact	VP Contact Center Services		Battle	Dorry							customerservice@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	07/29/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8009104691				HMO - Health Maintenance Organization		C	Chicago
H7746	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Contact Services		Brewer	Kathy							customerservice@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	07/29/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active	8009104691				HMO - Health Maintenance Organization		C	Chicago
H7746	PHR Beneficiary Contact																	03/26/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS	MDwise Inc	McLaren Health Care Corporation	494	Yes	Active	8003561204				HMO - Health Maintenance Organization		C	Chicago
H7746	Plan Directory Contact for Public Website			Services	Member		8333582140					medicarememberservices@mdwise.org	PO Box 44092		Indianapolis	IN	46208	04/01/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Plan to Plan Reconciliation Contact	Director of Finance		Brown	Kristine		3178227398					krbrown@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	09/11/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Processor Contact	Director, Claims and Membership		Laney	Vicki		8107339724					vicki.laney@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Quality Contact	Director of Quality Programs		Wilson	Ashley		3178227239					awilson@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	11/11/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Reconciliation Contact	Director of Finance		Brown	Kristine		3178227398					krbrown@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	09/11/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Reconciliation Contact (Secondary)	MIG Vice President Pharmacy		Musial	Brian		3178227523					bmusial@mdwise.org	2955 N Meridian St		Indianapolis	IN	46208	03/02/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Recovery Audit Contact	Director of Finance	Ms.	Brown	Kristine		3178227398					krbrown@mdwise.org	2955 N. Meridian St	Ste 201	Indianapolis	IN	46208	09/11/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	SNP Application Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	SNP State Contact	VP General Counsel		Hebenstreit	Patty		3178227306					phebenstreit@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	01/27/2021	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Surveillance Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	System Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Third Party Administrator (TPA) Liaison	Director of Finance		Brown	Kristine		3178227398					krbrown@mdwise.org	2955 N Meridian St	Ste 201	Indianapolis	IN	46208	03/23/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	User Access Contact	Medicare Compliance Officer	Ms.	Anderson	Paula		7656313511					Paula.Anderson1@mclaren.org	G-3245 Beecher Rd		Flint	MI	48532	02/28/2023	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Utilization Management Contact	VP of Health Services		Clark	Mary Lynn		8107339642					marylynn.clark@mclaren.org	G-3245 Beecher Rd	Ste 201	Flint	MI	48532	11/11/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7746	Utilization Review Contact	VP of Health Services		Clark	Mary Lynn		8107339642					marylynn.clark@mclaren.org	G-3245 Beecher Rd	Ste 201	Flint	MI	48532	11/11/2022	2023	MDWISE, INC	Local CCP	MDwise Medicare	HMO/HMOPOS		McLaren Health Care Corporation	494	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				HMO - Health Maintenance Organization		C	Chicago
H7778	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				HMO - Health Maintenance Organization		C	Chicago
H7778	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				HMO - Health Maintenance Organization		C	Chicago
H7778	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				HMO - Health Maintenance Organization		C	Chicago
H7778	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/27/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7778	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE OF ILLINOIS, INC.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H7779	Agent/Broker Compensation Data Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Automated TrOOP Balance Transfer Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Backup User Access Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Best Available Evidence Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Bid Audit Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Bid Audit Site Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Bid Primary Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	CAP Report Contact for Public Website	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	CEO - CMS Administrator Contact	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	CEO - Senior Official for Contracting	CEO	Mr.	Bailey	Michael	D	6157518131				8442805360	mbailey@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Chief Financial Officer	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Chief Operating Officer	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Chief Information Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Chief Information Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	CMMI Model Point of Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	CMS Casework Communication Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Complaints Tracking Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Contact for Fraud Investigations	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Coordination of Benefits Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Corporate Mailing						6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Customer Service Operations Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	05/18/2020	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	DIR Contact	VP Formulary & Rebate Economics		Ellermeir	Nicole		9133875120					nellermeir@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	DIR Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Electronic Health Record Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Emergency Part D Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Emergency Part D Contact (Secondary)	Pharmacy Operations	Mrs.	Sanchez	Lynn		4056014429				8442805360	lsanchez@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Encounter Data & Risk Adjustment Operations Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Enrollment Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	EOB Transfer Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Financial Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Financial Reporting Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Formulary Contact	Clinical Formulary Pharmacist	Ms.	Quinn	Kelsey		3304864954					kquinn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Formulary Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	General Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Government Relations Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	HIPAA Privacy Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	HIPAA Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Hospice Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Interoperability Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	MA Appeals/Grievances Contact	A&G Team Lead	Mrs.	Henderson	Maya		6156268442				8442805360	mhenderson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	MA Claims Processing Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		8003997524				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Marketing Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Medical Director	Medical Director	Dr.	Misra	Sumathi		6156365478					SMisra@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/17/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Medicare Compliance Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Medicare Coordinator	Executive Director	Ms.	Voigtmann	Kari		6156036996				8442805360	kvoigtmann@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Medicare Part D Opioid Overutilization Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Medication Therapy Management Contact	Director of Clinical Product Development and Strat	Ms.	Miller	Holly		3304866457				3304058094	hrmiller@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	OffShore Subcontractor Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Online Enrollment Center Contact (Back-up)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Online Enrollment Center Contact (Primary)	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Part C Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Part C Reporting Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Appeals	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations	Mr	Binegar	Sam						3304058081	appeals@ElixirSolutions.com	2181 E Aurora Road	Building B, Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8003997524				HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Benefits Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Claims Submission Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Exceptions Contact	Associate VP of Clinical Operations	Ms.	Lavignette	Amanda						3304864801	alavignette@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Exceptions Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Price File Contact (Back-up)	Sr Financial Manager Reporting & Analytics	Mr	Campbell	Tim		3308886988					tcampbell@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Price File Contact (Optional)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Price File Contact (Primary)	Senior Director Rebates, Trade Relations	Mr.	Bonus	Jason		3304864841				3304864801	jbonus@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Quality Assurance Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Part D Reporting Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Patient Safety Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Pharmacy Director	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Pharmacy Network Management Contact	Director of Pharmacy Network Development and Ops	Ms	Profio	Lauren		3304864864				3304058094	lprofio@EnvisionRx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Pharmacy Network Management Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8335026757				HMO - Health Maintenance Organization		C	Dallas
H7779	Pharmacy Technical Help Desk Contact (Secondary)			Sanchez	Lynn						4056015627	lsanchez@amhealthplans.com	909 S. Meridian Ave. Ste 425		Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8334786370				HMO - Health Maintenance Organization		C	Dallas
H7779	Plan Directory Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Plan to Plan Reconciliation Contact	Sr. Manager,  Financial Accounting	Ms.	Tilley	Stephanie		9312420499					stilley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	08/30/2023	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Processor Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Quality Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Reconciliation Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Reconciliation Contact (Secondary)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Recovery Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	SNP Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	SNP State Contact	Executive Director	Ms.	Voigtmann	Kari		6156036996				8442805360	kvoigtmann@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Surveillance Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	System Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Third Party Administrator (TPA) Liaison	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	User Access Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Utilization Management Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7779	Utilization Review Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN, INC.	Local CCP	American Health Advantage of Tennessee	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7787	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	4805480643				PPO - BBA		C	New York
H7787	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	8609024668				PPO - BBA		C	New York
H7787	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	4805480643				PPO - BBA		C	New York
H7787	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	8609024668				PPO - BBA		C	New York
H7787	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	8009221557				PPO - BBA		C	New York
H7787	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	8603389867				PPO - BBA		C	New York
H7787	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7787	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7813	Agent/Broker Compensation Data Contact	EVP of Government Relations and Corporate Planning		Valk	Andrea		5853136427					andrea.valk@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Automated TrOOP Balance Transfer Contact	Consulting Pharmacist		SokalDavidson	Anita		3155939953					Anita.SokalDavidson@cdsrx.org	860 Hard Rd		Webster	NY	14580	09/02/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Backup User Access Contact	COO		Marble	Sharon		5853471215					sharon.marble@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Best Available Evidence Contact	Consulting Pharmacist		SokalDavidson	Anita		3155939953					Anita.SokalDavidson@cdsrx.org	860 Hard Rd		Webster	NY	14580	09/02/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Bid Audit Contact	EVP of Government Relations and Corporate Planning		Valk	Andrea		5853136427					andrea.valk@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Bid Primary Contact	Corporate CFO		Ferrari	Richard		5853471209					richard.ferrari@cdslt.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	CAP Report Contact for Public Website	EVP of Government Relations and Corporate Planning		Valk	Andrea		5853136427					andrea.valk@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	CEO - CMS Administrator Contact	CEO	Mr	Sewnauth	Andrew		5853471070					andrew.sewnauth@cdslt.org	860 Hard Rd.		Webster	NY	14580	06/05/2023	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	CEO - Senior Official for Contracting	CEO	Mr.	Sewnauth	Andrew		5853471070					andrew.sewnauth@cdslt.org	860 Hard Rd.		Webster	NY	14580	06/05/2023	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Chief Financial Officer	Corporate CFO	Mr	Ferrari	Richard		5853471209					richard.ferrari@cdslt.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Chief Operating Officer	COO	Ms	Marble	Sharon		5853471215					sharon.marble@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Chief Information Officer	VP of IT	Mr.	Marinaccio	Damian		5853471228					damian.marinaccio@cdslt.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Chief Information Security Officer	Manager of Information Security	Mr.	Ricketts	Stephen		5853471945					stephen.ricketts@cdslt.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	CMS Casework Communication Contact	COO		Marble	Sharon		5853471215					sharon.marble@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Complaints Tracking Contact	VP of Quality & Compliance		Frederico	Diane		5853471924					diane.frederico@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Contact for Fraud Investigations	VP of Quality & Compliance		Frederico	Diane		5853471924					diane.frederico@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Coordination of Benefits Contact	COO		Marble	Sharon		5853471215					sharon.marble@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Corporate Mailing						5853471215					sharon.marble@icirclecny.org	860 Hard Rd		Webster	NY	14580	01/31/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Coverage Gap Discount Program (CGDP) Payment Contact	Corporate CFO		Ferrari	Richard		5853471209					richard.ferrari@cdslt.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Customer Service Operations Contact	Manager of Enrollment & Member Services		Ortiz	Becky		5853471923					becky.ortiz@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	DIR Contact	VP of Quality & Compliance		Frederico	Diane		5853471924					diane.frederico@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Emergency Part D Contact	Consulting Pharmacist		SokalDavidson	Anita		3155939953					Anita.SokalDavidson@cdsrx.org	860 Hard Rd		Webster	NY	14580	09/02/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Encounter Data & Risk Adjustment Operations Contact	EVP of Government Relations and Corporate Planning		Valk	Andrea		5853136427					andrea.valk@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Enrollment Contact	Manager of Enrollment & Member Services		Ortiz	Becky		5853471923					becky.ortiz@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	EOB Transfer Contact	Corporate CFO		Ferrari	Richard		5853471209				8443275551	richard.ferrari@cdslt.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Financial Audit Contact	Corporate CFO	Mr.	Ferrari	Richard		5853471209					richard.ferrari@cdslt.org	860 Hard Rd		Webster	NY	14580	01/31/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Financial Reporting Contact	Corporate CFO		Ferrari	Richard		5853471209					richard.ferrari@cdslt.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Formulary Contact	Clinical Formulary Pharmacist		Sagoo	Sukhjit		3304866311					ssagoo@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	07/20/2023	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Formulary Contact (Secondary)	Formulary Director		Rossi	David		3304866311					drossi@elixirsolutions.com	7835 Freedom Ave NW		North Canton	OH	44720	07/20/2023	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	General Contact	EVP of Government Relations and Corporate Planning		Valk	Andrea		5853136427					andrea.valk@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Government Relations Contact	EVP of Government Relations and Corporate Planning		Valk	Andrea		5853136427					andrea.valk@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	HIPAA Privacy Officer	VP of Quality & Compliance		Frederico	Diane		5853471924					diane.frederico@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	HIPAA Security Officer	Manager of Information Security		Ricketts	Stephen		5853471245					stephen.ricketts@cdslt.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Hospice Contact	COO		Marble	Sharon		5853471215					sharon.marble@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Interoperability Contact	VP of IT		Marinaccio	Damian		5853471228					damian.marinaccio@cdslt.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	MA Appeals/Grievances Contact	VP of Quality & Compliance		Frederico	Diane		5853471924					diane.frederico@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	MA Claims Processing Contact for Public Website	Corporate CFO		Ferrari	Richard		8444247253					icircleclaims@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Marketing Contact	Director of Provider Relations		Marble	Sharon		5853471215					sharon.marble@icirclecny.org	860 Hard Rd		Webster	NY	14580	09/02/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Medical Director	CMO	Dr.	Haas	Joel		5853471248					joel.haas@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Medicare Compliance Officer	VP of Quality & Compliance	Ms.	Frederico	Diane		5853471924					diane.frederico@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Medicare Coordinator	EVP of Government Relations and Corporate Planning		Valk	Andrea		5853136427					andrea.valk@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Medicare Part D Opioid Overutilization Contact	Consulting Pharmacist		SokalDavidson	Anita		3155939953					Anita.SokalDavidson@cdsrx.org	860 Hard Rd		Webster	NY	14580	09/02/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Medication Therapy Management Contact	VP Pharmacy Solutions		Miller	Holly		3302931916					hmiller@healthdialog.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Part C Application Contact	COO		Marble	Sharon		5853471215					sharon.marble@icirclecny.org	860 Hard Road		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Part C Reporting Contact	EVP of Government Relations and Corporate Planning		Valk	Andrea		5853136427					andrea.valk@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Part D Appeals	VP of Quality & Compliance		Frederico	Diane							diane.frederico@icirclecny.org	860 Hard Rd.		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active	8557753778				HMO - Health Maintenance Organization		C	New York
H7813	Part D Application Contact	COO		Marble	Sharon		5853471215					sharon.marble@icirclecny.org	860 Hard Road		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Part D Benefits Contact	Consulting Pharmacist		SokalDavidson	Anita		3155939953					Anita.SokalDavidson@cdsrx.org	860 Hard Rd		Webster	NY	14580	09/02/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Part D Claims Submission Contact			Meyocks	Kristen		9547672690					kmeyocks@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/09/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Part D Exceptions Contact	Consulting Pharmacist		SokalDavidson	Anita							ryanthomas@icirclecny.org	860 Hard Rd		Webster	NY	14580	09/02/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active	8336821192				HMO - Health Maintenance Organization		C	New York
H7813	Part D Price File Contact (Back-up)	Financial Analyst III		Wentz	Christophe		3308886988					cwentz@elixirsolutions.com	8957 Canyon Falls Blvd.		Twinsburg	OH	44087	06/14/2023	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Part D Price File Contact (Primary)	Sr. Financial Manager Reporting & Analytics		Campbell	Tim		3308886988					tcampbell@elixirsolutions.com	8957 Canyon Falls Blvd.		Twinsburg	OH	44087	06/14/2023	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Part D Quality Assurance Contact	Consulting Pharmacist		SokalDavidson	Anita		3155939953					Anita.SokalDavidson@cdsrx.org	860 Hard Rd		Webster	NY	14580	09/02/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Part D Reporting Contact	Consulting Pharmacist		SokalDavidson	Anita		3155939953					Anita.SokalDavidson@cdsrx.org	860 Hard Rd		Webster	NY	14580	09/02/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Patient Safety Contact	VP of Quality & Compliance		Frederico	Diane		5853471924					diane.frederico@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Payment Contact	COO		Ferrari	Richard		5853471209					richard.ferrari@cdslt.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Pharmacy Director	Consulting Pharmacist		SokalDavidson	Anita		3155939953					Anita.SokalDavidson@cdsrx.org	860 Hard Rd		Webster	NY	14580	09/02/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Pharmacy Network Management Contact	Director Pharmacy Network Development & Operations		Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	05/31/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Pharmacy Technical Help Desk Contact	Vice President Operations		Conn	Todd							tconn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active	8336821192				HMO - Health Maintenance Organization		C	New York
H7813	Plan Directory Contact for Public Website	Director of Provider Relations		Mullane	James		8444247253					memberservices@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Plan to Plan Reconciliation Contact	Manager of Enrollment & Member Services		Ortiz	Becky		5853471923					becky.ortiz@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Processor Contact	Corporate CFO		Ferrari	Richard		5853471209					richard.ferrari@cdslt.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Quality Contact	VP of Quality & Compliance		Frederico	Diane		5853471924					diane.frederico@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Reconciliation Contact	Manager of Enrollment & Member Services		Ortiz	Becky		5853471923					becky.ortiz@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Recovery Audit Contact	Corporate CFO	Mr.	Ferrari	Richard		5853471209					richard.ferrari@cdslt.org	860 Hard Rd		Webster	NY	14580	02/01/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	SNP Application Contact	COO		Marble	Sharon		5853471215					sharon.marble@icirclecny.org	860 Hard Road		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Surveillance Contact	VP of Quality & Compliance		Frederico	Diane		5853471924					diane.frederico@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	System Contact	VP of IT		Marinaccio	Damian		5853471228					damian.marinaccio@cdslt.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Third Party Administrator (TPA) Liaison	Director of Provider Contracting & Network Managem		Granger	Jennifer		5852784516					jennifer.granger@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	User Access Contact	EVP of Government Relations and Corporate Planning		Valk	Andrea		5853136427					andrea.valk@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Utilization Management Contact	Manager of Utilization Management		Ross	Millissa		5857388902					millissa.ross@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7813	Utilization Review Contact	Manager of Utilization Management		Ross	Millissa		5857388902					millissa.ross@icirclecny.org	860 Hard Rd		Webster	NY	14580	03/28/2022	2023	ICIRCLE SERVICES OF THE FINGER LAKES, INC.	Local CCP	iCircle Services of the Finger Lakes, Inc	HMO/HMOPOS		CDS Monarch, Inc.	756	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7831	Automated TrOOP Balance Transfer Contact	CEO		Dickens	Elizabeth	D	3148977223	30002				ddickens@newhorizonspace.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Backup User Access Contact	Director of Center Services		Young	Cyndi		3148977223					cyoung@chliving.org	5035 Manchester Ave		Saint Louis	MO	63110	06/07/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Best Available Evidence Contact	Executive Director		Dickens	Denise		3148977223	30002				ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Bid Primary Contact	Executive Director		Dickens	Denise		3148977223	30002				ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	CAP Report Contact for Public Website	Executive Director		Dickens	Denise		3145877958					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	12/08/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active	3145897722				PACE - Nat		C	Kansas City
H7831	CEO - CMS Administrator Contact	Executive Director	MS	Dickins	Denise		3148977223					ddickens@chliving.org	5035 Manchester Ave		Saint Louis	MO	63110	06/07/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	CEO - Senior Official for Contracting	Executive Director	Ms.	Dickens	Denise		3148977223					ddickens@chliving.org	5035 Manchester Ave		Saint Louis	MO	63110	06/07/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Chief Financial Officer	Contoller	Ms.	Hudson	Kenna		3145877900					khudson@chliving.org	Two City Place 2nd Floor		Saint Louis	MO	63141	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Chief Operating Officer	Director of Center Services	Ms	Young	Cyndi		3148977223	30005				cyoung@chliving.org	5035 Manchester Ave		Saint Louis	MO	63110	06/07/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Chief Information Officer	Director of Center Services	Mr.	Young	Cyndi		3148977223	30005				cyoung@chliving.org	5035 Manchester Ave		Saint Louis	MO	63110	06/07/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Chief Information Security Officer	Director of Center Services	Ms	Young	Cyndi		3148977223	30005				cyoung@chliving.org	5035 Manchester Avenue		St. Louis	MO	63110	06/07/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	CMS Casework Communication Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Complaints Tracking Contact	Executive Director		Young	Cynthia		3148977223					cyoung@chliving.org	5035 Manchester Ave		Saint Louis	MO	63110	01/25/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Contact for Fraud Investigations	Executive Director		Young	Cynthia		3148977223					cyoung@chliving.org	5035 Manchester Ave		Saint Louis	MO	63110	01/25/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Coordination of Benefits Contact	CEO		Dickens	Elizabeth	D	3148977223	30002				ddickens@chliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	08/03/2023	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Corporate Mailing						3145877958	40900				drallo@chliving.org	2 City Place 2nd Floor		St. Louis	MO	63141	08/03/2023	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Coverage Gap Discount Program (CGDP) Payment Contact	CEO		Dickens	Denise		3148977223	30002				ddickens@newhorizonspace.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Customer Service Operations Contact	Executive Director		Dickens	Denise		3148977223	30002				ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	DIR Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	DIR Contact (Secondary)			Dickens	Elizabeth	D	3148977223	30002				ddickens@newhorizonspace.org	5035  Manchester Road		St. Louis	MO	63110	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Emergency Part D Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Emergency Part D Contact (Secondary)	Director of Center Services		Young	Cyndi	A	3148977223	30005				cyoung@chliving.org	5035 Manchester Ave		Saint Louis	MO	63110	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Encounter Data & Risk Adjustment Operations Contact	CEO		Dickens	Elizabeth		3149877223	30002				ddickens@newhorizonspace.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Enrollment Contact	CEO		Dickens	Denise		3148977223	30002				ddickens@newhorizonspace.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	EOB Transfer Contact	CEO		Dickens	Denise		3148977002				3145886021	ddickens@newhorizonspace.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Financial Audit Contact	Controller	Ms.	Hudson	Kenna		3145877900					khudson@chliving.org	Two City Place 2nd Floor		Saint Louis	MO	63141	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Financial Reporting Contact	Senior Accountant	Ms	Waltke	Susan		3145877928	30007				swaltke@chliving.org	Two City Place 2nd Floor		Saint Louis	MO	63141	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Formulary Contact	Executive Director		Dickens	Denise		3148977223	30002				ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	General Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Government Relations Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	HIPAA Privacy Officer	Executive Director		Dickens	Denise		3148977002					ddickens@newhorizonspace.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/04/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	HIPAA Security Officer	Vice President of Corporate Compliance		Young	Cyndi		3148977223					cyoung@chliving.org	2 City Place 2nd Floor		St. Louis	MO	63141	03/17/2023	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Interoperability Contact			Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	12/09/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	MA Appeals/Grievances Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	MA Claims Processing Contact for Public Website	CEO		Dickens	Elizabeth	D	3148977223	30002				ddickens@newhorizonspace.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Marketing Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Medical Director	Medical Director		Dandamudi	Babu		3148977223					mmwilliams@newhorizonsliving.org	5035 MANCHESTER AVE		St. Louis	MO	63110	03/17/2023	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Medicare Compliance Officer	Director of Center Services	Ms.	Young	Cynthia		3148977223					cyoung@chliving.org	5035 Manchester Ave		Saint Louis	MO	63110	05/31/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Medicare Coordinator	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Medicare Part D Opioid Overutilization Contact	Dir of Center Services		Young	Cynthia		4238977223					cyoung@chliving.org	5035 Manchester Ave		Saint Louis	MO	63110	01/25/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Medication Therapy Management Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Online Enrollment Center Contact (Primary)	CEO		Dickens	Elizabeth	D	3148977223	30002				ddickens@newhorizonspace.org	5035 Manchester Ave		Saint Louis	MO	63110	08/19/2022	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Part C Application Contact			Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Part D Appeals	Executive Director		Dickens	Denise							ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active	8336547223				PACE - Nat		C	Kansas City
H7831	Part D Application Contact			Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Part D Benefits Contact	Executive Director		Dickens	Denise		3148977223					ddickens@NewHorizonsLiving.org	5035 MANCHESTER AVE		St. Louis	MO	631416727	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Part D Claims Submission Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Part D Exceptions Contact	Executive Director		Dickens	Denise							ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active	8336547223				PACE - Nat		C	Kansas City
H7831	Part D Price File Contact (Back-up)	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Part D Price File Contact (Primary)	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Part D Quality Assurance Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Part D Reporting Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Patient Safety Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Payment Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Pharmacy Director	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Pharmacy Network Management Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Pharmacy Technical Help Desk Contact	Executive Director		Dickens	Denise							ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active	8336547223				PACE - Nat		C	Kansas City
H7831	Plan Directory Contact for Public Website	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Plan to Plan Reconciliation Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Processor Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Quality Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Reconciliation Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Recovery Audit Contact	Executive Director	Mrs.	Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Surveillance Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	System Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Third Party Administrator (TPA) Liaison	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	User Access Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Utilization Management Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7831	Utilization Review Contact	Executive Director		Dickens	Denise		3148977223					ddickens@newhorizonsliving.org	5035 MANCHESTER AVE		ST LOUIS	MO	63110	11/29/2021	2023	PRIME ACQUISITIONS, LLC	National PACE	New Horizons PACE	National PACE		Midwest Christian Villages, Inc.	781	Yes	Active					PACE - Nat		C	Kansas City
H7833	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	MMP Reporting Requirements Contact			Berardi	Christophe		7632833501					chris.berardi@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	MMP Point of Contact			Thompson	Sterling		9522026419					sterling. thompson@uhc.com	PO BOX 9472		MINNEAPOLIS	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7833	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE COMMUNITY PLAN OF TEXAS, L.L.C.	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H7844	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	CAP Report Contact for Public Website			Services	Member		8557355604					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Government Relations Contact	MHM- Associate Vice President, Government Contract		Crandell	Peggy		9472180965					peggy.crandell@molinahealthcare.com	880 E.Long Lake Rd		Troy	MI	48098	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	MA Claims Processing Contact for Public Website			Services	Member		8557355604					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					Rohit.Gupta2@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/15/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/15/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	MMP Reporting Requirements Contact	MHI - Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate Suite 100		Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	MMP Point of Contact	MHI - Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate Suite 100		Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Plan Directory Contact for Public Website			Services	Member		8557355604					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7844	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF MICHIGAN, INC.	Demo	Molina Healthcare of Michigan	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H7849	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	4805480643				PPO - BBA		C	New York
H7849	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	8609024668				PPO - BBA		C	New York
H7849	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	4805480643				PPO - BBA		C	New York
H7849	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	8609024668				PPO - BBA		C	New York
H7849	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	8009221557				PPO - BBA		C	New York
H7849	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active	8603389867				PPO - BBA		C	New York
H7849	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7849	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	Local CCP	Cigna Healthcare	Local PPO		The Cigna Group	38	Yes	Active					PPO - BBA		C	New York
H7855	Automated TrOOP Balance Transfer Contact	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Backup User Access Contact	Executive Director	Ms	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	01/07/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Best Available Evidence Contact	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	01/07/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Bid Primary Contact	Health Plan Specialist	Ms	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	01/07/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	CAP Report Contact for Public Website	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	01/07/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	CEO - CMS Administrator Contact	CEO and President	Mr.	Surowitz	Dale		8189422295				8187743020	dale.surowitz@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/02/2020	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	CEO - Senior Official for Contracting	CEO and President	Mr.	Surowitz	Dale		8189422295				8187743020	dale.surowitz@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/02/2020	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Chief Financial Officer	Chief Financial Officer	Ms	Ruditsky	Crystal		8187743336				8187743020	crystal.ruditsky@jha.org	7150 Tampa Avenue		Reseda	CA	91335	03/03/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Chief Operating Officer	Chief Operating Officer	Ms	Stepanians	Larrisa		8187743371				8187742424	larrisa.stepanians@jha.org	7150 Tampa Avenue		Reseda	CA	91335	02/15/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Chief Information Officer	Director of Information Services	Mr.	Lucich	Tony		8187743350				8187743389	tony.lucich@jha.org	7150 Tampa Ave.		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Chief Information Security Officer	DIrector of Information Services	Mr.	Lucich	Tony		8187743350				8187743389	tony.lucich@jha.org	7150 Tampa Ave		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	CMS Casework Communication Contact	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	01/07/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Complaints Tracking Contact	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	11/08/2017	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Contact for Fraud Investigations	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	11/08/2017	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Coordination of Benefits Contact	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Corporate Mailing						8186545571				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	11/08/2017	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Coverage Gap Discount Program (CGDP) Payment Contact	Health Plan Specialist		Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa		Reseda	CA	91335	05/23/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Customer Service Operations Contact	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	11/08/2017	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	DIR Contact	Health Plan Specialist	Miss	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	03/19/2018	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	DIR Contact (Secondary)	Executive Director	Mrs.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	03/14/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Emergency Part D Contact	Executive Director	Ms	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	02/15/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Encounter Data & Risk Adjustment Operations Contact	Executive Director	Ms	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Ave		Reseda	CA	91335	10/22/2019	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Enrollment Contact	Executive Director	Ms	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/26/2020	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	EOB Transfer Contact	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Financial Audit Contact	Executive Director	Ms	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	08/09/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Financial Reporting Contact	CFO	Ms	Ruditsky	Crystal		8187743336				8187743020	crystal.ruditsky@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Formulary Contact	Medical Director, Brandman Centers for Senior Care	Dr.	Ott	Casey		8187574418				8187745907	casey.ott@jha.org	7150 Tampa Avenue		Reseda	CA	91335	03/20/2019	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Formulary Contact (Secondary)	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Ave		Reseda	CA	91335	01/07/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	General Contact	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	01/07/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Government Relations Contact	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	01/07/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	HIPAA Privacy Officer	Chief Nursing & Compliance Officer	Mr.	Carlson	Timothy		8187743397				8187742424	timothy.carlson@jha.org	7150 Tampa Avenue		Reseda	CA	91335	08/11/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	HIPAA Security Officer	Director of Information Technology	Mr.	Lucich	Tony		8187743350				8187743020	tony.lucich@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Interoperability Contact	Executive Director	Ms	Fishenfeld	Susie	t	8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Ave		Reseda	CA	91335	02/15/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	MA Appeals/Grievances Contact	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	11/08/2017	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	MA Claims Processing Contact for Public Website	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Marketing Contact	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/26/2020	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Medical Director	Medical Director, Brandman Centers for Senior Care	Dr.	Ott	Casey		8187574418				8187745907	casey.ott@jha.org	7150 Tampa Avenue		Reseda	CA	91335	03/20/2019	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Medicare Compliance Officer	Compliance Officer	Mr.	Carlson	Timothy		8187743397				8187742424	timothy.carlson@jha.org	7150 Tampa Avenue		Reseda	CA	91335	04/24/2017	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Medicare Coordinator	Health Plan Specialist	Ms	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Medicare Part D Opioid Overutilization Contact	Medical Director, Brandman Centers for Senior Care	Dr.	Ott	Casey		8187574418				8187745907	casey.ott@jha.org	7150 Tampa Avenue		Reseda	CA	91335	03/20/2019	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Medication Therapy Management Contact	Medical Director, Brandman Centers for Senior Care	Dr.	Ott	Casey		8187574418				8187745907	casey.ott@jha.org	7150 Tampa Avenue		Reseda	CA	91335	03/20/2019	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	OffShore Subcontractor Contact	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	01/07/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Online Enrollment Center Contact (Primary)	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	11/08/2017	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Part C Application Contact	Executive Director	Ms	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	02/15/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Part D Appeals	Executive Director	Ms	Fishenfeld	Susie						8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	08/11/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active	8187743274				PACE - Nat		C	San Francisco
H7855	Part D Appeals Contact (Secondary)	Health Plan Specialist	Ms.	Boothe	Janice						8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	01/11/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active	8187743033				PACE - Nat		C	San Francisco
H7855	Part D Application Contact	Executive Director	Ms	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	02/15/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Part D Benefits Contact	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Part D Claims Submission Contact	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Part D Exceptions Contact	Health Plan Specialist	Ms.	Boothe	Janice						8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active	8557748444				PACE - Nat		C	San Francisco
H7855	Part D Price File Contact (Back-up)	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Part D Price File Contact (Primary)	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Part D Quality Assurance Contact	Health Plan Specialist	Ms.	Boothe	Janice		8187748444				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	08/11/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Part D Reporting Contact	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Patient Safety Contact	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	08/11/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Payment Contact	Controller	Mr.	Debaca	Mark		8187743396				8187743020	mark.debaca@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/22/2019	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Personal Health Record Contact	Center Manager	Ms.	Graham	Amy		8187743328				8187745900	amy.graham@jha.org	7150 Tampa Avenue		Reseda	CA	91335	11/08/2017	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Pharmacy Director	Medical Director, Brandman Centers for Senior Care	Dr.	Ott	Casey		8187574418				8187745907	casey.ott@jha.org	7150 Tampa Avenue		Reseda	CA	91335	03/20/2019	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Pharmacy Network Management Contact	Medical Director, Brandman Centers for Senior Care	Dr.	Ott	Casey		8187574418				8187745907	casey.ott@jha.org	7150 Tampa Avenue		Reseda	CA	91335	03/20/2019	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Pharmacy Network Management Contact (Secondary)	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Pharmacy Technical Help Desk Contact	Pharmacist	Ms.	Aramyan	Ani						8187745900	ani.aramyan@jha.org	7150 Tampa Avenue		Reseda	CA	91335	01/07/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active	8556543023				PACE - Nat		C	San Francisco
H7855	PHR Beneficiary Contact																	02/21/2012	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE	Los Angeles Jewish Home	Los Angeles Jewish Home for the Aging	506	Yes	Active	8187743274				PACE - Nat		C	San Francisco
H7855	Plan Directory Contact for Public Website	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	11/08/2017	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Plan to Plan Reconciliation Contact	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Processor Contact	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Quality Contact	Chief Nursing & Compliance	Ms.	Carlson	Timothy		8187743397				8187745907	timothy.carlson@jha.org	7150 Tampa Avenue		Reseda	CA	91335	08/11/2022	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Reconciliation Contact	CFO	Ms	Ruditsky	Crystal		8187743336				8187743020	crystal.ruditsky@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Reconciliation Contact (Secondary)	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Recovery Audit Contact	Health Plan Specialist	Ms.	Boothe	Janice		8187743033				8187745907	janice.boothe@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Surveillance Contact	Executive Director	Ms.	Fishenfeld	Susie		8187743274				8187745907	susie.fishenfeld@jha.org	7150 Tampa Avenue		Reseda	CA	91335	11/08/2017	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	System Contact	Director of Information Technology	Mr.	Lucich	Tony		8187743350				8187743020	tony.lucich@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Third Party Administrator (TPA) Liaison	Executive Director		Fishenfeld	Susie		8187748444				8187745907	susie.fishenfeld@jha.org	7150 Tampa Ave		Reseda	CA	91335	05/23/2016	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	User Access Contact	Director of Information Technology	Mr.	Lucich	Tony		8187743350				8187743020	tony.lucich@jha.org	7150 Tampa Avenue		Reseda	CA	91335	10/04/2021	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Utilization Management Contact	Medical Director, Brandman Centers for Senior Care	Dr.	Ott	Casey		8187574418				8187745907	casey.ott@jha.org	7150 Tampa Avenue		Reseda	CA	91335	03/20/2019	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7855	Utilization Review Contact	Medical Director, Brandman Centers for Senior Care	Dr.	Ott	Casey		8187574418				8187745907	casey.ott@jha.org	7150 Tampa Avenue		Reseda	CA	91335	03/20/2019	2023	BRANDMAN CENTERS FOR SENIOR CARE, INC.	National PACE	Brandman Centers for Senior Care	National PACE		Los Angeles Jewish Home for the Aging	506	Yes	Active					PACE - Nat		C	San Francisco
H7917	Agent/Broker Compensation Data Contact	Manager Broker Administration		Logan	Lynne		4235356550				4235353178	Lynne_Logan@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/01/2012	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Automated TrOOP Balance Transfer Contact	Advisor Business CVS		Davis	Brittany		4806064613					FIRSupport@CVSHealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	12/21/2021	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Backup User Access Contact	Medicare Compliance Officer	Mrs.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Best Available Evidence Contact	Manager MedAdv Member & Recon		Mills	Aaron		4235353848					Aaron_Mills@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/10/2012	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Bid Audit Contact	Medicare Compliance Officer	Mrs	Womble	Charriet		6292046752					Charriet_Womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	374022011	12/09/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Bid Primary Contact	Product Manager		Case	Taylor		4235354013					Taylor_Case@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	CEO - CMS Administrator Contact	CEO	Mr.	Hickey	JD		4235357767					JD_Hickey@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	01/04/2023	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	CEO - Senior Official for Contracting	President and Chief Executive Officer	Mr.	Hickey	JD		4235357767				4235351957	JD_Hickey@bcbst.com	One Cameron Hill Circle		Chattanooga	TN	37402	09/01/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Chief Financial Officer	Exec VP & Chief Financial Officer	Mr	Giblin	John		4235354884					John_Giblin@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	01/10/2013	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Chief Operating Officer	Chief Operating Officer	Mr	Pierce	Scott		4235357556				4235359109	Scott_Pierce@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/01/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Chief Information Officer	VP Infrastructure & Operations	Ms	Weaver	Jennifer		4235355173				4235359109	Jennifer_Weaver@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/16/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Chief Information Security Officer	VP/Chief Information Security Officer	Ms	Lee	Rosemarie		4235355853				4235359109	Rosemarie_Lee@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	07/24/2023	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	CMS Casework Communication Contact	Manager Operations		Flagg	Kendra		4235357524				4235355498	Kendra_Flagg@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Complaints Tracking Contact	Business Analyst II		Morgan	Christi		4235358872				4235355270	Christi_Morgan@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/11/2019	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Contact for Fraud Investigations	Director Special Investigations Unit	Mr.	Tidwell	Norman		6153483005				4235357024	Norman_Tidwell@bcbst.com	1 Cameron Hill Circle, Bldg 1.4		Chattanooga	TN	37402	05/02/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Coordination of Benefits Contact	Manger Revenue Reconciliation		Camp	Jan		4235353639					jan_camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/29/2017	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Corporate Mailing						4235355600					Todd_Ray@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr Investments & Financial Mgt		Conway	Kendrick		4236819483					Kendrick_Conway@BCBST.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/10/2023	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Customer Service Operations Contact	Manager Operations		Walters	Karen		4235357696					Karen_Walters@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	03/31/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	DIR Contact	Pharmacy Operations Manager	Mrs	Moore	Mary-Marga		4235356116					Mary-Margaret_Moore@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	DIR Contact (Secondary)	Director Pharmacy Operations	Mrs	Owen	Rebecca		4235358347					Rebecca_Owen@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/19/2021	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Emergency Part D Contact	VP of Pharmacy		Tate	Natalie		4234437868				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/20/2016	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Emergency Part D Contact (Secondary)	Sr Account Manager CVS		Hale	Amy		4803277718					Amy.Hale2@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Encounter Data & Risk Adjustment Operations Contact	Director Medicare Advantage Risk Adjustment		Livingood	Eric		4235357352					Richard_Livingood@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/18/2019	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Enrollment Contact	Manager  MedAdv Member & Recon		Mills	Aaron		4235353848					Aaron_Mills@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/10/2012	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	EOB Transfer Contact	Director Medicare Advantage Service Operations		Dobbs	Damon		4235355374				4235353558	Damon_Dobbs@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	04/16/2020	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Financial Audit Contact	External Audit Coordinator	Ms	Grafe	Kimberly		4232909053					Kimberly_Grafe@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/21/2023	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Financial Reporting Contact	Principal Consultant, Financial Reporting		Harris	Bernard		4235353829					Bernard_Harris@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	04/17/2020	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Formulary Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Formulary Contact (Secondary)	Clinical Advisor Med D CVS		Tolbert	Myla		4698656265					Myla.Tolbert@CVSHealth.com	750 W John Carpenter Frwy		Irving	TX	75039	12/20/2021	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	General Contact	Medicare Compliance Officer	Mrs.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Government Relations Contact	Medicare Compliance Officer	Mrs.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	HIPAA Privacy Officer	VP & Deputy General Counsel		Oliver	Alicia		4235352922					Alicia_Oliver@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	07/26/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	HIPAA Security Officer	VP & Deputy General Counsel		Oliver	Alicia		4235352922					Alicia_Oliver@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	01/11/2023	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Hospice Contact	Supervisor MA Reconciliation		Hicks	Brandon		4235353006	3006			4235355498	Brandon_Hicks@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/15/2023	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Interoperability Contact	Application Manager		Foust	Adam		4235356672					Adam_Foust@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/28/2023	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	MA Appeals/Grievances Contact	Director MA Member Experience & Engagment		Gordon	Destiny		4235358447				4235355270	Destiny_Gordon@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	MA Claims Processing Contact for Public Website	Director Medicare Advantage Service Operations		Dobbs	Damon		4235355374				4235353558	Damon_Dobbs@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	04/16/2020	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Marketing Contact	Ethics & Compliance Manager		Clements	Amy		4235358225					Amy_Clements@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/09/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Medical Director	Medical Director	Dr	Brunetto	Angeline		4235358629					angeline_brunetto@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/07/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Medicare Coordinator	Director Medicare Advantage Service Operations		Dobbs	Damon		4235355374					Damon_Dobbs@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	01/03/2020	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Medicare Part D Opioid Overutilization Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/19/2018	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Medication Therapy Management Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	OffShore Subcontractor Contact	Medicare Compliance Officer	Mrs	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Online Enrollment Center Contact (Back-up)	Business Analyst II		Sharp	Dana		4235354453					Dana_Sharp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/29/2017	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Online Enrollment Center Contact (Optional)	Manager MedAdv Member & Recon		Mills	Aaron		4235353848					Aaron_Mills@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/04/2013	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Online Enrollment Center Contact (Primary)	Operations Supervisor II (QIP)		Bowling	Jameekah		4235356646					Jameekah_Bowling@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/15/2023	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Part C Application Contact	Product Manager		Case	Taylor		4235354013					Taylor_Case@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	03/22/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Part C Reporting Contact	Business Analytics Manager		Carson	Mindy		4235358476					Mindy_Carson@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Part D Appeals	Clinical Pharmacy Director		Moss	Portia							Portia_Moss@bcbst.com	1 Cameron Hill Circle	Suite 51	Chattanooga	TN	37402	09/22/2021	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				PPO - BBA		C	Atlanta
H7917	Part D Appeals Contact (Secondary)	Coverage Review Pharmacist		Holloway	Angela							Angela_Holloway@BCBST.com	1 Cameron Hill Circle	Suite 51	Chattanooga	TN	37402	12/31/2020	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				PPO - BBA		C	Atlanta
H7917	Part D Application Contact	Product Manager		Case	Taylor		4235354013					Taylor_Case@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	03/22/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Part D Benefits Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Part D Claims Submission Contact	Sr Account Manager CVS		Mesa	Samantha		4803492867					Samantha.Mesa@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Part D Exceptions Contact	Manager Coverage Reviews 1		Moss	Portia							Portia_Moss@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/08/2019	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				PPO - BBA		C	Atlanta
H7917	Part D Exceptions Contact (Secondary)	Coverage Review Pharmacist		Dillon	Celia							Celia_Dillon@BCBST.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/12/2020	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				PPO - BBA		C	Atlanta
H7917	Part D Price File Contact (Back-up)	Manager PBM Finance Operations CVS		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Part D Price File Contact (Optional)	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Part D Price File Contact (Primary)	Pharmacy Operations Manager		Moore	Mary	M	4235356116				4235357599	Mary-Margaret_Moore@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	07/12/2019	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Part D Quality Assurance Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Part D Reporting Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Patient Safety Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Payment Contact	Manager Revenue Reconciliation		Camp	Jan		4235353639					Jan_Camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Pharmacy Director	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Pharmacy Network Management Contact	Advisor Network Products CVS		Lowe	David		4807449231				8773875800	David.Lowe2@CVSHealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	12/20/2021	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Pharmacy Network Management Contact (Secondary)	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Pharmacy Technical Help Desk Contact	Vendor Management		Horton	Kasena							Kasena.Horton@CVSHealth.com	2401 Cherahala  Blvd		Knoxville	TN	37932	12/21/2021	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active	8666934620				PPO - BBA		C	Atlanta
H7917	Pharmacy Technical Help Desk Contact (Secondary)	VP of Pharmacy		Tate	Natalie							Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/31/2020	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				PPO - BBA		C	Atlanta
H7917	Plan Directory Contact for Public Website	Director Operations		Service	Customer		8008312583					BlueAdvantageCS_GM@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Plan to Plan Reconciliation Contact	Business Analyst Associate		Stinnett	James		4235351624					P2PAdministration_GM@bcbst.com	Attn: P2P Coordinator	1 Cameron Hill Circle Suite 0050	Chattanooga	TN	374020050	02/07/2018	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Processor Contact	Mgr Ops & Claims		Dobbs	Damon		4235355374				4235353558	Damon_Dobbs@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	07/15/2015	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Quality Contact	Director MA Quality Improvement & Stars Program		Leun	Dianna		4235351654					Dianna_Leun@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/09/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Reconciliation Contact	Manager Revenue Reconciliation		Camp	Jan		4235353639					Jan_Camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Reconciliation Contact (Secondary)	Manager Actuarial Services		Styga	Chris		4235353276				4235353467	Christopher_Styga@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/29/2017	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Recovery Audit Contact	Medicare Compliance Officer	Mrs.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Surveillance Contact	Medicare Compliance Officer	Mrs.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	System Contact	Director Applications Solutions		Jackson	Barbara		4235357380					Barbara_Jackson@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/04/2019	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Third Party Administrator (TPA) Liaison	Accountant		Gillenwater	Jonathan		4235351259					Jonathan_Gillenwater@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/06/2020	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	User Access Contact	Sr Ethics & Compliance Specialist		Underwood	Jackie		4235354424					Jackie_Underwood@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Utilization Management Contact	Director MA Health Services		Swoope	LaShonda		4236676183					lashonda_swoope@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7917	Utilization Review Contact	Director MA Health Services		Swoope	LaShonda		4236676183					lashonda_swoope@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	BLUECROSS BLUESHIELD OF TENNESSEE, INC.	Local CCP	BlueCross BlueShield of Tennessee	Local PPO		BlueCross BlueShield of Tennessee	34	Yes	Active					PPO - BBA		C	Atlanta
H7925	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H7925	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Medical Director	Chief Medical Director	Dr.	Lucas	Brad		8662464356					blucas@centene.com	3700 Embassy Parkway, Suite 200		Akron	OH	44333	03/30/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/05/2020	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H7925	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H7925	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8335250824				HMO - Health Maintenance Organization		C	Dallas
H7925	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	03/31/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7925	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY INDIANA, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H7993	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7812272122					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		7812272123					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7812272124					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		7812272127					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Chief Information Security Officer	Security Officer	Mr.	Careless	Jason		6025764139					Jason.careless@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Contact for Fraud Investigations	Head of SIU		Bowman	John		3144732898					john.bowman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	General Contact	Compliance Manager	Ms.	Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		7812272122					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	HIPAA Privacy Officer	Privacy Officer		Reilly	Emily		4043049090					Emily.reilly@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	HIPAA Security Officer	Information Security Officer		Careless	Jason		6025764139					Jason.careless@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Marketing Contact	Marketing Manager		Lord	Austin		5085964196					Austin.lord@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Medicare Coordinator	Compliance Manager	Ms.	Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7993	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7993	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7993	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7993	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Payment Contact	CFO	Mr.	Yale	Brad		7812272124					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H7993	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H7993	PHR Beneficiary Contact																	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H7993	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Processor Contact	Chief Operating Officer		Henry	Larry		7812272127					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Surveillance Contact	Chief Compliance Officer		OKane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	User Access Contact	Chief Compliance Officer	Ms.	OKane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H7993	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF TEXAS, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8003	Agent/Broker Compensation Data Contact	VP - Medicare Advantage & Strategic Initiatives		Edwards	Don		8032649482					Don.Edwards@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/23/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Automated TrOOP Balance Transfer Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Backup User Access Contact	Director - Medicare Advantage Operations		Morris	Charles		8032641799					charles.morris@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Best Available Evidence Contact	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Bid Audit Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Bid Audit Site Contact	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Bid Primary Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	CAP Report Contact for Public Website	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	CEO - CMS Administrator Contact	CEO	Mr.	Mizeur	Michael	J	8032646000					CEO@BCBSSC.com	I-20 at Alpine Road	AA-X01	Columbia	SC	29219	01/03/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	CEO - Senior Official for Contracting	CEO	Mr.	Mizeur	Michael	J	8032646000					CEO@BCBSSC.com	I-20 at Alpine Road	AA-X01	Columbia	SC	29219	01/03/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Chief Financial Officer	VP & CFO, BCBS Div	Mrs.	Srulevich	Heather		8032649488					Heather.Srulevich@BCBSSC.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	10/26/2017	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Chief Operating Officer	President, BlueCross BlueShield of SC	Mr	Graves	Scott		8033825114					SCOTT.GRAVES@bcbssc.com	I-20 Apline Road	AA-X18	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Chief Information Officer	Senior VP, CIO	Mrs.	McCormick	Renee		8032642369					Renee.McCormick@bcbssc.com	1-20 Alpine Road	AA-X01	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Chief Information Security Officer	Senior VP, CIO	Mrs.	McCormick	Renee		8032642369					Renee.McCormick@bcbssc.com	1-20 Alpine Road	AA-X01	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	CMS Casework Communication Contact	Manager - Medicare Advantage Operations		Dewitt	Tanika		8032641103					Tanika.Dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Complaints Tracking Contact	Manager - Medicare Advantage Operations		Dewitt	Tanika		8032641103					Tanika.Dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Contact for Fraud Investigations	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Coordination of Benefits Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Corporate Mailing						8032642944					katrina.gesh-wilson@bcbssc.com	PO Box 100191		Columbia	SC	29202	11/15/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Coverage Gap Discount Program (CGDP) Payment Contact	Director - Private Business Accounting		Campbell	Newt		8032640357					CGDP_REPORTING@bcbssc.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Customer Service Operations Contact	Director Operations		Rodillo-Fowler	Ellen		8032640965				8032649581	ellen.rodillo-fowler@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	DIR Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris		8032644347				8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	DIR Contact (Secondary)	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Electronic Health Record Contact	VP- Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Emergency Part D Contact	VP - Medicare Advantage Operations		Boggero	Laurin		8034224440				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Emergency Part D Contact (Secondary)	VP Medicare Advantage		Gesh-Wilson	Kat		2816841626					kat.gesh-wilson@bcbssc.com	I-20 at Alpine Road	AG-770	Columbia	SC	29219	12/13/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Employer Waiver Contact	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Encounter Data & Risk Adjustment Operations Contact	Director, Research and Statistics		Kosnosky	Brenda		8032642744					brenda.kosnosky@bcbssc.com	I-20 Alpine Rd	AX-555	Columbia	SC	29219	11/15/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Enrollment Contact	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	EOB Transfer Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Financial Audit Contact	Compliance Officer	Mr.	Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Financial Reporting Contact	Director - Financial Reporting		Haile	Karin		8032642089					Karin.Haile@bcbssc.com	1-20 at Alpine Road	AX-200	Columbia	SC	29219	08/09/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Formulary Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris		8032644347				8038708162	Chris.Puffenbarger@bcbssc.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Formulary Contact (Secondary)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	General Contact	VP - Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	Laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Government Relations Contact	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	HIPAA Privacy Officer	Privacy Compliance Officer		Weeks	Linda		8032643562					linda.weeks@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	02/21/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	HIPAA Security Officer	AVP, I/S Goverance		Hubbard	Elizabeth		8032646146					Elizabeth.Hubbard@bcbssc.com	I-20 at Alpine Road	AA-225	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Hospice Contact	Supervisor - Medicare Advantage Operations		DeWitt	Tanika		8032641103					tanika.dewitt@bcbssc.com	1-20 @ Alpine Rd.	AG-780	Columbia	SC	29223	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Interoperability Contact	VP Medicare Operations		Boggero	Laurin		8032646635					laurin.boggero@bcbssc.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/27/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	MA Appeals/Grievances Contact	Manager - Medicare Advantage Operations		Dewitt	Tanika		8032641103					tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	MA Claims Processing Contact for Public Website	Director Operations		Morris	Charles		8032641799					charles.morris@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Marketing Contact	VP -  Medicare Advantage Operations Marketing		Edwards	Don		8032649482					Don.Edwards@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Medical Director	Chief Medical Officer		Sungurov	Max		8032645729					max.sungurov@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	05/18/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Medicare Compliance Officer	Compliance Officer	Mr.	Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	01/05/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Medicare Coordinator	Manager Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	tanika.dewitt@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Medicare Part D Opioid Overutilization Contact	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Medication Therapy Management Contact	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	OffShore Subcontractor Contact	VP-Medicare Advantage Operations	Ms.	Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Online Enrollment Center Contact (Back-up)	VP, Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	Laurin.Boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Online Enrollment Center Contact (Optional)	Manager Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	Tanika.Dewitt@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Online Enrollment Center Contact (Primary)	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Part C Application Contact	VP Medicare Advantage		Gesh-Wilson	Katrina		8032642944					kat.gesh-wilson@bcbssc.com	I-20 @ Alpine Rd	AG-770	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Part C Reporting Contact	VP - Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Part D Appeals	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris						8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/31/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032645355				PPO - BBA		C	Atlanta
H8003	Part D Appeals Contact (Secondary)	Supervisor - Medicare Advantage Operations		Dewitt	Tanika						8032649581	tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032641103				PPO - BBA		C	Atlanta
H8003	Part D Application Contact	VP Medicare Advantage		Gesh-Wilson	Katrina		8032642944					kat.gesh-wilson@bcbssc.com	I-20 @ Alpine Rd	AG-770	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Part D Benefits Contact	Sr. Director -  Medicare Pharmacy		Coleman	Terrica		8032642728				8032649581	terrica.coleman@bcbssc.com	I-20 at Alpine Road	AG-770	Columbia	SC	29219	07/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Part D Claims Submission Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Part D Exceptions Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris						8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/31/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032645355				PPO - BBA		C	Atlanta
H8003	Part D Exceptions Contact (Secondary)	Supervisor - Medicare Advantage Operations		Dewitt	Tanika							tankia.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032641103				PPO - BBA		C	Atlanta
H8003	Part D Price File Contact (Back-up)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Part D Price File Contact (Primary)	Manager, MA Pharmacy Management		Puffenbarger	Chris		8032644347					Chris.Puffenbarger@bcbssc.com	1-20 Alpine Road	AX-740	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Part D Quality Assurance Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Part D Reporting Contact	Corporate Compliance Manager		Ramsey	Ryan		8032642735					BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	01/02/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Patient Safety Contact	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Payment Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Personal Health Record Contact	VP, Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Pharmacy Director	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Pharmacy Network Management Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris		8032644347				8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Pharmacy Network Management Contact (Secondary)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Pharmacy Technical Help Desk Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris							Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/31/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8555405951				PPO - BBA		C	Atlanta
H8003	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica							terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8555405951				PPO - BBA		C	Atlanta
H8003	PHR Beneficiary Contact																	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO	BlueCross BlueShield of South Carolina, Medicare Advantage	BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8886456025				PPO - BBA		C	Atlanta
H8003	Plan Directory Contact for Public Website			Services	Provider		8003342583					Provider.Education@BCBSSC.com	I-20 at Alpine Road	AX-624	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Plan to Plan Reconciliation Contact	Director, Accounting		Campbell	Newt		8032640357					Newt.Campbell@bcbssc.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	04/13/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Processor Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					tanika.dewitt@BCBSSC.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Quality Contact	Medicare Star Performance Officer		Sloan	Jason		8032647645					jason.sloan@bcbssc.com	1-20 at Alpine Road	AG-A10	Columbia	SC	29219	03/17/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Reconciliation Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Reconciliation Contact (Secondary)	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Recovery Audit Contact	VP-Medicare Advantage Operations	Ms.	Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Surveillance Contact	VP- MA Marketing		Edwards	Don		8032649482					Don.Edwards@bcbssc.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	08/29/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	System Contact	Assistant Vice President - Information Systems		Aldinger	Eugenia		8032645410					Eugenia.Aldinger@bcbssc.com	I-20 at Alpine Road	AF-123	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Third Party Administrator (TPA) Liaison	Director - Private Business Accounting		Campbell	Newt		8032640357					CGDP_REPORTING@bcbssc.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	User Access Contact	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Utilization Management Contact	VP - Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	laurin.boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8003	Utilization Review Contact	VP - Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	Med.Partd@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/25/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	Local CCP	Blue Cross Blue Shield of South Carolina	Local PPO		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					PPO - BBA		C	Atlanta
H8010	Agent/Broker Compensation Data Contact	Telesales Director	Mr.	Gorman	Scott		7576399577					scott.gorman@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Automated TrOOP Balance Transfer Contact	Finance Manager		Harte	Declan		2533067269					declan.harte@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Backup User Access Contact	Compliance Sr. Associate	Mrs.	Terrell	Linda		6153970882				2012554173	linda.terrell@cloverhealth.com	3401 Mallory Lane  Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Best Available Evidence Contact	Enrollment Dir	Ms	Newman	Jennifer		7542456377					jennifer.newman@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Bid Audit Contact	Chief Actuary	Ms.	Wang	Julie		6306702853				2012554173	julie.wang@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Bid Audit Site Contact	Chief Actuary	Ms.	Wang	Julie		6306702853				2012554173	julie.wang@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Bid Primary Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@Cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	CAP Report Contact for Public Website	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	Wendy.Richey@cloverhealth.com	3401 Mallory Lane ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Toy	Andrew		6463183182				2012554173	andrew.toy@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Toy	Andrew		6463183180				2012554173	andrew.toy@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Chief Financial Officer	CFO	Mr.	Leffler	Scott		4406543104				2012554173	scott.leffler@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Chief Operating Officer	Chief Operating Officer	Ms.	Reynoso	Jamie		2014322133					jamie.reynoso@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Chief Information Officer	CEO	Mr.	Toy	Andrew		6463183182					andrew.toy@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Chief Information Security Officer	Chief Security Officer	Mr.	Ross	Christophe		4257378141					christopher.ross@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	CMMI Model Point of Contact	CCO	Mrs.	Richey	Wendy		5512252014					wendy.richey@Cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	CMS Casework Communication Contact	Compliance Director	Mr.	Davis	Robert		2013200506					robert.davis@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Complaints Tracking Contact	Sr Compliance Director	Mr.	Davis	Robert		2012554173					robert.davis@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Contact for Fraud Investigations	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Coordination of Benefits Contact	Enrollment Director	Ms.	Newman	Jennifer		7542456377					jennifer.newman@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Corporate Mailing						2014322133				2018587355	wendy.richey@cloverhealth.com	Clover Health	30 Montgomery Street, 15th Floor	Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant	Mr.	Bhatt	Mital		5513584582				2018587355	Mital.Bhatt@Cloverhealth.com	30 Montgomery  St	Suite 803	Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Customer Service Operations Contact	Chief Operating Officer	Ms	Reynoso	Jamie		2014322133				2012554173	jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	DIR Contact	Manager	Ms	Bhatt	Mital		5513584582					mital.bhatt@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	DIR Contact (Secondary)	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Electronic Health Record Contact	Chief Operating Officer	Ms	Reynoso	Jamie		2015322133					jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Emergency Part D Contact	VP of Pharmacy	Mr.	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Emergency Part D Contact (Secondary)	Pharmacy Operations Manager	Ms.	Zawadzki	Marta		5513490059				2019183179	Marta.Zawadzki@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Employer Waiver Contact	CCO	Mrs.	Richey	Wendy		5512252014					wendy.richey@Cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Encounter Data & Risk Adjustment Operations Contact	COO	Ms.	Reynoso	Jamie		2014322133					jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Enrollment Contact	Enrollment Director	Ms	Newman	Jennifer		7542456377					jennifer.newman@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	EOB Transfer Contact	COO	Ms	Reynoso	Jamie		2014322133				2018587355	jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Financial Audit Contact	CFO	Mr.	Leffler	Scott		4406543104				2012554173	scott.leffler@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Financial Reporting Contact	CFO	Mr.	Leffler	Scott		4406543104				2012554173	scott.leffler@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Formulary Contact	VP of Pharmacy	Mr.	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Formulary Contact (Secondary)	Pharmacy Operations Manager	Ms.	Zawadzki	Marta		5513490059				2019183179	Marta.Zawadzki@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	General Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Government Relations Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	HIPAA Privacy Officer	Privacy Officer	Ms.	Smith	Stephanie		7246104449					stephanie.smith@cloverhealth.com	30 Montgomery Street. ,15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	HIPAA Security Officer	Security Officer	Mr.	Ross	Christophe		4257378141					christopher.ross@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Hospice Contact	COO	Ms	Reynoso	Jamie		2014322133				2018587355	jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Interoperability Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014					wendy.richey@cloverhealth.com	3401 Mallory Lane  Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	MA Appeals/Grievances Contact	COO	Ms.	Reynoso	Jamie		2014322133				2018587355	jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	MA Claims Processing Contact for Public Website	Chief Information Officer	Mr.	Zumbum	Paul		2022156080					paul.zumbum@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Marketing Contact	Sr. Compliance Director	Mr.	Davis	Robert		2012554173				2012554171	robert.davis@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Medical Director	Chief Medical Officer / Medical Director	Dr.	Spektor	Mark		2014322133					mark.spektor@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Medicare Compliance Officer	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Medicare Coordinator	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Medicare Part D Opioid Overutilization Contact	Manager of Pharmacy Programs	Ms.	Zawadzki	Marta		5513490059				8665090944	Marta.Zawadzki@cloverhealth.com	30 Montgomery St	15th Floor	Jersery City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Medication Therapy Management Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	OffShore Subcontractor Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Online Enrollment Center Contact (Back-up)	Telesales Director	Mr.	Gorman	Scott		7576399577					scott.gorman@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Online Enrollment Center Contact (Primary)	Enrollment Director	Ms	Newman	Jennifer		7542456377					jennifer.newman@cloverhealth.com	30 Montgomery Street, 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Part C Application Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Part C Reporting Contact	Chief Compliance Officer	Mrs	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Part D Appeals	VP Pharmacy	Mr	Pica	Mike							mike.pica@Cloverhealth.com	30 Montgomery Street 15th Floor		Jersery City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active	2014322133				HMO - Health Maintenance Organization		C	New York
H8010	Part D Appeals Contact (Secondary)	Pharmacy Manager	Ms.	Zawadzki	Marta						2019183179	Marta.Zawadzki@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active	5513490059				HMO - Health Maintenance Organization		C	New York
H8010	Part D Application Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Part D Benefits Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Part D Claims Submission Contact	VP Pharmacy	Mr.	Pica	Mike		8887781478				2014322133	mike.pica@cloverhealth.com	30 Montgomery  St	MC080	Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Part D Exceptions Contact	VP of Pharmacy	Mr	Pica	Michael						2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active	2014322133				HMO - Health Maintenance Organization		C	New York
H8010	Part D Exceptions Contact (Secondary)	Pharmacy Operations Manager	Ms	Zawadzki	Marta						2019183179	Marta.Zawadzki@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active	5513490059				HMO - Health Maintenance Organization		C	New York
H8010	Part D Price File Contact (Back-up)	Pharmacy manager	Ms	Zawadzki	Marta		5512674583					Marta.Zawadzki@cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Part D Price File Contact (Optional)	Pharmacy Manager	Ms	Zawadzki	Marta		5513490059					Marta.Zawadzki@cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Part D Price File Contact (Primary)	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Part D Quality Assurance Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Part D Reporting Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Patient Safety Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Payment Contact	Finance Director	Mr.	Evans	Jimea		4043124432					jimea.evans@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Personal Health Record Contact	CEO	Mr	Toy	Andrew		6463183182					andrew.toy@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Pharmacy Director	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Pharmacy Network Management Contact	SV Pharmacy	Mr	Pica	Mike		2014322133				4803146023	mike.pica@Cloverhealth.com	30 Montgomery  St	MC080	Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Pharmacy Network Management Contact (Secondary)	Pharmacy manager	Ms	Zawadzki	Marta		5513490059					Marta.Zawadzki@cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Pharmacy Technical Help Desk Contact	VP of Pharmacy	Mr	Pica	Michael							mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H8010	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy manager	Ms	Zawadzki	Marta							Marta.Zawadzki@cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active	5513490059				HMO - Health Maintenance Organization		C	New York
H8010	PHR Beneficiary Contact																	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS	Clover Health	Clover Health Holdings, Inc.	491	Yes	Active	8886571207				HMO - Health Maintenance Organization		C	New York
H8010	Physician Incentive Contact	President & CEO	Mr.	Toy	Andrew		6463183182					andrew.toy@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Plan Directory Contact for Public Website	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Plan to Plan Reconciliation Contact	Accounting Manager	Mr	Bhatt	Mitah		5513584582					mitah.bhatt@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Processor Contact	VP of Pharmacy	Mr	Pica	Michael		2014322133				2012554173	mike.pica@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Quality Contact	COO	Ms	Reynoso	Jamie		2014322133				2018587355	jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Reconciliation Contact	VP, Controller	Ms.	Wei	Wei		7182497136					wei.wei@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Reconciliation Contact (Secondary)	CFO	Mr.	Leffler	Scott		6308629384				2012554173	scott.leffler@cloverhealth.com	30 Montgomery Street, 15th Floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Recovery Audit Contact	VP Controller	Ms.	Wei	Wei		7182497136				2012554173	wei.wei@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	SNP Application Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	SNP State Contact	SVP, Deputy, General Counsel	Ms.	Sores	Karen		2059087838					karen.sores@cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Surveillance Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	System Contact	Chief Information Officer	Mr.	Zumbum	Paul		2022156080					pau;.zumbum@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Third Party Administrator (TPA) Liaison	Sr. Accountant	Mr.	Bhatt	Mital		5513584582				2018587355	Mital.Bhatt@Cloverhealth.com	30 Montgomery  St	Suite 803	Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	User Access Contact	Chief Compliance Officer	Mrs.	Richey	Wendy		5512252014				2012554173	wendy.richey@cloverhealth.com	3401 Mallory Lane Ste 210		Franklin	TN	37067	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Utilization Management Contact	COO	Ms	Reynoso	Jamie		2010432213					jamie.reynoso@cloverhealth.com	30 Montgomery Street , 15th floor		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8010	Utilization Review Contact	COO	Ms	Reynoso	Jamie		2014322133					jamie.reynoso@Cloverhealth.com	30 Montgomery  St		Jersey City	NJ	07302	09/25/2023	2023	CLOVER HMO OF NEW JERSEY INC.	Local CCP	Clover Health	HMO/HMOPOS		Clover Health Holdings, Inc.	491	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8014	Agent/Broker Compensation Data Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/07/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Automated TrOOP Balance Transfer Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Backup User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Best Available Evidence Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Bid Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Bid Audit Site Contact	Director, Compliance	Ms.	Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Bid Primary Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	CAP Report Contact for Public Website	Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	11/09/2021	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	8773841241				PPO - BBA		C	Chicago
H8014	CEO - CMS Administrator Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	CEO - Senior Official for Contracting	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Chief Financial Officer	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Chief Operating Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Chief Information Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Chief Information Security Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	CMMI Model Point of Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	CMS Casework Communication Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Complaints Tracking Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Contact for Fraud Investigations	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Coordination of Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Corporate Mailing						8476968500					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway		Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	Thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Customer Service Operations Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	DIR Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	DIR Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Emergency Part D Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Emergency Part D Contact (Secondary)	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Encounter Data & Risk Adjustment Operations Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/18/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Enrollment Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	EOB Transfer Contact	Claims Manager	Mr.	Salgado	Miguel		8476968578				8008861082	Miguel.Salgado@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	11/09/2021	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Financial Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Financial Reporting Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Formulary Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3308886015	Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	General Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Government Relations Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	HIPAA Privacy Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	12/06/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	HIPAA Security Officer	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539				8555158166	Eric.Annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Hospice Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Interoperability Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	MA Appeals/Grievances Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	MA Claims Processing Contact for Public Website	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Marketing Contact	VP of Marketing	Ms.	Branco	Margaret		7187957495					margaret.branco@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/06/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Medical Director	MD	Dr	Butt	Tariq		3125458471					tariq.butt@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Medicare Compliance Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	12/06/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Medicare Coordinator	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Medicare Part D Opioid Overutilization Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Medication Therapy Management Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3304058084	Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	OffShore Subcontractor Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Online Enrollment Center Contact (Primary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 302	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Part C Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Part C Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Part D Appeals	Sr Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy	Suite 450	Dublin	OH	43017	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	8003443405	733326			PPO - BBA		C	Chicago
H8014	Part D Appeals Contact (Secondary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica							Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue		Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	7542085865				PPO - BBA		C	Chicago
H8014	Part D Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Part D Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions		Dovico	Rosario		2012696398					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Part D Exceptions Contact	Sr Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	6143363326				PPO - BBA		C	Chicago
H8014	Part D Price File Contact (Back-up)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3304058084	Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Part D Price File Contact (Primary)	Sr. Manager Medicare Product Management  Plan Fin		Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Part D Quality Assurance Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Part D Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Patient Safety Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Payment Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Pharmacy Director	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Pharmacy Network Management Contact	Provider Contracting Principal, Retail Strategy an		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Pharmacy Network Management Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Pharmacy Technical Help Desk Contact	Director, Customer Service	Ms	Monroe	LaTasha							Latsha_Monroe@express-scripts.com	13051 N Telecom Pkwy	Suite 150	Temple Terrace	FL	33637	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	8009221557				PPO - BBA		C	Chicago
H8014	Plan Directory Contact for Public Website	Vice President, Provider Operations	Ms.	Cuevas	Elizabeth		7542085880					Elizabeth.Cuevas@clearspringhealthcare.com	250 South Northwest Highway Suite 302	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Plan to Plan Reconciliation Contact	Senior Accountant	Ms.	Wrenn	Alisa		2249855588				3124290194	Alisa.Wrenn@Clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Processor Contact	Sr. Directory  Product Management		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Quality Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Reconciliation Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Recovery Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Surveillance Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	System Contact	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539					eric.annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Third Party Administrator (TPA) Liaison	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Utilization Management Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8014	Utilization Review Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/22/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H8019	Agent/Broker Compensation Data Contact	Director - Sales	Mr	Weber	Michael		6088274014				6082520829	Michael.Weber@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Automated TrOOP Balance Transfer Contact	Operations Manager, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	Relay.Health@Navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Backup User Access Contact	GRC & Regulatory Audit Coordinator		Hewitt	Deb		6088285034					deb.hewitt@deancare.com	1255 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Best Available Evidence Contact	Manager - Enrollment & Billing		Kaderabek	Kay		6088281976					kay.kaderabek@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Bid Audit Contact	Sr. Actuary		Lowenberg	Nicholas		6088274158					Nicholas.Lowenberg@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Bid Audit Site Contact	Manager - Compliance		Herbst	Travis		6088272856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Bid Primary Contact	Director - Product		Jacobson	Jaclyn		8002791301					jaclyn.jacobson@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	CAP Report Contact for Public Website	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	CEO - CMS Administrator Contact	Interm President & CFO	Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	CEO - Senior Official for Contracting		Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Chief Financial Officer	Chief Financial Officer	Mr	Ruplinger	Randy		6088274030					hpmscfo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Chief Operating Officer	President	Mr.	Docherty	David		6088274458					hpmscoo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Abdul	Dan		9529922997					Daniel.Abdul@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Chief Information Security Officer	Sr. Director of Information Risk Management - CISO	Mr.	Abbott	Brad		9529920081					Bradley.Abbott@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	CMS Casework Communication Contact	Consumer Affairs Supervisor		Sikorski	TJ		9529928542					Thomas.Sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/23/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Complaints Tracking Contact	Manager Customer Service		Riske	Christina		8002791302					Christina.Riske@deancare.com	1277 Deming Way		Madison	WI	53717	08/23/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Contact for Fraud Investigations	SIU Director		Monson	Peter		9509921149					Peter.Monson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Coordination of Benefits Contact	Manager - Enrollment & Billing		Kaderabek	Kay		6088281976					Kay.Kaderabek@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Corporate Mailing						6088274301					hpmsceo@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Coverage Gap Discount Program (CGDP) Payment Contact	Manager - Accounting		Lewis	Felicia		6088361400					felicia.lewis@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Customer Service Operations Contact	Manager Customer Service		Riske	Christina	J	8002791302					Christina.Riske@deancare.com	1277 Deming Way		Madison	WI	53717	08/23/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	DIR Contact	Sr. Actuary		Lowenberg	Nicholas		6088274158					nicholas.lowenberg@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	DIR Contact (Secondary)	Manager Government Programs Oversight	Mr	Herbst	Travis		6088282856					travis.herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Emergency Part D Contact	President		Docherty	David		6088274458					hpmsceo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Emergency Part D Contact (Secondary)	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Employer Waiver Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Encounter Data & Risk Adjustment Operations Contact	Director - Risk Adjustment Operations		Werwinski	Michelle		6088305958					Michelle.Werwinski@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Enrollment Contact	Manager - Enrollment & Billing		Kaderabek	Kay		6088281976					Kay.Kaderabek@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	EOB Transfer Contact	Manager, Pharmacy		Borleske	Amanda		6088361400				6088274212	Amanda.Borleske@deancare.com	1277 Deming Way		Madison	WI	53717	07/07/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Financial Audit Contact	Manager - Finance	Ms	Nelson	Alyssa		6084060543					alyssa.nelson@deancare.com	1277 Deming Way		Madison	WI	53717	09/21/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Financial Reporting Contact	Chief Financial Officer	Mr	Ruplinger	Randy		6088274030					hpmscfo@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Formulary Contact	Clinical Pharmacist		Valeo-Seabright	Diane		6088361400					Diane.Valeo-Seabright@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	deanna.paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	General Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Government Relations Contact	VP - Legal		Sutton	Dean		6088274301					dean.sutton@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	HIPAA Privacy Officer	Director of Privacy		Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	HIPAA Security Officer	Director - IT Operations and Shared Services		Barnes	Justin		6088285053					Justin.Barnes@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Hospice Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Interoperability Contact	Director of Privacy		Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/24/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	MA Appeals/Grievances Contact	Manager - Customer Relations		Olson	Michelle		6088274469					michelle.olson@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	MA Claims Processing Contact for Public Website	Manager Claims		Sago	Murielle	J	8002791302					Murielle.Sago@deancare.com	1277 Deming Way		Madison	WI	53717	08/23/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Marketing Contact	Legal & Regulatory Analyst		Warren	Jennifer		6088305919					jennifer.warren1@deancare.com	1277 Deming Way		Madison	WI	53717	06/22/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Medical Director	Chief Medical Officer	MD	Eichhorn	Kevin		6088281955					kevin.eichhorn@ssmhealth.com	1277 Deming Way		Madison	WI	53717	05/21/2020	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Koranteng	Milly		9529922090					Mildred.Koranteng@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/01/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Medicare Coordinator	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Valeo-Seabright	Diane		6088361400					Diane.Valeo-Seabright@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Medication Therapy Management Contact	Mgr-Pharmacy		Jakowski	Nathan		6088361400					Nathan.Jakowski@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	OffShore Subcontractor Contact	Director of Privacy		Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/24/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Online Enrollment Center Contact (Optional)	Manager - Enrollment & Billing		Kaderabek	Kay		6088281976					kay.kaderabek@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Online Enrollment Center Contact (Primary)	Manager - Enrollment & Billing		Kaderabek	Kay		6088281976					Kay.Kaderabek@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Part C Application Contact	Director - Products		Jacobson	Jaclyn		8002791301					jaclyn.jacobson@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Part C Reporting Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						9202214629	Justin.LaCrosse@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	04/16/2021	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Kansas City
H8019	Part D Application Contact	Director - Products		Jacobson	Jaclyn		8002791301					jaclyn.jacobson@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Part D Benefits Contact	Clinical Pharmacist		Valeo-Seabright	Diane		6088361400					Diane.Valeo-Seabright@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Part D Claims Submission Contact	Sr. Manager, Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/01/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Part D Exceptions Contact	Sr. Manager, Clinical Prior Authorization		LeClair	Christophe						9202214676	Christopher.LeClair@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Kansas City
H8019	Part D Price File Contact (Back-up)	Pharmacy Quality Specialist		Seager	Deb		6087291578				6087292578	Deb.Saeger@navitus.com	361 Integrity Drive		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Part D Price File Contact (Primary)	Provider Quality Analyst		Buie	Megan		5122313140					Megan.Buie@navitus.com	12301 Research Blvd, Plaza V, Suite 350		Austin	TX	78759	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Part D Quality Assurance Contact	Program Manager, Health Services		Smith	Julee		6088287579					Julee.Smith@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Part D Reporting Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Patient Safety Contact	Chief Medical Officer		Eichhorn, MD	Kevin		6088281955					kevin.eichhorn@ssmhealth.com	1277 Deming Way		Madison	WI	53717	05/21/2020	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Payment Contact	Manager - Accounting		Lewis	Felicia		6088275950					felicia.lewis@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Pharmacy Director	Director of Pharmacy Services		Wilhelm	Sue		6088287576					Sue.Wilhelm@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		9202214176					Jan.Robinson@navitus.com	361 Integrity Drive		Appleton	WI	54913	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						8665951975	Danielle.Nett@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/09/2021	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	8662703877				HMO - Health Maintenance Organization		C	Kansas City
H8019	Plan Directory Contact for Public Website	Customer Service		Service	Customer		8772327566					DHP.CustomerRelationsResolutionTeam@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Plan to Plan Reconciliation Contact	Sr. Actuary		Lowenberg	Nicholas		6088274157					nicholas.lowenberg@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Processor Contact	Clinical Pharmacist		Valeo-Seabright	Diane		6088361400					Diane.Valeo-Seabright@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Quality Contact	Program Manager, Health Services		Smith	Julee		6088287579					Julee.Smith@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Reconciliation Contact	Sr. Actuary		Lowenberg	Nicholas		6088274158					nicholas.lowenberg@medica.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Reconciliation Contact (Secondary)	Sr. Actuary		Lowenberg	Nicholas		6088274158					nicholas.lowenberg@medica.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Recovery Audit Contact	Manager - Compliance	Mr.	Herbst	Travis		6088272856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Surveillance Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	System Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Third Party Administrator (TPA) Liaison	Accounting Manager		Lewis	Felicia		6088274276					felicia.lewis@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	User Access Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Utilization Management Contact	RN - Manager - Utilization Management		Drake	Amy		6088282807					Amy.Drake@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8019	Utilization Review Contact	RN - Manager - Utilization Management		Drake	Amy		6088282807					Amy.Drake@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	MEDICA CENTRAL HEALTH PLAN	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8026	Agent/Broker Compensation Data Contact	Lead Director, Compliance		Brown	Kristen		6144395370					brownk5@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/01/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Best Available Evidence Contact	Lead Director, Compliance		Brown	Kristen		6144395370					brownk5@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/01/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	12/19/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	12/19/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Bid Primary Contact	Sr. Manager, Project Program Mgmnt		Fahrner	Melanie		6186061189					mafahrner@aetna.com	7400 W. Campus Road		New Albany	OH	43054	06/20/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	05/04/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	CMS Casework Communication Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Complaints Tracking Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Coordination of Benefits Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Corporate Mailing						4107525721				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/01/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Customer Service Operations Contact	Director, Service Operations		Phillips	Tish		8666002139					PhillipsL1@aetna.com	7400 Camous Road		New Albany	OH	43054	01/02/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Emergency Part D Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Emergency Part D Contact (Secondary)	Director, Pharmacy		Stekol	Ilona		3478806082					stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Employer Waiver Contact	Lead Director, Compliance		Brown	Kristen		6144395370					brownk5@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/01/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Encounter Data & Risk Adjustment Operations Contact	Director, Informatics		Sevchik	Melissa		6026591404					sevchikm@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	12/17/2019	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Enrollment Contact	Director, Service Operations		Truitt	Michelle		7176716847					MLTruitt@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	07/01/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Formulary Contact	Pharmacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Formulary Contact (Secondary)	Director, Pharmacy		Stekol	Ilona		3478806082					stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	General Contact	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Government Relations Contact	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	HIPAA Privacy Officer	Lead Director, Compliance		Brown	Kristen		6144395370					brownk5@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/01/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Hospice Contact	Director, Service Operations		Truitt	Michelle		7176716847					MLTruitt@aetna.com	3721 TecPort Drive		Harrisburg	PA	17111	07/01/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	MA Appeals/Grievances Contact	Lead Director, Complaint and Appeals	Ms.	Mougey	Melissa		7408191678					mougeym@aetna.com	109 Hunters Trl		Wheelersburg	OH	45694	04/14/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	09/06/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	09/06/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Medical Director	Senior Medical Director		Chand, MD	David		3303882849					chandd@aetna.com	3526 Torey Pines Drive		Fairlawn	OH	44333	09/06/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Medicare Coordinator	Vice President, Duals Markets	Mr	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Medicare Part D Opioid Overutilization Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	02/07/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Medication Therapy Management Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	MMP Reporting Requirements Contact	Lead Director, Compliance		Brown	Kristen		6144395370					brownk5@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/01/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	MMP Point of Contact	Lead Director, Compliance		Brown	Kristen		6144395370					brownk5@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/01/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	OffShore Subcontractor Contact	Lead Director, Compliance		Brown	Kristen		6144395370					brownk5@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/01/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part C Application Contact	Exec Dir, Business Operations		Washington	Chaz		3854993702					washingtonc3@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/29/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part D Appeals	Supervisor, Clinical Pharmacy	Ms.	Spencer	Tiffane						8442420914	MedicareCoverageDeterminationMMP-SNP@AETNA.com	4500 E Cotton Center, Blvd	F829	Phoenix	AZ	85040	12/16/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8609004579				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part D Appeals Contact (Secondary)	Pharmacy Director	Ms.	Vergil	Gina						8553658108	VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/05/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	4026997768				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	06/24/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part D Benefits Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part D Claims Submission Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part D Exceptions Contact	Phamacy Director		Vergil	Gina							VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	4026997768				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part D Exceptions Contact (Secondary)	Director, Pharmacy		Stekol	Ilona							stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	12/05/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	3478806082				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part D Price File Contact (Back-up)	Pharmacy Director		Vergil	Gina		4026997768					Vergilg@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part D Quality Assurance Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Patient Safety Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Payment Contact	Lead Director, FP&A	Ms.	Stefanich	Anita		3129283105					StefanichA@cvshealth.com	333 West Wacker Drive	Suite 2100	Chicago	IL	60606	12/05/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Personal Health Record Contact	Sr. Director Medical Health Services		Simmons MD	Jacqueline		3134651562					SimmonsJ3@aetna.com	28588 Northwestern Hwy	Suite 380B	Southfield	MI	48034	11/16/2020	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Pharmacy Director	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Pharmacy Network Management Contact	Phamacy Director		Vergil	Gina		4026997768					VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy		Stekol	Ilona		3478806082					Stekoli@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/02/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Pharmacy Technical Help Desk Contact	Phamacy Director		Vergil	Gina							VergilG@aetna.com	7400 West Campus Road		New Albany	OH	43054	01/18/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8553196287				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Physician Incentive Contact	Lead Director, Compliance		Brown	Kristen		6144395370					brownk5@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/01/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Plan Directory Contact for Public Website	Senior Manager, Duals	Ms.	Brown	Anne Marie		7272720427					browna36@aetna.com	3482 Maclaren Dr.		Palm Harbor	FL	34684	09/08/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Processor Contact	Vice President, Duals Markets	Mr.	Smith	Jason		6145514237					SmithT25@aetna.com	4500 E. Cotton Center Blvd.		Phoenix	AZ	85040	01/14/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Reconciliation Contact (Secondary)	Lead Director, FP&A	Ms.	Stefanich	Anita		3129283105					StefanichA@cvshealth.com	333 West Wacker Drive	Suite 2100	Chicago	IL	60606	12/05/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	01/31/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Surveillance Contact	Lead Director, Compliance		Brown	Kristen		6144395370					brownk5@aetna.com	7400 West Campus Road		New Albany	OH	43054	05/01/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	System Contact	Director Business Information Magement	Ms.	Tanzillo	Hollie	M	7407398501					tanzilloh@aetna.com	7400 Campus Road		New Albany	OH	43054	07/07/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Utilization Management Contact	Sr. Director Straregic Programs, AMA COE Clinical		Hawkins	Erin		8175288743					hawkinse@aetna.com	4300 Centreway Place		Arlington	TX	76018	07/07/2021	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8026	Utilization Review Contact	Duals Utilization Mgmt Principal Clinical Leader		Jones	Leslye		8606870283					JonesL12@cvshealth.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/19/2022	2023	AETNA BETTER HEALTH OF MICHIGAN INC.	Demo	Aetna Better Health Premier Plan	Medicare-Medicaid Plan HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	CAP Report Contact for Public Website			Services	Member		8779018181					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	3133 E. Washington Rd.		Washington	NH	03280	03/25/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	3133 E Washington Rd.		Washington	NH	03280	01/21/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Government Relations Contact	MIL- Director, Government Contracts		Welton	Michael		8885625442					michael.welton@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	12/31/2019	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	3133 E Washington Rd.		Washington	NH	03280	01/21/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	MA Claims Processing Contact for Public Website			Services	Member		8779018181					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	MMP Reporting Requirements Contact	MHI - Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate Suite 100		Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	MMP Point of Contact	MHI - Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate Suite 100		Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Plan Directory Contact for Public Website			Services	Member		8779018181					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8046	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF ILLINOIS, INC.	Demo	Molina Healthcare of Illinois	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8048	Automated TrOOP Balance Transfer Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Backup User Access Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Best Available Evidence Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Bid Primary Contact	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		FLushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	CAP Report Contact for Public Website	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371				5592389224	GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Chicago
H8048	CEO - CMS Administrator Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	CEO - Senior Official for Contracting	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Chief Financial Officer	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Chief Operating Officer	Chief Strategy Officer	Ms	Kohn	Judy		9172700599					Jkohn@kinshiphs.com	260 Pearsall Place		Lawrence	NY	11559	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Chief Information Officer	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Chief Information Security Officer	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	CMS Casework Communication Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Complaints Tracking Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Contact for Fraud Investigations	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Coordination of Benefits Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Corporate Mailing						8006391305				5592389224	ahulon@kinshiphs.com	136-65 37th Ave		Flushing	NY	11354	09/07/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Coverage Gap Discount Program (CGDP) Payment Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Customer Service Operations Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	DIR Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Emergency Part D Contact	Director of Operations and Implementation	Mr	Beijer	David		8287029191					dbeijer@kinshiphs.com	14 Berry Lane		Fletcher	NC	28732	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Encounter Data & Risk Adjustment Operations Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Enrollment Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	EOB Transfer Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371				5592389224	GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Financial Audit Contact	Regional Program Director	Mrs.	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Financial Reporting Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Formulary Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	General Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Government Relations Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	HIPAA Privacy Officer	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	HIPAA Security Officer	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Interoperability Contact	Regional Director of Operations	Mrs	Hulon	Amber		7274175819					ahulon@kinshiphs.com	9907 NE 138th Ct		Vancouver	WA	98682	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	MA Appeals/Grievances Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	MA Claims Processing Contact for Public Website	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Marketing Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Medical Director	Medical Director	Dr.	Ogando	Heather		5165516345					hogando@centerlight.org	8275 Allison Pointe Trail, Suite 370		Indianapolis	IN	46250	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Medicare Compliance Officer	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Medicare Coordinator	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Medicare Part D Opioid Overutilization Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Medication Therapy Management Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Part C Application Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Part D Appeals	Regional Director of Operations	Mrs	KornBlatt	Georgia							GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Chicago
H8048	Part D Application Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Part D Benefits Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Part D Claims Submission Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Part D Exceptions Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia							GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Chicago
H8048	Part D Price File Contact (Back-up)	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Part D Price File Contact (Primary)	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Part D Quality Assurance Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Part D Reporting Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Patient Safety Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Payment Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Pharmacy Director	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Pharmacy Network Management Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Pharmacy Technical Help Desk Contact	Regional Program Director	Mrs	KornBlatt	Georgia						5592389224	GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Chicago
H8048	Plan Directory Contact for Public Website	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Plan to Plan Reconciliation Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Processor Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Quality Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Reconciliation Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Reconciliation Contact (Secondary)	Director of Operations and Implementation	Mr	Beijer	David		8287029191					dbeijer@kinshiphs.com	14 Berry Lane		Fletcher	NC	28732	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Recovery Audit Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Surveillance Contact	Reginal Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	System Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Third Party Administrator (TPA) Liaison	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	User Access Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Utilization Management Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8048	Utilization Review Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF INDIANA, LLC	National PACE	Kinship PACE of Indiana, LLC	National PACE				Yes	Pending					PACE - Nat		C	Chicago
H8064	Agent/Broker Compensation Data Contact	Medicare Sales and Services Manager	Ms	Walston	Deborah		9106876559				9106876506	Deborah.Walston@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Automated TrOOP Balance Transfer Contact	VP, Chief Compliance Officer	Ms.	Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@Healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Backup User Access Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Best Available Evidence Contact	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Bid Audit Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Bid Audit Site Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Bid Primary Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	CAP Report Contact for Public Website	Director, Operations and Program Management	Ms.	Heckethorn	Erin	K	9106876582				9106876506	Erin.Heckethorn@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	CEO - CMS Administrator Contact	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	CEO - Senior Official for Contracting	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Chief Financial Officer	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/29/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Chief Operating Officer	President & COO	Mr	Humphrey	Craig		9106876585				9106876506	Craig.Humphrey@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Chief Information Officer	VP, Operations and IT	Ms.	Griffith	Kim		2179029004				2179029740	Kim.Griffith@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Chief Information Security Officer	Information Security Officer	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	CMS Casework Communication Contact	Manager of Regulatory and Medicare Compliance	Ms	Russell	Petrina		9106876560				9106876506	Petrina.Russell@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Complaints Tracking Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Contact for Fraud Investigations	Corporate Compliance and ERM Mgr		Adamson	Susan		2179029137					Susan.Adamson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Coordination of Benefits Contact	Medicare Operations Manager		Rentmeester	Kurt		9106876629				9106876506	Kurt.Rentmeester@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Corporate Mailing						9106876582				9106876506	Erin.Heckethorn@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Financial Analyst-Risk Adjustment		Boyce	Heather	R	2179029467					heather.boyce@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Customer Service Operations Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	DIR Contact	Director of Accounting		Deane	Laura		2179028322					laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	DIR Contact (Secondary)	Finance Manager-Risk Adjustment		Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Electronic Health Record Contact	Medical Director	Dr	Edgerton	Arthur		9107158194				9106876506	Art.Edgerton@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Emergency Part D Contact	Manager of Pharmacy Services	Ms	Lukow	Christine		9106876569					Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Encounter Data & Risk Adjustment Operations Contact	Applications Service manager		Walsh	Pam		2179029449				2173657111	Pam.Walsh@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/27/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Enrollment Contact	Director, Operations and Program Management	Ms.	Heckethorn	Erin	K	9106876582				9106876506	Erin.Heckethorn@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	EOB Transfer Contact	Director, Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	jennifer.marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/27/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Financial Audit Contact	Executive Director of Finance	Mr.	Maxwell	Jamey		2179028321				2179029740	jamey.maxwell@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Financial Reporting Contact	Chief Financial Officer	Mr	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Formulary Contact	Manager of Pharmacy	Ms.	Lukow	Christine		2179028224				2179029794	christine.lukow@firstcarolinacare.com	42 Memorial Dr.		Pinehurst	NC	28374	01/27/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Formulary Contact (Secondary)	Managed Care Pharmacist	Ms	Deschler	Jena		2179029368				2179029798	jena.deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/27/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	General Contact	Director,  Operations and Program Management	Ms.	Heckethorn	Erin	K	9106876582				9106876506	Erin.Heckethorn@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Government Relations Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029740	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	HIPAA Privacy Officer	Director, Corporate Compliance and Privacy Officer		Jensen	Traci		2179029152				2179029794	traci.jensen@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	HIPAA Security Officer	Director of Information Security	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Hospice Contact	Manager of Pharmacy	Ms.	Lukow	Christine		2179028224				2179029794	christine.lukow@firstcarolinacare.com	42 Memorial Dr.		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Interoperability Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	MA Appeals/Grievances Contact	Member / Provider Relations Manager		Regal	Wendi		2179028017				2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	MA Claims Processing Contact for Public Website	Medicare Operations Manager	Mr.	Rentmeester	Kurt		9106876629				9106876506	Kurt.Rentmeester@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Marketing Contact	Manager of Regulatory and Medicare Compliance	Ms.	Russell	Petrina		9106876560				9106876506	Petrina.Russell@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Medical Director	Medical Director	Dr.	Edgerton	Arthur		9107158194				9106876506	Art.Edgerton@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Medicare Compliance Officer	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Medicare Coordinator	Medicare Operations Manager	Mr.	Rentmeester	Kurt		9106876629				9106876506	Kurt.Rentmeester@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Medicare Part D Opioid Overutilization Contact	Manager of Pharmacy Services	Ms	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/15/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Medication Therapy Management Contact	Manager of Pharmacy Services		Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	FirstCarolinaCare Insurance Company	42 Memorial Drive	Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	OffShore Subcontractor Contact	Manager, Medicare and Regulatory Compliance	Ms	Russell	Petrina	R	9106876560				9106876506	Petrina.Russell@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Online Enrollment Center Contact (Back-up)	Manager, Medicare and Regulatory Compliance	Ms	Russell	Petrina	R	9106876560				9106876506	Petrina.Russell@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Online Enrollment Center Contact (Optional)	Compliance Analyst		Pait	Russell	R	9106876593				9106876506	Russell.Pait@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Online Enrollment Center Contact (Primary)	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Part C Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Part C Reporting Contact	Compliance Analyst		Pait	Russell		9106876593				9106876506	Russell.Pait@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Part D Appeals	Lead Member Relations Coordinator	Ms	Lewis	Chelsea							Chelsea.Lewis@HealthAlliance.org	3510 Fields Drive South		Champaign	IL	61822	01/08/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active	8005003373				PPO - BBA		C	Chicago
H8064	Part D Appeals Contact (Secondary)	Member/Provider Resolutions Manager		Regal	Wendi						2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active	8008513379				PPO - BBA		C	Chicago
H8064	Part D Application Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Part D Benefits Contact	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Part D Claims Submission Contact	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Part D Exceptions Contact	Manager of Pharmacy Services	Ms.	Lukow	Christine						9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active	9106876569				PPO - BBA		C	Chicago
H8064	Part D Exceptions Contact (Secondary)	Medical Director	Dr.	Edgerton	Arthur						9106876506	Art.Edgerton@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active	9107158194				PPO - BBA		C	Chicago
H8064	Part D Price File Contact (Back-up)	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Part D Price File Contact (Primary)	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Part D Quality Assurance Contact	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Part D Reporting Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Patient Safety Contact	Compliance Analyst		Pait	Russell		9106876593				9106876506	Russell.Pait@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Payment Contact	Director of BECS		Kleinert	Traci		2179029508				2179029797	Traci.Kleinert@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Personal Health Record Contact	Medical Director	Dr.	Edgerton	Arthur		9107158194				9106876506	Art.Edgerton@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Pharmacy Director	Director of Pharmacy		Buhr	Aimee		2179029366				2179029798	Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Pharmacy Network Management Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224					hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Pharmacy Network Management Contact (Secondary)	Manager of Pharmacy Services	Ms.	Lukow	Christine		9106876569				9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Pharmacy Technical Help Desk Contact	Manager of Pharmacy	Ms.	Lukow	Christine						2179029794	christine.lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/27/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active	8008801188	2			PPO - BBA		C	Chicago
H8064	Pharmacy Technical Help Desk Contact (Secondary)	Manager of Pharmacy Services	Ms.	Lukow	Christine						9106876506	Christine.Lukow@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active	9106876569				PPO - BBA		C	Chicago
H8064	Plan Directory Contact for Public Website	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Plan to Plan Reconciliation Contact	Finance Manager-Risk Adjustment		Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign,	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Processor Contact	Medicare Compliance Officer		Wilson	Hollie		2179028224				2179029497	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Quality Contact	Medical Director	Dr.	Edgerton	Arthur		9107158194				9106876506	Art.Edgerton@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Reconciliation Contact	Director of Accounting		Deane	Laura		2179078322					laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Reconciliation Contact (Secondary)	Finance Manager-Risk Adjustment		Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Recovery Audit Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Surveillance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	System Contact	Director, Operations and Program Management	Ms.	Heckethorn	Erin	K	9106876582				9106876506	Erin.Heckethorn@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Third Party Administrator (TPA) Liaison	Senior Financial Analyst-Risk Adjustment		Johnson	Danica	J	2179028322					danica.johnson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	11/16/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	User Access Contact	Manager, Medicare and Regulatory Compliance	Ms	Russell	Petrina	R	9106876560				9106876506	Petrina.Russell@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	02/14/2022	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Utilization Management Contact	Director of Health Services	Ms.	Taylor	Sharon		9106876580				9106876506	Sharon.Taylor@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8064	Utilization Review Contact	Director of Health Services	Ms.	Taylor	Sharon		9106876580				9106876506	Sharon.Taylor@firstcarolinacare.com	42 Memorial Drive		Pinehurst	NC	28374	01/11/2021	2023	FIRSTCAROLINACARE INSURANCE COMPANY	Local CCP	FirstMedicare Direct	Local PPO		The Carle Foundation	583	Yes	Active					PPO - BBA		C	Chicago
H8067	Agent/Broker Compensation Data Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Automated TrOOP Balance Transfer Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Backup User Access Contact		Mr	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Best Available Evidence Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Bid Audit Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Bid Audit Site Contact	President & CEO	Mr.	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Bid Primary Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	CAP Report Contact for Public Website	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	CEO - CMS Administrator Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	CEO - Senior Official for Contracting	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Chief Financial Officer	CFO	Mr	Persinger	Keith		4104563946					kpersinger@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	12/29/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Chief Operating Officer	Chief Operating Officer	Mr	Persinger	Keith		4104563946					kpersinger@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	12/29/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Chief Information Officer	Director of Information Technology	Mr	Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Chief Information Security Officer	Director of Information Technology	Mr.	Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	CMS Casework Communication Contact	Chief Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Complaints Tracking Contact		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite  300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Contact for Fraud Investigations	Director, Operations	Ms.	Winton	Linda		8173743812					lwinton@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/24/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Coordination of Benefits Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/30/2019	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Corporate Mailing						4104240772					info@pphealthplan.com	785 Elkridge Landing Rd	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/30/2019	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Customer Service Operations Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	DIR Contact	Financial Analyst	Mr	Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Avenue NW	Suite 100	North Canton	OH	44720	02/21/2023	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	DIR Contact (Secondary)	Sr Financial Manager Reporting & Analytics		Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW	Suite 100	North Canton	OH	44720	02/21/2023	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Emergency Part D Contact	Director of Pharmacy	Dr	Ford	James	E	4433100351					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Emergency Part D Contact (Secondary)	Pharmacy Operations Manager	Dr	Brown	Latrese		4437621114					lbrown@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Encounter Data & Risk Adjustment Operations Contact	Software Engineer		Rifkin	Joshua		4108977578					jrifkin@pphealthplan.com	785 Elkridge Landing Road		Linthicum	MD	21090	10/18/2019	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Enrollment Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	EOB Transfer Contact	Sr. Director of  Operations		Brain	Jay		2403672626				8448134544	JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Financial Audit Contact	Director of Finace	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Financial Reporting Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Formulary Contact	Formulary Pharmacist	MS	Baggett	Renee		3308886243					rbaggett@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Formulary Contact (Secondary)	Director Formulary Operations		Singh	Roop		3304866482					rsingh@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	General Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Government Relations Contact			Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	HIPAA Privacy Officer		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	HIPAA Security Officer	Director of Information Technology		Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Hospice Contact	Account Manager	Ms.	Sousa	Ana		2158724933					asousa@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Interoperability Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	MA Appeals/Grievances Contact	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	MA Claims Processing Contact for Public Website	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Marketing Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623019	Sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Medical Director	Medical Director	Dr	Kimmel	Alan		4102183691					akimmel@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Medicare Compliance Officer	Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	11/10/2022	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Medicare Coordinator		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Medicare Part D Opioid Overutilization Contact	Pharmacy Director	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/15/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Medication Therapy Management Contact	VP Pharmacy Solutions	Ms	Miller	Holly		3302931916					hmiller@healthdialog.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	OffShore Subcontractor Contact	Chief Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part C Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part C Reporting Contact	Medicare Advantage Reporting Process Manager	Ms	Butler	Christina		2403532930					cbutler@pphealthplan.com	785  Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/13/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Appeals	Pharmacy Director	Dr	Ford	James	E						jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/12/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	8448468007				HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Appeals Contact (Secondary)	Clinical Operations Supervisor	Ms.	Binegar	Samantha	J					3304058081	Appeals@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Benefits Contact	Director of Pharmacy	Dr	Ford	James	E	4432759810					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Claims Submission Contact	Elixir Account Manager	Ms	Brisson	Carly		9169392883					cbrisson@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Exceptions Contact	Associate Vice President	Ms	Lavignette	Amanda							alavignette@envsionrx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	11/10/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Exceptions Contact (Secondary)	Senior Director, Pharmacy Services	Dr	Ford	James							jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	11/10/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	4432759801				HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Price File Contact (Back-up)	Financial Analyst III		Wentz	Christophe		3304864910					cwentz@elixirsolutions.com	8957 Canyon Falls Blvd		Twinsburg	OH	44087	06/08/2023	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Price File Contact (Optional)	Director of Reporting & Analytics		Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	8957 Canyon Falls Blvd		Twinsburg	OH	44087	06/08/2023	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Price File Contact (Primary)	Director of Pharmacy	Mr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	10/10/2022	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Quality Assurance Contact	Pharmacy Operations Manager	Dr	Brown	Latrese		4437621114					lbrown@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Part D Reporting Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Patient Safety Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Payment Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Pharmacy Director	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Pharmacy Network Management Contact	Director Pharmacy Network Development & Operations	Ms	Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Pharmacy Technical Help Desk Contact	Vice President of Operations	Mr	Conn	Todd							tconn@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	8448468007				HMO - Health Maintenance Organization		C	Philadelphia
H8067	Plan Directory Contact for Public Website	Director of Partner Development	Ms	Radice	Sue		4109913213					Sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Plan to Plan Reconciliation Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/30/2019	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Processor Contact	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Rd	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Quality Contact	Dir. of Performance Improvement & Quality	Mr	Kirwan	Mark		4104240411					mkirwan@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Reconciliation Contact	Director of Finance	Ms	McIntyre	Marybeth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/30/2019	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Reconciliation Contact (Secondary)	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Recovery Audit Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	SNP Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	SNP State Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Surveillance Contact	Chief Compliance Officer	Mr	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	System Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					jbrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Third Party Administrator (TPA) Liaison	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	User Access Contact	Chief Compliance Officer	Mr	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/25/2021	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Utilization Management Contact	Director of Utilization Review	Mr	Derby	Thomas		4846823923					tderby@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8067	Utilization Review Contact	Director of Utilization Review	Mr	Derby	Thomas		4846823923					tderby@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8070	Agent/Broker Compensation Data Contact	Associate Vice President Sales		Eck	Brian		6126763380					beck@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Automated TrOOP Balance Transfer Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					FIR_Transactions@ucare.org	500 Stinson Boulevard NE		Minnneapolis	MN	55413	10/25/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Backup User Access Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Best Available Evidence Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/25/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Bid Audit Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Bid Audit Site Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Bid Primary Contact	Corporate Actuary		Uding	Chris		6126763372					bids@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	CAP Report Contact for Public Website	Senior Regulatory  Auditor		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/14/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Chief Financial Officer	SVP and Chief Financial Officer	Ms.	Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Chief Operating Officer	SVP and Chief Administrative Officer	Ms.	Schmitt	Pat		6126763460					pschmitt@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Chief Information Officer	Chief Information Officer	Mr	McDonald	Darin		9493098524					dmcdonald@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Chief Information Security Officer	Chief Information Security Officer, Director	Mr	Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	CMS Casework Communication Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Complaints Tracking Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Contact for Fraud Investigations	Manager SIU		Weidemann	Angie		6128171655					aweidemann@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Coordination of Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Corporate Mailing						6126766500				6126766501	sschwartz@ucare.org	UCare	500 Stinson Boulevard NE	Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Senior		Ly	Tong		6126277157					tly@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Customer Service Operations Contact	CS Support Services Sr Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	DIR Contact	Principal Actuarial Analyst		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	DIR Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Emergency Part D Contact	Customer Service Workforce Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Emergency Part D Contact (Secondary)	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	600 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Encounter Data & Risk Adjustment Operations Contact			Olberding	Milissia		6126763205					molberding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Enrollment Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/25/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	EOB Transfer Contact	CS Support Services Sr Manager		Vang	Pakou		6126763585				6128842145	pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Financial Audit Contact	Controller	Mr.	Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Financial Reporting Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Formulary Contact	Pharmacy Supervisor		Merk	Zachariah		6126763483					zmerk@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	07/29/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Formulary Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	General Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Government Relations Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	HIPAA Privacy Officer	Associate General Counsel - Privacy Officer		Heacox	Katie		5073408378					kheacox@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	HIPAA Security Officer	Chief Information Security Officer, Director		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Hospice Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Interoperability Contact	VP, Deputy General Counsel		Owen	Elizabeth		6513992800					eowen@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	MA Appeals/Grievances Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	MA Claims Processing Contact for Public Website	CCO Audit & Compliance Manager		Tenhoff	Reed		6126763664					rtenhoff@ucare.og	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/11/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Marketing Contact	Government Relations Materials Coordinator		Morales	Ana Sophia		6122945641					amorales@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Medical Director	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	McMahon	Jane		6124567817					federalgrleadershipteam@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/30/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Medicare Coordinator	Federal Government Relations Manager		Mitchell	Milonda		6122945143					mmitchell1@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/12/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030					anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/08/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Medication Therapy Management Contact	Pharmacy Quality Manager		Bower	Erika		6122945800				6128842321	ebower@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	OffShore Subcontractor Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Online Enrollment Center Contact (Back-up)	MBE Operations Manager		Rooney	Courtney		6126763468					crooney@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Online Enrollment Center Contact (Primary)	Enrollment Manager		Messbarger	Tami		6126763484					tmessbarger@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Part C Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Part C Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Part D Appeals	A&G Regulatory and Compliance Specialist		Wood	Nakia							cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active	6122945668				PPO - BBA		C	Chicago
H8070	Part D Appeals Contact (Secondary)	Manager Appeals & Grievances		Paciorek	Joshua							jpaciorek@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active	6122945225				PPO - BBA		C	Chicago
H8070	Part D Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Part D Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Part D Claims Submission Contact	Data Analyst Sr.		Krishnan	Kamali		6122945146					kkrishnan@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Part D Exceptions Contact	Vice President Pharmacy Management		Mitsch	Patrick						6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active	6122945051				PPO - BBA		C	Chicago
H8070	Part D Exceptions Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam						6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active	6122945030				PPO - BBA		C	Chicago
H8070	Part D Price File Contact (Back-up)	Pharmacy Operations Manager Sr.		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Part D Price File Contact (Optional)	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Part D Price File Contact (Primary)	Sr Manager, Government Programs		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	01/18/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Part D Quality Assurance Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Part D Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Patient Safety Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Payment Contact	Chief Financial Officer		Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Pharmacy Director	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	patmitsch@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Pharmacy Network Management Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Pharmacy Technical Help Desk Contact	Director, Customer Service		Moore	LaTasha							LaTasha_Monroe@expressscripts.com	13051 N Telecom Parkway	Suite 150	Temple Terrace	FL	33637	01/18/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active	8009221557				PPO - BBA		C	Chicago
H8070	PHR Beneficiary Contact																	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO	UCare	UCare Minnesota	238	Yes	Active	8775231515				PPO - BBA		C	Chicago
H8070	Physician Incentive Contact	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/06/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Plan Directory Contact for Public Website	CS Support Services Sr Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Plan to Plan Reconciliation Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Processor Contact	Pharmacy Operations Manager Sr		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Quality Contact	Vice President Quality Management		Hanley	Greg		6122945296					ghanley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Reconciliation Contact	Principal Actuarial Analyst		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Reconciliation Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Recovery Audit Contact	Audit Director	Mr.	Schach	Steve		6126763562					sschach@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	554132615	04/17/2023	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	SNP Application Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	SNP State Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Surveillance Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	System Contact	Chief Information Security Officer, Director		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Third Party Administrator (TPA) Liaison	Accountant		Zator	Chris		6126763563					czator@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/24/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	User Access Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/19/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Utilization Management Contact	VP Clinical Services		Wickman	Amy		6126763418					awickman@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8070	Utilization Review Contact	Clinical Regulatory Specialist		Brown	Julie	B	6126763433					jbbrown@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE MINNESOTA	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8082	Automated TrOOP Balance Transfer Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Backup User Access Contact		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Best Available Evidence Contact			Cadena	Maria		6505022961					maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Bid Primary Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	CAP Report Contact for Public Website			Wilds	Mindy		8037603916					melinda.wilds@welbehealth.com	1649 Van Ness Ave		Fresno	CA	93721	01/13/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	CEO - CMS Administrator Contact		Ms.	Wilds	Mindy		8037603916					melinda.wilds@welbehealth.com	1649 Van Ness Ave		Fresno	CA	93721	01/13/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	CEO - Senior Official for Contracting		Ms.	Wilds	Mindy		8037603916					melinda.wilds@welbehealth.com	1649 Van Ness Ave		Fresno	CA	93721	01/13/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Chief Financial Officer		Mr.	Epstein	Ethan		2036951178					ethan.epstein@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Chief Operating Officer		Ms.	Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 North Barranca Ave #4051	#4051	Covina	CA	91723	09/29/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Chief Information Officer		Ms.	O'Leary	Kate		9733031835					kate.oleary@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Chief Information Security Officer		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	CMS Casework Communication Contact	Compliance Director		Costigan	Bobbie		2192106392					Bobbie.Costigan@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Complaints Tracking Contact	Compliance Director		Costigan	Bobbie		2192106392					Bobbie.Costigan@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Contact for Fraud Investigations			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Coordination of Benefits Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Corporate Mailing						6508626371					matt.patterson@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Coverage Gap Discount Program (CGDP) Payment Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Customer Service Operations Contact			Wilds	Mindy		8037603916					Melinda.Wilds@welbehealth.com	1649 Van Ness Avenue		Fresno	CA	93721	01/13/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	DIR Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Emergency Part D Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Emergency Part D Contact (Secondary)			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Encounter Data & Risk Adjustment Operations Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Enrollment Contact			Cadena	Maria		6505022961					maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	EOB Transfer Contact			Cadena	Maria		6505022961				6263600082	maria.cadena@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Financial Audit Contact	Director of Accounting	Ms.	Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Financial Reporting Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Formulary Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	655 Oak Grove Ave #1279		Menlo Park	CA	94205	12/15/2021	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	General Contact			Wilds	Mindy		8037603916					Melinda.Wilds@welbehealth.com	1649 Van Ness Avenue		Fresno	CA	93721	01/13/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Government Relations Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	HIPAA Privacy Officer			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	HIPAA Security Officer		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Interoperability Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	MA Appeals/Grievances Contact	Quality Improvement Director		Flake	Crissy		2094426077					crissy.flake@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	MA Claims Processing Contact for Public Website			Grant	Alexsa		6503360300					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Marketing Contact			Castro	Marta		6509186233					marta.castro@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Medical Director	Chief Medical Officer		Le	Mike		7146086457					mike.le@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Medicare Compliance Officer		Ms.	Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Medicare Coordinator			Wilds	Mindy		8037603916					Melinda.Wilds@welbehealth.com	1649 Van Ness Avenue		Fresno	CA	93721	01/13/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Medicare Part D Opioid Overutilization Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Medication Therapy Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Part C Application Contact			Harden	Gabriele		3037754823					gabriele.harden@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Part D Appeals	Quality Improvement Director		Flake	Crissy							crissy.flake@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	2094426077				PACE - Nat		C	San Francisco
H8082	Part D Appeals Contact (Secondary)			Wilds	Mindy							melinda.wilds@welbehealth.com	1649 Van Ness Ave		Fresno	CA	93721	01/13/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8037603916				PACE - Nat		C	San Francisco
H8082	Part D Application Contact			Harden	Gabriele		3037754823					gabriele.harden@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Part D Benefits Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Part D Claims Submission Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Part D Exceptions Contact			Grant	Alexsa							alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8006373187				PACE - Nat		C	San Francisco
H8082	Part D Price File Contact (Back-up)			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Part D Price File Contact (Primary)			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Part D Quality Assurance Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Part D Reporting Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Patient Safety Contact	Quality Improvement Director		Flake	Crissy		2094426077					crissy.flake@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Payment Contact			Kong	Shelley		6508439275					shelley.kong@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Pharmacy Director			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Pharmacy Network Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Pharmacy Technical Help Desk Contact			Grant	Alexsa							alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active	8006373187				PACE - Nat		C	San Francisco
H8082	Plan Directory Contact for Public Website			Grant	Alexsa		6503360300					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Plan to Plan Reconciliation Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Processor Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Quality Contact	Quality Improvement Director		Flake	Crissy		2094426077					crissy.flake@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	04/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Reconciliation Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Recovery Audit Contact	VP Compliance	Ms.	Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Surveillance Contact			Lee	Elizabeth		6505141390					elizabeth.lee@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	System Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Third Party Administrator (TPA) Liaison			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	User Access Contact		Mr.	Kim	David		6502920551					david.kim@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Utilization Management Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8082	Utilization Review Contact			Grant	Alexsa		3109635394					alexsa.grant@welbehealth.com	440 N BARRANCA AVE #4051		COVINA	CA	91723	01/19/2023	2023	STOCKTON PACE	National PACE	WelbeHealth	National PACE		WelbeHealth LLC.	707	Yes	Active					PACE - Nat		C	San Francisco
H8087	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	5025809138				PPO - BBA		C	Kansas City
H8087	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	5025807929				PPO - BBA		C	Kansas City
H8087	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	5025809138				PPO - BBA		C	Kansas City
H8087	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	5024682494				PPO - BBA		C	Kansas City
H8087	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	8008658715				PPO - BBA		C	Kansas City
H8087	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	5025800475				PPO - BBA		C	Kansas City
H8087	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8087	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANADENTAL INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H8093	Agent/Broker Compensation Data Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Automated TrOOP Balance Transfer Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Backup User Access Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Best Available Evidence Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Bid Audit Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Bid Audit Site Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Bid Primary Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	CAP Report Contact for Public Website	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	CEO - CMS Administrator Contact	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	CEO - Senior Official for Contracting	CEO	Mr.	Bailey	Michael	D	6157518131				8442805360	mbailey@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Chief Financial Officer	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Chief Operating Officer	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Chief Information Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Chief Information Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	CMMI Model Point of Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	CMS Casework Communication Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Complaints Tracking Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Contact for Fraud Investigations	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Coordination of Benefits Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Corporate Mailing						6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Customer Service Operations Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	05/18/2020	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	DIR Contact	VP Formulary & Rebate Economics		Ellermeir	Nicole		9133875120					nellermeir@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	DIR Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Electronic Health Record Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Emergency Part D Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Emergency Part D Contact (Secondary)	Pharmacy Operations	Mrs.	Sanchez	Lynn		4056014429				8442805360	lsanchez@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Encounter Data & Risk Adjustment Operations Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Enrollment Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	EOB Transfer Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Financial Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Financial Reporting Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Formulary Contact	Clinical Formulary Pharmacist	Ms.	Quinn	Kelsey		3304864954					kquinn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Formulary Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	General Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Government Relations Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	HIPAA Privacy Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	HIPAA Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Hospice Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Interoperability Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	MA Appeals/Grievances Contact	A&G Team Lead	Mrs.	Henderson	Maya		6156268442				8442805360	mhenderson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	MA Claims Processing Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		8003997524				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Marketing Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Medical Director	Medical Director	Dr.	Misra	Sumathi		6156365478					SMisra@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/17/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Medicare Compliance Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Medicare Coordinator	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Medicare Part D Opioid Overutilization Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Medication Therapy Management Contact	Director of Clinical Product Development and Strat	Ms.	Miller	Holly		3304866457				3304058094	hrmiller@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	OffShore Subcontractor Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Online Enrollment Center Contact (Back-up)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Online Enrollment Center Contact (Primary)	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Part C Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Part C Reporting Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Appeals	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations	Mr	Binegar	Sam						3304058081	appeals@ElixirSolutions.com	2181 E Aurora Road	Building B, Suite 201	Twinsburg	OH	44087	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8003997524				HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Benefits Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Claims Submission Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Exceptions Contact	Associate VP of Clinical Operations	Ms.	Lavignette	Amanda						3304864801	alavignette@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Exceptions Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Price File Contact (Back-up)	Sr Financial Manager Reporting & Analytics	Mr	Campbell	Tim		3308886988					tcampbell@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Price File Contact (Optional)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Price File Contact (Primary)	Senior Director Rebates, Trade Relations	Mr.	Bonus	Jason		3304864841				3304864801	jbonus@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Quality Assurance Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Part D Reporting Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Patient Safety Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Pharmacy Director	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Pharmacy Network Management Contact	Director of Pharmacy Network Development and Ops	Ms	Profio	Lauren		3304864864				3304058094	lprofio@EnvisionRx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Pharmacy Network Management Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	09/07/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8336655420				HMO - Health Maintenance Organization		C	Dallas
H8093	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Technician		Sanchez	Lynn						6157610920	lsanchez@amhealthplans.com	909 S Meridian Avenue	Ste 425	Oklahoma City	OK	73108	12/24/2019	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8336655420				HMO - Health Maintenance Organization		C	Dallas
H8093	Plan Directory Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Plan to Plan Reconciliation Contact	Sr. Manager,  Financial Accounting	Ms.	Tilley	Stephanie		9312420499					stilley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	08/30/2023	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Processor Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Quality Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Reconciliation Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Reconciliation Contact (Secondary)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Recovery Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	SNP Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	SNP State Contact	VP, Operations	Mr	Haney	Jason		6159055420				8442805360	jhaney@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Surveillance Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	System Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Third Party Administrator (TPA) Liaison	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	User Access Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Utilization Management Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8093	Utilization Review Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	GEORGIA ASSURANCE, INC.	Local CCP	Georgia Health Advantage	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8095	Agent/Broker Compensation Data Contact	Director, Finance Operations		Hoeg	Andrea		5153764509					commissioninquiry@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	02/16/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Automated TrOOP Balance Transfer Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Backup User Access Contact	Manager		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	07/06/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Best Available Evidence Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Bid Audit Contact	Director		Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Bid Audit Site Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/14/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Bid Primary Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	CAP Report Contact for Public Website	Managing Director		Pickens	Veronica		2483955887					vpickens@bcsbm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	CEO - CMS Administrator Contact	Plan President	Mr.	Hamor	Briggs		5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	05/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	CEO - Senior Official for Contracting	Plan President	Mr.	Hamor	Briggs		5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	05/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Chief Financial Officer	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Chief Operating Officer	Managing Director, Operations	Mr.	Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Chief Information Officer	IT Director II	Mrs.	Krause	Amy		3132256638					akrause@bcbsm.com	600 East Lafayette Blvd. MC 0506		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Cieszynski	Brent		3132258766					bcieszynski@bcbsm.com	600 Lafayette East		Detroit	MI	48226	08/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	CMMI Model Point of Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	CMS Casework Communication Contact	Compliance Consultant		White	Jasmin		2486654235					JWhite4@bcbsm.com	1000 Town Center		Southfield	MI	48075	03/23/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Complaints Tracking Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Contact for Fraud Investigations	Manager		Zasadny	Brian		3132255956					bzasadny@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Coordination of Benefits Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Corporate Mailing						5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	1000 Town Center		Southfield	MI	48075	12/28/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Customer Service Operations Contact	Director, Workforce Management, Analytics, & Supp		Weber	Julie		3132250555					jweber@bcbsm.com	600 East Lafayette		Detroit	MI	48226	11/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	DIR Contact	VP Chief Medical Officer		Munir	Naim		5153766818					MunirN@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	03/02/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	DIR Contact (Secondary)	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Electronic Health Record Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Emergency Part D Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Emergency Part D Contact (Secondary)	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Employer Waiver Contact	Manager, Functional Operations		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center	TC1505	Southfeld	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Encounter Data & Risk Adjustment Operations Contact	Director,RASubs &ElectronicSupp Data		Jensen	Robert		2486654115					robert.jenson@advantasure.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Enrollment Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	EOB Transfer Contact	Director, Medicare Programs		Frank	Jesica		5153767878				8556337633	frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Financial Audit Contact	Director	Mr.	Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Financial Reporting Contact	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Formulary Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Formulary Contact (Secondary)	Manager, Functional Operations		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center	TC1505	Southfeld	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	General Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Government Relations Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	HIPAA Privacy Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	HIPAA Security Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Hospice Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Interoperability Contact	Manager, Functional Operations		Kingsley	Chris		2484444160					Christopher.kingsley@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	MA Appeals/Grievances Contact	Chief Operating Officer		Hower	Johanna		8048594034					Johanna.Hower@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	08/11/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	MA Claims Processing Contact for Public Website	Manager, Claims and Recovery Operations		Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Marketing Contact	Plan President	Mr.	Hamor	Briggs		5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	05/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Medical Director	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Medicare Compliance Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/03/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Medicare Coordinator	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Medicare Part D Opioid Overutilization Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Medication Therapy Management Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	OffShore Subcontractor Contact	Manager	Mrs.	Stretch	Kaitlin		2486654275					kstretch@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Online Enrollment Center Contact (Back-up)	Enrollment Business Lead		Schulz	Bryan		5084390769					Bryan.Schulz@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Online Enrollment Center Contact (Optional)	Manager		Woods	Cheyenne		2484173449					cheyenne.woods@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Online Enrollment Center Contact (Primary)	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Part C Application Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Part C Reporting Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Appeals	Manager		Moran	Vickie							Vickie.Moran@CVSHealth.com	620 Epsilon Dr		Pittsburgh	PA	15238	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	4125263320				HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Appeals Contact (Secondary)	Director		Christensen	Ann							Ann.Christensen@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	6023883829				HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Application Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Benefits Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	06/01/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Claims Submission Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Exceptions Contact	Director, Medicare Programs		Frank	Jesica							frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8553440930				HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Exceptions Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8553440930				HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Price File Contact (Back-up)	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Price File Contact (Optional)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Price File Contact (Primary)	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Quality Assurance Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Part D Reporting Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Patient Safety Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Payment Contact	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Personal Health Record Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Pharmacy Director	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Pharmacy Network Management Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Pharmacy Network Management Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Pharmacy Technical Help Desk Contact	Director, Medicare Programs		Frank	Jesica							frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	06/01/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8006008065				HMO - Health Maintenance Organization		C	Chicago
H8095	Pharmacy Technical Help Desk Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8006008065				HMO - Health Maintenance Organization		C	Chicago
H8095	Physician Incentive Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Plan Directory Contact for Public Website	Manager		Nelson	Jessica		8557162556					Jessica.Nelson@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Plan to Plan Reconciliation Contact	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Processor Contact	Manager, Claims and Recovery Operations		Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Quality Contact	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Reconciliation Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Reconciliation Contact (Secondary)	Manager, Pharmacy Operations		Jones	Marini		3135706777					Marini.Jones@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Recovery Audit Contact	Manager, Program Oversight	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	SNP Application Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	SNP State Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Surveillance Contact	Manager		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	07/06/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	System Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Third Party Administrator (TPA) Liaison	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	1000 Town Center		Southfield	MI	48075	12/28/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	User Access Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/15/2021	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Utilization Management Contact	Managing Director, Medical Management	Dr.	Park	Gerald		2485047408					Gerald.Park@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8095	Utilization Review Contact	Managing Director, Medical Management	Dr.	Park	Gerald		2485047408					Gerald.Park@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	Local CCP	Wellmark Advantage Health Plan	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8096	Automated TrOOP Balance Transfer Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Backup User Access Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Best Available Evidence Contact	Quality Manager	Mrs	Woodley	Kimberly		4342006516					Kimberly.Woodley@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	02/19/2018	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Bid Primary Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	CAP Report Contact for Public Website	Site Director	Mrs.	Boyd	Jennifer	H	4342006320					Jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	CEO - CMS Administrator Contact	Site Director	Mrs.	Boyd	Jennifer	H	4342006320					jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	CEO - Senior Official for Contracting	President & CEO	Ms.	Carrier	Amy		4342004705					amy.carrier@centrahealth.com	1901 Atherholt Road		Lynchburg	VA	24501	05/26/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Chief Financial Officer	Sr. Vice President & CFO	Mr	Davenport	Douglas	C	4342004708					doug.davenport@centrahealth.com	1901 Tate Springs Rd.		Lynchburg	VA	24501	12/07/2020	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Chief Operating Officer	SVP	Mr.	Davenport	Douglas		4342004708					doug.davenport@centrahealth.com	1901 Atherholt Road		Lynchburg	VA	24501	05/26/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Chief Information Officer	CIO	Ms.	Hildwein	Robin		4342006081					cio.office@centrahealth.com	1920 Atherholt Road		Lynchburg	VA	24501	08/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Chief Information Security Officer	Director IT Security/Privacy	Ms.	MEWBORN	BETSY	C	4342007996					betsy.mewborn@centrahealth.com	1901 Atherholt Road		Lynchburg	VA	24501	03/08/2016	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	CMS Casework Communication Contact	Site Director	Mrs.	Boyd	Jennifer	H	4342006320					Jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Complaints Tracking Contact	Quality Manager	Mrs	Woodley	Kimberly		4342006313					Kimberly.Woodley@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	04/21/2017	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Contact for Fraud Investigations	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Coordination of Benefits Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Corporate Mailing						4342006516				4342006263	Jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Coverage Gap Discount Program (CGDP) Payment Contact	Business Manager	Mrs.	Beach	Megan	F	4342006516	6303			4342006263	megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/08/2016	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Customer Service Operations Contact	Site Director	Mrs.	Boyd	Jennifer	H	4342006320					jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	DIR Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303				4342006263	megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	DIR Contact (Secondary)	Senior Business Office Coordinator		Ferrer	Colleen		4342006516				4342006263	colleen.ferrer@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	03/02/2023	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Emergency Part D Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Emergency Part D Contact (Secondary)	Senior Business Office Coordinator		Ferrer	Colleen		4342006516					colleen.ferrer@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	03/02/2023	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Encounter Data & Risk Adjustment Operations Contact	Business Manager	Mrs.	Beach	Megan	F	4342006516				4342006263	megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Enrollment Contact	Site Director	Mrs.	Boyd	Jennifer	H	4342006320					Jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	EOB Transfer Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303				4342006263	megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Financial Audit Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303				4342006263	megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Financial Reporting Contact	Business Manager	Mrs.	Beach	Megan		4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Formulary Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Formulary Contact (Secondary)	Senior Business Office Coordinator		Ferrer	Colleen		4342006516					colleen.ferrer@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	03/02/2023	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	General Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/06/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Government Relations Contact	Site Director	Mrs	Boyd	Jennifer	H	4342006320					Jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	HIPAA Privacy Officer	Site Director	Mrs.	Boyd	Jennifer	H	4342006320					Jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	HIPAA Security Officer	Site Director	Mrs.	Boyd	Jennifer	H	4342006320					jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Interoperability Contact	Site Director	Mrs.	Boyd	Jennifer	H	4342006320					jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	MA Appeals/Grievances Contact	Quality Manager	Mrs	Woodley	Kimberly		4342006516					kimberly.woodley@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	MA Claims Processing Contact for Public Website	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Marketing Contact	Site Director	Mrs.	Boyd	Jennifer	H	4342006320					Jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Medical Director	Medical  Director	Dr.	Howard	Laura		4342004190					laura.howard@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Medicare Compliance Officer	CORPORATE DIRECTOR COMPLIANCE & REGULATORY AFFAIRS	Ms.	Inlow	Jenny		4342001539					jenny.inlow@centrahealth.com	2301 Langhorne Road		Lynchburg	VA	24501	07/13/2023	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Medicare Coordinator	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Medicare Part D Opioid Overutilization Contact	Business Manager		Beach	Megan		4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	04/18/2019	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Medication Therapy Management Contact	Business Manager	Mrs.	Beach	Megan	F	4342006320					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	OffShore Subcontractor Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Online Enrollment Center Contact (Back-up)	Business Manager	Mrs.	Beach	Megan	F	4342006320					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Online Enrollment Center Contact (Optional)	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Online Enrollment Center Contact (Primary)	Business Manager	Mrs.	Beach	Meagn	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Part C Application Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Part D Appeals	Business Manager	Mrs.	Beach	Megan	F						megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active	8883169540				PACE - Nat		C	Philadelphia
H8096	Part D Appeals Contact (Secondary)	Quality Coordinator	Mrs	Woodley	Kimberly							Kimberly.Woodley@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	07/08/2013	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active	8883169540				PACE - Nat		C	Philadelphia
H8096	Part D Application Contact	Centra PACE Program Director	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Part D Benefits Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Part D Claims Submission Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Part D Exceptions Contact	Business Manager	Mrs.	Beach	Megan	F						megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active	8883169540				PACE - Nat		C	Philadelphia
H8096	Part D Exceptions Contact (Secondary)	Senior Director	Mrs	Boyd	Jennifer	H						jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active	8883169540				PACE - Nat		C	Philadelphia
H8096	Part D Price File Contact (Back-up)	Business Manager	Mrs.	Beach	Megan	F	4342006516					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Part D Price File Contact (Optional)	Business Manager	Mrs.	Beach	Megan	F	4342006516					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Part D Price File Contact (Primary)	Business Manager	Mr.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Part D Quality Assurance Contact	Quality Manager	Mrs	Woodley	Kimberly		4342006313					Kimberly.Woodley@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	04/21/2017	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Part D Reporting Contact	Business Manager	Mrs.	Beach	Megan	F	4342006516					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Patient Safety Contact	Site Director	Mrs.	Boyd	Jennifer	H	4342006516					jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Payment Contact	Business Manager	Mrs.	Beach	Megan	F	4342006516					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Personal Health Record Contact	Site Director	Mrs	Boyd	Jennifer	H	4342006516					Jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Pharmacy Director	Centra PACE Pharmacy Director	Mr	Puckett	Randall	K	4342003179					randall.puckett@centrahealth.com	3300 Rivermont Ave		Lynchburg	VA	24503	08/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Pharmacy Network Management Contact	Business Manager	Mrs.	Beach	Megan	F	4342006303					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Pharmacy Network Management Contact (Secondary)	Site Director	Mrs	Boyd	Jennifer	H	4342006516					Jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Pharmacy Technical Help Desk Contact	Centra PACE Pharmacy Technical Help Desk	Mr	Hawkins	Patrick							patrick.hawkins@centrahealth.com	407 Federal Street, Suite B		Lynchburg	VA	24504	06/03/2013	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active	4342002148				PACE - Nat		C	Philadelphia
H8096	Pharmacy Technical Help Desk Contact (Secondary)	Business Manager	Mrs.	Beach	Megan	F						megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active	8003169540				PACE - Nat		C	Philadelphia
H8096	Plan Directory Contact for Public Website	Site Director	Mrs.	Boyd	Jennifer	H	4342006516					Jennifer.boyd@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	09/02/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Plan to Plan Reconciliation Contact	Business Manager	Mrs.	Beach	Megan	F	4342006516					megan.beach@centrahealth.com	Centra PACE	407 Federal Street	Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Processor Contact	Centra PACE Program Director	Mr.	Graham	George	C	4342006516					george.graham@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	07/08/2013	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Quality Contact	Quality Manager	Mrs	Woodley	Kimberly		4342006313					Kimberly.Woodley@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	04/21/2017	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Reconciliation Contact	Business Manager	Mrs.	Beach	Megan	F	4342006516				4342006263	megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Reconciliation Contact (Secondary)	Senior Business Office Coordinator		Ferrer	Colleen	F	4342006516				4342006263	colleen.ferrer@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	03/02/2023	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Recovery Audit Contact	Business Manager	Mrs	Beach	Megan	F	4342006516					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Surveillance Contact	Quality Coordinator		Woodley	Kimberly		4342006313				4342006263	kimberly.woodley@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	02/15/2011	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	System Contact	Business Manager	Mrs.	Beach	Megan	F	4342006516					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Third Party Administrator (TPA) Liaison	Client Support Specialist		Yukawa	Mari		7155989513				7158522053	myukawa@pharmastar.com	Pharmastar LLC	2503 North Hillcrest Parkway	Altoona	WI	54720	08/09/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	User Access Contact	Centra PACE EPOC	Mrs	Burgess	Beth	R	4342004513					beth.burgess@centrahealth.com	1901 Tate Springs Road		Lynchburg	VA	24501	11/12/2012	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Utilization Management Contact	Business Manager	Mrs.	Beach	Megan	F	4342006516					megan.beach@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	08/31/2022	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8096	Utilization Review Contact	Quality Manager	Mrs	Woodley	Kimberly		4342006516					Kimberly.Woodley@centrahealth.com	407 Federal Street		Lynchburg	VA	24504	02/19/2018	2023	CENTRA HEALTH, INC.	National PACE	Centra PACE	National PACE		Centra Health, Inc.	394	Yes	Active					PACE - Nat		C	Philadelphia
H8099	Automated TrOOP Balance Transfer Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Backup User Access Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Best Available Evidence Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Bid Primary Contact	Business Office Manager		Cox	Terra		9709643500	3556			9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	CAP Report Contact for Public Website	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	CEO - CMS Administrator Contact	Chief of Community Healthcare	Mr.	Soczynski	Paul	F	4144068843				5173190650	psoczynski@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	CEO - Senior Official for Contracting	Chief of Community Healthcare	Mr.	Soczynski	Paul	F	4144068843					psoczynski@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Chief Financial Officer	Sr. Director, Health Plan Operations	Mr	Nilsen	Eric		6124287858				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	06/09/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Chief Operating Officer	Executive DIrector	Mr.	Robbins	Ken		5173190700					krobbins@voa.org	1921 E. Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Chief Information Officer	Vice President of Information Technologies	Mr	Osborne	David		9529410305				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Chief Information Security Officer	Vice President of Information Technologies	Mr	Osborne	David		9529410305				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	CMS Casework Communication Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Complaints Tracking Contact	Quality and Compliance Manager		Hardin	Jessica		5173190700				5179135991	jhardin@voa.org	1921 East Miller Road		Lansing	MI	48911	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Contact for Fraud Investigations	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Coordination of Benefits Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Corporate Mailing						9529410305				9529410428	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Coverage Gap Discount Program (CGDP) Payment Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Customer Service Operations Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	DIR Contact	Business Office Manager		Cox	Terra		9705087737				9702520166	tecox@voa.org	2377 Robins Way		Montrose	CO	81401	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	DIR Contact (Secondary)	Finance Manger	Mr	Raynor	Eddy		9194253053					eraynor@voa.org	4022 Stirrup Creek Drive, Suite 315		Durham	NC	27703	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Emergency Part D Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Emergency Part D Contact (Secondary)	Director of Program Integrity	Ms.	Linnell	Kathryn	R	9709643500				9702520166	klinnell@voa.org	2377Robins Way		Montrose	CO	81401	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Encounter Data & Risk Adjustment Operations Contact	Executive Director	Mr.	Robbins	Kenneth		5173190700				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Enrollment Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	EOB Transfer Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Financial Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Financial Reporting Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Formulary Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	General Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Government Relations Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	HIPAA Privacy Officer	Vice President of Information Technology	Mr.	Osborne	David		9529410305				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	HIPAA Security Officer	Vice President of Information Technology	Mr.	Osborne	David		9529410305				9529410428	dosborne@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Interoperability Contact	Executive Director	Mr.	Robbins	Ken	S	5173190700					krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	02/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	MA Appeals/Grievances Contact	Quality & Compliance Manager		Hardin	Jessica		5173190700				5179135991	jhardin@voa.org	1921 East Miller Road		Lansing	MI	48911	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	MA Claims Processing Contact for Public Website	Claims Administrator		Ford	Jill		9705087711				9707971984	jford@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Marketing Contact	Marketing Coordinator		Rincon	Michelle		5173190700				5173190650	mrincon@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Medical Director	Medical Director	Dr.	Hengstebeck	Elizabeth		5173190700				5173190717	ehengstebeck@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Medicare Compliance Officer	PACE Director of Program Integrity/Compliance	Ms.	Linnell	Kathryn	R	9705087757				8668299949	klinnell@voa.org	2377 Robins Way		Montrose	CO	81401	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Medicare Coordinator	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Hengstebeck	Elizabeth		5173190700				5179135991	ehengstebeck@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Medication Therapy Management Contact	Medical Director	Dr.	Hengstebeck	Elizabeth		5173190700				5179135991	ehengstebeck@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Part C Application Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Part D Appeals	Executive Director	Mr.	Robbins	Ken						5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending	5173190690				PACE - Nat		C	Atlanta
H8099	Part D Appeals Contact (Secondary)	Executive Director		Robbins	Ken	S						krobbins@vova.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending	2316383079				PACE - Nat		C	Atlanta
H8099	Part D Application Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Part D Benefits Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Part D Claims Submission Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Part D Exceptions Contact	Executive Director	Mr.	Robbins	Ken						5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending	5173190690				PACE - Nat		C	Atlanta
H8099	Part D Price File Contact (Back-up)	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Part D Price File Contact (Primary)	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Part D Quality Assurance Contact	Quality & Compliance Manager		Hardin	Jessica		5173190700				5179135991	jhardin@voa.org	1921 East Miller Road		Lansing	MI	48911	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Part D Reporting Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Patient Safety Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Payment Contact	Finance Manager	Mr	Raynor	Eddy		9194253053				9194253001	eraynor@voa.org	4022 Stirrup Creek Drive Suite 315		Durham	NC	27703	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Pharmacy Director	Medical Director	Dr.	Hengstebeck	Elizabeth		5173190700				5179135991	ehengstebeck@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Pharmacy Network Management Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Pharmacy Technical Help Desk Contact	Executive Director	Mr.	Robbins	Ken						5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending	5173190690				PACE - Nat		C	Atlanta
H8099	Plan Directory Contact for Public Website	Marketing Coordinator		Rincon	Michelle		5173190700				5173190650	mrincon@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Plan to Plan Reconciliation Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Processor Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Quality Contact	Quality & Compliance Manager		Hardin	Jessica		5173190700				5179135991	jhardin@voa.org	1921 East Miller Road		Lansing	MI	48911	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Reconciliation Contact	Sr. Director, Health Plan Operations	Mr.	Nilsen	Eric		6124287858					enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Recovery Audit Contact	Healthcare Controller	Ms	Nutz	Faith		6124287841				9529417097	fnutz@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Surveillance Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	System Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Third Party Administrator (TPA) Liaison	Sr. Director, Health Plan Operations		Nilsen	Eric		6124287858				9529417097	enilsen@voa.org	7485 Office Ridge Circle		Eden Prairie	MN	55344	09/21/2023	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	User Access Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Utilization Management Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8099	Utilization Review Contact	Executive Director	Mr.	Robbins	Ken		5173190690				5173190650	krobbins@voa.org	1921 East Miller Road		Lansing	MI	48911	12/23/2022	2023	VOANS SENIOR COMMUNITY CARE OF NORTHERN KENTUCKY	National PACE	Senior CommUnity Care of Northern Kentucky	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8121	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H8121	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	02/02/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/02/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Medical Director	Medical Director	Mr	Haake	Karl		9132951245					karl.haake@sunflowerhealthplan.com	77 West Wacker Drive, 14th Floor		Chicago	IL	60601	03/30/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H8121	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H8121	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H8121	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H8121	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H8121	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H8121	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8339062876				PPO - BBA		C	Dallas
H8121	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Plan Directory Contact for Public Website			Services	Provider		8667960530					CorporateMedicareComplianceDept@Centene.com	1301 International Parkway,	Suite 400	Sunrise	FL	33323	03/31/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8121	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY TENNESSEE	Local CCP	Ascension Complete	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8130	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	CAP Report Contact for Public Website			Services	Member		8665539494					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	MA Claims Processing Contact for Public Website			Services	Member		8665539494					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	5625170246				HMO - Health Maintenance Organization		C	New York
H8130	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H8130	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	8012525706				HMO - Health Maintenance Organization		C	New York
H8130	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	5708612665				HMO - Health Maintenance Organization		C	New York
H8130	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	8666934620				HMO - Health Maintenance Organization		C	New York
H8130	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	8012525706				HMO - Health Maintenance Organization		C	New York
H8130	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Plan Directory Contact for Public Website			Services	Member		8665539494					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8130	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/02/2023	2023	MOLINA HEALTHCARE OF FLORIDA, INC.	Local CCP	Molina Healthcare of Florida	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8133	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	01/30/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	11/27/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	12/04/2018	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	02/27/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/04/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8133	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8133	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	08/09/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8133	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8133	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	11/27/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/22/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8772777898				HMO - Health Maintenance Organization		C	Denver
H8133	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/23/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	0000000000				HMO - Health Maintenance Organization		C	Denver
H8133	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	09/21/2018	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Reconciliation Contact (Secondary)	Accountant II	Ms.	Nipabi	Ola		9727661324				0000000000	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	07/29/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	04/26/2016	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8133	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	04/26/2016	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Agent/Broker Compensation Data Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Automated TrOOP Balance Transfer Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Backup User Access Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Best Available Evidence Contact	Director HP Enrollment		Wilson	Deanna		2542983340					Deanna.Wilson@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Bid Audit Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Bid Audit Site Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Bid Primary Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	CAP Report Contact for Public Website	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	CEO - CMS Administrator Contact	CEO and President	Mr.	Ingrum	Jeff		2542986090					Jeffrey.Ingrum@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/23/2020	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	CEO - Senior Official for Contracting	CEO and President	Mr.	Ingrum	Jeff		2542986088					Jeffrey.Ingrum@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/20/2017	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Chief Financial Officer	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/20/2017	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Chief Operating Officer	Chief Operating Officer	Mr.	Richey	Victor		2148204200					Vic.Richey@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Chief Information Officer	Director of Information Systems	Mr.	Fort	Rob		2542983233					Rob.Fort@bswhealth.org	1206 West Campus Drive		Temple	TX	76502	07/12/2019	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Chief Information Security Officer	Director of Information Systems	Mr.	Fort	Rob		2542983233					Rob.Fort@bswhealth.org	1206 West Campus Drive		Temple	TX	76502	07/12/2019	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	CMMI Model Point of Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	CMS Casework Communication Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Complaints Tracking Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Contact for Fraud Investigations	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Coordination of Benefits Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Corporate Mailing						2542986088					Jeffrey.Ingrum@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Coverage Gap Discount Program (CGDP) Payment Contact	VP Finance		Cutroni	Michael		2542983085				2542983005	michael.cutroni@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	09/19/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Customer Service Operations Contact	Manager, Customer Advocacy		Perkins	Michelle		2542983393					Michelle.Perkins@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	DIR Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	DIR Contact (Secondary)	VP Finance		Cutroni	Michael		2542983085				2542983005	michael.cutroni@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	09/19/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Electronic Health Record Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Emergency Part D Contact	Director Pharmacy Operations		Luebbert	Charlotte		2546243358					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/23/2020	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Emergency Part D Contact (Secondary)	Manager Pharmacy Operations	Ms.	Symm	Sheila		2542929095					Sheila.Symm@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/23/2020	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Employer Waiver Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Encounter Data & Risk Adjustment Operations Contact	Director Risk Adjustment		Coakley	Deborah		5059342320					Deborah.Coakley@BSWHealth.org	1206 West Campus Dr.		Temple	TX	76502	10/22/2019	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Enrollment Contact	Director HP Enrollment		Wilson	Deanna		2542983340					Deanna.Wilson@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	EOB Transfer Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Financial Audit Contact	VP Finance	Mr.	Cutroni	Michael		2542983000					Michael.Cutroni@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	08/14/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Financial Reporting Contact	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/20/2017	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Formulary Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Formulary Contact (Secondary)	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	General Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Government Relations Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	HIPAA Privacy Officer	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	HIPAA Security Officer	Director IS	Mr.	Fort	Rob		2542983233					Rob.Fort@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/12/2019	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Hospice Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Interoperability Contact	Director of Information Systems	Mr.	Fort	Rob		2542983233					Rob.Fort@bswhealth.org	1206 West Campus Drive		Temple	TX	76502	01/10/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	MA Appeals/Grievances Contact	Director, Appeals and Grievance		Saravia	Sharon		2542986156					Sharon.Saravia@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	MA Claims Processing Contact for Public Website	Claims Manager		Fabianke	Elizabeth		2542983385					Elizabeth.Fabianke@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/20/2017	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Marketing Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Medical Director	Chief Medical Officer	Dr.	Ramalingam	S		2542983487					S.Ramalingam@BSWHealth.org	1206 West Campus Dr		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Medicare Compliance Officer	Compliance Officer	Mrs	Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Medicare Coordinator	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Medicare Part D Opioid Overutilization Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Medication Therapy Management Contact	Clinical Pharmacist		Thomas	Megan		2542986154					Megan.Cunningham@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	OffShore Subcontractor Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Online Enrollment Center Contact (Back-up)	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Online Enrollment Center Contact (Primary)	Director HP Enrollment		Wilson	Deanna		2542983340					Deanna.Wilson@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Part C Application Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Part C Reporting Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Part D Appeals	Director, Appeals and Grievance		Saravia	Sharon							Sharon.Saravia@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	2542986156				HMO - Health Maintenance Organization		C	Denver
H8142	Part D Appeals Contact (Secondary)	Director, Appeals and Grievance		Saravia	Sharon						2542983086	sharon.saravia@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	2542986156				HMO - Health Maintenance Organization		C	Denver
H8142	Part D Application Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Part D Benefits Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Part D Claims Submission Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Part D Exceptions Contact	Manager Pharmacy Admin.		Thomas	Megan							Megan.Cunningham@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/15/2019	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	2542986108				HMO - Health Maintenance Organization		C	Denver
H8142	Part D Exceptions Contact (Secondary)	Director Pharmacy Operations		Luebbert	Charlotte							Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/15/2019	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	2542986151				HMO - Health Maintenance Organization		C	Denver
H8142	Part D Price File Contact (Back-up)	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/15/2019	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Part D Price File Contact (Optional)	Manager Rx Operations		Symm	Sheila		2542986173					Sheila.Symm@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/12/2019	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Part D Price File Contact (Primary)			Rx	Optum		6514955363					medops_planfinder@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/02/2020	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Part D Quality Assurance Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Part D Reporting Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Patient Safety Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Payment Contact	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/20/2017	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Pharmacy Director	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Pharmacy Network Management Contact	Director Pharmacy Operations		Luebbert	Charlotte		2542986151					Charlotte.Luebbert@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Pharmacy Network Management Contact (Secondary)	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Pharmacy Technical Help Desk Contact	OptumRx		Rx	Optum								1600 McConnor Parkway		Schaumburg	IL	601736801	01/14/2019	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	8442309357				HMO - Health Maintenance Organization		C	Denver
H8142	Pharmacy Technical Help Desk Contact (Secondary)	SWHP Pharmacy Customer Service		Customer Service	Pharmacy								1206 W Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active	8007287947				HMO - Health Maintenance Organization		C	Denver
H8142	Physician Incentive Contact	Chief Financial Officer	Mr.	Bush	Stephen	P	2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	01/26/2017	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Plan Directory Contact for Public Website	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Plan to Plan Reconciliation Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Processor Contact	Chief Financial Officer		Bush	Stephen		2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/24/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Quality Contact	Director of Quality		Martin	Kathleen		5033274425				2542983005	Kathleen.Martin@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	08/17/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Reconciliation Contact	Chief Financial Officer		Bush	Stephen		2542983568				2542983005	Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	02/16/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Reconciliation Contact (Secondary)	Financial Advisor II		Albright	Irina		5122576254					Irina.Albright@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Recovery Audit Contact	Chief Financial Officer	Mr.	Bush	Stephen		2542983568					Stephen.Bush@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	07/09/2018	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	SNP Application Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	SNP State Contact	Director, Government Programs		Jaber	Danielle		5122576136					Danielle.Jaber@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Surveillance Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	System Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Third Party Administrator (TPA) Liaison	VP Finance		Cutroni	Michael		2542983085				2542983005	michael.cutroni@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	09/19/2022	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	User Access Contact	Compliance Officer		Cornett	Amy		2542983211					Amy.Cornett@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	12/28/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Utilization Management Contact	Director of Health Services		Starks	Chmyra		2542983386				2542983005	Chmyra.Starks@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	08/24/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8142	Utilization Review Contact	Director of Health Services		Starks	Chmyra		2542983386				2542983005	Chmyra.Starks@BSWHealth.org	1206 West Campus Drive		Temple	TX	76502	08/24/2021	2023	SCOTT AND WHITE HEALTH PLAN	Local CCP	Baylor Scott & White Health Plan	HMO/HMOPOS		Baylor Scott & White Holdings	588	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8145	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	5025809138				PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	5025807929				PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	5025809138				PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	5024682494				PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	PFFS Terms and Conditions of Payment Contact for Public Website			Hunt	Stephanie		8004574708					InquiriesForPFFS@humana.com	PO Box 14601		Lexington	KY	40512	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	8008658715				PFFS - Private Fee for Service		C	Kansas City
H8145	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active	5025800475				PFFS - Private Fee for Service		C	Kansas City
H8145	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8145	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PFFS	Humana	PFFS		Humana Inc.	128	Yes	Active					PFFS - Private Fee for Service		C	Kansas City
H8166	Agent/Broker Compensation Data Contact	Manager, Sales Support & Operations	Mr.	Thompson	Seth		4128883167					Seth.Thompson@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Backup User Access Contact	Sr. Risk and Regulatory Intelligence Analyst	Ms.	Hegedus	Emily		6078219034					emily.hegedus@highmarkhealth.org	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Best Available Evidence Contact	Manager, Government Business Enrollment	Mr.	Stanhoff	David		4125445689					LISBAE@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Bid Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Bid Audit Site Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Bid Primary Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	01/13/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	CEO - CMS Administrator Contact	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	CEO - Senior Official for Contracting	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Chief Financial Officer	CFO Highmark Health Plan	Mr.	Bridges	Ja'Ron		4125441452					JaRon.Bridges@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/27/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Chief Operating Officer	SVP, Government Business Segment President	Ms.	Miller	Alexis	A	4125447389					Alexis.Miller@Highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/10/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Chief Information Officer	Senior Vice President, Infrastructure & Architectu	Mr.	Krebs	Mark		7173026255					mark.krebs@goenGen.com	120 Fifth Avenue		Pittsbrugh	PA	15222	09/25/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Chief Information Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	CMMI Model Point of Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/15/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	CMS Casework Communication Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Complaints Tracking Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne		4125444579				7176354209	Lynne.Walsh@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Contact for Fraud Investigations	VP Financial Investigation & Provider Review	Mr.	Spear	Kurt		4125447069					Kurt.Spear@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Coordination of Benefits Contact	Sr. Process Analyst	Ms.	Cassidy	Christina		4125444417					Christina.Cassidy@highmark.com	120 Fifth Avenue	PAP P5111	Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Corporate Mailing						4125447031					Thomas.Boettler@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Cash Mgmt and Forecasting	Mr.	DeVan	Walter		7173026609					Walter.DeVanJr@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	03/02/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Customer Service Operations Contact	Director, Member & Provider Services		Scarnati	Chris		8148716712					Chris.Scarnati@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	DIR Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	DIR Contact (Secondary)	Senior Risk & Compliance Case Manager		Stetson	Kelsey		4125445816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Emergency Part D Contact	Director, Customer Experience		Scarnati	Chris		8148716712					Chris.Scarnati@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Emergency Part D Contact (Secondary)	Manager, Customer Service		Merritt	Meggan		3042992512					Meggan.Hostuttler@highmark.com	120 Fifth Avenue Place	Suite PKSB-2	Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Employer Waiver Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Encounter Data & Risk Adjustment Operations Contact	Director, Actuarial Services		Morris	Edward		4125447079					edward.morris@highmark.com	501 Penn Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Enrollment Contact	Director, Enrollment and Billing	Mr.	Palmer	David		4125446384					David.Palmer@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/22/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	EOB Transfer Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	bob.opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Financial Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Financial Reporting Contact	Vice President, Accounting & Reportin	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Formulary Contact	Senior Pharmacist, Clinical Pharmacy Services		DiTullio	Kelly		4128884336					Kelly.DiTullio@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/08/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Formulary Contact (Secondary)	Senior Pharmacist, Clinical Pharmacy Services		Humphries	Jessica		4128884890					jessica.humphries@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/08/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	General Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Government Relations Contact	SVP, Government Affiars	Mr.	Warfel	Michael	G	7173023979					michael.warfel@highmark.com	1800 Center St.		Camp Hill	PA	17011	03/18/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	HIPAA Privacy Officer	Chief Privacy and Data Ethics Officer	Ms.	Patrick	Justine		4125444643					Justine.Patrick@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	HIPAA Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Hospice Contact	Intake Coordinator		Welker	Jessica		7178883043					DrugHelp_Authorizations@highmark.com	120 5th Avenue Place		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Interoperability Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	MA Appeals/Grievances Contact	Manager, Appeals & Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	MA Claims Processing Contact for Public Website	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/22/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Marketing Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					Jillian.Pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	10/14/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Medical Director	VP, Executive Medical Director	Dr,	Law	Timothy		4125446445					timothy.law@highmark.com	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Medicare Coordinator	Director, Government Compliance	Ms.	Carl	Kathleen	A	4125447156					Kathleen.Carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Medicare Part D Opioid Overutilization Contact	Pharmacist	Ms.	Ali	Dewaa		4129040214					Dewaa.ali@highmark.com	120 Fifth Avenue PAP P4207		Pittsburgh	PA	15222	07/31/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Medication Therapy Management Contact	Senior Pharmacist	Ms.	Adlesic	Meredith		4128883749					Meredith.Adlesic@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	OffShore Subcontractor Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Online Enrollment Center Contact (Back-up)	Manager Enrollment & Billing	Mr.	Stanhoff	David		4125445689					LISBAE@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Online Enrollment Center Contact (Optional)	Manager, Business Platform	Mr.	Hudson	Brian		7173025964					Brian.Hudson@highmark.com	1800 Center St.		Camp Hill	PA	17011	07/22/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Online Enrollment Center Contact (Primary)	Director, Enrollment and Billing	Mr.	Palmer	David		4125446384					David.Palmer@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/22/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Part C Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Part C Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Part D Appeals	Manager, Member Appeals & Grievances	Ms.	Walsh	Lynne	M					7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	4125444579				PPO - BBA		C	Philadelphia
H8166	Part D Appeals Contact (Secondary)	Supervisor, Appeals & Grievances	Ms.	Miller	Rachel	M					7176354209	Rachel.Miller@highmark.com	Fifth Ave Place	120 Fifth Avenue, Ste 5322	Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	4125441596				PPO - BBA		C	Philadelphia
H8166	Part D Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Part D Benefits Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Part D Claims Submission Contact	Director Regulated Marketing Medicare Solutions		Dovico	Rosario		9145896300				8882822583	Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	11/08/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Part D Exceptions Contact			Affairs	Pharmacy							drughelp@highmark.com	120 Fifth Avenue	Suite P4207	Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8006002227				PPO - BBA		C	Philadelphia
H8166	Part D Exceptions Contact (Secondary)	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	08/04/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8003443405	733326			PPO - BBA		C	Philadelphia
H8166	Part D Price File Contact (Back-up)	Pharmacy Analyst	Mr.	Nolder	Tim		4124398263					timothy.nolder@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Part D Price File Contact (Optional)	Director, Government Programs	Mr.	Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	02/14/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Part D Price File Contact (Primary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Part D Quality Assurance Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Part D Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Patient Safety Contact	Director, Clinical Pharmacy Operations	Mr.	Causer	Derek		4125445835					Derek.Causer@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	12/20/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Payment Contact	Vice President, Accounting and Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Pharmacy Director	Manager, Pharmacy Programs		Winterhalter	Christa		4128884108					Christa.Winterhalter@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Pharmacy Network Management Contact	Network Account Director, Retail Strat & Contract	Ms.	Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	11/08/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	8009221557				PPO - BBA		C	Philadelphia
H8166	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Government Operations	Ms	Lynn Schill	Jodie							Jodie.LynnSchill@highmark.com	120 Fifth Avenue Pittsburgh, PA 15222		Pittsburgh	PA	15222	08/16/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active	5705783579				PPO - BBA		C	Philadelphia
H8166	PHR Beneficiary Contact																	03/23/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO	Highmark BCBSD Inc	Highmark Health	123	Yes	Active	8665886967				PPO - BBA		C	Philadelphia
H8166	Physician Incentive Contact	VP Prov Reimbursement & Network	Mr.	McDonald	Brendan		4125446611					brendan.mcdonald@highmarkhealth.org	120 5th Avenue Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Plan Directory Contact for Public Website			Service	Provider		8665886967					resourcecenter@highmark.com	120 Fifth Ave		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Plan to Plan Reconciliation Contact	Manager, Operational Accounting	Mr.	Stehr	Brett	J	7173022748					P2Precon@highmark.com	Highmark Inc. Attn: Cashier	PO Box 898820	Camp Hill	PA	170890407	06/28/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Processor Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Quality Contact	VP, Clinical Quality and Medical Policy	Dr.	Onuoha-Obilor	Stella		4125444335					Stella.Onuoha-Obilor@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Reconciliation Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Reconciliation Contact (Secondary)	Senior Risk * Compliance Case manager		Stetson	Kelsey		4125448816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Recovery Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Surveillance Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					jillian.pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	System Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Third Party Administrator (TPA) Liaison			Jurgiewicz	Kimberly		5707807969					kimberly.jurgiewicz@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	05/25/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	User Access Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Utilization Management Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8166	Utilization Review Contact	VP, UM Transformation & Operations	Mr.	Erickson	Justin		6126690506					justin.erickson@highmark.com	150 5th Ave Place		Pittsburgh	PA	152223099	08/16/2023	2023	HIGHMARK BCBSD, INC.	Local CCP	Highmark Blue Cross Blue Shield	Local PPO		Highmark Health	123	Yes	Active					PPO - BBA		C	Philadelphia
H8173	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7812272122					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		7812272123					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7812272124					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		7812272127					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Chief Information Security Officer	Security Officer	Mr.	Careless	Jason		6025764139					Jason.careless@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Contact for Fraud Investigations	Head of SIU		Bowman	John		3144732898					john.bowman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	General Contact	Compliance Manager	Ms.	Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		7812272122					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	HIPAA Privacy Officer	Privacy Officer		Reilly	Emily		4043049090					Emily.reilly@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	HIPAA Security Officer	Information Security Officer		Careless	Jason		6025764139					Jason.careless@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Marketing Contact	Marketing Manager		Lord	Austin		5085964196					Austin.lord@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Medicare Coordinator	Compliance Manager	Ms.	Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H8173	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H8173	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H8173	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H8173	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Payment Contact	CFO	Mr.	Yale	Brad		7812272124					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H8173	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active	2072990251				HMO - Health Maintenance Organization		C	New York
H8173	PHR Beneficiary Contact																	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				HMO - Health Maintenance Organization		C	New York
H8173	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Processor Contact	Chief Operating Officer		Henry	Larry		7812272127					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Surveillance Contact	Chief Compliance Officer		OKane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	User Access Contact	Chief Compliance Officer	Ms.	OKane	Shannon		7812272132					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8173	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	09/21/2023	2023	DEVOTED HEALTH PLAN OF ARIZONA, INC.	Local CCP	Devoted Health	HMO/HMOPOS		Devoted Health, Inc.	690	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	CAP Report Contact for Public Website			Services	Member		8445263195					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	MA Claims Processing Contact for Public Website			Services	Member		8445263195					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/12/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H8176	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H8176	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H8176	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H8176	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/31/2019	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H8176	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H8176	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Plan Directory Contact for Public Website			Services	Member		8445263195					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8176	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF SOUTH CAROLINA,INC	Local CCP	Molina Healthcare of South Carolina	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8181	Agent/Broker Compensation Data Contact	Commission Analyst	Ms.	Westley	Tracey		4029828256					tracey.westley@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Automated TrOOP Balance Transfer Contact	Director PBM Operations	Ms.	Allie	Cindy		6127776755					EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Backup User Access Contact	Medicare Liaison	Ms.	Ellison	LeeAnn		4029826477					leeann.ellison@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Best Available Evidence Contact	Enrollment and Billing Manager	Ms.	Ware	Anita		5083309500					Anita.Ware@advantasure.com	134 Turnpike Road		Southborough	MA	01772	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Bid Audit Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Bid Audit Site Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Bid Primary Contact	Senior Consultant	Ms.	Fox	Angela		6027174493					afox@rebellisgroup.com	17090 S Highland Ridge Dr		Village of Loch Lloyd	MO	64012	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Vaughn	Shannon		4029827846					shannon.vaughn@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	CEO - CMS Administrator Contact	Chief Revenue Officer	Mr	Rowe	Ron		4029826013					ron.rowe@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	CEO - Senior Official for Contracting	Chief Revenue Officer	Mr	Rowe	Ron		4029826013					ron.rowe@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Chief Financial Officer	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Chief Operating Officer	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Chief Information Officer	VP Information Services, CIO	Mr.	Kolli	Rama		4029827556					Rama.Kolli@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Chief Information Security Officer	Director of Information Assurance and CSO	Mr.	Kremke	Kerry		4029827583					Kerry.Kremke@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	CMS Casework Communication Contact	Senior Direction, Operations	Ms.	Franke	Dana		5035516818					dfranke@rebellisgroup.com	17090 S Highland Ridge Dr	TC1301	Village of Loch Lloyd	MO	64012	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Complaints Tracking Contact	Project Consultant	Ms.	Hill	Erin		2164829422					ehill@rebellisgroup.com	17090 S Highland Ridge Dr		Village of Loch Lloyd	MO	64012	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Contact for Fraud Investigations	Sr Dir, Associate General Counsel		Nogosek	Kory		4029828936					kory.nogosek@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Coordination of Benefits Contact	Director PBM Operations	Ms.	Allie	Cindy		6127776755					COBMedD@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Corporate Mailing						4029827842					MedicareCompliance@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Coverage Gap Discount Program (CGDP) Payment Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Customer Service Operations Contact	Director, Workforce Management, Analytics & Suppor		Weber	Julie		8885052022					jweber@bcbsm.com	500 Lafayette East		Detroit	MI	48226	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	DIR Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	DIR Contact (Secondary)	MA Compliance Officer	Ms.	Vaughn	Shannon		4029827846					shannon.vaughn@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Electronic Health Record Contact	Director Clnical Quality Improvement	Ms.	Collins	Shelley		4029828564					Shelley.Collins@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Emergency Part D Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Emergency Part D Contact (Secondary)	MA Compliance Officer	Ms.	Vaughn	Shannon		4029827846					shannon.vaughn@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Employer Waiver Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Encounter Data & Risk Adjustment Operations Contact	Manager Risk Adjustment	Ms.	Boardman	Laura		4029827636					laura.boardman@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Enrollment Contact	Enrollment and COB Manager	Ms.	LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road, Suite 200		Glen Allen	VA	23060	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	EOB Transfer Contact	Manager, PBM Operations	Ms.	Allie	Cindy		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Financial Audit Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Financial Reporting Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Formulary Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negashl@primetherapeutics.com	29090 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	General Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Government Relations Contact	Chief Actuary and Analytics Officer	Mr.	Konnath	Steven		4029828862					steven.konnath@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	HIPAA Privacy Officer	Director of Information Assurance and CSO	Mr.	Kremke	Kerry		4029827583					Kerry.Kremke@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	HIPAA Security Officer	Director of Information Assurance and CSO	Mr.	Kremke	Kerry		4029827583					Kerry.Kremke@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Hospice Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Interoperability Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	MA Appeals/Grievances Contact	Manager, MA Grievances and Appeals	Ms.	Catlin	Shelly		3132257317					SCatlin@bcbsm.com	600 East Lafayette		Detroit	MI	48226	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	MA Claims Processing Contact for Public Website	Operations Manager	Ms.	Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	4121 Cox Road, Suite 200		Glen Allen	VA	23060	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Marketing Contact	Marketing Specialist, Direct to Consumer	Ms.	Young	Morgan		4029827000					morgan.young@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Medical Director	CMO, VP Healthcare Svcs	Dr.	Gordon-Simet	Josette		4029828925					josette.gordonsimet@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Medicare Compliance Officer	MA Compliance Officer	Ms.	Vaughn	Shannon		4029827846					shannon.vaughn@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Medicare Coordinator	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Medicare Part D Opioid Overutilization Contact	Supv Pharmacists		Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Medication Therapy Management Contact	Manager, MTM and Case/Care Managmeent		Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	2900 Ames Crossing Road		EAgan	MN	55120	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Online Enrollment Center Contact (Back-up)	Enrollment Business Lead	Mr.	Schulz	Bryan		5084390769					Bryan.Schulz@advantasure.com	134 Turnpike Road		Southborough	MA	01772	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Online Enrollment Center Contact (Optional)	Sr Market Operations Specialist		Broussard Booker	Dwuane		4029827000					dwuane.broussardbooker@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Online Enrollment Center Contact (Primary)	Enrollment and COB Manager	Ms.	LaMontagne	Amanda		5084399720					Amanda.Lamontagne@advantasure.com	4121 Cox Road, Suite 200		Glen Allen	VA	23060	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Part C Application Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Part C Reporting Contact	Consultant	Ms.	Purdy	Caitlin		5037980382					cpurdy@rebellisgroup.com	17090 S Highland Ridge Dr	TC 1301	Village of Loch Lloyd	MO	64012	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active	8006936651				PPO - BBA		C	Kansas City
H8181	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetheraputics.com	2900 Ames Crossing Road		Eagan	MN	55120	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active	5054690403				PPO - BBA		C	Kansas City
H8181	Part D Application Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Part D Benefits Contact	Director, Benefit Operations	Ms.	Gergen	Ashley		6127772506					agergeni@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Part D Claims Submission Contact	Functional Business Consultant - Government Progra	Mr.	Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active	8006936703				PPO - BBA		C	Kansas City
H8181	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active	8006936651				PPO - BBA		C	Kansas City
H8181	Part D Price File Contact (Back-up)	Price File Analyst Sr		Trudeau	Ashley		6127771338					ashley.trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Part D Price File Contact (Optional)	QA Analyst	Ms.	Tastad	Emily		6127771699					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Part D Price File Contact (Primary)	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Part D Quality Assurance Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Part D Reporting Contact	Client Relations Compliance Consultant	Ms.	Leon	Megan		2486654675					mleon@bcbsm.com	600 Lafayette East	TC 1301	Detroit	MI	48226	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Patient Safety Contact	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Payment Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Pharmacy Director	Pharmacy Program Manager	Mr.	Keiser	Michael		4029827700					Michael.Keiser@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Pharmacy Network Management Contact	AVP, Network Management	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Pharmacy Network Management Contact (Secondary)	Sr. Dir Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active	8554571351				PPO - BBA		C	Kansas City
H8181	Pharmacy Technical Help Desk Contact (Secondary)	AVP , Customer Experience & Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active	8554571351				PPO - BBA		C	Kansas City
H8181	Physician Incentive Contact	CMO, VP Healthcare Svcs	Dr.	Gordon-Simet	Josette		4029828925					josette.gordonsimet@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Plan Directory Contact for Public Website	Director, Workforce Management, Analytics & Suppor		Weber	Julie		8885052022					jweber@bcbsm.com	500 Lafayette East		Detroit	MI	48226	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Plan to Plan Reconciliation Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Processor Contact	Director PBM Operations	Ms.	Allie	Cindy		6127776755				6127776706	MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing		Eagan	MN	55121	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Quality Contact	Director Clnical Quality Improvement	Ms.	Collins	Shelley		4029828564					Shelley.Collins@nebraskablue.com	1919 Aksarben Drive		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Reconciliation Contact	Director, SBD Business Performance & Finance	Ms.	Crawford	Constance		2486654231					ccrawford@bcbsm.com	600 Lafayette East	TC 1301	Detroit	MI	48226	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Reconciliation Contact (Secondary)	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Recovery Audit Contact	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Surveillance Contact	Executive Consultant	Ms.	Hollie	Diane		2154991417					dhollie@rebellisgroup.com	17090 S. Highland Ridge Dr		Village of Loch Lloyd	MO	64012	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	System Contact	VP Actuarial, Underwriting & Data Analytics	Mr	Konnath	Steven		4029828862					Steven.Konnath@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Third Party Administrator (TPA) Liaison	Sr Accountant Medicare Advantage	Ms.	Richter	Sarah		4029828790					Sarah.Richter@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	User Access Contact	MA Compliance Officer	Ms.	Vaughn	Shannon		4029827846					shannon.vaughn@nebraskablue.com	1919 Aksarben Dr		Omaha	NE	68180	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Utilization Management Contact	Managing Director, Clinical Operations, Medicare P	Ms.	Cooper	Kristi		8127866496					kristi.cooper@advantasure.com	4121 Cox Rd.	Ste 200	Glenn Allen	VA	23060	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8181	Utilization Review Contact	Director, Health Management	Mr.	Cooper	Kristi		8127866496					kristi.cooper@advantasure.com	4121 Cox Rd.	Ste 200	Glenn Allen	VA	23060	08/04/2023	2023	SAPPHIRE EDGE, INC.	Local CCP	Blue Cross and Blue Shield of Nebraska	Local PPO		Blue Cross Blue Shield of Nebraska	647	Yes	Active					PPO - BBA		C	Kansas City
H8189	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H8189	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/11/2017	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Medical Director	Chief Medical Director	Dr	Nichols	Thomas		4143869127					thomas.nichols@mhswi.com	10700 Research Drive	Suite 300	Milwaukee	WI	53226	08/11/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	09/23/2015	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H8189	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H8189	PHR Beneficiary Contact																	09/27/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8779358024				HMO - Health Maintenance Organization		C	Dallas
H8189	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Plan Directory Contact for Public Website			Services	Provider		8002229831					CorporateMedicareComplianceDept@CENTENE.COM	10700 W Research Drive	Suite 300	Milwaukee	WI	53226	03/31/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8189	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	MANAGED HEALTH SERVICES INSURANCE CORP.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8197	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	CAP Report Contact for Public Website			Services	Member		8668568699					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	CEO - Senior Official for Contracting	MTX - Plan President	Mr.	Coffey	Chris		7266103470					chris.coffey@molinahealthcare.com	1660 North Westridge Circle		Irving	TX	75038	06/27/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Government Relations Contact	Vice President, Government Contracts		Letcher	Kelsey		8885625442					Kelsey.Letcher@molinahealthcare.com	84 NE Loop 410		San Antonio	TX	78216	10/18/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	MA Claims Processing Contact for Public Website			Services	Member		8668568699					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/15/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	MMP Reporting Requirements Contact	MHI - Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate Suite 100		Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	MMP Point of Contact	MHI - Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate Suite 100		Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	jennifer.browning@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/31/2020	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Plan Directory Contact for Public Website			Services	Member		8668568699					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8197	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF TEXAS, INC.	Demo	Molina Healthcare of Texas	Medicare-Medicaid Plan HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8211	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H8211	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H8211	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H8211	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H8211	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8211	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8213	Agent/Broker Compensation Data Contact	VP, Integrated Health Plans& Revenue Mgt	Mr.	McDade	Chris		4844971892					cmcdade@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	09/08/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Automated TrOOP Balance Transfer Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	12/30/2020	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Backup User Access Contact	Medicare Compliance Sr Operations Analyst		Morris	Ms. Gail	P	2158178922					gpmorris@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	300 Stevens Drive, Suite 201	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Best Available Evidence Contact	Medicare Enrollment Manager	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	12/26/2018	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Bid Audit Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Bid Audit Site Contact	VP, Integrated Health Plans& Revenue Mgt	Mr.	McDade	Chris		4844971892					cmcdade@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	09/08/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Bid Primary Contact	Director, Product Development	Mr.	Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Dr.	Philadelphia	PA	19113	07/24/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Lovin	Dan		2676085073					dlovin@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive, 2nd flr.	Philadelphia	PA	19113	01/05/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	CEO - CMS Administrator Contact	VP, Integrated Health Plans& Revenue Mgt	Mr.	McDade	Chris		4844971892					cmcdade@amerihealthcaritas.com	AmeriHealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	09/08/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	CEO - Senior Official for Contracting	VP, Integrated Health Plans& Revenue Mgt	Mr.	McDade	Chris		4844971892					cmcdade@ameriHealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	09/08/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Chief Financial Officer	Chief Financial Officer	Mr.	Burgoyne	Michael		2159378875					mburgoyne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive	Philadelphia	PA	19113	04/04/2019	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Chief Operating Officer	VP, Integrated Health Plans& Revenue Mgt	Mr.	McDade	Chris		4844971892					cmcdade@ameriHealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	07/24/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Chief Information Officer	Chief Information Officer	Mr.	Dickson	Fred		2158636570					fdickson@amerihealthcaritas.com	Amerihealth Caritas, Inc.	1 International Plaza IP2-4009	Philadelphia	PA	19113	08/08/2018	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Chief Information Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive	Philadelphia, PA	PA	19113	07/05/2016	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	CMS Casework Communication Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	06/23/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Complaints Tracking Contact	Medicare QA Contract Acct Mgr	Ms.	Lopez	Yismell		2158635677					yelopez@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	06/23/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Contact for Fraud Investigations	Director, SIU	Mr.	McCall	Trevor		4844971241					tmccall2@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr	Philadelphia	PA	19113	08/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Coordination of Benefits Contact	Manager, Provider Network Oversight	Ms.	Williams	Kathy		8437467499					kwilliams@firstchoicevipcareplus.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Corporate Mailing						8434143130					cmcdade@amerihealthcaritas.com	Select Health of South Carolina	4390 Belle Oaks Drive	Charleston	SC	29405	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager	Ms.	Maheepathi	Geetha		4435279822					gmaheepathi@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	3875 West Chester Pike	Newtown Square	PA	19073	03/15/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Customer Service Operations Contact	Director, Medicare Customer Service	Ms.	Veras	Helen		2672981794					hveras@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	08/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	DIR Contact	Director, Medicare Risk Adjustment and Performance	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	DIR Contact (Secondary)	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Electronic Health Record Contact	Manager, Information Services		Drumming	Ms. Terri		2159378578					tdrumming@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Emergency Part D Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadephia	PA	19113	12/28/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Emergency Part D Contact (Secondary)	Director, Corporate Pharmacy		Cherian	Sheena		2158635768					scherian@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	12/28/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Encounter Data & Risk Adjustment Operations Contact	Director, Medicare ACA and Risk Adjustment	Mr.	Greer	Kevin		2159378761					kgreer@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Enrollment Contact	Manager Enrollment Operations,	Ms.	Mullins	Naketa		4844971171					nmullins@amerihealtharitas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	04/04/2019	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	EOB Transfer Contact	Director, Medicare Claims	Mr.	Boyer	Joseph		2158636668				2159375321	Jboyer@Amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/27/2015	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Financial Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Financial Reporting Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Formulary Contact	Director of Clinical Services, Formulary/DUR	Ms.	Megargell	Lauren		2159374135					Lauren.megargell@performrx.com	PerformRx	200 Stevens Dr. 4th Floor	Philadelphia	PA	19113	12/26/2018	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Formulary Contact (Secondary)	Director of Pharmacy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family	4000 Towne Center Drive, Suite 1300	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	General Contact	VP, Integrated Health Plans& Revenue Mgt	Mr.	McDade	Chris		4844971892					cmcdade@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philidelphia	PA	19113	09/08/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Government Relations Contact	Director, Public Policy		Cozzo	Mr.Steven		2159378236					scozzo@Amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	HIPAA Privacy Officer	Director of Privacy	Ms.	Gustafson	Rebecca		2158636634					rgustafson@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr	Philadelphia	PA	19113	08/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	HIPAA Security Officer	Chief Information Security Officer	Mr.	Talbot	Robert		2158636428					rtalbot@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Dr.	Philadelphia	PA	19113	12/28/2017	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Hospice Contact	Director of Phamarcy, Medicare	Ms.	Shepard	Jen		2159378685					jshepard1@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Interoperability Contact	Director, Medicare Performance Management		Kindred	Amanda		2484045991					akindred@amerihealthcaritas.com	4000 Town Center	Suite 1300	Southfield	MI	48075	03/10/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	MA Appeals/Grievances Contact	Director, Corporate Appeals	Ms.	Garber	Brenda		2158635585					bgarber@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	12/03/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	MA Claims Processing Contact for Public Website			Services	Provider		8889780862					VIPProviderComm@amerihealthcaritas.com	The AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	01/17/2017	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Marketing Contact	Medicare Compliance Sr Operations Analyst	Ms.	Morris	Gail	P	2158178922					gpmorris@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	300 Stevens Dr, Suite 201	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Medical Director	Medicare Medical Director	Dr.	Busch	Gregory		8562174603					gbusch@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	09/02/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Dupre	Colleen		2035068413					cdupre@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	100 Stevens Drive, 2flr.	Philadelphia	PA	19113	12/08/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Medicare Coordinator	VP Medicare Integrated Health Plans	Mr.	McDade	Chris		4844971892					cmcdad@amerihealthcaritas.com	200 Stevens Drive		Philadelphia	PA	19113	04/07/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Medicare Part D Opioid Overutilization Contact	Director of Phamarcy, Medicare		Shepard	Ms. Jen		8562174603					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Medication Therapy Management Contact	Director, Clinical Outcomes	Ms	Patel	Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	11/19/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	MMP Reporting Requirements Contact	Manager, Medicare Performance Management	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	MMP Point of Contact	VP, Integrated Health Plans& Revenue Mgt	Mr.	McDade	Chris		8484971892					cmcdade@ameriheathcaritas.com	200 Stevens Dr		Philadelphia	PA	19113	09/08/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	OffShore Subcontractor Contact	Performance Program Oversight Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	3785 Chester Pike	Newtown Square	PA	19073	01/05/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part C Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part C Reporting Contact	Manager, Medicare Performance Management	Ms.	Griggs	Sarah		6073426766					smgriggs@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	03/10/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Appeals	Manager, Corporate Appeals	Ms.	Swindell	Katrina							kswindell@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Dr	Philadelphia	PA	19113	09/02/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158635677				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Appeals Contact (Secondary)	Director, Corporate Appeals		Garber	Ms. Brenda							bgarber@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2159378685				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Application Contact	Product Development Manager		Osborne	Daniel		5025992595					dosborne@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	07/04/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Benefits Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jennifer		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Claims Submission Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	12/29/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Bonko	Gerald						2158635100	gbonko@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	12/26/2018	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636483				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Utilization Management	Mr.	McHale	Shawn						2158635100	smchale@performrx.com	PerformRx	200 Stevens Dr	Philadelphia	PA	19113	12/26/2018	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	2158636370				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Price File Contact (Back-up)	Claims Processor Associate		Reed	Ms Lindsay		8473466370					lindsay.reed@abarcahealth.com	Abarca Health	14650 Ave Munoz Rivera, Suite 701	San Juan	PR	00918	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Price File Contact (Optional)	Claims Processor Associate	Ms	Canales	Desiree		7875231212	1107				desiree.canales@abarcahealth.com	650 Ave Munoz Rivera	Suite 701	San Juan	PR	00918	11/19/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Price File Contact (Primary)	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	12/30/2020	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Quality Assurance Contact	Director of Pharmacy, Medicare	Ms.	Shepard	Jennifer		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Part D Reporting Contact	Quality Assurance Contract Account Manager	Ms.	Griggs	Sarah		6073426766					smgriggs@keystonefirstpa.com	AmeriHealth Caritas Family of Companies	300 Stevens Dr. Suite 201	Philadelphia	PA	19113	03/10/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Patient Safety Contact	Director, Clinical Outcomes	Ms	Patel	Binal		2159374188					bpatel1@performrx.com	PerformRx	200 Stevens Drive, 4th Floor	Philadelphia	PA	19113	11/19/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Payment Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Pharmacy Director	Director of Pharmacy, Medicare	Ms.	Shepard	Jennifer		2159378685					jshepard1@amerihealthcaritas.com	AmeriHealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Pharmacy Network Management Contact	Director	Ms.	Leal	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Dr. 4th Floor	Philadelphia	PA	19113	12/30/2020	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Pharmacy Network Management Contact (Secondary)			Kramerov	Mr. Allen		2159374120					akramerov@performrx.com	PerformRx	200 Stevens Dr. 4th Floor	Philadelphia	PA	19113	11/17/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Pharmacy Technical Help Desk Contact	Director, Service Operations	Ms.	Leal	Avelina							aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	11/05/2019	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8553270511				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Care Center	Ms.	Lee	Pamela								PerformRx	200 Stevens Drive	Philadelphia	PA	19113	08/28/2018	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active	8553270511				Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Plan Directory Contact for Public Website			Services	Provider		8889780862					VIPProviderComm@amerihealthcaritas.com	The AmeriHealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	01/12/2017	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Plan to Plan Reconciliation Contact	Director, Finance	Ms	Sow	Oumou		4102584587					osow@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	P.O. 7137	London	KY	40742	06/15/2023	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Processor Contact	Director, Clinical Operations	Mr.	Ortiz	Noel		2159375325					nortiz@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/30/2020	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Quality Contact	Director Quality Management	Ms.	Trimble	Dorothea		6162507322					dtrimble@amerihealthcaritas.com	Amerihealth Michigan	4000 Town Center, Suite 1300	Southfield	MI	48075	10/22/2020	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Reconciliation Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					ak16850@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Reconciliation Contact (Secondary)	Business Analyst	Ms.	Griggs	Sarah		6073426766					sg31189@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Dr.	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Recovery Audit Contact	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Surveillance Contact	Business Development Manager	Ms.	Kumagai	Naoko		2157563724					nkumagai@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/08/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	System Contact	Business Systems Analyst Lead	Ms.	Drumming	Terri		2159378578					tdrumming@amerihealthcaritas.com	Amerihealth Caritas	200 Stevens Drive, 1st Floor	Philadelphia	PA	19113	06/04/2020	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Third Party Administrator (TPA) Liaison	Director, Medicare Performance Management	Ms.	Kindred	Amanda		2484045991					AKindred@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	08/10/2022	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	User Access Contact	Medicare Compliance Officer	Mr.	Lovin	Dan		2676085073					dlovin@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	100 Stevens Drive, 2nd flr	Philadelphia	PA	19113	02/03/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Utilization Management Contact	VP, Utilization Management Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	09/02/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8213	Utilization Review Contact	VP, Utilization Management Operations	Ms.	Johnson	Vanessa		2159378766					vmjohnson@amerihealthcaritas.com	Amerihealth Caritas Family of Companies	200 Stevens Drive	Philadelphia	PA	19113	09/02/2021	2023	SELECT HEALTH OF SOUTH CAROLINA, INC.	Demo	FIRST CHOICE VIP CARE PLUS	Medicare-Medicaid Plan HMO/HMOPOS		Independence Health Group, Inc.	609	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Atlanta
H8220	Automated TrOOP Balance Transfer Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Backup User Access Contact			Killian	Joseph		5133826688					jkillian@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Best Available Evidence Contact			Killian	Joseph		5133826688					jkillian@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Bid Primary Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	CAP Report Contact for Public Website			Rolfe	Tammy		3212694240					trolfe@reflectionslc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	CEO - CMS Administrator Contact		Mr.	Killian	Joseph		5133826688					jkillian@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	CEO - Senior Official for Contracting		Mr.	Killian	Joseph		5133826688					jkillian@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Chief Financial Officer		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Chief Operating Officer		Ms.	Rolfe	Tammy		3212694240					trolfe@reflectionslc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Chief Information Officer		Ms.	Rolfe	Tammy		3212694240					trolfe@reflectionslc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Chief Information Security Officer		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	CMS Casework Communication Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Complaints Tracking Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Contact for Fraud Investigations		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Coordination of Benefits Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Corporate Mailing						5133826688					jkillian@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Coverage Gap Discount Program (CGDP) Payment Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Customer Service Operations Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	DIR Contact		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Emergency Part D Contact		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Encounter Data & Risk Adjustment Operations Contact		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Enrollment Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	EOB Transfer Contact			Rolfe	Tammy		2072425386				3212695428	trolfe@reflectionslc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Financial Audit Contact	Chief Compliance Officer	Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Financial Reporting Contact		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Formulary Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	General Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Government Relations Contact			Killian	Joseph		5133826688					jkillian@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	HIPAA Privacy Officer		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	HIPAA Security Officer		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Interoperability Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	MA Appeals/Grievances Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	MA Claims Processing Contact for Public Website			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Marketing Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Medical Director			Killian	Joseph		5133826688					jkillian@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Medicare Compliance Officer		Ms.	Rolfe	Tammy		3212694240					trolfe@reflectionslc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Medicare Coordinator			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Medicare Part D Opioid Overutilization Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Medication Therapy Management Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Part C Application Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	07/07/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Part D Appeals			Rolfe	Tammy							trolfe@reflectionslc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending	2072425386				PACE - Nat		C	Atlanta
H8220	Part D Application Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	07/07/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Part D Benefits Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Part D Claims Submission Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Part D Exceptions Contact			Rolfe	Tammy							trolfe@reflectionslc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending	2072425386				PACE - Nat		C	Atlanta
H8220	Part D Price File Contact (Back-up)			Killian	Joseph		5133826688					jkillian@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Part D Price File Contact (Primary)			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Part D Quality Assurance Contact		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/28/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Part D Reporting Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Patient Safety Contact		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Payment Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Pharmacy Director			Killian	Joseph		5133826688					jkillian@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Pharmacy Network Management Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Pharmacy Technical Help Desk Contact			Rolfe	Tammy							trolfe@reflectionslc.org	1250 B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending	2072425386				PACE - Nat		C	Atlanta
H8220	Plan Directory Contact for Public Website			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Plan to Plan Reconciliation Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Processor Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Quality Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Reconciliation Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Recovery Audit Contact	Chief Compliance Officer	Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Surveillance Contact		Ms.	Forbes	Angela		3216158762					aforbes@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	System Contact			Killian	Joseph		5133826688					jkillian@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Third Party Administrator (TPA) Liaison			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	User Access Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Utilization Management Contact			Killian	Joseph		5133826688					jkillian@reflectionslsc.org	1250 B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8220	Utilization Review Contact			Rolfe	Tammy		3212694240					trolfe@reflectionslsc.org	1250-B Grumman Place		Titusville	FL	32780	09/29/2022	2023	HOSPICE OF ST. FRANCIS, INC.	National PACE	St. Francis Reflections PACE	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8225	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	CAP Report Contact for Public Website	Vice President, Regulatory Compliance	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H8225	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	01/24/2019	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Medical Director	Chief Medical Director	Mr	Martorana	Jeff		9548391530	22182				jmartorana@centene.com	1301 International Parkway	Suite 400	Sunrise	FL	33323	03/30/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/24/2019	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H8225	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H8225	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8336032971				HMO - Health Maintenance Organization		C	Dallas
H8225	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Plan Directory Contact for Public Website			Services	Provider		8667960530					CorporateMedicareComplianceDept@Centene.com	1301 International Parkway,	Suite 400	Sunrise	FL	33323	03/31/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8225	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE COMPANY FLORIDA	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8229	Agent/Broker Compensation Data Contact	SVP Health Plan Operations		Cochran	Rick		4026306924					rcochran@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/18/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Automated TrOOP Balance Transfer Contact	Director Enrollment, Eligibility &B OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Backup User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Best Available Evidence Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Bid Audit Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Bid Audit Site Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Bid Primary Contact	ACTUARY	Mr.	Copeland	Joe		3142095834					jcopeland@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	CAP Report Contact for Public Website	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	CEO - CMS Administrator Contact	COO	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	CEO - Senior Official for Contracting	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Chief Financial Officer	Chief Financial Officer	Mr.	Grabski	Ben		7633007611					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Chief Operating Officer	Chief Operating Officer	Ms.	Butler	Martha		3142092741					mbutler@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Chief Information Officer	Chief Information Officer	Mr.	Saghabini	JeanClaude		6173124659					jsaghbini@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Chief Information Security Officer	Chief Information Security Officer	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	CMMI Model Point of Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	CMS Casework Communication Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Complaints Tracking Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Contact for Fraud Investigations	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Coordination of Benefits Contact			Inquiries	COB		8665979560					COBInquiry@lumeris.com	P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Corporate Mailing						8665979560					customerservice@essencehealthcare.com	CUSTOMER SERIVCE	P O BOX 5907	TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Coverage Gap Discount Program (CGDP) Payment Contact	Sr Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Customer Service Operations Contact	Vice President, Health Plan Operations	Ms.	Meyerhoffer	Linda		6366869682					rmeyerhoffer@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	DIR Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	DIR Contact (Secondary)	Sr Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly	M	3142092795					pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Emergency Part D Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		6307425966					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Emergency Part D Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Encounter Data & Risk Adjustment Operations Contact	VP - Risk Adjustment Services	Mr.	Eschbach	Jason		6144397608					jeschbach@lumeris.com	13900 Riverport Drive		St. Louis	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Enrollment Contact	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	EOB Transfer Contact	Director, Claims	Ms.	Wasserman	Rachelle		3147703520				3147706096	rwasserman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Financial Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Financial Reporting Contact	Corporate Accounting Director	Ms.	Pinkerton	Amanda		3145183519					apinkerton@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Formulary Contact		Ms	Nyawabila	Christina		8447906297					FAS@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Formulary Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	General Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Government Relations Contact	Chief Legal Officer	Ms.	Halterman	Gail		3142092717					ghalterman@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Davis	Amy		3142093945					adavis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	HIPAA Security Officer	CISO	Mr.	Vannatta	Aaron		3147703700					avannatta@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Hospice Contact	Vice President, Clinical Operations		Cruz	Jennifer		3147703556					pharmacy@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Interoperability Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Darnell	Erika		3144382410					ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	MA Claims Processing Contact for Public Website			Service	Customer		8665979560				8884802577	customerservice@essencehealthcare.com	P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Marketing Contact	Manager, Compliance Marketing	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Medical Director	Senior Medical Officer, UM	Dr.	Fusco	Michael		3147703770					mfusco@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Medicare Compliance Officer	VP Compliance, Medicare Compliance Officer	Mr,	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Medicare Coordinator	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Medicare Part D Opioid Overutilization Contact	Snr. Clinical Pharmacist	Ms.	Pasagic	Melita		3147703775					mpasagic@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Medication Therapy Management Contact	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	OffShore Subcontractor Contact	SVP Corporate Accounting & Chief Compliance Office	Ms.	Venable	Erin		3142093957					evenable@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Online Enrollment Center Contact (Back-up)	Manager, Compliance	Mr.	Ruiz	Lee		6366869602					lruiz@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Online Enrollment Center Contact (Optional)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Online Enrollment Center Contact (Primary)	Director Enrollment, Eligibility & OHI		Meyer	Jenell		3147703733					enrollment@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Part C Application Contact	Sr. Director CMS Applications & PBP submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Part C Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Part D Appeals	Director, Appeals & Grievances	Ms.	Darnell	Erika							ebenefield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	3144382410				PPO - BBA		C	Kansas City
H8229	Part D Appeals Contact (Secondary)	Sr. Manager, Compliance Monitoring & Reporting	Ms.	Young	Polly	M						pyoung@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	3147209279				PPO - BBA		C	Kansas City
H8229	Part D Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Part D Benefits Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Part D Claims Submission Contact		Ms.	Scherlippens	Carine		8587907415					Carine.Scherlippens@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Part D Exceptions Contact		Ms.	Byers	June							June.Byers@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	8445136003				PPO - BBA		C	Kansas City
H8229	Part D Exceptions Contact (Secondary)		Mr	Elias	Jason							Jason.Elias@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	8445136003				PPO - BBA		C	Kansas City
H8229	Part D Price File Contact (Back-up)	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Part D Price File Contact (Optional)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Part D Price File Contact (Primary)		Ms.	Finder	Plan		8445136003					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Part D Quality Assurance Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Part D Reporting Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Patient Safety Contact	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly		3147703788					ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Payment Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Pharmacy Director	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Pharmacy Network Management Contact	Vice President, Clinical Operations	Ms.	Cruz	Jennifer		3147703556					jcruz@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Pharmacy Network Management Contact (Secondary)			Pharmacy Operations	MedImpact		8445136003					PharmacyOperationsSups@MedImpact.com	10182 Scripps Gateway Court		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services	Ms.	Brewer	Kathy							Customerservice@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	8445136003				PPO - BBA		C	Kansas City
H8229	Pharmacy Technical Help Desk Contact (Secondary)	Sr Manager, Clinical Pharmacist	Ms.	Summerfield	Kelly							ksummerfield@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract	3147703788				PPO - BBA		C	Kansas City
H8229	Physician Incentive Contact	Sr. Manager, Health Plan Finance	Mr.	Privott	David		3147703732					dprivott@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/21/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Plan Directory Contact for Public Website			Service	Customer		8665979560					customerservice@essencehealthcare.com	1P O BOX 5907		TROY	MI	48007	09/29/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Plan to Plan Reconciliation Contact	Sr Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Dr		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Processor Contact		Ms.	Scott	Susan		8447906565					Susan.Scott@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Quality Contact	Snr. Director, Quality Improvement		Pattison	Lisa		5082728692					lpattison@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Reconciliation Contact	Vice President, Health Plan Finance	Ms.	McGinnis	Lisa		3142092780					lmcginnis@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Reconciliation Contact (Secondary)	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Recovery Audit Contact	VP Compliance, Medicare Compliance Officer	Mr.	Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/15/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	SNP Application Contact	Sr. Director, CMS Applications & PBP Submissions	Mr.	Moser	Phil		3142092725					pmoser@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	SNP State Contact	CEO	Mr.	Grabski	Ben		3143442060					bgrabski@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Surveillance Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	System Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Third Party Administrator (TPA) Liaison	Client AP Specialist	Ms.	Brock	Letecea		3142548778					lbrock@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	User Access Contact	VP Compliance, Medicare Compliance Officer		Whitbeck	Jeremy		3142093989					jwhitbeck@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	09/14/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Utilization Management Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8229	Utilization Review Contact		Ms.	Emoto	Julie		8587906270					Julie.Emoto@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	06/01/2023	2023	ESSENCE HEALTHCARE OF GEORGIA, INC.	Local CCP	Essence Healthcare	Local PPO		Lumeris Group Holdings Corporation	86	Yes	Withdrawn Contract					PPO - BBA		C	Kansas City
H8244	Agent/Broker Compensation Data Contact	VP, Sales		Simonds	Kristina		6572187635					KSimonds@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Automated TrOOP Balance Transfer Contact	PBM - Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Backup User Access Contact	Compliance Director		Spitzer	Chandra		6572745530					CSpitzer@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Best Available Evidence Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Bid Audit Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Bid Audit Site Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Bid Primary Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	CAP Report Contact for Public Website	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	CEO - CMS Administrator Contact	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	CEO - Senior Official for Contracting	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Chief Financial Officer	Chief Financial Officer	Mr.	Freeman	Thomas		6572187604					TFreeman@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Chief Operating Officer	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Kardes	Hakan		6572187772					hkardes@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Chief Information Security Officer	VP, Technology & CISO	Mr.	MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	CMMI Model Point of Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	CMS Casework Communication Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Complaints Tracking Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Contact for Fraud Investigations	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Coordination of Benefits Contact	AVP, Membership & Eligibility		Torres	Carrie		6572187409	2109				CArreola@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Corporate Mailing						6572187713				8443202247	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122			5622074634	adelatorre@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Customer Service Operations Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	DIR Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	DIR Contact (Secondary)	AVP, Pharmacy		Liu	Ruby		3237287232	2316				RLiu@AHCUSA.com	1100 W. Town & Country Rd., Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Electronic Health Record Contact	AVP, Platform Product		Brown Hayes	Michael		7144979628					MBrown-Hayes@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Emergency Part D Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Emergency Part D Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		3108667966				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Employer Waiver Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment		Bogdanov	Eyosef		5623666179					ebogdanov@ahcusa.com	1100 W. Town and Country Rd.	Suite 1600	Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Enrollment Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	EOB Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Financial Audit Contact	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Financial Reporting Contact	Sr. Director, Accounting & Reporting		Tran	Sue Anne		6572187673	7673				stran@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Formulary Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Formulary Contact (Secondary)	PBM - Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	General Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Government Relations Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	HIPAA Privacy Officer	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	HIPAA Security Officer	VP, Technology & CISO		MacLeod	David		3033967531					DMacleod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Hospice Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Interoperability Contact	VP, Data Engineering & BI CTO Data and Al		Sam	Georgie		8188807212					gsam@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	MA Appeals/Grievances Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	MA Claims Processing Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Marketing Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Medical Director	SVP Market Management WCR	Dr.	Kim	John		6572187640				5622074617	JKim@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Medicare Compliance Officer	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy	B	6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Medicare Coordinator	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Medicare Part D Opioid Overutilization Contact	PBM - Supv Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Medication Therapy Management Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	OffShore Subcontractor Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	CLynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Online Enrollment Center Contact (Back-up)	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Online Enrollment Center Contact (Optional)	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Online Enrollment Center Contact (Primary)	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Part C Application Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Part C Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Part D Appeals	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6127775393				PPO - BBA		C	San Francisco
H8244	Part D Appeals Contact (Secondary)	Sr. Manager, Appeals & Grievance		Jimenez	Gudelia							GJimenez@ahcusa.com	1100 W. Town and Country Road, Suite #300		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6572187488	2188			PPO - BBA		C	San Francisco
H8244	Part D Application Contact	CEO		Maroney	Dawn		5623346192				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Part D Benefits Contact	PBM - Director, Benefit Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Part D Claims Submission Contact	PBM - Functional Business Consultant Govt Programs		Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Part D Exceptions Contact	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8006936651				PPO - BBA		C	San Francisco
H8244	Part D Exceptions Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali							AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6572187709				PPO - BBA		C	San Francisco
H8244	Part D Price File Contact (Back-up)	PBM - Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Part D Price File Contact (Optional)	PBM - QA Analyst		Tastad	Emily		6127776931					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Part D Price File Contact (Primary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Part D Quality Assurance Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Part D Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Patient Safety Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Payment Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Personal Health Record Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Pharmacy Director	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Pharmacy Network Management Contact	PBM - AVP, Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Pharmacy Network Management Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				PPO - BBA		C	San Francisco
H8244	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				PPO - BBA		C	San Francisco
H8244	PHR Beneficiary Contact																	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO	Alignment Health Plan	Alignment Healthcare USA, LLC	612	Yes	Active	8666342247				PPO - BBA		C	San Francisco
H8244	Physician Incentive Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Plan Directory Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Plan to Plan Reconciliation Contact	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122			5622074266	adelatorre@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Processor Contact	Manager, PBM Operations		Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Quality Contact	Sr. Director, Quality Management/Credentialing		Lacock	Lisa		6572187638					LLacock@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Reconciliation Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Reconciliation Contact (Secondary)	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122				adelatorre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Recovery Audit Contact	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	SNP Application Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	SNP State Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Surveillance Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	System Contact	VP, AVA Health Plan Systems & Operations		Bates	Patrick		6572187636	7636				PBates@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Third Party Administrator (TPA) Liaison	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122				adelatorre@ahcusa.com	1100 W. Town and Country Rd, Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	User Access Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Utilization Management Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8244	Utilization Review Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H8293	Agent/Broker Compensation Data Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/07/2023	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Automated TrOOP Balance Transfer Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Backup User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Best Available Evidence Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Bid Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Bid Audit Site Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/27/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Bid Primary Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	CAP Report Contact for Public Website	Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/28/2020	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8773841241				HMO - Health Maintenance Organization		C	Chicago
H8293	CEO - CMS Administrator Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	CEO - Senior Official for Contracting	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Chief Financial Officer	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Chief Operating Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Chief Information Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Chief Information Security Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	CMMI Model Point of Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	CMS Casework Communication Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Complaints Tracking Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Contact for Fraud Investigations	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Coordination of Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Corporate Mailing						8476968500					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway		Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	Thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Customer Service Operations Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	DIR Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	DIR Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Emergency Part D Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Emergency Part D Contact (Secondary)	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Encounter Data & Risk Adjustment Operations Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/18/2023	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Enrollment Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	EOB Transfer Contact	Claims Manager	Mr.	Salgado	Miguel		8476968578				8008861082	Miguel.Salgado@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	10/04/2021	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Financial Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Financial Reporting Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Formulary Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3308886015	Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Formulary Contact (Secondary)	Pharmacy Director		Lopez	Eduardo		7542085867					elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/07/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	General Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Government Relations Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	HIPAA Privacy Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	HIPAA Security Officer	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539				8555158166	Eric.Annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Hospice Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Interoperability Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	MA Appeals/Grievances Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	MA Claims Processing Contact for Public Website	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Marketing Contact	VP of Marketing	Ms.	Branco	Margaret		7187957495					margaret.branco@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/06/2023	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Medical Director		Dr	Butt	Tariq		3125458471					tariq.butt@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	11/09/2021	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Medicare Compliance Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Medicare Coordinator	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Medicare Part D Opioid Overutilization Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Medication Therapy Management Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3304058084	Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	OffShore Subcontractor Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Online Enrollment Center Contact (Primary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 302	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Part C Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Part C Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Part D Appeals			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy	Suite 450	Dublin	OH	43017	12/28/2020	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H8293	Part D Appeals Contact (Secondary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica							Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue		Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	7542085865				HMO - Health Maintenance Organization		C	Chicago
H8293	Part D Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Part D Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Part D Claims Submission Contact			Dovico	Rosario		2012696398					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	12/31/2020	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Part D Exceptions Contact			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	6143363326				HMO - Health Maintenance Organization		C	Chicago
H8293	Part D Price File Contact (Back-up)			Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Part D Price File Contact (Optional)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Part D Price File Contact (Primary)			Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	12/31/2020	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Part D Quality Assurance Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Part D Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Patient Safety Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Payment Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Pharmacy Director	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Pharmacy Network Management Contact			Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Pharmacy Network Management Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Pharmacy Technical Help Desk Contact			Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	12/20/2021	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H8293	Plan Directory Contact for Public Website	Vice President, Provider Operations	Ms.	Cuevas	Elizabeth		7542085880					Elizabeth.Cuevas@clearspringhealthcare.com	250 South Northwest Highway Suite 302	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Plan to Plan Reconciliation Contact	Senior Accountant	Ms.	Wrenn	Alisa		2249855588				3124290194	Alisa.Wrenn@Clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Processor Contact			Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Quality Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Reconciliation Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Recovery Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	SNP Application Contact	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	02/15/2023	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Surveillance Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	System Contact	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539					eric.annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Third Party Administrator (TPA) Liaison	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Utilization Management Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8293	Utilization Review Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (VA), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8298	Agent/Broker Compensation Data Contact	Medicare Program Analyst		Wilbanks	Dasha		9734665601					dasha_wilbanks@horizonblue.com	3 Penn Plaza	16-C	Newark	NJ	07105	04/19/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Automated TrOOP Balance Transfer Contact	Director, PBM Ops.	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/28/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Backup User Access Contact	Medicare Program Analyst		Vargas	Mario		9734666379					mario_vargas@horizonblue.com	3 Penn Plaza East	16-C	Newark	NJ	07105	07/23/2019	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Best Available Evidence Contact	Supervisor, Govt. Programs		Achoe	Kisha		9734667328					Kisha_Achoe@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	07/27/2023	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Bid Audit Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319					jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	12/30/2015	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Bid Audit Site Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319					jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	12/30/2015	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Bid Primary Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319					jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	12/30/2015	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	CAP Report Contact for Public Website	VP, Reg. Compliance/MCO	Mr	McGrady	Daniel		6095372317					daniel_mcgrady@horizonblue.com	3 Penn Plaza East	PP-16	Newark	NJ	07105	04/06/2023	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	CEO - CMS Administrator Contact	Executive VP, Service	Mr.	Barnard	Mark		9734666380					Mark_Barnard@horizonblue.com	3 Penn Plaza	PP-16	Newark	NJ	07105	12/04/2018	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	CEO - Senior Official for Contracting	Executive VP, Service	Mr.	Barnard	Mark		9734666380					Mark_Barnard@horizonblue.com	3  Penn Plaza	PP-16	Newark	NJ	07105	12/04/2018	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Chief Financial Officer	SVP & Chief Financial Offcr.	Mr.	Rosenberg	David		9734664600					david_rosenberg@horizonblue.com	3 Penn Plaza	PP-16	Newark	NJ	07105	11/02/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Chief Operating Officer	Executive VP, Service	Mr.	Barnard	Mark		9734666380					Mark_Barnard@horizonblue.com	3 Penn Plaza	PP-16	Newark	NJ	07105	12/04/2018	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Chief Information Officer	Chief Information Officer	Ms.	Machemer	Michelle		9734664188					Michelle_Machemer@horizonblue.com	3 Penn Plaza East	PP-10	Newark	NJ	07105	04/22/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Chief Information Security Officer	Chief Information Security Officer	Mr.	Constantino	Daniel		9734665127					Daniel_Constantino@horizonblue.com	3 Penn Plaza	PP-16K	Newark	NJ	07105	01/04/2023	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	CMS Casework Communication Contact	Director, GP Operations		Maramraju	Venkata		6095372113					venkata.maramraju@horizonblue.com	1700 American Boulevard		Pennington	NJ	08534	01/03/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Complaints Tracking Contact	Mgr, Exec DOBI Compl & Appls		Mestres	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	06/15/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Contact for Fraud Investigations	Director, Special Investigations		Dineen	Timothy		9734668723					timothy_dineen@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	12/30/2015	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Coordination of Benefits Contact	Director, PBM Ops	Ms.	Allie	Cindy		6127776722				6127776706	COBMedD@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/28/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Corporate Mailing						6095372317					daniel_mcgrady@horizonblue.com	3 Penn Plaza East	PP-16	Newark	NJ	07105	04/06/2023	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Reporting		Griffin	Kevin		6095372464					kevin_griffin@horizonblue.com	1700 American Blvd	HL-03Q	Pennington	NJ	08534	01/12/2018	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Customer Service Operations Contact	Director, Service Operations	Mr.	Yanek	John		5182208000					john_yanek@horizonblue.com	3 Penn Plaza		Newark	NJ	07105	06/13/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	DIR Contact	Director, Clinical Pharm. Programs		Patrikios	Athena		9734666542				9734664665	athena_patrikios@horizonblue.com	3 Penn Plaza East,  PP-12Q		Newark	NJ	07105	12/22/2016	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	DIR Contact (Secondary)	Pharmacy Analyst II		Farber	Keri	A	9734668995					keri_farber@horizonblue.com	3 Penn Plaza East	PP-12	Newark	NJ	07105	06/11/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Emergency Part D Contact	Pharmacy Analyst II		Farber	Keri	A	9734668995					keri_farber@horizonblue.com	3 Penn Plaza	PP -12	Newark	NJ	07105	06/11/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Emergency Part D Contact (Secondary)	Manager, Clinical Pharmacy		Sun	Jane		9734665044					jane_sun@horizonblue.com	3 Penn Plaza	PP 12-Q	Newark	NJ	07105	12/11/2018	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Encounter Data & Risk Adjustment Operations Contact	Mgr, Medicare & Medicaid Risk Assessment		Goryachkovsky	Jenny		9734665956					jenny_goryachkovsky@horizonblue.com	3 Penn Plaza	PP-12	Newark	NJ	07105	12/02/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Enrollment Contact	Director, G. P. Operations		Maramraju	Venkata		6095372113					venkata_maramraju@horizonblue.com	1700 American Blvd. HL-03		Pennington	NJ	08534	10/31/2017	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	EOB Transfer Contact	Director, PBM Ops.	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	2990 Ames Crossing Rd		Eagan	MN	55121	09/28/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Financial Audit Contact	Director, Regulatory Compliance/ MCO	Mr.	McGrady	Daniel		7325393680					daniel_mcgrady@horizonblue.com	1700 American Blvd	HL-03	Pennington	NJ	08534	02/25/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Financial Reporting Contact	Corporate Controller		Concepcion	Ivan		9734664188					Ivan_Concepcion@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	05/01/2023	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Formulary Contact	Director, Clinical Pharm Prg & Op - Medicare		Patrikios	Athena		9734666542					athena_patrikios@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	09/27/2016	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Formulary Contact (Secondary)	Supervisor, Formulary Ops.	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	10/06/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	General Contact	Director, Regulatory Compliance/ MCO	Mr.	McGrady	Daniel		7325393680					daniel_mcgrady@horizonblue.com	1700 American Blvd.	HL-03	Pennington	NJ	08534	02/25/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Government Relations Contact	Director, Regulatory Compliance/ MCO	Mr.	McGrady	Daniel		7325393680					daniel_mcgrady@horizonblue.com	1700 American Blvd.	HL-03	Pennington	NJ	08534	02/25/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	HIPAA Privacy Officer	Privacy Official		Dates	Chris	A	9734667669					chris_dates@horizonblue.com	3 Penn Plaza East, PP-16C		Newark	NJ	07105	12/30/2015	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	HIPAA Security Officer	Chief Information Security Officer	Mr.	Constantino	Daniel		9734665127					Daniel_Constantino@horizonblue.com	3 Penn Plaza	PP-16K	Newark	NJ	07105	01/04/2023	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Hospice Contact	Director, Clinical Special Needs Plan		Smolij	Carol		8566383595					Carol_Smolij@horizonblue.com	250 Century Pkwy		Mt. Laurel	NJ	08054	04/04/2018	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Interoperability Contact	Director, Mandate Implementation		Gregory	Stacey		9734668278					Stacey_Gregory@horizonblue.com	3 Penn Plaza	PP-09	Newark	NJ	07105	01/04/2023	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	MA Appeals/Grievances Contact	Manager, Service Ops. II	Ms.	Mestres	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	06/13/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	MA Claims Processing Contact for Public Website	Mgr, Exec DOBI Compl & Appls		Mestress	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	06/15/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Marketing Contact	Sales Manager II		Cennamo	Steven	P	9084160480					steven_cennamo@horizonblue.com	3 Penn Plaza East	PP-12F	Newark	NJ	07105	02/09/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Medical Director	Medical Director III, Govt. Programs	Dr.	Johnson	Terry		6095372097					terry_johnson@horizonblue.com	1700 American Blvd	HL-02	Pennington	NJ	08534	07/13/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Medicare Compliance Officer	Director, Reg. Requirements/ MCO	Mr	McGrady	Daniel		7325393680					daniel_mcgrady@horizonblue.com	1700 American Blvd.	HL-03	Pennington	NJ	08534	07/12/2021	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Medicare Coordinator	VP, Reg. Compliance/MCO	Mr.	McGrady	Daniel		6095372317					daniel_mcgrady@horizonblue.com	3 Penn Plaza East	PP-16	Newark	NJ	07105	04/06/2023	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Medicare Part D Opioid Overutilization Contact	Supervisor, Pharmacists		Anderson	Ally		8554570763				8557297221	PartDoverutil@primetherapeutics.com	2900 Ames Crossing Rd	PRIME Therapeutics	Eagan	MN	55121	03/21/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Medication Therapy Management Contact	Manager, MTM and Case/Care Management		Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	PRIME Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	OffShore Subcontractor Contact	Manager, Medicaid Regulatory Requirements		McGrady	Daniel		6095372617					daniel_mcgrady@horizonblue.com	1700 American Blvd	HL-03P	Pennington	NJ	08534	12/11/2018	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Online Enrollment Center Contact (Back-up)	Supervisor		Johnson	Cheryl		9734666931					cheryl_johnson@horizonblue.com	3 Penn Plaza East, PP-12L		Newark	NJ	07105	10/21/2016	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Online Enrollment Center Contact (Optional)	Team Leader		Johnson	Cheryl		9734666931					Cheryl_Johnson@horizonblue.com	3 Penn Plaza - PP12L		Newark	NJ	07105	04/18/2016	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Online Enrollment Center Contact (Primary)	Manager, Medicare Operations		Santiago-Mercado	Nitza		9734667346					Nitza_Santiago-mercado@horizonblue.com	3 Penn Plaza East, PP-12L		Newark	NJ	07105	09/13/2018	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Part C Application Contact	Director, Product Administration		Duddy	Jacqueline		9734665169					jacqueline_duddy@horizonblue.com	3 Penn Plaza	PP-12	Newark	NJ	07105	01/13/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Part C Reporting Contact	Medicare Program Analyst		Wilbanks	Dasha	N	9734665601					dasha_wilbanks@horizonblue.com	3 Penn Plaza	16-C	Newark	NJ	07105	04/19/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd	PRIME Therapeutics	Eagan	MN	55121	03/21/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	New York
H8298	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd	Clinical Review	Eagan	MN	55121	03/21/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	New York
H8298	Part D Application Contact	Director, Product Administration		Duddy	Jacqueline		9734665169					jacqueline_duddy@horizonblue.com	3 Penn Plaza	PP-12	Newark	NJ	07105	01/13/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Part D Benefits Contact	Director, Benefits Ops.	Ms.	Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	10/06/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Part D Claims Submission Contact	Functional Business Consultant - Govt. Programs	Mr.	Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	PRIME Therapeutics, LLC	2655 Eagan Woods Drive	Eagan	MN	55122	04/09/2019	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Part D Exceptions Contact	Director, Reg/Audit Response	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd		Eagan,	MN	55121	04/15/2021	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	New York
H8298	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	New York
H8298	Part D Price File Contact (Back-up)	Bus. Solutions Analyst Lead		Bushman	John		6134599623					John.Bushman@PrimeTherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	09/28/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Part D Price File Contact (Optional)	Sr. Price File Analyst		Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/28/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Part D Price File Contact (Primary)	Manager, Pharmacy Operations	Ms.	Farber	Keri	A	9734668995					Keri_Farber@horizonblue.com	3 Penn Plaza East	PP-12	Newark	NJ	07105	08/20/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Part D Quality Assurance Contact	Director, Clinical Pharm Prg & Op - Medicare		Patrikios	Athena		9734666542					Athena_Patrikios@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	01/03/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Part D Reporting Contact	Medicare Program Analyst		Wilbanks	Dasha	N	9734665601					dasha_wilbanks@horizonblue.com	3 Penn Plaza	16-C	Newark	NJ	07105	04/19/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Patient Safety Contact	Director, Clinical Pharm Prg & Op - Medicare		Patrikios	Athena		9734666542					Athena_Patrikios@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	01/03/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Payment Contact	Manager, Financial Reporting		Griffin	Kevin		6095372464					kevin_griffin@horizonblue.com	1700 American Blvd	HL-03Q	Pennington	NJ	08534	01/12/2018	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Pharmacy Director	Director, Clinical Pharmacy Programs		Patrikios	Athena		9734664654					athena_patrikios@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	01/23/2017	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Pharmacy Network Management Contact	AVP, Network Mgmt	Ms	Conlin	Marci		6127772842					Marci.Conlin@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	04/15/2021	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Pharmacy Network Management Contact (Secondary)	Sr. Director Network Client Svcs.	Ms	Hanley	Megan		6127773969				8778236373	Megan.Hanley@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55122	01/05/2021	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	PRIME Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	09/28/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active	8003911926				HMO - Health Maintenance Organization		C	New York
H8298	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Exp. & Member Ops.		Bunch	Jonathan							jonathan.bunch@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	09/28/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active	8003911926				HMO - Health Maintenance Organization		C	New York
H8298	Plan Directory Contact for Public Website	Mgr, Exec DOBI Compl & Appls		Mestres	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	06/15/2020	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Plan to Plan Reconciliation Contact	Pharmacy Business Admin		Cunningham	Theresa		9734667886				9734664665	theresa_cunningham@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	12/22/2016	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Processor Contact	Director, PBM Ops.	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Rd	PRIME Therapeutics	Eagan	MN	55121	09/28/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Quality Contact	Director, Quality Improvement Operations		Harris	Andrea		6095373027					andrea_harris@horizonblue.com	1700 American Blvd	HL-02	Pennington	NJ	08534	10/10/2019	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Reconciliation Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319				7322565428	jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	12/30/2015	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Reconciliation Contact (Secondary)	Manager, Actuarial		Muellers	Barbara		7322565313				7322565428	barbara_muellers@horizonblue.com	1427 Wyckoff Road	WL-03R	Wall	NJ	07727	12/30/2015	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Recovery Audit Contact	Director, Special Investigations	Mr.	Dineen	Timothy		9734668723					timothy_dineen@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	12/30/2015	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	SNP Application Contact	Director, Clinical SNP	Ms.	Smolij	Carol		9735584774					Carol_Smolij@horizonblue.com	1700 American Blvd		Pennington	NJ	08534	04/18/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Surveillance Contact	VP, Reg. Compliance/MCO	Mr.	McGrady	Daniel		6095372317					daniel_mcgrady@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	04/06/2023	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	System Contact	Director, Information Security		Andreano	Matthew		9734667330					Matthew_Andreano@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	05/19/2022	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Third Party Administrator (TPA) Liaison	Director, Pharmacy (Medicare)		Patrikios	Athena		9734666542					athena_patrikios@horizonblue.com	3 Penn Plaza East	PP-12	Newark	NJ	07105	05/06/2021	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	User Access Contact	Medicare Program Analyst		Wilbanks	Dasha	N	6095372613					Dasha_Wilbanks@horizonblue.com	1700 American Blvd. HL-01	Hopewell Campus	Pennington	NJ	08534	10/30/2017	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Utilization Management Contact	Dir, Clin Ops & Delegate Vendor Oversight		Rush	Lisa		7322565016					Lisa_Rush@horizonblue.com	250 Century Parkway	3-D	Mount Laurel	NJ	08054	03/07/2019	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8298	Utilization Review Contact	Dir, Clin Ops & Delegate Vendor Oversight		Rush	Lisa		7322565016					Lisa_Rush@horizonblue.com	250 Century Parkway	3-D	Mount Laurel	NJ	08054	03/07/2019	2023	HORIZON HEALTHCARE OF NEW JERSEY, INC.	Local CCP	Horizon Blue Cross Blue Shield of New Jersey	HMO/HMOPOS		Horizon Mutual Holdings, Inc	126	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8330	Agent/Broker Compensation Data Contact	Director, Sales Operations		McManus	Marie		6179729400	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Automated TrOOP Balance Transfer Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Backup User Access Contact	Medicare Compliance Program Manager		Tran	Brenda		7816121000	85880				brenda.tran@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Best Available Evidence Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Bid Audit Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Bid Audit Site Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Bid Primary Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	CAP Report Contact for Public Website	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	01/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Chief Financial Officer	SVP Chief Financial Officer	Mr.	Walker	Scott		7816126840					r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	07/25/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Chief Operating Officer	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	06/12/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Chief Information Officer	SVP and Chief Information Officer	Ms.	Ferhatbegovic	Selma		7816121000	84633				Selma.Ferhatbegovic@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	07/28/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	CMS Casework Communication Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Complaints Tracking Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Contact for Fraud Investigations	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Coordination of Benefits Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Corporate Mailing						7816121000					Cain.Hayes@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	12/05/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Customer Service Operations Contact	Manager, Member Services	Ms.	Villatoro	Yesly		7816121000	54152				yesly.villatoro@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	DIR Contact	Senior Manager, Pharmacy reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	03/08/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	DIR Contact (Secondary)	Pharmacy Analyst Senior	Ms.	Santino	Cristina		7816121000	82560				cristina.santino@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Emergency Part D Contact	Director, Pharmacy Operations		Bonica	Joseph		7816123342					joseph.bonica@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Emergency Part D Contact (Secondary)	Manager, Pharmacy Compliance		Lake	Matthew		7816123976					matthew.lake@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Employer Waiver Contact	Manager, Client Service	Ms.	Bartkiewicz	Mary		7816121000	83937				mary.bartkiewicz@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Data Analyst Lead	Ms.	Quinlan	Judith		7816121000	83377				judith.quinlan@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Enrollment Contact	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	EOB Transfer Contact	Manager, Business Implementation		Nesmith	Tanisha		7816124861				6176730286	tanisha.nesmith@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Financial Audit Contact	Chief Financial Officer	Mr.	Walker	Scott		7816121000	86840				r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Financial Reporting Contact	SVP Finance & Chief Accounting Officer	Mr.	Porter	Mark		6179729400	85536				mark.porter@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Formulary Contact	Clinical Pharmacist Senior	Mr.	Kowalski	Alec		7816121000	82045				alec.kowalski@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Formulary Contact (Secondary)	Clinical Pharmacist Senior		Shafir	Frances		7816122897					frances.shafir@point32health.org	1 Wellness Way		Canton	MA	02021	07/19/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	General Contact	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Government Relations Contact	Chief Government Affairs Officer	Ms.	Lewis	Kristin		7816121000	83621				kristin.lewis@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	HIPAA Privacy Officer	VP Privacy & Special Investigation	Mr.	Walsh	Chris		7816121000	82508				Christopher.walsh@point32health.org	1600 Crown Colony Drive		Quincy	MA	02169	01/18/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	HIPAA Security Officer	VP Chief  Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	07/28/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Hospice Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Interoperability Contact	Vice President & Chief Technology Officer		Querusio	David		7816122629					david.querusio@point32health.org	One Wellness Way		Canton	MA	02021	02/10/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	MA Claims Processing Contact for Public Website	Vice President, Claims	Mr.	Fernandez	David		6175844884					david.fernandez@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Marketing Contact	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Medical Director	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Medicare Compliance Officer	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Medicare Coordinator	SVP, President Medicare	Ms.	Blake	Patty		7816124287					Patty.Blake@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Dohan	David		7816121000	82615				David.Dohan@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Medication Therapy Management Contact	Sr Pharmacy Program Manager		Burns	Ashlyn		7816122239					ashlyn.burns@point32health.org	1 Wellness Way		Canton	MA	02021	07/19/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	OffShore Subcontractor Contact	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	01/18/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Online Enrollment Center Contact (Back-up)	Director, Enrollment & Payment - Senior Products	Ms.	Bullock	Jennifer		7816121000	83183				jennifer.bullock@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Online Enrollment Center Contact (Optional)	Supervisor, Enrollment	Ms.	Van De Mortel	Migdalia		7816121000	84104				Migdalia.Van.De.Mortel@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Online Enrollment Center Contact (Primary)	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Part C Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Part C Reporting Contact	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Part D Appeals	Director, Appeals & Grievances		Evans	Kathleen							Kathleen.Evans@point32health.org	1 Wellness Way		Canton	MA	02021	09/20/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	6179729400	87204			HMO - Health Maintenance Organization		C	Boston
H8330	Part D Appeals Contact (Secondary)	Program Manager Senior	Ms.	Mello	Sheri							sheri.mello@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	84862			HMO - Health Maintenance Organization		C	Boston
H8330	Part D Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Part D Benefits Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Part D Claims Submission Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Chan	Bryan							bryan.chan@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7816121000	82370			HMO - Health Maintenance Organization		C	Boston
H8330	Part D Price File Contact (Back-up)	Advisor, Medicare Operations		Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	60173	07/19/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Part D Price File Contact (Optional)	Sr. Pharmacy Implementation Specialist		Sullivan	Tim		7816124922					tim.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	07/19/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Part D Price File Contact (Primary)	Sr Business Analyst		Moore-Elliott	Shalandria		7637974305					shalandria.moore-elliott@optum.com	1600 McConnor Pwy.		Schaumburg	IL	60173	07/19/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Part D Quality Assurance Contact	Vice President, Behavioral Health	Ms.	Borrelli	Jill		6179729400	85397				jill.borrelli@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Part D Reporting Contact	Director, Pharmacy Financial & Reporting	Mr.	Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Patient Safety Contact	Sr Pharmacy Implementation Specialist		von Fritzinger	Lisa		7816123778					lisa.vonfritzinger@point32health.org	1 Wellness Way		Canton	MA	02021	07/19/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Payment Contact	Program Manager III	Ms.	Cook	Tiffany		7816121000	84908				Tiffany.Cook@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Pharmacy Director	Vice President, Pharmacy	Ms.	Sullivan	Miriam		7816121000	84116				miriam.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	12/06/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations		Ashby	JoLynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	12/06/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Pharmacy Technical Help Desk Contact	Sr. Manager		Villaneuva	Juan							Juan.Villanueva@optum.com	3515 S Harbor Blvd.		Costa Mesa	CA	92626	07/19/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	7148253761				HMO - Health Maintenance Organization		C	Boston
H8330	Pharmacy Technical Help Desk Contact (Secondary)	Associate Director, Pharmacy Help Desk		Betten	Brad							bradley.betten@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	12/08/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active	8555240380				HMO - Health Maintenance Organization		C	Boston
H8330	Plan Directory Contact for Public Website	Supervisor, Marketing Materials Production	Mr.	Kayser	Kenneth		7816121000	83518				kenneth.kayser@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Plan to Plan Reconciliation Contact	Manager, Finance Operations	Ms.	Olson	Rachel		7816121000	84360				rachel.olson@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Processor Contact	Director, Claims	Ms.	Patel	Monal		7816121000	88187				monal.patel@point32health.org	1 Wellness Way		Canton	MA	02021	04/26/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Quality Contact	Senior Manager, Quality Informatics	Ms.	McCoy	Kelly		7816121000	83515				kelly.mccoy@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Reconciliation Contact	Senior Manager, Pharmacy Reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	03/08/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Reconciliation Contact (Secondary)	Director, Pharmacy Financial & Reporting		Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	09/11/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Recovery Audit Contact	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	SNP Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Surveillance Contact	Driector, Sales Operations		McManus	Marie		6179729400	87793				Marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	System Contact	Senior Manager, Business Account Management	Mr.	Allen	Jeffrey		7816121000	83167			6179729008	Jeffrey.Allen@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Third Party Administrator (TPA) Liaison	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	12/05/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	User Access Contact	Medicaid Compliance Officer	Mr.	Camper	Stephen		7816121000	84759				stephen.camper@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Utilization Management Contact	Director, Care Management	Ms.	Menery	Maureen		7816121000	83994				maureen.menery@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8330	Utilization Review Contact	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	01/19/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	HMO/HMOPOS		Point32Health, Inc.	398	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8332	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H8332	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	3900 Rogers Road		San Antonio	TX	78251	12/02/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/13/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8332	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF KANSAS, INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8343	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5133167654				PPO - BBA		C	Chicago
H8343	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract	8144498744				PPO - BBA		C	Chicago
H8343	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5133167654				PPO - BBA		C	Chicago
H8343	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5407984087				PPO - BBA		C	Chicago
H8343	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract	8333774266				PPO - BBA		C	Chicago
H8343	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract	3135973173				PPO - BBA		C	Chicago
H8343	PHR Beneficiary Contact																	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Withdrawn Contract	8004671199				PPO - BBA		C	Chicago
H8343	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8343	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	05/31/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Amerigroup Insurance Company	Local PPO		Elevance Health, Inc.	1	Yes	Withdrawn Contract					PPO - BBA		C	Chicago
H8379	Agent/Broker Compensation Data Contact	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Automated TrOOP Balance Transfer Contact	Enrollment Coordinator		Rice	Lori		6164648667					PH-MedicareTrOOPContact@PriorityHealth.com	1231 East Beltline Ave NE	MS 1175	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Backup User Access Contact	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Best Available Evidence Contact	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Bid Audit Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Bid Audit Site Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Bid Primary Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	CAP Report Contact for Public Website	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648824					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648424				HMO - Health Maintenance Organization		C	Chicago
H8379	CEO - CMS Administrator Contact	CEO	Mr	Thandani	Praveen		6164949365				6169421150	CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	CEO - Senior Official for Contracting	Vice President Medicare	Mr	Norman	Scott		2488803191					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Chief Financial Officer	Chief Financial Officer	Mr	Gates	Nick	P	6164648144					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Chief Operating Officer	CEO	Mr	Thandani	Praveen		6164649365					CEOMedicare@priorityhealth.com	1231 East Beltine NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Chief Information Officer	Chief Information Officer	Mr	Crook	Chris		6164649939					CEOMedicare@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Chief Information Security Officer	SVP, IS Technology Services	Mr	Dresen	Scott		6164864277					CEOMedicare@priorityhealth.com	100 Michigan Street NE	MC 843	Grand Rapids	MI	49503	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	CMMI Model Point of Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	CMS Casework Communication Contact	Manager for Business Monitoring - G & A		LaBelle	Julie		9178417869					Radha.LaBelle@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Complaints Tracking Contact	Manager for Business Monitoring - G & A		LaBelle	Julie		9178417869					Radha.LaBelle@priorityhealth.com	1231 East Beltline Ave NE	MS 1115	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Contact for Fraud Investigations	Manager, Special Investigations Unit		Gross	Brenda		6164648152					Brenda.Gross@PriorityHealth.com	1231 E Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Coordination of Benefits Contact	Claims Manager		Ball	Jill		8883896648					CEOMedicare@priorityhealth.com	1239 East Beltline Ave NE	MS2205	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Corporate Mailing						6169420954				6164640145	PH-DistributionSE@PriorityHealth.com	1231 East Beltline Ave, NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Coverage Gap Discount Program (CGDP) Payment Contact	Operations Supervisor		Johnston	Adam		6164648915					adam.johnston@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Customer Service Operations Contact	Customer Care Center Manager, Medicare		Storment	Joe		5033309550					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	DIR Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	DIR Contact (Secondary)	Senior Financial Analyst		McZee	Nikki		6164648205					nikki.mczee@corewellhealth.org	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Electronic Health Record Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648824					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648424				HMO - Health Maintenance Organization		C	Chicago
H8379	Emergency Part D Contact	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Emergency Part D Contact (Secondary)	Manager, Medicare Pharmacy Operations		VanLoenen	Amanda		6164648750					Amanda.VanLoenen@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Employer Waiver Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Encounter Data & Risk Adjustment Operations Contact			Florn	Cathy		7348902858					cathy.florn@priorityhealth.com	1239 E Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Enrollment Contact	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	EOB Transfer Contact	Claims Manager		Ball	Jill		6164648044				6169750247	CEOMedicare@priorityhealth.com	1239 East Beltline Ave NE	MS 2205	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Financial Audit Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Financial Reporting Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Formulary Contact	Medicare Part D Operations Manager		Van Loenen	Amanda		6164648750					PH-MedicareFormularyContact@PriorityHealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	General Contact	Vice President Medicare	Mr	Norman	Scott		2488803191					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Government Relations Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	HIPAA Privacy Officer	VP, Compliance & Privacy Officer		Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS1155	Grand Rapids	MI	49525	08/24/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	HIPAA Security Officer			Dresen	Scott		6164864277					CEOMedicare@priorityhealth.com	100 Michigan Street NE		Grand Rapids	MI	49503	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Hospice Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Interoperability Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	MA Appeals/Grievances Contact	Manager Grievance & Appeal		Macdonald	Amanda		6164648264					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1115	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	MA Claims Processing Contact for Public Website	Claims Manager		Ball	Jill		6164648044					CEOMedicare@priorityhealth.com	1239 East Beltline Ave NE	MS 2205	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Marketing Contact	Sr. Markets & Product Development Director		Brown	Samia		6164648002					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Medical Director	Medicare Director		Forshee	James		6164644873					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Medicare Compliance Officer	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					cindy.rollenhagen@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Medicare Coordinator	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Medicare Part D Opioid Overutilization Contact	Medicare Quality Manager		Gutierrez	Salvador		6165757622					salvador.gutierrez@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	06/29/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Medication Therapy Management Contact	Director of Pharmacy Operations		Chaffee	Jacob		6168261329					jacob.chaffee@priorityhealth.com	1231 East Beltline Dr Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	OffShore Subcontractor Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Online Enrollment Center Contact (Optional)	Government Programs Enrollment Coordinator		Rice	Lori		6164648667					lori.rice@priorityhealth.com	1231 East Beltline Ave NE	MS 1180	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Online Enrollment Center Contact (Primary)	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Part C Application Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Part C Reporting Contact	Sr. Compliance Analyst		Eizinger	Eric		2178400871					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Appeals	Supervisor, Medicare Part D Appeals		Anderson	Melissa							PHMedicarePartDAPPLS@spectrumhealth.org	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648547				HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Appeals Contact (Secondary)	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy							CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648424				HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Application Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Benefits Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Claims Submission Contact	Manager, Medicare Part D Operations		Van Loenen	Amanda		6164648750					part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Exceptions Contact			Help Desk	Pharmacy							part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	8004666642				HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Exceptions Contact (Secondary)	Mgr, Medicare Part D Operations	Ms.	Van Loenen	Amanda							amanda.vanloenen@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648750				HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Price File Contact (Back-up)	Product Manager Advisor		Williams	Stephanie		5135091549					Medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Price File Contact (Optional)	Manager, Medicare Part D Operations		Van Loenen	Amanda		6164648750					part.d.ops@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Quality Assurance Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Part D Reporting Contact	Sr. Compliance Analyst		Eizinger	Eric		2178400871					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Patient Safety Contact	Clinical Pharmacy Program Manager	Mr	Chaffee	Jacob		6165756149					CEOMedicare@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Payment Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Personal Health Record Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Pharmacy Director	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Pharmacy Network Management Contact	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Pharmacy Network Management Contact (Secondary)	Manager, Medicare Pharmacy Operations		Van Loenen	Amanda		6164648750					amanda.vanloenen@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Pharmacy Technical Help Desk Contact			Help Desk	Pharmacy							part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	8004666642				HMO - Health Maintenance Organization		C	Chicago
H8379	Pharmacy Technical Help Desk Contact (Secondary)	Mgr, Medicare Part D Ops	Ms.	Van Loenen	Amanda							amanda.vanloenen@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active	6164648750				HMO - Health Maintenance Organization		C	Chicago
H8379	Physician Incentive Contact	Director, Provider Strategy & Solutions		Ryan	Susan		3137010444					CEOMedicare@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Plan Directory Contact for Public Website			Service	Customer		8883896648					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Plan to Plan Reconciliation Contact	Reconciliation & Billing Specialist		Bentley-Brown	Linda		6164648582				6169573420	linda.bentley-brown@priorityhealth.com	1231 East Beltline Ave NE	MS 1190	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Processor Contact	ESI Sr Dir - Product Management Medicare		Mahon	Snezana		3146846361					SMahon@express-scripts.com	ESI	One Express Way	St. Louis	MO	63121	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Quality Contact	Manager, Quality	Mr	Straayer	Ian		6165752782					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Reconciliation Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Reconciliation Contact (Secondary)	Manager, Finance Reporting		Hendricks	Rachel		6164648205					rachel.hendricks@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Recovery Audit Contact	Manager Cost Recovery	Ms	Gross	Brenda		6164648152					brenda.gross@priorityhealth.com	1231 East Beltline NE	Mail Stop 2305	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	SNP Application Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					janine.bishop@priorityhealth.com	1231 E Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	SNP State Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					janine.bishop@priorityhealth.com	1231 E Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Surveillance Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	System Contact	Data Analytics Analyst-Senior, Sr Markets		Johnson	Joshua		6165755760					PH-MedicareSystemsContact@PriorityHealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Third Party Administrator (TPA) Liaison	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					cindy.rollenhagen@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/06/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	User Access Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Utilization Management Contact	Director, Utilization Mgmt PH Pre-Service		Mahoney	Diana		8439068561					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8379	Utilization Review Contact	Director, Medicare Care Management		Scovel	Janet		6164648656					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH CHOICE, INC.	Local CCP	Priority Health Medicare	HMO/HMOPOS		Corewell Health	190	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8384	Agent/Broker Compensation Data Contact	Vice President of Sales		McKee	Debbie		3158574541					dmckee@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Automated TrOOP Balance Transfer Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Backup User Access Contact	Director Appeals & Grievances	Ms.	Vega	Vanessa		9546994087					vvega@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Best Available Evidence Contact	Senior Director, Claims and Enrollment		Dugan	Todd		5704706267					tdugan@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Bid Audit Contact	Chief Actuary		Mone	Bob		4043533226					bmone@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Bid Audit Site Contact	Chief Actuary		Mone	Bob		4043533226					bmone@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Bid Primary Contact	Chief Actuary		Mone	Bob		4043533226					bmone@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	CAP Report Contact for Public Website	Chief Compliance Officer	Mrs.	Kirchner	Rocio		6155047120					rkirchner@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Coffman	Aric		5055062893					acoffman@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/23/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Coffman	Aric		5055062893					acoffman@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Chief Financial Officer	Chief Actuary	Mr.	Mone	Bob		4043533226					bmone@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/29/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Chief Operating Officer	Chief Executive Officer	Mr.	Coffman	Aric		5055062893					acoffman@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Chief Information Officer	Chief Information Officer	Mr.	Dees	Gary		9162025430					gdees@honestmedicalgroup.com	210 Athens Way, Suite 200		Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Chief Information Security Officer	Chief Information Officer	Mr.	Dees	Gary		9162025430					gdees@honestmedicalgroup.com	210 Athens Way, Suite 200		Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	CMS Casework Communication Contact	Director Appeals & Grievances	Ms.	Vega	Vanessa		9546994087					vvega@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Complaints Tracking Contact	Director Appeals & Grievances	Ms.	Vega	Vanessa		9546994087					vvega@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Contact for Fraud Investigations	Chief Compliance Officer	Mrs.	Kirchner	Rocio		6155047120					rkirchner@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Coordination of Benefits Contact	Senior Director, Claims and Enrollment		Dugan	Todd		5704706267					tdugan@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Corporate Mailing						8336331295					info@honestmedicalgroup.com	220 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Coverage Gap Discount Program (CGDP) Payment Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Customer Service Operations Contact	Director Contact Center Operations		Rivers-Moya	Elle		6153589050					erivers-moya@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	DIR Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	DIR Contact (Secondary)																	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Emergency Part D Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Emergency Part D Contact (Secondary)																	05/23/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Employer Waiver Contact																	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Encounter Data & Risk Adjustment Operations Contact	VP Risk Adjustment,		Silvius	Kevin		6104168794					ksilvius@honestmedicalgroup.com	210 Athens Way	Suite 100	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Enrollment Contact	Senior Director, Claims and Enrollment		Dugan	Todd		5704706267					tdugan@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	EOB Transfer Contact	Senior Director, Claims and Enrollment		Dugan	Todd		5704706267				8336331292	tdugan@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Financial Audit Contact	Vice President of Finance	Mr.	Meyers	Clayton		9063228010					cmeyers@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Financial Reporting Contact	Vice President of Finance	Mr.	Meyers	Clayton		9063228010					cmeyers@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Formulary Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Formulary Contact (Secondary)																	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	General Contact	Chief Compliance Officer	Mrs.	Kirchner	Rocio		6155047120					rkirchner@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Government Relations Contact	General Counsel		Jordan	Teresa		7132137534					tjordan@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	HIPAA Privacy Officer	Chief Compliance Officer	Mrs.	Kirchner	Rocio		6155047120					rkirchner@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	HIPAA Security Officer	Chief Information Officer	Mr.	Dees	Gary		9162025430					gdees@honestmedicalgroup.com	210 Athens Way, Suite 200		Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Hospice Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Interoperability Contact	Chief Information Officer	Mr.	Dees	Gary		9162025430					gdees@honestmedicalgroup.com	210 Athens Way, Suite 200		Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	MA Appeals/Grievances Contact	Director Appeals & Grievances	Ms.	Vega	Vanessa		9546994087					vvega@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	MA Claims Processing Contact for Public Website	Senior Director, Claims and Enrollment		Dugan	Todd		5704706267					tdugan@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Marketing Contact	Vice President of Sales		McKee	Debbie		3158574541					dmckee@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Medical Director	Chief Medical Officer of Health Plans		Mancuso	Scott		8336331295					smancuso@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Medicare Compliance Officer	Chief Compliance Officer	Mrs.	Kirchner	Rocio		6155047120					rkirchner@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Medicare Coordinator	Chief Executive Officer	Mr.	Coffman	Aric		5055062893					acoffman@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/23/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Medicare Part D Opioid Overutilization Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Medication Therapy Management Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Part C Application Contact	General Counsel		Jordan	Teresa		7132137534					tjordan@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Part C Reporting Contact	Chief Information Officer	Mr.	Dees	Gary		9162025430					gdees@honestmedicalgroup.com	210 Athens Way, Suite 200		Nashville	TN	37228	05/23/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Part D Appeals	Senior Director of Pharmacy		Lincoln-Giang	Pam							pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated	7143925198				HMO - Health Maintenance Organization		C	Chicago
H8384	Part D Appeals Contact (Secondary)																	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Part D Application Contact	General Counsel		Jordan	Teresa		7132137534					tjordan@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Part D Benefits Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Part D Claims Submission Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Part D Exceptions Contact	Senior Director of Pharmacy		Lincoln-Giang	Pam							pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated	7143925198				HMO - Health Maintenance Organization		C	Chicago
H8384	Part D Price File Contact (Back-up)	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Part D Price File Contact (Primary)	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Part D Quality Assurance Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Part D Reporting Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Patient Safety Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Payment Contact	Vice President of Finance	Mr.	Meyers	Clayton		9063228010					cmeyers@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Pharmacy Director	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Pharmacy Network Management Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Pharmacy Technical Help Desk Contact	Senior Director of Pharmacy		Lincoln-Giang	Pam							pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated	7143925198				HMO - Health Maintenance Organization		C	Chicago
H8384	Pharmacy Technical Help Desk Contact (Secondary)																	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Plan Directory Contact for Public Website	Chief Executive Officer	Mr.	Coffman	Aric		5055062893					acoffman@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/23/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Plan to Plan Reconciliation Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Processor Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Quality Contact	Chief Medical Officer of Health Plans		Mancuso	Scott		8336331295					smancuso@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Reconciliation Contact	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Recovery Audit Contact	Vice President of Finance	Mr.	Meyers	Clayton		9063228010					cmeyers@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	SNP Application Contact	General Counsel		Jordan	Teresa		7132137534					tjordan@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	SNP State Contact	General Counsel		Jordan	Teresa		7132137534					tjordan@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Surveillance Contact	Chief Compliance Officer	Mrs.	Kirchner	Rocio		6155047120					rkirchner@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	System Contact	Chief Information Officer	Mr.	Dees	Gary		9162025430					gdees@honestmedicalgroup.com	210 Athens Way, Suite 200		Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Third Party Administrator (TPA) Liaison	VP of Clinical Programs and Pharmacy		Lincoln-Giang	Pam		7143925198					pgiang@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	06/16/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	User Access Contact	Chief Compliance Officer	Mrs.	Kirchner	Rocio		6155047120					rkirchner@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Utilization Management Contact	Vice President Health Services	Mrs.	Parente	Robin		7742860270					rparente@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8384	Utilization Review Contact	Vice President Health Services	Mrs.	Parente	Robin		7742860270					rparente@honestmedicalgroup.com	210 Athens Way	Suite 200	Nashville	TN	37228	05/19/2023	2023	HONEST HMO OF MICHIGAN LLC	Local CCP	Honest Health Plan	HMO/HMOPOS		Honest Medical Group LLC	789	Yes	Terminated					HMO - Health Maintenance Organization		C	Chicago
H8385	Agent/Broker Compensation Data Contact	Director of Product Development	Ms.	Meyer	Courtney		6053122613					Courtney.Meyer@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Automated TrOOP Balance Transfer Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	05/24/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Backup User Access Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Best Available Evidence Contact	Director of Billing & Enrollment	Mr.	Reichelt	Daniel		6053122624					daniel.reichelt@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Bid Audit Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Bid Audit Site Contact	Director of Acturial Services	Mr.	Pence	Gregory		4156018550					gregory.pence@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Bid Primary Contact	Director of Actuarial Services	Mr.	Pence	Gregory		4156018550					gregory.pence@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	CAP Report Contact for Public Website	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active	6053286806				PPO - BBA		C	Dallas
H8385	CEO - CMS Administrator Contact	President	Mr.	Snyder	John		6053122750					john.snyder@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	CEO - Senior Official for Contracting	President	Mr.	Snyder	John		6053122750					john.snyder@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Chief Financial Officer	Vice President of Finance	Mr.	Maude	Brian		6053286801					Brian.Maude@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Chief Operating Officer	Chief Operating Officer	Ms.	Griese	Emily		6053287020					Emily.Griese@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Chief Information Officer	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Chief Information Security Officer	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	CMMI Model Point of Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	CMS Casework Communication Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 Cherapa place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Complaints Tracking Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Contact for Fraud Investigations	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Coordination of Benefits Contact	Director of Payment Integrity	Ms.	Lieser	Mesa		6053287024					mesa.lieser@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Corporate Mailing						8005354831					sanfordhealthplan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Customer Service Operations Contact	Director of Customer Service	Mr.	Ling	Ryan		6053127459					ryan.ling@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	DIR Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	DIR Contact (Secondary)	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Electronic Health Record Contact	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Emergency Part D Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	05/24/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Emergency Part D Contact (Secondary)	Senior Director of Goverment Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Employer Waiver Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Encounter Data & Risk Adjustment Operations Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Enrollment Contact	Director of Product Development	Ms.	Meyer	Courtney		6053122613					courtney.meyer@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	EOB Transfer Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182				6053286811	aleesa.jansick@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Financial Audit Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Financial Reporting Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Formulary Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Formulary Contact (Secondary)	Principal Pharmacy Benefits Specialist		Chen	Honghua		2242312740					Christine.Chen2@optum.com	1600  McConnor Parkway	Suite 201	Schaumburg	IL	601736801	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	General Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Government Relations Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	HIPAA Privacy Officer	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	HIPAA Security Officer	Systems Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Hospice Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Interoperability Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	MA Appeals/Grievances Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	MA Claims Processing Contact for Public Website	Executive Director Operations	Ms.	Guggisberg	Stacey		6053286802					stacey.guggisberg@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Marketing Contact	Director of Marketing	Ms.	McCloskey	Diana		6053122762					diana.mccloskey@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Medical Director	Vice President, Medical Officer	Dr.	Faber	Kevin		6053287192					kevin.faber@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Medicare Compliance Officer	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Medicare Coordinator	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Medication Therapy Management Contact	Clinical Program Manager	Ms.	Liaqat	Tazeen		6305440541					Tazeen.liaqat@optum.com	1240 South Pine Island Rd.		Plantation	FL	33324	01/13/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	OffShore Subcontractor Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Online Enrollment Center Contact (Back-up)	Director of Medicare Programs	Mr.	Ovenden	Nathan		6053122606					nathan.ovenden@sanfordhealth.org	300 Cherapa Place, Suite 201		Sioux Falss	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Online Enrollment Center Contact (Optional)	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Online Enrollment Center Contact (Primary)	Senior Director of Development and Distribution	Ms.	Meyer	Courtney		6053122613					courtney.meyer@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Part C Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Part C Reporting Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Part D Appeals	Manager, Prior Authorization Appeals	Ms.	Le	Christina						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active	8884033398				PPO - BBA		C	Dallas
H8385	Part D Appeals Contact (Secondary)	Pharmacy Technician, PA Appeals		Chavez	Kelly						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active	8884033398				PPO - BBA		C	Dallas
H8385	Part D Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Part D Benefits Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Part D Claims Submission Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Part D Exceptions Contact	Manager, Prior Authorization	Ms.	Le	Christina						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active	8884033398				PPO - BBA		C	Dallas
H8385	Part D Exceptions Contact (Secondary)	Pharmacy Technician, PA		Chavez	Kelly						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active	8884033398				PPO - BBA		C	Dallas
H8385	Part D Price File Contact (Back-up)	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615				6053286811	timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Part D Price File Contact (Optional)	Senior Director of Government Program	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Part D Price File Contact (Primary)	Senior Business Analyst	Ms.	Lyman	Dorothy		6514955369					Dorothy.Lyman@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Part D Quality Assurance Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007				6053286811	rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Part D Reporting Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Patient Safety Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Payment Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Personal Health Record Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Pharmacy Director	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615				6053286811	timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations	Ms.	Ashby	Jolynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk	Mr.	Summers	Todd							Todd.Summers@optum.com	1600 McConnor Parkway	Suite 200	Schaumburg	IL	601736801	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active	8446429090				PPO - BBA		C	Dallas
H8385	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Service	Mr.	Juarez	Ethan							ethan.juarez@optum.com	3515 Harbor Blvd		Costa Mesaa	CA	92626	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active	7148256891				PPO - BBA		C	Dallas
H8385	PHR Beneficiary Contact																	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO	Sanford Health Plan	Sanford Health	740	Yes	Active	8885354831				PPO - BBA		C	Dallas
H8385	Physician Incentive Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Plan Directory Contact for Public Website	Senior Director of Risk & Regulation	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Plan to Plan Reconciliation Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Processor Contact	Senior Manager, Benefit Administration	Ms.	Lievanos	Cassandra		7637974205					cassandra.lievanos@optum.com	5701 Katella Ave		Cypress	CA	90630	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Quality Contact	Senior Director of Risk & Regulation	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Reconciliation Contact	Director of Billing & Enrollment	Mr.	Reichelt	Daniel		6053122624					daniel.reichelt@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Reconciliation Contact (Secondary)	Executive Director of Opertions	Ms.	Guggisberg	Stacey		6053286802					stacey.guggisberg@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Recovery Audit Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	SNP Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	SNP State Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Surveillance Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	System Contact	Systems Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Third Party Administrator (TPA) Liaison	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	User Access Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Utilization Management Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8385	Utilization Review Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	01/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Sanford Health Plan	Local PPO		Sanford Health	740	Yes	Active					PPO - BBA		C	Dallas
H8390	Agent/Broker Compensation Data Contact	AVP, Sales Operations	Mr.	Handerhan	Bill		7328291160					bill.handerhan@caresource.com	230 N Main St		Dayton	OH	45402	07/15/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Backup User Access Contact	Regulatory Submission Specialist	Mr.	Houser	Aaron		9374874147					macompliance@CareSource.com	230 North Main St		Dayton	OH	45402	06/04/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Best Available Evidence Contact	Enrollment Team Lead	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 45401		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Bid Audit Contact	Senior Director, Actuarial Science	Mr.	Butz	Stephen		9376091705					stephen.butz@caresource.com	P. O. Box 8738		Dayton	OH	45401	02/17/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Bid Audit Site Contact	Senior Director, Actuarial Science	Mr.	Butz	Stephen		9376091705					stephen.butz@caresource.com	P. O. Box 8738		Dayton	OH	45401	02/17/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Bid Primary Contact	Senior Director, Actuarial Science	Mr.	Butz	Stephen		9376091705					stephen.butz@caresource.com	P. O. Box 8738		Dayton	OH	45401	02/17/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	CAP Report Contact for Public Website	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@caresource.com	230 N Main St		Dayton	OH	45402	05/04/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Preitauer	Erhardt		9375312455					Erhardt.Preitauer@caresource.com	P. O. Box 8738		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Preitauer	Erhardt		9375312455					Erhardt.Preitauer@caresource.com	P. O. Box 8738		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Chief Financial Officer	Chief Financial Officer	Mr.	Smart	Lawrence		9375313335					Lawrence.Smart@caresource.com	P. O. Box 8738		Dayton	OH	45401	01/05/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Chief Operating Officer	(Interim) Chief Operating Officer	Mr.	Davidi	Isacc		9372715922					isaac.davidi@caresource.com	P. O. Box 8738		Dayton	OH	45401	04/12/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Chief Information Officer	Chief Information Officer	Ms.	Valencia	Devon		9375312552					devon.valencia@caresource.com	P.O. Box 8738		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Chief Information Security Officer	VP , Information Security and Privacy	Mrs.	Heckler	Lisa		9375313895					lisa.heckler@caresource.com	P.O. Box 8738		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	CMS Casework Communication Contact	Director, Grievance and Appeals	Ms.	Acuna	Celeste		4806406815					celeste.acuna@caresource.com	P.O. Box 1947		Dayton	OH	45401	01/20/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Complaints Tracking Contact	Director, Grievance and Appeals	Ms.	Acuna	Celeste		4806406815					celeste.acuna@caresource.com	P.O. Box 1947		Dayton	OH	45401	01/20/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Contact for Fraud Investigations	Program Integrity Analyst	Ms.	Johnson	Alexis	N	9372243300	2870			9373963876	SIUprogramintegrity@caresource.com	P. O. Box 8738		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Coordination of Benefits Contact	Manager, Enrollment Operations	Mr.	Spivey	Michael		9375313682				9374870643	COBInquiry@caresource.com	230 N. Main St.		Dayton	OH	45402	04/15/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Corporate Mailing						9372243300					macompliance@caresource.com	P. O. Box 8738		Dayton	OH	45401	08/31/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	230 N. Main Street		Dayton	OH	45402	09/01/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Customer Service Operations Contact	Director, Customer Care		Cary	Lisa		9372326458					lisa.cary@caresource.com	40 W 2nd St		Dayton	OH	45402	10/04/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	DIR Contact	VP, Actuarial Science		Farmer	Nikki		9372863350					nikki.farmer@caresource.com	230 N. Main Street		Dayton	OH	45402	06/26/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	DIR Contact (Secondary)	Manager, Accounting	Ms.	Nelson	Megan		9374876597					megan.nelson@caresource.com	P. O. Box 8738		Dayton	OH	45401	09/23/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Emergency Part D Contact	Manager, Contact Center	Ms.	Davidson	Regina		7722362766					Regina_Davidson@express-scripts.com	10045 South Federal Highway		Port St. Lucie	FL	34952	07/01/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Emergency Part D Contact (Secondary)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Encounter Data & Risk Adjustment Operations Contact	Director, Claims Encounter Data	Mr.	Shareef	Akbar		9374876640					MyCare-MA_EncounterRequests@caresource.com	220 E. Monument Ave.		Dayton	OH	45402	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Enrollment Contact	Enrollment Team Lead	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 45401		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	EOB Transfer Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479				9374870359	rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Financial Audit Contact	AVP, Compliance	Ms.	Frazee	Margaux		9375313338					margaux.frazee@caresource.com	230 N. Main Street		Dayton	OH	45402	09/06/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Financial Reporting Contact	Chief Financial Officer	Mr.	Smart	Lawrence		9375313335					Lawrence.Smart@caresource.com	P. O. Box 8738		Dayton	OH	45401	02/15/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Formulary Contact	Director, Clinical Strategy	Ms.	Condon	Kelani		7373142944					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Formulary Contact (Secondary)	Pharmacist Formulary Strategy and Management		Cabrera	Lourdes		9374875477					maria.cabrera@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/04/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	General Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/20/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Government Relations Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@caresource.com	230 North Main Street		Dayton	OH	45402	05/04/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	HIPAA Privacy Officer	Privacy Officer	Ms.	Heckler	Lisa		9372243300	3895				Lisa.Heckler@caresource.com	P.O. Box 8738		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	HIPAA Security Officer	Chief Information Officer	Ms.	Valencia	Devon		9375312552					devon.valencia@caresource.com	P. O. Box 8738		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Hospice Contact	Director, Enrollment	Mr.	Castro	Armando		9375312291					armando.castro@caresource.com	230 N Main St		Dayton	OH	45402	05/29/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Interoperability Contact	AVP, Enterprise Architecture		Hanley	Michael		8033721957					michael.hanley@caresource.com	230 N Main St		Dayton	OH	45402	06/01/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	MA Appeals/Grievances Contact	Director, Grievance and Appeals	Ms.	Acuna	Celeste		4806406815					celeste.acuna@caresource.com	P.O. Box 1947		Dayton	OH	45401	01/20/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	MA Claims Processing Contact for Public Website	VP of Claims and Configuration	Ms.	Hans	Holly		9375312750					Holly.Hans@caresource.com	P. O. Box 8738		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Marketing Contact	Regulatory Lead	Mr.	Houser	Aaron		9377891840					macompliance@CARESOURCE.COM	230 N Main St		Dayton	OH	45402	06/04/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Medical Director	Medical Director	Dr.	Mukunda	Beejadi		2166459092					beejadi.mukunda@caresource.com	5900 Landerbrook Drive	Ste 300	Mayfield Heights	OH	44124	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Medicare Compliance Officer	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@caresource.com	230 N. Main St.		Dayton	OH	45402	05/04/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Medicare Coordinator	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/20/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Medicare Part D Opioid Overutilization Contact	Part D Diversion Specialist	Ms.	Wendell	Amy		9372243300	12543			9373963605	amy.wendell@caresource.com	P. O. Box 1940		Dayton	OH	45401	07/01/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Medication Therapy Management Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Online Enrollment Center Contact (Optional)	Director, Enrollment	Mr.	Castro	Armando		9375312291					armando.castro@caresource.com	230 N Main Street		Dayton	OH	45402	05/29/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Online Enrollment Center Contact (Primary)	Enrollment Team Lead	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 45401		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Part C Application Contact	Director, Medicare & Marketplace Filing		Gray	Melissa		9375312328					melissa.gray@caresource.com	230 N Main St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Part C Reporting Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/04/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Part D Appeals	Express Scripts, Sr. Pharmacy Manager		Schumm	Brian						8555858246	Brian_Schumm@express-scripts.com	5151 B		Dublin	OH	43017	06/08/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	New York
H8390	Part D Appeals Contact (Secondary)		Ms.	Maze	Megan						8555858246	MLMaze@express-scripts.com	8455 University Place	# HQ2L-04 Attention: Leslie Smith	St Louis	MO	63121	01/11/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	9375804173				HMO - Health Maintenance Organization		C	New York
H8390	Part D Application Contact	Director, Medicare & Marketplace Filing		Gray	Melissa		9375312328					melissa.gray@caresource.com	230 N Main St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Part D Benefits Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Part D Claims Submission Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	06/08/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	New York
H8390	Part D Exceptions Contact (Secondary)	Director. Pharmacy Operations	Ms.	Rattan	Sangeet							rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	9375911634				HMO - Health Maintenance Organization		C	New York
H8390	Part D Price File Contact (Back-up)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Part D Price File Contact (Optional)	Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	11/22/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Part D Price File Contact (Primary)	Sr Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/22/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Part D Quality Assurance Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Part D Reporting Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Patient Safety Contact	Director, Clinical Strategy	Ms.	Condon	Kelani		7373142944					rxcompliancerequest@caresource.com	140 N Jefferson St.		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Payment Contact	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	P. O. Box 8738		Dayton	OH	45401	03/07/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Pharmacy Director	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Pharmacy Network Management Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Pharmacy Network Management Contact (Secondary)	Network Account Director (ESI)		Kelly	Heather		8003579578					hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	11/22/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H8390	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol							rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active	9378187479				HMO - Health Maintenance Organization		C	New York
H8390	Plan Directory Contact for Public Website	Manager HPLC Operations	Ms.	Smith	Allana		9296714107					allana.smith@caresource.com	P. O. Box 8378		Dayton	OH	45401	02/09/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Plan to Plan Reconciliation Contact	Manager, Accounting	Ms.	Nelson	Megan		9374876597					CareSourceP2P@caresource.com	CareSource Accounting	PO Box 2208	Dayton	OH	45401	03/07/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Processor Contact	VP Claims and Configuration		Hans	Holly		9372243300	12750				Holly.Hans@caresource.com	PO Box 8738		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Quality Contact	AVP, Medicare Quality	Mr.	Manetti	Thomas		3109358122					thomas.manetti@caresource.com	230 N Main St.		Dayton	OH	45502	03/05/2022	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Reconciliation Contact	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	P. O. Box 8738		Dayton	OH	45401	03/07/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Reconciliation Contact (Secondary)	Associate Director, Accounting	Ms.	North	Sara		9375312669					sara.north@caresource.com	PO Box 8738		Dayton	OH	45401	03/07/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Recovery Audit Contact	VP, Claims	Ms.	Hans	Holly		9375312750					holly.hans@caresource.com	P. O. Box 8738		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	SNP Application Contact	Director, Medicare & Marketplace Filing		Gray	Melissa		9375312328					melissa.gray@caresource.com	230 N Main St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Surveillance Contact	Manager Program Integrity	Ms.	Johnson	Alexis		9375312870					Alexis.Johnson@CareSource.com	230 North Main Street		Dayton	OH	45402	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	System Contact	Chief Information Officer	Ms.	Valencia	Devon		9375312552					devon.valencia@caresource.com	P. O. Box 8738		Dayton	OH	45401	01/16/2020	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Third Party Administrator (TPA) Liaison	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	230 N. Main Street		Dayton	OH	45402	03/07/2023	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	User Access Contact	Director, Medicare Compliance Officer	Ms.	de Cardenas	Deonys		6784710101					deonys.decardenas@CareSource.com	230 North Main Street		Dayton	OH	45402	05/20/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Utilization Management Contact	Director, Clinical Operations		Honig	Deronda		2162180296					Deronda.Honig@CareSource.com	P. O. Box 8738		Dayton	OH	45401	03/01/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8390	Utilization Review Contact	Director, Clinical Operations		Honig	Deronda		2162180296					Deronda.Honig@CareSource.com	P. O. Box 8738		Dayton	OH	45401	03/01/2021	2023	CARESOURCE GEORGIA CO.	Local CCP	CareSource	HMO/HMOPOS		CareSource	321	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8424	Automated TrOOP Balance Transfer Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Backup User Access Contact	Executive Director		Swanstrom	Matt		3194640051				7122247253	matt.swanstrom@unitypoint.org	1776 Westlakes Pkwy	Suite 400	West Des Moines	IA	50266	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Best Available Evidence Contact	Executive Director		Swanstrom	Matt		3194640051				7122247253	matt.swanstrom@unitypoint.org	1776 Westlakes Pkwy	Suite 400	West Des Moines	IA	50266	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Bid Primary Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	CAP Report Contact for Public Website	COO		Smith	Wendy		7122247223				7122247253	Wendy.smith@unitypoint.org	1200 TriView Ave		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active	7122247316				PACE - Nat		C	Kansas City
H8424	CEO - CMS Administrator Contact	Executive Director	Mr	Swanstrom	Matt		3194640051				7122247253	matt.swanstrom@unitypoint.org	1776 Westlakes Pkwy	Suite 400	West Des Moines	IA	50266	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	CEO - Senior Official for Contracting	Executive Director	Mr	Swanstrom	Matt		3194640051				7122247253	matt.swanstrom@unitypoint.org	1776 Westlakes Pkwy	Suite 400	West Des Moines	IA	50266	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Chief Financial Officer	Chief Financial Officer	Ms	Marsh	Sarah		5155746260					sarah.marsh@unitypoint.org	2720 Stone Park Blvd		Sioux City	IA	51104	03/06/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Chief Operating Officer	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Chief Information Officer	Compliance Officer	Ms	Corell	Jennifer	S	5155706548					jennifer.corell@unitypoint.org	2720 Stone Park Blvd		Sioux City	IA	51104	02/11/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Chief Information Security Officer	Compliance Officer	Ms	Corell	Jennifer	S	5155746941				7122247250	jennifer.corell@unitypoint.org	2720 Stone Park Blvd.		Sioux City	IA	51104	02/11/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	CMS Casework Communication Contact	Executive Director	Mr	Swanstrom	Matt		3194640051				7122247253	matt.swanstrom@unitypoint.org	1776 Westlakes Pkwy	Suite 400	West Des Moines	IA	50266	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Complaints Tracking Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Contact for Fraud Investigations	Compliance Officer	Ms	Corell	Jennifer	S	5155746941					jennifer.corell@unitypoint.org	2720 Stone Park Blvd		Sioux City	IA	51104	02/11/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Coordination of Benefits Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Corporate Mailing						7122247223				7122247253	matt.swanstrom@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Coverage Gap Discount Program (CGDP) Payment Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Customer Service Operations Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	DIR Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	DIR Contact (Secondary)			Hanson	Roberta	S	7122247223					roberta.hanson@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	03/06/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Emergency Part D Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Emergency Part D Contact (Secondary)	Executive Director	Mr	Ehlers	Randall		7122247223				7122247253	Randy.Ehlers@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	08/10/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Encounter Data & Risk Adjustment Operations Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Enrollment Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	EOB Transfer Contact	COO		Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	Siouxland PACE		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Financial Audit Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Financial Reporting Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Formulary Contact	Pharmacist	Ms	Huber	Michelle		7122247223				7122247251	michelle.huber@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	02/11/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	General Contact	Executive Director		Swanstrom	Matt		3194640051				7122247253	matt.swanstrom@unitypoint.org	1776 Westlakes Pkwy	Suite 400	West Des Moines	IA	50266	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Government Relations Contact	Executive Director		Swanstrom	Matt		3194640051				7122247253	matt.swanstrom@unitypoint.org	1776 Westlakes Pkwy	Suite 400	West Des Moines	IA	50266	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	HIPAA Privacy Officer	Compliance Officer	Ms	Corell	Jennifer	S	5155746941					jennifer.corell@unitypoint.org	2720 Stone Park Blvd.		Sioux City	IA	51104	02/11/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	HIPAA Security Officer	Compliance Officer	Ms	Corell	Jennifer	S	5155746941					jennifer.corell@unitypoint.org	2720 Stone Park Blvd.		Sioux City	IA	51104	02/11/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Interoperability Contact			Swanstrom	Matt		3194640051					matt.swanstrom@unitypoint.org	1776 Westlakes Pkwy	Suite 400	West Des Moines	IA	50266	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	MA Appeals/Grievances Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	MA Claims Processing Contact for Public Website	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Marketing Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Medical Director	Medical Director	Dr.	Prince	Danielle		7122247223				7122247251	danielle.prince@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	02/11/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Medicare Compliance Officer	Compliance Officer	Ms	Corell	Jennifer	S	5155746941					jennifer.corell@unitypoint.org	2720 Stone Park Blvd		Sioux City	IA	51104	02/11/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Medicare Coordinator	Executive Director	Mr	Swanstrom	Matt		3194640051				7122247253	matt.swanstrom@unitypoint.org	1776 Westlakes Pkwy	Suite 400	West Des Moines	IA	50266	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Medicare Part D Opioid Overutilization Contact	Pharmacist		Huber	Michelle		7122247223				7122247251	michelle.huber@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	02/11/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Medication Therapy Management Contact	Pharmacist		Huber	Michelle		7128981996				7122247250	Michelle.Huber@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	10/17/2019	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Part C Application Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Part D Appeals	COO		Smith	Wendy						7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active	8887223713				PACE - Nat		C	Kansas City
H8424	Part D Application Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Part D Benefits Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Part D Claims Submission Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Part D Exceptions Contact	COO		Smith	Wendy						7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active	8887223713				PACE - Nat		C	Kansas City
H8424	Part D Price File Contact (Back-up)	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Part D Price File Contact (Optional)	Executive Director		Ehlers	Randall		7122247223				7122247253	Randy.Ehlers@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	02/06/2020	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Part D Price File Contact (Primary)	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Part D Quality Assurance Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Part D Reporting Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Patient Safety Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Payment Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Pharmacy Director	Pharmacist		Huber	Michelle		7128981996				7122247254	Michelle.Huber@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	09/07/2017	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Pharmacy Network Management Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Pharmacy Technical Help Desk Contact	COO		Smith	Wendy						7122247253	Wendy.smith@unitypoint.org	Siouxland PACE		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active	7122247256				PACE - Nat		C	Kansas City
H8424	Plan Directory Contact for Public Website	Executive Director		Swanstrom	Matt		3194640051				7122247253	matt.swanstrom@unitypoint.org	1776 Westlakes Pkwy	Suite 400	West Des Moines	IA	50266	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Plan to Plan Reconciliation Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Processor Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Quality Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Reconciliation Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Recovery Audit Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Surveillance Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	System Contact	Executive Director		Swanstrom	Matt		3194640051				7122247253	matt.swanstrom@unitypoint.org	1776 Westlakes Pkwy	Suite 400	West Des Moines	IA	50266	02/27/2023	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Third Party Administrator (TPA) Liaison	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	User Access Contact	Compliance Officer		Corell	Jennifer	S	5155746941					jennifer.corell@unitypoint.org	St. Luke''s Regional Medical Center	2720 Stone Park Blvd	Sioux City	IA	51104	02/11/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Utilization Management Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8424	Utilization Review Contact	COO	Ms	Smith	Wendy		7122247316				7122247253	Wendy.smith@unitypoint.org	1200 Tri View Ave.		Sioux City	IA	51103	11/03/2022	2023	SIOUXLAND PACE, INC.	National PACE	SIOUXLAND PACE, INC.	National PACE		Iowa Health System	657	Yes	Active					PACE - Nat		C	Kansas City
H8432	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/10/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H8432	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H8432	PHR Beneficiary Contact																	11/05/2015	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H8432	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8432	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	EMPIRE HEALTHCHOICE HMO, INC.	Local CCP	Anthem BlueCross BlueShield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8439	Automated TrOOP Balance Transfer Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Backup User Access Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Best Available Evidence Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Bid Primary Contact	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		FLushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	CAP Report Contact for Public Website	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371				5592389224	GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Atlanta
H8439	CEO - CMS Administrator Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	CEO - Senior Official for Contracting	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Chief Financial Officer	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Chief Operating Officer	Chief Strategy Officer	Ms	Kohn	Judy		9172700599					Jkohn@kinshiphs.com	260 Pearsall Place		Lawrence	NY	11559	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Chief Information Officer	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Chief Information Security Officer	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	CMS Casework Communication Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Complaints Tracking Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Contact for Fraud Investigations	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Coordination of Benefits Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Corporate Mailing						8006391305				5592389224	ahulon@kinshiphs.com	136-65 37th Ave		Flushing	NY	11354	09/07/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Coverage Gap Discount Program (CGDP) Payment Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Customer Service Operations Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	DIR Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Emergency Part D Contact	Director of Operations and Implementation	Mr	Beijer	David		8287029191					dbeijer@kinshiphs.com	14 Berry Lane		Fletcher	NC	28732	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Encounter Data & Risk Adjustment Operations Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Enrollment Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	EOB Transfer Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371				5592389224	GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Financial Audit Contact	Regional Program Director	Mrs.	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Financial Reporting Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Formulary Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	General Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Government Relations Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	HIPAA Privacy Officer	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	HIPAA Security Officer	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Interoperability Contact	Regional Director of Operations	Mrs	Hulon	Amber		7274175819					ahulon@kinshiphs.com	9907 NE 138th Ct		Vancouver	WA	98682	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	MA Appeals/Grievances Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	MA Claims Processing Contact for Public Website	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Marketing Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Medical Director	Medical Director	Dr.	Ogando	Heather		5165516345					hogando@centerlight.org	8275 Allison Pointe Trail, Suite 370		Indianapolis	IN	46250	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Medicare Compliance Officer	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Medicare Coordinator	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Medicare Part D Opioid Overutilization Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Medication Therapy Management Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Part C Application Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Part D Appeals	Regional Director of Operations	Mrs	KornBlatt	Georgia							GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Atlanta
H8439	Part D Application Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Part D Benefits Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Part D Claims Submission Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Part D Exceptions Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia							GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Atlanta
H8439	Part D Price File Contact (Back-up)	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Part D Price File Contact (Primary)	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Part D Quality Assurance Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Part D Reporting Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Patient Safety Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Payment Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Pharmacy Director	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Pharmacy Network Management Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Pharmacy Technical Help Desk Contact	Regional Program Director	Mrs	KornBlatt	Georgia						5592389224	GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Atlanta
H8439	Plan Directory Contact for Public Website	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Plan to Plan Reconciliation Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Processor Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Quality Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Reconciliation Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Reconciliation Contact (Secondary)	Director of Operations and Implementation	Mr	Beijer	David		8287029191					dbeijer@kinshiphs.com	14 Berry Lane		Fletcher	NC	28732	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Recovery Audit Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Surveillance Contact	Reginal Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	System Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Third Party Administrator (TPA) Liaison	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	User Access Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Utilization Management Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8439	Utilization Review Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF CENTRAL FLORIDA, LLC	National PACE	Kinship PACE of Central Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8452	Agent/Broker Compensation Data Contact	Director, Community Marketing, Sales	Ms.	Korte	Jody		6146194282					jody.korte@caresource.com	3455 Mill Run Drive		Hilliard	OH	43026	10/29/2018	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	11/08/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Backup User Access Contact	Regulatory Submission Specialist	Mr.	Houser	Aaron		9374874147					aaron.houser@CareSource.com	230 North Main St		Dayton	OH	45402	10/24/2018	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Best Available Evidence Contact	Enrollment Business Analyst	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 8738		Dayton	OH	45401	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Bid Audit Contact	VP, Actuarial Science	Mr.	Brockman	Scott	W	9375312626					scott.brockman@caresource.com	P. O. Box 8738		Dayton	OH	45401	12/06/2017	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Bid Audit Site Contact	VP,  Actuarial Science	Mr.	Brockman	Scott	W	9375312626					scott.brockman@caresource.com	230 North Main Street		Dayton	OH	45402	10/24/2018	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Bid Primary Contact	Senior Director, Actuarial Science	Mr.	Butz	Stephen		9376091705					stephen.butz@caresource.com	P. O. Box 8738		Dayton	OH	45401	09/26/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	CAP Report Contact for Public Website	AVP, Ohio Compliance Officer	Ms.	Frazee	Margaux		9375313338					margaux.frazee@caresource.com	230 N Main St		Dayton	OH	45402	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	CEO - CMS Administrator Contact	President	Mr.	Ringel	Stephen	L	9372243300					stephen.ringel@caresource.com	230 North Main Street		Dayton	OH	45402	12/16/2020	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	CEO - Senior Official for Contracting	President	Mr.	Ringel	Stephen	L	9372243300					stephen.ringel@caresource.com	230 North Main Street		Dayton	OH	45402	12/16/2020	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Chief Financial Officer	Chief Financial Officer	Mr.	Smart	Lawrence		9375313335					Lawrence.Smart@caresource.com	P. O. Box 8738		Dayton	OH	45401	01/05/2021	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Chief Operating Officer	(Interim) Chief Operating Officer	Mr.	Davidi	Isaac		9372715922					isaac.davidi@caresource.com	P. O. Box 8738		Dayton	OH	45401	04/12/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Chief Information Officer	Chief Information Officer	Ms.	Valencia	Devon		9375312552					devon.valencia@caresource.com	PO Box 8738		Dayton	OH	45401	09/25/2019	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Chief Information Security Officer	Vice President, Information Security and Privacy	Ms.	Heckler	Lisa		9375313895	3895				Lisa.Heckler@caresource.com	230 N. Main St.		Dayton	OH	45402	02/23/2016	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	CMMI Model Point of Contact	AVP, Ohio Compliance Officer	Ms.	Frazee	Margaux		9375313338					margaux.frazee@caresource.com	230 North Main Street		Dayton	OH	45402	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	CMS Casework Communication Contact	Director, Grievance & Appeals	Ms.	Acuna	Celeste		9372243300	2604				Celeste.Acuna@caresource.com	P.O. Box 1947		Dayton	OH	45401	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Complaints Tracking Contact	Director, Grievance & Appeals	Mr.	Acuna	Celeste		9372243300				9374250833	Celeste.Acuna@caresource.com	P. O. Box 1947		Dayton	OH	45401	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Contact for Fraud Investigations	Program Integrity Analyst	Ms.	Johnson	Alexis	N	9372243300	2870			9373963876	SIUprogramintegrity@caresource.com	P. O. Box 8738		Dayton	OH	45401	09/25/2019	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Coordination of Benefits Contact	Senior Manager, Enrollment Operations	Mr.	Spivey	Michael		9375313682					COBInquiry@caresource.com	230 N. Main St		Dayton	OH	45402	05/04/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Corporate Mailing						9372243300	3338			9374870610	Margaux.Frazee@caresource.com	P. O. Box 8738		Dayton	OH	45401	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	230 N. Main Street		Dayton	OH	45402	09/01/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Customer Service Operations Contact	Director, Customer Care	Ms.	Cary	Lisa		9375313313					lisa.cary@caresource.com	P. O. Box 8738		Dayton	OH	45401	10/04/2021	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	DIR Contact	VP, Actuarial Science		Farmer	Nikki		9372863350					nikki.farmer@caresource.com	230 N. Main Street		Dayton	OH	45402	07/31/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	DIR Contact (Secondary)	Manager, Accounting	Ms.	Nelson	Megan		9374876597					megan.nelson@caresource.com	P. O. Box 8738		Dayton	OH	45401	09/23/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Emergency Part D Contact	AVP, Pharmacy	Ms.	Hatton	Jessica		9374874477					jessica.hatton@caresource.com	140 N Jefferson St		Dayton	OH	45402	11/10/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Emergency Part D Contact (Secondary)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Encounter Data & Risk Adjustment Operations Contact	Senior Director, Claims Encounters		Akbar	Shareef		9374876640					mycare-MA_EncounterRequests@caresource.com	220 E. Monument Ave.		Dayton	OH	45402	03/07/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Enrollment Contact	Enrollment Business Analyst	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 8738		Dayton	OH	45401	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	EOB Transfer Contact	Director, Clinical Strategy	Ms.	Hatton	Jessica		9379747830				9374870359	rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Financial Audit Contact	AVP, Compliance	Ms.	Frazee	Margaux		9375313338					margaux.frazee@caresource.com	230 N. Main Street		Dayton	OH	45402	09/06/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Financial Reporting Contact	Chief Financial Officer	Mr.	Smart	Lawrence		9372243300	3310				lawrence.smart@caresource.com	P. O. Box 8738		Dayton	OH	45401	02/15/2021	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Formulary Contact	Director, Clinical Strategy	Ms.	Condon	Kelani		7373142944				9374870359	rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	09/26/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Formulary Contact (Secondary)	Pharmacist Formulary Strategy & Management	Ms.	Cabrera	Lourdes		9374875477					lourdes.cabrera@caresource.com	230 North Main Street		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	General Contact	MyCare Regulatory Contract Manager	Ms.	Tuttle	Amanda		6142554612					MyCareOhio@CareSource.com	3455 Mill Run Drive	Ste 200	Hilliard	OH	43026	09/25/2019	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Government Relations Contact	AVP, Ohio Compliance Officer	Ms.	Frazee	Margaux		9375313338					margaux.frazee@caresource.com	230 North Main Street		Dayton	OH	45402	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	HIPAA Privacy Officer	Dir, Privacy	Ms.	Fogler	Anne		9375312728					Anne.Fogler@caresource.com	P. O. Box 8738		Dayton	OH	45401	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	HIPAA Security Officer	VP, Information Security and Privacy Officer	Ms.	Heckler	Lisa		9375313895					lisa.heckler@caresource.com	P. O. Box 8738		Dayton	OH	45401	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Hospice Contact	Director of Enrollment	Mr.	Castro	Armando		9375312291					Armando.Castro@caresource.com	230 N Main St		Dayton	OH	45402	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Interoperability Contact	AVP, Enterprise Architecture		Hanley	Michael		8033721957					michael.hanley@caresource.com	230 N Main St		Dayton	OH	45402	06/01/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	MA Appeals/Grievances Contact	Director, Grievance & Appeals	Ms.	Acuna	Celeste		9372243300				9374250833	celeste.acuna@caresource.com	P. O. Box 8738		Dayton	OH	45401	01/19/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	MA Claims Processing Contact for Public Website	VP of Claims & Configuration	Ms.	Hans	Holly		9375312750				9374871596	holly.hans@caresource.com	P. O. Box 8738		Dayton	OH	45401	09/25/2019	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Marketing Contact	Director, Community Marketing, Sales	Ms.	Korte	Jody		6146194282					jody.korte@caresource.com	3455 Mill Run Drive		Hilliard	OH	43026	10/29/2018	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Medical Director	Medical Director	Dr.	Mukunda	Beejadi		2166459092					beejadi.mukunda@caresource.com	5922 Landerbrook Drive Suite 300		Mayfield Heights	OH	44124	09/25/2019	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Medicare Compliance Officer	AVP, Ohio Compliance Officer	Ms.	Frazee	Margaux		9375313338					margaux.frazee@caresource.com	230 N. Main St.		Dayton	OH	45402	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Medicare Coordinator	AVP, Ohio Compliance Officer	Ms.	Frazee	Margaux		9375313338					OHCompliance@CareSource.com	230 North Main Street		Dayton	OH	45402	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Medicare Part D Opioid Overutilization Contact	Medicare Part D Diversion Specialist	Ms.	Wendell	Amy		9372243300	12543			9373963605	amy.wendell@caresource.com	P. O. Box 1940		Dayton	OH	45401	10/24/2018	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Medication Therapy Management Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	MMP Reporting Requirements Contact	Director, Integrated Care	Mrs.	Meyer	Cheryl	L	9378182993					cheryl.meyer@caresource.com	140 North Jefferson St.		Dayton	OH	45402	02/15/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	MMP Point of Contact	MyCare Regulatory Contract Manager	Ms.	Tuttle	Amanda		6152554612					MyCareOhio@CareSource.com	230 North Main Street		Dayton	OH	45402	06/14/2017	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Online Enrollment Center Contact (Optional)	Director, Enrollment		Castro	Armando		9375312291					Armando.Castro@caresource.com	230 North Main Street		Dayton	OH	45401	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Online Enrollment Center Contact (Primary)	Team Lead - Enrolllment	Mr.	Richardson	Kal		9372243300	3437			9374250909	kal.richardson@caresource.com	P. O. Box 8738		Dayton	OH	45401	04/13/2012	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part C Application Contact	Director, Medicare & Marketplace Filing	Mr.	Melleby	Brian		6062052303					brian.melleby@caresource.com	230 N Main St		Dayton	OH	45402	01/12/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part C Reporting Contact	AVP, Ohio Compliance Officer	Ms.	Frazee	Margaux		9375313338					margaux.frazee@caresource.com	230 North Main Street		Dayton	OH	45402	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Appeals	Sr. Pharmacy Manager	Mr.	Schumm	Brian							brian_schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	04/18/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active	6143363326				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Appeals Contact (Secondary)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol							rxcompliancerequest@caresource.com	140 N. Jefferson St.		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active	9378187479				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Application Contact	Director, Medicare & Marketplace Filing	Mr.	Melleby	Brian		6062052303					brian.melleby@caresource.com	230 N Main St		Dayton	OH	45402	01/12/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Benefits Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	10/14/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	03/25/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active	6143363326				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Exceptions Contact (Secondary)	Director, Pharmacy Operations	Ms.	Rattan	Sangeet							rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active	9375911634				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Price File Contact (Back-up)	Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	11/24/2021	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Price File Contact (Optional)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/24/2021	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Quality Assurance Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferon St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Part D Reporting Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Patient Safety Contact	Director, Clinical Strategy	Ms.	Condon	Kelani		7373142944					rxcompliancerequest@caresource.com	140 N Jefferson St.		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Payment Contact	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	P. O. Box 8738		Dayton	OH	45401	04/06/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Pharmacy Director	AVP, Pharmacy	Ms.	Hatton	Jessica		9379747830					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	04/18/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Pharmacy Network Management Contact	Director, Pharmacy Innovation	Ms.	Loricco	Nichol		9378187479					rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	11/24/2021	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active	8009221557				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy Innovation	Ms.	Loricco	Nichol							rxcompliancerequest@caresource.com	140 N Jefferson St		Dayton	OH	45402	03/25/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active	9378187479				Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Plan Directory Contact for Public Website	Manager, HPLC Operations	Ms.	Smith	Allana		9296714107					allana.smith@caresource.com	P. O. Box 8378		Dayton	OH	45401	02/09/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Plan to Plan Reconciliation Contact	Manager, Accounting	Ms.	Nelson	Megan		9374876597					CareSourceP2P@CareSource.com	CareSource Accounting	P.O. Box 2208	Dayton	OH	45401	04/06/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Processor Contact	VP, Claims & Configuration	Ms.	Hans	Holly		9372243300	12750				holly.hans@caresource.com	PO Box 8378		Dayton	OH	45401	09/25/2019	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Quality Contact	Director, Quality	Ms.	Meyer	Cheryl	L	9378182993					cheryl.meyer@CareSource.com	140 North Jefferson St.		Dayton	OH	45402	02/15/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Reconciliation Contact	Manager, Accounting	Ms.	Nelson	Megan		9374876597					megan.nelson@caresource.com	P. O. Box 8738		Dayton	OH	45401	02/23/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Reconciliation Contact (Secondary)	Manager, Accounting	Ms.	Nelson	Megan		9374876597					megan.nelson@caresource.com	PO Box 8738		Dayton	OH	45401	09/23/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Recovery Audit Contact	VP of Claims & Configuration	Ms.	Hans	Holly		9375312750					holly.hans@caresource.com	P. O. Box 8738		Dayton	OH	45401	09/25/2019	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	SNP Application Contact	Director, Medicare & Marketplace Filing	Mr.	Melleby	Brian		6062052303					brian.melleby@caresource.com	230 N Main St		Dayton	OH	45402	01/12/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Surveillance Contact	Manager Program Integrity	Ms.	Johnson	Alexis		9375312870					Alexis.Johnson@CareSource.com	230 North Main Street		Dayton	OH	45402	06/14/2017	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	System Contact	Chief Information Officer	Ms.	Valencia	Devon		9375312552					devon.valencia@caresource.com	P. O. Box 8738		Dayton	OH	45401	09/25/2019	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Third Party Administrator (TPA) Liaison	Manager, Accounting		Nelson	Megan		9374876597					megan.nelson@caresource.com	230 N. Main Street		Dayton	OH	45402	04/06/2023	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	User Access Contact	AVP, Ohio Compliance Officer	Ms.	Frazee	Margaux		9375313338					margaux.frazee@caresource.com	230 North Main Street		Dayton	OH	45402	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Utilization Management Contact	Director, Clinical Operations		Honig	Deronda		2162180296					Deronda.honig@caresource.com	P. O. Box 8738		Dayton	OH	45401	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8452	Utilization Review Contact	Director, Clinical Operations		Honig	Deronda		2162180296					Deronda.Honig@caresource.com	P. O. Box 8738		Dayton	OH	45401	03/06/2022	2023	CARESOURCE OHIO, INC.	Demo	CareSource MyCare Ohio	Medicare-Medicaid Plan HMO/HMOPOS		CareSource	321	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H8457	Agent/Broker Compensation Data Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Automated TrOOP Balance Transfer Contact			Rush	Jamie		5616901134					ESITroopTransfer@express-scripts.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Backup User Access Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1, Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Best Available Evidence Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N 107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Bid Audit Contact			Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Bid Audit Site Contact			Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Bid Primary Contact		Mr.	Granow	Les		5614440709					Les.Granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	CAP Report Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	CEO - CMS Administrator Contact		Dr.	Lerer	Rene		5614440780					rene.lerer@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	CEO - Senior Official for Contracting		Ms.	Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Chief Financial Officer		Mr.	Granow	Les		5614440709					les.granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Chief Operating Officer		Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Chief Information Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Chief Information Security Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	CMS Casework Communication Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Complaints Tracking Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Contact for Fraud Investigations			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Coordination of Benefits Contact		Ms.	Burdelik	Dawn		5618153729					dawn.burdelik@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Corporate Mailing						5616901134					compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Coverage Gap Discount Program (CGDP) Payment Contact		Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	Longevity Health Plan	485 Madison Avenue Suite 202	New York	NY	10022	03/09/2021	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Customer Service Operations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	DIR Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	DIR Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Electronic Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Emergency Part D Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Emergency Part D Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Encounter Data & Risk Adjustment Operations Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Enrollment Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	EOB Transfer Contact		Ms.	Socoski	Beth		5616901134				5616901134	Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Financial Audit Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Financial Reporting Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Formulary Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Formulary Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	General Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Government Relations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	HIPAA Privacy Officer		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	HIPAA Security Officer		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Hospice Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Interoperability Contact	CIO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	MA Appeals/Grievances Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	MA Claims Processing Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Marketing Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Medical Director		Mr.	Orgain	Javette		3127206656					javette.orgain@longevityhealthplan.com	Longevity Health Plan	1611 Church Street	Evanston	IL	60201	02/15/2021	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Medicare Compliance Officer		Ms.	Lacey	Jennifer		8133677169					Jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Medicare Coordinator	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Medicare Part D Opioid Overutilization Contact	Director, Clinical & Trend Solutions	Ms.	Muralidharan	Adrienne		5616901134					amuralidharan@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Medication Therapy Management Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	OffShore Subcontractor Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Part C Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Part C Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Part D Appeals	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H8457	Part D Appeals Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H8457	Part D Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Part D Benefits Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		8002040016					Rosario_dovico@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H8457	Part D Exceptions Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H8457	Part D Price File Contact (Back-up)	Product Manager Advisor	Ms.	Williams	Stephanie		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Part D Price File Contact (Optional)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Part D Price File Contact (Primary)	sr mgr, Government Programs		Dolfi	Amanda		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Part D Quality Assurance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Part D Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Patient Safety Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Payment Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Personal Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Pharmacy Director	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra	Ms.	Kelly	Heather		8002040016					hakelly@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Pharmacy Network Management Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Pharmacy Technical Help Desk Contact	Director, Customer Service	Ms.	Moore	LaTasha						8882358551	LaTasha_Monroe@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H8457	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Account Manager	Ms.	Kolesar	Bhrena							Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H8457	Physician Incentive Contact		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Plan Directory Contact for Public Website	Medicare Compliance Director	Ms.	Socoski	Beth		8883133609					Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Plan to Plan Reconciliation Contact		Ms.	Zhai	Vicky		5616328915					Vicky.Zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Processor Contact		Ms.	Gibson	Sharon		6143766614					SGGibson@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Quality Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Reconciliation Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Reconciliation Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Recovery Audit Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	SNP Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	SNP State Contact		Ms.	Lacey	Jennifer		5614440706					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Surveillance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	System Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Third Party Administrator (TPA) Liaison	COO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	User Access Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Utilization Management Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8457	Utilization Review Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW YORK, INC.	Local CCP	Longevity Health Plan	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8458	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/05/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H8458	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/27/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	01/27/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/27/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/27/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Medical Director	Sr. VP, Medical Affairs	Dr.	Nelson	Vincent		3145056872					vincent.nelson@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/17/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H8458	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H8458	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H8458	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H8458	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/27/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H8458	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H8458	PHR Beneficiary Contact																	09/27/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8338544766				PPO - BBA		C	Dallas
H8458	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Plan Directory Contact for Public Website			Services	Provider		8665498289					CorporateMedicareComplianceDept@Centene.com	2500 N. Buffalo Drive	Suite 250	Las Vegas	NV	89128	03/31/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/05/2021	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8458	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SILVERSUMMIT HEALTHPLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8492	Agent/Broker Compensation Data Contact	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Automated TrOOP Balance Transfer Contact	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Backup User Access Contact			Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	09/09/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Best Available Evidence Contact	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Bid Audit Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/09/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Bid Audit Site Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/09/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Bid Primary Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/09/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	CAP Report Contact for Public Website		Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	CEO - CMS Administrator Contact	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	02/11/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	CEO - Senior Official for Contracting		Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	09/09/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Chief Financial Officer	CFO	Mr.	Lundberg	Alec		5044914718					alundberg@commcaremgt.com	950 West Causeway Approach		Mandeville	LA	70471	06/16/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Chief Operating Officer		Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	09/09/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Chief Information Officer		Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Chief Information Security Officer	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	CMS Casework Communication Contact	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Complaints Tracking Contact	Compliance Officer		Ward	Debbie		4054046691					dward@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	07/03/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Contact for Fraud Investigations	Compliance Officer		Ward	Debbie		4054046691					dward@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	07/03/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Coordination of Benefits Contact	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Corporate Mailing						2259648581					dharvey@digntyhmo.com	950 Causeway Approach		Mandeville	LA	70471	08/25/2020	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mrs	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	Dignity Health Plan- CommCare	950 West Causeway Approach	Mandeville	LA	70471	03/23/2021	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Customer Service Operations Contact	CEO	Mrs.	Psarellis	Dawn	R	2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	12/15/2020	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	DIR Contact	Senior Director Government Programs		Farmer	Jim		3308886098					jfarmer@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	DIR Contact (Secondary)	Analyst III Government Programs		Houchens	Logan		3308886095					lhouchens@elixirsolutions.com	835 Freedom Avenue NW		North Canton	OH	44720	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Emergency Part D Contact	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Emergency Part D Contact (Secondary)			Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	09/09/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Encounter Data & Risk Adjustment Operations Contact	CEO	Mrs.	Psarellis	Dawn	R	2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	12/15/2020	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Enrollment Contact	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	07/26/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	EOB Transfer Contact		Ms.	Psarellis	Dawn	R	5043248950	1101			9856243477	dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	12/15/2020	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Financial Audit Contact	CEO	Mrs	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	03/23/2021	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Financial Reporting Contact	CEO	Mrs	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	03/23/2021	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Formulary Contact	Clinical Formulary Pharmacist		Quinn	Kelsey		3304864954					kquinn@elixirsolutions.com	7835 Freedom Avenue NW	Suite 100	North Canton	OH	44720	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Formulary Contact (Secondary)	Director Formulary Operation		Singh	Roop		3304866482					rsingh@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	General Contact		Ms.	Psarellis	Dawn	R	2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	12/15/2020	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Government Relations Contact	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	HIPAA Privacy Officer	Compliance Officer		Ward	Debbie		4054046691					dward@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	07/03/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	HIPAA Security Officer	Compliance Officer		Corbett	Debra		7189643058					dcorbett@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Hospice Contact	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Interoperability Contact			Psarellis	Dawn		5043292656					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	06/06/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	MA Appeals/Grievances Contact	Sr Director, Health Plan Administration		Brimm	Angie		4054046691					abrimm@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	07/03/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	MA Claims Processing Contact for Public Website	COO		Psarellis	Dawn	R	2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Marketing Contact	Compliance Manager		Burguieres	Fredrick		4054046691					rburguieres@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	07/03/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Medical Director	Medical Director		Herpich, MD	Byron		6012601661					byron.herpich@gmail.com	1709 Lakeshore Drive		Mandeville	LA	70448	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Medicare Compliance Officer		Ms.	Ward	Debbie		4054046691					dward@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	07/03/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Medicare Coordinator			Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	09/09/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Medicare Part D Opioid Overutilization Contact	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Medication Therapy Management Contact	VP, Pharmacy Solutions		Miller	Holly		3302931916					hmiller@healthdialog.com	7835 Freedom Avenue NW	Suite #100	North Canton	OH	44720	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Part C Application Contact	CEO	Mrs	Psarellis	Dawn		5043292656					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	08/04/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Part C Reporting Contact	COO	Mrs	Psarellis	Dawn	R	2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Part D Appeals	Pharmacy Director		Roper	Lisa						3304058081	Appeals@elixirsolutions.com	Elixir c/o Dignity Health Plan ATTN: Clinical Services	7835 Freedom Avenue NW	North Canton	OH	44720	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Dallas
H8492	Part D Appeals Contact (Secondary)	Supervisor, Clinical Operations		Binegar	Sam						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Dallas
H8492	Part D Application Contact	CEO	Mrs.	Psarellis	Dawn		5043292656					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	08/04/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Part D Benefits Contact	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Part D Claims Submission Contact			Voss	Laurie		2342123780					lvoss@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Part D Exceptions Contact	Pharmacy Director		Roper	Lisa						3304058081	lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Dallas
H8492	Part D Price File Contact (Back-up)	Financial Analyst		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Part D Price File Contact (Optional)	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Part D Price File Contact (Primary)	Sr. Financial Manager Reporting & Analytics		Campbell	Tim		3308886988					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Part D Quality Assurance Contact	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Part D Reporting Contact	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Patient Safety Contact	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Payment Contact		Ms.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	12/15/2020	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Pharmacy Director	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Pharmacy Network Management Contact	Director Pharmacy Network Development and Operatio		Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Pharmacy Technical Help Desk Contact	Vice President Operations		Conn	Todd							tconn@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active	8336611989				HMO - Health Maintenance Organization		C	Dallas
H8492	Plan Directory Contact for Public Website	COO	Mr.	Psarellis	Dawn	R	2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	12/05/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Plan to Plan Reconciliation Contact	Sr. Manager,  Financial Accounting	Ms.	Tilley	Stephanie		9312420499					stilley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	08/30/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Processor Contact	Pharmacy Director		Roper	Lisa		4058262110					lroper@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/21/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Quality Contact			Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	09/09/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Reconciliation Contact	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Recovery Audit Contact	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	SNP Application Contact	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Surveillance Contact	Compliance Officer	Ms.	Ward	Debbie		4054046691					dward@amhealthplans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	07/03/2023	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	System Contact	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Third Party Administrator (TPA) Liaison	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	User Access Contact	CEO	Mrs.	Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	05/08/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Utilization Management Contact			Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	09/09/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8492	Utilization Review Contact			Psarellis	Dawn		2259648581					dpsarellis@dignityhmo.com	950 West Causeway Approach		Mandeville	LA	70471	09/09/2022	2023	DIGNITY CARE CORPORATION	Local CCP	Dignity Health Plan	HMO/HMOPOS		CommCare Corporation	726	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8547	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	02/05/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/09/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	01/13/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/13/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/09/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	01/13/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	01/13/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/04/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8547	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8547	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	01/13/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8547	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8547	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/13/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/22/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8772777898				HMO - Health Maintenance Organization		C	Denver
H8547	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/23/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	0000000000				HMO - Health Maintenance Organization		C	Denver
H8547	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	01/13/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	05/20/2021	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/13/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	07/29/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/13/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8547	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/13/2020	2023	ILLINOIS BLUE CROSS BLUE SHIELD INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of Illinois	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8552	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/10/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/25/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/25/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H8552	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				PPO - BBA		C	Chicago
H8552	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H8552	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				PPO - BBA		C	Chicago
H8552	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				PPO - BBA		C	Chicago
H8552	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				PPO - BBA		C	Chicago
H8552	PHR Beneficiary Contact																	03/15/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				PPO - BBA		C	Chicago
H8552	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8552	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	ANTHEM BLUE CROSS LIFE AND HEALTH INS COMPANY	Local CCP	Anthem Blue Cross Life and Health Insurance Co.	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H8553	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H8553	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H8553	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H8553	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1850 W. Rio Salado Parkway		Tempe	AZ	85281	07/19/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H8553	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H8553	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H8553	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H8553	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8553	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/13/2022	2023	WELLCARE HEALTH INSURANCE OF THE SOUTHWEST, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8554	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	01/30/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	01/03/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482					Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	01/03/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	01/03/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	11/27/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	12/04/2018	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	03/25/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/04/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	06/30/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8554	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8554	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	08/09/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8554	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H8554	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	11/27/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/04/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/22/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8772777898				HMO - Health Maintenance Organization		C	Denver
H8554	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/23/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	0000000000				HMO - Health Maintenance Organization		C	Denver
H8554	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	09/21/2018	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/04/2021	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	07/29/2020	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	06/09/2017	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8554	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	06/09/2017	2023	GHS INSURANCE COMPANY	Local CCP	Blue Cross and Blue Shield of OK, TX	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H8578	Agent/Broker Compensation Data Contact	Medicare Sales Manager	Ms.	Fernandes	Sarah		4132332222				4132332222	sfernandes@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/16/2014	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Automated TrOOP Balance Transfer Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Backup User Access Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/26/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Best Available Evidence Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/12/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Bid Audit Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/12/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Bid Audit Site Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/12/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Bid Primary Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/12/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	CAP Report Contact for Public Website	Medicare Compliance Program Supervisor	Ms	Blais	Christine	A	4132333424				4132333424	cblais@hne.com	1414 Main Street	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active	4132333424				HMO - Health Maintenance Organization		C	New York
H8578	CEO - CMS Administrator Contact	President & CEO	Mr.	Swift	Richard		6024211000					rswift2@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	12/28/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	CEO - Senior Official for Contracting	President & CEO	Mr.	Swift	Richard		4132333050					rswift2@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	11/19/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Chief Financial Officer	Chief Financial Officer	Ms.	Cohen	Lisa		4132333024					lcohen@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	08/26/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Chief Operating Officer	Chief Financial Officer / VP of Operations	Ms.	Cohen	Lisa		4132333024					lcohen@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	06/30/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Chief Information Officer	IT Security Officer and VP of Information  Tech	Mr.	Hossa	Casey		4132333575					chossa@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	12/07/2021	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Chief Information Security Officer	IT Security Officer and VP of Information  Tech	Mr.	Hossa	Casey		4132333575					chossa@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	12/07/2021	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	CMS Casework Communication Contact	Complaints & Appeals Manager	Mr.	Farrell	James		4132333231				4132333231	jfarrell@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	03/01/2018	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Complaints Tracking Contact	Complaints & Appeals Manager	Mr.	Farrell	James		4132333231				4132333231	jfarrell@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	03/01/2018	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Contact for Fraud Investigations	Director of Compliance	Ms.	Tulloch	Charmalee		4132333566				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	09/27/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Coordination of Benefits Contact	Recovery and Reinsurance Manager	Ms.	Carter	Ronda		4132333353				4132333353	rcarter@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/26/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Corporate Mailing						4137874000				4137343356	soconnor@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/16/2014	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Compliance		Tulloch	Charmalee		8602335656					ctulloch@hne.com	One Monarch Place	Springfield, MA 01144	Springfield	MA	01144	09/21/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Customer Service Operations Contact	Manager Member Services	Ms.	Armstrong	Carolyn		4132333301				4132333301	carmstrong@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	02/17/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	DIR Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	DIR Contact (Secondary)	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/12/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Emergency Part D Contact	Director of Pharmacy	Mr.	Tereso	Gary		4135311752				4137343356	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	12/28/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Emergency Part D Contact (Secondary)	Director of Compliance	Ms	Tulloch	Charmalee		8607090397				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	12/28/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Employer Waiver Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Program Manager		Morgan	Stephne		4132333431				4132333431	smorgan@hne.com	One Monarch Place	Suite 1500	Springfield	MA	01144	04/26/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Enrollment Contact	Medicare Enrollment Supervisor	Ms.	Henriques	Christina		4137874000	3232				chenriques@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/14/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	EOB Transfer Contact	Claims Production Manager	Mr.	Decker	Shawn		4132333087				4132333444	sdecker@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	04/28/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Financial Audit Contact	Director of Accounting	Ms	Faford	Rebecca		4132333371				4132333371	rfaford@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	08/26/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Financial Reporting Contact	Chief Financial Officer	Ms.	Cohen	Lisa		4132333024					lcohen@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	08/25/2021	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Formulary Contact		Ms.	Maloney	Julia		2242312718					julia.maloney@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Formulary Contact (Secondary)	Director of Pharmacy	Mr.	Tereso	Gary		4137874000	3420			4137343356	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	06/06/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	General Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Government Relations Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	HIPAA Privacy Officer	Director of Compliance	Ms	Tulloch	Charmalee		4132333566				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	09/27/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	HIPAA Security Officer	IT Security Officer and VP of Information  Tech	Mr.	Hossa	Casey		4132333575					chossa@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	12/07/2021	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Hospice Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	03/01/2018	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Interoperability Contact	IT Security Officer and VP of Information  Tech	Mr.	Hossa	Casey		4132333575					chossa@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	12/07/2021	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	MA Appeals/Grievances Contact	Complaints & Appeals Manager	Mr.	Farrell	James		4132333231				4132333231	jfarrell@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	03/01/2018	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	MA Claims Processing Contact for Public Website	Claims Analytics & Payment Policy Manager	Ms.	Shaw	Joanne		4132333444				4132333444	jshaw@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	03/13/2017	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Marketing Contact	Director of Marketing & Digital Strategy	Ms.	Cordial	Melissa		4132333180					mcordial@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	11/19/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Medical Director	VP & Chief Medical Officer	Dr	McIntosh	Kate		4132333052					kmcintosh@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	12/07/2021	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Medicare Compliance Officer	Director of Compliance	Ms	Tulloch	Charmalee		4132333566				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	09/27/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Medicare Coordinator	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy	Mr.	Tereso	Gary		4132333420				4132333420	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	06/06/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Medication Therapy Management Contact	Clinical Program Manager	Ms.	Russo	Nicole	B	4013441003					nbrusso@magellanhealth.com	Magellan Rx Management	88 Silva Lane, Tech 4	Middletown	RI	02842	04/23/2018	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	OffShore Subcontractor Contact	Director of Compliance	Ms	Tulloch	Charmalee		4132333566				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	09/27/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Online Enrollment Center Contact (Back-up)	Medicare Enrollment Supervisor		Henriques	Christina		4137874000	3232			4132333232	chenriques@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/19/2015	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Online Enrollment Center Contact (Optional)	Director of Revenue Managemen & Recovery	Mr.	Carabine	Daniel		4132333339				4132333339	dcarabine@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	06/17/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Online Enrollment Center Contact (Primary)	Director of Revenue Management & Recovery	Mr.	Carabine	Daniel		4132333339				4132333339	dcarabine@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	08/26/2021	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Part C Application Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/12/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Part C Reporting Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/12/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Part D Appeals	Manager, Prior Authorization		Mourad	Hala							hala.mourad@optum.com	2441 Warrenville Rd	Suite 400	Lisle	IL	60532	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active	6303285837				HMO - Health Maintenance Organization		C	New York
H8578	Part D Appeals Contact (Secondary)	Complaints & Appeals Supervisor	Mr.	Farrell	James						4132333231	jfarrell@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/19/2015	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active	4137874000	3231			HMO - Health Maintenance Organization		C	New York
H8578	Part D Application Contact	Medicare compliance Program supervisor		Blais	Christine		4132333424					cblais@hne.com	One Monarch Place		Springfield	MA	01144	05/12/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Part D Benefits Contact	PharmD, Clinical Pharmacist	Mr.	Tereso	Gary		4137874000	3420			4137343356	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	08/07/2008	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Part D Claims Submission Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Part D Exceptions Contact	Manager, Prior Authorization		Mourad	Hala							hala.mourad@optum.com	2441 Warrenville Rd	Suite 400	Lisle	IL	60532	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active	6303285837				HMO - Health Maintenance Organization		C	New York
H8578	Part D Exceptions Contact (Secondary)	Director of Pharmacy	Mr.	Tereso	Gary						4127343356	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	06/06/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active	8008424464	3420			HMO - Health Maintenance Organization		C	New York
H8578	Part D Price File Contact (Back-up)	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Part D Price File Contact (Optional)	Director of Pharmacy	Mr.	Tereso	Gary		4137874000	3420			4137343356	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	06/06/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Part D Price File Contact (Primary)	Sr. Business Analyst	Ms.	Moore-Elliott	Shalandria		7637974305					MedOps-planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	60173	10/14/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Part D Quality Assurance Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Part D Reporting Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Patient Safety Contact	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Payment Contact	Chief Financial Officer	Ms.	Cohen	Lisa		4132333024				4132333024	lcohen@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	08/26/2021	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Personal Health Record Contact	Director Population Health Clinical Programs	Ms.	Perracchio	Margaret		4132333058				4132333058	mperracchio@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	09/27/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Pharmacy Director	Director of Pharmacy	Mr.	Tereso	Gary		4132333420				4132333420	gtereso@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	06/06/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Pharmacy Network Management Contact			Pham	Katie		8178469722					katie.pham@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Pharmacy Network Management Contact (Secondary)	Pharmacy Services Specialist	Ms.	Bacaj	Blerina		4132333423				4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk		Summers	Todd							todd.summers@optum.com	755 Research Parkway	Suite 300	Oklahoma City	OK	73104	06/06/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active	8003930395				HMO - Health Maintenance Organization		C	New York
H8578	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Services Specialist	Ms.	Bacaj	Blerina						4132333423	bbacaj@hne.com	One Monarch Place	Suitr 1500	Springfield	MA	01144	12/23/2019	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active	8774433314	3423			HMO - Health Maintenance Organization		C	New York
H8578	PHR Beneficiary Contact																	02/15/2008	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS	Health New England, Inc.	Baystate Health, Inc.	381	Yes	Active	8008424464	3439			HMO - Health Maintenance Organization		C	New York
H8578	Physician Incentive Contact	VP & Chief Medical Officer	Dr.	McIntosh	Kate		4132333052					kmcintosh@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	12/07/2021	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Plan Directory Contact for Public Website			Services	Member		8774433314					memberservices@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	10/05/2015	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Plan to Plan Reconciliation Contact	Assistant Controller	Ms.	King	Katie		4137874000	3008				kking2@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/13/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Processor Contact	Senior Manager, Benefits Administration		Cassata	Mercedes		6307809152					mercedes.cassata@optum.com	1600  McConnor Parkway		Schaumburg	IL	60173	01/01/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Quality Contact	Healthcare Quality Improvement Manager	Mr	Rogers	Benjamin		4132333360					brogers@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	11/15/2018	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Reconciliation Contact	Director of Pharmacy	Mr	Tereso	Gary		4132333420					gtereso@hne.com	One Monarch Place	Suite 1500	Springfield	MA	01144	06/06/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Reconciliation Contact (Secondary)	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Recovery Audit Contact	Director of Revenue Managemen & Recovery	Mr.	Carabine	Daniel		4132333339				4132333339	dcarabine@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	06/17/2020	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Surveillance Contact	Director of Compliance	Ms	Tulloch	Charmalee		4132333566				4132333566	ctulloch@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	09/27/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	System Contact	IT Security Officer and VP of Information  Tech	Mr.	Hossa	Casey		4132333575					chossa@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	12/07/2021	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Third Party Administrator (TPA) Liaison	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	User Access Contact	Medicare Compliance Program Supervisor	Ms.	Blais	Christine		4132333424				4132333424	cblais@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	05/16/2023	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Utilization Management Contact	Director Population Health Clinical Programs	Ms.	Perracchio	Margaret		4132333058				4132333058	mperracchio@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	09/27/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8578	Utilization Review Contact	Director Population Health Clinical Programs	Ms.	Perracchio	Margaret		4132333058				4132333058	mperracchio@hne.com	Health New England, Inc.	One Monarch Place, Suite 1500	Springfield	MA	01144	09/27/2022	2023	HEALTH NEW ENGLAND, INC.	Local CCP	Health New England Medicare Advantage Plans	HMO/HMOPOS		Baystate Health, Inc.	381	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8597	Agent/Broker Compensation Data Contact	Lead Director, Compliance		Brown	Kristen	J	6149336060					BrownK5@aetna.com	7400 West Campus Road		New Albany	OH	43054	06/20/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/01/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	07/10/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	05/29/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/13/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4128653823				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	11/30/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	12/05/2019	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/05/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	12/16/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jessica		8602734006					dorazioj1@aetna.com	151 Farmington Ave., R6C1		Hartford	CT	06156	09/14/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4807075698				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	05/05/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/14/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	MA Claims Processing Contact for Public Website	Executive Director, Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	01/14/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	09/14/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	12/19/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/18/2019	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	12/19/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	12/19/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	02/18/2019	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/17/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	12/05/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	02/18/2019	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		6034355581					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	06/13/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H8597	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Plan Directory Contact for Public Website	Lead Director, D-SNP Program Management		Penn	Linda		6827600262					PennL1@aetna.com	CVS Irving Tower	750 W. John Carpenter Freeway	Irving	TX	75039	06/21/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	11/30/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	07/17/2020	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	02/15/2021	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Surveillance Contact	Lead Director, Compliance		Brown	Kristen	J	6149336060					BrownK5@aetna.com	7400 West Campus Road		New Albany	OH	43054	06/20/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	System Contact	Lead Director, Compliance		Brown	Kristen	J	6149336060					BrownK5@aetna.com	7400 West Campus Road		New Albany	OH	43054	06/20/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Utilization Management Contact	Lead Director, Compliance		Brown	Kristen	J	6149336060					BrownK5@aetna.com	7400 West Campus Road		New Albany	OH	43054	06/20/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8597	Utilization Review Contact	Lead Director, Compliance		Brown	Kristen	J	6149336060					BrownK5@aetna.com	7400 West Campus Road		New Albany	OH	43054	06/20/2022	2023	AETNA BETTER HEALTH OF TEXAS INC.	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8604	Agent/Broker Compensation Data Contact	Director, Medicare Sales		Christian	Cindy		3308342303					CChristian@healthplan.org	The Health Plan	100 Lillian Gish Blvd	Massillon	OH	44647	10/30/2018	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Automated TrOOP Balance Transfer Contact	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Backup User Access Contact	VP of Medicare		Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/07/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Best Available Evidence Contact	Manager Medicare Operations		Panas	Lori		7406996208				7406996164	lorip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	01/10/2018	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Bid Audit Contact	Gov''t Compliance Officer		Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Bid Audit Site Contact	Gov''t Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Bid Primary Contact	VP of Medicare		Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	04/26/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	CAP Report Contact for Public Website	Gov''''t Compliance Officer		Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	CEO - CMS Administrator Contact	CEO	Mr	Knight	Jeff		7406957585					JeffK@healthplan.org	The Health Plan	1110 Main Streeet	Wheeling	WV	26003	01/04/2023	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	CEO - Senior Official for Contracting	CEO	Mr	Knight	Jeff		7406957585					JeffK@healthplan.org	The Health Plan	1110 Main Streeet	Wheeling	WV	26003	11/07/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Chief Financial Officer	Chief Financial Officer	Mr	Ralston	Ryan		7406996236				7406996161	rralston@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/13/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Chief Operating Officer	VP of Medicare	Ms.	Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Chief Information Officer	CIO	Mr	Bryan	Ken		7406957877					kbyran@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Chief Information Security Officer	CIO	Mr	Bryan	Ken		7406957877					kbryan@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	CMS Casework Communication Contact	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Complaints Tracking Contact	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Contact for Fraud Investigations	Director SIU	Ms	Crowder	Trina		3042206390				7406996150	tcrowder@healthplan.org	The Health Plan	141 Summers St.	Charleston	WV	25301	10/07/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Coordination of Benefits Contact	Manager COB		Fetty	Jackie		7406957699				7406996163	jfetty@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Corporate Mailing						7406953585					info@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	01/10/2018	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Coverage Gap Discount Program (CGDP) Payment Contact	Assistant Controller	Mr	Blinco	David		7406996151				7406996161	dblinco@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/04/2018	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Customer Service Operations Contact	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	DIR Contact	Controller		Marsh	Jane		7406996121					jmarsh@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	DIR Contact (Secondary)	Chief Financial Officer		Ralston	Ryan		7406996236					rralston@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Emergency Part D Contact	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Emergency Part D Contact (Secondary)	Director Pharmacy		Kovalski	Amy		7402324320				3048857592	akovalski@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	12/27/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Employer Waiver Contact	Gov''t Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Encounter Data & Risk Adjustment Operations Contact	Manager, Risk Adjustment		Davis	Matt		7406996283					mdavis@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/23/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Enrollment Contact	Manager Medicare Enrollment		Panas	Lori		7406996208				7406996164	LoriP@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	EOB Transfer Contact	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Financial Audit Contact	Gov''t Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Financial Reporting Contact	Chief Financial Officer	Mr	Ralston	Ryan		7406996236				7406996161	rralston@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/07/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Formulary Contact	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Formulary Contact (Secondary)	Director Pharmacy		Kovalski	Amy		7402324320				3048857592	akovalski@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	04/27/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	General Contact	Gov''t Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Government Relations Contact	Gov''t Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	HIPAA Privacy Officer	Gov''''t Compliance Officer		Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	HIPAA Security Officer	CIO	Mr	Bryan	Ken		7406957877					kbryan@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/02/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Hospice Contact	Manager, Pharmacy Compliance		Johnson	Chasity		7403598592				3048857592	ChasityJ@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	04/27/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Interoperability Contact	Gov''t Compliance Officer		Medley	Jill		7406957693					jmedley@healthplan.org	1110 Main Street		Wheeling	WV	26003	12/27/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	MA Appeals/Grievances Contact	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	MA Claims Processing Contact for Public Website	Manager Medicare Claims		Westfall	Vickie		7406957636				7406996163	VickieW@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Marketing Contact	Director, Medicare Sales		Christian	Cindy		3308342303					CChristian@healthplan.org	The Health Plan	100 Lillian Gish Blvd	Massillon	OH	44647	11/04/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Medical Director	Medical Director	Dr	Kairis	Ed		7406957686				7406955297	ekairis@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/03/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Medicare Compliance Officer	Gov''t Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Medicare Coordinator	VP of Medicare	Ms.	Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Hill	Brendal	J	8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/14/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Medication Therapy Management Contact	Director, Clinical & Trend Solutions		Muralidharan	Adrienne		3143131932					AMuralidharan@express-scripts.com	One Express Way		St. Louis	MO	63121	12/22/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	OffShore Subcontractor Contact	Gov''''t Compliance Officer		Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Online Enrollment Center Contact (Back-up)	Enrollment Service Representative		Knutsen	Megan		7406957890				7406996164	mknutsen@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	05/20/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Online Enrollment Center Contact (Primary)	Manager Medicare Operations		Panas	Lori		7406996208				7406996164	lorip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	01/10/2018	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Part C Application Contact	VP of Medicare		Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	05/20/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Part C Reporting Contact	VP of Medicare	Ms.	Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Part D Appeals	Appeal & Grievance Supervisor		Devault	Paige						7406996163	appeals_grievances_department@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/30/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active	8778477907				PPO - BBA		C	Philadelphia
H8604	Part D Appeals Contact (Secondary)	Appeal & Grievance Manager		Trigg	Leisha						7406996163	appeals_grievances_department@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/30/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active	8778477907				PPO - BBA		C	Philadelphia
H8604	Part D Application Contact	VP of Medicare		Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	05/20/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Part D Benefits Contact	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Part D Claims Submission Contact	Director Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	10/14/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Part D Exceptions Contact	Clinical Pharmacist		Hill	Brendal						3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active	8006246961	6627			PPO - BBA		C	Philadelphia
H8604	Part D Exceptions Contact (Secondary)	Director Pharmacy		Kovalski	Amy						3048857592	akovalski@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	04/27/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active	8006246961	6608			PPO - BBA		C	Philadelphia
H8604	Part D Price File Contact (Back-up)	Manager, Regulated Markets Product		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	Express Scripts	4865 Dixie Hwy	Fairfield	OH	45014	04/10/2023	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Part D Price File Contact (Optional)	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Part D Price File Contact (Primary)	Sr. Manager, Regulated Markets		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	Express Scripts	5151 Blazer Pkwy	Dublin	OH	43017	04/10/2023	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Part D Quality Assurance Contact	VP Pharmacy Services		Cecil	Luke		7405791681				3048857592	lcecil@healthplan.org	The Health Plan	1110 Main Street	Wheeling WV	WV	26003	10/15/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Part D Reporting Contact	Manager, Pharmacy Compliance		Johnson	Chasity		7403598592				3048857592	ChasityJ@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	04/27/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Patient Safety Contact	Clinical Pharmacist		Hill	Brendal		8652565940				3048857592	bhill@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	03/25/2022	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Payment Contact			Piergallini	Jeremy		7406996138				7406996161	jpiergallini@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	09/04/2018	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Pharmacy Director	VP Pharmacy Services		Cecil	Luke		7405791681				3048857592	lcecil@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Pharmacy Network Management Contact	Network Account Dir, Retail Strategy & Contracting		Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	01/12/2023	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	Express Scripts	13051 N. Telecom PKWY STE 150	Temple Terrace	FL	33637	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active	8009221557				PPO - BBA		C	Philadelphia
H8604	Physician Incentive Contact	VP of Medicare	Ms.	Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Plan Directory Contact for Public Website	Director Medicare Operations		Richard	Penny		7406957597				7406996163	PennyR@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Plan to Plan Reconciliation Contact	Controller		Marsh	Jane		7406996121				7406996161	jmarsh@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/30/2018	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Processor Contact	Sr Dir Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	Express Scripts	One Expressway	St. Louis	MO	63121	10/30/2018	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Quality Contact	Assistant VP Population Health		Cappellini	Brenda		3042856501					bcappellini@healthplan.org	The Health Plan	1110 Main Street	Wheeling WV	WV	26003	10/15/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Reconciliation Contact	Controller		Marsh	Jane		7406996121					jmarsh@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	02/21/2023	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Reconciliation Contact (Secondary)	Chief Financial Officer		Ralston	Ryan		7406996236					rralston@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	02/21/2023	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Recovery Audit Contact	Gov''t Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	SNP Application Contact	VP of Medicare		Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	05/20/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	SNP State Contact	VP of Medicare	Ms.	Pennybacker	Vicki		7406957622					vickip@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/06/2019	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Surveillance Contact	Gov''t Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	System Contact	CIO	Mr	Bryan	Ken		7406957877					kbryan@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/02/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Third Party Administrator (TPA) Liaison	Assistant Controller		Blinco	David		7406996151					dblinco@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	07/11/2018	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	User Access Contact	Gov''t Compliance Officer	Ms	Medley	Jill		7406957693					jmedley@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	11/18/2021	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Utilization Management Contact	Director, Utilization Management		Jones	Heather		7406996980					hjones@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8604	Utilization Review Contact	Director, Utilization Management		Jones	Heather		7406996980					hjones@healthplan.org	The Health Plan	1110 Main Street	Wheeling	WV	26003	10/20/2020	2023	THP INSURANCE COMPANY	Local CCP	The Health Plan	Local PPO		The Health Plan of West Virginia, Inc.	354	Yes	Active					PPO - BBA		C	Philadelphia
H8614	Automated TrOOP Balance Transfer Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Backup User Access Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Best Available Evidence Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Bid Primary Contact	Business Office Manager		Kasprzewski	Brenda	L	3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	12/29/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	CAP Report Contact for Public Website	Marketing Director		Steele	Erin		3028653565	101				esteele@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	CEO - CMS Administrator Contact	President	Mr.	Gelley	Meir		7322622255	2108			7322769866	Mgelley@nationwidehealthcare.com	21 W. Clarke Ave.		Milford	DE	19963	11/15/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	CEO - Senior Official for Contracting	President	Mr.	Gelley	Meir		7322622255	2108			7322769866	Mgelley@nationwidehealthcare.com	21 W. Clarke Ave.		Milford	DE	19963	11/15/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Chief Financial Officer	CFO	Mr.	Braun	Sheldon		7322622255				7322769866	Sbraun@nationwidehealthcare.com	260 Chambers Bridge Road		Brick	NJ	08723	10/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Chief Operating Officer	Executive  Director	Ms.	Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	09/05/2023	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Chief Information Officer	Director Information Technology	Mr	Forman	Joe		7322622255	2120			7322769866	jforman@nationwidehealthcare.com	260 Chambers Bridge Road		Brick	NJ	08723	06/22/2020	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Chief Information Security Officer	Director Information Technology	Mr	Forman	Joe		7322622255	2120			7322769866	jforman@nationwidehealthcare.com	260 Chambers Bridge Road		Brick	NJ	08723	06/22/2020	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	CMS Casework Communication Contact	Marketing Director		Steele	Erin		3028653565	101				esteele@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Complaints Tracking Contact	Director of Quality, Compliance, & Education		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Contact for Fraud Investigations	Business Office Manager		Kasprzewski	Brenda		3028653565					bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Coordination of Benefits Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Corporate Mailing						7322622255	2108			7322769866	Mgelley@nationwidehealthcare.com	21 W. Clarke Ave.		Milford	DE	19963	10/21/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Coverage Gap Discount Program (CGDP) Payment Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Customer Service Operations Contact	Director Information Technology	Mr	Forman	Joe		7322622255	2120			7322769866	jforman@nationwidehealthcare.com	260 Chambers Bridge Road		Brick	NJ	08723	06/22/2020	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	DIR Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Emergency Part D Contact	Director of Quality, Compliance, & Education		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Emergency Part D Contact (Secondary)	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Encounter Data & Risk Adjustment Operations Contact	Director of Quality, Compliance, & Education		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Enrollment Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	EOB Transfer Contact	Business Office Manager		Kasprzewski	Brenda		3028653565				7322769866	bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Financial Audit Contact	Chief Financial Officer	Mr	Braun	Sheldon		7322622255	2110			7322769866	sbraun@nationwidehealthcare.com	260 Chambers Bridge Road		Brick	NJ	08723	06/22/2020	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Financial Reporting Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Formulary Contact	Medical Director	Dr.	Morgan	Mark		3028653565					mamorgan@beebehealthcare.org	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Formulary Contact (Secondary)	Business Office Manager		Kasprzewski	Brenda		3028653565					bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	General Contact	Executive  Director		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	09/05/2023	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Government Relations Contact	Officer	Mr	Halberstam	Yitzchock		7326429142				7322769866	Yhalberstam@nationwidehealthcare.com	260 Chambers Bridge Road		Brick	NJ	08723	06/22/2020	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	HIPAA Privacy Officer	Director of Quality, Compliance, & Education		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	HIPAA Security Officer	Director of Quality, Compliance, & Education		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Interoperability Contact	Executive  Director		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	09/05/2023	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	MA Appeals/Grievances Contact	Director of Quality, Compliance, & Education		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	MA Claims Processing Contact for Public Website	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Marketing Contact	Marketing Director		Steele	Erin		3028653565	101				esteele@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Medical Director	Medical Director	Dr.	Morgan	Mark		3022498333				7322769866	Mmorgaon@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	11/15/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Medicare Compliance Officer	Director of Quality, Compliance, & Education	Ms.	Schindler	Colleen		3028653565	108			7322769866	cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Medicare Coordinator	Program Director		Schindler	Colleen		3028653565	102				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	09/05/2023	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Morgan	Mark		3028653565				7322769866	Mamorgan@beebehealthcare.org	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	11/15/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Medication Therapy Management Contact	Medical Director	Dr.	Morgan	Mark		3028653565				7322769866	mamorgan@beebehealthcare.org	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	11/15/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Part C Application Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave.	Suite1010	Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Part D Appeals	Business Office Manager		Kasprzewski	Brenda						7322769866	bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active	8337223302				PACE - Nat		C	Philadelphia
H8614	Part D Appeals Contact (Secondary)	Director of Quality, Compliance, & Education		Schindler	Colleen							cschindler@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active	3028653565	108			PACE - Nat		C	Philadelphia
H8614	Part D Application Contact	Executive  Director		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	09/05/2023	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Part D Benefits Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Part D Claims Submission Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Part D Exceptions Contact	Business Office Manager		Kasprzewski	Brenda						7322769866	bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active	8337223302				PACE - Nat		C	Philadelphia
H8614	Part D Price File Contact (Back-up)	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Part D Price File Contact (Primary)	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Part D Quality Assurance Contact	Director of Quality, Compliance, & Education		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Part D Reporting Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Patient Safety Contact	Executive  Director		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	09/05/2023	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Payment Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Pharmacy Director	Medical Director	Dr.	Morgan	Mark		3022498333				7322769866	mamorgan@beebehealthcare.org	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	11/15/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Pharmacy Network Management Contact	Controller		Friedman	Ben		7322622255	2106			7322769866	bfriedman@nationwidehealthcare.com	260 Chambers Ridge Road		Brick	NJ	08723	06/22/2020	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Pharmacy Network Management Contact (Secondary)			Kasprzewski	Brenda		3028653565					bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Pharmacy Technical Help Desk Contact	Business Office Manager		Kasprzewski	Brenda						7322769866	bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active	8337223302				PACE - Nat		C	Philadelphia
H8614	Plan Directory Contact for Public Website	Marketing Director		Steele	Erin		3028653565	101				esteele@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Plan to Plan Reconciliation Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Processor Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Quality Contact	Director of Quality, Compliance, & Education		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Reconciliation Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Reconciliation Contact (Secondary)	Director of Quality, Compliance, & Education		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Recovery Audit Contact	Chief Financial Officer	Mr	Braun	Sheldon		7322622255	2110			7322769866	sbraun@nationwidehealthcare.com	260 Chambers Bridge Road		Brick	NJ	08723	06/22/2020	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Surveillance Contact	Quality Management Coordinator	Ms.	Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.		Milford	DE	19963	11/09/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	System Contact	Director of Quality, Compliance, & Education		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Third Party Administrator (TPA) Liaison	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave, Suite 1010		Milford	DE	19963	11/10/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	User Access Contact	Director of Quality, Compliance, & Education		Schindler	Colleen		3028653565	108				cschindler@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	10/13/2022	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Utilization Management Contact	Medical Director	Dr	Morgan	Mark		3028653565					mamorgan@beebehealthcare.org	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	12/29/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8614	Utilization Review Contact	Business Office Manager		Kasprzewski	Brenda		3028653565	104				bkasprzewski@paceyourlifemwv.com	21 W. Clarke Ave.	Suite 1010	Milford	DE	19963	12/29/2021	2023	MILFORD WELLNESS VILLAGE PACE	National PACE	Milford Wellness Village PACE	National PACE		Milford Wellness Village PACE, LLC	782	Yes	Active					PACE - Nat		C	Philadelphia
H8634	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	03/11/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	11/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	12/04/2018	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	02/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/04/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	06/30/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H8634	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H8634	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	08/09/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H8634	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active	8006936651				PPO - BBA		C	Denver
H8634	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	11/27/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/04/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/22/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active	8772777898				PPO - BBA		C	Denver
H8634	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/23/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active	0000000000				PPO - BBA		C	Denver
H8634	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	09/21/2018	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/04/2021	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	07/29/2020	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	09/21/2018	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8634	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	09/21/2018	2023	HEALTH CARE SERVICE CORPORATION	Local CCP	Blue Cross and Blue Shield of IL, NM	Local PPO		Health Care Service Corporation	110	Yes	Active					PPO - BBA		C	Denver
H8649	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8042966237				HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	7132085765				HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/23/2018	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6026183945				HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	6122633491				HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active	8002386279				HMO - Health Maintenance Organization		C	Philadelphia
H8649	PHR Beneficiary Contact																	08/12/2015	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				HMO - Health Maintenance Organization		C	Philadelphia
H8649	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/05/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Plan Directory Contact for Public Website			Customer Service	Aetna		8667844918					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/12/2015	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/23/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8649	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA HEALTH OF UTAH INC	Local CCP	Aetna Medicare	HMO/HMOPOS		CVS Health Corporation	49	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8655	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Backup User Access Contact	Chief Information Officer		Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Best Available Evidence Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Bid Primary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	CAP Report Contact for Public Website	VP of Clinical Compliance		Teter	Lezlie		7203929719				3039961600	lteter@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	CEO - CMS Administrator Contact	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	CEO - Senior Official for Contracting	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Chief Financial Officer	CFO	Mr	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Chief Operating Officer	Senior Advisor	Ms.	Lozzano	Maria		9098902854				3039961600	mlozzano@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Chief Information Officer	Chief Information Officer	Ms.	Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Chief Information Security Officer	SVP of Information Technology	Mr.	Naus	Cole		7209210443				3039961600	MNaus@innovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	CMS Casework Communication Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Complaints Tracking Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Contact for Fraud Investigations	Chief Legal Officer		D'Amato	Nicole		6154732250				3039961600	NDAmato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Coordination of Benefits Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Corporate Mailing						3038694664				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Customer Service Operations Contact	Senior Advisor		Lozanno	Maria		9098902854				3039961600	mlozanno@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	DIR Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	DIR Contact (Secondary)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Emergency Part D Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Emergency Part D Contact (Secondary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Encounter Data & Risk Adjustment Operations Contact	Director of PACE Finance		Hewitt	Jessica		7209746767					jhewitt@innovage.com	8950 E Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Enrollment Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	EOB Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Financial Audit Contact	Director of PACE Finance	Ms	Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Financial Reporting Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Formulary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Formulary Contact (Secondary)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	General Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Government Relations Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	HIPAA Privacy Officer	Corporate Counsel		Moxon	Jeff		3038694664				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	HIPAA Security Officer	SVP of Information Technology		Naus	Cole		7209210443				3039961600	MNaus@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Interoperability Contact	SVP of Applications		Zierolf	Kris		7209742380					kzierolf@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	MA Appeals/Grievances Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	MA Claims Processing Contact for Public Website	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Marketing Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Medical Director	Medical Director		Ferrance	Randy		2159514586				3039961600	rferrance@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Medicare Compliance Officer	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Medicare Coordinator	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Medicare Part D Opioid Overutilization Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 E. Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Medication Therapy Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Online Enrollment Center Contact (Back-up)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Online Enrollment Center Contact (Primary)	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Part C Application Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Part D Appeals	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H8655	Part D Application Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Part D Benefits Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Part D Claims Submission Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Part D Exceptions Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H8655	Part D Price File Contact (Back-up)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Part D Price File Contact (Primary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Part D Quality Assurance Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Part D Reporting Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Patient Safety Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Personal Health Record Contact	VP Associate of General Counsel		Moxon	Jeff		3033006930				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Pharmacy Director	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Pharmacy Network Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Pharmacy Technical Help Desk Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H8655	PHR Beneficiary Contact																	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE	Total Longterm Care Inc	Total Community Options, Inc.	230	Yes	Active	8772776163	732			PACE - Nat		C	Philadelphia
H8655	Plan Directory Contact for Public Website	Director of Marketing		Stavros	Sarah		3033006904				3039961600	sstavros@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Plan to Plan Reconciliation Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				7209173390	akizewski@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Processor Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Quality Contact	VP of Quality		Curry	Jill		2153782123				3039961600	jcurry@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Reconciliation Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Recovery Audit Contact	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444404					mcinque@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Surveillance Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	System Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Third Party Administrator (TPA) Liaison	Medicare Compliance Manager		Brown	Lauren		7209746767				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	User Access Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356				3039961600	adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	09/06/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Utilization Management Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8655	Utilization Review Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE VIRGINIA PACE II, LLC	National PACE	InnovAge Virginia PACE - Richmond and Peninsula	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H8711	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H8711	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H8711	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H8711	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H8711	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H8711	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H8711	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H8711	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8711	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF NEW JERSEY	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H8748	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	6126562187				HMO - Health Maintenance Organization		C	San Francisco
H8748	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	7632832653				HMO - Health Maintenance Organization		C	San Francisco
H8748	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8005959532				HMO - Health Maintenance Organization		C	San Francisco
H8748	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation	8007887871				HMO - Health Maintenance Organization		C	San Francisco
H8748	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8748	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Consolidation					HMO - Health Maintenance Organization		C	San Francisco
H8764	Agent/Broker Compensation Data Contact	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Zlotkus	Steve		8587906250					PartDCAT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/01/2020	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Backup User Access Contact	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Best Available Evidence Contact	Supervisor Medicare Membership Accounting	Ms.	Saucedo	Sonya		5035844236				5035844234	Sonya.saucedo@phtech.com	3990 Fairview Industrial Drive SE		Salem	OR	97302	02/28/2022	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Bid Audit Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	02/15/2013	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Bid Audit Site Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	02/15/2013	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Bid Primary Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	02/15/2013	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	CAP Report Contact for Public Website	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Munson	Tyler		8316254915					Tyler.Munson@aspirehealth.org	10 Ragsdale Drive	Suite 101	Monterey	CA	93940	09/22/2022	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Munson	Tyler		8316254915					Tyler.Munson@aspirehealth.org	10 Ragsdale Drive	Suite 101	Monterey	CA	93940	09/22/2022	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Chief Financial Officer	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	02/15/2013	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Chief Operating Officer	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Chief Information Officer	Chief Information Officer	Mr.	Conocenti	Paul		8316226308					Paul.Conocenti@montagehealth.org	P.O. Box HH		Monterey	CA	93942	08/03/2021	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Chief Information Security Officer	Chief Tech Officer & Chief Info Security Officer	Mr.	Ali	Tahir		8312936333					Tahir.Ali@montagehealth.org	P.O. Box HH		Monterey	CA	93942	06/16/2021	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	CMS Casework Communication Contact	Appeals and Grievances Analyst	Ms.	Pummell	Stef		8316447432				8316570703	stef.pummell@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	06/13/2017	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Complaints Tracking Contact	Appeals and Grievances Analyst	Ms.	Pummell	Stef		8316447432				8316570703	stef.pummell@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	06/13/2017	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Contact for Fraud Investigations	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Coordination of Benefits Contact	Supervisor Medicaid Membership Accounting	Ms.	Wilson	Jennifer		5033622818	1251			5035844234	jennifer.wilson@phtech.com	3990 Fairview Industrial Drive SE		Salem	OR	97302	02/28/2022	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Corporate Mailing						8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	03/04/2016	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Customer Service Operations Contact	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	DIR Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	02/15/2013	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	DIR Contact (Secondary)	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Electronic Health Record Contact	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	06/29/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Emergency Part D Contact	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Emergency Part D Contact (Secondary)	Pharmacy Director	Mr.	Hiley	Brent		3033880357				8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	12/11/2018	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Employer Waiver Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	02/15/2013	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Encounter Data & Risk Adjustment Operations Contact	Director, Practice Enhancement & Analytics		Dunton	Alison		8316447414					Alison.Dunton@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/18/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Enrollment Contact	Supervisor Medicare Membership Accounting	Ms.	Saucedo	Sonya		5035844236				5035844234	Sonya.saucedo@phtech.com	3990 Fairview Industrial Drive SE		Salem	OR	97302	02/28/2022	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	EOB Transfer Contact	Pharmacy Director	Mr.	Hiley	Brent		3033880357				8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	05/21/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Financial Audit Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	02/15/2013	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Financial Reporting Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	02/15/2013	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Formulary Contact	Pharmacy Director	Mr.	Hiley	Brent		3033880357				8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	11/27/2018	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Formulary Contact (Secondary)	Manager, Formulary Administration & Maintenance	Dr.	Nyawabila	Christina		8587906297					christina.nyawabila@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/23/2020	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	General Contact	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Government Relations Contact	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	HIPAA Privacy Officer	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	HIPAA Security Officer	Chief Tech Officer & Chief Info Security Officer	Mr.	Ali	Tahir		8312936333					Tahir.Ali@montagehealth.org	P.O. Box HH		Monterey	CA	93942	08/03/2021	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Hospice Contact	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Interoperability Contact	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	MA Appeals/Grievances Contact	Appeals and Grievances Analyst	Ms.	Pummell	Stef		8316447432				8316570703	stef.pummell@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	06/13/2017	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	MA Claims Processing Contact for Public Website	Director of Health Plan Operations	Ms.	Fagan	Elisabeth		8316447419				8316572669	elisabeth.fagan@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	06/13/2017	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Marketing Contact	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Medical Director	Medical Director	Dr.	Gilbert	James		8316447456					james.gilbert@aspirehealthplan.org	10 Ragsdale Drive	Suite 101	Monterey	CA	93940	06/29/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Medicare Compliance Officer	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Medicare Coordinator	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Medicare Part D Opioid Overutilization Contact	Pharmacy Director	Mr.	Hiley	Brent		3033880357				8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Medication Therapy Management Contact	Pharmacy Director	Mr.	Hiley	Brent		3033880357				8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	11/27/2018	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	OffShore Subcontractor Contact	Compliance Officer	Mr.	Serrano	Anthony		8316447409					anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive	Suite 101	Monterey	CA	93940	11/11/2020	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Online Enrollment Center Contact (Back-up)	Enrollment Specialist	Ms.	Flugum	Kathryn		5033622818	1268			5035844234	kathryn.flugum@phtech.com	3990 Fairview Industrial Drive SE		Salem	OR	97302	02/28/2022	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Online Enrollment Center Contact (Optional)	Director of Health Plan Operations	Ms.	Fagan	Elisabeth		8316447419				8316572669	elisabeth.fagan@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Online Enrollment Center Contact (Primary)	Supervisor Medicare Membership Accounting	Ms.	Saucedo	Sonya		5033154121				5035844234	Sonya.saucedo@phtech.com	3990 Fairview Industrial Drive SE		Salem	OR	97302	02/28/2022	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Part C Application Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965					matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	02/15/2013	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Part C Reporting Contact	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Appeals	Pharmacy Director	Mr.	Hiley	Brent							brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	01/01/2020	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active	3033880357				HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Appeals Contact (Secondary)	Manager, Appeals & Grievances		Martin	Dawn							Dawn.Martin@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/01/2020	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active	8587907118				HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Application Contact	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Benefits Contact	Pharmacy Director	Mr.	Hiley	Brent		3033880357				8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	05/21/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Claims Submission Contact	Sup Medicare Operations		Rivera-Aquino	Denisse		8582915269					PDE@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/01/2020	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Exceptions Contact	Dir PA & UM Programs		Emoto	Julianne							Julianne.emoto@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/01/2020	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active	8587905846				HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Exceptions Contact (Secondary)	Pharmacy Director	Mr.	Hiley	Brent						8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	11/27/2018	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active	8555701600				HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Price File Contact (Back-up)	Pharmacy Director	Mr.	Hiley	Brent		3033880357				8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	11/27/2018	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Price File Contact (Optional)	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Price File Contact (Primary)	Medicare Part D Project Manager		Keller	Sharon		8587907104					PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	06/15/2022	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Quality Assurance Contact	Pharmacy Director	Mr.	Hiley	Brent		3033880357				8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	11/27/2018	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Part D Reporting Contact	Medicare Part D Project Manager		MacLochlainn	Tine		8587907031					tine.maclochlainn@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/23/2020	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Patient Safety Contact	Pharmacy Director	Mr.	Hiley	Brent		3033880357				8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	11/27/2018	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Payment Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	02/15/2013	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Personal Health Record Contact	Medical Director	Dr.	Gilbert	James		8316447456					james.gilbert@aspirehealthplan.org	10 Ragsdale Drive	Suite 101	Monterey	CA	93940	06/29/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Pharmacy Director	Pharmacy Director	Mr.	Hiley	Brent		3033880357				8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	11/27/2018	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Pharmacy Network Management Contact	Director Configuration Services		Moe	Kathleen		8587907437					kathlene.moe@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/23/2020	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Pharmacy Network Management Contact (Secondary)	Pharmacy Director	Mr.	Hiley	Brent		3033880357				8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	11/27/2018	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Pharmacy Technical Help Desk Contact	VP, Contact Center Services		Battle	Dorry							Customerservice@Medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	01/01/2020	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active	8884953160				HMO - Health Maintenance Organization		C	San Francisco
H8764	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Director	Mr.	Hiley	Brent						8316570703	brent.hiley@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	11/27/2018	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active	8555701600				HMO - Health Maintenance Organization		C	San Francisco
H8764	PHR Beneficiary Contact																	02/15/2013	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS	Aspire Health Plan	Montage Health	517	Yes	Active	8005465677				HMO - Health Maintenance Organization		C	San Francisco
H8764	Physician Incentive Contact	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Plan Directory Contact for Public Website	Customer Service Representative		Service	Customer		8555701600				8315744939	csrII@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	02/25/2022	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	04/15/2015	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Processor Contact	VP, Medicare Programs		Davis-Jones	DeLona		8587906229					DeLona.Davis-Jones@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/01/2020	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Quality Contact	Medical Director	Dr.	Gilbert	James		8316447456					james.gilbert@aspirehealthplan.org	10 Ragsdale Drive	Suite 101	Monterey	CA	93940	06/29/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Reconciliation Contact	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	03/14/2016	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Reconciliation Contact (Secondary)	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Recovery Audit Contact	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	SNP Application Contact	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	SNP State Contact	Chief Operating Officer	Ms.	Hall	Melissa		8316447415				8316570703	melissa.hall@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	09/08/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Surveillance Contact	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	System Contact	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mr.	Morgan	Matthew		8316254965				8316247130	matthew.morgan@aspirehealthplan.org	23625 Holman Highway		Monterey	CA	93940	10/21/2016	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	User Access Contact	Compliance Officer	Mr.	Serrano	Anthony		8316447409				8316570703	anthony.serrano@aspirehealthplan.org	10 Ragsdale Drive, Suite 101		Monterey	CA	93940	10/11/2019	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Utilization Management Contact	Medical Director	Dr.	Gilbert	James		8316447456					james.gilbert@aspirehealthplan.org	10 Ragsdale Drive	Suite 101	Monterey	CA	93940	06/29/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8764	Utilization Review Contact	Medical Director	Dr.	Gilbert	James		8316447456					james.gilbert@aspirehealthplan.org	10 Ragsdale Drive	Suite 101	Monterey	CA	93940	06/29/2023	2023	ASPIRE HEALTH PLAN	Local CCP	Aspire Health	HMO/HMOPOS		Montage Health	517	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8768	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				PPO - BBA		C	San Francisco
H8768	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				PPO - BBA		C	San Francisco
H8768	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				PPO - BBA		C	San Francisco
H8768	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				PPO - BBA		C	San Francisco
H8768	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8768	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Local CCP	UnitedHealthcare	Local PPO		UnitedHealth Group, Inc.	239	Yes	Active					PPO - BBA		C	San Francisco
H8769	Automated TrOOP Balance Transfer Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Backup User Access Contact	Quality Coordinator		Haynes	Erin		8102367514				8102367558	erin.haynes1@ascension.org	412 E First Street		Flint	MI	48502	07/24/2018	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Best Available Evidence Contact	Medical Director	Dr.	Dudley	Morgan		8102367471				8102367558	morgan.dudley@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Bid Primary Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	CAP Report Contact for Public Website	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	CEO - CMS Administrator Contact	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	CEO - Senior Official for Contracting	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Chief Financial Officer	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					brian.cooper@ascension.org	4600 Edmundson Drive		St. Louis	MO	63134	09/22/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Chief Operating Officer	Vice President PACE Operations	Mr.	Cooper	Brian		3147293592					brian.cooper@ascension.org	4600 Edmundson Drive		St. Louis	MO	63134	06/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Chief Information Officer	Director of PACE Informatics	Mr.	Rice	Brandon		6202222766					brandon.rice@ascension.org	2622 W. Central #100		Wichita	KS	67203	04/04/2022	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Chief Information Security Officer	Director of PACE Informatics	Mr.	Rice	Brandon		6202222766					brandon.rice@ascension.org	2622 W. Central #100		Wichita	KS	67203	04/04/2022	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	CMS Casework Communication Contact	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Complaints Tracking Contact	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Contact for Fraud Investigations	Compliance Director	Mr.	Johnson	Jeff		3147293562					jeff.johnson1@ascension.org	4600 Edmundson Drive		St. Louis	MO	63134	06/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Coordination of Benefits Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Corporate Mailing						8102367500					Craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Customer Service Operations Contact	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	DIR Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	DIR Contact (Secondary)	Senior Director of Clinical Services-PACE	Ms.	Goetzinger	Jill		7725215733				4236226048	jill.goetzinger@ascension.org	4600 Edmundson Drive		St. Louis	MO	63134	06/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Emergency Part D Contact	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Emergency Part D Contact (Secondary)	Compliance Director	Mr.	Johnson	Jeff		3147293562					jeff.johnson1@ascension.org	4600 Edmundson Drive		St. Louis	MO	63134	06/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Encounter Data & Risk Adjustment Operations Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Enrollment Contact	Accounting	Ms.	Kennedy	Susan		3169465270					susan.kennedy@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/11/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	EOB Transfer Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Financial Audit Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Financial Reporting Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Formulary Contact	Medical Director	Dr.	Dudley	Morgan		8102367471				8102367558	morgan.dudley@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Formulary Contact (Secondary)	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	General Contact	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Government Relations Contact	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	HIPAA Privacy Officer	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	HIPAA Security Officer	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Interoperability Contact	Executive Director		Berry	Craig		8102367500					craig.berry@ascension.org	412 E. First St		Flint	MI	48502	12/29/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	MA Appeals/Grievances Contact	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	MA Claims Processing Contact for Public Website	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Marketing Contact	Marketing Director	Ms.	Carmell	Janet		8102367500				8102367558	janet.carmell@ascension.org	412 E First Street		Flint	MI	48502	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Medical Director	Medical Director	Dr.	Dudley	Morgan		8102367471				8102367558	morgan.dudley@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Medicare Compliance Officer	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Medicare Coordinator	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Medicare Part D Opioid Overutilization Contact	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	06/25/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Medication Therapy Management Contact	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Part C Application Contact	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Part D Appeals	Director of Quality	Ms.	Fierke	Christina						8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active	8102367472				PACE - Nat		C	Chicago
H8769	Part D Appeals Contact (Secondary)	Compliance Director	Mr.	Johnson	Jeff							jeff.johnson1@ascension.org	4600 Edmundson Drive		St. Louis	MO	63134	06/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active	8008814443				PACE - Nat		C	Chicago
H8769	Part D Application Contact	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Part D Benefits Contact	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Part D Claims Submission Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Part D Exceptions Contact	Manager: Accounting and Reporting	Mr.	Webster	Ty						4236226048	ty.webster@ascension.org	250 East 10th Street		Chattanooga	TN	37402	09/22/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active	8004418883				PACE - Nat		C	Chicago
H8769	Part D Exceptions Contact (Secondary)	Compliance Director	Mr.	Johnson	Jeff							jeff.johnson1@ascension.org	4600 Edmundson Drive		St. Louis	MO	63134	06/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active	8008814443				PACE - Nat		C	Chicago
H8769	Part D Price File Contact (Back-up)	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Part D Price File Contact (Primary)	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Part D Quality Assurance Contact	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Part D Reporting Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	09/22/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Patient Safety Contact	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Payment Contact	Accounting Manager	Mr.	Webster	Ty		3142702497					ty.webster@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Pharmacy Director	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Pharmacy Network Management Contact	Medical Director	Dr.	Dudley	Morgan		8102367471				8102367558	morgan.dudley@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Pharmacy Technical Help Desk Contact	Medical Director	Dr.	Dudley	Morgan						8102367558	morgan.dudley@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active	8102367500				PACE - Nat		C	Chicago
H8769	Plan Directory Contact for Public Website	Executive Director	Mr.	Berry	Craig		8102367500				8102367558	craig.berry@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Plan to Plan Reconciliation Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	03/14/2022	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Processor Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Quality Contact	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Reconciliation Contact	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Reconciliation Contact (Secondary)	Vice President PACE Operations	Mr.	Cooper	Brian		3147293592					brian.cooper@ascension.org	4600 Edmundson Drive		St. Louis	MO	63134	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Recovery Audit Contact	Vice President PACE Operations	Mr.	Cooper	Brian	D	3143849724					brian.cooper@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Surveillance Contact	Compliance Director	Mr.	Johnson	Jeff		3147293562					jeff.johnson1@ascension.org	4600 Edmundson Road		St. Louis	MO	63134	06/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	System Contact	Vice President PACE Operations	Mr.	Cooper	Brian	D	3147293592					brian.cooper@ascension.org	4600 Edmundson Droad		St. Louis	MO	63134	06/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Third Party Administrator (TPA) Liaison	Claims Manager	Mr.	Stengele	Brett		8155291077				4236226048	brett.stengele@ascension.org	250 East 10th Street		Chattanooga	TN	37402	04/14/2023	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	User Access Contact	Director of Quality	Ms.	Fierke	Christina		8102367472				8102367558	christina.fierke@ascension.org	412 E First Street		Flint	MI	48502	11/05/2020	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Utilization Management Contact	Medical Director	Dr.	Dudley	Morgan		8102367471				8102367558	Morgan.dudley@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8769	Utilization Review Contact	Medical Director	Dr.	Dudley	Morgan		8102367471				8102367558	morgan.dudley@ascension.org	412 E First Street		Flint	MI	48502	04/01/2021	2023	Center for Gerontology	National PACE	Ascension Living PACE Michigan	National PACE		Ascension Health Alliance	708	Yes	Active					PACE - Nat		C	Chicago
H8777	Automated TrOOP Balance Transfer Contact	Chief Financial Officer		Dafoe	Kevin		7162858224	220				Dafoe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Backup User Access Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Best Available Evidence Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Bid Primary Contact	Chief Financial Officer		Dafoe	Kevin		7162858224	220				Dafoe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/08/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	CAP Report Contact for Public Website	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	John	Kinner		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Chief Financial Officer	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220				Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Chief Operating Officer	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Chief Information Officer	Director of Quality and Compliance	Ms.	Passalugo	Anne	E	7162858248	241				passalugo@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	04/28/2022	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Chief Information Security Officer	Director of Quality and Compliance	Ms.	Passalugo	Anne	E	7162858248	241				passalugo@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	04/28/2022	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	CMS Casework Communication Contact	Clinical Manager		Hall	Bryan		7162858248					hall@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	12/04/2019	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Complaints Tracking Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Contact for Fraud Investigations	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Coordination of Benefits Contact	Chief Financial Officer		Dafoe	Kevin		7162858224	220				Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Corporate Mailing						7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Coverage Gap Discount Program (CGDP) Payment Contact			Dafoe	Kevin		7162858224	220			7162858232	dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	04/28/2016	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Customer Service Operations Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	DIR Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220				Dafoe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/08/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	DIR Contact (Secondary)	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	04/09/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Emergency Part D Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220				Dafoe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/08/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Emergency Part D Contact (Secondary)	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Encounter Data & Risk Adjustment Operations Contact	CFO		Dafoe	Kevin		7162858248					dafoe@hanci.com	Complete Senior Care	1302 Main Street	Niagara Falls	NY	14301	12/04/2019	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Enrollment Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220			7162858232	Dafoe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	04/09/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	EOB Transfer Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220			7162858232	Dafoe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/08/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Financial Audit Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220			7162858232	Dafoe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/08/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Financial Reporting Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220			7162858232	Dafoe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/08/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Formulary Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220			7162858232	Dafoe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/08/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Formulary Contact (Secondary)	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	General Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Government Relations Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	HIPAA Privacy Officer	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	HIPAA Security Officer	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Interoperability Contact	Chief Executive Officer	Mr.	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	04/28/2022	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	MA Appeals/Grievances Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	MA Claims Processing Contact for Public Website	Enrollment/Marketing		McAuliffe	Virginia		7162858248	111				McAuliffe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Marketing Contact	Enrollment/Marketing		McAuliffe	Virginia		7162858248	111				McAuliffe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Medical Director	Medical Director	Dr.	Sauvagneau	Philip		7162858248	109				sauvagneau@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	09/03/2020	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Medicare Compliance Officer	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Medicare Coordinator	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220			7162858232	Dafoe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	04/09/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Sauvagneau	Philip		7162858248	109				sauvagneau@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	09/03/2020	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Medication Therapy Management Contact	Medical Director	Dr.	Sauvagneau	Philip		7162858248	109				sauvagneau@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	09/03/2020	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Part C Application Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Part D Appeals	Chief Executive Officer	Mr	Kinner	John							kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active	1800303433				PACE - Nat		C	New York
H8777	Part D Appeals Contact (Secondary)	Chief Executive Officer	Mr	Kinner	John							kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active	1800303433				PACE - Nat		C	New York
H8777	Part D Application Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Part D Benefits Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220			7162858232	Dafoe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/08/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Part D Claims Submission Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220				Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Part D Exceptions Contact	Chief Executive Officer	Mr	Kinner	John							kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active	8003034333				PACE - Nat		C	New York
H8777	Part D Exceptions Contact (Secondary)	Chief Financial Officer	Mr	Dafoe	Kevin							Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active	8003034333	220			PACE - Nat		C	New York
H8777	Part D Price File Contact (Back-up)	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Part D Price File Contact (Primary)	Chief Financial Officer		Dafoe	Kevin		7162858224	220				Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Part D Quality Assurance Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Part D Reporting Contact	Chief Financial Officer		Dafoe	Kevin		7162858224	220				Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Patient Safety Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Payment Contact	CFO	Mr	Dafoe	Kevin		7162858224	220				dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	03/05/2012	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Personal Health Record Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Pharmacy Director	Medical Director	Dr.	Sauvagneau	Philip		7162858248	109				sauvagneau@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	09/03/2020	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Pharmacy Network Management Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Pharmacy Network Management Contact (Secondary)	Chief Financial Officer		Dafoe	Kevin		7162858224	220				Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Pharmacy Technical Help Desk Contact	Chief Financial Officer		Dafoe	Kevin							Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active	8883034333	220			PACE - Nat		C	New York
H8777	Pharmacy Technical Help Desk Contact (Secondary)	Chief Executive Officer	Mr	John	Kinner							kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active	1800111111				PACE - Nat		C	New York
H8777	Plan Directory Contact for Public Website	Enrollment/Marketing		McAuliffe	Virginia		7162858248	111				McAuliffe@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220				Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Processor Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220				Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Quality Contact	Director of Quality and Compliance	Ms.	Passalugo	Anne	E	7162858248	241				passalugo@completeseniorcare.org	1302 Main Street		Niagara Falls	NY	14301	04/28/2022	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Reconciliation Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220				Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Reconciliation Contact (Secondary)	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Recovery Audit Contact	Chief Financial Officer	Mr	Dafoe	Kevin		7162858224	220				Dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/19/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Surveillance Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	System Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Third Party Administrator (TPA) Liaison	CFO		Dafoe	Kevin		7162858224	220			7162858232	dafoe@hanci.com	1302 Main Street		Niagara Falls	NY	14301	04/28/2016	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	User Access Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/22/2013	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Utilization Management Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8777	Utilization Review Contact	Chief Executive Officer	Mr	Kinner	John		7162858224	147				kinner@hanci.com	1302 Main Street		Niagara Falls	NY	14301	02/03/2014	2023	COMPLETE SENIOR CARE, INC.	National PACE	Complete Senior Care	National PACE		Health Association of Niagara County, Incorp.	425	Yes	Active					PACE - Nat		C	New York
H8783	Agent/Broker Compensation Data Contact	Associate Vice President Sales		Eck	Brian		6126763380					beck@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/08/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Automated TrOOP Balance Transfer Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					FIR_Transactions@ucare.org	500 Stinson Boulevard NE		Minnneapolis	MN	55413	10/25/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Backup User Access Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Best Available Evidence Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/25/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Bid Audit Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Bid Audit Site Contact	Corporate Actuary		Uding	Chris		6126763372					cuding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Bid Primary Contact	Corporate Actuary		Uding	Chris		6126763372					bids@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/23/2020	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	CAP Report Contact for Public Website	Senior Regulatory  Auditor		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/14/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Marden-Resnik	Hilary		6126763302					hmarden-resnik@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Chief Financial Officer	SVP and Chief Financial Officer	Ms.	Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Chief Operating Officer	SVP and Chief Administrative Officer	Ms.	Schmitt	Pat		6126763460					pschmitt@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/03/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Chief Information Officer	Chief Information Officer	Mr	McDonald	Darin		9493098524					dmcdonald@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	06/13/2021	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Chief Information Security Officer	Chief Information Security Officer, Director	Mr	Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	CMS Casework Communication Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Complaints Tracking Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Contact for Fraud Investigations	Manager SIU		Weidemann	Angie		6128171655					aweidemann@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Coordination of Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Corporate Mailing						6126766500				6126766501	sschwartz@ucare.org	UCare	500 Stinson Boulevard NE	Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Senior		Ly	Tong		6126277157					tly@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/17/2021	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Customer Service Operations Contact	CS Support Services Sr Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	DIR Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	DIR Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Emergency Part D Contact	Customer Service Workforce Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Emergency Part D Contact (Secondary)	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	600 Stinson Boulevard NE		Minneapolis	MN	55413	01/03/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Encounter Data & Risk Adjustment Operations Contact			Olberding	Milissia		6126763205					molberding@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/29/2019	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Enrollment Contact	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/25/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	EOB Transfer Contact	CS Support Services Sr Manager		Vang	Pakou		6126763585				6128842145	pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Financial Audit Contact	Controller	Mr.	Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Financial Reporting Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Formulary Contact	Pharmacy Supervisor		Merk	Zachariah		6126763483					zmerk@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	07/29/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Formulary Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	General Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Government Relations Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	HIPAA Privacy Officer	Associate General Counsel - Privacy Officer		Heacox	Katie		5073408378					kheacox@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	HIPAA Security Officer	Chief Information Security Officer, Director		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Hospice Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051					pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Interoperability Contact	VP, Deputy General Counsel		Owen	Elizabeth		6513992800					eowen@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	04/17/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	MA Appeals/Grievances Contact	A&G Regulatory and Compliance Specialist		Wood	Nakia		6122945668					cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	MA Claims Processing Contact for Public Website	CCO Audit & Compliance Manager		Tenhoff	Reed		6126763664					rtenhoff@ucare.og	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/11/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Marketing Contact	Government Relations Materials Coordinator		Morales	Ana Sophia		6122945641					amorales@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/22/2021	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Medical Director	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	McMahon	Jane		6124567817					federalgrleadershipteam@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/30/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Medicare Coordinator	Federal Government Relations Manager		Mitchell	Milonda		6122945143					mmitchell1@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/12/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030					anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Medication Therapy Management Contact	Pharmacy Quality Manager		Bower	Erika		6122945800				6128842321	ebower@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/10/2021	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	OffShore Subcontractor Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Online Enrollment Center Contact (Back-up)	MBE Operations Manager		Rooney	Courtney		6126763468					crooney@ucare.org	500 Stinson Blvd NE		Minneapolis	MN	55413	11/12/2020	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Online Enrollment Center Contact (Primary)	Medicare Enrollment Supervisor		Johnson	Michael		6126767220					mjohnson4@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/25/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Part C Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Part C Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	12/13/2021	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Part D Appeals	A&G Regulatory and Compliance Specialist		Wood	Nakia							cag@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active	6122945668				PPO - BBA		C	Chicago
H8783	Part D Appeals Contact (Secondary)	Manager Appeals & Grievances		Paciorek	Joshua							jpaciorek@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active	6122945225				PPO - BBA		C	Chicago
H8783	Part D Application Contact	Vice President Government Relations		Schwartz	Stephanie		6126763632				6128842275	sschwartz@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Part D Benefits Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Part D Claims Submission Contact	Data Analyst Sr.		Krishnan	Kamali		6122945146					kkrishnan@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/30/2019	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Part D Exceptions Contact	Vice President Pharmacy Management		Mitsch	Patrick						6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active	6122945051				PPO - BBA		C	Chicago
H8783	Part D Exceptions Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam						6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active	6122945030				PPO - BBA		C	Chicago
H8783	Part D Price File Contact (Back-up)	Pharmacy Operations Manager Sr.		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Part D Price File Contact (Optional)	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Part D Price File Contact (Primary)	Sr Manager, Government Programs		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	01/18/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Part D Quality Assurance Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Part D Reporting Contact	Federal Government Relations Specialist		Jacobsen	Sarah		6126763630					sjacobsen@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	11/13/2019	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Patient Safety Contact	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	10/17/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Payment Contact	Chief Financial Officer		Monsrud	Beth		6126763217				6126766501	bmonsrud@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Pharmacy Director	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	patmitsch@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Pharmacy Network Management Contact	Vice President Pharmacy Management		Mitsch	Patrick		6122945051				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacy Manager		Nelson	Adam		6122945030				6128842013	anelson@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Pharmacy Technical Help Desk Contact	Director, Customer Service		Moore	LaTasha							LaTasha_Monroe@expressscripts.com	13051 N Telecom Parkway	Suite 150	Temple Terrace	FL	33637	01/18/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active	8009221557				PPO - BBA		C	Chicago
H8783	PHR Beneficiary Contact																	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO	UCare	UCare Minnesota	238	Yes	Active	8775231515				PPO - BBA		C	Chicago
H8783	Physician Incentive Contact	Senior VP Chief Medical Officer		Emiru	Tenbit		6122945865					temiru@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	04/06/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Plan Directory Contact for Public Website	CS Support Services Sr Manager		Vang	Pakou		6126763585					pvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Plan to Plan Reconciliation Contact	Controller		Marshall	Greg		6126763213					gmarshall@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Processor Contact	Pharmacy Operations Manager Sr		Lex	Brian		6122945907				6128842263	pharmacyintake@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Quality Contact	Vice President Quality Management		Hanley	Greg		6122945296					ghanley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	02/09/2018	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Reconciliation Contact	Actuarial Services Manager		Ordansky	Nathan		6122945999					nordansky@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/04/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Reconciliation Contact (Secondary)	Actuarial Analyst		Rapley	Craig		6513413709					crapley@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/23/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Recovery Audit Contact	Audit Director	Mr.	Schach	Steve		6126763562					sschach@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	554132615	04/17/2023	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	SNP Application Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	SNP State Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Surveillance Contact	Federal Government Relations Specialist		Vang	Julie		6122945654					jvang@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/30/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	System Contact	Chief Information Security Officer, Director		Wiech	Justin		6122945218					jwiech@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Third Party Administrator (TPA) Liaison	Accountant		Zator	Chris		6126763563					czator@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	03/15/2021	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	User Access Contact	Federal Government Relations Specialist		Berglund	Marie		6126763598					mberglund@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	09/19/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Utilization Management Contact	VP Clinical Services		Wickman	Amy		6126763418					awickman@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8783	Utilization Review Contact	Clinical Regulatory Specialist		Brown	Julie	B	6126763433					jbbrown@ucare.org	500 Stinson Boulevard NE		Minneapolis	MN	55413	08/01/2022	2023	UCARE HEALTH, INC.	Local CCP	UCare	Local PPO		UCare Minnesota	238	Yes	Active					PPO - BBA		C	Chicago
H8786	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Best Available Evidence Contact	Manager II Enrollment Data		Young	Carrie		7573231029					carrie.young@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	10/17/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	MMP Reporting Requirements Contact	Compliance Consultant		Yearwood	Khadysha		8045508540					Khadysha.yearwood@elevancehealth.com	2015 Staples Mill Rd		Richmond	VA	23230	04/24/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	MMP Point of Contact	RVP Medicare Market Performance		Ashmore	David		6822613108					david.ashmore@elevancehealth.com	2505 N Hwy 360	Ste 300	Grand Prairie	TX	75050	02/16/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	PHR Beneficiary Contact																	11/05/2015	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS	Amerigroup	Elevance Health, Inc.	1	Yes	Active	8004671199				Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	System Contact	IT Account Manager		Barrentine	Lindsay		2142870257					lindsay.barrentine@elevancehealth.com	2505 N Hwy 360	Ste 300	Grand Prairie	TX	75050	04/24/2023	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8786	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	AMERIGROUP TEXAS, INC.	Demo	Wellpoint STAR+PLUS MMP	Medicare-Medicaid Plan HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Dallas
H8797	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Backup User Access Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	CAP Report Contact for Public Website	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Rd	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	CEO - CMS Administrator Contact	Executive Director	Ms.	Elam	Jennifer		5132757952					jennifer.elam@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	03/17/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	CEO - Senior Official for Contracting	Executive Director	Ms.	Elam	Jennifer		5132757952					jennifer.elam@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	03/17/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Chief Financial Officer	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Chief Operating Officer	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Contact for Fraud Investigations	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Rd. Suite 300		Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Corporate Mailing						8447886986					customerservice@perennialadvantage.com	P.O. Box 2190		Glen Allen	VA	230582190	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	06/21/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Encounter Data & Risk Adjustment Operations Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	EOB Transfer Contact			Lowry	Kristy		8447886986				8336102390	kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Financial Audit Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Financial Reporting Contact	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	General Contact	Executive Director	Ms.	Elam	Jennifer		5132757952					jennifer.elam@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	HIPAA Privacy Officer	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Rd	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	HIPAA Security Officer	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Rd	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Medical Director		Dr.	Papernek	Holly		9374703285					holly.papanek@perennialadvantage.com	9200 Worthington Rd	Suite 300	Westerville	OH	43082	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Medicare Compliance Officer	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Medicare Coordinator	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/07/2023	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Part C Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Part C Reporting Contact			Rennie	Lynda		8043966383					lynda@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	01/08/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/08/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Payment Contact	CFO	Mr.	Ragland	Robert		8042663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Chicago
H8797	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/09/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Chicago
H8797	Physician Incentive Contact	Executive Director	Ms.	Elam	Jennifer		5132757952					jennifer.elam@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Plan Directory Contact for Public Website			Sindlinger	Rocio		8447886986					rocio.sindlinger@allyalign.com	P.O. Box 2190		Glen Allen	VA	230582190	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Plan to Plan Reconciliation Contact	Chief Operating Officer	Mr.	Dressen	Jeremy		6127474241					p2padministration@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	02/16/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Quality Contact			Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Reconciliation Contact		Mr.	Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/17/2020	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Reconciliation Contact (Secondary)	CFO	Mr.	Ragland	Robert		8043663300					Robert.Ragland@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Recovery Audit Contact	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Rd	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Third Party Administrator (TPA) Liaison	Manager of Regulatory Accounting	Ms.	Weis	Katelyn		6073294042					kate.weis@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	User Access Contact	Compliance Officer	Mr.	Chrisman	Allen		5132164256					allen.chrisman@perennialadvantage.com	9200 Worthington Road	Suite 300	Westerville	OH	43082	03/24/2023	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8797	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/15/2021	2023	PERENNIAL ADVANTAGE OF OHIO, INC.	Local CCP	Perennial Advantage	HMO/HMOPOS		Perennial Consortium, LLC	759	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8800	Automated TrOOP Balance Transfer Contact	Accounting Manager	Mrs.	Johnson	Stephanie		7163798474				7163798543	sjohnson@homecare-hospice.org	519 North Union Street		Olean	NY	14760	04/22/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Backup User Access Contact	Communications and Information Systems Co.	Mr.	Smith	Russell		7163722106					rsmith@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	06/03/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Best Available Evidence Contact	Chief Executive Officer	Ms.	Sullivan	Melissa		7163722106					msullivan@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	01/31/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Bid Primary Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	CAP Report Contact for Public Website	CEO	Ms.	Sullivan	Melissa		7163725735				7163723156	msullivan@homecare-hospice.org	1225 West State Street		Olean	NY	14760	02/02/2023	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active	8007197129				PACE - Nat		C	New York
H8800	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Sullivan	Melissa		7163722106					msullivan@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	01/31/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Sullivan	Melissa		7163722106					msullivan@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	01/31/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Chief Financial Officer	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	06/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Chief Operating Officer	Executive Program Director	Mrs	Padlo	Roxanne		7163798474					rpadlo@totalseniorcare.org	519 North Union Street		Olean	NY	147602135	10/21/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Chief Information Officer	Communications and Information Systems Co.	Mr	Smith	Russell		7163722106					rsmith@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	02/09/2016	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Chief Information Security Officer	Health Information Systems Manager	Mr	Pavlock	Lawrence		7163798474					lpavlock@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	11/10/2021	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	CMS Casework Communication Contact	QI Manager	Ms	Gibble	Roberta		7163798474					rgibblel@totalseniorcare.org	1225 West State Street		Olean	NY	147602135	01/16/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Complaints Tracking Contact	Executive Program Director	Ms	Padlo	Roxanne		7163798474					rpadlo@totalseniorcare.org	519 North Union Street		Olean	NY	14760	10/21/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Contact for Fraud Investigations	Executive Program Director	Mrs	Padlo	Roxanne		7163798474					rpadlo@totalseniorcare.org	519 North Union Street		Olean	NY	147602135	10/21/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Coordination of Benefits Contact	Accounting Manager	Mrs.	Johnson	Stephanie		7163798474				7163798543	sjohnson@homecare-hospice.org	519 North Union Street		Olean	NY	14760	04/22/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Corporate Mailing						7162282884				7163798543	snelson@homecare-hospice.org	1225 W State St		Olean	NY	147602135	01/24/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	05/19/2016	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Customer Service Operations Contact	Executive Program Director	Mrs	Padlo	Roxanne		7163798474					rpadlo@totalseniorcare.org	519 North Union Street		Olean	NY	147602135	01/31/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	DIR Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	01/26/2010	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	DIR Contact (Secondary)	Accounting Manager	Mrs.	Johnson	Stephanie		7163798474				7163798543	sjohnson@homecare-hospice.org	519 North Union Street		Olean	NY	14760	04/22/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Emergency Part D Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Encounter Data & Risk Adjustment Operations Contact	CFO		Nelson	Susan	A	7163722106				7163723156	snelson@homecare-hospice.org	1225 West State St.		Olean	NY	14760	10/22/2019	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Enrollment Contact	Enrollment/Intake Services Coordinator	Ms.	McAndrew	Joann		7163798474				7163798543	jmcandrew@totalseniorcare.org	519 North Union Street		Olean	NY	14760	06/15/2018	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	EOB Transfer Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106				7163723156	snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Financial Audit Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	03/22/2011	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Financial Reporting Contact	Chief FinancialOfficer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Formulary Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	General Contact	Chief Executive Officer	Ms	Sullivan	Melissa		7163722106					msullivan@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	01/31/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Government Relations Contact	Chief Executive Officer	Ms	Sullivan	Melissa		7163722106					msullivan@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	01/31/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	HIPAA Privacy Officer	Quality Improvement Manager	Mrs	Gibble	Roberta		7163798474	112				rgibble@totalseniorcare.org	519 North Union Street		Olean	NY	147602135	02/18/2021	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	HIPAA Security Officer	Communications and Information Systems Co.	Mr	Smith	Russell		7163722106					rsmith@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	11/03/2015	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Interoperability Contact	health information systems manager		Pavlock	Larry		7163722106					lpavlock@homecare-hospice.org	1225 West State Street		Olean	NY	14760	06/03/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	MA Appeals/Grievances Contact	QI Manager	Ms	Gibble	Roberta		7163798474					rgibblel@totalseniorcare.org	1225 West State Street		Olean	NY	147602135	04/22/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	MA Claims Processing Contact for Public Website	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Marketing Contact	CEO	Ms	Sullivan	Melissa		7163722106					msullivan@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	02/02/2023	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Medical Director	Medical Director / Primary Care Physician	Dr.	Patel	Arun		7163798474				7163798543	patel14779@icloud.com	519 North Union Street		Olean	NY	14760	11/15/2013	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Medicare Compliance Officer	Executive Program Director	Mrs	Padlo	Roxanne		7163798474					rpadlo@totalseniorcare.org	519 North Union Street		Olean	NY	147602135	10/21/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Medicare Coordinator	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Medicare Part D Opioid Overutilization Contact	Executive Program Director		Padlo	Roxanne		7163798474				7163798543	rpadlo@totalseniorcare.org	519 North Union Street		Olean	NY	14760	10/21/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Medication Therapy Management Contact	Executive Program Director	Ms	Padlo	Roxanne		7163798474					rpadlo@totalseniorcare.org	Total Senior Care	519 North Union Street	Olean	NY	14760	03/10/2021	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Online Enrollment Center Contact (Primary)	Enrollment/Intake Services Coordinator	Ms.	McAndrew	Joann		7163798474				7163798543	jmcandrew@totalseniorcare.org	519 North Union Street		Olean	NY	14760	09/13/2018	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Part C Application Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106				7163723156	snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Part D Appeals	Quality Improvement Manager	Ms	Gibble	Roberta							rgibble@totalseniorcare.org	519 North Union Street		Olean	NY	14760	02/07/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active	8669398613				PACE - Nat		C	New York
H8800	Part D Appeals Contact (Secondary)	CNO		Wiseman	Nikki						7163798543	nwiseman@homecare-hospice.org	1225 West State Street		Olean	NY	14760	02/16/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active	7163798474				PACE - Nat		C	New York
H8800	Part D Application Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106				7163723156	snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Part D Benefits Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Part D Claims Submission Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Part D Exceptions Contact	Chief Financial Officer	Ms	Nelson	Susan	A						snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active	7167197129				PACE - Nat		C	New York
H8800	Part D Price File Contact (Back-up)	Chief Executive Officer	Ms	Sullivan	Melissa		7163722106					msullivan@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	01/31/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Part D Price File Contact (Primary)	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Part D Quality Assurance Contact	Quality Improvement Manager	Ms	Gibble	Roberta		7163798474					rgibble@totalseniorcare.org	519 North Union Street		Olean	NY	14760	01/16/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Part D Reporting Contact	Accounting Manager	Mrs.	Johnson	Stephanie		7163798474				7163798543	sjohnson@homecare-hospice.org	519 North Union Street		Olean	NY	14760	04/22/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Patient Safety Contact	Quality Improvement Manager	Ms	Gibble	Roberta		7163798474					rgibble@totalseniorcare.org	519 North Union Street		Olean	NY	14760	01/16/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Payment Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Pharmacy Director	Chief Executive Officer	Ms	Sullivan	Melissa		7162282884					msullivan@homecare-hospice.org	1225 W State St		Olean	NY	147602135	01/31/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Pharmacy Network Management Contact	Chief Financial Officer	Ms	Nelson	Susan		7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	11/10/2021	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Pharmacy Network Management Contact (Secondary)	Health Information Systems Manager	Mr.	Pavlock	Lawrence		7163798474					lpavlock@homecare-hospice.org	1225 W State St		Olean	NY	147602135	11/10/2021	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Pharmacy Technical Help Desk Contact	Health Information Systems Manager	Mr.	Pavlock	Lawrence							lpavlock@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	11/10/2021	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active	8007197129				PACE - Nat		C	New York
H8800	PHR Beneficiary Contact																	07/07/2009	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE	Total Senior Care, Inc.	Community Care of Western New York, Inc.	472	Yes	Active	8669398613				PACE - Nat		C	New York
H8800	Plan Directory Contact for Public Website	Health Information Systems Manager	Ms.	Pavlock	Larry		7163798474					lpavlock@homecare-hospice.org	519 North Union Street		Olean	NY	147602135	02/02/2023	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Plan to Plan Reconciliation Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Processor Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	12/16/2008	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Quality Contact	QI Manager	Ms	Gibble	Roberta		7163798474					rgibblel@totalseniorcare.org	1225 West State Street		Olean	NY	147602135	04/22/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Reconciliation Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	01/26/2010	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Recovery Audit Contact	Chief Financial Officer	Ms	Nelson	Susan	A	7163722106					snelson@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	03/27/2012	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Surveillance Contact	Health Information Systems Manager	Mr.	Pavlock	Larry		7163798474				7163798543	lpavlock@homecare-hospice.org	519 North Union St.		Olean	NY	14760	11/10/2021	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	System Contact	Communications and Information Systems Co.	Mr	Smith	Russell		7163722106					rsmith@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	11/03/2015	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Third Party Administrator (TPA) Liaison	Chief Executive Officer	Ms	Sullivan	Melissa		7163722106					msullivan@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	01/31/2022	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	User Access Contact	Communications and Information Systems Co.	Mr	Smith	Russell		7163722106					rsmith@homecare-hospice.org	1225 West State Street		Olean	NY	147602135	11/03/2015	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Utilization Management Contact	Quality Improvement Manager	Ms	Gibble	Roberta		7163798474					rgibble@totalseniorcare.org	519 North Union Street		Olean	NY	14760	01/16/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8800	Utilization Review Contact	Quality Improvement Manager	Ms	Gibble	Roberta		7163798474					rgibblel@totalseniorcare.org	519 North Union Street		Olean	NY	14760	04/22/2020	2023	TOTAL SENIOR CARE, INC.	National PACE	Total Senior Care, Inc.	National PACE		Community Care of Western New York, Inc.	472	Yes	Active					PACE - Nat		C	New York
H8845	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	CAP Report Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	12/14/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	09/16/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/03/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	MA Claims Processing Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	02/15/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H8845	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H8845	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H8845	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H8845	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	09/16/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	09/16/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	09/16/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H8845	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H8845	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Plan Directory Contact for Public Website			Services	Member		8006650898					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/14/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8845	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF ARIZONA, INC.	Local CCP	Molina Healthcare of Arizona	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H8849	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	02/12/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/27/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/10/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/21/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/21/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/12/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/12/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	02/12/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@ingenio-rx.com	4 Varesa		Irvine	CA	92620	11/14/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	02/12/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H8849	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H8849	PHR Beneficiary Contact																	02/12/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H8849	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	02/12/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8849	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	02/12/2020	2023	AMERIGROUP INSURANCE COMPANY	Local CCP	Wellpoint	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H8854	Agent/Broker Compensation Data Contact	Chief External Operations	Ms.	Yahyazadeh	Sheila		4109984534					Sheila.Yahyazadeh@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/17/2022	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Automated TrOOP Balance Transfer Contact	Part D Business Analyst	Ms.	Ellerbee	Ashley		4109984314					Ashley.Ellerbee@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Backup User Access Contact	Medicare Compliance Analyst	Ms.	Adolphi	Patricia		4109984456					Pat.Adolphi@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/19/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Best Available Evidence Contact	Manager, Enrollment	Ms.	Knox	Dorothea		4109985559					Dorothea.Knox@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/28/2022	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Bid Audit Contact	Manager, Product Lifecycle	Ms.	Franklin	Lisa		4109984647					Lisa.Franklin@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2022	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Bid Audit Site Contact	Manager, Product Lifecycle	Ms.	Franklin	Lisa		4109984647					Lisa.Franklin@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2022	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Bid Primary Contact	Manager, Product Lifecycle	Ms.	Franklin	Lisa		4109984647					Lisa.Franklin@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2022	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	CAP Report Contact for Public Website	CEO, CFCHP-MD	Mr.	Rapach	Mike		4109984601					Mike.Rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	CEO - CMS Administrator Contact	President and CEO	Mr.	Pieninck	Brian	D	4109985320					Brian.Pieninck@carefirst.com	1501 S. Clinton Street	7th Floor	Baltimore	MD	21224	02/10/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	CEO - Senior Official for Contracting	President and CEO	Mr.	Pieninck	Brian	D	4109985320					Brian.Pieninck@carefirst.com	1501 S. Clinton Street	7th Floor	Baltimore	MD	21224	02/10/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Chief Financial Officer	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Chief Operating Officer	CEO, CFCHP-MD	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Chief Information Officer	VP, IT Ops and Infrastructure	Ms.	Henderson	Dori		4109985656					Dori.Henderson@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	11/10/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Chief Information Security Officer	Chief Information Security Officer	Mr.	Suarez	Roberto		4109985716					Roberto.Suarez@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	CMMI Model Point of Contact	CEO, CFCHP-MD	Mr.	Rapach	Mike		4109984601					Mike.Rapach@carefirst.com	PO Box 915		Owings MIlls	MD	21117	09/17/2022	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	CMS Casework Communication Contact	Director, Medical Review & Appeals	Ms.	Faulkner	Pamela		4105287105					Pamela.Faulkner@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	01/12/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Complaints Tracking Contact	Director, Medical Review & Appeals	Ms.	Faulkner	Pamela		4105287105					Pamela.Faulkner@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	01/12/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Contact for Fraud Investigations	Director, SIU	Ms.	Kennedy	Elizabeth		4105287067					elizabeth.kennedy@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Coordination of Benefits Contact	Director, Medicare Operations	Ms.	Challis	Juanita		4109987534					CFGroupMA@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Corporate Mailing						4109987534					Julie.Billman@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	03/02/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Financial Accountant	Ms.	Mitchell	Patrice		4109985273					patrice.mitchell@carefirst.com	10455 Mill Run Circle, MC 01-635		Owings Mills, MD 21117	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Customer Service Operations Contact	Manager, Member Services	Ms.	Boer	Kelsey		4109985359					Kelsey.Boer@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/23/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	DIR Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	DIR Contact (Secondary)	Directory, Pharmacy Services	Mr.	Nardone	Mark		4109985675					Mark.Nardone@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/24/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Emergency Part D Contact	Director Pharmacy Government Programs	Mr.	Nardone	Mark		4109985675					Mark.Nardone@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Emergency Part D Contact (Secondary)	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					john.vellutato@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/24/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Encounter Data & Risk Adjustment Operations Contact	VP, Quality & Risk Adjustment	Mr.	Ramalingam	Subbu		4106052605					Subbu.Ramalingam@carefirst.com	10455 Mill Run Circle	Mailstop OWML1 18192	Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Enrollment Contact	Manager, Enrollment	Ms.	Knox	Dorothea		4109985559					Dorothea.Knox@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/28/2022	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	EOB Transfer Contact	Chief Operations Officer DSNP	Ms.	Toland	Cheryl		4109985107				4109987534	Cheryl.Toland@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Financial Audit Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	08/19/2022	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Financial Reporting Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Formulary Contact	Director, Pharmacy Services	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/17/2022	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Formulary Contact (Secondary)	Clinical Pharmacist	Ms.	Atueyi	Ifeoma		7578198483					Ifeoma.Atueyi@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	General Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Government Relations Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	10/10/2020	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	HIPAA Privacy Officer	Dir, Privacy & Compliance	Ms.	Gregory	Lauren		4105285066					lauren.gregory@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	HIPAA Security Officer	Chief Information Security Officer	Mr.	Suarez	Roberto		4109985716					Roberto.Suarez@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Hospice Contact	Director, Utilization Management	Ms.	Westeburg	Sarah		4105287145					Sarah.Westburg@carefirst.com	P.O. Box 915		Owing Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Interoperability Contact	VP, Enterprise Arch. & Integr.	Mr.	Heyl	Bob		2026806682					Bob.Heyl@carefirst.com	840 First Street, NE		Washington	DC	20065	02/16/2022	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	MA Appeals/Grievances Contact	Director, Medical Review & Appeals	Ms.	Faulkner	Pamela		4105287105					Pamela.Faulkner@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	01/12/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	MA Claims Processing Contact for Public Website			Services	Member		4107799932					Chery.Toland@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Marketing Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Medical Director	Medical Director	Dr.	Park	Kevin		4105287136					Kevin.Park@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/24/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Medicare Coordinator	Medicare Compliance Analyst	Ms.	Adolphi	Patricia		4109984456					Pat.Adolphi@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	07/28/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	08/15/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Medication Therapy Management Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	08/15/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	10/10/2020	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Online Enrollment Center Contact (Back-up)	Chief Ops Officer-DSNP	Ms.	Toland	Cheryl		4109985107					Cheryl.Toland@carefirst.com	P. O. Box 915		Owings Mills	MD	21117	12/20/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Online Enrollment Center Contact (Primary)	Manager, Enrollment	Ms.	Knox	Dorothea		4109985559					Dorothea.Knox@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	09/17/2022	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part C Application Contact	CF CHP-MD Chief Executive Officer	Mr.	Rapach	Mike		4109984601					Mike.Rapach@carefirst.com	10455 Mill Run Cirlce		Owings Mills	MD	21117	09/17/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Appeals	Manager, Clinical Operations	Ms.	Beyda	Trista						7326914838	_REReconsideration@cvscaremark.com	3424 William Penn Hwy,		Pittsburg	PA	15235	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	8889700917				HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Appeals Contact (Secondary)	Medicare Appeals Analyst	Ms.	Gabor-Lyon	Pam						7326914838	Trista.Beyda@cvshealth.com	3424 William Penn Hwy		Pittsburgh	PA	15235	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	8889700917				HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Application Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Benefits Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	08/15/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Claims Submission Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	08/15/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Exceptions Contact	Sr. Dir., Pharm Eval & Oversight	Ms.	Poplawski	Mandi							Mandi.Poplawski@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	08/15/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	4105285053				HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Exceptions Contact (Secondary)	Clinical Pharmacist	Mr.	Vellutato	John							john.vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	08/15/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	4105722606				HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Price File Contact (Back-up)	Clinical Pharmacist	Mr.	Vellutato	John		4105722606					john.vellutato@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	08/15/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Price File Contact (Optional)		Mr.	Loveland	Chet		4806064873					Chet.Loveland@cvshealth.com	9501 E Shea Blvd	MC 121	Scottsdale	AZ	85260	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Price File Contact (Primary)	Director Pharmacy Government Programs	Mr.	Nardone	Mark		4109985675					Mark.Nardone@Carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	08/15/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Quality Assurance Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105732602					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Part D Reporting Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Patient Safety Contact	Clinical Pharmacist	Mr.	Vellutato	John		4105732602					John.Vellutato@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	08/15/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Payment Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Pharmacy Director	Sr. Director, Pharmacy Evaluation & Oversight	Ms	Poplawski	Mandi		4105285053					Mandi.Poplawski@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	04/23/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Pharmacy Network Management Contact	Directory, Pharmacy Government Programs	Mr.	Nardone	Mark		4109985675					Mark.Nardone@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	04/23/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Pharmacy Network Management Contact (Secondary)	Sr. Dir., Pharm Eval & Oversight	Ms.	Poplawski	Mandi		4105285303					Mandi.Poplawski@carefirst.com	1501 S Clinton St		Baltimore	MD	21224	08/15/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Pharmacy Technical Help Desk Contact	Director, Pharmacy Government Programs	Mr.	Nardone	Mark							Mark.Nardone@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	04/23/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Philadelphia
H8854	Pharmacy Technical Help Desk Contact (Secondary)	Part D Business Analyst	Ms	Ellerbee	Ashley							Ashley.Ellerbee@carefirst.com	P.O. Box 915		Owings Mills	MD	21117	11/10/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Philadelphia
H8854	PHR Beneficiary Contact																	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS	CareFirst BlueCross Blue Shield Medicare Advantage	CareFirst, Inc.	45	Yes	Active	8552905744				HMO - Health Maintenance Organization		C	Philadelphia
H8854	Physician Incentive Contact	Manager, Payment Transformation	Mr.	Coffey	Nathan		4104692167					Nathan.Coffey@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Plan Directory Contact for Public Website			Services	Member		8443866762					contactus@ummshealthplans.com	P.O. Box 915		Owings Mills	MD	21117	11/11/2021	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Plan to Plan Reconciliation Contact	Financial Analyst	Ms.	Rohsner	Lian		4109985710					Lian.Rohsner@Carefirst.com	P.O. Box 782437		Philadelphia	PA	191782437	02/17/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Processor Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Quality Contact	VP,Govt. Prg Star & Risk Adj	Mr.	Ramalingam	Subbu		4106052605					Subbu.Ramalingam@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Reconciliation Contact	VP Financial Planning/CFO	Mr.	Phillips	Christophe		4109987213					Christopher.Phillips@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	09/16/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Reconciliation Contact (Secondary)	Director, Pharmacy Services	Mr.	Nardone	Mark		4109985675					Mark.Nardone@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					Mary-Paul.Snapp-Borleis@Carefirst.com	1501 S Clinton St		Baltimore	MD	21224	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	SNP Application Contact	Health Plan CEO	Mr.	Rapach	Mike		4109984601					Mike.Rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	SNP State Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	10/10/2020	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Surveillance Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	10/10/2020	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	System Contact	CEO of Health Plan	Mr.	Rapach	Mike		4109984601					mike.rapach@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Third Party Administrator (TPA) Liaison	Lead Business Analyst	Ms.	Ford	Michelle	R	4437387978					Michelle.Ford@carefirst.com	10455 Mill Run Circle		Owings Mills	MD	21117	06/29/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	User Access Contact	Medicare Compliance Officer	Ms.	Snapp-Borleis	Mary-Paul		4106052579					mary-paul.snapp-borleis@carefirst.com	1501 S. Clinton Street		Baltimore	MD	21224	10/10/2020	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Utilization Management Contact	Director, Utilization Management	Ms.	Westeburg	Sarah		4105287145					Sarah.Westburg@carefirst.com	10455 Mill Run Circle		Owing Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8854	Utilization Review Contact	Director, Utilization Management	Ms.	Westeburg	Sarah		4105287145					Sarah.Westburg@carefirst.com	10455 Mill Run Circle		Owing Mills	MD	21117	07/22/2023	2023	CareFirst Advantage DSNP, Inc.	Local CCP	CareFirst BlueCross BlueShield Medicare Advantage Dual Prime	HMO/HMOPOS		CareFirst, Inc.	45	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H8889	Agent/Broker Compensation Data Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Automated TrOOP Balance Transfer Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Backup User Access Contact			Berg	Lynnsey		6126326655					lynnsey.berg@optum.com	P.O. Box 9472		Minneapolis	MN	554409472	11/30/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Best Available Evidence Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Bid Audit Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Bid Audit Site Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Bid Primary Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	CAP Report Contact for Public Website			Jacobson	Marissa		9529922093					marissa.jacobson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	CEO - CMS Administrator Contact	Interm President & CFO	Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	CEO - Senior Official for Contracting		Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Chief Financial Officer		Ms	Quist	Mary		9529922058					mary.quist@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Chief Operating Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Chief Information Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Chief Information Security Officer		Mr	Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	CMMI Model Point of Contact			Schaefer	Jennifer		9529912803					jennifer.schaefer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	CMS Casework Communication Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Complaints Tracking Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Contact for Fraud Investigations			Monson	Peter		9529921149					peter.monson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/03/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Coordination of Benefits Contact			Vilendrer	Krista		9529923252					krista.vilendrer@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	04/22/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Corporate Mailing						9529922900					ann.kinsella@medica.com	401 Carlson Parkway	P.O. Box 9310 CP320	Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Coverage Gap Discount Program (CGDP) Payment Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Customer Service Operations Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	DIR Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	DIR Contact (Secondary)			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	03/13/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Emergency Part D Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Emergency Part D Contact (Secondary)			Janes	Kathy		9529928989					kathy.janes@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Employer Waiver Contact			Alness	Stacy		9529923825					stacy.alness@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/19/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Encounter Data & Risk Adjustment Operations Contact			Leth	Maria		9529928366					Maria.Leth@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/29/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Enrollment Contact			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/28/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	EOB Transfer Contact			Bourdages	Kathy		9529923653				9529923636	kathy.bourdages@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Financial Audit Contact	Director Finance & Strategy	Mr	Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/11/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Financial Reporting Contact			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Formulary Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Formulary Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	General Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Government Relations Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	HIPAA Privacy Officer			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/20/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	HIPAA Security Officer		Mr	Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Hospice Contact			Bourdages	Kathy		9529923653				9529923636	PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Interoperability Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/14/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	MA Appeals/Grievances Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	MA Claims Processing Contact for Public Website			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Marketing Contact			Teff	Melissa		9529923972					melissa.teff@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Medical Director	Chief Clinical & Provider Strategy Officer		Webster	David		9529922801					david.webster@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/15/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Medicare Compliance Officer		Mrs	Koranteng	Milly		9529922090					mildred.koranteng@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/22/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Medicare Coordinator			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Medicare Part D Opioid Overutilization Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Medication Therapy Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	OffShore Subcontractor Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Online Enrollment Center Contact (Primary)			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Part C Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Part C Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Part D Appeals			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active	9529922353				PPO - BBA		C	Kansas City
H8889	Part D Appeals Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active	9529923448				PPO - BBA		C	Kansas City
H8889	Part D Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Part D Benefits Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/09/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Part D Claims Submission Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Part D Exceptions Contact			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active	9529922353				PPO - BBA		C	Kansas City
H8889	Part D Exceptions Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active	9529923448				PPO - BBA		C	Kansas City
H8889	Part D Price File Contact (Back-up)			Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Farifield	OH	45014	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Part D Price File Contact (Optional)			Bourdages	Kathy		9529923653					PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/28/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Part D Price File Contact (Primary)			Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Part D Quality Assurance Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Part D Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Patient Safety Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Payment Contact			Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/11/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Pharmacy Director			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/10/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Pharmacy Network Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Pharmacy Network Management Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	La Tasha							LaTasha_Monroe@expressscripts.com	13051 N. Telecom Pkwy		Temple Terrace	FL	33637	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active	8009221557				PPO - BBA		C	Kansas City
H8889	Pharmacy Technical Help Desk Contact (Secondary)			Bourdages	Kathy							PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/09/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active	8009221557				PPO - BBA		C	Kansas City
H8889	Plan Directory Contact for Public Website			Service	Customer		8002348755					AskGovtPrograms@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Plan to Plan Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Processor Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Quality Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Reconciliation Contact (Secondary)			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Recovery Audit Contact	Manager Claims Operations	Mr	Foley	Steve		9529924160					steven.foley@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	SNP Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	SNP State Contact			Zillhardt	John		9529922290					John.Zillhardt@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Surveillance Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	System Contact			Schwartz	Pamela		9529922584					pamela.schwartz@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Third Party Administrator (TPA) Liaison			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	User Access Contact			Sherman	Autumn		9529923483					autumn.sherman@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Utilization Management Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8889	Utilization Review Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	Local PPO		Medica Holding Company	439	Yes	Active					PPO - BBA		C	Kansas City
H8894	Agent/Broker Compensation Data Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Automated TrOOP Balance Transfer Contact	Director, Clinical Pharmacy & Product Strategy		Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Backup User Access Contact	Analyst III   Regulatory Affairs		Vong	Janit		9098904608					vong-j@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Best Available Evidence Contact	Manager, Eligibility and Member Configuration		Ramirez	Tiana		9098902073					ramirez-t@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/05/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Bid Audit Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Bid Primary Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	CAP Report Contact for Public Website	Chief Executive Officer	Mr.	McNaughton	Jarrod		9098902010				9098902973	mcnaughton-jb@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/05/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	McNaughton	Jarrod		9097672276				9098902973	mcnaughton-jb@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	12/27/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	McNaughton	Jarrod		9098902010				9098902973	mcnaughton-jb@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/05/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Chief Financial Officer	Chief Financial Officer	Mr.	Freeman	Keenan		9098902130				9098902019	freeman-k2@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/05/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Chief Operating Officer	Chief Operating Officer	Ms.	White	Susie		9098902710				9098902973	white-s@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/05/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Chief Information Officer	Chief Information Officer	Mr.	Devabhaktuni	Vinil		9099422460					vinil.devabhaktuni@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/05/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Chief Information Security Officer	Chief Information Officer	Mr.	Devabhaktuni	Vinil		9099422460					vinil.devabhaktuni@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/05/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	CMS Casework Communication Contact	Director, Grievance & Appeals		Wellmaker	Jennifer		9098902701				9098905748	wellmaker-j@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	04/03/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Complaints Tracking Contact	Director, Grievance & Appeals		Wellmaker	Jennifer		9098902701				9098905748	wellmaker-j@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	04/03/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Contact for Fraud Investigations	SIU Manager		Coiner	Veronica		9092963575				9094778536	coiner-v@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Coordination of Benefits Contact	Director, Clinical Pharmacy & Product Strategy		Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Corporate Mailing						8772734347				9098905877	haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Coverage Gap Discount Program (CGDP) Payment Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Customer Service Operations Contact	Director Member Services Call Management		Zamudio	Olivia		9513743235				9098905877	zamudio-o@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	DIR Contact	Manager Pharmacy Informatics		Yip	Richard		9097677368					yip-r@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	02/27/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	DIR Contact (Secondary)	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Emergency Part D Contact	Director Clinical Pharmacy and Strategy		Blatt	Michael		9092560753				9518911577	Blatt-M@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Encounter Data & Risk Adjustment Operations Contact	Manager Healthcare informatics		Lee	Jason		9513743181					lee-j2@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Enrollment Contact	Manager, Eligibility and Member Configuration		Ramirez	Tiana		9098902073					ramirez-t@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	EOB Transfer Contact	Director, Clinical Pharmacy & Product Strategy		Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Financial Audit Contact	Manager Regulatory Affairs Medicare	Mr.	Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Financial Reporting Contact	Chief Financial Officer	Mr.	Freeman	Keenan		9098902130	32130			9098902019	freeman-k2@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Formulary Contact	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Formulary Contact (Secondary)	Regulatory Affairs Analyst III		Wilson	Michael		9092573851					Michael.Wilson@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	General Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Government Relations Contact	Chief Executive Officer	Mr	McNaughton	Jarrod		9098902010				9098902973	mcnaughton-jb@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	HIPAA Privacy Officer	Manager, Special Investigations Unit		Coiner	Veronica		9092963575					coiner-v@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	01/17/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	HIPAA Security Officer	Chief Information Officer		Devabhaktuni	Vinil		9099422460					vinil.devabhaktuni@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Hospice Contact	Clinical Pharmacy Program & Formulary	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Interoperability Contact	Manager, Enterprise Application Support		Singelman	John		9098902173					Singelman-J@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	MA Appeals/Grievances Contact	Director, Grievance & Appeals		Wellmaker	Jennifer		9098902701				9098905748	wellmaker-j@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	04/03/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	MA Claims Processing Contact for Public Website	Senior Director of Claims		Baray	David		9098902790				9098902068	baray-d@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Marketing Contact	Director of Communications and Marketing		Steward	Lisa		9098902786				9098902019	steward-l@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Medical Director	Chief Medical Officer	Dr.	Wada	Takashi		9098905105				9098902019	wada-t@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Medicare Compliance Officer	Senior Director, Compliance	Ms	Nery	Lourdes		9094205546					dgmedicarecomplianceofficer@iehp.org	10801 Sixth St		Rancho Cucamonga, CA 91730	CA	91730	05/25/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Medicare Coordinator	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Medicare Part D Opioid Overutilization Contact	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Medication Therapy Management Contact	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Part C Application Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251					haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Part C Reporting Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Part D Appeals	Director, Grievance & Appeals		Wellmaker	Jennifer						9098905748	wellmaker-j@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	04/03/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active	9098902701				HMO - Health Maintenance Organization		C	San Francisco
H8894	Part D Application Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251					haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Part D Benefits Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Part D Claims Submission Contact	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Part D Exceptions Contact	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael						9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active	9092560753				HMO - Health Maintenance Organization		C	San Francisco
H8894	Part D Price File Contact (Back-up)	Manager, Pharmacy Business Development		Chang-Vega	Sun		9092566082					dgpharmbusinessdevelopment@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	05/23/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Part D Price File Contact (Primary)	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Part D Quality Assurance Contact	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Part D Reporting Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Patient Safety Contact	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Payment Contact	Chief Financial Officer	Mr.	Freeman	Keenan		9098902130	32130			9098902019	freeman-k2@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Pharmacy Director	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Pharmacy Network Management Contact	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Pharmacy Technical Help Desk Contact	Director, Contact Center Services		Brewer	Kathy							Customerservice@Medimpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	11/29/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active	8884953147				HMO - Health Maintenance Organization		C	San Francisco
H8894	Plan Directory Contact for Public Website	Member Services		Services	Member		8772734347				9098905877	member_services@IEHP.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Plan to Plan Reconciliation Contact	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Processor Contact	Director, Clinical Pharmacy & Product Strategy	Dr.	Blatt	Michael		9092560753				9518911577	blatt-m@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	03/10/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Quality Contact	Chief Quality Officer	Dr.	Juhn	Ed		9098902930				9098901633	juhn-e@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Reconciliation Contact	Vice President Actuarial Services		Chio	Carol		9092725224					Chio-C@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	05/23/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Reconciliation Contact (Secondary)	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251					haines-r@iehp.org	10801 Sixth St		Rancho Cucamonga, CA 91730	CA	92504	02/27/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Recovery Audit Contact	Manager Regulatory Affairs Medicare	Mr.	Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	SNP Application Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	SNP State Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth St.		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Surveillance Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	System Contact	Chief Information Officer		Devabhaktuni	Vinil		9099422460					vinil.devabhaktuni@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	01/12/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Third Party Administrator (TPA) Liaison	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	User Access Contact	Manager Regulatory Affairs Medicare		Haines	Randy		9092960251				9098902973	haines-r@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	09/22/2022	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Utilization Management Contact	Senior Director, Utilization Management Operations		Spargo	Bridget		9092691989				9098902909	spargo-b@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	04/13/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8894	Utilization Review Contact	Senior Director, Utilization Management Operations		Spargo	Bridget		9092691989				9098902909	spargo-b@iehp.org	10801 Sixth Street		Rancho Cucamonga	CA	91730	04/13/2023	2023	Inland Empire Health Plan	Local CCP	IEHP DualChoice	HMO/HMOPOS		INLAND EMPIRE HEALTH PLAN	285	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Agent/Broker Compensation Data Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Automated TrOOP Balance Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189			5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Backup User Access Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Best Available Evidence Contact	Director, Enrollment & Reconciliation	Mr.	Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Bid Audit Contact	CVP Strategic Iniatives & Product Development	Ms.	Selby	Jill		5629898382					jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Bid Audit Site Contact	CVP Strategic Initiatives & Product Development	Ms.	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Bid Primary Contact	CVP Strategic Initiatives & Product Development	Ms.	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	CAP Report Contact for Public Website	COO	Ms.	Monk	Nancy		5629898320				5629895225	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	CEO - CMS Administrator Contact	President, Medicare	Mrs.	Schulte	Karen		5626371205					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/03/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	CEO - Senior Official for Contracting	CEO	Dr.	Jain	Sachin		5629898314	8314				sjain@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Chief Financial Officer	Chief Financial Officer	Mr.	Plumb	Michael		5629971589					MPlumb@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/10/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Chief Operating Officer	President	Mrs.	Schulte	Karen		5626371205	1205				kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Chief Information Officer	President	Mrs.	Schulte	Karen		5626371205	1205				kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Chief Information Security Officer	President	Mrs.	Schulte	Karen		5626371205	1205				kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	CMS Casework Communication Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Complaints Tracking Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Contact for Fraud Investigations	Chief Risk Executive		Hawkins	Ginette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	03/07/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Coordination of Benefits Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189			5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Corporate Mailing						5629895100				5629895200	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	Isaac	Sharon		5629894423					sisaac@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Customer Service Operations Contact	Director, (Customer) Member Services	Ms.	McBeath	Kim		5629971805				5629895181	kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	DIR Contact	Financial Accounting Specialist	Ms.	McClour	Tina		5629894459				5629890101	tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	DIR Contact (Secondary)	Manager Revenue Accounting	Ms.	Moreno	Sonia		5623081122					smoreno@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Emergency Part D Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		3237027662				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/21/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Emergency Part D Contact (Secondary)	Director,  Technical Pharmacy Operations	Ms.	Vaca	Ivette		5622091104				5629973196	ivaca@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/22/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Employer Waiver Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Encounter Data & Risk Adjustment Operations Contact	Chief Data Officer		Leung	Moon		5629895269					mleung@scanhealthplan.com	3800 Kilroy Airport Way suite 100		Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Enrollment Contact	Director, Enrollment & Reconciliation	Mr.	Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	EOB Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189				5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Financial Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Financial Reporting Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Formulary Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Formulary Contact (Secondary)	Clinical Pharmacist	Ms.	Truong	Weilan		5629973187				5629973196	wtruong@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	General Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Government Relations Contact	VP of Government Relations		Hill	Ryann		2023499008				5629899439	rhill@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	HIPAA Privacy Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835					a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	HIPAA Security Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835					a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Hospice Contact	Manager, Pharmacy Experience & Access	Mr.	Tran	Tri		5623082884				5629973196	TMTran@scanhealthplan.com	3800 Kilroy Airport Way		Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Interoperability Contact	VP, IT Software & Services	Mr.	Carren	Marc		5629971821					mcarren@scanhealthplan.com	3800 Kilroy Airport Way, Suite 100		Long Beach	CA	90806	02/10/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	MA Appeals/Grievances Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	MA Claims Processing Contact for Public Website	Vice President, Claims & Shared Services	Mr.	Wheeler	Nathan		5623084341					nwheeler@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Marketing Contact	Compliance Specialist	Mr.	Lin	Richard		5623081156					rlin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Medical Director	Medical Director	Dr.	Hammash	Muhannad		5623081148	1148			5629899439	mhammash@scanhelathplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/11/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Medicare Compliance Officer	Compliance Officer	Ms.	Hawkins	Ginette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Medicare Coordinator	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist Programs	Ms.	Kelley	Mackenzie		5629973165				5629973196	mkelley@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/26/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Medication Therapy Management Contact	Director Pharmacy Quality & 5 Star	Mr.	Dinh	Matthew		5629895261				5629973196	mdinh@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	OffShore Subcontractor Contact	Dir, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131					ecordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment and Reconciliation	Ms.	Gongora	Irene		5629895209				5629895243	IGongora@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Online Enrollment Center Contact (Primary)	Director, Enrollment & Reconciliation	Mr.	Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Part C Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Part C Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Part D Appeals	Director, Grievance & Appeals	Ms.	Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way MS 220		Long Beach	CA	90801	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	5629895100	1290			HMO - Health Maintenance Organization		C	San Francisco
H8902	Part D Appeals Contact (Secondary)	Director, Grievance & Appeals	Ms.	Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way MS 220		Long Beach	CA	90801	02/09/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	5629895100	1290			HMO - Health Maintenance Organization		C	San Francisco
H8902	Part D Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Part D Benefits Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Part D Exceptions Contact	Senior Pharmacy Manager	Mr.	Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	San Francisco
H8902	Part D Price File Contact (Back-up)	Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfiled	OH	45014	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Part D Price File Contact (Optional)	Pharmacy Analyst		Ramirez	Anthony		5623084348	4348			5629973196	a.ramirez@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Part D Quality Assurance Contact	CVP/Chier Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Part D Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Patient Safety Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Payment Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Pharmacy Director	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Pharmacy Network Management Contact	Network Acct Director, Retail Strategy	Ms.	Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		St Louis	MO	63121	01/23/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkwy	STE 150	Temple Terrace	FL	33637	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	San Francisco
H8902	Physician Incentive Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Plan Directory Contact for Public Website	Director, (Customer) Member Services	Ms.	McBeath	Kim		8777787226					kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Plan to Plan Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	P2PAdmin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Processor Contact	Senior Director Government Programs, Medicare	Ms.	Gibson	Sharon		8052361175					sggibson@express-scripts.com	One Express Way		St. Louis	MO	63121	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Quality Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Reconciliation Contact (Secondary)	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Recovery Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	SNP Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	SNP State Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Surveillance Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	System Contact	Chief  Technology Exective	Mr.	Goode	Josh		5623082789					jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Third Party Administrator (TPA) Liaison	Financial Accounting Specialist	Ms.	McClour	Tina		5629894459					tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/17/2021	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	User Access Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Utilization Management Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8902	Utilization Review Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431	4431			5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN TEXAS, INC.	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H8908	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025807929				HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025809138				HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5024682494				HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	8008658715				HMO - Health Maintenance Organization		C	Kansas City
H8908	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active	5025800475				HMO - Health Maintenance Organization		C	Kansas City
H8908	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8908	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA MEDICAL PLAN OF MICHIGAN, INC.	Local CCP	Humana	HMO/HMOPOS		Humana Inc.	128	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H8928	Agent/Broker Compensation Data Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689722					Keith.Greiner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Automated TrOOP Balance Transfer Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Backup User Access Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689722					Keith.Greiner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Best Available Evidence Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Bid Audit Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Bid Audit Site Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Bid Primary Contact	Actuary	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/09/2023	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	CAP Report Contact for Public Website	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	CEO - CMS Administrator Contact	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	CEO - Senior Official for Contracting	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Chief Financial Officer	Chief Financial Officer	Mr.	Bailey	Todd		5083689097				5087914332	Todd.Bailey@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Chief Operating Officer	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Chief Information Officer	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Chief Information Security Officer	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	CMS Casework Communication Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Heather.Ulfves@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Complaints Tracking Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Heather.Ulfves@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Contact for Fraud Investigations	Director Internal Audit	Ms.	Brown	Velinda		5083689016				5083689111	Velinda.Brown@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Coordination of Benefits Contact	Senior Director, Claims Administration	Ms	Straitiff	Kirsten		5083689047					kirsten.straitiff@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/20/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Corporate Mailing						5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Manager Accounting	Mr.	McNamara	Shawn		5083689085					Shawn.McNamara@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Customer Service Operations Contact	VP, Customer Service	Mr.	Perron	Donald		5083689701					Donald.Perron@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	DIR Contact	Actuary	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	DIR Contact (Secondary)	Director and Senior Actuary, Government Programs	Mr.	Leung	Hang		5083689258					Hang.Leung@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/15/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Emergency Part D Contact	Manager, Customer Service	Mr.	Fregeau	Andrew		9784347996					Andrew.Fregeau@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Emergency Part D Contact (Secondary)	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Encounter Data & Risk Adjustment Operations Contact	Manager, Business Service Delivery	Ms.	Ernst	Alicia		5083689369					Alicia.Ernst@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Enrollment Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	EOB Transfer Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089			5088311136	Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Financial Audit Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Financial Reporting Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Formulary Contact	Sr. Director, Pharmacy Therapeutics	Ms.	Kendall	Kate		5087992100	79169				Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Formulary Contact (Secondary)	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	General Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Government Relations Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	HIPAA Privacy Officer	Privacy Officer	Ms.	Sanford	Katrin		5083689838					Katrin.Sanford@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	HIPAA Security Officer	VP IT Operations	Mr.	Petisce	Tony		5083689300					Tony.Petisce@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Hospice Contact	Supervisor, Pharmacy Technician Team	Ms.	Kendall	Kate		8003332535	79169				Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Interoperability Contact	VP, Enterprise Technology Officer		Budaj	John		5083689362					john.budaj@fallonhealth.org	10 Chestnut Street		Worcester	MA	01608	12/29/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	MA Appeals/Grievances Contact	Director, Care Services Support	Ms.	Ryan	Patricia		5083689771					Patricia.Ryan@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	MA Claims Processing Contact for Public Website			Service	Customer		5087992100	69988				CustomerService@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Marketing Contact	Manager, Medicare Programs	Ms.	Kudron	Julie		5083689591					Julie.Kudron@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Medical Director	Chief Medical Officer (Interim)	Dr.	David	Brumley		5083689567					David.Brumley@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	07/09/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Medicare Compliance Officer	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Medicare Coordinator	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Medicare Part D Opioid Overutilization Contact	Supervisor, Formulary Coordinators & Technicians	Ms.	Kendall	Kate		8003332535	79169				Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/16/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Medication Therapy Management Contact	Manager, Pharmacy Ops & Clinical Programs	Mr.	Sartini	David		5083689790					David.Sartini@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	OffShore Subcontractor Contact	Medicare Compliance & Regulatory Affairs Associate	Ms.	DeMarco	Kristie		5083689514					Kristie.DeMarco@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Online Enrollment Center Contact (Back-up)	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Online Enrollment Center Contact (Optional)	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689772					Keith.Greiner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Online Enrollment Center Contact (Primary)	Enrollment & Billing Operations Coordinator	Ms.	Walsh	Lisa		5083689597					Lisa.Walsh@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Part C Application Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Part C Reporting Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689772					Keith.Greiner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Part D Appeals	Director, Care Services Support	Ms.	Ryan	Patricia							Patricia.Ryan@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689771				HMO - Health Maintenance Organization		C	Boston
H8928	Part D Appeals Contact (Secondary)	Manager, Member Appeals and Grievances	Ms.	Foulkes	Christina							Christina.Foulkes@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689447				HMO - Health Maintenance Organization		C	Boston
H8928	Part D Application Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Part D Benefits Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Part D Claims Submission Contact	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Part D Exceptions Contact	Manager, Pharmacy Ops & Clinical Programs	Mr.	Sartini	David							David.Sartini@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689790				HMO - Health Maintenance Organization		C	Boston
H8928	Part D Exceptions Contact (Secondary)	Sr. Director, Pharmacy Therapeutics	Ms.	Kendall	Kate							Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	5087992100	79169			HMO - Health Maintenance Organization		C	Boston
H8928	Part D Price File Contact (Back-up)	Manager, Pharmacy Ops & Clinical Programs	Mr.	Sartini	David		5083689790					David.Sartini@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Part D Price File Contact (Optional)	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Part D Price File Contact (Primary)	Govt Programs and Quality Clinical Pharmacist	Mr.	Huynh	Jayce		5087992100	69212				Jayce.Huynh@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Part D Quality Assurance Contact	Sr. Director, Pharmacy Therapeutics	Mr.	Huynh	Jayce		5083689212					Jayce.Huynh@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Part D Reporting Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689772					Keith.Greiner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Patient Safety Contact	VP,  Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	04/04/2023	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Payment Contact	Senior Manager Accounting	Mr.	McNamara	Shawn		5083689085					Shawn.McNamara@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Pharmacy Director	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Pharmacy Network Management Contact	VP, Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Ops and Clinical Programs	Mr.	Sartini	David		5083689790					David.Sartini@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Pharmacy Technical Help Desk Contact			Help Desk	OptumRx								1600 McConnor Parkway		Schaumburg	IL	60173	12/29/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	8443688734				HMO - Health Maintenance Organization		C	Boston
H8928	Pharmacy Technical Help Desk Contact (Secondary)			Summers	Todd								OptumRx	755 Research Pkwy, Suite 300	Oklahoma City	OK	73104	12/29/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	8664431095				HMO - Health Maintenance Organization		C	Boston
H8928	Physician Incentive Contact	VP, Network Development and Management	Ms.	Keser	Susan		5083689261					Susan.Keser@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Plan Directory Contact for Public Website			Service	Customer		5087992100	69988				CustomerService@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Plan to Plan Reconciliation Contact	Director, Medical Accounting	Mr.	Beaulieu	Michael		5083689020					Michael.Beaulieu@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/07/2023	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Processor Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Heather.Ulfves@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Quality Contact	Director of Quality	Ms.	Little	Dawn		5083689263					Dawn.Little@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/04/2023	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Reconciliation Contact	Actuarial Associate	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/09/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Reconciliation Contact (Secondary)	Director and Senior Actuary, Government Programs	Mr.	Leung	Hang		5083689258					Hang.Leung@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/15/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Recovery Audit Contact	Senior Director, Claims Administration	Ms	Straitiff	Kirsten		5083689047					kirsten.straitiff@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/08/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	SNP Application Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	SNP State Contact	Executive Director, NaviCare	Ms.	Daviau	Deborah		5083689489					Deborah.Daviau@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Surveillance Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	System Contact	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Third Party Administrator (TPA) Liaison	Financial Accounting & Reporting Sr. Analyst	Ms.	Maesto	Alison		5083689486					Alison.Maesto@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	User Access Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Utilization Management Contact	VP Clinical Operations	Ms.	Aiello	Linda		5083689134					Linda.Aiello@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8928	Utilization Review Contact	VP Clinical Operations	Ms.	Aiello	Linda		5083689134					Linda.Aiello@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/14/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H8961	Agent/Broker Compensation Data Contact	Associate Director	Mr.	Isea	Jason		9175616957					jisea@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Automated TrOOP Balance Transfer Contact	Medicare Pharmacy Program Manager		Freking	Alicia		9175028368					afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Backup User Access Contact	Senior Analyst, Compliance Operations		Macias	Angie		4807199000					amacias@hioscar.com	615 S. River Drive		Tempe	AZ	85281	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Best Available Evidence Contact	Senior Director, Insurance Operations		Fierro Randazzo	Michael		2243427889					mfierrorandazzo@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Bid Audit Contact	Senior Director, Actuarial		Dority	Jake		2167768372					jacob@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Bid Audit Site Contact	Director, Medicare Compliance	Mrs.	Jaikaran	Nandini		9176532676					njaikaran@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/03/2022	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Bid Primary Contact	Senior Director, Actuarial		Dority	Jake		2167768372					jacob@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	CAP Report Contact for Public Website	Associate, Medicare Compliance	Mr.	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Bertolini	Mark		8609669109					mark@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Bertolini	Mark		8609669109					mark@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Chief Financial Officer	Chief Financial Officer	Mr	Sankaran	Sid		4073333284					sid@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Chief Operating Officer	Chief Operating Officer	Mr.	Wolin	Steven		6177210401					swolin@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Chief Information Officer	Chief Technology Officer	Ms.	Rajpal	Neetu		4255916950					neetu@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Chief Information Security Officer	Chief Security Officer	Mr.	Tower-Pierce	Hugh		7814297297					hugh@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	CMS Casework Communication Contact	Grievance and Appeal Lead		Bella	Frankie		6023803902					frankie@hioscar.com	615 S. River Drive		Tempe	AZ	85281	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Complaints Tracking Contact	Grievance and Appeal Lead		Bella	Frankie		6023803902					frankie@hioscar.com	615 S. River Drive		Tempe	AZ	85281	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Contact for Fraud Investigations	Sr. Manager, Special Investigations Unit	Mrs	Matty	Nicole		6465984333					nmatty@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Coordination of Benefits Contact	Associate Director of Insurance Operations		Avon	Nicholas		8122047309					navon@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Corporate Mailing						8552726788					help@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Reporting Manager		Yang	Elaine		6467700382					elaine@hioscar.com	75 Varick Street	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Customer Service Operations Contact	Director Concierge Medicare Advantage		Riley	John		4016541223					jriley@hioscar.com	615 S. River Drive		Tempe	AZ	85281	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	DIR Contact	Senior Director, Actuarial		Dority	Jake		2167768372					jacob@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Emergency Part D Contact	Chief Operating Officer	Mr.	Wolin	Steven		6177210401					swolin@hioscar.com	75 Varick Street	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Emergency Part D Contact (Secondary)	Medicare Pharmacy Program Manager		Freking	Alicia		9175028368					afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Encounter Data & Risk Adjustment Operations Contact	Associate Director, Value Capture		Cices	Rafi		8455480392					rafi@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Enrollment Contact	Senior Director, Insurance Operations		Fierro Randazzo	Michael		2243427889					mfierrorandazzo@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	EOB Transfer Contact	Associate Director of Insurance Operations		Avon	Nicholas		8122047309				8889772062	navon@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Financial Audit Contact	Associate, Medicare Compliance	Mr.	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Financial Reporting Contact	Financial Reporting Manager		Yang	Elaine		6467700382					elaine@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Formulary Contact	Medicare Pharmacy Program Manager		Freking	Alicia		9175028368					afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	General Contact	Associate, Medicare Compliance	Mr.	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Government Relations Contact	Director, Government Affairs		Canter	Alyssa		9177100091					acanter@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	HIPAA Privacy Officer	Senior Manager, Privacy		Khan	Mohsin		9492338157					mohsin@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	HIPAA Security Officer	Director and Interim CISO		Hornat	Charles		9089303222					chornat@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Hospice Contact	Medicare Pharmacy Program Manager		Freking	Alicia		9175028368					afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Interoperability Contact	Chief Product Officer		Horowitz	Jesse		2032145759					jesse@hioscar.com	75th Varick ST	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	MA Appeals/Grievances Contact	Grievance and Appeal Lead		Bella	Frankie		6023803902					frankie@hioscar.com	615 S. River Drive		Tempe	AZ	85281	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	MA Claims Processing Contact for Public Website	Director, Insurance Operations		Gibson	Jerry		8556722755					jgibson@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Marketing Contact	Chief Communications Officer		Kahn	Jackie		8556722755					jkahn@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Medical Director	Medicare Advantage Medical Director	Dr	Martin	Sean		7132894054					smartin@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Medicare Compliance Officer	Director, Corporate Compliance	Mrs.	Reynolds	Gloria		8047279985					greynolds@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Medicare Coordinator	Associate, Medicare Compliance	Mr.	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Medicare Part D Opioid Overutilization Contact	Medicare Pharmacy Program Manager		Freking	Alicia		9175028368					afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Medication Therapy Management Contact	Medicare Pharmacy Program Manager		Freking	Alicia		9175028368					afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Online Enrollment Center Contact (Primary)	Senior Director, Insurance Operations		Fierro Randazzo	Michael		2243427889					mfierrorandazzo@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Part C Application Contact	Associate, Medicare Compliance	Mr.	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Part C Reporting Contact	Associate, Medicare Compliance	Mr.	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Part D Appeals	Pharmaceutical Program Manager		Freking	Alicia							afreking@hioscar.com	75 Varick St, 5th Fl		New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract	9175028368				HMO - Health Maintenance Organization		C	New York
H8961	Part D Appeals Contact (Secondary)	Complaints & Grievances Team Lead		Bella	Frankie							frankie@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract	6023803902				HMO - Health Maintenance Organization		C	New York
H8961	Part D Application Contact	Associate, Medicare Compliance	Mr.	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Part D Benefits Contact	Medicare Pharmacy Program Manager		Freking	Alicia		9175028368					afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Part D Claims Submission Contact	Medicare Pharmacy Program Manager		Freking	Alicia		9175028368					afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Part D Exceptions Contact	Medicare Pharmacy Program Manager		Freking	Alicia							afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract	8556722720				HMO - Health Maintenance Organization		C	New York
H8961	Part D Price File Contact (Back-up)	Associate, Medicare Compliance	Mr.	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Part D Price File Contact (Optional)	Director of Pharmacy		Vecchiet	Jon		2014520476					jvecchiet@hioscar.com	75 Varick Street	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Part D Price File Contact (Primary)	Pharmaceutical Program Manager		Freking	Alicia		9175028368					afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Part D Quality Assurance Contact	Associate Director, Pharmacy		Dymon	Tara		2177259293					tdymon@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Part D Reporting Contact	Associate, Medicare Compliance	Mr.	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Patient Safety Contact	Medicare Pharmacy Program Manager		Freking	Alicia		9175028368					afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Payment Contact	Financial Reporting Manager		Yang	Elaine		6467700382					elaine@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Pharmacy Director	Director of Pharmacy		Vecchiet	Jon		2014520476					jvecchiet@hioscar.com	75 Varick Street	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Pharmacy Network Management Contact	Medicare Pharmacy Program Manager		Freking	Alicia		9175028368					afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Pharmacy Technical Help Desk Contact	Medicare Pharmacy Program Manager		Freking	Alicia							afreking@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract	8666934620				HMO - Health Maintenance Organization		C	New York
H8961	Plan Directory Contact for Public Website	Associate, Medicare Compliance	Mr.	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Plan to Plan Reconciliation Contact	Financial Reporting Manager		Yang	Elaine		6467700382					elaine@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Processor Contact	Director, Insurance Operations		Gibson	Jerry		8556722755					jgibson@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Quality Contact	Director, Quality Improvement		Juliano	Patricia		2012206165					pjuliano@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Reconciliation Contact	Financial Reporting Manager		Yang	Elaine		6467700382					elaine@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Recovery Audit Contact	Associate, Medicare Compliance	Mr,	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Surveillance Contact	Sr. Manager, Special Investigations Unit	Mrs	Matty	Nicole		6465984333					nmatty@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	System Contact	Associate, Medicare Compliance	Mr.	Hernandez Gomez	Juan		5054106732					jhernandezgomez@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Third Party Administrator (TPA) Liaison	Associate Director,  Accounting	Mr.	Schroeder	Gregory		7329911255					gregory@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	User Access Contact	Corporate Compliance Analyst		Macias	Angela		4807199000					amacias@hioscar.com	615 S. River Drive		Tempe	AZ	85281	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Utilization Management Contact	Sr. Director, Clinical Strategy and Optimization		Sharma	Poonam		3128823766					poonam@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8961	Utilization Review Contact	Sr. Director, Clinical Strategy and Optimization		Sharma	Poonam		3128823766					poonam@hioscar.com	75 Varick St	5th Floor	New York	NY	10013	06/02/2023	2023	OSCAR MANAGED CARE OF SOUTH FLORIDA, INC	Local CCP	Oscar	HMO/HMOPOS		Oscar Health, Inc.	731	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H8967	Agent/Broker Compensation Data Contact	Director of Product Development	Ms.	Meyer	Courtney		6053122613					Courtney.Meyer@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Automated TrOOP Balance Transfer Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Backup User Access Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Best Available Evidence Contact	Director of Billing & Enrollment	Mr.	Reichelt	Daniel		6053122624					daniel.reichelt@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Bid Audit Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Bid Audit Site Contact	Director of Acturial Services	Mr.	Pence	Gregory		4156018550					gregory.pence@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Bid Primary Contact	Director of Actuarial Services	Mr.	Pence	Gregory		4156018550					gregory.pence@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	CAP Report Contact for Public Website	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	6053286806				HMO - Health Maintenance Organization		C	Dallas
H8967	CEO - CMS Administrator Contact	President	Mr.	Snyder	John		6053122750					john.snyder@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	CEO - Senior Official for Contracting	President	Mr.	Snyder	John		6053122750					john.snyder@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Chief Financial Officer	Vice President of Finance	Mr.	Maude	Brian		6053286801					Brian.Maude@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Chief Operating Officer	Chief Operating Officer	Ms.	Griese	Emily		6053287020					Emily.Griese@SanfordHealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Chief Information Officer	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Chief Information Security Officer	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	CMMI Model Point of Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	CMS Casework Communication Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 Cherapa place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Complaints Tracking Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Contact for Fraud Investigations	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Coordination of Benefits Contact	Director of Payment Integrity	Ms.	Lieser	Mesa		6053287024					mesa.lieser@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Corporate Mailing						8005354831					sanfordhealthplan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Customer Service Operations Contact	Director of Customer Service	Mr.	Ling	Ryan		6053127459					ryan.ling@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	DIR Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	DIR Contact (Secondary)	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Electronic Health Record Contact	System Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Emergency Part D Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Emergency Part D Contact (Secondary)	Senior Director of Goverment Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Employer Waiver Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Encounter Data & Risk Adjustment Operations Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Enrollment Contact	Director of Product Development	Ms.	Meyer	Courtney		6053122613					courtney.meyer@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	EOB Transfer Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182				6053286811	aleesa.jansick@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Financial Audit Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Financial Reporting Contact	Vice President of Finance	Mr.	Maude	Brian		6053286801					brian.maude@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Formulary Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Formulary Contact (Secondary)	Principal Pharmacy Benefits Specialist		Chen	Honghua		2242312740					Christine.Chen2@optum.com	1600  McConnor Parkway	Suite 201	Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	General Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Government Relations Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	HIPAA Privacy Officer	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	HIPAA Security Officer	Systems Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Hospice Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Interoperability Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	MA Appeals/Grievances Contact	Senior Director of Regulation & Risk	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	MA Claims Processing Contact for Public Website	Executive Director Operations	Ms.	Guggisberg	Stacey		6053286802					stacey.guggisberg@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Marketing Contact	Director of Marketing	Ms.	McCloskey	Diana		6053122762					diana.mccloskey@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Medical Director	Vice President, Medical Officer	Dr.	Faber	Kevin		6053287192					kevin.faber@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Medicare Compliance Officer	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Medicare Coordinator	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Medication Therapy Management Contact	Clinical Program Manager	Ms.	Liaqat	Tazeen		6305440541					Tazeen.liaqat@optum.com	1240 South Pine Island Rd.		Plantation	FL	33324	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	OffShore Subcontractor Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Online Enrollment Center Contact (Back-up)	Director of Medicare Programs	Mr.	Ovenden	Nathan		6053122606					nathan.ovenden@sanfordhealth.org	300 Cherapa Place, Suite 201		Sioux Falss	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Online Enrollment Center Contact (Optional)	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Online Enrollment Center Contact (Primary)	Senior Director of Development and Distribution	Ms.	Meyer	Courtney		6053122613					courtney.meyer@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Part C Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Part C Reporting Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Appeals	Manager, Prior Authorization Appeals	Ms.	Le	Christina						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Appeals Contact (Secondary)	Pharmacy Technician, PA Appeals		Chavez	Kelly						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Benefits Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Claims Submission Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Exceptions Contact	Manager, Prior Authorization	Ms.	Le	Christina						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Exceptions Contact (Secondary)	Pharmacy Technician, PA		Chavez	Kelly						8772394565	rxsol_prior_auth_redirected_queue_DL@uhc.com	3515 Harbor Blvd		Costa Mesa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8884033398				HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Price File Contact (Back-up)	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615				6053286811	timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Price File Contact (Optional)	Senior Director of Government Program	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Price File Contact (Primary)	Senior Business Analyst	Ms.	Lyman	Dorothy		6514955369					Dorothy.Lyman@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Quality Assurance Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007				6053286811	rebecca.fuller@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Part D Reporting Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Patient Safety Contact	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615					timothy.habeck@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Payment Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Personal Health Record Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Pharmacy Director	Clinical Pharmacist, Government Programs	Mr.	Habeck	Tim		6053122615				6053286811	timothy.habeck@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations	Ms.	Ashby	Jolynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk	Mr.	Summers	Todd							Todd.Summers@optum.com	1600 McConnor Parkway	Suite 200	Schaumburg	IL	601736801	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	8446429090				HMO - Health Maintenance Organization		C	Dallas
H8967	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Customer Service	Mr.	Juarez	Ethan							ethan.juarez@optum.com	3515 Harbor Blvd		Costa Mesaa	CA	92626	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active	7148256891				HMO - Health Maintenance Organization		C	Dallas
H8967	PHR Beneficiary Contact																	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS	Sanford Health Plan	Sanford Health	740	Yes	Active	8885354831				HMO - Health Maintenance Organization		C	Dallas
H8967	Physician Incentive Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Plan Directory Contact for Public Website	Senior Director of Risk & Regulation	Ms.	Jansick	Aleesa		6053287182					aleesa.jansick@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Plan to Plan Reconciliation Contact	Director of Finance	Ms.	Harris	Debora		6053129344					debora.harris@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Processor Contact	Senior Manager, Benefit Administration	Ms.	Lievanos	Cassandra		7637974205					cassandra.lievanos@optum.com	5701 Katella Ave		Cypress	CA	90630	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Quality Contact	Senior Director of Risk & Regulation	Ms.	Jansick	Aleesa		6053287182					Aleesa.Jansick@SanfordHealth.org	300 Cherapa Place Suite 201		Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Reconciliation Contact	Director of Billing & Enrollment	Mr.	Reichelt	Daniel		6053122624					daniel.reichelt@sanfordhealth.org	300 N Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Reconciliation Contact (Secondary)	Executive Director of Opertions	Ms.	Guggisberg	Stacey		6053286802					stacey.guggisberg@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Recovery Audit Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	SNP Application Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	SNP State Contact	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Surveillance Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	System Contact	Systems Executive Director	Ms.	Sullivan	Jennifer		6053127515					jennifer.sullivan@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Third Party Administrator (TPA) Liaison	Senior Director of Government Programs	Ms.	Fuller	Rebecca		6053287007					rebecca.fuller@sanfordhealth.org	300 Cherapa Pl	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	User Access Contact	Compliance Officer	Mr.	Yeoman	Dallan		6053286806					dallan.yeoman@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Utilization Management Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8967	Utilization Review Contact	Director of Utilization Management	Ms.	Kanta	Misty		6053122788					misty.kanta@sanfordhealth.org	300 Cherapa Place	Suite 201	Sioux Falls	SD	57103	08/04/2023	2023	SANFORD HEALTH PLAN	Local CCP	Great Plains Medicare Advantage	HMO/HMOPOS		Sanford Health	740	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H8982	Automated TrOOP Balance Transfer Contact	Business Office Manager		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/29/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Backup User Access Contact	QAPI Manager		Orozco	Andrew		3057518626	66754				borozco@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/29/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Best Available Evidence Contact	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/29/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Bid Primary Contact	EVP PACE		Hess	Steve		3057518626	66799				SHess@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/29/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	CAP Report Contact for Public Website	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/29/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	CEO - CMS Administrator Contact	EVP PACE	Mr.	Hess	Steve		3057518626	66799				SHess@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/29/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	CEO - Senior Official for Contracting	AVP PACE	Ms.	Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/29/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Chief Financial Officer	CFO	Mr.	Durr	Michael		3057518626	63298				MDurr@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Chief Operating Officer	COO	Mr	Goldsmith	Alan		3057518626	63296				Agoldsmith@miamijewishealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Chief Information Officer	Chief Information Officer	Mr.	Larralde	Bernie		3057518626	65499				Blarralde@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Chief Information Security Officer	Chief Information Officer	Mr	Larralde	Bernie		3057518626	65499				Blarralde@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	CMS Casework Communication Contact	QAPI Manager		Orozco	Andrew		3057518626	66754				borozco@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Complaints Tracking Contact	QAPI Manager		Orozco	Andrew		3057518626	66754				borozco@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Contact for Fraud Investigations	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Coordination of Benefits Contact	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Corporate Mailing						3057518626					mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Coverage Gap Discount Program (CGDP) Payment Contact	Business Office Manager		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Customer Service Operations Contact	AVP PACE	Mr.	Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	DIR Contact	AVP PACE		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Emergency Part D Contact	Business Office Manager		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Encounter Data & Risk Adjustment Operations Contact	Business Office Manager		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Enrollment Contact	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	EOB Transfer Contact	Business Office Manager		Lewars	Olga		3057518626	68299			3057951855	olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Financial Audit Contact	Business Office Manager	Ms.	Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Financial Reporting Contact	Business Office Manager		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Formulary Contact	Director of Pharmacy		Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	General Contact	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Government Relations Contact	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	HIPAA Privacy Officer	QAPI Manager		Orozco	Andrew		3057518626	66754				borozco@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	HIPAA Security Officer	Chief Information Officer		Larralde	Bernie		3057518626	65499				Blarralde@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Interoperability Contact	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	MA Appeals/Grievances Contact	QAPI Manager		Orozco	Andrew		3057518626	66754				borozco@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	MA Claims Processing Contact for Public Website	Business Office Manager		Lewars	Olga		3057518626	68299				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Marketing Contact	EVP PACE		Hess	Steve		3057518626	66799				SHess@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Medical Director	Medical Director		Alzugaray	Edilia		3057518626	66796				EAlzugaray@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Medicare Compliance Officer	AVP PACE	Ms.	Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Medicare Coordinator	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy		Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Medication Therapy Management Contact	Director of Pharmacy		Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Part C Application Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1700 NW 49th Street		Fort Lauderdale	FL	33309	07/20/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Part D Appeals	QAPI Manager		Orozco	Andrew						3057951855	borozco@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending	3057518626	66754			PACE - Nat		C	Atlanta
H8982	Part D Application Contact			Fernandez	Alexander		9544737483					amfernandez@browardhealth.org	1700 NW 49th Street		Fort Lauderdale	FL	33309	07/20/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Part D Benefits Contact	Director of Pharmacy		Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Part D Claims Submission Contact	Business Office Manager		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Part D Exceptions Contact	Business Office Manager		Lewars	Olga						3057951855	olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending	3057518626	66299			PACE - Nat		C	Atlanta
H8982	Part D Price File Contact (Back-up)	Director of Pharmacy		Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Part D Price File Contact (Primary)	Director of Pharmacy		Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Part D Quality Assurance Contact	QAPI Manager		Orozco	Andrew		3057518626	66754				borozco@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Part D Reporting Contact	Business Office Manager		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Patient Safety Contact	QAPI Manager		Orozco	Andrew		3057518626	66754				borozco@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Payment Contact	Business Office Manager		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Pharmacy Director	Director of Pharmacy		Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Pharmacy Network Management Contact	Director of Pharmacy		Martinez	Mario		3057518626	66299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Pharmacy Technical Help Desk Contact	Director of Pharmacy		Martinez	Mario						3057951855	MMartinez1@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending	3057518626	66299			PACE - Nat		C	Atlanta
H8982	Plan Directory Contact for Public Website	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Plan to Plan Reconciliation Contact	Business Office Manager		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Processor Contact	Business Office Manager		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Quality Contact	QAPI Manager		Orozco	Andrew		3057518626	66754				borozco@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Reconciliation Contact	Business Office Manager		Lewars	Olga		3057518626	68299				MMartinez1@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Recovery Audit Contact	AVP PACE	Ms.	Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Surveillance Contact	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	System Contact	Chief Information Officer		Larralde	Bernie		3057518626	65499				Blarralde@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Third Party Administrator (TPA) Liaison	Business Office Manager		Lewars	Olga		3057518626	68299				olewars@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	User Access Contact	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Utilization Management Contact	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8982	Utilization Review Contact	AVP PACE		Lane	Maria		3057518626	66703				mlane@miamijewishhealth.org	5200 NE 2nd Ave		Miami	FL	33137	09/30/2022	2023	BROWARD PACE PROGRAM LLC	National PACE	Broward PACE Program, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H8992	Automated TrOOP Balance Transfer Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Backup User Access Contact			Patel	Naimish		8165995552					npatel@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Best Available Evidence Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Bid Primary Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	CAP Report Contact for Public Website			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending	8163213250				PACE - Nat		C	Kansas City
H8992	CEO - CMS Administrator Contact		Mr.	Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	CEO - Senior Official for Contracting		Mr.	Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Chief Financial Officer		Mr.	Patel	Naimish		8165995552					npatel@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Chief Operating Officer		Mr.	Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Chief Information Officer		Mr.	Smith	Thurston		8165995558					tlsmith@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Chief Information Security Officer		Mr.	Smith	Thurston		8165995558					tlsmith@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	CMS Casework Communication Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Complaints Tracking Contact			Webster	Atha		8165595571					AWebster@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Contact for Fraud Investigations			Webster	Atha		8165995571					AWebster@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Coordination of Benefits Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Corporate Mailing						8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Coverage Gap Discount Program (CGDP) Payment Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Customer Service Operations Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	DIR Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	DIR Contact (Secondary)			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Emergency Part D Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Encounter Data & Risk Adjustment Operations Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Enrollment Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	EOB Transfer Contact			Rath	Heath		8163213250				8165995996	hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Financial Audit Contact	CFO	Mr.	Patel	Naimish		8165995552					npatel@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Financial Reporting Contact			Patel	Naimish		8165995552					npatel@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Formulary Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	General Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Government Relations Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	HIPAA Privacy Officer			Webster	Atha		8165995571					AWebster@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	HIPAA Security Officer			Webster	Atha		8165995571					AWebster@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Interoperability Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	MA Appeals/Grievances Contact			Webster	Atha		8165995571					AWebster@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	MA Claims Processing Contact for Public Website			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Marketing Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Medical Director			Jamal	Naiomi		8165995215					NJamal@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Medicare Compliance Officer		Mrs.	Webster	Atha		8165995571					AWebster@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Medicare Coordinator			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Medicare Part D Opioid Overutilization Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Medication Therapy Management Contact			Jamal	Naiomi		8165595215					NJamal@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Part C Application Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. Martin Luther King Jr. Blvd.		Kansas City	MO	64130	01/31/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Part D Appeals			Webster	Atha							AWebster@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending	8163213250				PACE - Nat		C	Kansas City
H8992	Part D Application Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. Martin Luther King Jr. Blvd.		Kansas City	MO	64130	01/31/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Part D Benefits Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Part D Claims Submission Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Part D Exceptions Contact			Rath	Heath							hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending	8163213250				PACE - Nat		C	Kansas City
H8992	Part D Price File Contact (Back-up)			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Part D Price File Contact (Primary)			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Part D Quality Assurance Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Part D Reporting Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Patient Safety Contact			Webster	Atha		8165995571					AWebster@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Payment Contact			Patel	Naimish		8165995552					npatel@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Pharmacy Director			Hattaway	Michael		8165995457					MHattaway@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Pharmacy Network Management Contact			Hattaway	Michael		8165995457					MHattaway@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Pharmacy Technical Help Desk Contact			Hattaway	Michael							MHattaway@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending	8165595457				PACE - Nat		C	Kansas City
H8992	Plan Directory Contact for Public Website			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Plan to Plan Reconciliation Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Processor Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Quality Contact			Webster	Atha		8165995571					AWebster@swopehealth.org	3801 Dr. MLK Blvd.		Kansas City	MO	64113	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Reconciliation Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Recovery Audit Contact	Executive Director	Mr.	Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Surveillance Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	System Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Third Party Administrator (TPA) Liaison			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	User Access Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Utilization Management Contact			Rath	Heath		8163213250					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8992	Utilization Review Contact			Jamal	Naiomi		8165995215					hrath@pacekc.org	3801 Dr. MLK Blvd.		Kansas City	MO	64130	03/13/2023	2023	PACE KC, LLC	National PACE	PACE KC	National PACE		Swope Health Services	817	Yes	Pending					PACE - Nat		C	Kansas City
H8998	Agent/Broker Compensation Data Contact	Director of Sales		Dues	Travis		6145463157				6145463131	Travis.Dues@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Automated TrOOP Balance Transfer Contact	Part D Analyst		Houk	Kim		6145463183				6145463131	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Backup User Access Contact	Sr. Application Specialist		Crawford	Carl		6145463215				6145463144	ccrawford@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Best Available Evidence Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Bid Audit Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463211	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Bid Audit Site Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Bid Primary Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	CAP Report Contact for Public Website	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	CEO - CMS Administrator Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	Jack.Randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	CEO - Senior Official for Contracting	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Chief Financial Officer	Chief Financial Officer	Mr	Vis	David		6145463211				6145463131	david.vis@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Chief Operating Officer	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Chief Information Officer	VP Service Optimization	Mr.	Trimmer	Matt		3017547190					matt.trimmer@trinity-health.org	3100 Easton Square Place		Columbus	OH	43219	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Chief Information Security Officer	Sr Security Manager, Enterprise Information Securi	Mr.	Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	CMS Casework Communication Contact	Compliance Specialist	Mr.	Jordan	David	A	6147068474				6142348372	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Complaints Tracking Contact	Compliance Specialist	Mr	Jordan	David	A	6147068474					djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Contact for Fraud Investigations	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Coordination of Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Corporate Mailing						4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Customer Service Operations Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	DIR Contact	CEO		Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square  Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	DIR Contact (Secondary)	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Electronic Health Record Contact	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Emergency Part D Contact	Chief Compliance Officer		Suffern	Patricia		4124780244				6145463132	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	12/23/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Emergency Part D Contact (Secondary)	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Employer Waiver Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Reconciliation Analyst		Sloan	Mike		6145463134					mike.sloan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Enrollment Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	EOB Transfer Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Financial Audit Contact	Chief Administration Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Financial Reporting Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Formulary Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Formulary Contact (Secondary)	Director, Pharmacy		Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	General Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Government Relations Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	HIPAA Privacy Officer	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	HIPAA Security Officer	Sr Security Manager, Enterprise Information Securi		Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Hospice Contact	Senior Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Interoperability Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	MA Appeals/Grievances Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	MA Claims Processing Contact for Public Website	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Marketing Contact	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Medical Director	MD	Dr.	Wise	Greg		6145463151				6145463131	gwise@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Medicare Compliance Officer	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Medicare Coordinator	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Medicare Part D Opioid Overutilization Contact	Pharmacy Data Analyst	Ms.	Houk	Kimberly		6145463183					kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Medication Therapy Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	OffShore Subcontractor Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment	Ms	Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Online Enrollment Center Contact (Optional)	Director, Enrollment and Premium Billing		Caudle	Jeff		6145463224				6145463148	jcaudle@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Online Enrollment Center Contact (Primary)	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Part C Application Contact	Director, Product Management and Business Devlpt		Mauck	Brandon		6145955681					brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Part C Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Part D Appeals	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H8998	Part D Appeals Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H8998	Part D Application Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Part D Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Part D Claims Submission Contact	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Part D Exceptions Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H8998	Part D Exceptions Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H8998	Part D Price File Contact (Back-up)	Formulary Consultant		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea		Scottsdale	AZ	85260	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Part D Price File Contact (Primary)	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Part D Quality Assurance Contact	Director of Pharmacy, Health Plans		Turoff	Chris		6144030394				6142346481	chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Part D Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Patient Safety Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Payment Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Pharmacy Director	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Pharmacy Network Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Pharmacy Network Management Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Pharmacy Technical Help Desk Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active	8666934620				PPO - BBA		C	Chicago
H8998	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Data Analyst	Mrs	Miller	Kim							kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active	8666934620				PPO - BBA		C	Chicago
H8998	PHR Beneficiary Contact																	02/02/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO	MediGold	Trinity Health Corporation	234	Yes	Active	8002403851				PPO - BBA		C	Chicago
H8998	Physician Incentive Contact	Interim VP, Health Services	Ms	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Plan Directory Contact for Public Website	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Plan to Plan Reconciliation Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Processor Contact	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Quality Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Reconciliation Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Reconciliation Contact (Secondary)	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Recovery Audit Contact	Chief Administrative Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Surveillance Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	System Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Third Party Administrator (TPA) Liaison	Sr Finance Analyst		Fountain	Lisa		6145463220					lfountain@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	User Access Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Utilization Management Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H8998	Utilization Review Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF CONNECTICUT INC	Local CCP	Trinity Health Plan Of New England	Local PPO		Trinity Health Corporation	234	Yes	Active					PPO - BBA		C	Chicago
H9001	Agent/Broker Compensation Data Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689722					Keith.Greiner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	10/16/2017	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Automated TrOOP Balance Transfer Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Backup User Access Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689722					Keith.Greiner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	11/06/2017	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Best Available Evidence Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Bid Audit Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Bid Audit Site Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Bid Primary Contact	Actuary	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/01/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	CAP Report Contact for Public Website	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/20/2020	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	CEO - CMS Administrator Contact	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/20/2020	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	CEO - Senior Official for Contracting	President & Chief Executive Officer	Mr.	Burke	Richard	P	5083689511					Richard.Burke@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/20/2020	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Chief Financial Officer	Chief Financial Officer	Mr.	Bailey	Todd		5083689097				5087914332	Todd.Bailey@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/27/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Chief Operating Officer	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Chief Information Officer	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/10/2017	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Chief Information Security Officer	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/10/2017	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	CMS Casework Communication Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Heather.Ulfves@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/09/2018	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Complaints Tracking Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Heather.Ulfves@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/09/2018	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Contact for Fraud Investigations	Director Internal Audit	Ms.	Brown	Velinda		5083689016				5083689111	Velinda.Brown@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/26/2016	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Coordination of Benefits Contact	Senior Director, Claims Administration	Ms	Straitiff	Kirsten		5083689047					kirsten.straitiff@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/20/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Corporate Mailing						5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Manager Accounting	Mr.	McNamara	Shawn		5083689085					Shawn.McNamara@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/14/2016	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Customer Service Operations Contact	VP, Customer Service	Mr.	Perron	Donald		5083689701					Donald.Perron@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	DIR Contact	Actuary	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/05/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	DIR Contact (Secondary)	Director and Senior Actuary, Government Programs	Mr.	Leung	Hang		5083689258					Hang.Leung@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/15/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Emergency Part D Contact	Manager, Customer Service	Mr.	Fregeau	Andrew		9784347996					Andrew.Fregeau@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/23/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Emergency Part D Contact (Secondary)	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Encounter Data & Risk Adjustment Operations Contact	Manager, Business Service Delivery	Ms.	Ernst	Alicia		5083689369					Alicia.Ernst@fallonhealth.org	One Chestnut Place	10 Chestnut St	Worcester	MA	01608	07/13/2020	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Enrollment Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	EOB Transfer Contact	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089			5088311136	Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Financial Audit Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Financial Reporting Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Formulary Contact	Sr. Director, Pharmacy Therapeutics	Ms.	Kendall	Kate		5087992100	79169				Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	08/09/2018	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Formulary Contact (Secondary)	VP,  Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	General Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Government Relations Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	HIPAA Privacy Officer	Privacy Officer	Ms.	Sanford	Katrin		5083689838					Katrin.Sanford@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/14/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	HIPAA Security Officer	VP IT Operations	Mr.	Petisce	Tony		5083689300					Tony.Petisce@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Hospice Contact	Supervisor, Pharmacy Technician Team	Ms.	Kendall	Kate		8003332535	79169				Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/31/2018	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Interoperability Contact	VP, Enterprise Technology Officer		Budaj	John		5083689362					john.budaj@fallonhealth.org	10 Chestnut Street		Worcester	MA	01608	12/29/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	MA Appeals/Grievances Contact	Director, Care Services Support	Ms.	Ryan	Patricia		5083689771					Patricia.Ryan@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/04/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	MA Claims Processing Contact for Public Website			Service	Customer		5087992100	69988				CustomerService@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Marketing Contact	Manager, Medicare Programs	Ms.	Kudron	Julie		5083689591					Julie.Kudron@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	05/14/2018	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Medical Director	Chief Medical Officer (Interim)	Dr.	David	Brumley		5083689567					David.Brumley@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	07/09/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Medicare Compliance Officer	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Medicare Coordinator	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Medicare Part D Opioid Overutilization Contact	Supervisor, Formulary Coordinators & Technicians	Ms.	Kendall	Kate		8003332535	79169				Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	10/30/2018	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Medication Therapy Management Contact	Manager, Pharmacy Ops & Clinical Programs	Mr.	Sartini	David		5083689790					David.Sartini@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/26/2017	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	OffShore Subcontractor Contact	Medicare Compliance & Regulatory Affairs Associate	Ms.	DeMarco	Kristie		5083689514					Kristie.DeMarco@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/02/2020	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Online Enrollment Center Contact (Back-up)	Enrollment and Billing Operations Manager	Ms.	Farrar	Christina		8003332535	79089				Christina.Farrar@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/24/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Online Enrollment Center Contact (Optional)	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689772					Keith.Greiner@fallonhealth.org	One Chestnut Place	10Chestnut Street	Worcester	MA	01608	10/16/2017	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Online Enrollment Center Contact (Primary)	Enrollment & Billing Operations Coordinator	Ms.	Walsh	Lisa		5083689597					Lisa.Walsh@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	05/14/2018	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Part C Application Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/27/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Part C Reporting Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689772					Keith.Greiner@fallonhealth.org	One Chestnut Place	10Chestnut Street	Worcester	MA	01608	10/16/2017	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Part D Appeals	Director, Care Services Support	Ms.	Ryan	Patricia							Patricia.Ryan@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/04/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689771				HMO - Health Maintenance Organization		C	Boston
H9001	Part D Appeals Contact (Secondary)	Manager, Member Appeals and Grievances	Ms.	Foulkes	Christina							Christina.Foulkes@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/08/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689447				HMO - Health Maintenance Organization		C	Boston
H9001	Part D Application Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/27/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Part D Benefits Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Part D Claims Submission Contact	VP,  Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Part D Exceptions Contact	Manager, Pharmacy Ops & Clinical Programs	Mr.	Sartini	David							David.Sartini@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	01/26/2017	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	5083689790				HMO - Health Maintenance Organization		C	Boston
H9001	Part D Exceptions Contact (Secondary)	Sr. Director, Pharmacy Therapeutics	Ms.	Kendall	Kate							Kate.Kendall@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	08/09/2018	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	5087992100	79169			HMO - Health Maintenance Organization		C	Boston
H9001	Part D Price File Contact (Back-up)	VP,  Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Part D Price File Contact (Primary)	Govt Programs and Quality Clinical Pharmacist	Mr.	Huynh	Jayce		5087992100	69212				Jayce.Huynh@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	07/13/2020	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Part D Quality Assurance Contact	Sr. Director, Pharmacy Therapeutics	Mr.	Huynh	Jayce		5083689212					Jayce.Huynh@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	08/09/2018	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Part D Reporting Contact	Medicare Regulatory Affairs Manager	Mr.	Greiner	Keith		5083689772					Keith.Greiner@fallonhealth.org	One Chestnut Place	10Chestnut Street	Worcester	MA	01608	10/16/2017	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Patient Safety Contact	VP,  Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	04/04/2023	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Payment Contact	Senior Manager Accounting	Mr.	McNamara	Shawn		5083689085					Shawn.McNamara@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Pharmacy Director	VP,  Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Pharmacy Network Management Contact	VP,  Pharmacy Services	Mr.	Barner	Benjamin		5083689660					Benjamin.Barner@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	016082810	09/19/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Ops and Clinical Programs	Mr.	Sartini	David		5083689790					David.Sartini@fallonhealth.org	One Chestnut Place,	10 Chestnut Street	Worcester	MA	01608	09/10/2020	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Pharmacy Technical Help Desk Contact			Help Desk	OptumRx								1600 McConnor Parkway		Schaumburg	IL	60173	12/29/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	8443688734				HMO - Health Maintenance Organization		C	Boston
H9001	Pharmacy Technical Help Desk Contact (Secondary)			Summers	Todd								OptumRx	755 Research Pkwy, Suite 300	Oklahoma City	OK	73104	12/29/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active	8664431095				HMO - Health Maintenance Organization		C	Boston
H9001	Physician Incentive Contact	VP, Network Development and Management	Ms.	Keser	Susan		5083689261					Susan.Keser@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/27/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Plan Directory Contact for Public Website			Service	Customer		5087992100	69988				CustomerService@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Plan to Plan Reconciliation Contact	Director, Medical Accounting	Mr.	Beaulieu	Michael		5083689020					Michael.Beaulieu@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	09/07/2023	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Processor Contact	Customer Service Team Lead	Ms.	Ulfves	Heather		5087992100	79275				Heather.Ulfves@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/09/2018	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Quality Contact	Director of Quality	Ms.	Little	Dawn		5083689263					Dawn.Little@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	04/04/2023	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Reconciliation Contact	Actuarial Associate	Mr.	Nganga	Francis		5087992100	79339				Francis.Nganga@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/03/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Reconciliation Contact (Secondary)	Director and Senior Actuary, Government Programs	Mr.	Leung	Hang		5083689258					Hang.Leung@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/15/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Recovery Audit Contact	Senior Director, Claims Administration	Ms	Straitiff	Kirsten		5083689047					kirsten.straitiff@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	02/08/2022	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	SNP Application Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	SNP State Contact	Executive Director, NaviCare	Ms.	Daviau	Deborah		5083689489					Deborah.Daviau@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/17/2021	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Surveillance Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	System Contact	Senior Vice President and Chief Operations Officer	Ms.	West	Emily		5083689592					Emily.West@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	03/10/2017	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Third Party Administrator (TPA) Liaison	Financial Accounting & Reporting Sr. Analyst	Ms.	Maesto	Alison		5083689486					Alison.Maesto@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	08/27/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	User Access Contact	SrDirector MDCR Programs & MDCR Compliance Officer	Ms.	Lashbrook	Lisa		5083689539					Lisa.Lashbrook@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	12/01/2015	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Utilization Management Contact	VP Clinical Operations	Ms.	Aiello	Linda		5083689134					Linda.Aiello@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	07/10/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9001	Utilization Review Contact	VP Clinical Operations	Ms.	Aiello	Linda		5083689134					Linda.Aiello@fallonhealth.org	One Chestnut Place	10 Chestnut Street	Worcester	MA	01608	07/10/2019	2023	FALLON COMMUNITY HEALTH PLAN	Local CCP	Fallon Health	HMO/HMOPOS		Fallon Community Health Plan, Inc.	88	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9003	Agent/Broker Compensation Data Contact	Manager, Medicare Compliance		Lawrence	Winston		5105070510					winston.d.lawrence@kp.org	1 Kaiser Plaza, 12th Floor		Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Automated TrOOP Balance Transfer Contact	Project Manager III, Pharmacy Benefit Mgmt		Perez	Elizabeth	R	5623670592					Elizabeth.R.Perez@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	08/02/2018	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Backup User Access Contact	Compliance Consultant, Medicare		Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St.		Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Best Available Evidence Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Bid Audit Contact	Executive Director Actuarial		Kenny	Kevin		5102677544					kevin.x.kenny@kp.org	300 Lakeside Drive, 28th Floor		Oakland	CA	94612	12/18/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Bid Audit Site Contact	Compliance Consultant		Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/01/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Bid Primary Contact	Actuary		Chong	Evelyn		5102677544					evelyn.c.chong@kp.org	3100 Thornton Ave.		Burbank	CA	91504	12/18/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	CAP Report Contact for Public Website	Compliance Consultant, Medicare		Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St.		Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	CEO - CMS Administrator Contact	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	CEO - Senior Official for Contracting	Senior VP, Medicare & Individual Lines of Business	Ms	Weiss	Tina		5103004941					tina.a.weiss@kp.org	One Kaiser Plaza		Oakland	CA	94612	04/10/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Chief Financial Officer	SVP, CFO Business Units and Finance Operations	Mr.	Beltch	Robert	R	8184897560					rob.beltch@kp.org	1 Kaiser Plaza, Suite 806	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/15/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Chief Operating Officer	Executive Director, Medicare Market Strategy & Ops	Mr.	Miller	Paul		5033410073					paul.a.miller@kp.org	500 NE Multnomah St., Ste. 100		Portland	OR	97232	04/10/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Chief Information Officer	Chief Information Officer	Ms.	Comer	Diane		5102258777					Diane.B.Comer@kp.org	2600 Napa Valley Corporate Drive		Napa	CA	94558	09/17/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Chief Information Security Officer	VP, Chief Information Security Officer	Mr.	Goddard	Jim		3037133890					James.P.Goddard@kp.org	6560 Greenwood Plaza Blvd.		Greenwood Village	CO	80111	02/03/2016	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	CMS Casework Communication Contact	Compliance Consultant, Medicare		Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St.		Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Complaints Tracking Contact	Customer Concern Resolution Center, Manager		Lutz	Heidi		9714047562					Heidi.A.Lutz@kp.org	500 NE Multnomah St., Suite 100		Portland	OR	97232	09/23/2022	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Contact for Fraud Investigations	Director, Fraud Control		Janiga	Marita	C	5102716937					Marita.C.Janiga@kp.org	One Kaiser Plaza, Ordway Bldg., 12th Floor		Oakland	CA	94612	06/09/2010	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Coordination of Benefits Contact	Senior Director		Chung	Clarence		5623909293				5626583866	clarence.j.chung@kp.org	12254 Bellflower Blvd - Suite 106, 1st Floor		Downey	CA	90242	04/28/2022	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Corporate Mailing						9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St., 10th Floor	Attn: Heidi Lutz, Compliance Dept.	Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Coverage Gap Discount Program (CGDP) Payment Contact			Ballestros	Mayra		6262525164					mayra.x.lujano@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	02/15/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Customer Service Operations Contact			Services	Member		8004430815					mscc@kp.org	1800 Harrison St., 23rd Floor		Oakland	CA	94612	10/25/2019	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	DIR Contact	Senior Business Process Manager		Hsiue	Tony		5626583836					tony.x.hsiue@kp.org	12254 Bellflower Blvd.  Flr. 2		Downey	CA	90242	03/09/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	DIR Contact (Secondary)	Sr. Financial Analyst		San	Kei		5626583445					Kei.San@kp.org	12254 Bellflower Blvd. Fl. 2		Downey	CA	90242	07/17/2018	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Electronic Health Record Contact	Sr Manager, Meaningful Use PMO		Poole	Dolly		5106255813					dolly.poole@kp.org	1800 Harrison St.		Oakland	CA	94612	07/02/2018	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Emergency Part D Contact	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/04/2022	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Emergency Part D Contact (Secondary)	Compliance Consultant, Medicare	Ms.	Lutz	Heidi		2403308451					heidi.a.lutz@kp.org	500 NE Multnomah St., Suite 100	Attn: Compliance Department	Portland	OR	97232	01/04/2022	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Employer Waiver Contact	Compliance Consultant, Medicare		Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St., Suite 100	Attn: Compliance Department	Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Encounter Data & Risk Adjustment Operations Contact	Director, Risk Adjustment Submission	Ms.	Gu	Jialin		3033383507					jialin.gu@kp.org	2500 South Havana		Aurora	CO	80014	10/21/2019	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Enrollment Contact	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	EOB Transfer Contact	Pharmacy Medicare Operations, Project Manager II		Bonoan	John	B	5624180564				5626583848	john.b.bonoan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/12/2012	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Financial Audit Contact	Compliance Consultant	Ms.	Tadevosyan	Syuzi		8182992300					syuzi.x.tadevosyan@kp.org	3100 Thornton Ave.		Burbank	CA	91504	06/02/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Financial Reporting Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Formulary Contact	Pharmacy Project Manager		Kim	Jung		5624459129					jung.x3.kim@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/20/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Formulary Contact (Secondary)	Pharmacy Project Manager		Lin	Clement		5624459129					Clement.J.Lin@kp.org	12254 Bellflower Blvd		Downey	CA	90242	08/09/2018	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	General Contact	Compliance Consultant, Medicare		Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St., Suite 100	Attn: Compliance Department	Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Government Relations Contact	Senior Vice President, Government Relations		Barrueta	Anthony	A	5102716835					Anthony.Barrueta@kp.org	One Kaiser Plaza		Oakland	CA	94612	10/10/2014	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	HIPAA Privacy Officer	Compliance Director		Anderson	Angela		5104353413					Angela.B.Anderson@kp.org	1800 Harrison Street	16th Floor	Oakland	CA	94612	11/06/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	HIPAA Security Officer	Senior Director		Vourthis	Bill		9252065125					bill.d.vourthis@kp.org	5820 Owens Drive	Building E	Pleasanton	CA	94588	08/25/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Hospice Contact	Senior Team Manager, Medicare Membership Admin.		Salcido	Adam		8588293521					CSC-SD-Hospice-BAE@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	04/24/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Interoperability Contact	National EDI Business Operations		Plattner	Cathy		6268336526					cathy.p.plattner@kp.org	75 N Fair Oaks Ave.		Pasadena	CA	91103	11/03/2021	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	MA Appeals/Grievances Contact	Executive Director, Member Relatio		Osborne	Susan		5038133924					Susan.A.Osborne@kp.org	500 NE Multnomah St., Suite 100		Portland	OR	97232	10/29/2021	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	MA Claims Processing Contact for Public Website	Dir Customer Engagement Mgmt		Galloway	Lonnie		9094772466					Lonnie.L.Galloway@kp.org	10740 4th Street		Rancho Cucamonga	CA	91730	08/02/2018	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Marketing Contact	Program Manager Consumer Plans		Kelly	Meghan		5038134469					KP-MedicareFilings@kp.org	500 NE Multnomah Suite 100		Portland	OR	97232	06/30/2021	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Medical Director	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	11/16/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Medicare Compliance Officer	Compliance Consultant, Medicare	Ms.	Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St., Suite 100	Attn: Compliance Department	Portland	OR	97232	01/31/2022	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Medicare Coordinator	Director, Medicare		Sage	Brian		5033105368					Brian.E.Sage@kp.org	500 NE Multnomah Suite 100		Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Medicare Part D Opioid Overutilization Contact	Pharmacist Project Manager		Chong	Sue	H	5626583661					sue.h.chong@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	12/05/2018	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Medication Therapy Management Contact	Medication Therapy Management		Deguzman	Lynn		5106253989					lynn.f.deguzman@kp.org	1800 Harrison St., 13th Floor		Oakland	CA	94612	10/25/2019	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	OffShore Subcontractor Contact	Compliance Consultant - Privacy and Security		Glenn	Jovan		9092512010					Jovan.Robinson@kp.org	10740 Fourth Street	2nd Floor  Cubicle: 023W02	Rancho Cucamonga	CA	91730	08/26/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Online Enrollment Center Contact (Back-up)	Senior Team Manager, Medicare Membership Admin		Nugent	Kristin		8586376801					kristin.n.nugent@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Online Enrollment Center Contact (Optional)	Operations Manager, Medicare Membership Admin		Duda	Arlet		8586143377					arlet.b.duda@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Online Enrollment Center Contact (Primary)	Team Manager, Medicare Membership Administration		Covarrubio	Danny		8586143433					danny.x.covarrubio@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Part C Application Contact	Compliance Consultant, Medicare		Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St., Suite 100	Attn: Compliance Department	Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Part C Reporting Contact	Compliance Consultant, Medicare		Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St.		Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Part D Appeals	Executive Director, Member Relations		Osborne	Susan							Susan.A.Osborne@kp.org	500 NE Multnomah St., Suite 100		Portland	OR	97232	10/29/2021	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8774083496				HMO - Health Maintenance Organization		C	San Francisco
H9003	Part D Application Contact	Compliance Consultant, Medicare		Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St., Suite 100	Attn: Compliance Department	Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Part D Benefits Contact	Pharmacy Medicare Business Line Manager		Bonvie	Claudette		5623199392					claudette.r.bonvie@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	10/25/2019	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Part D Claims Submission Contact	Director, Business Process Management		Pappas	Theodore		5033079849					theodore.pappas@kp.org	500 NE Multnomah		Portland	OR	97232	05/15/2018	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Part D Exceptions Contact	Executive Director, Member Relations		Osborne	Susan							Susan.A.Osborne@kp.org	500 NE Multnomah St., Suite 100		Portland	OR	97232	10/29/2021	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8774083496				HMO - Health Maintenance Organization		C	San Francisco
H9003	Part D Price File Contact (Back-up)	Project Manager	Ms.	Kamikawa	Emely		5622998753					Emely.A.Kamikawa@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	10/31/2019	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Part D Price File Contact (Optional)	Associate Consultant		Quan	Mariclare		5623850395					mariclare.a.quan@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Part D Price File Contact (Primary)	Pharmacy Pricing		Bullard	Myra		5623195747				5626583712	myra.c.bullard@kp.org	12254 Bellflower Blvd., 2nd Floor		Downey	CA	90242	01/26/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Part D Quality Assurance Contact	Vice President, Clinical Pharmacy Services		Le	Kim		5622997015					Kim.N1.Le@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Part D Reporting Contact	Compliance Consultant, Medicare		Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St.		Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Patient Safety Contact	Vice President, Clinical Pharmacy Services		Le	Kim		5622997015					Kim.N1.Le@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	06/01/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Payment Contact	Controller National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza, Suite 2552		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Pharmacy Director	Pharmacy Director		Lyman, Jr.	Alfred	E	5032617926					alfred.e.lyman@kp.org	5725 NE 138th Ave		Portland	OR	97230	04/18/2017	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Pharmacy Network Management Contact	National Pharmacy Benefits, Project Manager II		Munoz	Vanessa		5624477739					Vanessa.L.Munoz@kp.org	12254 Bellflower Blvd.		Downey	CA	90242	10/25/2019	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Pharmacy Technical Help Desk Contact			OptumRx	PBM								755 Research Parkway Suite 160		Oklahoma City	OK	73104	11/02/2016	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active	8887917245				HMO - Health Maintenance Organization		C	San Francisco
H9003	Physician Incentive Contact	Compliance Consultant, Medicare		Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St., Suite 100	Attn: Compliance Department	Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Plan Directory Contact for Public Website			Services	Member		8772218221					kaiserpermanente@kp.org	500 NE Multnomah St.,Suite 100		Portland	OR	97232	04/05/2007	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Plan to Plan Reconciliation Contact	Interim Director, Medicare Accounting		Wright	Mark	A	9253239443					mark.a.wright@kp.org	1 Kaiser Plaza, 25th Floor		Oakland	CA	94612	01/20/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Processor Contact	Medicare Compliance Consultant	Mr.	Carver	Jon	R	4257578659					jonathan.r.carver@kp.org	1300 SW 27th St.		Renton	WA	98057	09/05/2023	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Quality Contact	Executive Vice President, Chief Medical Officer	Dr.	Bindman	Andrew	B	5102716624					Andrew.B.Bindman@kp.org	One Kaiser Plaza	26th floor	Oakland	CA	94612	05/25/2022	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Reconciliation Contact	Controller, National Medicare Finance	Ms.	Gaeta	Ines		9517433423					ines.gaeta@kp.org	1 Kaiser Plaza		Oakland	CA	94612	03/28/2022	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Reconciliation Contact (Secondary)	Vice President & Chief Financial Officer	Ms.	Shepler	Courtney	R	5102714644					courtney.r.shepler@kp.org	National Medicare Finance, 1 Kaiser Plaza, 13th Floor	c/o Kaiser Foundation Health Plan	Oakland	CA	94612	09/01/2017	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Recovery Audit Contact	Manager, Revenue Mgmt Compliance	Ms	Gonzalez	Heidy	G	6263723181					heidy.gonzalez@kp.org	74 S Fair Oaks Avenue		Pasadena	CA	91103	08/03/2022	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Surveillance Contact	Compliance Consultant, Medicare		Lutz	Heidi		9714047562					heidi.a.lutz@kp.org	500 NE Multnomah St., Suite 100	Attn: Compliance Department	Portland	OR	97232	08/07/2020	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	System Contact	Director, Membership Administration Systems & S.S.		Putman	Anthony		8586506364					anthony.m.putman@kp.org	3840 Murphy Canyon Rd.		San Diego	CA	92123	09/01/2017	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Third Party Administrator (TPA) Liaison	Senior Accountant		Thornal	Sun		6264056311					sun.a.thornal@kp.org	393 E Walnut St., 4th floor		Pasadena	CA	91188	12/12/2016	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	User Access Contact	Compliance Consultant, Medicare		Lutz	Heidi		5038132694					heidi.a.lutz@kp.org	500 NE Multnomah St., Suite 100	Att: Compliance department	Portland	OR	97232	11/16/2017	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Utilization Management Contact	Sr. Director, Utilization Mgmt.		Roberts	Christi		3608015698					Christi.R.Roberts@kp.org	500 NE Multnomah, #100		Portland	OR	97232	10/29/2021	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9003	Utilization Review Contact	Utilization Review Administrator		Fazio	Kathleen		5038134488					Kathleen.M.Fazio@kp.org	500 NE Multnomah, #100		Portland	OR	97232	05/15/2018	2023	KAISER FOUNDATION HP OF THE N W	Local CCP	Kaiser Permanente	HMO/HMOPOS		Kaiser Foundation Health Plan, Inc.	138	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9042	Agent/Broker Compensation Data Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Automated TrOOP Balance Transfer Contact	Director of Data Integration & Development	Mr.	Katheeder	Tim		8123787066					Tim.Katheeder@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Backup User Access Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Best Available Evidence Contact	Member and Provider Services		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Bid Audit Contact	COO	Mr.	McConnell	Roy	E	8323858189					Roy.McConnell@MyTruAdvantage.com	417 Washington Street		Columbus	IN	47201	09/01/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Bid Primary Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	CAP Report Contact for Public Website	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	10/22/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	CEO - CMS Administrator Contact	President & CEO	Mr.	Sadtler	John		8123738714					John.Sadtler@siho.org	PO Box 1787		Columbus	IN	472021787	02/06/2020	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	CEO - Senior Official for Contracting	President & CEO	Mr.	Sadtler	John		8123738714					John.Sadtler@siho.org	PO Box 1787		Columbus	IN	472021787	02/06/2020	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Chief Financial Officer	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington Street		Columbus	IN	472021787	08/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Chief Operating Officer	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington St		Columbus	IN	47201	04/07/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Chief Information Officer	Vice President, Information Technology	Mr.	Clancy	Mike		8123787052					Mike.Clancy@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Chief Information Security Officer	Director of Technology Services	Mr.	Taylor	Rob		8123787046					Rob.Taylor@siho.org	PO Box 1787		Columbus	IN	472021787	02/06/2020	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	CMS Casework Communication Contact	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.do@siho.org	417 Washington Street		Columbus	IN	47201	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Complaints Tracking Contact	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.do@siho.org	417 Washington Street		Columbus	IN	47201	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Contact for Fraud Investigations	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.do@siho.org	417 Washington Street		Columbus	IN	47201	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Coordination of Benefits Contact	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.do@siho.org	417 Washington Street		Columbus	IN	47201	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Corporate Mailing						8123787000					Hannah.Hauser@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington Street		Columbus	IN	472021787	08/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Customer Service Operations Contact	Director of Customer Service		Diedrich	Bridget		8123142500	1073				Bridget.Diedrich@siho.org	PO Box 1787		Columbus	IN	472021787	10/05/2020	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	DIR Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington Street		Columbus	IN	472021787	08/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	DIR Contact (Secondary)	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington Street		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Electronic Health Record Contact	Member and Provider Services		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active	8444254280				PPO - BBA		C	Chicago
H9042	Emergency Part D Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Emergency Part D Contact (Secondary)	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Encounter Data & Risk Adjustment Operations Contact	VP Operations	Mr.	Massard	Gary		8123787083					Gary.Massard@siho.org	PO Box 1787		Columbus	IN	472021787	06/24/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Enrollment Contact	Director of Data Integration & Development	Mr.	Katheeder	Tim		8123787066					Tim.Katheeder@siho.org	PO Box 1787		Columbus	IN	472021787	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	EOB Transfer Contact	Member and Provider Services		Services	Member		8444254280				3178603632	memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Financial Audit Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington Street		Columbus	IN	472021787	08/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Financial Reporting Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington Street		Columbus	IN	472021787	08/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Formulary Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Formulary Contact (Secondary)			Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	03/25/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	General Contact	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington Street		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Government Relations Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	HIPAA Privacy Officer	Administration and PHO Lead		Prabhune	Sheetal		8123787097	3003				sprabhune@inspirehealthpartners.com	PO Box 1787		Columbus	IN	472021787	02/06/2020	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	HIPAA Security Officer	Director Technology Services	Mr.	Taylor	Rob		8123787046					Rob.Taylor@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Hospice Contact	Member and Provider Services		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	47201	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Interoperability Contact	Director of Provider Relations		Jones	Michelle		8123787107					Michelle.Jones@siho.org	417 Washington Street		Columbus	IN	47201	12/17/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	MA Appeals/Grievances Contact	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.do@siho.org	417 Washington Street		Columbus	IN	47201	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	MA Claims Processing Contact for Public Website	Member and Provider Service		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/24/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Marketing Contact	Reports Specialist	Ms.	Gottman	Melissa		8123142500	1107				Melissa.Gottman@MyTruAdvantage.com	417 Washington Street		Columbus	IN	472021787	09/01/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Medical Director	Medical Director	Dr.	Goode	Roy		8123430967					Roy.Goode@siho.org	PO Box 1787		Columbus	IN	472021787	08/23/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Medicare Compliance Officer	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington Street		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Medicare Coordinator	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Medicare Part D Opioid Overutilization Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Medication Therapy Management Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	OffShore Subcontractor Contact	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington St		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Online Enrollment Center Contact (Back-up)	Manager of Quality Assurance, G&A, FWA & RA		Do	Nicole		8123142500	1102				Nicole.Do@siho.org	417 Washington Street		Columbus	IN	47201	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Online Enrollment Center Contact (Optional)	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington Street		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Online Enrollment Center Contact (Primary)	Director of Data Integration & Development	Mr.	Katheeder	Tim		8123787066					Tim.Katheeder@siho.org	PO Box 1787		Columbus	IN	472021787	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Part C Application Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Part C Reporting Contact	Reports Specialist		Gottman	Melissa		8123142500	1107				Melissa.Gottman@siho.org	417 Washington Street		Columbus	IN	47202	10/22/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Part D Appeals	Member and Provider Services		Services	Member							memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active	8444254280				PPO - BBA		C	Chicago
H9042	Part D Appeals Contact (Secondary)	Member and Provider Services		Services	Member							memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	47202	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active	8444254280				PPO - BBA		C	Chicago
H9042	Part D Application Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	05/10/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Part D Benefits Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Part D Claims Submission Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Part D Exceptions Contact	Member and Provider Services		Services	Member							memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active	8444254280				PPO - BBA		C	Chicago
H9042	Part D Exceptions Contact (Secondary)	Member and Provider Services		Services	Member							memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active	8444254280				PPO - BBA		C	Chicago
H9042	Part D Price File Contact (Back-up)	General Consultant User		Keller	Sharon		8587907104					PlanFinderCommunications@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	09/19/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Part D Price File Contact (Optional)	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@SIHO.org	417 Washington St		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Part D Price File Contact (Primary)	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Part D Quality Assurance Contact	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington St.		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Part D Reporting Contact	Reports Specialist		Gottman	Melissa		8123142500	1107				Melissa.Gottman@siho.org	417 Washington Street		Columbus	IN	47201	10/22/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Patient Safety Contact	Reports Specialist		Gottman	Melissa		8123142500	1107				Melissa.Gottman@SIHO.org	417 Washington Street		Columbus	IN	47201	11/18/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Payment Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington Street		Columbus	IN	47202	08/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Personal Health Record Contact	Member and Provider Service		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/24/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Pharmacy Director	Medical Director	Dr.	Goode	Roy		8123430967					Roy.Goode@siho.org	PO Box 1878		Columbus	IN	472021787	08/23/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Pharmacy Network Management Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly		8123787028					Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Pharmacy Network Management Contact (Secondary)	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	08/20/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Pharmacy Technical Help Desk Contact	Director, Part D Operations & Vendor Oversight		Helsley	Kimberly							Kim.Helsley@siho.org	417 Washington Street		Columbus	IN	47201	03/21/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active	8666934620				PPO - BBA		C	Chicago
H9042	Pharmacy Technical Help Desk Contact (Secondary)	COO	Mr.	McConnell	Roy							Roy.McConnell@mytruadvantage.com	417 Washington Street		Columbus	IN	47201	08/20/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active	8666934620				PPO - BBA		C	Chicago
H9042	PHR Beneficiary Contact																	02/24/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO	Southeastern Indiana Health Organization Inc	SIHO Holding, Inc.	761	Yes	Active	8444254280				PPO - BBA		C	Chicago
H9042	Physician Incentive Contact	Director of Provider Relations		Jones	Michelle		8123787107					Michelle.Jones@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Plan Directory Contact for Public Website	Member and Provider Service		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/18/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Plan to Plan Reconciliation Contact	Staff Accountant I		Dobbs	Rachel		8123142500	1202				rachel.dobbs@siho.org	417 Washington Street		Columbus	IN	47201	05/12/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Processor Contact	Senior Executive	Mr.	Massard	Gary		8123787083					Gary.Massard@siho.org	PO Box 1787		Columbus	IN	472021787	02/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Quality Contact	Manager of Quality Assurance		Do	Nicole		8123142500	1102				Nicole.Do@siho.org	PO Box 1787		Columbus	IN	472021787	08/03/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Reconciliation Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington St		Columbus	IN	47201	08/19/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Reconciliation Contact (Secondary)	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@SIHO.org	417 Washington St		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Recovery Audit Contact	Chief Financial Officer	Ms.	Newell	Wendy		8123787040					Wendy.Newell@SIHO.org	417 Washington St		Columbus	IN	47201	08/20/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Surveillance Contact	COO	Mr.	McConnell	Roy		8323858189					Roy.McConnell@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	10/22/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	System Contact	Vice President Information Technology	Mr.	Clancy	Mike		8123787052					Mike.Clancy@siho.org	PO Box 1787		Columbus	IN	472021787	01/05/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Third Party Administrator (TPA) Liaison	Staff Accountant I		Dobbs	Rachel		8123142500	1202				rachel.dobbs@siho.org	417 Washington Street		Columbus	IN	47201	05/12/2021	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	User Access Contact	Chief Compliance Officer	Mr.	Marx	David		8123787101					David.Marx@siho.org	417 Washington Street		Columbus	IN	47201	12/13/2022	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Utilization Management Contact	Member and Provider Services		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9042	Utilization Review Contact	Member and Provider Services		Services	Member		8444254280					memberservices@mytruadvantage.com	PO Box 1787		Columbus	IN	472021787	02/16/2023	2023	SOUTHEASTERN INDIANA HEALTH ORGANIZATION, INC.	Local CCP	MyTruAdvantage	Local PPO		SIHO Holding, Inc.	761	Yes	Active					PPO - BBA		C	Chicago
H9047	Agent/Broker Compensation Data Contact	Director Sales Medicare/Individual		Drotning	Shannon		5035747123					shannon.drotning@providence.org	4400 NE Halsey St		Portland	OR	97213	10/18/2019	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Automated TrOOP Balance Transfer Contact	Business Analyst Systems Coord, Pharmacy	Ms.	Cintron	Alicia		5035748064				5035748646	alicia.cintron@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/08/2021	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Backup User Access Contact	Supervisor- Medicare Membership Accounting		Hopkins	Chantel		5035745723					chantel.hopkins@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	05/24/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Best Available Evidence Contact	Supervisor- Medicare Membership Accounting		Hopkins	Chantel		5035745723					chantel.hopkins@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	05/24/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Bid Audit Contact	Director Actuarial Analytics		Phillips	Brittney		5035747955					brittney.phillips@providence.org	4400 NE Halsey St.		Portland	OR	97213	09/12/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Bid Primary Contact	Director Actuarial Analytics		Phillips	Brittney		5035747955					brittney.phillips@providence.org	4400 NE Halsey St.		Portland	OR	97213	09/12/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	CAP Report Contact for Public Website	Director-Medicare Compliance	Mrs.	Dunphy	Misty		3106178718					misty.dunphy@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	08/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Antonucci	Don		5035747540					don.antonucci@providence.org	4400 NE Halsey Street, Building 2	Suite 690	Portland	OR	97213	01/04/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Antonucci	Don		5035747540					don.antonucci@providence.org	4400 NE Halsey Street, Building 2	Suite 690	Portland	OR	97213	01/04/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Chief Financial Officer	Chief Financial Officer	Ms.	Saadzoi	Lina		5035747425					lina.saadzoi@providence.org	4400 NE Halsey ST	Building 1	Portland	OR	97213	06/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Chief Operating Officer	Chief Operating Officer	Ms.	Morrison	Cheryl		5035746605					cheryl.morrison@providence.org	4400 NE Halsey Street	Building 2 Suite 690	Portland	OR	97213	04/14/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Chief Information Officer	Chief Information Officer	Mr.	Mathias	Michael		5035748083					michael.mathias@providence.org	4400 NE Halsey Street	Building 1	Portland	OR	97213	08/08/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Chief Information Security Officer	Chief Information Officer	Mr.	Mathias	Michael		5035748083					michael.mathias@providence.org	4400 NE Halsey Street	Building 1	Portland	OR	97213	08/08/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	CMS Casework Communication Contact	Compliance Medicare Consultant		Saucy	Tara		5035747431					tara.saucy@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	11/22/2022	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Complaints Tracking Contact	Associate Medicare Compliance Specialist		Smith	Cassie		5035747323	47323				Cassie.smith@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	06/21/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Contact for Fraud Investigations	Director Payment Integrity		Yue	Katherine		5035747165	47165				Katherine.Yue@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	01/31/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Coordination of Benefits Contact	Manager-OFT		Parish	Lori		5035745861					Lori.parish@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	01/26/2022	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Corporate Mailing						3106178718					misty.dunphy@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	08/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Coverage Gap Discount Program (CGDP) Payment Contact	Principal Healthcare Data Analyst		Rodgers	Tyler		5035746351					tyler.rodgers@providence.org	4400 NE Halsey Street	Bldg 2, Suite 690	Portland	OR	97213	02/21/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Customer Service Operations Contact	Supervisor Service Ops-Customer Service		Aronson	Elizabeth		5035746589					Elizabeth.Aronson@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	11/05/2019	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	DIR Contact	Principal Healthcare Data Analyst		Rodgers	Tyler		5035746351					tyler.rodgers@providence.org	4400 NE Halsey Street	Bldg 2. Suite 690	Portland	OR	97213	02/21/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	DIR Contact (Secondary)	Business Analyst - Systems Coord, Pharmacy		Williams	Teresa		5035747308					Teresa.Williams@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	07/11/2018	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Emergency Part D Contact	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M	5035443208					Helen.Noonan-Harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Emergency Part D Contact (Secondary)	Director, Pharmacy		Clark	James		3609537484					james.clark2@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	04/19/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Encounter Data & Risk Adjustment Operations Contact	Supervisor-Clinical Informatics		Gaskin	Robert		3603592678					Robert.gaskin@providence.org	3601 SW Murray Blvd		Beaverton	OR	97005	06/21/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Enrollment Contact	Supervisor- Medicare Membership Accounting		Hopkins	Chantel		5035745723					chantel.hopkins@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	05/24/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	EOB Transfer Contact	Director, Pharmacy	Mr.	Clark	James		5035746571	6571			8002497714	james.clark2@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	03/02/2022	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Financial Audit Contact	Director-Medicare Compliance	Mrs.	Dunphy	Misty		3106178718					misty.dunphy@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	08/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Financial Reporting Contact	Chief Financial Officer		Saadzoi	Lina		5035747425					lina.saadzoi@providence.org	4400 NE Halsey Street	Building 1	Portland	OR	97123	06/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Formulary Contact	Program Manager - Clinical Pharmacy Outcomes	Dr.	Smith	Jenifer		5035747829					Jenifer.Smith@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	12/21/2018	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Formulary Contact (Secondary)	Senior Pharmacy Technician		Frost	Sarah		5035747158					Sarah.Frost@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	05/28/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	General Contact	Director-Medicare Compliance	Mrs.	Dunphy	Misty		3106178718					misty.dunphy@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	08/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Government Relations Contact	Chief Compliance & Risk Officer	Mr.	Bals	Aaron		5035746562					aaron.bals@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	06/17/2022	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	HIPAA Privacy Officer			Bals	Aaron		5035746562					aaron.bals@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	06/25/2019	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	HIPAA Security Officer	VP of Engineering		Acosta	Fernando		5035748083					Fernando.Acosta@providence.org	4400 NE Halsey Street	Building 1	Portland	OR	97213	08/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Hospice Contact	Compliance & Product Mgmt Coordinator, Pharmacy		Moore	James		5035747924					James.Moore@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	03/25/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Interoperability Contact	Compliance Medicare Consultant		Saucy	Tara	J	5035747431					Tara.Saucy@providence.org	3601 SW Murray Blvd		Beaverton	OR	97005	02/11/2022	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	MA Appeals/Grievances Contact	Supervisor Appeals and Grievances		Nichuals	Ronni		5035746236					Ronni.Nichuals@providence.org	3601 SW Murray Blvd		Beaverton	OR	97005	01/04/2021	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	MA Claims Processing Contact for Public Website	Manager, Public Programs Claims		Jointer	Priscilla		5035745626					Priscilla.jointer@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	12/22/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Marketing Contact	Medicare Compliance Specialist		Humm	Merry		5035747469					Merry.Humm@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	10/13/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Medical Director	Chief Medical Officer	Dr.	Gluckman	Robert		5035746406				5035746464	Robert.Gluckman@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	06/20/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Medicare Compliance Officer	Director-Medicare Compliance	Mrs.	Dunphy	Misty		3106178718					misty.dunphy@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	08/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Medicare Coordinator	Director-Medicare Compliance	Mrs.	Dunphy	Misty		3106178718				5035746543	misty.dunphy@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	08/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Medicare Part D Opioid Overutilization Contact	Program Manager - Quality & UM Programs		Wallenslager	Daniel		5035745628					Daniel.Wallenslager@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	06/17/2022	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Medication Therapy Management Contact	Manager-Pharmacy		Criswell-Cacho	John		5413878245					john.criswell-cacho2@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	04/19/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Online Enrollment Center Contact (Back-up)	Manager Medicare Membership Accounting		Maust	Cathy		5035745690				5035748627	cathleen.maust@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	09/29/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Online Enrollment Center Contact (Primary)	Supervisor- Medicare Membership Accounting		Hopkins	Chantel		5035745723					chantel.hopkins@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	05/24/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Part C Application Contact	Director-Medicare Compliance	Mrs.	Dunphy	Misty		3106178718					misty.dunphy@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	08/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Part C Reporting Contact	Manager, Medicare Compliance Program	Mrs.	Ocheltree	Amy		5035746098					amy.ocheltree@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	07/21/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Appeals	Supervisor Part D Appeals	Ms.	Nichuals	Ronni							Ronni.Nichuals@providence.org	PO Box 4158		Portland	OR	97208	01/05/2021	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active	8008784445				HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Appeals Contact (Secondary)	VP Health Care Services Administration	Mr	Dietzman	Greg							gregory.dietzman@providence.org	PO Box 4158		Portland	OR	97208	04/14/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active	8008784445				HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Application Contact	Director-Medicare Compliance		Dunphy	Misty		3106178718					Misty.dunphy@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	08/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Benefits Contact	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M	5035745708				5035748646	Helen.noonan-harnsberger@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	12/29/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Claims Submission Contact	VP, Pharmacy		Noonan-Harnsberger	Helen		5035745708					helen.noonan-harnsberger@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	04/19/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Exceptions Contact	Director, Pharmacy		Clark	James							james.clark2@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	03/02/2022	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active	8772163644				HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Exceptions Contact (Secondary)	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M						Helen.noonan-harnsberger@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	12/23/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active	5035745708				HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Price File Contact (Back-up)	Business Analyst - Systems Coord, Pharmacy	Mrs.	Williams	Teresa		5035747308					Teresa.Williams@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	05/24/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Price File Contact (Optional)	DST Health Systems		Boileau	Tiffany		5165510627					tiffany.boileau@sscinc.com	210 10th Street		Kansas City	MO	64105	01/05/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Price File Contact (Primary)	DST Health Systems		Joslin	Karen		8167567860					karen.joslin@sscinc.com	210 10th Street		Kansas City	MO	64105	01/05/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Quality Assurance Contact	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M	5035745708				5035748646	Helen.noonan-harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Part D Reporting Contact	Manager, Medicare Compliance Program	Mrs.	Ocheltree	Amy		5035746098					amy.ocheltree@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	07/21/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Patient Safety Contact	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen		5035745708				5035748646	Helen.noonan-harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/29/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Payment Contact	Chief Financial Officer		Saadzoi	Lina		5035747425					lina.saadzoi@providence.org	4400 NE Halsey ST	Building 1	Portland	OR	97213	06/27/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Pharmacy Director	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M	5035745708				5035748646	Helen.noonan-harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Pharmacy Network Management Contact	VP, Pharmacy	Dr.	Noonan-Harnsberger	Helen	M	5035745708				5035748646	Helen.noonan-harnsberger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	12/23/2020	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Business	Mrs.	Joffer	Kathleen	M	5035746485					kathleen.joffer@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	07/11/2018	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Pharmacy Technical Help Desk Contact	Director, Pharmacy	Mr.	Clark	James							james.clark2@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	10/12/2022	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active	8884455518				HMO - Health Maintenance Organization		C	Seattle
H9047	Pharmacy Technical Help Desk Contact (Secondary)			Andrade	Chris							chris.andrade@sscinc.com	210 10th Street		Kansas City	MO	64105	01/31/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active	8164352321				HMO - Health Maintenance Organization		C	Seattle
H9047	Physician Incentive Contact	Manager		Meidinger	Kurt		5035746584					kurtis.Meidinger@providence.org	3601 SW Murray Blvd. Suite 10		Portland	OR	97005	05/24/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Plan Directory Contact for Public Website	Director, Medicare Compliance		Dunphy	Misty		5035746608					misty.dunphy@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	08/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Plan to Plan Reconciliation Contact	Healthcare Data Analyst		Williams	Rachelle		5035746316					rachelle.williams@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	08/09/2021	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Processor Contact	Manager, Analytics Business Intelligence, Pharmacy		Perry	Jeffrey		5035747154					jeffrey.perry@providence.org	3601 SW Murray Blvd	Suite 10	Beaverton	OR	97005	04/19/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Quality Contact	Sr. Director - Quality		Francesconi	Brett		5035746535					brett.francesconi@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	04/17/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Reconciliation Contact	Principal Healthcare Data Analyst		Rodgers	Tyler		5035746351					tyler.rodgers@providence.org	4400 NE Halsey Street	Bldg 2, Suite 690	Portland	OR	97213	02/21/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Reconciliation Contact (Secondary)	Healthcare Data Analyst		Williams	Rachelle		5035746316					rachelle.williams@providence.org	4400 NE Halsey Street		Portland	OR	97213	08/09/2021	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Recovery Audit Contact	Mgr, Medicare Compliance	Mrs.	Ocheltree	Amy		5035746098					amy.ocheltree@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	03/29/2021	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	SNP Application Contact	Medicare/Medicaid Program Manager	Mrs.	Enger	Deanne		5035746488					Deanne.enger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	01/30/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	SNP State Contact	Medicare/Medicaid Program Manager	Mrs.	Enger	Deanne		5035746488					deanne.enger@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	01/30/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Surveillance Contact	Director - Medicare Compliance		Dunphy	Misty		3106178718					misty.dunphy@providence.org	3601 SW Murray Blvd, Suite 10		Beaverton	OR	97005	08/22/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	System Contact	Director System Admin.		Schuller	Martha		5035747415					martha.schuller@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	05/24/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Third Party Administrator (TPA) Liaison	Healthcare Data Analyst		Williams	Rachelle		5035746316					rachelle.williams@providence.org	4400 NE Halsey Street	Bldg 2, Suite 690	Portland	OR	97213	08/09/2021	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	User Access Contact	Compliance Medicare Consultant	Ms.	Saucy	Tara		5035747431					Tara.saucy@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	08/21/2023	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Utilization Management Contact	Chief Medical Officer	Dr.	Gluckman	Robert		5035746406				5035746464	Robert.Gluckman@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	05/24/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9047	Utilization Review Contact	Chief Medical Officer	Dr.	Gluckman	Robert		5035746406				5035746464	Robert.Gluckman@providence.org	3601 SW Murray Blvd. Suite 10		Beaverton	OR	97005	05/24/2017	2023	PROVIDENCE HEALTH ASSURANCE	Local CCP	Providence Medicare Advantage Plans	HMO/HMOPOS		Providence St Joseph Health	798	Yes	Active					HMO - Health Maintenance Organization		C	Seattle
H9052	Automated TrOOP Balance Transfer Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Backup User Access Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Best Available Evidence Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Bid Primary Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	CAP Report Contact for Public Website	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active	8882912647				PACE - Nat		C	Chicago
H9052	CEO - CMS Administrator Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	CEO - Senior Official for Contracting	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Chief Financial Officer	Financial Director	Mr.	Visuri	Elliott		9898934506					visurie@region7aaa.org	1615 S. Euclid Avenue		Bay City	MI	48706	10/01/2021	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Chief Operating Officer	COO	Mrs.	F	Monica		9898934506					freierm@region7aaa.org	1615 S. Euclid		Bay City	MI	48706	08/03/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Chief Information Officer	IT Manager	Ms.	Rusho	Sherry		9898934506	216				rushos@region7aaa.org	1615 S. Euclid Avenue		Bay City	MI	48706	08/26/2021	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Chief Information Security Officer	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	CMS Casework Communication Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Complaints Tracking Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Contact for Fraud Investigations	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Coordination of Benefits Contact	Fin Operations Mgr	Mrs.	Allison	Christy		8103886300					allisonch@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	09/13/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Corporate Mailing						9898934506					vilasm@region7aaa.org	1615 S. Euclid Avenue		Bay City	MI	48706	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Coverage Gap Discount Program (CGDP) Payment Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Customer Service Operations Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	DIR Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	DIR Contact (Secondary)	Quality	Ms.	Potestivo	Candace		8103886300					potestivoc@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	02/10/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Emergency Part D Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Emergency Part D Contact (Secondary)	Pharmacist	Mr.	Le	Viet		8103886300					viet@kltcpharmacy.com	5229 Lakeshore		Fort Gratiot	MI	48059	08/03/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Encounter Data & Risk Adjustment Operations Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Enrollment Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	EOB Transfer Contact	Director	Mrs.	Vilas	Michele		8103886300				8103886305	vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Financial Audit Contact	Financial Director	Mr.	Visuri	Elliott		9898934506					visurie@region7aaa.org	1615 S. Euclid Avenue		Bay City	MI	48706	02/18/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Financial Reporting Contact	Financial Director	Mr.	Visuri	Elliott		9898934506					visurie@region7aaa.org	1615 S. Euclid Avenue		Bay City	MI	48706	02/18/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Formulary Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Formulary Contact (Secondary)	CFO	Mr.	Visuri	Elliot		8103886300					visurie@region7aaa.org	5229 Lakeshore		Fort Gratiot	MI	48059	02/10/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	General Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Government Relations Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	HIPAA Privacy Officer	CHRO	Mrs.	Johnson	Megan		9898934506					johnsonm@region7aaa.org	1615 Euclid		Bay City	MI	48706	08/03/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	HIPAA Security Officer	CHRO	Mrs.	Johnson	Megan		9898934506					johnsonm@region7aaa.org	1615 S. Euclid		Bay city	MI	48706	08/03/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Interoperability Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	MA Appeals/Grievances Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	MA Claims Processing Contact for Public Website	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Marketing Contact	Director	Mrs.	Vilas	Michele		8103886300				8103886305	vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	11/02/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Medical Director	Medical Director	Dr.	Chapin	Norman		8103886300				8103886305	chapinn@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	11/02/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Medicare Compliance Officer	CHRO	Mrs.	Johnson	Megan		9898934506					johnsonm@region7aaa.org	1615 S. Euclid		Bay City	MI	48706	08/03/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Medicare Coordinator	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Chapin	Norman		8103886300				8103886305	chapinn@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	11/02/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Medication Therapy Management Contact	Medical Director	Dr.	Chapin	Norman		8103886300				8103886305	chapinn@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	11/02/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Part C Application Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Part D Appeals	Director	Mrs.	Vilas	Michele							vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active	8882912647				PACE - Nat		C	Chicago
H9052	Part D Appeals Contact (Secondary)	Pharmacist	Mr.	Le	Viet							mccoyk@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/03/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active	8103886300				PACE - Nat		C	Chicago
H9052	Part D Application Contact	Finance	Mr	Visuri	Elliot		8103886300					visurie@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	02/10/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Part D Benefits Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Part D Claims Submission Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Part D Exceptions Contact	Director	Mrs.	Vilas	Michele							vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active	8103886300				PACE - Nat		C	Chicago
H9052	Part D Exceptions Contact (Secondary)	Quality	Ms.	Potestivo	Candace							mccoyk@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/03/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active	8882912647				PACE - Nat		C	Chicago
H9052	Part D Price File Contact (Back-up)	Medical Director	Ms.	Chapin	Norman		8103886300	216				chapinn@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	11/02/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Part D Price File Contact (Optional)	Quality	Ms.	McCoy	Krisna		8103886300					mccoyk@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	02/18/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Part D Price File Contact (Primary)	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Part D Quality Assurance Contact	Quality	Ms.	Potestivo	Candace		8103886300				8103886305	Potestivoc@region7aaa.org	5229 Lakeshore Road		Fort Gratiot	MI	48059	08/03/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Part D Reporting Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Patient Safety Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Payment Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Pharmacy Director	Pharmacist	Mr.	Le	Viet		8103886300					viet@kltcpharmacy.com	5229 Lakeshore		Fort Gratiot	MI	48059	08/03/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Pharmacy Network Management Contact	Pharmacist	Mr.	Le	Viet		8103886300					viet@kltcpharmacy.com	5229 Lakeshore		Fort Gratiot	MI	48059	08/03/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Pharmacy Network Management Contact (Secondary)	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Pharmacy Technical Help Desk Contact	Director	Mrs.	Vilas	Michele							vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active	8882912647				PACE - Nat		C	Chicago
H9052	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy	Mr	Le	Viet							bergmann@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/03/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active	8103886300				PACE - Nat		C	Chicago
H9052	PHR Beneficiary Contact																	02/18/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE	Sunrise PACE	Region VII Area Agency on Aging, Inc.	778	Yes	Active	8882912647				PACE - Nat		C	Chicago
H9052	Plan Directory Contact for Public Website	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Plan to Plan Reconciliation Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Processor Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Quality Contact	Quality Improvement Coordinator	Ms.	Potestivo	Candace		8103886300				8103886305	potestivoc@region7aaa.org	5229 Lakeshore Road		Fort Gratiot	MI	48059	02/10/2023	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Reconciliation Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Reconciliation Contact (Secondary)	Financial Director	Mr.	Visuri	Elliott		9898934506					visurie@region7aaa.org	1615 S. Euclid Avenue		Bay City	MI	48706	02/18/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Recovery Audit Contact	Financial Director	Mr.	Visuri	Elliott		9898934506					visurie@region7aaa.org	1615 S. Euclid Avenue		Bay City	MI	48706	02/18/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Surveillance Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	System Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Third Party Administrator (TPA) Liaison	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	User Access Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Utilization Management Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9052	Utilization Review Contact	Director	Mrs.	Vilas	Michele		8103886300					vilasm@region7aaa.org	5229 Lakeshore Road		FORT GRATIOT	MI	48059	08/08/2022	2023	REGION VII AREA AGENCY ON AGING	National PACE	Sunrise PACE	National PACE		Region VII Area Agency on Aging, Inc.	778	Yes	Active					PACE - Nat		C	Chicago
H9065	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	02/04/2019	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/28/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/10/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/04/2019	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H9065	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H9065	PHR Beneficiary Contact																	02/04/2019	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H9065	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9065	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	AMH HEALTH, LLC	Local CCP	AMH Health	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9066	Agent/Broker Compensation Data Contact	Exec Vp Strategic Operations	Ms	Lindsay	Tammy		3154779587					tlindsay@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Automated TrOOP Balance Transfer Contact	Chief Financial Officer	Mr	Ariglio	Buzz		3158707772					bariglio@477home.org	1050 West Genesee St		Syracuse	NY	13204	08/16/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Backup User Access Contact	VP Health Plan Operations	Ms	Frederick	Amanda		3154779275					Afrederick@477home.org	1050 West Genesee St		Syracuse	NY	13204	08/16/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Best Available Evidence Contact	Chief Clinical Officer	Ms	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/12/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Bid Audit Contact	Chief Administrative Officer		Castle	June		3154779320					jcastle@477home.org	1050 West Genesee St		Syracuse	NY	13204	09/28/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Bid Audit Site Contact	Chief Administrative Officer		Castle	June		3154779320					jcastle@477home.org	1050 West Genesee St		Syracuse	NY	13204	09/28/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Bid Primary Contact	Chief Administrative Officer		Castle	June		3154779320					jcastle@477home.org	1050 West Genesee St		Syracuse	NY	13204	09/28/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	CAP Report Contact for Public Website	VP Performance Excellence		Billington	Janet		3154779233					JBillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/22/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	CEO - CMS Administrator Contact	President/Chief Executive Officer	MS	Rolf	Mary Kate		3154779500	595				mkrolf@477home.org	1050 West Genesee St		Syracuse	NY	13204	03/23/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	CEO - Senior Official for Contracting	President/Chief Executive Officer	MS	Rolf	Mary Kate		3154779500	595				mkrolf@477home.org	1050 West Genesee St		Syracuse	NY	13204	03/23/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Chief Financial Officer	Chief Financial Officer	Mr	Ariglio	Buzz		3158707772					bariglio@477home.org	1050 West Genesee St		Syracuse	NY	13204	08/16/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Chief Operating Officer		Mr	Twardy	Joseph		3158707763					jtwardy@477home.org	1050 West Genesee St		Syracuse	NY	13204	09/09/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Chief Information Officer		Ms	Manna	Cheryl		3154779500	594				Cmanna@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Chief Information Security Officer		Ms	Billington	Janet		3154779500	233				jbillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/12/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	CMS Casework Communication Contact	UR Manager	MS	Ginestro	Suzanne		3154779304					sginestro@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Complaints Tracking Contact	UR Manager	MS	Ginestro	Suzanne		3154779304					sginestro@477home.org	1050 West Genesee St		Syracuse	NY	13204	11/27/2019	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Contact for Fraud Investigations	VP Performance Excellence		Billington	Janet		3154779233					JBillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/22/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Coordination of Benefits Contact	VP Health Plan Operations	Ms	Frederick	Amanda		3154779275					afrederick@477home.org	1050 West Genesee St		Syracuse	NY	13204	08/16/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Corporate Mailing						3158707763					jtwardy@477home.org	1050 West Genesee St		Syracuse	NY	13204	05/28/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mr	Ariglio	Buzz		3158707772					bariglio@477home.org	1050 West Genesee St		Syracuse	NY	13204	08/16/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Customer Service Operations Contact	EVP Strategic Operations	Ms	Lindsay	Tammy		3159601827					tlindsay@477home.org	1050 West Genesee St		Syracuse	NY	13204	03/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	DIR Contact	Senior Director	Mr	Farmer	Jim		3308886098					jfarmer@elixirsolutions.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	09/13/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	DIR Contact (Secondary)	Mgr, QC Ops Gov Programs		Houchens	Logan		3308886095					lhouchens@elixirsolutions.com	2181 East Aurora Road Suite 201		Twinsburg	OH	44087	07/21/2023	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Electronic Health Record Contact		Ms	Billington	Janet		3154779500	233				jbillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Emergency Part D Contact	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Encounter Data & Risk Adjustment Operations Contact	Chief Adminstrative Officer		castle	June		3154779320					jcastle@477home.org	1050 west genesee St		syracuse	NY	13420	01/21/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Enrollment Contact		Ms	Billington	Janet		3154779500	233				jbillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	EOB Transfer Contact		Ms	Billington	Janet		3154779500	233			3158707788	jbillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Financial Audit Contact	Chief Administrative Officer	Ms	Castle	June		3154779320					jcastle@477home.org	1050 West Genesee St		Syracuse	NY	13204	09/28/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Financial Reporting Contact	Chief Financial Officer	Mr	Ariglio	Buzz		3158707772					bariglio@477home.org	1050 West Genesee St		Syracuse	NY	13204	11/27/2019	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Formulary Contact	Clinical Formulary Pharmacist		Sagoo	Sukhjit		3304866482					ssagoo@elixirsolutions.com	2181 East Aurora Rd Canyon Falls Blvd		Twinsburg	OH	44087	07/20/2023	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Formulary Contact (Secondary)			Pharmacist	Formulary		3304866482					FormularyPharmacists@envisionrx.com	2181 East Aurora Road Suite 201		Twinsburg	OH	44087	07/20/2023	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	General Contact	EVP Health Plans	Mr	Twardy	Joseph		3154124684					jtwardy@477home.org	1050 West Genesee St		Syracuse	NY	13204	03/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Government Relations Contact	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	HIPAA Privacy Officer	VP Performance Excellence		Billington	Janet		3154779233					JBillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/22/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	HIPAA Security Officer	VP Performance Excellence	Ms	Billington	Janet		3154779500	233				jbillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Hospice Contact	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Interoperability Contact	VP Performance Excellence		Billington	Janet		3154779233					jbillington@477home.org	1050 West Genesse St		Syracuse	NY	13204	01/24/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	MA Appeals/Grievances Contact	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	MA Claims Processing Contact for Public Website		Ms	Billington	Janet		3154779500	233			3158707788	jbillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Marketing Contact	Chief Administrative Officer	Ms	Castle	June		3154779320					Jcastle@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/18/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Medical Director	Medical Director	Dr	Amidon	Joel		3154779500					jamidon@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Medicare Compliance Officer	Compliance Officer	Ms.	Billington	Janet		3154779233					JBillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	05/05/2023	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Medicare Coordinator	VP Health Plan Operations	Ms	Frederick	Amanda		3154779275					afrederick@477home.org	1050 West Genesee St		Syracuse	NY	13204	08/16/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Medicare Part D Opioid Overutilization Contact	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/13/2019	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Medication Therapy Management Contact	Dir Of Clinical Product Develpment	Ms	Miller	Holly		3304866457	598				hmiller@healthdialog.com	2181 east Aurora RD	Suite 201	Twinsburg	OH	44087	02/11/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Online Enrollment Center Contact (Back-up)	Chief of Staff, EVP Strategic Operations  Strateg		Lindsay	Tammy		3154779587					tlindsay@nascentiahealth.org	1050 West Genesee Street		Syracuse	NY	13204	05/04/2023	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Online Enrollment Center Contact (Primary)	Medicare Enrollment & Sales Manager  Business Com		Cavanagh	Mary		3154779331					mcavanagh@nascentiahealth.org	1050 West Genesee Street		Syracuse	NY	13204	05/04/2023	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Part C Application Contact	EVP Health Plans	Mr	Twardy	Joseph		3154124684					jtwardy@477home.org	1050 West Genesee St		Syracuse	NY	13204	03/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Part C Reporting Contact	Chief Clinical Officer	Ms	Lazarek LaQuay	Andrea		3157250130					alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	03/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Part D Appeals	Utilization Review Manager	Ms	Ginestro	Suzanne							sginestro@477home.org	1050 West Genesee St		Syracuse	NY	13204	12/30/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active	8884774663	9304			HMO - Health Maintenance Organization		C	New York
H9066	Part D Appeals Contact (Secondary)	Appeals Sup		Binegar	Sam							appeals@elixirsolutions.com	8921 Canyon Falls Blvd		Twinsburg	OH	44087	09/13/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	New York
H9066	Part D Application Contact	EVP Health Plans	Mr	Twardy	Joseph		3154124684					jtwardy@477home.org	1050 West Genesee St		Syracuse	NY	13204	03/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Part D Benefits Contact	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Part D Claims Submission Contact	Account manager	Mr	Kambron-Jones	Wahi		9133228484					wahjones@elixisolutions.com	8920 Canyon Falls	Suite 123	Twinsburg	OH	44087	09/13/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Part D Exceptions Contact	VP	ms	Russo	Joan							jrusso@elixirsolutions.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	08/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active	9179021557				HMO - Health Maintenance Organization		C	New York
H9066	Part D Exceptions Contact (Secondary)	AVP Clinical Operations		Lavignette	Amanda							alavignette@elixirsolutions.com	2181 East Aurora Road Suite 201 Twinsburg		Twinsburg	OH	44087	08/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	New York
H9066	Part D Price File Contact (Back-up)	Financial Analyst		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	2181 East Aurora Road Suite 201		Twinsburg	OH	44087	02/17/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Part D Price File Contact (Optional)			Kessler	Cameron		9179021552					ckessler@elixirsolutions.com	2181 East Aurora Road Suite 201		Twinsburg	OH	44087	09/13/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Part D Price File Contact (Primary)	Sr Financial Manager Reporting & Analytics		Campbell	Tim		3308886988					tcampbell@elixirsolutions.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/17/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Part D Quality Assurance Contact	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Part D Reporting Contact	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Patient Safety Contact	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Payment Contact	Chief Financial Officer	Mr	Ariglio	Buzz		3158707772					bariglio@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Pharmacy Director	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Pharmacy Network Management Contact	Director Pharmacy Network Development and Operatio	Mrs	Profio	Lauren		3304864864					lprofio@elixirsolutions.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/17/2022	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr	Conn	Todd							tconn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	08/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active	8662502005				HMO - Health Maintenance Organization		C	New York
H9066	Pharmacy Technical Help Desk Contact (Secondary)	Senior Director Customer Care		Jernigan	Gia							gjernigan@elixirsolutions.com	2181 East Aurora Road Suite 201		Twinsburg	OH	44087	08/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active	3308886225				HMO - Health Maintenance Organization		C	New York
H9066	Plan Directory Contact for Public Website	Exec Vp Strategic Operations	Ms	Lindsay	Tammy		8884774663					tlindsay@477home.org	1050 West Genesee St		Syracuse	NY	13204	05/27/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Plan to Plan Reconciliation Contact	Chief Administrative Officer	Ms	Castle	June		3154779500				3158707788	jcastle@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Processor Contact		Ms	Billington	Janet		3154779500	233			3158707788	jbillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Quality Contact	Chief Clinical Officer	Ms	LaQuay Lazarek	Andrea		3157250130					alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	03/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Reconciliation Contact	Chief Administrator Officer	Ms	Castle	June		3154779320					jcastle@477home.org	1050 West Genesee St		Syracuse	NY	13204	11/27/2019	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Recovery Audit Contact	Chief Financial Officer	Mr	Ariglio	Buzz		3158707772					bariglio@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	SNP Application Contact	EVP Health Plans	Mr	Twardy	Joseph		3154124684					jtwardy@477home.org	1050 West Genesee St		Syracuse	NY	13204	03/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Surveillance Contact	Exec Vp Strategic Operations	Ms	Lindsay	Tammy		3154779587					tlindsay@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	System Contact	EVP Health Plans	Mr	Twardy	Joseph		3154124684					jtwardy@477home.org	1050 West Genesee St		Syracuse	NY	13204	03/19/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Third Party Administrator (TPA) Liaison		Ms	Billington	Janet		3154779500	233			3158707788	jbillington@477home.org	1050 West Genesee St		Syracuse	NY	13204	01/13/2020	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	User Access Contact	VP Health Plan Operations		Frederick	Amanda		3154779275					afrederick@477home.org	1050 West Genesee St		Syracuse	NY	13204	12/16/2021	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Utilization Management Contact	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9066	Utilization Review Contact	Chief Clinical Officer	MS	Lazarek-Laquay	Andrea		3154779500	598				alaquay@477home.org	1050 West Genesee St		Syracuse	NY	13204	02/11/2018	2023	VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	Local CCP	Nascentia Health Plus	HMO/HMOPOS		VISITING NURSE ASSOCIATION OF CENTRAL NEW YORK	703	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9068	Automated TrOOP Balance Transfer Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Backup User Access Contact	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/24/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Best Available Evidence Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Bid Primary Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	CAP Report Contact for Public Website	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	CEO - CMS Administrator Contact	CEO	Mr.	Smith	Shaun		5705223889				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	12/21/2021	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	CEO - Senior Official for Contracting	CEO	Mr.	Smith	Shaun		5705223880				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	05/24/2012	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Chief Financial Officer	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Chief Operating Officer	President/CEO	Mr.	Smith	Shaun		5705223880				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Chief Information Officer	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/24/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Chief Information Security Officer	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/24/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	CMS Casework Communication Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Complaints Tracking Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Contact for Fraud Investigations	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Coordination of Benefits Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Corporate Mailing						5705223880				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/20/2016	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Coverage Gap Discount Program (CGDP) Payment Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Customer Service Operations Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	DIR Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	DIR Contact (Secondary)	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Emergency Part D Contact	CEO	Mr.	Smith	Shaun		5705223889				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	12/21/2021	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Emergency Part D Contact (Secondary)	Medicare Compliance Officer	Mrs.	Shively	LouAnn		5705223853				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	12/21/2021	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Encounter Data & Risk Adjustment Operations Contact	LIFE DON		Byrne	Belinda		5705223880				5705249068	belinda.byrne@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	12/20/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Enrollment Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	EOB Transfer Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Financial Audit Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Financial Reporting Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Formulary Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Formulary Contact (Secondary)	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	General Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Government Relations Contact	CEO	Mr.	Smith	Shaun		5705223880				5705249068	shaun.smith@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	05/24/2012	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	HIPAA Privacy Officer	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	HIPAA Security Officer	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/24/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Interoperability Contact	VP of LIFE Finance	Mr.	Blessing	John		5705223880					john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	12/15/2021	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	MA Appeals/Grievances Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	MA Claims Processing Contact for Public Website	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/24/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Marketing Contact	Albright LIFE Marketing Director	Mrs.	Miller	Chris		7177567004				5705249068	chmiller@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	12/23/2022	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Medical Director	Medical Director	Dr.	Nguyen	Donald		5705223880				5705249068	don.nguyen@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/12/2021	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Medicare Compliance Officer	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	12/03/2013	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Medicare Coordinator	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/24/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Medicare Part D Opioid Overutilization Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	12/21/2018	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Medication Therapy Management Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Online Enrollment Center Contact (Back-up)	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/24/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Online Enrollment Center Contact (Optional)	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/24/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Online Enrollment Center Contact (Primary)	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/24/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Part C Application Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Part D Appeals	Corporate Compliance Officer	Mrs.	Shively	Louann						5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	12/29/2020	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active	8887910094				PACE - Nat		C	Philadelphia
H9068	Part D Appeals Contact (Secondary)	Sr. Director of Operations	Mr.	McDonough	John						5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	12/29/2020	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active	8887910094				PACE - Nat		C	Philadelphia
H9068	Part D Application Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Part D Benefits Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Part D Claims Submission Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Part D Exceptions Contact	Corporate Compliance Officer	Mrs.	Shively	Louann						5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active	5705223880				PACE - Nat		C	Philadelphia
H9068	Part D Exceptions Contact (Secondary)	Treasurer/VP of Finance	Mr.	Blessing	John						5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active	8887910094				PACE - Nat		C	Philadelphia
H9068	Part D Price File Contact (Back-up)	Senior Director of Operations	Mr.	McDonough	John		5705223880				5705249068	john.mcdonough@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Part D Price File Contact (Optional)	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Part D Price File Contact (Primary)	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Part D Quality Assurance Contact	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Part D Reporting Contact	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Patient Safety Contact	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Payment Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Personal Health Record Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Pharmacy Director	Director of Pharmacy	Mrs.	Beitz	Krystal		5705233108				5705233109	krystal.beitz@albrightcare.org	110 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Pharmacy Network Management Contact	Director of Pharmacy	Mrs.	Beitz	Krystal		5705233108				5705233109	krystal.beitz@albrightcare.org	110 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Pharmacy Network Management Contact (Secondary)	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Pharmacy Technical Help Desk Contact	Director of Pharmacy	Mrs.	Beitz	Krystal						5705233109	krystal.beitz@albrightcare.org	110 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active	5705233108				PACE - Nat		C	Philadelphia
H9068	Pharmacy Technical Help Desk Contact (Secondary)	Corporate Compliance Officer	Mrs.	Shively	Louann						5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active	5705223880				PACE - Nat		C	Philadelphia
H9068	PHR Beneficiary Contact																	07/11/2011	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	Asbury Communities, Inc.	461	Yes	Active	5705223880				PACE - Nat		C	Philadelphia
H9068	Plan Directory Contact for Public Website	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Plan to Plan Reconciliation Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Processor Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Quality Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Reconciliation Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Reconciliation Contact (Secondary)	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Recovery Audit Contact	Treasurer/VP of Finance	Mr.	Blessing	John		5705223880				5705249068	john.blessing@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	03/21/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Surveillance Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	System Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/24/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Third Party Administrator (TPA) Liaison	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	04/26/2016	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	User Access Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	09/24/2019	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Utilization Management Contact	Corporate Compliance Officer	Mrs.	Shively	Louann		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9068	Utilization Review Contact	Corporate Compliance Officer	Mrs.	Shively	LouAnn		5705223880				5705249068	louann.shively@albrightcare.org	90 Maplewood Drive		Lewisburg	PA	17837	02/26/2015	2023	ALBRIGHT CARE SERVICES	National PACE	ALBRIGHT CARE SERVICES	National PACE		Asbury Communities, Inc.	461	Yes	Active					PACE - Nat		C	Philadelphia
H9070	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	5025809138				PPO - BBA		C	Kansas City
H9070	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	5025807929				PPO - BBA		C	Kansas City
H9070	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	5025809138				PPO - BBA		C	Kansas City
H9070	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	5024682494				PPO - BBA		C	Kansas City
H9070	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	8008658715				PPO - BBA		C	Kansas City
H9070	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation	5025800475				PPO - BBA		C	Kansas City
H9070	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9070	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	COMPBENEFITS INSURANCE COMPANY	Local CCP	Humana	Local PPO		Humana Inc.	128	Yes	Consolidation					PPO - BBA		C	Kansas City
H9082	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	CAP Report Contact for Public Website			Services	Member		8664400127					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		3852352159					shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	MA Claims Processing Contact for Public Website			Services	Member		8664400127					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	5625170246				HMO - Health Maintenance Organization		C	New York
H9082	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H9082	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	8012525706				HMO - Health Maintenance Organization		C	New York
H9082	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	5708612665				HMO - Health Maintenance Organization		C	New York
H9082	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	8666934620				HMO - Health Maintenance Organization		C	New York
H9082	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract	8012525706				HMO - Health Maintenance Organization		C	New York
H9082	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Plan Directory Contact for Public Website			Services	Member		8664400127					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9082	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	06/05/2023	2023	MOLINA HEALTHCARE OF NEW MEXICO, INC.	Local CCP	Molina Healthcare of New Mexico, Inc.	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	New York
H9096	Agent/Broker Compensation Data Contact	Director - Sales	Mr	Weber	Michael		6088274014				6082520829	Michael.Weber@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Automated TrOOP Balance Transfer Contact	Operations Manager, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	Relay.Health@Navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Backup User Access Contact	GRC & Regulatory Audit Coordinator		Hewitt	Deb		6088285034					deb.hewitt@deancare.com	1255 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Best Available Evidence Contact	Manager - Enrollment & Billing		Kaderabek	Kay		6088281976					Kay.Kaderabek@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Bid Audit Contact	Sr. Actuary		Lowenberg	Nicholas		6088274158					nicholas.lowenberg@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Bid Primary Contact	Director - Product		Jacobson	Jaclyn		8002791301					jaclyn.jacobson@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	CAP Report Contact for Public Website	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	CEO - CMS Administrator Contact	Interm President & CFO	Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	CEO - Senior Official for Contracting		Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Chief Financial Officer	Chief Financial Officer	Mr	Ruplinger	Randy		6088274030					hpmscfo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Chief Operating Officer	President	Mr.	Docherty	David		6088274458					hpmscoo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Chief Information Officer	SVP - Chief Technology	Mr.	Abdul	Dan		9529922997					Daniel.Abdul@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	02/01/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Chief Information Security Officer	Sr. Director of Information Risk Management - CISO	Mr.	Abbott	Brad		9529920081					Bradley.Abbott@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	02/01/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	CMS Casework Communication Contact	Consumer Affairs Supervisor		Sikorski	TJ		9529928542					Thomas.Sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/23/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Complaints Tracking Contact	Manager Customer Service		Riske	Christina		8002791302					Christina.Riske@deancare.com	1277 Deming Way		Madison	WI	53717	08/23/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Contact for Fraud Investigations	SIU Director		Monson	Peter		9509921149					Peter.Monson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Coordination of Benefits Contact	Manager - Enrollment & Billing		Kaderabek	Kay		6088281976					Kay.Kaderabek@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Corporate Mailing						6088274301					hpmsceo@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Coverage Gap Discount Program (CGDP) Payment Contact	Manager - Accounting		Lewis	Felicia		6088361400					felicia.lewis@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Customer Service Operations Contact	Manager Customer Service		Riske	Christina		8002791302					Christina.Riske@deancare.com	1277 Deming Way		Madison	WI	53717	08/23/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	DIR Contact	Sr. Actuary		Lowenberg	Nicholas		6088274158					nicholas.lowenberg@deancare.com	277 Deming Way Madison, WI 53717		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	DIR Contact (Secondary)	Manager Government Programs Oversight	Mr	Herbst	Travis		6088282856					travis.herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Emergency Part D Contact	President		Docherty	David		6088274458					hpmsceo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Emergency Part D Contact (Secondary)	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Encounter Data & Risk Adjustment Operations Contact	Director - Risk Adjustment Operations		Werwinski	Michelle		6088305958					Michelle.Werwinski@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Enrollment Contact	Manager - Enrollment & Billing		Kaderabek	Kay		6088281976					Kay.Kaderabek@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	EOB Transfer Contact	Manager, Pharmacy		Borleske	Amanda		6088361400				6088274212	Amanda.Borleske@deancare.com	1277 Deming Way		Madison	WI	53717	07/07/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Financial Audit Contact	Manager - Finance	Ms	Nelson	Alyssa		6084060543					alyssa.nelson@deancare.com	1277 Deming Way		Madison	WI	53717	09/21/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Financial Reporting Contact	Chief Financial Officer	Mr	Ruplinger	Randy		6088274030					hpmscfo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Formulary Contact	Clinical Pharmacist		Valeo-Seabright	Diane		6088361400					Diane.Valeo-Seabright@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	deanna.paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	General Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Government Relations Contact	VP - Legal		Sutton	Dean		6088274301					dean.sutton@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	HIPAA Privacy Officer	Director of Privacy		Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/25/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	HIPAA Security Officer	Sr. Director of Information Risk Management - CISO		Abbott	Brad		9529920081					Bradley.Abbott@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Hospice Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Interoperability Contact	Director of Privacy		Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/24/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	MA Appeals/Grievances Contact	Manager - Customer Relations		Olson	Michelle		6088274469					michelle.olson@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	MA Claims Processing Contact for Public Website	Manager Claims		Sago	Murielle		8002791302					Murielle.Sago@deancare.com	1277 Deming Way		Madison	WI	53717	08/23/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Marketing Contact	Legal & Regulatory Analyst		Warren	Jennifer		6088305919					jennifer.warren1@deancare.com	1277 Deming Way		Madison	WI	53717	06/22/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Medical Director	Chief Medical Officer	MD	Eichhorn	Kevin		6088281955					kevin.eichhorn@ssmhealth.com	1277 Deming Way		Madison	WI	53717	05/21/2020	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Medicare Compliance Officer	VP - Compliance	Ms.	Koranteng	Milly		9529922090					Mildred.Koranteng@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Medicare Coordinator	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Valeo-Seabright	Diane		6088361400					Diane.Valeo-Seabright@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Medication Therapy Management Contact	Manager Pharmacy		Jakowski	Nathan		6088361400					Nathan.Jakowski@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	OffShore Subcontractor Contact	Director of Privacy		Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/24/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Online Enrollment Center Contact (Optional)	Manager - Enrollment & Billing		Kaderabek	Kay		6088281976					kay.kaderabek@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Online Enrollment Center Contact (Primary)	Manager - Enrollment & Billing		Kaderabek	Kay		6088281976					Kay.Kaderabek@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Part C Application Contact	Director - Product		Jacobson	Jaclyn		8002791301					jaclyn.jacobson@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Part C Reporting Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						9202214629	Justin.LaCrosse@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	04/16/2021	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Kansas City
H9096	Part D Application Contact	Director - Product		Jacobson	Jaclyn		8002791301					jaclyn.jacobson@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Part D Benefits Contact	Clinical Pharmacist		Valeo-Seabright	Diane		6088361400					Diane.Valeo-Seabright@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Part D Claims Submission Contact	Sr. Manager, Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/01/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Part D Exceptions Contact	Sr. Manager, Clinical Prior Authorization		LeClair	Christophe						9202214622	Christopher.LeClair@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Kansas City
H9096	Part D Price File Contact (Back-up)	Pharmacy Quality Specialist		Seager	Deb		6087291578					Deb.Saeger@navitus.com	361 Integrity Drive		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Part D Price File Contact (Primary)	Provider Quality Analyst		Buie	Megan		5122313140					Megan.Buie@navitus.com	12301 Research Blvd, Plaza V, Suite 350		Austin	TX	78759	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Part D Quality Assurance Contact	Program Manager, Health Services		Smith	Julee		6088287579					Julee.Smith@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Part D Reporting Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Patient Safety Contact	Chief Medical Officer		Eichhorn, MD	Kevin		6088281955					kevin.eichhorn@ssmhealth.com	1277 Deming Way		Madison	WI	53717	05/21/2020	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Payment Contact	Manager - Accounting		Lewis	Felicia		6088275950					felicia.lewis@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Pharmacy Director	Director of Pharmacy Services		Wilhelm	Sue		6088287576					Sue.Wilhelm@medica.com	1277 Deming Way		Madison	WI	53717	02/01/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		9202214176				9202214772	Jan.Robinson@navitus.com	361 Integrity Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						8665951975	Danielle.Nett@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/09/2021	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	8662703877				HMO - Health Maintenance Organization		C	Kansas City
H9096	Plan Directory Contact for Public Website	Customer Service		Service	Customer		8772327566					DHP.CustomerRelationsResolutionTeam@medica.com	1277 Deming Way		Madison	WI	53717	02/01/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Plan to Plan Reconciliation Contact	Sr. Actuary		Lowenberg	Nicholas		6088274157					nicholas.lowenberg@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Processor Contact	Clinical Pharmacist		Valeo-Seabright	Diane		6088361400					Diane.Valeo-Seabright@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Quality Contact	Program Manager, Health Services		Smith	Julee		6088287579					Julee.Smith@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Reconciliation Contact	Sr. Actuary		Lowenberg	Nicholas		2628881812					nicholas.lowenberg@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Reconciliation Contact (Secondary)	Sr. Actuary		Lowenberg	Nicholas		6088274158					nicholas.lowenberg@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Recovery Audit Contact	Manager - Compliance	Mr.	Herbst	Travis		6088272856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Surveillance Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	System Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Third Party Administrator (TPA) Liaison	Accounting Manager		Lewis	Felicia		6088274276					felicia.lewis@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	User Access Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Utilization Management Contact	Clinical Pharmacist		Valeo-Seabright	Diane		6088361400					Diane.Valeo-Seabright@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9096	Utilization Review Contact	Manager RN - Utilization Management		Drake	Amy		6088282807					Amy.Drake@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH PLAN, INC.	Local CCP	Dean Advantage	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9104	Agent/Broker Compensation Data Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Automated TrOOP Balance Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189			5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Backup User Access Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Best Available Evidence Contact	Director, Enrollment & Reconciliation		Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/28/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Bid Audit Contact	CVP Strategic Iniatives & Product Development	Ms	Selby	Jill		5629898382					jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Bid Audit Site Contact	CVP Strategic Initiatives & Product Development	Ms	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Bid Primary Contact	CVP Strategic Initiatives & Product Development	Ms	Selby	Jill		5629898382				5629899439	jselby@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	CAP Report Contact for Public Website	Chief Operating Officer	Ms.	Monk	Nancy		5629898320				5629895225	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	CEO - CMS Administrator Contact	President, Medicare	Mrs.	Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	CEO - Senior Official for Contracting	Chief Executive Officer	Dr.	Jain	Sachin		5629898314				5629895225	sjain@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/30/2020	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Chief Financial Officer	Chief Financial Officer	Mr	Plumb	Michael		5639971589					MPlumb@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	11/02/2020	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Chief Operating Officer	Chief Operating Officer	Mrs.	Monk	Nancy		5629898320				5629895225	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Chief Information Officer	Chief Information Officer	Mr.	Goode	Josh		5623082789					jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Chief Information Security Officer	Chief Information Officer	Mr.	Goode	Josh		5623082789				5629895225	jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	CMS Casework Communication Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Complaints Tracking Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Contact for Fraud Investigations	Chief Risk Executive	Mrs.	Hawkins	Ginette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Coordination of Benefits Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189	1189			5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Corporate Mailing						5629895100				5629895200	nmonk@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/11/2012	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms.	Isaac	Sharon		5629894423					sisaac@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2018	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Customer Service Operations Contact	Director, (Customer) Member Services	Ms.	McBeath	Kim		5629971805				5629895181	kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/27/2014	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	DIR Contact	Financial Accounting Specialist	Ms.	McClour	Tina		5629894459				5629890101	tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	03/03/2016	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	DIR Contact (Secondary)	Manager Revenue Accounting	Ms.	Moreno	Sonia		5623081122					smoreno@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	03/03/2016	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Emergency Part D Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		3237027662				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/21/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Emergency Part D Contact (Secondary)	Director,  Technical Pharmacy Operations	Ms.	Vaca	Ivette		5622091104				5629973196	ivaca@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/22/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Employer Waiver Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Encounter Data & Risk Adjustment Operations Contact	Chief Data Officer		Leung	Moon		5629895269					mleung@scanhealthplan.com	3800 Kilroy Airport Way suite 100		Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Enrollment Contact	Director, Enrollment & Reconciliation		Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/28/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	EOB Transfer Contact	Pharmacy Analyst		Banks	Marcia	D	5623081189				5629973196	mcurtis@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Financial Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Financial Reporting Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/11/2012	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Formulary Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Formulary Contact (Secondary)	Clinical Pharmacist	Ms.	Truong	Weilan		5629973187				5629973196	wtruong@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/03/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	General Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Government Relations Contact	VP of Government Relations		Hill	Ryann		2023499008				5629899439	rhill@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	HIPAA Privacy Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835					a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	HIPAA Security Officer	VP, Chief Privacy Officer		Archer	Anthony		5623085835					a.archer@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Hospice Contact	Manager, Pharmacy Experience and Access	Mr.	Tran	Tri		5623082884				5629973196	TMTran@scanhealthplan.com	3800 Kilroy Airport Way		Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Interoperability Contact	VP, IT Software & Services	Mr.	Carren	Marc		5629971821					mcarren@scanhealthplan.com	3800 Kilroy Airport Way, Suite 100		Long Beach	CA	90806	02/10/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	MA Appeals/Grievances Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	MA Claims Processing Contact for Public Website	Vice President, Claims & Shared Services	Mr.	Wheeler	Nathan		5623084341					nwheeler@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/09/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Marketing Contact	Compliance Specialist	Mr.	Lin	Richard		5623081156					rlin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	10/02/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Medical Director	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431				5629899439	RBatraM.D@scanhelathplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Medicare Compliance Officer	Compliance Officer	Ms.	Hawkins	Ginette		5623081195					GHawkins@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	07/16/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Medicare Coordinator	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist Programs	Ms.	Kelley	Mackenzie		5629973165				5629973196	mkelley@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/26/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Medication Therapy Management Contact	Director Pharmacy Quality & 5 Star	Mr.	Dinh	Matthew		5629895261				5629973196	mdinh@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/03/2020	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	OffShore Subcontractor Contact	Dir, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131				5629895120	ecordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment and Reconciliation	Ms.	Gongora	Irene		5629895209				5629895243	IGongora@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	12/31/2015	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Online Enrollment Center Contact (Primary)	Director, Enrollment & Reconciliation		Coronel	Vincent		5626371234				5629895243	vcoronel@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	09/02/2020	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Part C Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Part C Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Part D Appeals	Director, Grievance & Appeals		Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/12/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	5626371290	1290			HMO - Health Maintenance Organization		C	San Francisco
H9104	Part D Appeals Contact (Secondary)	Director, Grievances & Appeals		Bupp	Lisa						5629890958	lbupp@scanhealthplan.com	3800 Kilroy Airport Way MS 220		Long Beach	CA	90801	01/11/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	5629895100	1290			HMO - Health Maintenance Organization		C	San Francisco
H9104	Part D Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Part D Benefits Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	04/29/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Part D Exceptions Contact	Senior Pharmacy Manager	Mr.	Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/01/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	San Francisco
H9104	Part D Price File Contact (Back-up)	Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfiled	OH	45014	12/01/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Part D Price File Contact (Optional)	Pharmacy Analyst		Ramirez	Anthony		5623084348	4348			5629973196	a.ramirez@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/26/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/01/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Part D Quality Assurance Contact	CVP/Chier Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Part D Reporting Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Patient Safety Contact	Sr. Director, Pharmacy and Formulary Operations	Ms.	Slavina	Yelena		5623082816				5629973196	yslavina@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	08/18/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Payment Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/11/2012	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Pharmacy Director	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Pharmacy Network Management Contact	Network Acct Director, Retail Strategy	Ms.	Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		St Louis	MO	63121	01/23/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkwy	STE 150	Temple Terrace	FL	33637	12/01/2021	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	San Francisco
H9104	Physician Incentive Contact	President, Medicare		Schulte	Karen		3106121937					kschulte@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	06/07/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Plan Directory Contact for Public Website	Director, (Customer) Member Services	Ms.	McBeath	Kim		8777787226					kmcbeath@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/03/2020	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Plan to Plan Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	P2PAdmin@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/09/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Processor Contact	Senior Director Government Programs, Medicare	Ms.	Gibson	Sharon		8052361175					sggibson@express-scripts.com	One Express Way		St. Louis	MO	63121	01/03/2018	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Quality Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431				5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Reconciliation Contact	Vice President, Controller	Ms.	Havai	Virginia		5629898300				5629890101	vhavai@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/02/2015	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Reconciliation Contact (Secondary)	CVP/Chief Pharmacy Officer	Ms.	Jhawar	Sharon		5629895168				5629973196	sjhawar@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	02/12/2019	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Recovery Audit Contact	Director, Reg Audit & Ent Mntrng	Mrs.	Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	SNP Application Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	SNP State Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Surveillance Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	System Contact	Chief  Technology Exective	Mr.	Goode	Josh		5623082789					jgoode@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	07/03/2018	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Third Party Administrator (TPA) Liaison	Financial Accounting Specialist	Ms.	McClour	Tina		5629894459					tmcclour@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	04/17/2018	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	User Access Contact	Director, Reg Audit & Ent Mntrng		Cordova	Elizabeth		5629973131	3131			5629895120	ECordova@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	05/19/2022	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Utilization Management Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431				5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9104	Utilization Review Contact	Chief Medical Officer	Dr.	Batra	Romilla	A	5629894431				5629895120	rbatra@scanhealthplan.com	3800 Kilroy Airport Way	Suite 100	Long Beach	CA	90806	01/09/2023	2023	SCAN HEALTH PLAN	Local CCP	SCAN Health Plan	HMO/HMOPOS		SCAN Group	768	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9147	Agent/Broker Compensation Data Contact	Director, Financial Systems		Lazar	Lisa		9197653359					Lisa.Lazar@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/28/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Automated TrOOP Balance Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776706					eobp2p@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Backup User Access Contact	EDI Analyst		Umstead	Kamala		9197654363					kamala.umstead@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27707	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Best Available Evidence Contact	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Bid Audit Contact	AVP, Head of Actuarial and Pricing Services		Turner	Danica		9847775665					danica.turner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/30/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Bid Audit Site Contact	AVP, Head of Actuarial and Pricing Services		Turner	Danica		9847775665					danica.turner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/30/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Bid Primary Contact	Director, Actuarial Services		Vander Berg	Lucas		9842193485					Lucas.VanderBerg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	CAP Report Contact for Public Website	Sr Communications Advisor		Stinneford	Mark		9197653005					media.inquiry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	CEO - CMS Administrator Contact	President and CEO	Mr.	Sotunde	Tunde		9197657160					Tunde.Sotunde@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	02/08/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	CEO - Senior Official for Contracting	President and CEO	Mr.	Sotunde	Tunde		9197657160					Tunde.Sotunde@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	02/08/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Chief Financial Officer	SVP, Chief Financial Officer and Treasurer	Mr.	Perry	Mitchell	W	9197653923					mitch.perry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Chief Operating Officer	SVP, Chief Operations & Member Experience Officer	Ms.	Mizelle	Karla		9849603787					karla.mizelle@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Chief Information Officer	Chief Information Officer	Ms.	Abernathy	Jo		9197652383					Jo.Abernathy@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	277022291	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Chief Information Security Officer	Chief Information Security Officer	Mr.	Chilton	Richard		9197652021					Rick.Chilton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	277022291	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	CMS Casework Communication Contact	Director, Stakeholder Escalations		Holder	Nicole		9197651320					Caseworker@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/28/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Complaints Tracking Contact	Director, Stakeholder Escalations		Holder	Nicole		9197651320					Nicole.Holder@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/28/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Contact for Fraud Investigations	VP, Audit		Bennett	Tracy		3362014290					tracyr.bennett@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Coordination of Benefits Contact	Team Lead, Operations		Pridgen	David		3362014141					David. Pridgen@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Corporate Mailing						3362014460				3366592969	deborah.washington-mcneill@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Coverage Gap Discount Program (CGDP) Payment Contact	Principal Financial Accounting & Reporting Analyst		Varshney	Monisha		3528705750					Monisha.Varshney@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	12/04/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Customer Service Operations Contact	Sr. Manager, Contact Center		Woods	Renita		9197657057					Renita.Woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/18/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	DIR Contact	Director, Actuarial Services		Pigg	Ryland		9196168313					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P. O. Box 2291	Durham	NC	27702	03/15/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	DIR Contact (Secondary)	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Emergency Part D Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Emergency Part D Contact (Secondary)	VP, Government Markets Ops		Perry	Endya		9197775504					endya.perry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/06/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Employer Waiver Contact	Manager, Medicare Plan Administration		Brown	Alison		9196728994					alison.brown@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/28/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Encounter Data & Risk Adjustment Operations Contact	Manager, Risk Adjustment		Kimbrell	Tammy		9844448393					Tammy.Kimbrell2@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	05/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Enrollment Contact	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	EOB Transfer Contact	Medicare Pharmacy Operations Admin		Edwards	Chrissie		9197653536				9197657291	Corporate.pharmacy@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Financial Audit Contact	Director, Audit	Ms.	Ferrell	Kim		3362014038					kim.ferrell@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Financial Reporting Contact	Director, Subsidiary Reporting		Hill	Adam		5044950050					Adam.Hill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Formulary Contact	Clinical Pharmacist		Hiller	Debra		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics Inc	2900 Ames Crossing Road	Eagan	MN	55121	10/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	General Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Government Relations Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	HIPAA Privacy Officer	Director, Privacy, Ethics & Corp Policies		Hamlet	Lynn		9197657416					lynn.hamlet@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/24/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	HIPAA Security Officer	Chief Information Security Official		Chilton	Rick		9197652021					rick.chilton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Hospice Contact	Pharmacy Services Coordinator		Leggett	Ursula		9197654599					Ursula.Leggett@bcbsnc.com	PO Box 2291		Durham	NC	27702	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Interoperability Contact	Director, Corporate Compliance Official		Haith	Elenor		9842125897					Elenor.Haith@bcbsnc.com	PO Box 2291		Durham	NC	27702	07/20/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	MA Appeals/Grievances Contact	Director, Commercial and Medicare Appeals & Griev		McFall	Adonna		9197654061					Adonna.McFall@bcbsnc.com	Blue Cross Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	MA Claims Processing Contact for Public Website	Call Center Support		Woods	Renita		8882969790					Renita.Woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/18/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Marketing Contact	Manager, Medicare Plan Administration		Brown	Alison		9196728994					alison.brown@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/28/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Medical Director	Lead Medical Director	Dr.	Campbell	John		9197652718					john.campbell@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Medicare Compliance Officer	Director, Corporate Compliance	Mrs.	Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/09/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Medicare Coordinator	Director, CMS Contract Administration		Washington-McNeill	Deborah		3362014460				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Medicare Part D Opioid Overutilization Contact	Medicare Part D Operations Administrator		Edwards	Chrissie		9197653536					chrissie.edwards@bcbsnc.com	Blue Cross Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/31/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Medication Therapy Management Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	OffShore Subcontractor Contact	Director, Corporate Compliance		Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Online Enrollment Center Contact (Back-up)	Business Solutions Architect		Povathingal	Raj		9197654138					Raj.Povathingal@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Online Enrollment Center Contact (Optional)	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Online Enrollment Center Contact (Primary)	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Part C Application Contact		Ms.	Washington-McNeill	Deborah		3362014460					deborah.washington-mcneill@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Part C Reporting Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Appeals	Director, Commercial and Medicare Appeals & Griev		McFall	Adonna							Adonna.McFall@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882987520				HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Appeals Contact (Secondary)	Mgr, MA and PDP Appeals and Grievances		Lanier	Paige						8883758836	paige.lanier@bcbsnc.com	PO Box 17509	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8774947647				HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Application Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Benefits Contact	Team Leader, Clinical Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Claims Submission Contact	Functional Business Consultant - Govt Prgms		Brooke	Lance		4026862603					lbrooke@primetherapeutics.com	Prime Therapeutics LLC	2900  Ames Crossing Road	Eagan	MN	55121	10/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Exceptions Contact	Manager		Swanson	Ryan							PartDExceptions@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/30/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882969790				HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Exceptions Contact (Secondary)	Team Leader, Clinical Pharmacy Reviews - Medicare		Parikh	Swati							PartDExceptions@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	01/04/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882969790				HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Price File Contact (Back-up)	Team Leader, Clinical Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Price File Contact (Optional)	Price File Analyst Sr		Trudeau	Ashley		6127771338					ashley.trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Price File Contact (Primary)	Medicare Pharmacy Operations Administrator		Edwards	Chrissie		9197653536					chrissie.edwards@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Quality Assurance Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Part D Reporting Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3362014460					deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Patient Safety Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Payment Contact	AVP, Head of Actuarial Services & Valuation		Pigg Jr.	Ryland		9847776107					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/11/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Pharmacy Director	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Pharmacy Network Management Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Pharmacy Network Management Contact (Secondary)	Team Leader, Clinical Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Pharmacy Technical Help Desk Contact			Helpdesk	Pharmacy							MGarzarodriguez@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8772777893				HMO - Health Maintenance Organization		C	Atlanta
H9147	Physician Incentive Contact	VP, Provider Network & Transformation		Werner	Mark		9197654700					mark.werner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	10/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Plan Directory Contact for Public Website	Call Center support		Services	Member		8882969790					renita.woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Plan to Plan Reconciliation Contact	Manager, Financial Accounting & Reporting		Hitchcock	Grace		9197657999					grace.hitchcock@bcbsnc.com	ATTN:  Sheila Adams or Yvonne Stancil (Medicare P2P)	PO Box 30060 Mailstop 700-1AP	Durham	NC	27702	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Processor Contact	Dir Govt Programs & Ops		Zeien	Daniel		6127776775					daniel.zeien@primetherapeutics.com	Prime Therapeutics, LLC	2655 Eagan Woods Drive	Eagan	MN	55122	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Quality Contact	Dir, Quality and Risk Mgmt		Moon	Gregory		9847775524					Gregory.Moon@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/28/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Reconciliation Contact	Director, Actuarial Services		Pigg	Ryland		9196168313					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P. O. Box 2291	Durham	NC	27702	03/11/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Reconciliation Contact (Secondary)	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Recovery Audit Contact	Director, Corporate Compliance	Mrs	Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina,	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	SNP Application Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	SNP State Contact	Mgr, CMS Contract Administration		Brown	Alison		9198674599					alison.brown@bcbsnc.com	PO Box 2291		Durham	NC	27702	07/27/2021	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Surveillance Contact	Director, Corporate Compliance		Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	System Contact	Director, IT Solution Delivery		Holbrook	Janice		3362014101					janice.holbrook@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Third Party Administrator (TPA) Liaison	AVP, Head of Actuarial Services & Valuation		Pigg Jr.	Ryland		9847776107					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/11/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	User Access Contact	Electronic Data Interchange Analyst		Dunn	Lorrie		9197653669					lorrie.dunn@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27707	02/06/2020	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Utilization Management Contact	Director, Clinical Teams		Perdue	Angela		3362014352					angela.perdue@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9147	Utilization Review Contact	Director, Clinical Teams		Perdue	Angela		3362014352					angela.perdue@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NC SENIOR HEALTH	Local CCP	Blue Cross and Blue Shield of North Carolina	HMO/HMOPOS		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9153	Agent/Broker Compensation Data Contact	Mgr. Sales and Marketing	Mr	Beasley	Corey		5135698544				5136056845	cobeasley@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Automated TrOOP Balance Transfer Contact	Chief Financial Officer		Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Backup User Access Contact	Compliance Auditing & Monitoring Manager	Mrs.	McBratney	Kimberly		7852246063				5136056845	kmcbratney@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Best Available Evidence Contact	Enrollment Compliance Specialist	Mr	Nelson	Robert		5134698552				5136056845	robert.nelson@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	07/26/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Bid Audit Contact	CFO		Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Bid Audit Site Contact	CFO		Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Bid Primary Contact	Director of Product Growth & Development		Muldowney	Jessica		5138355228					jmuldowney@communicare-advantage.com	10123 Alliance Drive, Blue Ash, OH 45242		Blue Ash	OH	45242	01/12/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	CAP Report Contact for Public Website	Chief Compliance Officer		Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	01/12/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Hager	Robert		5133564280				5136056845	rhager@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Hager	Robert		5133564280				5136056845	rhager@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Chief Financial Officer	CFO	Mr	Heimgarter	Jeremy		3043431950				3043431949	jheimgartner@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	10/31/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Chief Operating Officer	CFO	Mr	Heimgarter	Jeremy		3043431950				3043431949	jheimgartner@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Chief Information Officer	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Chief Information Security Officer	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	CMMI Model Point of Contact		Mrs.	McMillian	Tomi		3043432680					tomi@stonerisehealthcare.com	700 Chappell Road		Charleston	WV	25304	11/10/2020	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	CMS Casework Communication Contact	VP Healthcare Services & Quality Operations		Gramlick	Stephanie		5134698547				5136056845	stgramlick@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Complaints Tracking Contact		Ms	Jackson	Sherri		3044100273				8662254179	sherri.jackson@communicare-advantage.com	700 Chappell Rd.		Charleston	WV	25304	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Contact for Fraud Investigations	Chief Compliance Officer	Mr	Guzman	Fabian		5134699586				5136056845	fguzman@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Coordination of Benefits Contact		Ms	Jackson	Sherri		3044100273				8662254179	sherri.jackson@communicare-advantage.com	700 Chappell Rd.		Charleston	WV	25304	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Corporate Mailing						3047579333					kmcbratney@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Coverage Gap Discount Program (CGDP) Payment Contact	CFO		Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Customer Service Operations Contact		Ms	Jackson	Sherri		3044100273				8662254179	sherri.jackson@communicare-advantage.com	700 Chappell Rd.		Charleston	WV	25304	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	DIR Contact	Sr. Director, Government Programs		Farmer	Jim		3308886098					jfarmer@elixirsolutions.com	8921 Canyon Falls Blvd,	Suite 100	Twinsburg	OH	44087	09/21/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	DIR Contact (Secondary)	Mgr Fin. Report & Analytic Finance		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	8957 Canyon Falls Blvd.		Twinsburg	OH	44087	02/23/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Electronic Health Record Contact	President		Satterfield	Chuck		5135301830				5136056845	csatterfield@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Emergency Part D Contact	Pharmacist		McGhee	Anna	C	5137061309				5136056845	aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Emergency Part D Contact (Secondary)	Chief Financial Officer		Heimgartner	Jeremy		5132404810				5136056845	jheimgartner@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Employer Waiver Contact		Ms.	McMillian	Tomi		3043482630					tomi@stonerisehealthcare.com	700 Chappell Road		Charleston	WV	25304	07/09/2020	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Encounter Data & Risk Adjustment Operations Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Enrollment Contact	Chief Compliance Officer	Mr	Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	EOB Transfer Contact	Chief Financial Officer	Mr.	Heimgartner	Jeremy		5132404810				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road, Suite 240		Blue Ash	OH	45242	12/21/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Financial Audit Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Financial Reporting Contact	Chief Financial Officer	Mr	Heimgartner	Jeremy		5132404810				5136056845	jheimgartner@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Formulary Contact			Quinn	Kelsey		3304864954					kquinn@elixirsolutions.com	8921 Canyon Falls Blvd,	Suite 100	Twinsburg	OH	44087	09/21/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Formulary Contact (Secondary)	Clinical Formulary Pharmacist		Singh	Roop		3304866482					rsingh@elixirsolutions.com	8921 Canyon Falls Blvd,	Suite 100	Twinsburg	OH	44087	09/21/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	General Contact	CEO	Mr.	Hager	Robert		5134699593				5136056845	rhager@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Government Relations Contact	COMPLIANCE OFFICER	Mr	Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	01/12/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	HIPAA Privacy Officer	Chief Compliance Officer	Mr	Guzman	Fabian		5134699586				5136056845	fguzman@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	HIPAA Security Officer	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Hospice Contact	Medical Director	Dr.	Malone	James		3046691233					James.Malone@wvumedicine.org	700 Chappell Road		Charleston	WV	25304	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Interoperability Contact	CFO	Mr	Heimgartner	Jeremy		5134698545				5136056845	jheimgartner@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	MA Appeals/Grievances Contact		Ms	Jackson	Sherri		3044100273				8662254179	sherri.jackson@communicare-advantage.com	700 Chappell Rd.		Charleston	WV	25304	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	MA Claims Processing Contact for Public Website		Ms	Jackson	Sherri		3044100273				8662254179	sherri.jackson@communicare-advantage.com	700 Chappell Rd.		Charleston	WV	25304	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Marketing Contact	Mgr. Sales and Marketing	Mr	Beasley	Corey		5135698544				5136056845	cobeasley@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	01/12/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Medical Director	Medical Director	Dr.	Malone	James		3046691233					James.Malone@wvumedicine.org	700 Chappell Road		Charleston	WV	25304	06/05/2019	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Medicare Compliance Officer	Chief Compliance Officer	Mr	Guzman	Fabian		5132404810				5136056845	fguzman@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Medicare Coordinator	Compliance Auditing & Monitoring Manager	Mrs.	McBratney	Kimberly		7852246063				5136056845	kmcbratney@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Medicare Part D Opioid Overutilization Contact	Pharmacist		McGhee	Anna	C	5137061309				5136056845	aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Medication Therapy Management Contact	Vice President, Pharmacy Solutions		Miller	Holly		3302931916					hmiller@healthdialog.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/15/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	OffShore Subcontractor Contact	Manager Compliance Auditing & Monitoring	Mrs.	McBratney	Kim		7852246063				5136056845	kmcbratney@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	01/12/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Part C Application Contact	Chief Compliance Officer	Mr.	Guzman	Fabian		5134699586				5136056845	fguzman@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Part C Reporting Contact	Chief Compliance Officer		Guzman	Fabian		5134699586				5136056845	fguzman@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Part D Appeals	Appeals Supervisor, Clinical Operations		Binegar	Sam						3304058081	Appeals@elixirsolutions.com	8921 Canyon Falls Blvd,	Suite 100	Twinsburg	OH	44087	09/21/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Chicago
H9153	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations		Binegar	Samantha						3304058081	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Chicago
H9153	Part D Application Contact	Chief Compliance Officer	Mr	Guzman	Fabian		5134699586				5136056845	fguzman@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	01/30/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Part D Benefits Contact	Pharmacist		McGhee	Anna	C	5137061309				5136056845	aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Part D Claims Submission Contact	Account Manager		Easterling	Christy		3308886974					ceasterling@elixirsolutions.com	8920 Canyon Falls Blvd.	Suite 100	Twinsburg	OH	44087	09/21/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Part D Exceptions Contact	Assoc. VP of Clinical Operations		Lavingnette	Amanda						3304058081	calmer@envisionrx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/27/2021	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active	8336655424				HMO - Health Maintenance Organization		C	Chicago
H9153	Part D Exceptions Contact (Secondary)	Dir. of Clinical Development and Strategy		Collins	Andrea						3304058081	acollins@envisionrx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/27/2021	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active	8336655424				HMO - Health Maintenance Organization		C	Chicago
H9153	Part D Price File Contact (Back-up)	Financial Analyst, Finance		Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	8921 Canyon Falls Blvd,	Suite 100	Twinsburg	OH	44087	09/21/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Part D Price File Contact (Primary)	Sr. Financial Manager Reporting & Analytics	Mr.	Campbell	Tim		3308886988					tcampbell@elixirsolutions.com	8921 Canyon Falls Blvd,	Suite 201	Twinsburg	OH	44087	09/21/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Part D Quality Assurance Contact	Pharmacist		McGhee	Anna	C	5137061309				5136056845	aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Part D Reporting Contact	Manager Compliance Auditing & Monitoring	Mrs.	McBratney	Kim		7852246063				5136056845	kmcbratney@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Patient Safety Contact	VP Healthcare Services & Quality Operations		Gramlick	Stephanie		5134698547				5136056845	stgramlick@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Payment Contact	CFO	Mr	Heimgartner	Jeremy		3043431959				3043431949	jheimgartner@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	10/31/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Personal Health Record Contact	Chief Compliance Officer	Mr.	Guzman	Fabian		5134699586				5136056845	fguzman@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Pharmacy Director	Pharmacist		McGhee	Anna	C	5137061309				5136056845	aclobas@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Pharmacy Network Management Contact	Dir. Pharmacy Network Development and Operations		Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	8921 Canyon Falls Blvd,	Suite 100	Twinsburg	OH	44087	09/21/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Pharmacy Technical Help Desk Contact	VP of Operations		Conn	Todd							tconn@elixirsolutions.com	8921 Canyon Falls Blvd,	Suite 100	Twinsburg	OH	44087	09/21/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active	8336655423				HMO - Health Maintenance Organization		C	Chicago
H9153	Physician Incentive Contact		Mrs.	Acker	Amy		7037891929					aacker@communicare-advantage.com	10123 Alliance Drive		Blue Ash	OH	45242	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Plan Directory Contact for Public Website	Enrollment Specialist		Piper	Carole		5136056845				5136056845	cpiper@communicare-advantage.com	10123 Alliance Road		Blue Ash	OH	45242	04/28/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Plan to Plan Reconciliation Contact	Chief Financial Officer		Heimgartner	Jeremy		5132404810				5136056845	jheimgartner@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Processor Contact	CFO	Mr	Heimgarter	Jeremy		3043431950				3043431949	jheimgartner@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Quality Contact	VP Healthcare Services & Quality Operations	Mrs.	Gramlick	Stephanie		5134698547				5136056845	sgramlick@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Reconciliation Contact	Chief Financial Officer		Heimgartner	Jeremy		5132404810				5136056845	jheimgartner@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Reconciliation Contact (Secondary)	Director Part D Clinical Operations		Auda	Ayad		3043431950				8662254179	ayad.auda@wvsasenioradvantage.com	700 Chappell Road		Charleston	WV	25304	02/27/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Recovery Audit Contact	CFO	Mr	Heimgartner	Jeremy		3043431959				3043431949	jheimgartner@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	10/31/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	SNP Application Contact	Chief Compliance Officer	Ms.	Guzman	Fabian		5134699586				5136056845	fguzman@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	SNP State Contact	Chief Compliance Officer	Mr	Guzman	Fabian		5134699586				5136056845	fguzman@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	01/30/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Surveillance Contact	Manager Compliance Auditing & Monitoring	Mrs.	McBratney	Kim		7852246063				5136056845	kmcbratney@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	System Contact	EPOC		Krumm	Shawn		5136086027				5136056845	skrumm@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Third Party Administrator (TPA) Liaison	Chief Financial Officer		Heimgartner	Jeremy		5132404810				5136056845	jheimgartner@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	12/28/2022	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	User Access Contact	Chief Compliance Officer	Mr	Guzman	Fabian		5134699586				5136056845	fguzman@communicare-advantage.com	700 Chappell Road		Charleston	WV	25304	03/08/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Utilization Management Contact	Medical Director	Dr.	Malone	James		3046691233					James.Malone@wvumedicine.org	700 Chappell Road		Charleston	WV	25304	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9153	Utilization Review Contact	Medical Director	Dr.	Malone	James		3046691233					James.Malone@wvumedicine.org	700 Chappell Road		Charleston	WV	25304	03/15/2023	2023	WEST VIRGINIA SENIOR ADVANTAGE, INC.	Local CCP	West Virginia Senior Advantage	HMO/HMOPOS		SNP Holdings, LLC	758	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9185	Automated TrOOP Balance Transfer Contact	Health Plan Specialist I		Wahl	Beth		9892727610					bthompson@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Backup User Access Contact	Health Plan Specialist I		Wahl	Beth		9892727610					bthompson@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Best Available Evidence Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Bid Primary Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	CAP Report Contact for Public Website	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	CEO - CMS Administrator Contact	Program Director	Mr.	Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	CEO - Senior Official for Contracting	Program Director	Mr.	Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Chief Financial Officer	Chief Financial Officer	Mr.	Sen	Tuhin		9892727610					sen70@cs.com	3378 Fashion Square Blvd		Saginaw	MI	48603	07/19/2018	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Chief Operating Officer	Program Director	Mr.	Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Chief Information Officer	Program Director	Mr.	Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Chief Information Security Officer	Program Director	Mr.	Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	CMS Casework Communication Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Complaints Tracking Contact	Quality Assurance Coordinator		Hurley	Ashley		9892727610					ahurley@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Contact for Fraud Investigations	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Coordination of Benefits Contact	Health Plan Specialist I		Wahl	Beth		9892727610					bthompson@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Corporate Mailing						9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Coverage Gap Discount Program (CGDP) Payment Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Customer Service Operations Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	DIR Contact	Program Director	Mr	Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	DIR Contact (Secondary)	Health Plan Specialist I		Wahl	Beth		9892727610					bwahl@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	02/19/2021	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Emergency Part D Contact	Program Director		Benjamin	David		9892727610	108			9892727669	dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	12/30/2020	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Emergency Part D Contact (Secondary)	Health Plan Specialist 1	Mrs.	Wahl	Beth		9892727610	2727610			9892727669	bwahl@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	12/30/2020	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Encounter Data & Risk Adjustment Operations Contact	Health Plan Specialist 1		Wahl	Beth		9892727610				9892727669	bthompson@greatlakespace.org	3378 Fashion Square Blvd.		Saginaw	MI	48603	10/24/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Enrollment Contact	Health Plan Specialist I		Wahl	Beth		9892727610					bthompson@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	EOB Transfer Contact	Program Director	Mr.	Benjamin	David		9892727610				9892727669	dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Financial Audit Contact	Health Plan Specialist I	Mrs	Wahl	Beth		9892727610				9892727669	bthompson@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Financial Reporting Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Formulary Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	General Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Government Relations Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	HIPAA Privacy Officer	Quality Assurance Coordinator		Hurley	Ashley		9892727610					ahurley@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	HIPAA Security Officer	Quality Assurance Coordinator		Hurley	Ashley		9892727610					ahurley@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Interoperability Contact			Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	02/22/2022	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	MA Appeals/Grievances Contact	Quality Assurance Coordinator		Hurley	Ashley		9892727610					ahurley@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	MA Claims Processing Contact for Public Website	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Marketing Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	10/24/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Medical Director	Medical Director	Mr.	Argyle	Michael		9892727610					margyle@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	07/19/2018	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Medicare Compliance Officer	Quality Assurance Coordinator	Mrs	Hurley	Ashley		9892727610				9892727669	ahurley@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Medicare Coordinator	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Medicare Part D Opioid Overutilization Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/15/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Medication Therapy Management Contact	Quality Assurance Coordinator		Hurley	Ashley		9892727610					ahurley@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Part C Application Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Part D Appeals	Program Director	Mr.	Benjamin	David						9892727669	dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active	8444457223				PACE - Nat		C	Chicago
H9185	Part D Appeals Contact (Secondary)	Program Director	Mr.	Benjamin	David	S					9892727669	dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	12/30/2020	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active	8444457223				PACE - Nat		C	Chicago
H9185	Part D Application Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Part D Benefits Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Part D Claims Submission Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Part D Exceptions Contact	Program Director	Mr.	Benjamin	David						9892727669	dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active	8444457223				PACE - Nat		C	Chicago
H9185	Part D Exceptions Contact (Secondary)	Quality Assurance Coordinator		Hurley	Ashley							ahurley@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active	9892727610				PACE - Nat		C	Chicago
H9185	Part D Price File Contact (Back-up)	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Part D Price File Contact (Primary)	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Part D Quality Assurance Contact	Quality Assurance Coordinator		Hurley	Ashley		9892727610					ahurley@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Part D Reporting Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Patient Safety Contact	Quality Assurance Coordinator		Hurley	Ashley		9892727610					ahurley@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Payment Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Pharmacy Director	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Pharmacy Network Management Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Pharmacy Technical Help Desk Contact	Program Director	Mr.	Benjamin	David						9892727669	dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active	8444457223				PACE - Nat		C	Chicago
H9185	Plan Directory Contact for Public Website	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Plan to Plan Reconciliation Contact	Health Plan Specialist I		Wahl	Beth		9892727610					bthompson@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Processor Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Quality Contact	Quality Assurance Coordinator		Hurley	Ashley		9892727610					ahurley@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	04/18/2019	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Reconciliation Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Recovery Audit Contact	Program Director	Mr.	Benjamin	David		9892727610				9892727669	dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Surveillance Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	System Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Third Party Administrator (TPA) Liaison	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	User Access Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Utilization Management Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9185	Utilization Review Contact	Program Director		Benjamin	David		9892727610					dbenjamin@greatlakespace.org	3378 Fashion Square Blvd		Saginaw	MI	48603	03/14/2017	2023	A&D CHARITABLE FOUNDATION, INC.	National PACE	Great Lakes PACE	National PACE		A&D Charitable Foundation, Inc.	608	Yes	Active					PACE - Nat		C	Chicago
H9191	Agent/Broker Compensation Data Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Automated TrOOP Balance Transfer Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Backup User Access Contact		Mr	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Best Available Evidence Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Bid Audit Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Bid Audit Site Contact	President & CEO	Mr.	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Bid Primary Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	CAP Report Contact for Public Website	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	CEO - CMS Administrator Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	CEO - Senior Official for Contracting	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Chief Financial Officer	CFO	Mr	Persinger	Keith		4104563946					kpersinger@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	12/29/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Chief Operating Officer	Chief Operating Officer	Mr	Persinger	Keith		4104563946					kpersinger@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	12/29/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Chief Information Officer	Director of Information Technology	Mr	Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Chief Information Security Officer	Director of Information Technology	Mr.	Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	CMS Casework Communication Contact	Chief Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Complaints Tracking Contact		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite  300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Contact for Fraud Investigations	Director, Operations	Ms.	Winton	Linda		8173743812					lwinton@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/24/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Coordination of Benefits Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/17/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Corporate Mailing						4104240772					info@pphealthplan.com	785 Elkridge Landing Rd	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/17/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Customer Service Operations Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	DIR Contact	Financial Analyst	Mr	Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	7835 Freedom Avenue NW	Suite 100	North Canton	OH	44720	02/21/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	DIR Contact (Secondary)	Sr Financial Manager Reporting & Analytics		Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW	Suite 100	North Canton	OH	44720	02/21/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Emergency Part D Contact	Director of Pharmacy	Dr	Ford	James	E	4433100351					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Emergency Part D Contact (Secondary)	Pharmacy Operations Manager	Dr	Brown	Latrese		4437621114					lbrown@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Encounter Data & Risk Adjustment Operations Contact	Software Engineer		Rifkin	Joshua		4108977578					jrifkin@pphealthplan.com	785 Elkridge Landing Road		Linthicum	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Enrollment Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623091	sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	EOB Transfer Contact	Sr. Director of  Operations		Brain	Jay		2403672626				8448134544	JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Financial Audit Contact	Director of Finace	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/17/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Financial Reporting Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Formulary Contact	Formulary Pharmacist	MS	Baggett	Renee		3308886243					rbaggett@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Formulary Contact (Secondary)	Director Formulary Operations		Singh	Roop		3304866482					rsingh@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	General Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Government Relations Contact			Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	HIPAA Privacy Officer		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	HIPAA Security Officer	Director of Information Technology		Boyer	Brantdon		4438131738					Bboyer@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	07/16/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Hospice Contact	Account Manager	Ms.	Sousa	Ana		2158724933					asousa@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Interoperability Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	MA Appeals/Grievances Contact	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	MA Claims Processing Contact for Public Website	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Marketing Contact	Director of Partner Development	Ms	Radice	Sue		4109913213				8444623019	Sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Medical Director	Medical Director	Dr	Kimmel	Alan		4102183691					akimmel@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Medicare Compliance Officer	Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	11/10/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Medicare Coordinator		Mr.	Grindrod	Rick		4104240772					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Medicare Part D Opioid Overutilization Contact	Pharmacy Director	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/15/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Medication Therapy Management Contact	VP Pharmacy Solutions	Ms	Miller	Holly		3302931916					hmiller@healthdialog.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	OffShore Subcontractor Contact	Chief Compliance Officer	Mr.	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part C Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part C Reporting Contact	Medicare Advantage Reporting Process Manager	Ms	Butler	Christina		2403532930					cbutler@pphealthplan.com	785  Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/13/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Appeals	Pharmacy Director	Dr	Ford	James	E						jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/12/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	8448468007				HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Appeals Contact (Secondary)	Clinical Operations Supervisor	Ms.	Binegar	Samantha	J					3304058081	Appeals@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	3303449571	0409			HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Benefits Contact	Director of Pharmacy	Dr	Ford	James	E	4432759810					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Claims Submission Contact	Elixir Account Manager	Ms	Brisson	Carly		9169392883					cbrisson@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Exceptions Contact	Associate Vice President	Ms	Lavignette	Amanda							alavignette@envsionrx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	11/10/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Exceptions Contact (Secondary)	Senior Director, Pharmacy Services	Dr	Ford	James							jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	11/10/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	4432759801				HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Price File Contact (Back-up)	Financial Analyst III		Wentz	Christophe		3304864910					cwentz@elixirsolutions.com	8957 Canyon Falls Blvd		Twinsburg	OH	44087	06/08/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Price File Contact (Optional)	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Price File Contact (Primary)	Director of Reporting & Analytics	Mr	Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	8957 Canyon Falls Blvd		Twinsburg	OH	44087	06/08/2023	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Quality Assurance Contact	Pharmacy Operations Manager	Dr	Brown	Latrese		4437621114					lbrown@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Part D Reporting Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Patient Safety Contact	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Payment Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Pharmacy Director	Director of Pharmacy	Dr	Ford	James	E	4432759801					jford@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Pharmacy Network Management Contact	Director Pharmacy Network Development & Operations	Ms	Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Pharmacy Technical Help Desk Contact	Vice President of Operations	Mr	Conn	Todd							tconn@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/14/2022	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active	8448468007				HMO - Health Maintenance Organization		C	Philadelphia
H9191	Plan Directory Contact for Public Website	Director of Partner Development	Ms	Radice	Sue		4109913213					Sradice@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Plan to Plan Reconciliation Contact	Director of Finance	Ms	McIntyre	Mary Beth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/17/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Processor Contact	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Rd	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Quality Contact	Dir. of Performance Improvement & Quality	Mr	Kirwan	Mark		4104240411					mkirwan@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Reconciliation Contact	Director of Finance	Ms	McIntyre	Marybeth		4109672097					mmcintyre@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/17/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Reconciliation Contact (Secondary)	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Recovery Audit Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	SNP Application Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	SNP State Contact	President & CEO	Mr	Grindrod	Rick		4109137653					rgrindrod@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Surveillance Contact	Chief Compliance Officer	Mr	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/03/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	System Contact	Sr. Director of Operations	Mr.	Brain	Jay		2403672626					jbrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Third Party Administrator (TPA) Liaison	Sr. Director of Operations		Brain	Jay		2403672626					JBrain@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	09/29/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	User Access Contact	Chief Compliance Officer	Mr	Nunez	Kenneth		8132301048					knunez@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	02/25/2021	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Utilization Management Contact	Director of Utilization Review	Mr	Derby	Thomas		4846823923					tderby@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9191	Utilization Review Contact	Director of Utilization Review	Mr	Derby	Thomas		4846823923					tderby@pphealthplan.com	785 Elkridge Landing Road	Suite 300	Linthicum Heights	MD	21090	01/30/2020	2023	PROVIDER PARTNERS HEALTH PLAN OF MISSOURI, INC.	Local CCP	Provider Partners Health Plans	HMO/HMOPOS		Rifkin Managed Care Holding, LLC	673	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Agent/Broker Compensation Data Contact	Vice President, Sales		Olmstead	Jim		7176093994					jolmstead@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Automated TrOOP Balance Transfer Contact	Vice President, Pharmacy Operations		Vangala	Ramesh		2152197864				2159674482	troop@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Backup User Access Contact	Compliance Officer	Mrs.	Lloyd	Angela		2159914090					alloyd@hpplans.com	1101 Market Street	Suite 3000	Philadelphia	PA	19107	07/20/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Best Available Evidence Contact	AVP, Enrollment		Johnson	Chris		2159914320				2159679267	cjohnson@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Bid Audit Contact	SVP, Health Care Data Analytics		Potts	Carol		2159914077					cpotts@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Bid Primary Contact	SVP, Health Care Data Analytics		Potts	Carol		2159914077					cpotts@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	CAP Report Contact for Public Website	Compliance Officer		Lloyd	Angela		2159914090					alloyd@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	09/15/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	CEO - CMS Administrator Contact	President and CEO	Mrs.	Napier	Denise		6097814776					dnapier@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	CEO - Senior Official for Contracting	President and CEO	Mrs.	Napier	Denise		6097814776					dnapier@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Chief Financial Officer	Chief Financial Officer	Mr.	Clancy	Kevin		2678315363					Kclancy@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Chief Operating Officer	Chief Operating Officer	Mr.	McTiernan	Chris		2157797914					cmctiernan@jeffersonhealthplans.com	1101 Market Street	30th Floor	Philadelphia	PA	19107	09/11/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Chief Information Officer	Vice President, IT (TJU)	Mr.	Nizami	Nassar		9999999999					nassar.nizami@jefferson.edu	1101 Market Street		Philadelphia	PA	19107	02/06/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Chief Information Security Officer	Vice President, Security (TJU)	Mr.	Odom	Mark		2155032439					Mark.Odom@jefferson.edu	833 Chestnut		Philadelphia	PA	19107	02/06/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	CMMI Model Point of Contact	Compliance Officer	Mrs.	Lloyd	Angela		2159914090					alloyd@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	09/15/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	CMS Casework Communication Contact	Manager, Complaints, Grievances and Appeals		Watkins	Leah		2159914023					Lwatkins@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Complaints Tracking Contact	Manager, Complaints, Grievances and Appeals		Watkins	Leah		2159914023					Lwatkins@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Contact for Fraud Investigations	Director, Special Investigations Unit		Sondergaard	Christian		2159914046					csondergaard@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Coordination of Benefits Contact	Vice President, Pharmacy Operations		Vangala	Ramesh		2152197864				2159674482	cob@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Corporate Mailing						2159914051				2155921034	jbaker@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President, Pharmacy Operations		Vangala	Ramesh		2152197864				2159674482	rvangala@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Customer Service Operations Contact	General Manager, Health Plan Operations		Dans	Kim		2159914067					kdans@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	DIR Contact	Vice President, Pharmacy Operations		Vangala	Ramesh		2152197864					DIR@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	DIR Contact (Secondary)	SVP, Health Care Data Analytics		Potts	Carol		2159914077					cpotts@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Emergency Part D Contact	Vice President, Pharmacy Operations		Vangala	Ramesh		2152197864				2159674482	rvangala@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Emergency Part D Contact (Secondary)	Manager, Pharmacy Regulations & Implementations		McCaffrey	Hannah		2159657142					pharmacymedicare@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Encounter Data & Risk Adjustment Operations Contact	Director, Encounter Data Reporting & EDI Trans		Raupp	Mike		2159914145					mraupp@hpplans.com	901 market street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Enrollment Contact	AVP, Enrollment		Johnson	Chris		2159914320					cjohnson@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	EOB Transfer Contact	AVP, Claims		McConaghy	Sandy		2159914308				2159679261	smcconaghy@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/30/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Financial Audit Contact	Chief Financial Officer	Mr.	Clancy	Kevin		2678315364					kclancy@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Financial Reporting Contact	Chief Financial Officer		Clancy	Kevin		2678315364					kclancy@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Formulary Contact	Manager, Pharmacy Regulations & Implementations		McCaffrey	Hannah		2159657142					Formulary@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Formulary Contact (Secondary)	Formulary Pharmacist		Vaisberg	Fallan		2158454278					fvaisberg@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	General Contact	Compliance Officer	Mrs.	Lloyd	Angela		2159914090					alloyd@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	09/15/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Government Relations Contact	SVP, Government Affairs		Jones	Kearline		2159914063					kdjones@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	HIPAA Privacy Officer	Manager, Privacy		Dahiya	Prerna		2159914154					pdahiya@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	HIPAA Security Officer	Manager, Privacy		Dahiya	Prerna		2159914154					pdahiya@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Hospice Contact	Manager, Pharmacy Regulations & Implementations		McCaffrey	Hannah		2159657142					pharmacymedicare@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Interoperability Contact	Vice President, Head of IT		Marino	Anthony		2159914413					amarino@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	MA Appeals/Grievances Contact	Manager, Complaints, Grievancesand Appeals		Watkins	Leah		2159914023					Lwatkins@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	MA Claims Processing Contact for Public Website	AVP, Claims		McConaghy	Sandy		2159914308					smcconaghy@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/30/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Marketing Contact	Director, Marketing Communications		Grzyb	Sarah		6098657999					sgrzyb@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Medical Director	Senior Medical Director		Harris-Williams	Merleen		2676258290					mhwilliams@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Medicare Compliance Officer	Compliance Officer	Mrs.	Lloyd	Angela		2159914090					alloyd@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	09/15/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Medicare Coordinator	Director, Compliance		Henderson	Patricia		2159914394					phenderson@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Medicare Part D Opioid Overutilization Contact	Clinical Programs Pharmacist		Olchowecky	Kateryna		2159914245				2159679270	Overutilization@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	02/13/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Medication Therapy Management Contact	Director, Pharmacy Services		Dolores	Danielle		2159914329				2159679270	MTM@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	OffShore Subcontractor Contact	Compliance Officer	Mrs.	Lloyd	Angela		2159914090					alloyd@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	09/15/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Online Enrollment Center Contact (Primary)	AVP, Enrollment		Johnson	Chris		2159914320				2159679267	cjohnson@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part C Application Contact	Compliance Officer	Mrs.	Lloyd	Angela		2159914090					alloyd@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	09/15/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part C Reporting Contact	Director,  Compliance		Henderson	Patricia		2159914394					phenderson@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part D Appeals	Manager, Complaints, Grievances and Appeals		Watkins	Leah							Lwatkins@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active	2159914023				HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part D Appeals Contact (Secondary)	Supervisor, Complaints, Grievances and Appeals		Rostovskis	Tara							trostovskis@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active	2673853491				HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part D Application Contact	Compliance Officer	Mrs.	Lloyd	Angela		2159914090					alloyd@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	09/15/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part D Benefits Contact	Manager, Pharmacy Benefit Design and Audit		Chan	Kay		2159914197				2159679270	Overutilization@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part D Claims Submission Contact	Manager, Pharmacy Benefit Design and Audit		Chan	Kay		2159914197				2159679270	Overutilization@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part D Exceptions Contact	Director, Pharmacy Services		Dolores	Danielle						8663713239	Exceptions@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active	2159914329				HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part D Price File Contact (Back-up)	Manager, Pharmacy Regulations & Implementations		McCaffrey	Hannah		2159657142					Formulary@hpplans.com	901 Market St	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part D Price File Contact (Primary)	Manager, Pharmacy Benefit Design and Audit		Chan	Kay		2159914197				2159679270	Overutilization@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part D Quality Assurance Contact	Vice President, Pharmacy Operations		Vangala	Ramesh		2152197864					rvangala@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Part D Reporting Contact	Director, Compliance		Henderson	Patricia		2159914394					phenderson@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Patient Safety Contact	Director, Pharmacy Services		Dolores	Danielle		2159914329					ddolores@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Payment Contact	Chief Financial Officer		Clancy	Kevin		2678315363					Kclancy@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Pharmacy Director	Director, Pharmacy Services		Dolores	Danielle		2159914328				8663713239	ddolores@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Pharmacy Network Management Contact	Vice President, Pharmacy Operations		Vangala	Ramesh		2152197864				2159674482	Pharmacynetwork@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Services		Dolores	Danielle		2159914329				8663713239	ddolores@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Pharmacy Technical Help Desk Contact	Director, Pharmacy Services		Dolores	Danielle						2159679270	Formulary@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active	8668417659				HMO - Health Maintenance Organization		C	Philadelphia
H9207	Pharmacy Technical Help Desk Contact (Secondary)	Supervisor Pharmacy Technician		Mahler	Brandi						2159679270	bmahler@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active	8668417659				HMO - Health Maintenance Organization		C	Philadelphia
H9207	Plan Directory Contact for Public Website	Director, Marketing Communications		Grzyb	Sarah		6098657999					sgrzyb@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Plan to Plan Reconciliation Contact	Pharmacy Regulatory Business Coordinator		Rutledge-Glazov	Rose	A	2159657142				2159679263	P2P@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Processor Contact	Vice President, Pharmacy Operations		Vangala	Ramesh		2152197864				2159674482	rvangala@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Quality Contact	AVP Quality Improvement & Performance		Mullen	Alyssa		6095054006					amullen@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Reconciliation Contact	Chief Financial Officer		Clancy	Kevin		2678315363					Kclancy@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Reconciliation Contact (Secondary)	Vice President, Pharmacy Operations		Vangala	Ramesh		2152197864				2159674482	DIR@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Recovery Audit Contact	SVP Health Care Data Analytics	Mrs.	Potts	Carol		2159914077					cpotts@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	SNP Application Contact	Compliance Officer	Mrs.	Lloyd	Angela		2159914090					alloyd@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	09/15/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	SNP State Contact	Compliance Officer	Mrs.	Lloyd	Angela		2159914090					alloyd@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	09/15/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Surveillance Contact	Vice President, Sales		Olmstead	Jim		7176093994					jolmstead@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	System Contact	Vice President, Head of IT		Marino	Anthony		2159914413					AMarino@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	07/07/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Third Party Administrator (TPA) Liaison	Vice President, Pharmacy Operations		Vangala	Ramesh		2152197864				2159679263	rvangala@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	User Access Contact	Compliance Officer	Mrs.	Lloyd	Angela		2159914090					alloyd@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	09/15/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Utilization Management Contact	Vice President, Medical Management		Mattiace	Michelle		8563320698					mmattiace@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9207	Utilization Review Contact	Vice President, Medical Management		Mattiace	Michelle		8563320698					mmattiace@hpplans.com	901 Market Street	Suite 500	Philadelphia	PA	19107	01/24/2023	2023	HEALTH PARTNERS PLANS, INC.	Local CCP	Jefferson Health Plans	HMO/HMOPOS		Thomas Jefferson University	523	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9219	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	02/12/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/28/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/10/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/12/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	02/12/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	02/12/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	02/12/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H9219	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				PPO - BBA		C	Chicago
H9219	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H9219	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				PPO - BBA		C	Chicago
H9219	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				PPO - BBA		C	Chicago
H9219	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				PPO - BBA		C	Chicago
H9219	PHR Beneficiary Contact																	02/12/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				PPO - BBA		C	Chicago
H9219	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	02/12/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9219	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	02/12/2020	2023	AMH HEALTH PLANS OF MAINE, INC.	Local CCP	AMH Health	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9231	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9231	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9231	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9231	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9231	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H9231	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9231	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H9231	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9231	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF TENNESSEE INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9239	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	CEO - CMS Administrator Contact	CEO (MA C&S)	Mr.	Madondo	John		7812923537					john_madondo@uhc.com	950 Winter Street	3rd  Flr	Waltham	MA	02541	09/12/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	CEO - Senior Official for Contracting	CEO (MA C&S)	Mr.	Madondo	John		7812923537					john_madondo@uhc.com	950 Winter Street	3rd Flr	Waltham	MA	02541	09/12/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	MMP Reporting Requirements Contact			Berardi	Christophe		7632833501					chris.berardi@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	MMP Point of Contact			Thompson	Sterling		9522026419					sterling. thompson@uhc.com	PO BOX 9472		MINNEAPOLIS	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9239	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Demo	UnitedHealthcare	Medicare-Medicaid Plan HMO/HMOPOS		UnitedHealth Group, Inc.	239	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9252	Automated TrOOP Balance Transfer Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Backup User Access Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Best Available Evidence Contact	Director PACE Program Development & Implementation		Kiefert	Mary	D	9042344338					mary.kiefert@msmc.com	4300 Alton Rd		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Bid Primary Contact	Director PACE Program Development & Implementation		Kiefert	Mary	D	9042344338					mary.kiefert@msmc.com	4300 Alton Rd		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	CAP Report Contact for Public Website	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary,kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	CEO - CMS Administrator Contact	VP of Managed Care and Population Health	Ms.	Barcelo	Lynda		3055353306					lynda.barcelo@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/24/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	CEO - Senior Official for Contracting	VP Managed Care & Population Health	Ms.	Barcelo	Lynda		3055353306					lynda.barcelo@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/24/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Chief Financial Officer	EVP and Chief Financial Officer	Mr.	Mendez	Alex		3056742089					alex.mendez@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Chief Operating Officer	SVP and Chief Operating Officer	Mr.	Pallin	Angel		8506742520					angel.pallin@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Chief Information Officer	SVP and Chief Information Officer	Mr.	Gillette	Tom		3056742730					tom.gillette@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Chief Information Security Officer	SVP and Chief Information Officer	Mr.	Gillette	Tom		3056742730					tom.gillette@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	CMS Casework Communication Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Complaints Tracking Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Contact for Fraud Investigations	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Coordination of Benefits Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Corporate Mailing						7865845560					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Coverage Gap Discount Program (CGDP) Payment Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Customer Service Operations Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	DIR Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	DIR Contact (Secondary)	VP Managed Care and Population Health	Ms.	Barcelo	Lynda		3055353306					lynda.barcelo@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Emergency Part D Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Emergency Part D Contact (Secondary)	VP Managed Care and Population Health	Ms.	Barcelo	Lynda		3055353306					lynda.barcelo@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Encounter Data & Risk Adjustment Operations Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Enrollment Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	EOB Transfer Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338				3055353438	mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Financial Audit Contact	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Financial Reporting Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Formulary Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Formulary Contact (Secondary)	VP Managed Care and Population Health	Ms.	Barcelo	Lynda		3055353306					lynda.barcelo@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	General Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Government Relations Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	HIPAA Privacy Officer	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	HIPAA Security Officer	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Interoperability Contact	PACE Program Director		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 ALTON ROAD	WARNER BLDG., 5TH FLOOR	MIAMI BEACH	FL	33140	09/05/2022	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	MA Appeals/Grievances Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	MA Claims Processing Contact for Public Website	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Marketing Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Medical Director	Medical Director	Dr.	Medina	Clifford		7865845560	5083			7865845060	clifford.medina@msmc.com	6050 W. 20th Avenue	Suite 2001	Hialeah	FL	33016	02/20/2023	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Medicare Compliance Officer	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Medicare Coordinator	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Medicare Part D Opioid Overutilization Contact	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Medication Therapy Management Contact	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	OffShore Subcontractor Contact	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		3056742121	50920				mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Online Enrollment Center Contact (Back-up)	VP Managed Care and Population Health	Ms.	Barcelo	Lynda		3055353306					lynda.barcelo@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Online Enrollment Center Contact (Primary)	Director PACE Program Development & Implementation		Kiefert	Mary		3056742121	50920				mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Part C Application Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Part D Appeals			Kiefert	Mary							mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active	8333520939				PACE - Nat		C	Atlanta
H9252	Part D Appeals Contact (Secondary)			Barcelo	Lynda							lynda.barcelo@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active	3055353306				PACE - Nat		C	Atlanta
H9252	Part D Application Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Part D Benefits Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Part D Claims Submission Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Part D Exceptions Contact			Kiefert	Mary							mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active	9042344338				PACE - Nat		C	Atlanta
H9252	Part D Exceptions Contact (Secondary)			Barcelo	Lynda							lynda.barcelo@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active	3055353306				PACE - Nat		C	Atlanta
H9252	Part D Price File Contact (Back-up)	VP Managed Care and Population Health	Ms.	Barcelo	Lynda		3055353306					lynda.barcelo@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Part D Price File Contact (Primary)	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Part D Quality Assurance Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Part D Reporting Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Patient Safety Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Payment Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Personal Health Record Contact	Director PACE Program Development & Implementation		Kiefert	Mary		3056742121	50920				mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Pharmacy Director	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Pharmacy Network Management Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Pharmacy Network Management Contact (Secondary)	VP Managed Care and Population Health	Ms.	Barcelo	Lynda		3055353306					lynda.barcelo@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Pharmacy Technical Help Desk Contact			Kiefert	Mary							mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active	9042344338				PACE - Nat		C	Atlanta
H9252	Pharmacy Technical Help Desk Contact (Secondary)			Barcelo	Lynda								4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active	3055353306				PACE - Nat		C	Atlanta
H9252	PHR Beneficiary Contact																	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE	Mount Sinai Eldercare	Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active	3056742121	50920			PACE - Nat		C	Atlanta
H9252	Plan Directory Contact for Public Website	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Plan to Plan Reconciliation Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Processor Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Quality Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Reconciliation Contact	Director PACE Program Development & Implementation		Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Reconciliation Contact (Secondary)	VP Managed Care and Population Health	Ms.	Barcelo	Lynda		3055353306					lynda.barcelo@msmc.com	4300 Alton Road		Miami Beach	FL	33140	06/20/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Recovery Audit Contact	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Surveillance Contact	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	System Contact	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Third Party Administrator (TPA) Liaison	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	User Access Contact	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Utilization Management Contact	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9252	Utilization Review Contact	Director PACE Program Development & Implementation	Ms.	Kiefert	Mary		9042344338					mary.kiefert@msmc.com	4300 Alton Road		Miami Beach	FL	33140	11/12/2021	2023	MOUNT SINAI ELDERCARE, INC.	National PACE	Mount Sinai Eldercare	National PACE		Mount Sinai Medical Center of Florida, Inc.	799	Yes	Active					PACE - Nat		C	Atlanta
H9258	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H9258	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H9258	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H9258	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9258	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF RHODE ISLAND, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9266	Automated TrOOP Balance Transfer Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Backup User Access Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Best Available Evidence Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	Riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Bid Primary Contact	Chief Pharmacy Officer	Mrs.	Stout	Kelly		9195377493				9199339201	stoutk@piedmonthealth.org	88 Vilcom Center Drive	Suite 110	Chapel Hill	NC	27514	09/25/2023	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	CAP Report Contact for Public Website	Executive Director, Piedmont Health SeniorCare	Mr.	Sumpter	Jeffrey		9195457341				9199339201	sumpterj@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active	9195457341				PACE - Nat		C	Atlanta
H9266	CEO - CMS Administrator Contact	CEO	Mr.	Toomey	Brian		9195377494				9199339201	toomeyb@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	CEO - Senior Official for Contracting	CEO	Mr.	Toomey	Brian		9195377494				9199339201	toomeyb@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Chief Financial Officer	CFO	Ms.	Mason	Lydia		9195377483				9199339201	masonly@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hil	NC	27514	01/13/2020	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Chief Operating Officer	PACE Executive Director	Mr.	Sumpter	Jeffrey		9195457341				9199339201	sumpterj@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Chief Information Officer	IT Manager	Mrs.	Sosa	Jen		9199293080					sosaj@piedmonthealth.org	PHS corporate office	88 Vilcom Center Drive, Suite 110	Chapel Hill	NC	27514	01/13/2020	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Chief Information Security Officer	Director of Quality and Compliance	Mr.	Kundapati	Saini		9195377481					kundapas@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	01/13/2020	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	CMS Casework Communication Contact	Executive Director, Piedmont Health SeniorCare	Mr.	Sumpter	Jeffrey		9195457341				9199339201	sumpterj@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Complaints Tracking Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Contact for Fraud Investigations	Chief Pharmacy Officer	Mrs.	Stout	Kelly		9195377493				9199339201	stoutk@piedmonthealth.org	88 Vilcom Center Drive	Suite 110	Chapel Hill	NC	27514	09/25/2023	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Coordination of Benefits Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Corporate Mailing						9195457341				9199339201	sumpterj@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	09/03/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Coverage Gap Discount Program (CGDP) Payment Contact	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly		3365060441				3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	02/27/2019	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Customer Service Operations Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	DIR Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	DIR Contact (Secondary)	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly		3365060441				3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	02/28/2017	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Emergency Part D Contact	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly		3365060441				3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Emergency Part D Contact (Secondary)	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Encounter Data & Risk Adjustment Operations Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Enrollment Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	EOB Transfer Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Financial Audit Contact	Health Plan & Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hil	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Financial Reporting Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Formulary Contact	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly		3365060441				3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Formulary Contact (Secondary)	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	General Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	04/27/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Government Relations Contact	Health Plan Manager	Ms.	Rivera	Kisha		3365060445	1407			9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	HIPAA Privacy Officer	Director of Quality and Compliance		Kundapati	Saini		9195377481					kundapas@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	01/13/2020	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	HIPAA Security Officer	Director of Quality and Compliance		Kundapati	Saini		9195377481					kundapas@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	01/13/2020	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Interoperability Contact		Mrs.	Sosa	Jen		9199293080					sosaj@piedmonthealth.org	PHS Corporate Office	88 Vilcom Center Drive , Suite 110	Chapel Hill	NC	27514	04/25/2022	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	MA Appeals/Grievances Contact	Quality & Compliance Manager	Ms.	Green	Janessa		3365065825				3365320001	greenj@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	02/27/2019	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	MA Claims Processing Contact for Public Website	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Marketing Contact	Community Relations Manager	Mrs.	Chang	Starlene		3365060435				3365320001	changs@piedmonthealth.org	1214 Vaughn Road		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Medical Director	Piedmont Health SeniorCare Medical Director	Dr.	Reilly	Sharon		3365065853				3365320001	reillys@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Medicare Compliance Officer	PACE Executive Director	Mr.	Sumpter	Jeffrey		9195457341				9199339201	sumpterj@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Medicare Coordinator	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Medicare Part D Opioid Overutilization Contact	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly		3365060441				3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	11/20/2018	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Medication Therapy Management Contact	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly		3365060441				3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	OffShore Subcontractor Contact	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Online Enrollment Center Contact (Back-up)	PACE Executive Director	Mr.	Sumpter	Jeffrey		9195457341				9199339201	sumpterj@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Online Enrollment Center Contact (Optional)	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Online Enrollment Center Contact (Primary)	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Part C Application Contact	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Part D Appeals	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly						3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active	8777142100				PACE - Nat		C	Atlanta
H9266	Part D Appeals Contact (Secondary)	Health Plan Manager	Ms.	Rivera	Kisha						9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active	3365060445				PACE - Nat		C	Atlanta
H9266	Part D Application Contact	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly		3365060441				3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Part D Benefits Contact	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly		3365060441				3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Part D Claims Submission Contact	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Part D Exceptions Contact	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly						3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active	8777142100				PACE - Nat		C	Atlanta
H9266	Part D Exceptions Contact (Secondary)	Health Plan and Compliance Manager	Ms.	Rivera	Kisha						9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active	8777142100				PACE - Nat		C	Atlanta
H9266	Part D Price File Contact (Back-up)	Health Plan Manager	Ms.	Riverra	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Part D Price File Contact (Optional)	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Part D Price File Contact (Primary)	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly		3365060441				3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Part D Quality Assurance Contact	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly		3365060441				3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Part D Reporting Contact	Health Plan and Compliance Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Patient Safety Contact	Piedmont Health SeniorCare Medical Director	Dr.	Reilly	Sharon		3365065853				3365320001	reillys@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Payment Contact	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Personal Health Record Contact	Piedmont Health SeniorCare Medical Director	Dr.	Reilly	Sharon		3365065853				3365320001	reillys@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Pharmacy Director	Chief Pharmacy Officer	Mrs.	Stout	Kelly		9195377493				9199339201	stoutk@piedmonthealth.org	88 Vilcom Center Drive	Suite 110	Chapel Hill	NC	27514	09/25/2023	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Pharmacy Network Management Contact	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly		3365060441				3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Pharmacy Network Management Contact (Secondary)	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Pharmacy Technical Help Desk Contact	Associate Director of Pharmacy Administration	Mrs.	Stout	Kelly						3365320001	stoutk@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active	8777142100				PACE - Nat		C	Atlanta
H9266	Pharmacy Technical Help Desk Contact (Secondary)	Health Plan Manager	Ms.	Rivera	Kisha						9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active	8777142100				PACE - Nat		C	Atlanta
H9266	PHR Beneficiary Contact																	09/09/2008	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE	Piedmont Health SeniorCare	PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active	8777142100				PACE - Nat		C	Atlanta
H9266	Plan Directory Contact for Public Website	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Plan to Plan Reconciliation Contact	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Processor Contact	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Quality Contact	Piedmont Health SeniorCare Medical Director	Dr.	Reilly	Sharon		3365065853				3365320001	reillys@piedmonthealth.org	1214 Vaughn Rd		Burlington	NC	27217	09/23/2016	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Reconciliation Contact	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Reconciliation Contact (Secondary)	PACE Executive Director	Mr.	Sumpter	Jeffrey		9195457341				9199339201	sumpterj@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Recovery Audit Contact	Executive Director, Piedmont Health SeniorCare	Mr.	Sumpter	Jeffrey		9195457341				9199339201	sumpterj@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Surveillance Contact	PACE Executive Director	Mr.	Sumpter	Jeffrey		9195457341				9199339201	sumpterj@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	System Contact	PACE Executive Director	Mr.	Sumpter	Jeffrey		9195457341				9199339201	sumpterj@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Third Party Administrator (TPA) Liaison	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	User Access Contact	PACE Executive Director	Mr.	Sumpter	Jeffrey		9195457341				9199339201	sumpterj@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/11/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Utilization Management Contact	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9266	Utilization Review Contact	Health Plan Manager	Ms.	Rivera	Kisha		3365060445				9199339201	riverak@piedmonthealth.org	88 Vilcom Center Drive, Suite 110		Chapel Hill	NC	27514	06/01/2021	2023	PIEDMONT HEALTH SERVICES, INC.	National PACE	Piedmont Health SeniorCare	National PACE		PIEDMONT HEALTH SERVICES, INC.	383	Yes	Active					PACE - Nat		C	Atlanta
H9276	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H9276	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	CMS Casework Communication Contact	Sr. Director, Operations	Ms	Dolic Muratagic	Emsija		3142364606					emsija.DolicMuratagic@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	03/30/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Complaints Tracking Contact	Sr. Director, Operations	Ms.	Dolic Muratagic	Emsija		3142364606					emsija.DolicMuratagic@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	03/30/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Employer Waiver Contact	Director, Product Management		Henao	Angela		8132063757					product_SNP@wellcare.com	8725 Henderson Road	Ren 1	Tampa	FL	33634	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Government Relations Contact	Vice President, Complex Care Products	Ms.	Arden	Gale		3147254477	47759				garden@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	MA Claims Processing Contact for Public Website	VP, Claims Operations		Thomas	Chris	A	3145190908					Christopher.A.Thomas@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	09/13/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Medical Director	Chief Medical Director	Mr	Martorana	Jeff		9548391530	22182				jmartorana@centene.com	1301 International Parkway	Suite 400	Sunrise	FL	33323	03/30/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	OffShore Subcontractor Contact	Manager, Regulatory Compliance		Wilson	Ashley		3145056491					Ashley.L.Wilson@centene.com	7676 Forsyth Blvd.		St. Louis	MO	63105	11/07/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Online Enrollment Center Contact (Back-up)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd.		Woodland Hills	CA	91367	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Online Enrollment Center Contact (Optional)	Sr. Director, Business Operations		Desai	Shirali		8132061563					Shirali.Desai@wellcare.com	5520 Idlewild Ave		Tampa,	FL	33634	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Online Enrollment Center Contact (Primary)	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/30/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Benefits Contact	Supervisor, Clinical Audit (Pharmacy)	Mr.	Mantella	Jason		4084574913					giacinto.mantella@centene.com	1850 W. Rio Salado Pkwy. Suite 211		Tempe	AZ	85281	04/02/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	05/16/2019	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H9276	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H9276	Physician Incentive Contact	Sr. Director, Contracting & Network Development	Mr.	Figueroa	Jaime	J	3145056543					Jaime.J.Figueroa@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Plan Directory Contact for Public Website			Services	Provider		8667960530					CorporateMedicareComplianceDept@Centene.com	1301 International Parkway,	Suite 400	Sunrise	FL	33323	03/31/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Quality Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/30/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Recovery Audit Contact	Director, Payment Integrity	Ms.	Dunlap	Tara		3146408333					Tara.L.Dunlap@CENTENE.COM	7700 Forsyth Boulevard		St. Louis	MO	63105	09/17/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Utilization Management Contact	Sr. Director, Medical Management Operations		Rodwancy	Terry		4194942648					terry.l.rodwancy@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9276	Utilization Review Contact	Sr. Director, Medical Management Operations		Rodwancy	Terry		4194942648					terry.l.rodwancy@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	03/11/2021	2023	SUNSHINE HEALTH COMMUNITY SOLUTIONS, INC.	Local CCP	Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9302	Agent/Broker Compensation Data Contact	Senior Markets Producer Analyst	Ms.	Garfield	Bambee		4259184121					Bambee.Garfield@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Automated TrOOP Balance Transfer Contact	Director PBM Operations	Ms.	Barnhart	Lisa		5133176662					lisa.barnhart@advantasure.com	Advantasure, Inc.	134 Turnpike Road	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Backup User Access Contact	Med Adv Compliance Program Adm		Burruss	Amanda		4259187772				4259184163	amanda.burruss@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Best Available Evidence Contact	Senior Manager, Medicare Operations	Ms.	Browne	Kris		4259184213					kris.browne@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Bid Audit Contact	Senior Actuary	Mr.	Wang	Chunnan		4259185156					chunnan.wang@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Bid Audit Site Contact	Senior Actuary	Mr	Wang	Chunnan		4259185156					chunnan.wang@premera.com	7001 220th Street S.W.		Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Bid Primary Contact	Senior Product Manager	Ms	Elasky	Rachele		2244897372					rachele.elasky@premera.com	7001 220th Street S.W.		Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	CEO - CMS Administrator Contact	CEO	Mr.	Roe	Jeff		4259186239					jeffrey.roe@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	CEO - Senior Official for Contracting	President and CEO	Mr.	Roe	Jeff		4259186239					jeffrey.roe@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Chief Financial Officer	EVP, Chief Financial Officer	Mr.	Risse	Thomas		4259183926					thomas.risse@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Chief Operating Officer	EVP for Sales and Marketing	Mr.	Akers	Bill		5098682562					bill.akers@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Chief Information Officer	Chief Information Officer	Mr.	Katare	Brajesh		4259185055					brajesh.katare@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Chief Information Security Officer	VP, Chief Information Security Officer	Dr.	Mayers	Adrian		4259186416					Adrian.Mayers@PREMERA.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	CMMI Model Point of Contact	Sr Medicare Compliance Officer	Ms.	Connolly	Shawnna		4259183867				4259184163	shawnna.connolly@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	CMS Casework Communication Contact	Sr. Med Adv Compliance Program Adm	Ms.	Webster	Noni		4259188283				4259184163	Noni.Webster@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Complaints Tracking Contact	Sr. Med Adv Compliance Program Adm	Ms	Webster	Noni		4259188283				4259184163	Noni.Webster@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Contact for Fraud Investigations	Director, Special Investigations Unit	Ms.	Seifert	Christine		4259184073					Christine.Seifert@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Coordination of Benefits Contact	Enrollment and COB Manager	Ms.	LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	Advantasure,Inc.	1000 Town Center, 15th floor	Southfield	MI	48073	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Corporate Mailing						4259185400					jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Coverage Gap Discount Program (CGDP) Payment Contact	Actuary - FSA	Ms.	Harney	Suzie		4259186211					suzanne.harney@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Customer Service Operations Contact	Manager	Ms.	Woods	Remy		3132257369					rwoods2@bcbsm.com	Advantasure, Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	DIR Contact	Director Finance, Controller	Ms.	Bowen	Juli		4259185438					juli.bowen@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	DIR Contact (Secondary)	Senior Actuary	Mr.	Wang	Chunnan		4259185156					chunnan.wang@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Electronic Health Record Contact	Senior Manager, Medicare Operations	Ms.	Browne	Kris		4259184213					kris.browne@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Emergency Part D Contact	Director PBM Operations	Ms.	Barnhardt	Lisa		2483785273					lisa.barnhardt@advantasure.com	Advantasure, Inc.	7001	Glen Allen	VA	23060	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Emergency Part D Contact (Secondary)	Clinical Lead, PBM Operations	Mr.	Wiff	Roy		6144399079					roy.wiff@advantasure.com	Advantasure, Inc.	7001	Glen Allen	VA	23060	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Encounter Data & Risk Adjustment Operations Contact	Senior Manager Risk Adjustment Program Operations	Ms.	Landro	Karen		4259184858					karen.landro@premera.com	Premera Blue Cross	7001 220th St SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Enrollment Contact	Enrollment and Billing Manager	Ms.	Ware	Anita		5082514855					Anita.Ware@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	EOB Transfer Contact	Enrollment and Billing Manager	Ms.	Ware	Anita		5082514855				0000000000	Anita.Ware@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Financial Audit Contact	Director of Finance, Controller	Ms.	Bowen	Juli		4259185438					juli.bowen@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Financial Reporting Contact	Director Finance, Controller	Ms.	Bowen	Juli		4259184213					Juli.Bowen@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Formulary Contact	Clinical Pharmacist	Mr.	Wiff	Roy	W	7408336136					Roy.Wiff@advantasure.com	Advantasure,Inc.	118 Turnpike Rd	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Formulary Contact (Secondary)	Pharmacy Manager	Ms.	Polzin	Jennifer		4259186350					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	General Contact	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Government Relations Contact	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	HIPAA Privacy Officer	Privacy Senior Manager	Mr.	Brandt	Chris		4259185531					christopher.brandt@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	HIPAA Security Officer	Vice President, Chief Information Security Officer	Dr.	Mayers	Adrian		4259186416					Adrian.Mayers@PREMERA.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Hospice Contact	Pharmacy Manager, Clinical Programs	Ms.	Polzin	Jennifer		4253818236					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Interoperability Contact	Manager, Provider Programs	Ms.	Jain	Sakshi		4259183428					Sakshi.Jain@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	MA Appeals/Grievances Contact	Manager, Appeals and Grievances	Ms.	Price	Candace		8048963553					candace.price@advantasure.com	Advantasure,Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	MA Claims Processing Contact for Public Website	Claims Operations Manager	Ms.	Griffin	Suzanne		2486212356					Suzanne.Griffin@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Marketing Contact	Sr. MA Risk Adjustment Compliance Administrator	Ms	McLean	Lisa		4259792887				4259184163	lisa.mclean@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Medical Director	Medical Director, Government Programs	Dr.	Jacobson, MD MHA CPC	Steven		4259186471					steven.jacobson@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Medicare Coordinator	Senior Manager, Medicare Operations	Ms.	Browne	Kris		4259184213					kris.browne@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Medicare Part D Opioid Overutilization Contact	Pharmacy Manager	Ms.	Polzin	Jennifer		4259186350					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Medication Therapy Management Contact	Pharmacy Manager	Ms.	Polzin	Jennifer		4259186350					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Online Enrollment Center Contact (Back-up)	Senior Enrollment Specialist	Ms	Izzi	Jodi		2032145825					jodi.izzi@advantasure.com	Advantasure, Inc.	134 Turnpike Road	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Online Enrollment Center Contact (Primary)	Appeals and Grievances Manager	Ms.	LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	Advantasure, Inc.	134 Turnpike Road	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Part C Application Contact	VP & GM Senior Markets	Ms.	Bos	Tracy		4259184479					tracy.bos@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Part C Reporting Contact	Sr. Med Adv Compliance Program Adm	Ms	Webster	Noni		4259188283				4259184163	noni.webster@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Appeals	Clinical Pharmacist	Mr	Wiff	Roy	W						roy.wiff@advantasure.com	Advantasure, Inc.	118 Turnpike Rd	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation	7408336136				HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Appeals Contact (Secondary)	Director PBM Operations	Ms.	Barnhart	Lisa							lisa.barnhart@advantasure.com	Advantasure,Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation	7657202775				HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Application Contact	VP & GM Senior Markets	Ms.	Bos	Tracy		4259184479					tracy.bos@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Benefits Contact	Manager, Pharm Ops & PBM Oversight	Ms.	Phothirath	Pari		5592607700					pari.phothirath@advantasure.com	Advantasure, Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Claims Submission Contact	Director PBM Operations	Ms.	Phothirath	Pari		5592607700					pari.phothirath@advantasure.com	Advantasure,Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Exceptions Contact	Clnical Pharmacist	Mr.	Wiff	Roy							roy.wiff@advantasure.com	Advantasure,Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation	6144399079				HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Exceptions Contact (Secondary)	Pharmacy Manager	Ms	Polzin	Jennifer							jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation	4259186350				HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Price File Contact (Back-up)	Sr. Consultant	Mr.	Loveland	Chet		4806064865					Chet.Loveland@CVSHealth.com	CVS Health	8801 East Raintree Drive	Scottsdale	AZ	85260	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Price File Contact (Optional)	Senior ManagerManager, MedD Finance	Ms.	Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	CVS Health	9501 E. Shea Blvd., MC 121	Scottsdale	AZ	85260	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Price File Contact (Primary)	Manger, Pharm Ops & PBM Oversight	Ms.	Phothirath	Pari		5592607700					pair.phothirath@advantasure.com	Advantasure,Inc.	4121 Cox Road, Ste. 200	Glen Allen	VA	23060	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Quality Assurance Contact	Clinical Pharmacist	Mr.	Wiff	Roy		7408336136					roy.wiff@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Part D Reporting Contact	Clinical Pharmacist	Mr.	Wiff	Roy		7408336136					roy.wiff@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Patient Safety Contact	Expert IT/BI Analyst	Mr.	Mandadi	Sharath		2486654322					sharath.mandadi@advantasure.com	Advantasure, Inc.	1000 Town Center, Suite 1500	Southfield	MI	48075	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Payment Contact	Director Finance, Controller	Ms.	Bowen	Juli		4259185438					juli.bowen@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Personal Health Record Contact	Senior Manager, Medicare Operations	Ms.	Browne	Kris		4259184213					kris.browne@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Pharmacy Director	Manager Pharmacy Consulting	Ms.	Polzin	Jennifer		4259186350					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Pharmacy Network Management Contact	Pharmacy Manager	Ms.	Polzin	Jennifer		4259186350					jennifer.polzin@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist	Mr.	Wiff	Roy		8888508526					roy.wiff@advantasure.com	Advantasure, Inc.	118 Turnpike Rd	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Pharmacy Technical Help Desk Contact			Help Desk	Pharmacy								CVS Health	9501 E. Shea Blvd.	Scottsdale	AZ	85260	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation	8666934620				HMO - Health Maintenance Organization		C	Seattle
H9302	Pharmacy Technical Help Desk Contact (Secondary)	Clinical Pharmacist	Mr.	Wiff	Roy							roy.wiff@advantasure.com	Advantasure, Inc.	118 Turnpike Rd.	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation	8666934620				HMO - Health Maintenance Organization		C	Seattle
H9302	PHR Beneficiary Contact																	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS	Premera Blue Cross	Premera	537	Yes	Consolidation	8888508526				HMO - Health Maintenance Organization		C	Seattle
H9302	Physician Incentive Contact	Strategic Initiatives Manager	Ms.	Evans	Camille		4259185462					camille.evans@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Plan Directory Contact for Public Website	Senior Manager, Medicare Operations	Ms.	Browne	Kris		4259184213					kris.browne@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Plan to Plan Reconciliation Contact	Senior Actuary	Mr.	Wang	Chunnan		4259185156					chunnan.wang@premera.com	Premera Blue Cross Attn: P2P	P.O. Box 91060	Seattle	WA	98111	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Processor Contact	Claims Operations Mgr - MA Claims Only	Ms.	Griffin	Suzanne		2486212356					Suzanne.Griffin@advantasure.com	Advantasure,Inc.	134 Turnpike Road	Southborough	MA	01772	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Quality Contact	Director, Medicare Advantage Star Ratings	Ms.	Delostrinos	Wilhelmina		4259187782					wilhelmina.delostrinos@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Reconciliation Contact	Director Finance, Controller	Ms.	Bowen	Juli		4259185438					juli.bowen@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Reconciliation Contact (Secondary)	Senior Actuary	Mr.	Wang	Chunnan		4259185156					chunnan.wang@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Badgley	Jennifer		4259185400				4259184163	jennifer.badgley@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Surveillance Contact	Sr. MA Compliance Program Adm	Ms	Connolly	Shawnna		4259183867					Shawnna.Connolly@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	System Contact	Med Adv Compliance Program Adm	Ms.	Burruss	Amanda		4259187772					amanda.burruss@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Third Party Administrator (TPA) Liaison	Actuary - FSA		Harney	Suzie		4259186211					suzanne.harney@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	User Access Contact	Med Adv Compliance Program Adm	Ms.	Burruss	Amanda		4259187772				4259184163	amanda.burruss@premera.com	Premera Blue Cross	7001 220th St. SW, MS 221	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Utilization Management Contact	Medical Director, Government Programs	Dr.	Jacobson, MD MHA CPC	Steven		4259186471					steven.jacobson@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9302	Utilization Review Contact	Medical Director, Government Programs	Dr.	Jacobson, MD MHA CPC	Steven		4259186471					steven.jacobson@premera.com	Premera Blue Cross	7001 220th St. SW	Mountlake Terrace	WA	98043	09/13/2023	2023	PREMERA BLUE CROSS	Local CCP	Premera Blue Cross Medicare Advantage	HMO/HMOPOS		Premera	537	Yes	Consolidation					HMO - Health Maintenance Organization		C	Seattle
H9306	Agent/Broker Compensation Data Contact	Chief Marketing Officer	Mr	Davis	James		4438849082				4108015865	jdavis@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Automated TrOOP Balance Transfer Contact	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D	4433181076				4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Backup User Access Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Best Available Evidence Contact	Medicare Program Director	Ms	Zahangir	Nadia		3473075868				4433181060	nzahangir@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Bid Audit Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Bid Audit Site Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Bid Primary Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	CAP Report Contact for Public Website	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506					aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active	8446757664				HMO - Health Maintenance Organization		C	Philadelphia
H9306	CEO - CMS Administrator Contact	President & CEO	Mr	Puente	Mark		4102185543				4435587809	mpuente@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	CEO - Senior Official for Contracting	President & CEO	Mr	Puente	Mark		4438849116				4435587809	mpuente@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Chief Financial Officer	Chief Financial Officer	Mr	Yancisin	Matt		4438849108				4435587809	myancisin@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Chief Operating Officer	Chief Operating Officer	Mr	Margolit	David		4438849078				4435587809	dmargolit@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Chief Information Officer	Chief Information Officer	Mr	Myers	Dan		4438849075				4435587809	dmyers@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Chief Information Security Officer	Chief Information Officer	Mr	Myers	Dan		4438849075				4435587809	dmyers@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	CMMI Model Point of Contact	Chief Health & Quality Officer	Ms	Bavis	Jill		4438849083				4435587809	jbavis@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	CMS Casework Communication Contact	Director of Operations	Ms	Goss	April		6672905601				4108015704	agoss@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Complaints Tracking Contact	Director of Operations	Ms	Goss	April		6672905601				4108015704	agoss@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Contact for Fraud Investigations	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Coordination of Benefits Contact	Medicare Program Director	Ms	Zahangir	Nadia		3473075868				4433181060	nzahangir@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Corporate Mailing						4104466506				4435587809	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mr	Yancisin	Matt		4438849108				4435587809	myancisin@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Customer Service Operations Contact	Director of Operations	Ms	Goss	April		6672905601				4108015704	agoss@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	DIR Contact	Sr Director, Govt Programs	Mr	Farmer	Jim		3308886098					jfarmer@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	DIR Contact (Secondary)	Analyst III, Govt Programs	Mr	Houchens	Logan		3308886095					lhouchens@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Electronic Health Record Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506					aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active	8446757664				HMO - Health Maintenance Organization		C	Philadelphia
H9306	Emergency Part D Contact	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D	2165511376				4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Emergency Part D Contact (Secondary)	Clinical Pharmacist	Mr	Njoku	Samuel		4435977812				4108015703	snjoku@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	06/23/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Employer Waiver Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Encounter Data & Risk Adjustment Operations Contact	Chief Operating Officer	Mr	Margolit	David		4438849078				4435587809	dmargolit@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Enrollment Contact	Medicare Program Director	Ms	Zahangir	Nadia		3473075868				4433181060	nzahangir@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	EOB Transfer Contact	Chief Operating Officer	Mr	Margolit	David		4438849078				4435587809	dmargolit@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	09/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Financial Audit Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				4435587809	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	09/20/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Financial Reporting Contact	Chief Financial Officer	Mr	Yancisin	Matt		4438849108				4435587809	myancisin@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Formulary Contact	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D	4433181076				4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Formulary Contact (Secondary)	Formulary Contact	Ms	Sagoo	Sukhjit		4433181076				4108015703	ssagoo@elixirsolutions.com	7801 Freedom Way NW		N. Canton	OH	44720	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	General Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Government Relations Contact	Chief Marketing Officer	Mr	Davis	James		4438849082				4108015865	jdavis@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	HIPAA Privacy Officer	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	HIPAA Security Officer	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Hospice Contact	Chief Health & Quality Officer	Ms	Bavis	Jill		4438849083				4435587809	jbavis@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	06/23/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Interoperability Contact	Chief Information Officer	Mr	Myers	Dan		4438849075				4435587809	dmyers@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	MA Appeals/Grievances Contact	Director of Operations	Ms	Goss	April		6672905601				4108015704	agoss@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	MA Claims Processing Contact for Public Website	Chief Operating Officer	Mr	Margolit	David		6672629412					memberservcies@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	05/08/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Marketing Contact	Chief Marketing Officer	Mr	Davis	James		4438849082				4108015865	jdavis@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Medical Director	Medical Director	Mr	Yanuck	Michael		4108016066				4435587809	myanuck@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	05/22/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Medicare Compliance Officer	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Medicare Coordinator	Chief Operating Officer	Mr	Margolit	David		4438849078				4435587809	dmargolit@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Medicare Part D Opioid Overutilization Contact	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D	4433181076				4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Medication Therapy Management Contact	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D	4433181076				4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	OffShore Subcontractor Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Online Enrollment Center Contact (Back-up)	Medicare Program Director	Ms	Zahangir	Nadia		3473075868				4433181060	nzahangir@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Online Enrollment Center Contact (Optional)	Director of Sales & Marketing	Ms	Mullinix	Kaitlynn		4438849097				4108015865	kmullinix@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Online Enrollment Center Contact (Primary)	Medicare Program Director	Ms	Zahangir	Nadia		3473075868				4433181060	nzahangir@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part C Application Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part C Reporting Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Appeals	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D					4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active	8662673144				HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations	Ms	Binegar	Sam							Appeals@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active	8662673144				HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Application Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506					aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Benefits Contact	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D	4433181076				4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Claims Submission Contact	Account Manager	Ms	Mickelson	Khamla		2076711819					kmickelson@elixirsolutions.com	8921 Canyon Falls Blvd		Twinsburg	OH	44087	02/27/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Exceptions Contact	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D					4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active	8662673144				HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Exceptions Contact (Secondary)	Appeals Supervisor, Clinical Operations	Ms	Binegar	Sam						3304058081	Appeals@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active	8662673144				HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Price File Contact (Back-up)	Financial Analyst	Mr	Kessler	Cameron		2342123110					ckessler@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Price File Contact (Optional)	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D	4433181076				4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Price File Contact (Primary)	Sr Financial Manager Reporting & Analystics	Mr	Campbell	Tim		9547672633					tcampbell@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	02/27/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Quality Assurance Contact	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D	4433181076				4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Part D Reporting Contact	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D	4433181076				4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Patient Safety Contact	Chief Health & Quality Officer	Ms	Bavis	Jill		4438849083				4435587809	jbavis@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	06/23/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Payment Contact	Chief Financial Officer	Mr	Yancisin	Matt		4438849108				4435587809	myancisin@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Personal Health Record Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Pharmacy Director	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D	4433181076				4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Pharmacy Network Management Contact	Director Pharmacy Network Dev and Ops	Ms	Profio	Lauren		3304864864				3304058094	lprofio@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Pharmacy Network Management Contact (Secondary)	VP, Pharmacy Strategy & Oversight	Ms	Borja	Asuncion	D	4433181076				4108015703	sborja@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/23/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Pharmacy Technical Help Desk Contact	VP Operations	Mr	Conn	Todd							tconn@elixirsolutions.com	8921 Canyon Falls Blvd	Suite 100	Twinsburg	OH	44087	09/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active	8336932189				HMO - Health Maintenance Organization		C	Philadelphia
H9306	Pharmacy Technical Help Desk Contact (Secondary)	Clinical Pharmacist	Mr	Njoku	Samuel						4108015703	snjoku@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	06/23/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active	8666753944				HMO - Health Maintenance Organization		C	Philadelphia
H9306	PHR Beneficiary Contact																	04/22/2021	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS	Alterwood Advantage	Alterwood Health, Inc.	770	Yes	Active	8446757664				HMO - Health Maintenance Organization		C	Philadelphia
H9306	Physician Incentive Contact	Chief Development Officer	Mr	Bechtold	Paul		4104466506				4435587809	pbechtold@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Plan Directory Contact for Public Website	Chief Operating Officer	Mr	Margolit	David		6672629412					providers@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	05/08/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr	Yancisin	Matt		4438849108				4435587809	myancisin@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Processor Contact	Chief Operating Officer	Mr	Margolit	David		4438849078				4435587809	dmargolit@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Quality Contact	Chief Health & Quality Officer	Ms	Bavis	Jill		4438849083				4435587809	jbavis@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	06/23/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Reconciliation Contact	Chief Financial Officer	Mr	Yancisin	Matt		4438849108				4435587809	myancisin@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/15/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Reconciliation Contact (Secondary)	Vice President of Finance	Mr	Johnson	Brett		4103680990				4435587809	bjohnson@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/15/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Recovery Audit Contact	Chief Operating Officer	Mr	Margolit	David		4438849078				4435587809	dmargolit@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	SNP Application Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	SNP State Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Surveillance Contact	Director of Sales & Marketing	Ms	Mullinix	Kaitlynn		4438849097				4108015865	kmullinix@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	System Contact	Chief Information Officer	Mr	Myers	Dan		4438849075				4435587809	dmyers@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Third Party Administrator (TPA) Liaison	Vice President of Finance	Mr	Johnson	Brett		4103680990				4435587809	bjohnson@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	01/21/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	User Access Contact	Vice President, Business & Regulatory Affairs	Mr	Burch	Aaron		4104466506				2402019079	aburch@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	02/07/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Utilization Management Contact	Chief Health & Quality Officer	Ms	Bavis	Jill		4438849083				4435587809	jbavis@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	06/23/2022	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9306	Utilization Review Contact	Medical Director	Mr	Yanuck	Michael		4108016066				4435587809	myanuck@alterwoodhealth.com	PO Box 4175		Timonium	MD	21094	05/22/2023	2023	ALTERWOOD ADVANTAGE, INC.	Local CCP	Alterwood Advantage	HMO/HMOPOS		Alterwood Health, Inc.	770	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9317	Automated TrOOP Balance Transfer Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	06/10/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Backup User Access Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	06/10/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Best Available Evidence Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	06/10/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Bid Primary Contact	CFO		Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	06/10/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	CAP Report Contact for Public Website	PACE Consultant		Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/10/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	CEO - CMS Administrator Contact	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/10/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	CEO - Senior Official for Contracting	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/10/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Chief Financial Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Chief Operating Officer	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Chief Information Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Chief Information Security Officer	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	CMS Casework Communication Contact	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Complaints Tracking Contact	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Contact for Fraud Investigations	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Coordination of Benefits Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Corporate Mailing						2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Coverage Gap Discount Program (CGDP) Payment Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Customer Service Operations Contact	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	DIR Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	DIR Contact (Secondary)	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Emergency Part D Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Emergency Part D Contact (Secondary)	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Encounter Data & Risk Adjustment Operations Contact	Executive Director	Mrs	Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Enrollment Contact	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	EOB Transfer Contact	CFO	Mrs	Prentis	Kristin		7328063224				7328063224	kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Financial Audit Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Financial Reporting Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Formulary Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Formulary Contact (Secondary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	General Contact	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Government Relations Contact	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	HIPAA Privacy Officer	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	HIPAA Security Officer	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	MA Appeals/Grievances Contact	Executive Director	Mrs	Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	MA Claims Processing Contact for Public Website	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Marketing Contact	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Medical Director	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Medicare Compliance Officer	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Medicare Coordinator	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Medicare Part D Opioid Overutilization Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Medication Therapy Management Contact	Executive Director	Mrs	Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	OffShore Subcontractor Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Online Enrollment Center Contact (Back-up)	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Online Enrollment Center Contact (Primary)	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Part C Application Contact			Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenix	PA	19460	04/18/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Part D Appeals	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Atlanta
H9317	Part D Appeals Contact (Secondary)	Executive Director		Friedman	Pinni							Pfriedman@acutecarehs.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H9317	Part D Application Contact			Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenix	PA	19460	04/18/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Part D Benefits Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Part D Claims Submission Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Part D Exceptions Contact	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Atlanta
H9317	Part D Exceptions Contact (Secondary)			Friedman	Pinni							Pfriedman@acutecarehs.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H9317	Part D Price File Contact (Back-up)	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Part D Price File Contact (Primary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Part D Quality Assurance Contact	Executive Director	Mrs	Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Part D Reporting Contact	Executive Director		Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Patient Safety Contact	Executive Director		Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Payment Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Personal Health Record Contact	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Pharmacy Director	Executive Director	Mrs	Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, Suite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Pharmacy Network Management Contact	Executive Director		Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Pharmacy Network Management Contact (Secondary)	Executive Director		Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Pharmacy Technical Help Desk Contact	Executive Director		Friedman	Pinni							Pfriedman@acutecarehs.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H9317	Pharmacy Technical Help Desk Contact (Secondary)	CFO		Prentis	Kristin							kprentiss@acutecarehs.com	106 West Moore Avenue, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending	7328063224				PACE - Nat		C	Atlanta
H9317	PHR Beneficiary Contact																	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE	Beacon of Life SC			Yes	Pending	7325923400				PACE - Nat		C	Atlanta
H9317	Plan Directory Contact for Public Website	Executive Director		Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Plan to Plan Reconciliation Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Processor Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Quality Contact	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Reconciliation Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Ave, Suite A		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Reconciliation Contact (Secondary)	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Recovery Audit Contact	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Surveillance Contact	Executive Director		Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	System Contact	Executive Director		Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Third Party Administrator (TPA) Liaison	CFO	Mrs	Prentis	Kristin		7328063224					kprentiss@acutecarehs.com	106 West Moore Avenue		Mooresville	NC	28115	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	User Access Contact	PACE Consultant	Mrs	Austin	Mary		2156098714					maustin@srpathways.com	134 Mary Hill Road		Phoenixville	PA	19460	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Utilization Management Contact	Executive Director		Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9317	Utilization Review Contact	Executive Director		Friedman	Pinni		7325923400					Pfriedman@acutecarehs.com	1075 Stephenson Avenue, SUite B		Oceanport	NJ	07757	06/11/2021	2023	BEACON OF LIFE SC, LLC	National PACE	Beacon of Life SC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9323	Automated TrOOP Balance Transfer Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Backup User Access Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Best Available Evidence Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Bid Primary Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	CAP Report Contact for Public Website	Executive Director	Mr.	Tango	Jay		7327164600				7325923501	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	CEO - CMS Administrator Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	CEO - Senior Official for Contracting	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Chief Financial Officer	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Chief Operating Officer	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Chief Information Officer	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Chief Information Security Officer	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	CMS Casework Communication Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Complaints Tracking Contact	Quality Director		Thompson	Evelyn		7325923407				7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue	Suite B	Oceanport	NJ	07757	09/29/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Contact for Fraud Investigations	Quality Director		Thompson	Evelyn		7325923407				7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue	Suite B	Oceanport	NJ	07757	09/29/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Coordination of Benefits Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Corporate Mailing						7327164600					jtango@beaconpace.com	1075 Stephenson Avenue, B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Customer Service Operations Contact	Quality Director		Thompson	Evelyn		7325923407				7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue	Suite B	Oceanport	NJ	07757	09/29/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	DIR Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	DIR Contact (Secondary)	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Emergency Part D Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Emergency Part D Contact (Secondary)	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Encounter Data & Risk Adjustment Operations Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	03/11/2020	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Enrollment Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	EOB Transfer Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Financial Audit Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Financial Reporting Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Formulary Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Formulary Contact (Secondary)	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	General Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Government Relations Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	HIPAA Privacy Officer	Quality Director		Thompson	Evelyn		7325923407				7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue	Suite B	Oceanport	NJ	07757	09/29/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	HIPAA Security Officer	Quality Director		Thompson	Evelyn		7325923407				7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue	Suite B	Oceanport	NJ	07757	09/29/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Interoperability Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	MA Appeals/Grievances Contact	Quality Director		Thompson	Evelyn		7325923407				7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue	Suite B	Oceanport	NJ	07757	09/29/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	MA Claims Processing Contact for Public Website	Chief Financial Officer	Ms.	Prentiss	Kristin		7325923400					kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	06/16/2022	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Marketing Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Medical Director	Medical Director	Dr.	Glantz	Eric		7325923400					eglantz@beaconpace.com	1075 Stephenson Ave.	Suite B	Oceanport	NJ	07757	07/05/2022	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Medicare Compliance Officer	Chief Financial Officer	Ms.	Prentiss	Kristin		7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	01/09/2017	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Medicare Coordinator	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Medicare Part D Opioid Overutilization Contact	Quality Director		Thompson	Evelyn		7325923407				7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue	Suite B	Oceanport	NJ	07757	09/29/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Medication Therapy Management Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Part C Application Contact	Chief Financial Officer	Ms.	Prentiss	Kristin		7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	01/09/2017	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Part D Appeals	Director of Quality	Ms.	Thompson	Evelyn						7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue	Suite B	Oceanport	NJ	07757	10/13/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active	7325923407				PACE - Nat		C	New York
H9323	Part D Appeals Contact (Secondary)	Chief Financial Officer	Ms.	Prentiss	Kristin						7328063324	kprentiss@acutehs.com	106 Moore Avenue	Suite A	Mooresville	NC	28115	01/07/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active	7328063224				PACE - Nat		C	New York
H9323	Part D Application Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Part D Benefits Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Part D Claims Submission Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Part D Exceptions Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C					7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active	1800000000				PACE - Nat		C	New York
H9323	Part D Exceptions Contact (Secondary)	Quality Director		Thompson	Evelyn						7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	10/13/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active	1800000000				PACE - Nat		C	New York
H9323	Part D Price File Contact (Back-up)	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Part D Price File Contact (Primary)	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Part D Quality Assurance Contact	Director of Quality	Ms.	Thompson	Evelyn		7325923407				7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	07/05/2022	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Part D Reporting Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Patient Safety Contact	Quality Director		Thompson	Evelyn		7325923407				7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	10/12/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Payment Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Pharmacy Director	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Pharmacy Network Management Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Pharmacy Network Management Contact (Secondary)	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Pharmacy Technical Help Desk Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C					7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	06/15/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active	1800000000				PACE - Nat		C	New York
H9323	Pharmacy Technical Help Desk Contact (Secondary)	Chief Financial Officer	Ms.	Prentiss	Kristin	C					7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active	8008063200				PACE - Nat		C	New York
H9323	Plan Directory Contact for Public Website	Chief Financial Officer	Ms.	Prentiss	Kristin		7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	01/09/2017	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Plan to Plan Reconciliation Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Processor Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Quality Contact	Quality Director		Thompson	Evelyn		7325923407				7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	10/12/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Reconciliation Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Recovery Audit Contact	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Surveillance Contact	Quality Director		Thompson	Evelyn		7325923407				7325923507	ethompson@beaconhss.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	10/12/2021	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	System Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Ms.	Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	09/26/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	User Access Contact	Chief Financial Officer		Prentiss	Kristin	C	7328063224				7328063324	kprentiss@acutecarehs.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/09/2018	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Utilization Management Contact	Chief Financial Officer	Ms.	Prentiss	Kristin		7328063224				7328063324	kprentiss@acutecarehs.com	106 Moore Ave Suite A		Mooresville	NC	28115	01/09/2017	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9323	Utilization Review Contact	Executive Director	Mr.	Tango	Jay		7327164600				7325923500	jtango@beaconpace.com	1075 Stephenson Avenue Suite B		Oceanport	NJ	07757	08/07/2023	2023	ACUTE CARE HEALTH SYSTEM, LLC	National PACE	Beacon of LIFE PACE	National PACE		Acute Care Health System, LLC	682	Yes	Active					PACE - Nat		C	New York
H9335	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/25/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/27/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H9335	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H9335	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H9335	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9335	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MISSOURI, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9357	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H9357	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Medical Director	Medical Director	Mr	Wilson	Keith		5125966469					Robert.Wilson@SuperiorHealthPlan.com	77 West Wacker Drive, 14th Floor		Chicago	IL	60601	03/30/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H9357	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H9357	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H9357	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H9357	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/02/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H9357	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H9357	PHR Beneficiary Contact																	09/27/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8337051358				PPO - BBA		C	Dallas
H9357	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Plan Directory Contact for Public Website			Services	Provider		8555659519					CorporateMedicareComplianceDept@CENTENE.COM	8325 Lenexa Drive	Suite 200	Lenexa	KS	66214	03/31/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9357	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/10/2022	2023	CENTENE VENTURE INSURANCE COMPANY TEXAS	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9360	Automated TrOOP Balance Transfer Contact			Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street		Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Backup User Access Contact			Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street		Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Best Available Evidence Contact			Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street		Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Bid Primary Contact			Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street		Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	CAP Report Contact for Public Website			Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	CEO - CMS Administrator Contact		Mr.	Ng	Peter		2138081701					png@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	CEO - Senior Official for Contracting		Mr.	Ng	Peter		2138081701					png@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Chief Financial Officer	CFO	Ms.	Ramos	Yeryca		2138081702					yramos@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/22/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Chief Operating Officer	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Chief Information Officer	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Chief Information Security Officer	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	CMS Casework Communication Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Complaints Tracking Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Contact for Fraud Investigations	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Coordination of Benefits Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Corporate Mailing						2138081700					info@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Coverage Gap Discount Program (CGDP) Payment Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Customer Service Operations Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	DIR Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	DIR Contact (Secondary)	Director		Loc	Nina		2138081723					nyuen@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/22/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Emergency Part D Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Encounter Data & Risk Adjustment Operations Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Enrollment Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	EOB Transfer Contact			Cheng	Jack		2138081709				2137162634	jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Financial Audit Contact	CFO	Ms.	Ramos	Yeryca		2138081702					yramos@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Financial Reporting Contact		Ms.	Ramos	Yeryca		2138081702					yramos@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Formulary Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	General Contact	CEO	Mr.	Ng	Peter		2138081701					png@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/22/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Government Relations Contact	CEO	Mr.	Ng	Peter		2138081701					png@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/22/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	HIPAA Privacy Officer	COO		Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street		Los Angeles	CA	90012	12/22/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	HIPAA Security Officer	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Interoperability Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	MA Appeals/Grievances Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	MA Claims Processing Contact for Public Website	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Marketing Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Medical Director	CMO	Dr.	Aguilar	Felix		2138081709					faguilar@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Medicare Compliance Officer	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Medicare Coordinator	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Medicare Part D Opioid Overutilization Contact	COO	Mr.	Cheng	Jack		2138081709				2137162634	jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Medication Therapy Management Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Part C Application Contact	CEO		Ng	Peter		2138081701					png@cscla.org	767 N. Hill Street #400		Los Angeles	CA	90012	12/22/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Part D Appeals			Cheng	Jack							jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending	2138081709				PACE - Nat		C	San Francisco
H9360	Part D Application Contact	CEO		Ng	Peter		2138081701					png@cscla.org	767 N. Hill Street #400		Los Angeles	CA	90012	12/22/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Part D Benefits Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Part D Claims Submission Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Part D Exceptions Contact			Cheng	Jack							jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending	2138081709				PACE - Nat		C	San Francisco
H9360	Part D Price File Contact (Back-up)			Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Part D Price File Contact (Primary)			Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Part D Quality Assurance Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Part D Reporting Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Patient Safety Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Payment Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Pharmacy Director			Aguilar	Felix		2138081709					faguilar@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Pharmacy Network Management Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Pharmacy Technical Help Desk Contact			Cheng	Jack							jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending	2138081709				PACE - Nat		C	San Francisco
H9360	Plan Directory Contact for Public Website	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Plan to Plan Reconciliation Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Processor Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Quality Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Reconciliation Contact		Ms.	Ramos	Yeryca		2138081702					yramos@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Recovery Audit Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Surveillance Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	System Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Third Party Administrator (TPA) Liaison	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	User Access Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Utilization Management Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9360	Utilization Review Contact	COO	Mr.	Cheng	Jack		2138081709					jacheng@cscla.org	767 N. Hill Street	Suite 400	Los Angeles	CA	90012	12/16/2021	2023	CHINATOWN SERVICE CENTER	National PACE	www.cscla.org	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9364	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/28/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/27/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H9364	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H9364	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449088				HMO - Health Maintenance Organization		C	Dallas
H9364	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Plan Directory Contact for Public Website			Services	Provider		8555659519					CorporateMedicareComplianceDept@CENTENE.COM	8325 Lenexa Drive	Suite 200	Lenexa	KS	66214	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9364	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF MAINE, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9387	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H9387	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	01/29/2020	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/29/2020	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	01/29/2020	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/29/2020	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/29/2020	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H9387	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H9387	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H9387	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H9387	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/29/2020	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H9387	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H9387	PHR Beneficiary Contact																	09/27/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8555659519				PPO - BBA		C	Dallas
H9387	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Plan Directory Contact for Public Website			Services	Provider		8555659519					CorporateMedicareComplianceDept@CENTENE.COM	8325 Lenexa Drive	Suite 200	Lenexa	KS	66214	03/31/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9387	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	SUNFLOWER STATE HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9403	Agent/Broker Compensation Data Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/07/2023	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Automated TrOOP Balance Transfer Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Backup User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Best Available Evidence Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Bid Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Bid Audit Site Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/27/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Bid Primary Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	CAP Report Contact for Public Website	Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/28/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8773841241				HMO - Health Maintenance Organization		C	Chicago
H9403	CEO - CMS Administrator Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	CEO - Senior Official for Contracting	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Chief Financial Officer	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Chief Operating Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Chief Information Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Chief Information Security Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	CMMI Model Point of Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	CMS Casework Communication Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Complaints Tracking Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Contact for Fraud Investigations	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Coordination of Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Corporate Mailing						8476968500					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway		Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	Thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Customer Service Operations Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	DIR Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	DIR Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Electronic Health Record Contact		Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/07/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Emergency Part D Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Emergency Part D Contact (Secondary)	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Encounter Data & Risk Adjustment Operations Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/18/2023	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Enrollment Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	EOB Transfer Contact	Claims Manager	Mr.	Salgado	Miguel		8476968578				8008861082	Miguel.Salgado@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	10/04/2021	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Financial Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Financial Reporting Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Formulary Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3308886015	Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	General Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Government Relations Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	HIPAA Privacy Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	HIPAA Security Officer	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539				8555158166	Eric.Annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Hospice Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Interoperability Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	MA Appeals/Grievances Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	MA Claims Processing Contact for Public Website	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Marketing Contact	VP of Marketing	Ms.	Branco	Margaret		7187957495					margaret.branco@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/06/2023	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Medical Director		Dr	Butt	Tariq		3125458471					tariq.butt@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	11/09/2021	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Medicare Compliance Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Medicare Coordinator	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Medicare Part D Opioid Overutilization Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Medication Therapy Management Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3304058084	Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	OffShore Subcontractor Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Online Enrollment Center Contact (Primary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 302	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Part C Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Part C Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Part D Appeals			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy	Suite 450	Dublin	OH	43017	12/28/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H9403	Part D Appeals Contact (Secondary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica							Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue		Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	7542085865				HMO - Health Maintenance Organization		C	Chicago
H9403	Part D Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Part D Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Part D Claims Submission Contact			Dovico	Rosario		2012696398					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Part D Exceptions Contact			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	6143363326				HMO - Health Maintenance Organization		C	Chicago
H9403	Part D Price File Contact (Back-up)			Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Part D Price File Contact (Optional)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Part D Price File Contact (Primary)			Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Part D Quality Assurance Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Part D Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Patient Safety Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Payment Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Pharmacy Director	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Pharmacy Network Management Contact			Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Pharmacy Network Management Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Pharmacy Technical Help Desk Contact			Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	08/04/2021	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H9403	Plan Directory Contact for Public Website	Vice President, Provider Operations	Ms.	Cuevas	Elizabeth		7542085880					Elizabeth.Cuevas@clearspringhealthcare.com	250 South Northwest Highway Suite 302	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Plan to Plan Reconciliation Contact	Senior Accountant	Ms.	Wrenn	Alisa		2249855588				3124290194	Alisa.Wrenn@Clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Processor Contact			Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Quality Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Reconciliation Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Recovery Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	SNP Application Contact	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	07/06/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Surveillance Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	System Contact	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539					eric.annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Third Party Administrator (TPA) Liaison	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Utilization Management Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9403	Utilization Review Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (SC), INC.	Local CCP	Clear Spring Health	HMO/HMOPOS		Group 1001	689	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9411	Automated TrOOP Balance Transfer Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Backup User Access Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Best Available Evidence Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Bid Primary Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	CAP Report Contact for Public Website	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	CEO - CMS Administrator Contact	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	CEO - Senior Official for Contracting	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Chief Financial Officer	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Chief Operating Officer	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Chief Information Officer	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Chief Information Security Officer	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	CMS Casework Communication Contact	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Complaints Tracking Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Contact for Fraud Investigations	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Coordination of Benefits Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Corporate Mailing						2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Coverage Gap Discount Program (CGDP) Payment Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Customer Service Operations Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	DIR Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Emergency Part D Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Encounter Data & Risk Adjustment Operations Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Enrollment Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	EOB Transfer Contact	CEO	Mr.	Ko	David		2135969119				2135969119	edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Financial Audit Contact	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Financial Reporting Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Formulary Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	General Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Government Relations Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	HIPAA Privacy Officer	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	HIPAA Security Officer	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	MA Appeals/Grievances Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	MA Claims Processing Contact for Public Website	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Marketing Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Medical Director		Dr.	Lee	Young-Jik		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Medicare Compliance Officer	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Medicare Coordinator	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Medicare Part D Opioid Overutilization Contact		Dr.	Lee	Young-Jik		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Medication Therapy Management Contact			Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Part C Application Contact			Ko	David		8184388211					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Part D Appeals			Ko	David							edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending	2135969119				PACE - Nat		C	San Francisco
H9411	Part D Application Contact			Ko	David		8184388211					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Part D Benefits Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Part D Claims Submission Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Part D Exceptions Contact			Ko	David							edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending	2135969119				PACE - Nat		C	San Francisco
H9411	Part D Price File Contact (Back-up)	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Part D Price File Contact (Primary)	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Part D Quality Assurance Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Part D Reporting Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Patient Safety Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Payment Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Pharmacy Director		Dr.	Lee	Young-Jik		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Pharmacy Network Management Contact		Dr.	Lee	Young-Jik		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave		Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Pharmacy Technical Help Desk Contact			Ko	David							edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending	2135969119				PACE - Nat		C	San Francisco
H9411	Plan Directory Contact for Public Website	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Plan to Plan Reconciliation Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Processor Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Quality Contact	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Reconciliation Contact	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Recovery Audit Contact	CEO	Mr.	Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Surveillance Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	System Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Third Party Administrator (TPA) Liaison	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	User Access Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Utilization Management Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9411	Utilization Review Contact	CEO		Ko	David		2135969119					edenhospicecare@gmail.com	1818 S. Western Ave	Suite 100	Los Angeles	CA	90006	12/28/2020	2023	1818 WESTERN, LLC	National PACE	Asian Heritage Healthcare	National PACE				Yes	Pending					PACE - Nat		C	San Francisco
H9412	Agent/Broker Compensation Data Contact	Manager, Sales Operations	Ms.	Martz	Andrea	L	5705094265					amartz3@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223910	12/21/2021	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Automated TrOOP Balance Transfer Contact	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	eobp2p@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	10/31/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Backup User Access Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Best Available Evidence Contact	Director, Health Plan Operations - Enrollment	Ms.	Kinney	Noelle	C	5702149270					nckinney@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	10/25/2021	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Bid Audit Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Bid Audit Site Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Bid Primary Contact	VP, Government Programs	Ms.	Mastrandrea	Mary		4103037972					mmastrandrea@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	10/31/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	CEO - CMS Administrator Contact	COO/CFO	Mr.	McCullough	Mark	A	5023861395					mmccullough1@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	12/21/2021	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	CEO - Senior Official for Contracting	CEO and President, Geisinger Health Plan	Mr.	Wrobel	Kurt	J	5702717212				5702715268	kjwrobel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	03/10/2021	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Chief Financial Officer	COO/CFO	Mr.	McCullough	Mark	A	5702140783					mmccullough1@thehealthplan.com	100 North Academy Avenue		Danville	PA	17822	11/18/2020	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Chief Operating Officer	COO/CFO	Mr.	McCullough	Mark	A	5702140783					mmccullough1@thehealthplan.com	100 North Academy Avenue		Danville	PA	17822	11/18/2020	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Chief Information Officer	SVP/Chief Information Officer	Mr.	Kravitz	John	M	5702148833				5702141548	jmkravitz@geisinger.edu	Geisinger Health System	100 N. Academy Aveneu	Danville	PA	178223025	02/11/2016	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Chief Information Security Officer	Chief Information Security Officer	Mr.	Gable	Zachary	A	5702142452					zagable@geisinger.edu	Geisinger Information Security Office	100 N. Academy Avenue Mail Code 40-38	Danville	PA	178223003	07/25/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	CMS Casework Communication Contact	Customer Service Team Coordinator		Peters	Joanne		5702143285				5702715970	jpeters@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	12/31/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Complaints Tracking Contact	Customer Service Team Coordinator		Peters	Joanne		5702143285				5702715970	jpeters@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	12/31/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Contact for Fraud Investigations	Director, Special Investigations Unity	Mr.	Baker	John	W	5702716752					jwbaker@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	04/22/2020	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Coordination of Benefits Contact	Supervisor, Health Plan COB	Ms.	Minium, CPC	Joanne		5708497572					COB@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223251	04/20/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Corporate Mailing						5702716836				5702145305	fkdavis@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	05/17/2023	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Coverage Gap Discount Program (CGDP) Payment Contact	PDE/Part D Analyst	Mr.	Baylor	Blaze	A	5702144692				5702144692	babaylor1@thehealthplan.com	Geisinger Health Plan, Federal Government Programs	100 North Academy Avenue	Danville	PA	17822	05/03/2023	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Customer Service Operations Contact	Director, Health Plan Operations, Customer Care	Mr.	Sanders	John	R	5702148046					jrsanders@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	11/01/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	DIR Contact	Pharmacy Data Analyst Lead	Ms.	Bertollo	Krista	L	5702145059				5702146768	klbertollo@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	DIR Contact (Secondary)	Manager, Pharmacy Data and Reporting	Ms.	Chesnick	Candy		5702715555	59687			5702146768	cjchesnick@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Emergency Part D Contact	Director, Pharmacy Services	Dr.	Miller	Jamie		5703366446				5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/26/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Emergency Part D Contact (Secondary)	CEO and President, Geisinger Health Plan	Mr.	Wrobel	Kurt	J	5027519147				5702715268	kjwrobel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	12/21/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Encounter Data & Risk Adjustment Operations Contact	Actuarial Director		Trafton	Kristina	L	5702145043					kltrafton@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223225	10/29/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Enrollment Contact	Director, Health Plan Operations - Enrollment	Ms.	Kinney	Noelle	C	5702149270					nckinney@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	10/25/2021	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	EOB Transfer Contact	Pharmacy Data Analyst Lead	Ms.	Bertollo	Krista		5702145059				5702146768	EOBP2P@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Financial Audit Contact	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Financial Reporting Contact	VP Financial Reporting and Operations	Mr.	Teska	Christophe	S	5702146766					csteska@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223251	04/17/2023	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Formulary Contact	Medicare pharmacist	Dr.	Sponenberg	Todd	L	5702146597				5702146768	tsponenberg@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Formulary Contact (Secondary)	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen		5702149379				5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	General Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Government Relations Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	HIPAA Privacy Officer	Chief Privacy Officer	Mr.	Friesen, JD	Jonathan	R	5702716525					jfriesen@geisinger.edu	Geisinger Privacy Office	100 North Academy Avenue Mail Code 40-38	Danville	PA	178223003	07/25/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	HIPAA Security Officer	Chief Privacy Officer	Mr.	Friesen, JD	Jonathan	R	5702716525					jfriesen@geisinger.edu	Geisinger Privacy Office	100 North Academy Avenue Mail Code 40-38	Danville	PA	178223003	07/25/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Hospice Contact	Claims and Benefits Auditor, GHP Pharmacy	Ms.	Seabrook	Naiki	A	5702147851				5703002122	naseabrook@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	11/01/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Interoperability Contact	Sr. Director Information Technology	Mr.	Niedjaco	Felix	C	5708088538					fcniedjaco@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223911	03/23/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	MA Appeals/Grievances Contact	Director, Member Resolution Team	Ms.	Piepszowski	BethAnn		5702717166				5702717225	bapiepszowski@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	10/31/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	MA Claims Processing Contact for Public Website	Manager GHP Customer Service Operations/Claims	Ms.	George	Karen	M	5702140876					kmgeorge@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	12/22/2021	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Marketing Contact	Director, Health Plan Marketing	Ms.	Kimberland	Kelly		4122983841				5702717218	kkimberland@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	07/21/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Medical Director	Chief Medical Officer	Dr.	Bulger, DO, MBA	John		5702147020				5702715268	jbulger@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223008	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Medicare Coordinator	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Medicare Part D Opioid Overutilization Contact	Health Plan Pharmacist	Dr.	Shumlas	Leslie		5702141230					lshumlas1@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	07/21/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Medication Therapy Management Contact	Health Plan Pharmacist	Dr.	Scheib	Kristen		5702149238					kmscheib@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	11/01/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	OffShore Subcontractor Contact	Associate Vice President Legal Counsel	Mr.	Davis	F. Kelly		5702716836				5702145305	fkdavis@thehealthplan.com	Geisinger Health Plan Legal Services	100 N. Academy Avenue	Danville	PA	178223220	05/17/2023	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Online Enrollment Center Contact (Back-up)	Customer Service Team Coordinator	Ms.	Payne	Joni	L	5702140836					jlpayne@thehealthplan.com	Geisinger Health Plan Enrollment - GHP	100 N. Academy Avenue	Danville	PA	178222580	12/22/2021	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Online Enrollment Center Contact (Optional)	Manager, Customer Service Operations	Ms.	Hess	Becky	J	5702144421					bhess@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	10/31/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Online Enrollment Center Contact (Primary)	Director, Health Plan Operations - Enrollment	Ms.	Kinney	Noelle	C	5702149270					nckinney@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178222580	10/25/2021	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Part C Application Contact	Medicare Contract Specialist	Ms.	Wartinger	Lynn	S	5702718776					lswartinger@thehealthplan.com	Geisinger Health Plan, Federal Government Programs	100 North Academy Avenue	Danville	PA	178223220	07/25/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Part C Reporting Contact	Operations Specialist	Ms.	Utt	Bobbi	J	5702146718				5702148921	bjutt@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Part D Appeals	Manager, Pharmacy Cust. Srvc.	Ms	Bitler	Jessie	M						jmbitler@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/30/2020	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active	8009884861				PPO - BBA		C	Philadelphia
H9412	Part D Application Contact	Operations Specialist, Government Programs	Ms.	Wartinger	Lynn	S	5702718776				5702148921	lswartinger@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Part D Benefits Contact	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen	K	5702149379				5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Part D Claims Submission Contact	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen	K	5702149379				5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223229	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Part D Exceptions Contact	Director, Pharmacy Services	Dr.	Miller	Jamie						5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/22/2017	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active	8009884861				PPO - BBA		C	Philadelphia
H9412	Part D Exceptions Contact (Secondary)	Manager, Medicare Pharmacy Operations	Dr.	Bender	Kristen	K					5702146768	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active	8009884861				PPO - BBA		C	Philadelphia
H9412	Part D Price File Contact (Back-up)	Medicare Pharmacist	Dr.	Sponenberg	Todd		5702145059				5702146597	tsponenberg@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	10/29/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Part D Price File Contact (Optional)	MedImpact PlanFinder contact		Jordan	Felicia		8587906416				8587906040	PlanFinderCommunications@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/25/2012	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Part D Price File Contact (Primary)	Manager, Government Programs Pharmacy Operations	Dr.	Bender	Kristen		5702715555	59687			5702149379	kkbender@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17821	07/10/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Part D Quality Assurance Contact	Chief Medical Officer	Dr.	Bulger, DO, MBA	John		5702147020				5702715268	jbulger@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223008	11/01/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Part D Reporting Contact	Operations Specialist	Ms.	Utt	Bobbi	J	5702146718				5702148921	bjutt@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Patient Safety Contact	Chief Medical Officer	Dr.	Bulger, DO, MBA	John		5702147020				5702715268	jbulger@geisinger.edu	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223008	11/01/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Payment Contact	Actuarial Director		Trafton	Kristina	L	5702145043					kltrafton@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223225	10/29/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Pharmacy Director	Director, Pharmacy Services	Dr.	Miller	Jamie		5702715730				5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/22/2017	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Pharmacy Network Management Contact	PerformRx Director, Service Operations	Ms.	Leal MBA CHIE	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/28/2020	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Services	Dr.	Miller	Jamie		5702715730				5702146768	jlmiller12@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223245	12/22/2017	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Pharmacy Technical Help Desk Contact	PerformRx Director, Service Operations	Ms	Leal MBA CHIE	Avelina							aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/21/2021	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active	8555081715				PPO - BBA		C	Philadelphia
H9412	Physician Incentive Contact	Manager, Provider Management	Ms.	Ortiz	Massiel		5704920147					mortiz4@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	12/06/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Plan Directory Contact for Public Website	Geisinger Health Plan		Care	Customer		5704989731				5702715871	ghp_customer+service@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223229	11/13/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Plan to Plan Reconciliation Contact	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	eobp2p@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	10/31/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Processor Contact	PerformRx Director, Service Operations	Ms.	Leal MBA CHIE	Avelina		2158636540					aleal@performrx.com	PerformRx	200 Stevens Drive	Philadelphia	PA	19113	12/28/2020	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Quality Contact	Sr. Director, Medical Management	Mr.	Hummel	Eric		5702146405					ehummel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	11/01/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Reconciliation Contact	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	pwmerkel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	02/22/2021	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Reconciliation Contact (Secondary)	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Recovery Audit Contact	Associate Vice President Legal Counsel	Mr.	Davis	F Kelly		5702716836				5702145305	fkdavis@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	05/17/2023	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	SNP Application Contact	Operations Specialist, Government Programs	Ms.	Wartinger	Lynn	S	5702718776				5702718921	lswartinger@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	SNP State Contact	Director, Federal Government Programs	Mr.	Malett	Terry	L	5702142193					tlmalett@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	06/24/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Surveillance Contact	Medicare Compliance Officer	Mr.	Masser	Philip	J	5702149281				5702145305	pjmasser@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	System Contact	Technical Analyst Lead		Sholder	Richard	J	5702717895				5702715162	rjsholder@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	07/25/2022	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Third Party Administrator (TPA) Liaison	Manager, Government Programs	Mr.	Merkel	Patrick		5702144692				5702141367	pwmerkel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	17822	04/14/2020	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	User Access Contact	Operations Specialist, Government Programs	Ms.	Wartinger	Lynn	S	5702718776				5702148921	lswartinger@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	09/22/2015	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Utilization Management Contact	Sr. Director, Medical Management	Mr.	Hummel	Eric		5702146405					ehummel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	11/01/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9412	Utilization Review Contact	Sr. Director, Medical Management	Mr.	Hummel	Eric		5702146405					ehummel@thehealthplan.com	Geisinger Health Plan	100 North Academy Avenue	Danville	PA	178223220	11/01/2019	2023	GEISINGER QUALITY OPTIONS, INC.	Local CCP	Geisinger Gold	Local PPO		Geisinger Health	96	Yes	Active					PPO - BBA		C	Philadelphia
H9414	Agent/Broker Compensation Data Contact	Manager, Sales Operations	Mr.	Demos	John		6174260600					jdemos@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment and Eligibility		Sherman	Mandy		9202214083				9202214583	Relay.Health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Backup User Access Contact	Director, Health Plan Compliance		Dwinnells	Mark		6174260600	1239				mdwinnells@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Best Available Evidence Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931				randrade@commonwealthcare.org	30 Winter St		Boston	MA	02108	02/05/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Bid Audit Contact	Sr. Director, Actuarial Services		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Bid Audit Site Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Bid Primary Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/26/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	CAP Report Contact for Public Website	General Manager, Market Lead - Massachusetts		Waggoner	Mark		6174260600	51606				mwaggoner@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Palmieri	Chris	D	8572468897					cpalmieri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/05/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	CEO - Senior Official for Contracting	President of Markets	Ms.	Murphy	Courtney		6174260600	53892				cmurphy@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/23/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Chief Financial Officer	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/12/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Chief Operating Officer	Chief Operating Officer	Mr.	Mudunuri	Sesha		6178757140					smudunuri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/05/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Chief Information Officer	SVP & Chief Information Officer	Ms.	O'Rorke	Beth		6174260600	2485				bororke@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/21/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Chief Information Security Officer	VP, IT Governance and Cyber Security	Mr.	Jacobs	Tim		6174260600	52258				tjacobs@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	CMMI Model Point of Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	CMS Casework Communication Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320				8574534517	tschenk@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/29/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Complaints Tracking Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320				8574534517	tschenk@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/29/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Contact for Fraud Investigations	Director, FWA Program and SIU		Vasconcelos	Nadia		6174260600	52733				nvasconcelos@commonwealthcare.org	2 Lafayette	5th Floor	Boston	MA	02111	08/25/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Coordination of Benefits Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931			6174263109	randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/05/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Corporate Mailing						6174260600	1991				elgray@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Customer Service Operations Contact	Director, Contact Center Strategy		Cuevas	Sabrina		6174260600	51004				scuevas@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/05/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	DIR Contact	Sr. Director, Actuarial Services		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	DIR Contact (Secondary)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Electronic Health Record Contact	Director Clinical Informatics		Phan	Phuong		6174260600	52247				pphan@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	11/04/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Emergency Part D Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Emergency Part D Contact (Secondary)	Manager, Pharmacy Operations	Ms	Lee	Annie		6174263109					alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Encounter Data & Risk Adjustment Operations Contact	Manager, Encounters and Risk		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter St		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Enrollment Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931			6174263109	randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/05/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	EOB Transfer Contact	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194			6174260600	elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Financial Audit Contact	Director, Regulatory Audit	Ms.	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Financial Reporting Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Formulary Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Formulary Contact (Secondary)	Medicare Team Lead, Formulary Services		Paddock	Deanna		6087291628				6087292628	deanna.paddock@navitus.com	361 Integrity Drive		Madison	WI	53717	01/21/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	General Contact	General Manager, Market Lead - Massachusetts		Waggoner	Mark		6174260600	51606				mwaggoner@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Government Relations Contact	VP, Government Relations		Preede	Ken		6174260600	51412				kpreede@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	HIPAA Privacy Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	HIPAA Security Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Hospice Contact	Palliative Care Medical Director		Ragland	Julia		7815254203					jragland@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	10/04/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Interoperability Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	MA Appeals/Grievances Contact	Director, Appeals& Grievances		Schenk	Tyrone		8666102273	1652			8574534517	tschenk@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/29/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	MA Claims Processing Contact for Public Website	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194				elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Marketing Contact	SVP, Marketing		Kubilus	Melissa		6174260600	52448			6174263019	mkubilus@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/03/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Medical Director	Medical Director		Johnson	Brenda		6174260600	51639				brjohnson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/31/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Medicare Compliance Officer	Director, Medicare Compliance Officer	Ms.	Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/01/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Medicare Coordinator	Contract Manager		Belec	Steven		6174260600	1870				sbelec@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Medication Therapy Management Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	OffShore Subcontractor Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Online Enrollment Center Contact (Back-up)	Manager, Member Enrollment and Retention		Taylor	Lena		6174260600	51126				ltaylor@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Online Enrollment Center Contact (Optional)	VP, National Sales	Mr.	Spartano	Michael		6179139034					mspartano@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Online Enrollment Center Contact (Primary)	Director, Enrollment, Recon. & Retention	Mr	Andrade	Remo		6174260600	57931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Part C Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Part C Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Part D Appeals	Director, Appeals & Grievances		Schenk	Tyrone						8573273320	tschenk@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/29/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active	8666102273	1652			PPO - BBA		C	Boston
H9414	Part D Appeals Contact (Secondary)	Manager Clinical Appeals and Grievances		Mancuso	Jeremy							jmancuso@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600	51222			PPO - BBA		C	Boston
H9414	Part D Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Part D Benefits Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Part D Claims Submission Contact	Manager, Technical Operations		Derks	Bob		9202214176				9202214676	DL-TO-PDE@navitus.com	1025 West Navitus Dr		Appleton	WI	54913	05/04/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Part D Exceptions Contact	Sr. Manager, Clinical Prior Auth		LeClair	Christophe						9202214676	Christopher.LeClair@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	03/25/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active	8662703877				PPO - BBA		C	Boston
H9414	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Operations		Lee	Annie						6174263109	alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/09/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600				PPO - BBA		C	Boston
H9414	Part D Price File Contact (Back-up)	Manager, Pharmacy Operations		Lee	Annie		6174260600					alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/09/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Part D Price File Contact (Optional)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Part D Price File Contact (Primary)	Navitus Plan Finder		Finder	Plan		6087291578					Plan.Finder@Navitus.com	2601 West Beltline Highway	Suite 600	Madison	WI	53713	08/25/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Part D Quality Assurance Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Part D Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Patient Safety Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Payment Contact	VP Revenue Cycle Management		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Personal Health Record Contact	Mgr, Health Information Management		Lopez	Robin		6174260600	5235				rlopez@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/25/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Pharmacy Director	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688				6087292688	Jan.Robinson@Navitus.com	361 Integrity Drive		Madison	WI	53713	03/25/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Pharmacy Technical Help Desk Contact	Sr. Mgr, Customer Care Accounts		Nett	Danielle						9202214724	Danielle.Nett@navitus.com	1025 West Navitus Drive		Appleton	WI	53713	03/25/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active	8662703877	4224			PPO - BBA		C	Boston
H9414	PHR Beneficiary Contact																	03/25/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO	Commonwealth Care Alliance	Commonwealth Care Alliance, Inc.	60	Yes	Active	8666102273				PPO - BBA		C	Boston
H9414	Physician Incentive Contact	VP, Provider Network Strategy	Mr.	Tirimacco	Robert		6174260600	1013				rtirimacco@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/25/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Plan Directory Contact for Public Website			Services	Member		8664209332					memberservices@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/16/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Plan to Plan Reconciliation Contact	Manager, Accounts Payable		Reeves	Jennifer		6174260600	51632				jreeves@commonwealthcare.org	30 Winter St		Boston	MA	02108	05/08/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Processor Contact	VP, Claims and Provider Network Operations		Breen	Donna		6176804446					dbreen@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Quality Contact	VP, Quality		Feierstein	Anne		6174260600	56868				afeierstein@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/10/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Reconciliation Contact	Director, Actuarial Service		Jesik	David		6174260600	1808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/01/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Reconciliation Contact (Secondary)	VP Revenue Cycle		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Recovery Audit Contact	Director, Regulatory Audit	Ms.	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	SNP Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	SNP State Contact	Director SCO and ICO		Belec	Steve		6174260600	1870				sbelec@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Surveillance Contact	VP, National Sales		Spartano	Michael		6174260600	52179				mspartano@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	System Contact	Manager, Encounters and Risk Adjustment		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Third Party Administrator (TPA) Liaison	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	User Access Contact	Director Medicare Compliance Officer		Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	190 White Ave		Warwick	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Utilization Management Contact	VP UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9414	Utilization Review Contact	VP UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Massachusetts, LLC.	Local CCP	Commonwealth Care Alliance Massachusetts	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9428	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/15/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/28/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/15/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/15/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H9428	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H9428	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/15/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H9428	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H9428	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H9428	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/15/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H9428	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H9428	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/15/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9428	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/15/2022	2023	WELLCARE HEALTH INSURANCE OF TENNESSEE, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9431	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	10/29/2021	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	EOB Transfer Contact	Senior Director, Finance		Passuello	Clifford		7177292378				7247417216	capassuello@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	01/25/2018	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/02/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8042966237				PPO - BBA		C	Philadelphia
H9431	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	7132085765				PPO - BBA		C	Philadelphia
H9431	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	01/25/2018	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6026183945				PPO - BBA		C	Philadelphia
H9431	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	6122633491				PPO - BBA		C	Philadelphia
H9431	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active	8002386279				PPO - BBA		C	Philadelphia
H9431	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/02/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/25/2018	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/24/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9431	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY	Local CCP	Aetna Medicare	Local PPO		CVS Health Corporation	49	Yes	Active					PPO - BBA		C	Philadelphia
H9438	Automated TrOOP Balance Transfer Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Backup User Access Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Best Available Evidence Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Bid Primary Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	CAP Report Contact for Public Website	PACE Operations Director	Ms	Lefort	Chris		6205045917				6205045674	christinal@bluestemks.org	113 South Ash		McPherson	KS	67460	01/27/2017	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	CEO - CMS Administrator Contact	Exec Director	Ms	Rains	Emilie		6205045950				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	CEO - Senior Official for Contracting	Exec Director	Ms	Rains	Emilie		6205045950				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Chief Financial Officer	CFO	Mr.	Schrag	Jerol		3162842900				3162840173	jerols@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Chief Operating Officer	PACE Operations Director	Ms	Lefort	Chris		6205045917				6205045674	christinal@bluestemks.org	113 South Ash		McPherson	KS	67460	01/27/2017	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Chief Information Officer	IT Director	Mr.	Hardesty	Bryan		3168364852					bryanh@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/07/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Chief Information Security Officer	IT Director	Mr.	Hardesty	Bryan		3168364852					bryanh@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/07/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	CMS Casework Communication Contact	PACE Operations Director	Ms.	Lefort	Chris		6205045917				6205045674	christinal@bluestemks.org	113 South Ash		McPherson	KS	67460	01/27/2017	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Complaints Tracking Contact	QAPI Coordinator		Hilburn	Sandy		6205045901				6245045674	sandyh@bluestemks.org	113 South Ash		McPherson	KS	67460	04/19/2022	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Contact for Fraud Investigations	Exec Director	Ms	Rains	Emilie		6205045950				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Coordination of Benefits Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Corporate Mailing						6205045900				6205045674	justinl@bluestemks.org	113 South Ash St		McPherson	KS	67460	04/19/2022	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Coverage Gap Discount Program (CGDP) Payment Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/07/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Customer Service Operations Contact	Exec Director	Ms	Rains	Emilie		6205045950				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	DIR Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	DIR Contact (Secondary)	CFO		Schrag	Jerol		3168364827				3162840173	jerols@bluestemks.org	3001 Ivy Dr		North Newton	KS	67117	04/19/2022	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Emergency Part D Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Emergency Part D Contact (Secondary)	PACE Operations Director	Ms	Lefort	Chris		6205045917				6205045674	christinal@bluestemks.org	113 South Ash		McPherson	KS	67460	01/27/2017	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Encounter Data & Risk Adjustment Operations Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	113 South Ash St		McPherson	KS	67460	04/19/2022	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Enrollment Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	EOB Transfer Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Financial Audit Contact	PACE Director of Accounting	Ms.	Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Financial Reporting Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Formulary Contact	Medical Director	Dr.	Casimir	Jon		6205045908				6205045678	jonc@bluestemks.org	113 South Ash		McPherson	KS	67460	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	General Contact	Exec Director	Ms	Rains	Emilie		6205045900				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Government Relations Contact	Exec Director	Ms	Rains	Emilie		6205045950				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	HIPAA Privacy Officer	CFO		Schrag	Jerol		3162842900				3162840173	jerols@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	04/19/2022	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	HIPAA Security Officer	CFO		Schrag	Jerol		3162842900				3162840173	jerols@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	04/19/2022	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Interoperability Contact	PACE Operations Director		Lefort	Christina		6205045900					christinal@blustemks.org	113 South Ash		McPherson	KS	67460	04/19/2022	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	MA Appeals/Grievances Contact	QAPI Coordinator		Hilburn	Sandy		6205045901				6245045674	sandyh@bluestemks.org	113 South Ash		McPherson	KS	67460	04/19/2022	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	MA Claims Processing Contact for Public Website	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Marketing Contact	Marketing/Intake Director		Rains	Emilie		6205045919				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/01/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Medical Director	Medical Director	Dr.	Casimir	Jon		6205045908				6205045678	jonc@bluestemks.org	113 South Ash		McPherson	KS	67460	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Medicare Compliance Officer	PACE Director of Accounting	Ms	Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	04/19/2022	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Medicare Coordinator	PACE Operations Director	Ms	Lefort	Chris		6205045917				6205045674	christinal@bluestemks.org	113 South Ash		McPherson	KS	67460	01/27/2017	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Casimir	Jon		6205045908				6205045678	jonc@bluestemks.org	113 South Ash		McPherson	KS	67460	03/20/2019	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Medication Therapy Management Contact	Medical Director	Dr.	Casimir	Jon		6205045908				6205045674	jonc@bluestemks.org	113 South Ash		McPherson	KS	67460	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Online Enrollment Center Contact (Optional)	Exec Director	Ms	Rains	Emilie		6205045950				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Online Enrollment Center Contact (Primary)	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Part C Application Contact	Exec Director	Ms	Rains	Emilie		6205045900				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Part D Appeals	PACE Director of Accounting		Conner	Dee						3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	01/27/2017	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active	8445887223				PACE - Nat		C	Kansas City
H9438	Part D Appeals Contact (Secondary)	PACE Operations Director	Ms	Lefort	Chris						6205045674	christinal@bluestemks.org	113 South Ash		McPherson	KS	67460	01/27/2017	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active	8445887223				PACE - Nat		C	Kansas City
H9438	Part D Application Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Part D Benefits Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Part D Claims Submission Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Part D Exceptions Contact	PACE Director of Accounting		Conner	Dee						3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active	8008364880				PACE - Nat		C	Kansas City
H9438	Part D Exceptions Contact (Secondary)	PACE Operations Director	Ms	Lefort	Chris						6205045674	christinal@bluestemks.org	113 South Ash		McPherson	KS	67460	01/27/2017	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active	8445887223				PACE - Nat		C	Kansas City
H9438	Part D Price File Contact (Back-up)	Exec Director	Ms	Rains	Emilie		6205045950				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Part D Price File Contact (Primary)	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Part D Quality Assurance Contact	QAPI Coordinator		Hilburn	Sandy		6205045901				6245045674	sandyh@bluestemks.org	113 South Ash		McPherson	KS	67460	04/19/2022	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Part D Reporting Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Patient Safety Contact	QAPI Coordinator		Hilburn	Sandy		6205045901				6245045674	sandyh@bluestemks.org	113 South Ash		McPherson	KS	67460	04/19/2022	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Payment Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Personal Health Record Contact	PACE Operations Director	Ms	Lefort	Chris		6205045917				6205045674	christinal@bluestemks.org	113 South Ash		McPherson	KS	67460	01/27/2017	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Pharmacy Director	Medical Director	Dr.	Casimir	Jon		6205045908				6205045674	jonc@bluestemks.org	113 South Ash		McPherson	KS	67460	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Pharmacy Network Management Contact	Exec Director	Ms	Rains	Emilie		6205045950				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Pharmacy Network Management Contact (Secondary)	PACE Operations Director	Ms	Lefort	Chris		6205045917				6205045674	christinal@bluestemks.org	113 South Ash		McPherson	KS	67460	01/27/2017	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Pharmacy Technical Help Desk Contact			Schrag	Jerol						3162840173	jerols@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	07/15/2015	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active	3162842900				PACE - Nat		C	Kansas City
H9438	Plan Directory Contact for Public Website	Exec Director	Ms	Rains	Emilie		6205045900				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Plan to Plan Reconciliation Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Processor Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Quality Contact			Hilburn	Sandy		6205045901				6245045674	sandyh@bluestemks.org	113 South Ash		McPherson	KS	67460	03/23/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Reconciliation Contact	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Recovery Audit Contact	PACE Director of Accounting	Ms.	Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Surveillance Contact	Exec Director	Ms	Rains	Emilie		6205045950				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	System Contact	Exec Director	Ms	Rains	Emilie		6205045900				6205045674	emilier@bluestemks.org	113 South Ash		McPherson	KS	67460	08/02/2023	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Third Party Administrator (TPA) Liaison	PACE Director of Accounting		Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	3001 Ivy Drive		North Newton	KS	67117	03/07/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	User Access Contact	PACE Director of Accounting	Ms	Conner	Dee		3168364880				3168364250	deeannac@bluestemks.org	113 South Ash		McPherson	KS	67460	10/07/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Utilization Management Contact	Medical Director	Dr.	Casimir	Jon		6205045908				6205045674	jonc@bluestemks.org	113 South Ash		McPherson	KS	67460	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9438	Utilization Review Contact	Medical Director	Dr.	Casimir	Jon		6205045908				6205045674	jonc@bluestemks.org	113 South Ash		McPherson	KS	67460	03/02/2016	2023	BLUESTEM PACE, INC.	National PACE	Bluestem PACE	National PACE		Bluestem Communities, Inc.	645	Yes	Active					PACE - Nat		C	Kansas City
H9455	Agent/Broker Compensation Data Contact	Director of Medicare Sales		Hubbard	Brett		4357208345					Brett.Hubbard@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Automated TrOOP Balance Transfer Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Backup User Access Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Best Available Evidence Contact	Sales Coordinator		Johnson	Linda		3854140793					Linda.Johnson@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Bid Audit Contact	Director Medicare Advantage Program	Mr.	Tonga	Benjamin		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr.	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Bid Audit Site Contact	Director Medicare Advantage Program	Mr.	Tonga	Benjamin		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr.	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Bid Primary Contact	Director Medicare Advantage Program	Mr.	Tonga	Benjamin		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr.	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	CAP Report Contact for Public Website	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Westover	Chad		8015872636					Chad.Westover@hsc.utah.edu	6053  Fashion Square Drive	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	CEO - Senior Official for Contracting	Chief Operating Officer	Mr.	Larsen	John		8016467228					John.Larsen@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Chief Financial Officer	Director, Finance	Mr	Finlinson	Doug		8015872675					DOUG.FINLINSON@hsc.utah.edu	6053  Fashion Square Drive	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Chief Operating Officer	Chief Operating Officer	Mr.	Larsen	John		8016467228					John.Larsen@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Chief Information Officer	Manager, Information Technology	Mr	Wilcox	Dave		8015872650					Dave.Wilcox@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Chief Information Security Officer	Manager, Information Technology	Mr	Wilcox	Dave		8015872650					Dave.Wilcox@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	CMS Casework Communication Contact	Appeals Manager	Ms.	Willey	Katie		8012130291					Katie.Willey@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Complaints Tracking Contact	Grievance & Appeals Supervisor	Ms.	Willey	Katie		8012130291					Katie.Willey@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Contact for Fraud Investigations	SIU Coding Investigator	Ms	Hendry	Victoria		3852102333					Vicky.Hendry@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Coordination of Benefits Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Corporate Mailing						8016467271					John.Larsen@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Coverage Gap Discount Program (CGDP) Payment Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Customer Service Operations Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	DIR Contact	Controller	Mr	Soliman	Bishoy		4802783506					Bishoy.Soliman@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	DIR Contact (Secondary)	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8019716612				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Emergency Part D Contact	Supervisor Part D Operations		Maples	David		8012130099					David.Maples@utah.edu	6053 S Fashion Square Dr.	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Emergency Part D Contact (Secondary)	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Encounter Data & Risk Adjustment Operations Contact	Manager, Medicare Advantage Operations	Mr	Wilson	Mike		8016464833					Mike.Wilson@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Enrollment Contact	Enrollment/Sales Coordinator		Johnson	Linda		3854140793					Linda.Johnson@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	EOB Transfer Contact	Medicare Advantage Delegated Operations Supervisor	Mr	Beck	Michael		8016464834				8012131547	Michael.Beck@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Financial Audit Contact	Director Finance	Mr	Finlinson	Doug		8015872675					DOUG.FINLINSON@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Financial Reporting Contact	Director Finance	Mr	Finlinson	Doug		8015872675					DOUG.FINLINSON@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Formulary Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Formulary Contact (Secondary)	Director Pharmacy Services	Ms	Britton	Laura		8015872829					Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	General Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Government Relations Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	HIPAA Privacy Officer	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	HIPAA Security Officer	Manager, Information Technology	Mr	Wilcox	Dave		8015872650					Dave.Wilcox@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Hospice Contact	Supervisor Part D Operations		Maples	David		8012130099					David.Maples@utah.edu	6053 S Fashion Square Dr.	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Interoperability Contact	Director, Information Technology	Mr	Wilcox	Dave		8015872650					Dave.Wilcox@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	MA Appeals/Grievances Contact	Appeals Manager	Ms.	Willey	Katie		8012130291					Katie.Willey@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	MA Claims Processing Contact for Public Website	Manager, Medicare Advantage Operations	Mr	Wilson	Mike		8016464833					Mike.Wilson@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Marketing Contact	Compliance Specialist		Lofton	Ashley		8012130382					Ashley.Lofton@hsc.utah.edu	6053 S Fashion Square Drive	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Medical Director	Chief Medical Officer	Dr	Ferguson	Richard		5173035353					Richard.Ferguson@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Medicare Compliance Officer	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Medicare Coordinator	Director Medicare Advantage Program	Mr.	Tonga	Benjamin		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr.	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Medicare Part D Opioid Overutilization Contact	Director Pharmacy Services	Ms	Britton	Laura		8015872829					Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Medication Therapy Management Contact	Director Pharmacy Services	Ms	Britton	Laura		8015872829					Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	OffShore Subcontractor Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Online Enrollment Center Contact (Primary)	Medicare Adv Delegated Operations Supervisor	Mr	Beck	Michael		8016464834					Michael.Beck@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Part C Application Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Part C Reporting Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Appeals	Supervisor Part D Operations	Mr	Maples	David							David.Maples@utah.edu	6053 S Fashion Square Dr.	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract	8012130099				HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Appeals Contact (Secondary)	Compliance Manager	Mr.	Christensen	Eric							eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract	8012130292				HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Application Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Benefits Contact	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Claims Submission Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Exceptions Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David							David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract	8012130099				HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Exceptions Contact (Secondary)	Director Pharmacy Services	Ms	Britton	Laura							Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract	8015872829				HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Price File Contact (Back-up)	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Price File Contact (Optional)	Director Pharmacy Services	Ms	Britton	Laura		8015892829					Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Price File Contact (Primary)	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Quality Assurance Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Part D Reporting Contact	Supervisor Part D Operations		Maples	David		8012130099					David.Maples@utah.edu	6053 S Fashion Square Dr.	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Patient Safety Contact	Director Pharmacy Services	Ms	Britton	Laura		8015892829					Laura.Britton@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Payment Contact	Controller	Mr	Soliman	Bishoy		4802783506					Bishoy.Soliman@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Pharmacy Director	Director Pharmacy Services	Ms	Britton	Laura		8015872829					Laura.Britton@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Pharmacy Network Management Contact	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Pharmacy Network Management Contact (Secondary)	Director Medicare Advantage	Mr	Tonga	Ben		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Pharmacy Technical Help Desk Contact	CVS Health Technical Help Desk		Help Desk	CVS								CVS Health	9501 E Shea Blvd	Scottsdale	AZ	85260	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract	8666934620				HMO - Health Maintenance Organization		C	Dallas
H9455	Plan Directory Contact for Public Website	Director Medicare Advantage Program	Mr.	Tonga	Benjamin		8012130161					benjamin.tonga@utah.edu	6053 S Fashion Square Dr.	Suite 110	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Plan to Plan Reconciliation Contact	Controller	Mr	Soliman	Bishoy		4802783506					Bishoy.Soliman@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Processor Contact	Medicare Adv Delegated Operations Supervisor	Mr	Beck	Michael		8016464834					Michael.Beck@hsc.utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Quality Contact	Chief Medical Officer	Dr.	Ferguson	Richard		5173035353					Richard.Ferguson@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Reconciliation Contact	Controller	Mr	Soliman	Bishoy		4802783506					Bishoy.Soliman@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Recovery Audit Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	SNP Application Contact	Chief Operating Officer	Mr.	Larsen	John		8016467228					John.Larsen@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	SNP State Contact	Chief Operating Officer	Mr.	Larsen	John		8016467228					John.Larsen@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Surveillance Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	System Contact	Manager, Information Technology	Mr	Wilcox	Dave		8015872650					Dave.Wilcox@hsc.utah.edu	6053 Fashion Square Drive, Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Third Party Administrator (TPA) Liaison	Medicare Advantage Part D Oversight Supervisor	Mr	Maples	David		8012130099				8012131547	David.Maples@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	User Access Contact	Compliance Manager	Mr.	Christensen	Eric		8012130292					eric.n.christensen@utah.edu	6053 S Fashion Square Dr. Suite 110		Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Utilization Management Contact	Director of Clinical Operations		Ford	Jennifer		8012130589				8015874855	Jenn.Ford@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9455	Utilization Review Contact	Director of Clinical Operations		Ford	Jennifer		8012130589				8015874855	Jenn.Ford@healthchoiceutah.com	6056 S Fashion Square Drive	Suite 2400	Murray	UT	84107	06/05/2023	2023	HEALTH CHOICE UTAH, INC.	Local CCP	Health Choice Generations Utah	HMO/HMOPOS		University of Utah	762	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Dallas
H9460	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H9460	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H9460	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H9460	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H9460	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H9460	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H9460	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9460	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF ST LOUIS, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9468	Automated TrOOP Balance Transfer Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Backup User Access Contact	Director, Development		Hess	Ronald		6198852533					rhess@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Best Available Evidence Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Bid Primary Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State ST	Suite 200	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	CAP Report Contact for Public Website	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending	8444565433				PACE - Nat		C	Atlanta
H9468	CEO - CMS Administrator Contact	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street  Suite 201	Erie	PA	16507	12/19/2022	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	CEO - Senior Official for Contracting	CEO	Mr.	Fish	Richard		8144565433					rfish@oneseniorcare.com	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Chief Financial Officer	CFO	Mr.	Phillips	Jeffery		8144565433					jphillips@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	12/19/2022	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Chief Operating Officer	Executive Director	Mrs.	Lyons	Laura		8144565433					llyons@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Chief Information Officer	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	12/19/2022	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Chief Information Security Officer	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	12/19/2022	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	CMS Casework Communication Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Complaints Tracking Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Contact for Fraud Investigations	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Coordination of Benefits Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Corporate Mailing						8144565433					llyons@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street Suite 201	Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Coverage Gap Discount Program (CGDP) Payment Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Customer Service Operations Contact	Director of Center Operation		Kraus	Lisa		8148237906					lkraus@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	DIR Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	DIR Contact (Secondary)	Executive Director		Lyons	Laura	M	8149699465					llyons@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Emergency Part D Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Emergency Part D Contact (Secondary)	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Encounter Data & Risk Adjustment Operations Contact	Executive Director		Lyons	Laura		8144565433					llyons@lifenwpa.org	100 State Street   Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Enrollment Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	EOB Transfer Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433				8144542500	jkachersky@lifenwpa.org	100  State Street, Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Financial Audit Contact	VP, Finance and Quality	Mrs.	Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Financial Reporting Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Formulary Contact	Medical Director	Dr.	Shaffer	Kevin		8144565433					kshaffer@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	12/19/2022	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Formulary Contact (Secondary)	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	General Contact	Executive Director		Lyons	Laura		8144565433					llyons@lifenwpa.org	100 State Street Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Government Relations Contact	CEO	Mr.	Fish	Richard		8144565433					rfish@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	12/19/2022	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	HIPAA Privacy Officer	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	HIPAA Security Officer	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Interoperability Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	MA Appeals/Grievances Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	MA Claims Processing Contact for Public Website	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Marketing Contact	Director, Marketing and Intake		Campbell	Marcie		8144565433					mcampbell@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Medical Director	Medical Director	Dr.	Shaffer	Kevin		8144565433					kshaffer@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	12/19/2022	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Medicare Compliance Officer	Director of Quality	Mrs.	Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Medicare Coordinator	Executive Director	Mrs.	Lyons	Laura		8144565433					llyons@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 200	Erie	PA	16507	07/10/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Medicare Part D Opioid Overutilization Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street , suite 201		Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Medication Therapy Management Contact	Medical Director	Dr.	Shaffer	Kevin		8144565433					kshaffer@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	12/19/2022	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Part C Application Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	100 State Street   Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Part D Appeals	VP, Finance and Quality		Kachersky	Jennfer							jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending	8444565433				PACE - Nat		C	Atlanta
H9468	Part D Appeals Contact (Secondary)	Executive Director		Lyons	Laura						8144542500	llyons@lifenwpa.org	100 State Street  Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending	8444565433				PACE - Nat		C	Atlanta
H9468	Part D Application Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Part D Benefits Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Part D Claims Submission Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Part D Exceptions Contact	Medical Director	Dr.	Shaffer	Kevin							kshaffer@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending	8144565433				PACE - Nat		C	Atlanta
H9468	Part D Exceptions Contact (Secondary)	Executive Director		Lyons	Laura							llyons@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending	8144565433				PACE - Nat		C	Atlanta
H9468	Part D Price File Contact (Back-up)	CFO		Phillips	Jeff		8144565433					jphillips@lifenwpa.org	100 State Street   Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Part D Price File Contact (Primary)	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Part D Quality Assurance Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Part D Reporting Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	100 State Street  Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Patient Safety Contact	Medical Director	Dr.	Shaffer	Kevin		8144565433					kshaffer@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	12/19/2022	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Payment Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Personal Health Record Contact	Director of Quality		Sheeder	Shelby		8145927615				8144542500	ssheeder@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Pharmacy Director	Medical Director	Dr.	Shaffer	Kevin		8144565433					kshaffer@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	12/19/2022	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Pharmacy Network Management Contact	Director, Contracts		Feldmann	William		8144565433					wfeldmann@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Pharmacy Network Management Contact (Secondary)	Executive Director	Mrs.	Lyons	Laura		8144565433					llyons@lifenwpa.org	100 State Street , Suite 200		Erie	PA	16507	07/10/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Pharmacy Technical Help Desk Contact	VP, Finance and Quality		Kachersky	Jennfer							jkachersky@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending	8144565433				PACE - Nat		C	Atlanta
H9468	Pharmacy Technical Help Desk Contact (Secondary)	Executive Director		Lyons	Laura							llyons@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending	8444565433				PACE - Nat		C	Atlanta
H9468	Plan Directory Contact for Public Website	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Plan to Plan Reconciliation Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Processor Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Quality Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street, Suite 201	Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Reconciliation Contact	VP, Finance and Quality		Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Reconciliation Contact (Secondary)	CFO		Phillips	Jeffrey		8144565433					jphillips@lifenwpa.org	100 State Street   Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Recovery Audit Contact	VP, Finance and Quality	Mrs.	Kachersky	Jennifer		8144565433					jkachersky@lifenwpa.org	100 State Street, Suite 201		Erie	PA	16507	01/30/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Surveillance Contact	Director, Marketing and Intake		Campbell	Marcie		8144565433					mcampbell@lifenwpa.org	100 State ST	Suite 201	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	System Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Third Party Administrator (TPA) Liaison	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	100 State Street , Suite 201		Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	User Access Contact	VP, Finance and Quality		Kachersky	Jennfer		8144565433					jkachersky@lifenwpa.org	LIFE-NWPA -- MED-D Administration	100 State Street   Suite 201	Erie	PA	16507	01/26/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Utilization Management Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street   Suite 201		Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9468	Utilization Review Contact	Director of Quality		Sheeder	Shelby		8145927615					ssheeder@lifenwpa.org	100 State Street   Suite 201		Erie	PA	16507	04/05/2023	2023	ONE SENIOR CARE KENTUCKY, LLC	National PACE	One Senior Care Kentucky, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9469	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/28/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Bid Primary Contact	Product Management Director		Gray	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/03/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H9469	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				PPO - BBA		C	Chicago
H9469	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				PPO - BBA		C	Chicago
H9469	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				PPO - BBA		C	Chicago
H9469	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				PPO - BBA		C	Chicago
H9469	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				PPO - BBA		C	Chicago
H9469	PHR Beneficiary Contact																	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				PPO - BBA		C	Chicago
H9469	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9469	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/10/2022	2023	UNICARE LIFE AND HEALTH INSURANCE COMPANY	Local CCP	Simply Healthcare	Local PPO		Elevance Health, Inc.	1	Yes	Active					PPO - BBA		C	Chicago
H9485	Agent/Broker Compensation Data Contact	Manager, Broker Relations		Hamel	Tom		8572827469					thamel@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Automated TrOOP Balance Transfer Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Backup User Access Contact	Director, Regulatory Affairs & Compliance		Richardson	Stephanie		5087760489					srichardson@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	08/31/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Best Available Evidence Contact	Director, Enrollment		Fishkin	Carly		8572822762					cfishkin@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	08/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Bid Audit Contact	Chief Actuary		Sanghvi	Sujata		8572827525					ssanghvi@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Bid Primary Contact	Manager, Medicare Product		Cassidy	Cheryl		8572823348					CCassidy@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	01701	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	CAP Report Contact for Public Website	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	12/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active	8558333668				PPO - BBA		C	Boston
H9485	CEO - CMS Administrator Contact	President	Mr	Trembley	Shannon		2079394468					strembley@allwayshealth.org	399 Revolution Drive	Suite 820	Somerville	MA	02145	12/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	CEO - Senior Official for Contracting	President	Mr	Tringale	Steve		2079394468					stringale@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	12/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Chief Financial Officer	CFO	Ms	Silva	Lucy		2079394468					lsilva@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	12/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Chief Operating Officer	COO	Mr	Mcormick	Mark		2079394468					mmcormick@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	12/20/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Chief Information Officer	CIO	Mr	Bundela	Yogi		8572822863					ybundela@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Chief Information Security Officer	Chief Information Security and Privacy Officer	Mr	Kadakia	Jigar		8572827121					jkadakia@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	CMS Casework Communication Contact	Director, Quality		Sahar	Maurice		8572829076					msahar@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	07/06/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Complaints Tracking Contact	Director, Quality		Sahar	Maurice		8572829076					msahar@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	07/06/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Contact for Fraud Investigations	Director, Provider		Sargent	Marlene		8572823205					msargent@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Coordination of Benefits Contact	Manager, Recoveries		Ryan	Cathy		8572829131					cryan@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Corporate Mailing						8572823348					BBowen@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Customer Service Operations Contact	Director, Customer Services		Biron	Jonathan		8572829082					jbiron@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	DIR Contact	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Emergency Part D Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Emergency Part D Contact (Secondary)	Manager Pharmacy Operations Medicare		Hart	Maegen		8572825333					MHart@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	08/16/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Encounter Data & Risk Adjustment Operations Contact	Director, Risk Score Management and Medical Econom		Keefe	kevin		8572826420					kkeefe@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Enrollment Contact	Director, Enrollment		Fishkin	Carly		8572822762					cfishkin@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	EOB Transfer Contact	Director, Pharmacy		Gallagher	Angela		8572822493				8572823348	agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Financial Audit Contact	Controller	Mr	Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Financial Reporting Contact	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Formulary Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Formulary Contact (Secondary)	Manager Pharmacy Operations Medicare		Hart	Maegen		8572825333					MHart@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	08/16/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	General Contact	Manager, Medicare Product Development		Cassidy	Cheryl		8572823348					CCassidy@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	06/10/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Government Relations Contact	Director, Government Affairs		Sullivan	John		8572823376					jsullivan@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	HIPAA Privacy Officer	SVP, Legal, Regulatory Affairs and Compliance		Moore	ALice		8572826589					amoore@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	HIPAA Security Officer	SVP, Legal, Regulatory Affairs and Compliance		Moore	ALice		8572826589					amoore@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Hospice Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Interoperability Contact	Director, Regulatory Affairs & Compliance		Richardson	Stephanie		5087760489					srichardson@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	08/31/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	MA Appeals/Grievances Contact	Director, Quality		Sahar	Maurice		8572829076					msahar@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	07/06/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	MA Claims Processing Contact for Public Website	Director, Claims		Noel	Leticia		8572826499					lnoel@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Marketing Contact	Director, Customer Engagement Marketing		Miller	Chris		8572823360					cmiller@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	07/06/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Medical Director	Chief Medical Officer	Dr	Jubelt	Lindsay		8572821234					ljubelt@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Medicare Compliance Officer	Medicare Compliance Officer	Ms	Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Medicare Coordinator	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Drive		Somerville	MA	02145	11/08/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Gallagher	Angela		8572823348					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	08/16/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Medication Therapy Management Contact	Director, Pharmacy		Gallagher	Angela		8572822645					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Part C Application Contact			Cassidy	Cheryl		8572823348					CCassidy@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	11/15/2021	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Part C Reporting Contact	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Part D Appeals	Director, Quality		Sahar	Maurice							msahar@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	07/06/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active	8572829076				PPO - BBA		C	Boston
H9485	Part D Application Contact			Cassidy	Cheryl		8572823348					CCassidy@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	11/15/2021	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Part D Benefits Contact	Manager, Medicare Product		Cassidy	Cheryl		8572823348					ccassidy@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Part D Claims Submission Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Part D Exceptions Contact	Director, Pharmacy		Gallagher	Angela							agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active	8572822493				PPO - BBA		C	Boston
H9485	Part D Price File Contact (Back-up)	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Part D Price File Contact (Optional)	Manager Pharmacy Operations Medicare		Hart	Maegen		8572825333					MHart@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	08/16/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Part D Price File Contact (Primary)	Deputy Chief Medical Officer	Dr	Shafi	Farah		8572828040					fshafi@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Part D Quality Assurance Contact	Director, Pharmacy		Gallagher	Angela		8572822438					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Part D Reporting Contact	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Patient Safety Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Payment Contact	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Pharmacy Director	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Pharmacy Network Management Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Pharmacy Technical Help Desk Contact	Director, Pharmacy		Gallagher	Angela							agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active	8666934620				PPO - BBA		C	Boston
H9485	Pharmacy Technical Help Desk Contact (Secondary)	Manager Pharmacy Operations Medicare		Hart	Maegen							MHart@AllWaysHealth.org	399 Revolution Dr		Somerville	MA	02145	08/16/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active	8572825333				PPO - BBA		C	Boston
H9485	Plan Directory Contact for Public Website	Director, Customer Services		Biron	Jonathan		8572829082					jbiron@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Plan to Plan Reconciliation Contact	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Processor Contact	Director, Pharmacy		Gallagher	Angela		8572822493					agallagher@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Quality Contact	Director, Quality		Sahar	Maurice		8572822728					msahar@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Reconciliation Contact	Chief Actuary		Sanghvi	Sujata		8572827525					ssanghvi@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Reconciliation Contact (Secondary)	VP, Actuarial & Underwriting		Liang	Marybeth		8572820150					mliang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Recovery Audit Contact	Medicare Compliance Officer	Ms	Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Surveillance Contact	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	System Contact	Director, Business Systems Configuration		Malvo	Donovan		8572823015					dmalvo@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Third Party Administrator (TPA) Liaison	Controller		Tang	Tak		8572823317					ttang@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	User Access Contact	Medicare Compliance Officer		Trembley	Shannon		2079394468					STrembley@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	09/27/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Utilization Management Contact	VP, Clinical Operations		Scott	Joy		8572828039					jscott@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9485	Utilization Review Contact	VP, Clinical Operations		Scott	Joy		8572828039					jscott@allwayshealth.org	399 Revolution Dr		Somerville	MA	02145	02/15/2022	2023	Mass General Brigham Health Plan, Inc.	Local CCP	Mass General Brigham Health Plan	Local PPO		Mass General Brigham Incorporated	784	Yes	Active					PPO - BBA		C	Boston
H9489	Agent/Broker Compensation Data Contact	Product Coordinator		Armstrong	Chris		8023713250					carmstrong@bcbsvt.com	P.O. Box 186		Montpelier	VT	05601	02/07/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Automated TrOOP Balance Transfer Contact	Manager, Business Process		Diaz	Mario		7143172628					OptumRx-SupportServices@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Backup User Access Contact	Manager, Performance & Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	07/06/2021	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Best Available Evidence Contact	Manager, Enrollment and Billing		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road Suite 200		Glen Allen	VA	23060	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Bid Audit Contact	Director		Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Bid Audit Site Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/14/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Bid Primary Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	06/01/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	CAP Report Contact for Public Website	Director		Pickens	Veronica		2483955887					vpickens@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	CEO - CMS Administrator Contact	Plan President	Ms.	Getsie	Pamela		8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	CEO - Senior Official for Contracting	Plan President	Ms.	Getsie	Pamela		8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Chief Financial Officer	SVP, Controller	Mr.	Pisarik	Jason		2486654348					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	VT	05601	02/07/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Chief Operating Officer	Managing Director, Operations	Mr.	Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Chief Information Officer	IT Director II	Mrs.	Krause	Amy		3132256638					akrause@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Cieszynski	Brent		3132258766					bcieszynski@bcbsm.com	600 Lafayette East		Detroit	MI	48226	08/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	CMMI Model Point of Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	CMS Casework Communication Contact	Compliance Consultant		White	Jasmin		2486654235					JWhite4@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Complaints Tracking Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Contact for Fraud Investigations	Manager		Zasadny	Brian		3132255956					bzasadny@bcbsm.com	600 East Lafayette		Detroit	MI	48226	12/28/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Coordination of Benefits Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	03/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Corporate Mailing						8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	200 North Grand Avenue	PO	Lansing	MI	48901	12/28/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Customer Service Operations Contact	Director, Workforce Management, Analytics, & Supp		Weber	Julie		3132250555					jweber@bcbsm.com	600 East Lafayette		Detroit	MI	48226	11/15/2021	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	DIR Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	DIR Contact (Secondary)	Manager, Pharmacy Operations		Jones	Marini		3135706777					Marini.Jones@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Electronic Health Record Contact	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Emergency Part D Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Emergency Part D Contact (Secondary)	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Employer Waiver Contact	Manager		Nelson	Jessica		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Encounter Data & Risk Adjustment Operations Contact	Director,RASubs &ElectronicSupp Data		Jensen	Robert		2486654115					robert.jenson@advantasure.com	1000 Town Center		Southfield	MI	48075	02/05/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Enrollment Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	06/01/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	EOB Transfer Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880				9528375607	Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/08/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Financial Audit Contact	Director	Mr.	Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Financial Reporting Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Formulary Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Formulary Contact (Secondary)	Manager		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center		Southfield	MI	48075	06/01/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	General Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Government Relations Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	HIPAA Privacy Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	HIPAA Security Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Hospice Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/08/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Interoperability Contact	Manager, Functional Operations		Kingsley	Chris		2484444160					Christopher.kingsley@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	MA Appeals/Grievances Contact	Chief Operating Officer		Hower	Johanna		8048594034					Johanna.Hower@advantasure.com	4121 Cox Rd Suite 200		Glen Allen	VA	23060	08/11/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	MA Claims Processing Contact for Public Website	Manager, Claims and Recovery Operations		Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	03/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Marketing Contact	Plan President	Ms.	Getsie	Pamela		8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Medical Director	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Medicare Compliance Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/03/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Medicare Coordinator	Managing Director, Medicare Advantage Compliance		Pickens	Veronica		2483955887					vpickens@bcbsm.com	1000 Town Center		Southfield	MI	48075	11/15/2021	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Medicare Part D Opioid Overutilization Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/02/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Medication Therapy Management Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/02/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	OffShore Subcontractor Contact	Manager	Mrs.	Stretch	Kaitlin		2486654275					kstretch@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Online Enrollment Center Contact (Back-up)	Enrollment Business Lead		Schulz	Bryan		5084390769					Bryan.Schulz@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Online Enrollment Center Contact (Optional)	Manager		Woods	Cheyenne		2484173449					cheyenne.woods@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Online Enrollment Center Contact (Primary)	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Part C Application Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Part C Reporting Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Appeals	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8552075871				HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Appeals Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8003443405	733326			HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Application Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Benefits Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Claims Submission Contact	Manager, Business Process		Diaz	Mario		7143172628					OptumRx-SupportServices@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Exceptions Contact	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8552075871				HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Exceptions Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	9544985880				HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Price File Contact (Back-up)	Vice President		Siuta	Lori		2242312298					lori.siuta@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Price File Contact (Optional)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Price File Contact (Primary)	Sr. Business Analyst, Medicare Operations		Vargas	Danielle		4437101262					danielle.wooten@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Quality Assurance Contact	Managing Director, Operations		Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Part D Reporting Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Patient Safety Contact	Managing Director, Operations		Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Payment Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Personal Health Record Contact	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Pharmacy Director	Managing Director, Operations		Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Pharmacy Network Management Contact	Sr. Account Manager, Network Account Management		Brown	Casey		6126427367					casey.brown@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Pharmacy Network Management Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Pharmacy Technical Help Desk Contact	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8552075871				HMO - Health Maintenance Organization		C	Chicago
H9489	Pharmacy Technical Help Desk Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Chicago
H9489	Physician Incentive Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Plan Directory Contact for Public Website	Work Track Project Manager		Nelson	Jessica		8448395122					Jessica.Nelson@emergient.com	P.O. Box 186		Montpelier	VT	05601	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Plan to Plan Reconciliation Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/06/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Processor Contact	Manager, Claims and Recovery Operations		Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	03/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Quality Contact	Corporate Medical Director		Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Reconciliation Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Reconciliation Contact (Secondary)	Manager, Pharmacy Operations		Jones	Marini		3135706777					Marini.Jones@emergient.com	1000 Town Center		Southfield	MI	48075	03/01/2023	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Recovery Audit Contact	Manager, Performance and Oversight	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Surveillance Contact	Director, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	07/06/2021	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	System Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Third Party Administrator (TPA) Liaison	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	200 North Grand Avenue	PO Box 40790	Lansing	MI	48901	12/28/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	User Access Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/16/2020	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Utilization Management Contact	Managing Director, Medical Management	Dr.	Park	Gerald		2485047408					Gerald.Park@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	03/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9489	Utilization Review Contact	Managing Director, Medical Management	Dr.	Park	Gerald		2485047408					Gerald.Park@advantasure.com	4121 Cox Rd. Suite 200		Glen Allen	VA	23060	03/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	Local CCP	Vermont Blue Advantage	HMO/HMOPOS		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/28/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/10/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/21/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/21/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8144498744				HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5133167654				HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	5407984087				HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	8333774266				HMO - Health Maintenance Organization		C	Chicago
H9525	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active	3135973173				HMO - Health Maintenance Organization		C	Chicago
H9525	PHR Beneficiary Contact																	11/05/2015	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				HMO - Health Maintenance Organization		C	Chicago
H9525	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9525	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	COMPCARE HEALTH SERVICES INSURANCE CORPORATION	Local CCP	Anthem Blue Cross and Blue Shield	HMO/HMOPOS		Elevance Health, Inc.	1	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9564	Automated TrOOP Balance Transfer Contact	Pace, Director of finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Backup User Access Contact	Pace, Director of finance & Compliance	Mr.	Jean	Estenieau		6172859373					Estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		Wahsington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Best Available Evidence Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					Estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		Wahsington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Bid Primary Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					Estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		Wahsington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	CAP Report Contact for Public Website	Executive Director	Mrs	White	Sally		5716620555					sally.white@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	09/01/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	CEO - CMS Administrator Contact	Executive Director	Mrs	White	Sally		7033073236					sally.white@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	CEO - Senior Official for Contracting	Senior Vice President	Mr	McKaig	Brian		2399409561					brian.mckaig@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Chief Financial Officer	Pace, Director of Finance & Compliance	Mr	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend center		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Chief Operating Officer	Executive Director	Mrs.	White	Sally		7033073236					sally.white@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Chief Information Officer	Senior Vice President	Mr	Mckaig	Brian		2399409561					brian.mckaig@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Chief Information Security Officer	Pace, Director of Finance & Compliance	Mr	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Town center Drive SE		Washington	DC	20020	03/20/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	CMS Casework Communication Contact	Pace, Finance Director & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	03/20/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Complaints Tracking Contact	Pace, Finance Director & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@denbridgehealth.org	2211 Town center drive SE		Washington	DC	20020	03/20/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Contact for Fraud Investigations	Pace, Finance Director & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		washington	DC	20020	03/20/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Coordination of Benefits Contact	Pace Finance Director& Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Town center drive SE		Washington	DC	20020	03/20/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Corporate Mailing						7205304082					Tom@edenbridgehealth.org	50 Milk St	18th floor	Boston	MA	02110	03/21/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Coverage Gap Discount Program (CGDP) Payment Contact	Pace, Finance Director & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Town center Drive SE		Washington	DC	20020	03/20/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Customer Service Operations Contact	Executive Director	Mrs	White	Sally		7033073236					sally.white@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	DIR Contact	Pace, Finance Director & Compliance	Mr.	Jean	Estenieau		6172859373					Estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		Wahsington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	DIR Contact (Secondary)	Pace, Finance Director & Compliance	Mr.	Jean	Estenieau		6172859373					Estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		Wahsington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Emergency Part D Contact	Pace, Finance Director & Compliance	Mr.	Jean	Estenieau		6172859373					Estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		Wahsington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Emergency Part D Contact (Secondary)	Pace, Finance Director & Compliance	Mr.	Jean	Estenieau		6172859373					Estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		Wahsington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Encounter Data & Risk Adjustment Operations Contact	Pace, Finance Director & Compliance	Mr.	Jean	Estenieau		6172859373					Estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		Wahsington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Enrollment Contact	PACE, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	11/18/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	EOB Transfer Contact	PACE, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373				0000000000	estenieau.jean@edenbridgehealth.org	2211Townsend Center Drive SE		Washington	DC	20020	11/18/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Financial Audit Contact	PACE, Director of Finance & Compliance	Mr	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center Drive SE		Washington	DC	20020	11/18/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Financial Reporting Contact	PACE, Director Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center drive SE		Washington	DC	20020	11/18/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Formulary Contact	PACE, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend center Drive SE		Washington	DC	20020	11/18/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	General Contact	Executive Director	Mrs	White	Sally		7033073236					sally.white@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Government Relations Contact	Senior Vice President	Mr	McKaig	Brian		2399409561					brian.mckaig@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	HIPAA Privacy Officer	PACE, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center Drive SE		Washington	DC	20020	11/18/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	HIPAA Security Officer			Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center Drive SE		Washington	DC	20020	12/07/2021	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Interoperability Contact	Executive Director	Mrs	White	Sally		7033073236					sally.white@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	MA Appeals/Grievances Contact	Executive Director	Mrs	White	Sally		7033073236					sally.white@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	MA Claims Processing Contact for Public Website	PACE, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend center Drive SE		Washington	DC	20020	11/18/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Marketing Contact	Senior Vice President	Mr	McKaig	Brian		2399409561					brian.mckaig@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Medical Director	Medical Director		Bruce	Stephanie		5716220555					stephanie.bruce@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	05/30/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Medicare Compliance Officer	Director of Quality & Compliance	Mrs	Weeks	Willa		5716220555					willa.weeks@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	05/17/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Medicare Coordinator	PACE, Director of finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211  Townsend Center Drive SE		Washington	DC	20020	11/18/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Medicare Part D Opioid Overutilization Contact	PACE, Director Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend center Drive SE		Washington	DC	20020	11/18/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Medication Therapy Management Contact	PACE,  Director of Finance  & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center drive SE		Washington	DC	20020	11/18/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Part C Application Contact	Senior Vice President	Mr.	McKaig	Brian		2399409561					brian.mckaig@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Part D Appeals	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau							estenieau.jean@edenbridgehealth.org	2211 Townsend center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active	0000000000				PACE - Nat		C	Philadelphia
H9564	Part D Application Contact	Executive Director	Mrs	White	Sally		7033073236					sally.white@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Part D Benefits Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 townsend center SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Part D Claims Submission Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center Drive SE		Whashington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Part D Exceptions Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau							estenieau.jean@edenbridgehealth.org	2211 Townsend center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active	0000000000				PACE - Nat		C	Philadelphia
H9564	Part D Exceptions Contact (Secondary)	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau							estenieau.jean@edenbridgehealth.org	2211 Townsend center drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active	0000000000				PACE - Nat		C	Philadelphia
H9564	Part D Price File Contact (Back-up)	Pace, Director of Finance & compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend center drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Part D Price File Contact (Optional)	Pace, Finance Director & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center drive SE		Wasington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Part D Price File Contact (Primary)	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Part D Quality Assurance Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Part D Reporting Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend center drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Patient Safety Contact	Pace, Director of finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend center drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Payment Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Personal Health Record Contact	Executive Director	Mrs	White	Sally		7033073236					sally.white@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Pharmacy Director	Pace, Director of Finance & Compliance	Mr.	jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 townsend center drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Pharmacy Network Management Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Pharmacy Technical Help Desk Contact		Mr.	Jean	Estenieau								2211 Townsend Center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active	0000000000				PACE - Nat		C	Philadelphia
H9564	Plan Directory Contact for Public Website	Executive Director	Mrs	White	Sally		7033073236					sally.white@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Plan to Plan Reconciliation Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Processor Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center Drive		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Quality Contact	PACE Director of Compliance and Finance	Mr	Jean	Estenieau		5716220555					estenieau. jean@edenbridgehealth.org	2211 Town Center Drive SE		Washington	DC	20020	12/05/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Reconciliation Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center Drive SE		Wasington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Reconciliation Contact (Secondary)			Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 townsend Center Drive SE		Washington	DC	20020	12/07/2021	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Recovery Audit Contact	Director of Finance 7 Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211  Townsend Center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Surveillance Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	System Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Third Party Administrator (TPA) Liaison	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 townsend center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	User Access Contact	Pace, Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center Drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Utilization Management Contact	Executive Director	Mrs	White	Sally		7033073236					sally.white@edenbridgehealth.org	2211 Townsend Center Driv SE		Washington	DC	20020	06/27/2023	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9564	Utilization Review Contact	Director of Finance & Compliance	Mr.	Jean	Estenieau		6172859373					estenieau.jean@edenbridgehealth.org	2211 Townsend Center drive SE		Washington	DC	20020	08/04/2022	2023	PACE4DC LLC	National PACE	PACE4DC LLC	National PACE		Element Care INC.	801	Yes	Active					PACE - Nat		C	Philadelphia
H9572	Agent/Broker Compensation Data Contact	Manager	Mr.	Delaney	Brandon		3134482712					bdelaney@bcbsm.com	600 East Lafayette Blvd.	MC 520J	Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Automated TrOOP Balance Transfer Contact	Manager	Mr.	Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Backup User Access Contact	Manager	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/18/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Best Available Evidence Contact	Business Systems Analyst Sr		Hall	Barbara		3132256662					BHall@bcbsm.com	600 East Lafayette Blvd.	MC 1602	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Bid Audit Contact	Director		Weicker	Brian		3132259571					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Bid Audit Site Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/14/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Bid Primary Contact	Director	Ms.	Munoz	Karen		2486654020					kmunoz@bcbsm.com	600 East Lafayette Blvd.	TC 1516	Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	CAP Report Contact for Public Website	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	09/27/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	CEO - CMS Administrator Contact	President and CEO	Mr.	Loepp	Daniel	J	3132256822					BlueCrossBlueShieldofMichiganCEO@bcbsm.com	600 East Lafayette Blvd.	MC 2001	Detroit	MI	48226	01/05/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	CEO - Senior Official for Contracting	President and CEO	Mr.	Loepp	Daniel	J	3132256822					BlueCrossBlueShieldofMichiganCEO@bcbsm.com	600 East Lafayette Blvd.	MC 2001	Detroit	MI	48226	12/05/2016	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Chief Financial Officer	Executive Vice President CFO	Mr.	Mozak	Paul	L	3132257939					PMozak@bcbsm.com	600 East Lafayette Blvd.	MC 2104	Detroit	MI	48226	03/07/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Chief Operating Officer	Executive Vice President COO & President Emerg Mkt	Ms.	Keith	Tricia		3132250452					TKeith@bcbsm.com	600 East Lafayette Blvd.	MC 2000	Detroit	MI	48226	02/09/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Chief Information Officer	Senior Vice President	Mr.	Fandrich	William		3132255800					Wfandrich@bcbsm.com	600 East Lafayette Blvd.	MC 2010	Detroit	MI	48226	11/15/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Chief Information Security Officer	Senior Vice President	Mr.	Fandrich	William		3132255800					Wfandrich@bcbsm.com	600 East Lafayette Blvd.	MC 2010	Detroit	MI	48226	11/15/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	CMS Casework Communication Contact	Senior Analyst		Whitener	David		3136546885					DWhitener@bcbsm.com	1000 Town Center, Mail Code: TC1301		Southfield	MI	48075	09/19/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Complaints Tracking Contact	Senior Analyst		Whitener	David		3136546885					DWhitener@bcbsm.com	1000 Town Center, Mail Code: TC1301		Southfield	MI	48075	09/19/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Contact for Fraud Investigations	Manager, Fraud Investigation	Mr.	Zasadny	Brian		3132255956					BZasadny@bcbsm.com	600 East Lafayette Blvd.	MC 1825	Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Coordination of Benefits Contact	Manager	Ms.	Lang	Michelle		2486654529					mlang@bcbsm.com	600 East Lafayette Blvd.	MC 1515	Detroit	MI	48226	11/16/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Corporate Mailing						2483955887					vpickens@bcbsm.com	600 East Lafayette Blvd.	MC TC1301	Detroit	MI	48226	03/14/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Coordinator		Jovanovska	Natasa		2486654558					njovanovska@bcbsm.com	600 East Lafayette Blvd.	TC 1500	Detroit	MI	48226	03/22/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Customer Service Operations Contact	Director	Ms.	Judson	Johanna		3132255856					jjudson@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	DIR Contact	Manager	Mr.	Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	MC 1309	Detroit	MI	48226	03/07/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	DIR Contact (Secondary)	Senior Healthcare Analyst	Ms.	Desaraju	Vidhya		2486654514					vdesaraju@bcbsm.com	600 East Lafayette Blvd.	MC 1309	Detroit	MI	48226	11/18/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Emergency Part D Contact	Manager	Mr.	Nalamolu	Chandra		3132256810					hnalamolu@bcbsm.com	600 East Lafayette Blvd		Detroit	MI	48226	01/04/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Emergency Part D Contact (Secondary)	Director	Mrs.	Underhill	Molly		6163753398					MUnderhill@bcbsm.com	600 East Lafayette Blvd.	TC 1300	Detroit	MI	48226	12/28/2020	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Encounter Data & Risk Adjustment Operations Contact	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	09/13/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Enrollment Contact	Manager, MA Enrollment Oversight and Defect Manage		Carlisle-Brant	Terrie		3132256881					TBrant@bcbsm.com	600 East Lafayette Blvd.	MC 1602	Detroit	MI	48226	08/22/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	EOB Transfer Contact	Manager	Mrs.	Rawson	Lori		6169565796				8773459942	lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	12/27/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Financial Audit Contact	Director	Mr.	Weicker	Brian		3132259571					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Financial Reporting Contact	Director	Mr.	Nehls	Paul		2486654471					pnehls@bcbsm.com	1000 Town Center		Southfield	MI	48075	12/28/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Formulary Contact	Manager	Ms.	Facchini	Victoria		2486654657					VFacchini@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	03/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Formulary Contact (Secondary)	Supervisor	Ms.	Lota	Amardeep		2486654537					Alota@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	03/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	General Contact	Compliance Consultant	Ms.	White	Jasmin		2486654235					jwhite4@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/15/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Government Relations Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/14/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	HIPAA Privacy Officer	VP, Enterprise Compliance and Privacy Official	Ms.	Lange	Kelly		3132258554					KLange@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	12/27/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	HIPAA Security Officer	VP, Enterprise Compliance and Privacy Official	Ms.	Lange	Kelly		3132258554					KLange@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	12/27/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Hospice Contact	Manager	Mrs.	Rawson	Lori		6169565796					Lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Interoperability Contact	Director	Mr.	Kett	James		3132250224					jkett@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	02/11/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	MA Appeals/Grievances Contact	Manager	Mr.	McCarty	Kevin		2483507488				8773482251	scatlin@bcbsm.com	P.O. Box 2627		Detroit	MI	48231	02/03/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	MA Claims Processing Contact for Public Website	Manager	Ms.	Findley	Teri		3139830672					Tfindley@bcbsm.com	600 East Lafayette Blvd.	MC 1602	Detroit	MI	48226	11/16/2020	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Marketing Contact	Director		Parrish	Loralie		5173254050					lparrish1@bcbsm.com	600 East Lafayette Blvd.	MC 1401	Detroit	MI	48226	09/19/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Medical Director	Vice President	Dr.	Jois, MD	Preeti		3132256585					pjois@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	12/01/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Medicare Compliance Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/03/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Medicare Coordinator	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	09/13/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Medicare Part D Opioid Overutilization Contact	Pharmacist		Mott	Krystyna		8002874163				8778958667	MedicarePartDOverutilizationMonitoring@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	12/27/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Medication Therapy Management Contact	Manager	Ms.	Moon	Kim		3132695657					kmoon@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	09/19/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	OffShore Subcontractor Contact	Manager	Mrs.	Stretch	Kaitlin		2486654275					kstretch@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Online Enrollment Center Contact (Back-up)	Manager, MA Enrollment Oversight and Defect Manage		Carlisle-Brant	Terrie		3132256881					TBrant@bcbsm.com	600 East Lafayette Blvd.	MC 1602	Detroit	MI	48226	08/22/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Online Enrollment Center Contact (Primary)	Business Systems Analyst Sr		Hall	Barbara		3132256662					BHall@bcbsm.com	600 East Lafayette Blvd.	MC 1602	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Part C Application Contact	Manager	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/18/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Part C Reporting Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	12/28/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Part D Appeals	Manager	Mr.	Petkoff	Ryan						8666014428	dramspriorauthmedicareD@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	01/07/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8004373803				PPO - BBA		C	Chicago
H9572	Part D Appeals Contact (Secondary)	Supervisor	Ms.	Agnew	Amber						8666014428	Aagnew@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	01/07/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8004373803				PPO - BBA		C	Chicago
H9572	Part D Application Contact	Manager	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/18/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Part D Benefits Contact	Manager	Mrs.	Rawson	Lori		6169565796					lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	11/18/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Part D Claims Submission Contact	Manager		Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Part D Exceptions Contact	Manager	Mr.	Petkoff	Ryan						8004598027	dramspriorauthmedicareD@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/16/2020	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8004373803				PPO - BBA		C	Chicago
H9572	Part D Exceptions Contact (Secondary)	Supervisor	Ms.	Agnew	Amber						8666014428	dramspriorauthmedicare@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/15/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8004373803				PPO - BBA		C	Chicago
H9572	Part D Price File Contact (Back-up)	Senior Health Care Analyst		Khinchuk	Emily		2486654545					ekhinchuk@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Part D Price File Contact (Optional)		Mr.	Westrum	Josh		4807363132					Medicarewebsitefiles@express-scripts.com	7909 S. Hardy Drive #106		Tempe	AZ	85284	11/22/2016	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Part D Price File Contact (Primary)	Manager	Mr.	Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Part D Quality Assurance Contact	Director	Ms.	Underhill	Molly		2483955505					munderhill@bcbm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/16/2020	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Part D Reporting Contact	Manager	Mr.	Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Patient Safety Contact	Director		Connelly	Theresa		2483955529					Tconnelly@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	09/19/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Payment Contact	Director	Mr.	Nehls	Paul		2486654471					pnehls@bcbsm.com	1000 Town Center		Southfield	MI	48075	12/28/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Pharmacy Director	Director	Ms.	Underhill	Molly		6163753398					munderhill@bcbm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/18/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Pharmacy Network Management Contact	Director	Mr.	Perry	Glen	A	3134485949					gperry1@bcbsm.com	600 East Lafayette Blvd.	512H	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Pharmacy Network Management Contact (Secondary)	Manager	Mrs.	Rawson	Lori		6169565796					Lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Pharmacy Technical Help Desk Contact	Mgr	Mr.	Nalamolu	Chandra							hnalamolu@bcbsm.com	600 East Lafayette Blvd	MC 1309	Detroit	MI	48226	12/30/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8009221557				PPO - BBA		C	Chicago
H9572	Pharmacy Technical Help Desk Contact (Secondary)	Manager	Ms.	Rawson	Lori							lrawson@bcbsm.com	600 East Lafayette Blvd	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8009221557				PPO - BBA		C	Chicago
H9572	Plan Directory Contact for Public Website	Director	Ms.	Judson	Johanna		8663091719					jjudson@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Plan to Plan Reconciliation Contact	Financial Coordinator		Jovanovska	Natasa		2486654558					njovanovska@bcbsm.com	600 East Lafayette Blvd.	Attn: P2P Mail Code 0807 -  S English	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Processor Contact	Manager		Rawson	Lori		6169565796					LRawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Quality Contact	Manager, PPO Quality	Ms.	Sypien	Diane		2486654205				8773797314	dsypien@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Reconciliation Contact	Manager	Ms.	Cullen	Lynne		2486654562					lcullen@bcbsm.com	600 East Lafayette Blvd.	TC 1414	Detroit	MI	48226	03/02/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Reconciliation Contact (Secondary)	Financial Coordinator		Jovanovska	Natasa		2486654558					njovanovska@bcbsm.com	600 East Lafayette Blvd.	TC 1414	Detroit	MI	48226	03/02/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Recovery Audit Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/14/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	SNP Application Contact	Manager	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/18/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Surveillance Contact	Director		Crawford	Constance		2486654231					ccrawford@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	System Contact	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	09/13/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Third Party Administrator (TPA) Liaison	Financial Coordinator		Jovanovska	Natasa		2486654558					njovanovska@bcbsm.com	600 East Lafayette Blvd.	TC 1500	Detroit	MI	48226	03/22/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	User Access Contact	Analyst	Mr.	Teklinski	Greg		2486654284					gteklinski@bcbsm.com	600 East Lafayette Blvd.	MC S140	Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Utilization Management Contact	Manager		Sypien	Diane		2486654205					dsypien@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9572	Utilization Review Contact	Manager		Sypien	Diane		2486654205					dsypien@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	Local CCP	Blue Cross Blue Shield of Michigan	Local PPO		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					PPO - BBA		C	Chicago
H9576	Agent/Broker Compensation Data Contact	Director of Marketing, Sales and Outreach	Ms.	Carcieri	Lisa		4014596008					lcarcieri@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	11/16/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Automated TrOOP Balance Transfer Contact	Chief Financial Officer	Ms.	Sears	Michelle		4014278164					msears@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	05/11/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Backup User Access Contact	Product Manager MMP	Ms.	Duchesne	Lisa		4014596668					lduchesne@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	09/23/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Best Available Evidence Contact	Supervisor of Enrollment	Ms.	Garabo	Maria		4014596636					mgarabo@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Bid Audit Contact	Vice President MMP	Mr.	Cooper	Mark		4018893145					mcooper@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	09/23/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Bid Audit Site Contact	Vice President MMP	Mr.	Cooper	Mark		4018893145					mcooper@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	09/23/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Bid Primary Contact	Vice President MMP	Mr.	Cooper	Mark		4018893145					mcooper@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	09/23/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	CAP Report Contact for Public Website	Compliance and Privacy Officer	Mr.	Gitlitz	Gregory		4014596162					ggitlitz@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	11/16/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Marino	Peter		4014596141					PMARINO@NHPRI.ORG	910 Douglas Pike		Smithfield	RI	02917	01/03/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Marino	Peter		4014596141					PMARINO@NHPRI.ORG	910 Douglas Pike		Smithfield	RI	02917	03/16/2016	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Chief Financial Officer	Chief Financial Officer	Ms.	Sears	Michelle		4014278164					msears@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	05/11/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Chief Operating Officer	Chief Operating Officer	Ms.	Carlson	Karen		4014596633					kcarlson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	12/08/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Chief Information Officer	Chief Information Officer-Vice President	Mr.	Dibiasio	Steven		4014278825					sdibiasio@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	11/16/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Chief Information Security Officer	Enterprise Risk and Information Security Officer	Mr.	Francis Jr	Robert		4014435989					rfrancis@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	CMS Casework Communication Contact	Sr. Manager of Quality Improvement and Accred	Ms.	Elias	Cesarina		4014596087					celias@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Complaints Tracking Contact	Sr. Manager of Quality Improvement and Accred	Ms.	Elias	Cesarina		4014596087					celias@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Contact for Fraud Investigations	Compliance and Privacy Officer	Mr.	Gitlitz	Gregory		4014596162					ggitlitz@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	11/16/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Coordination of Benefits Contact	Chief Operating Officer	Ms.	Carlson	Karen		4014596633					kcarlson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	12/08/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Corporate Mailing						4018893145	0				mcooper@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	09/23/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Coverage Gap Discount Program (CGDP) Payment Contact	Manager of Financial Analysis	Mr.	Milton	Bryan		4014276726					bmilton@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Customer Service Operations Contact	Manager, Member Services	Mr.	Barnett	Ronald		4014596110					rbarnett@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	06/13/2019	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	DIR Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	DIR Contact (Secondary)	Director of Financial Reporting	Ms.	Miha	Mihaela		4014435931					mmiha@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Emergency Part D Contact	Interim Chief Medical Officer	Mr.	Ottiano	Chris		4014596168					cottiano@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	05/25/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Emergency Part D Contact (Secondary)	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Encounter Data & Risk Adjustment Operations Contact	Director of Risk Adjustment		Adu-Gyamfi	Opoku		4018894491					oadu-gyamfi@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	11/16/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Enrollment Contact	Supervisor of Enrollment	Ms.	Garabo	Maria		4014596636					mgarabo@nhpri.org	910 Douglas Pike		SMITHFIELD	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	EOB Transfer Contact	Chief Operating Officer	Ms.	Carlson	Karen		4014596633				4014596021	kcarlson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	12/08/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Financial Audit Contact	Chief Financial Officer	Ms.	Sears	Michelle		4014279164					msears@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	05/11/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Financial Reporting Contact	Chief Financial Officer	Ms.	Sears	Michelle		4014279164					msears@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	05/11/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Formulary Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Formulary Contact (Secondary)	Regulatory and Policy Pharmacist	Mr.	Broccoli	David		4014276785					dbroccoli@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	General Contact	Compliance and Privacy Officer	Mr.	Gitlitz	Gregory		4014596162					ggitlitz@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	01/09/2023	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Government Relations Contact	Chief Growth Officer	Mr.	Burnett	David		4014596161					dburnett@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	06/13/2019	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	HIPAA Privacy Officer	Compliance and Privacy Officer	Mr.	Gitlitz	Gregory		4014596162					ggitlitz@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	11/16/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	HIPAA Security Officer	Compliance and Privacy Officer	Mr.	Gitlitz	Gregory		4014596162					ggitlitz@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	11/16/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Hospice Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Interoperability Contact	Chief Information Officer-Vice President	Mr.	Dibiasio	Steven		4014278825					sdibiasio@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	11/16/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	MA Appeals/Grievances Contact	Sr. Manager of Quality Improvement and Accred	Ms.	Elias	Cesarina		4014596087					celias@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	MA Claims Processing Contact for Public Website	Chief Operating Officer	Ms.	Carlson	Karen		4014596633					kcarlson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	12/08/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Marketing Contact	Director of Marketing, Sales and Outreach	Ms.	Carcieri	Lisa		4014596008					lcarceri@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/18/2019	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Medical Director	Interim Chief Medical Officer	Dr.	Ottiano	Chris		4014596168					cottiano@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Medicare Compliance Officer	Compliance and Privacy Officer	Mr.	Gitlitz	Gregory		4014596162					ggitlitz@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	11/16/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Medicare Coordinator	Vice President MMP	Mr.	Cooper	Mark		4018893145					mcooper@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	09/23/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Medicare Part D Opioid Overutilization Contact	Director of Regulatory Pharmacy and Operations	Ms.	Kelly	Dalissa		4014278208					dkelly@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Medication Therapy Management Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	MMP Reporting Requirements Contact	Product Manager MMP	Ms.	Duchesne	Lisa		4014596668					lduchesne@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	09/23/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	MMP Point of Contact	Vice President Medicare Medicaid Integration	Mr.	Cooper	Mark		4014278875					mcooper@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	07/30/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part C Application Contact	Chief Growth Officer	Mr.	Burnett	David		4014596161					dburnett@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	01/06/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part C Reporting Contact	Product Manager MMP	Ms.	Duchesne	Lisa		4014596668					lduchesne@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	09/23/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Appeals		Ms.	Beyda	Trista						7326914838	REReconsideration@cvscaremark.com	620 Epsilon Drive		Pittsburgh	PA	15238	01/07/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active	4129672300	71910			Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Appeals Contact (Secondary)		Ms.	Gabor-Lyon	Pam						7326914838	Trista.Beyda@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	01/08/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active	4129672300	71910			Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Application Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Benefits Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Claims Submission Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Exceptions Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark							mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active	4014596640				Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Exceptions Contact (Secondary)	Director of Regulatory Pharmacy and Operations	Ms.	Kelly	Dalissa							dkelly@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active	4014278208				Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Price File Contact (Back-up)			Schilcher	Sydney		4806064873					sschilcher@cvshealth.com	CVS Caremark	9501 E Shea Blvd	Scottsdale	AZ	85260	12/14/2018	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Price File Contact (Optional)			Loveland	Chet		4806064865					Chet.Loveland@CVSHealth.com	CVS Caremark	9501 E Shea Blvd	Scottsdale	AZ	85260	03/31/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Price File Contact (Primary)			Loveland	Chet		4806064865					chet.loveland@cvshealth.com	CVS Caremark	9501 E Shea Blvd	Scottsdale	AZ	85260	03/11/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Quality Assurance Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Part D Reporting Contact	Product Manager MMP	Ms.	Duchesne	Lisa		4014596668					lduchesne@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	09/23/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Patient Safety Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Payment Contact	Chief Financial Officer	Ms.	Sears	Michelle		4014278164					msears@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	05/11/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Pharmacy Director	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Pharmacy Network Management Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Pharmacy Network Management Contact (Secondary)	Regulatory and Policy Pharmacist	Mr.	Broccoli	David		4014276785					dbroccoli@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Pharmacy Technical Help Desk Contact			Leeper	Shonda								CVS Caremark Pharmacy Help Desk	445 Great Circle Blvd.	Nashville	TN	37228	12/13/2018	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active	8666934620				Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Pharmacy Technical Help Desk Contact (Secondary)	Interim Vice President of Pharmacy	Mr.	Lorson	Mark							mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active	4014596640				Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Plan Directory Contact for Public Website	Director of Marketing, Sales and Outreach	Ms.	Carcieri	Lisa		4014596008					lcarceri@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/18/2019	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Plan to Plan Reconciliation Contact	Manager of Financial Analysis	Mr.	Milton	Bryan		4014276726					bmilton@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Processor Contact	Chief Operating Officer	Ms.	Carlson	Karen		4014596633					kcarlson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	12/08/2021	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Quality Contact	Director of Quality Improvement	Mr.	Buechner	Jay		4014596196					jbuechner@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Reconciliation Contact	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Reconciliation Contact (Secondary)	Manager of Financial Analysis	Mr.	Milton	Bryan		4014276726					bmilton@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Recovery Audit Contact	Compliance and Privacy Officer	Mr.	Gitlitz	Gregory		4014596162					ggitlitz@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	11/16/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Surveillance Contact	Vice President MMP	Mr.	Cooper	Mark		4018893145					mcooper@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	09/23/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	System Contact	System Administrator	Mrs.	Phouthavong	Maria		4014596119					mphouthavong@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	03/17/2020	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Third Party Administrator (TPA) Liaison	Interim Vice President of Pharmacy	Mr.	Lorson	Mark		4014596640					mlorson@nhpri.org	910 Douglas Pike		SMITHFIELD	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	User Access Contact	Compliance and Privacy Officer	Mr.	Gitlitz	Gregory		4014596162					ggitlitz@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	11/16/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Utilization Management Contact	Director, Utilization Management	Ms.	Dobitsch	Sue Ann		4014278183					sdobitsch@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9576	Utilization Review Contact	Director, Utilization Management	Ms.	Dobitsch	Sue Ann		4014278183					sdobitsch@nhpri.org	910 Douglas Pike		Smithfield	RI	02917	10/27/2022	2023	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Demo	NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	Medicare-Medicaid Plan HMO/HMOPOS		NEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND	530	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Boston
H9585	Agent/Broker Compensation Data Contact	Director, Sales Operations and Oversight		Hunt	Bae		2163751430					Bae.Hunt@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Automated TrOOP Balance Transfer Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					ashley.smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Backup User Access Contact	Medicare Compliance Manager		Johnson	Teressa		7733974408					teressa.johnson@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Best Available Evidence Contact	Sr Enrollment & Reconciliation Analyst		Cason	Joseph		6177486356					joseph.cason@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Bid Audit Contact	Director of Product Administration		Anderson	Renae		6177486267					Renae.Anderson@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Bid Audit Site Contact	Director of Product Administration		Anderson	Renae		6177486267					Renae.Anderson@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Bid Primary Contact	Director of Product Administration		Anderson	Renae		6177486267					Renae.Anderson@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	CAP Report Contact for Public Website	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	CEO - CMS Administrator Contact	President	Ms.	Thiltgen	Heather		6177486060					Heather.Thiltgen@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	CEO - Senior Official for Contracting	President	Ms.	Thiltgen	Heather		6177486060					Heather.Thiltgen@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Chief Financial Officer	Chief Financial Officer	Mr.	Collins	James		6177486384					James.Collins@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Chief Operating Officer	Chief Operating Officer	Ms.	Cruz	Diana		4235030063					Diana.Cruz@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Chief Information Officer	Acting WellSense Chief Information Officer	Mr	Harvey	Arthur		6176388505					arthur.harvey@bmc.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Chief Information Security Officer	Sr. Director - Chief Information Security Officer	Mr	Cullivan	Lee		6179010454					lee.cullivan@bmc.org	529 Main Street	Suite 500	Charlestown	MA	02129	02/15/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	CMS Casework Communication Contact	Director, Appeals & Grievances		Bigbee	Jacqueline		7746446922					jacqueline.bigbee@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Complaints Tracking Contact	Director, Appeals & Grievances		Bigbee	Jacqueline		7746446922					jacqueline.bigbee@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Contact for Fraud Investigations	Senior Manager, Special Investigations Unit		Boutin	Katherine		6032633044					Katherine.Boutin@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Coordination of Benefits Contact	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Corporate Mailing						7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Customer Service Operations Contact	Ops Mgr, Member & Provider Services		Mendez	Keyssir		6177483867					Keyssir.Mendez@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	DIR Contact	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	DIR Contact (Secondary)	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Emergency Part D Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Emergency Part D Contact (Secondary)	Sr. Director of Pharmacy Services		Pham	Phuong		6174783707					phuong.pham@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Encounter Data & Risk Adjustment Operations Contact	Senior Director of Pricing and Reserving		Tuan	Blesilda		6174783790					Blesilda.Tuan@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Enrollment Contact	Sr Enrollment & Reconciliation Analyst		Cason	Joseph		6177486356					joseph.cason@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	EOB Transfer Contact	Director, Claims, Enrollment & Provider Appeals		Hinderman	Emily		6174783614				6178970884	emily.hinderman@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Financial Audit Contact	Medicare Compliance Officer	Mr.	Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Financial Reporting Contact	Vice President of Finance & Corporate Controller		Goguen	Janice		6177486215					Janice.Goguen@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Formulary Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Formulary Contact (Secondary)	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	General Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Government Relations Contact	Director of Government Affairs	Mr.	Krintzman	Josh		6177486490					Josh.Krintzman@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	HIPAA Privacy Officer	Associate General & Privacy Officer Counsel		da Costa	Luis		6177486079					Luis.DaCosta@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	HIPAA Security Officer	Information Security Officer		Tavares	Heather		6177486221					Heather.Tavares@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Hospice Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Interoperability Contact	Sr. Director, IT Solutions		Ellis	Ezren		6177486381					ezren.ellis@wellsense.org	529 Main Street, Suite 500		Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	MA Appeals/Grievances Contact	Director, Appeals & Grievances		Bigbee	Jacqueline		7746446922					jacqueline.bigbee@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	MA Claims Processing Contact for Public Website	Director, Claims, Enrollment & Provider Appeals		Hinderman	Emily		6174783614					emily.hinderman@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Marketing Contact	Director of Medicare Marketing		Chrzanowski	Kelly		2166950332					Kelly.Chrzanowski@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	09/08/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Medical Director	Medical Director	Dr.	Lawhorne	Larry		9372864561					Larry.Lawhorne@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Medicare Coordinator	Medicare Compliance Manager		Johnson	Teressa		7733974408					teressa.johnson@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Medicare Part D Opioid Overutilization Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					ashley.smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	06/26/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Medication Therapy Management Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	OffShore Subcontractor Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Part C Application Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Part C Reporting Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Part D Appeals	Director, Appeals & Grievances		Bigbee	Jacqueline							jacqueline.bigbee@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	8558338125				HMO - Health Maintenance Organization		C	Boston
H9585	Part D Appeals Contact (Secondary)	Manager, Appeals & Grievances		DiSciscio	Felicia							Felicia.DiSciscio@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	09/19/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	6174783556				HMO - Health Maintenance Organization		C	Boston
H9585	Part D Application Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Part D Benefits Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Part D Claims Submission Contact	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@bmchp-wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Part D Exceptions Contact	Director of Clinical Pharmacy		Smith	Ashley							Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	8558338125				HMO - Health Maintenance Organization		C	Boston
H9585	Part D Exceptions Contact (Secondary)	Senior Director of Pharmacy Services		Pham	Phuong							Phuong.Pham@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	8558338125				HMO - Health Maintenance Organization		C	Boston
H9585	Part D Price File Contact (Back-up)	Manager of Pharmacy Services, SCO		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Part D Price File Contact (Optional)	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/23/2021	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Part D Quality Assurance Contact	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Part D Reporting Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@bmchp-wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Patient Safety Contact	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Payment Contact	VP, Finance & Corporate Controller		Goguen	Janice		6177486215					Janice.Goguen@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Pharmacy Director	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Pharmacy Network Management Contact	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Pharmacy Network Management Contact (Secondary)	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie		7812442649					Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Pharmacy Technical Help Desk Contact	Manager Of Pharmacy Operations & Contract Manager		Boyer	Nohemie							Nohemie.Boyer@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Boston
H9585	Pharmacy Technical Help Desk Contact (Secondary)	Director of Clinical Pharmacy		Smith	Ashley							medicareD@bmchp-wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	12/20/2021	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Boston
H9585	Plan Directory Contact for Public Website	Director Provider Data Integrity		de Medeiros	Sherri-Ann		8885660008					providerinfo@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Plan to Plan Reconciliation Contact	Staff Accountant		McGinnis	Kathleen		7819752780					Kathleen.McGinnis@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Processor Contact	Director, Claims, Enrollment & Provider Appeals		Hinderman	Emily		6174783614					emily.hinderman@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Quality Contact	VP, Quality & Clinical Programs		Valdez-Shipp	Kyra		3146081622					Kyra.Shipp@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Reconciliation Contact	Director, Actuarial Services		Nadler	Benjamin		6174783858					benjamin.nadler@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	09/08/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Reconciliation Contact (Secondary)	Chief Actuary		Li	Bo		7817889988					Bo.Li@Wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Recovery Audit Contact	Medicare Compliance Officer	Mr.	Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	SNP Application Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	SNP State Contact	Medicare Compliance Officer	Mr.	Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Surveillance Contact	Medicare Compliance Officer		Comerford	Michael		7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	System Contact	Director of IT Solutions		Ellis	Ezren		6177486381					ezren.ellis@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Third Party Administrator (TPA) Liaison	Director of Clinical Pharmacy		Smith	Ashley		6174783738					Ashley.Smith@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	User Access Contact	Medicare Compliance Officer		Comerford	Michael	J	7819620405					michael.comerford@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Utilization Management Contact	Director of Utilization Management		Costello	Barbara		6174783648					Barbara.Costello@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9585	Utilization Review Contact	Director of Utilization Management		Costello	Barbara		6174783648					Barbara.Costello@wellsense.org	529 Main Street	Suite 500	Charlestown	MA	02129	05/01/2023	2023	BOSTON MEDICAL CENTER HEALTH PLAN, INC.	Local CCP	WellSense Health Plan	HMO/HMOPOS		BMC Health System, Inc.	493	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9589	Agent/Broker Compensation Data Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/07/2023	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Automated TrOOP Balance Transfer Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Backup User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Best Available Evidence Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Bid Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Bid Audit Site Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/27/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Bid Primary Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	CAP Report Contact for Public Website	Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/28/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	8773841241				PPO - BBA		C	Chicago
H9589	CEO - CMS Administrator Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	CEO - Senior Official for Contracting	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Chief Financial Officer	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Chief Operating Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Chief Information Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Chief Information Security Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	CMMI Model Point of Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	CMS Casework Communication Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Complaints Tracking Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Contact for Fraud Investigations	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Coordination of Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Corporate Mailing						8476968500					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway		Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	Thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Customer Service Operations Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	DIR Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	DIR Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Electronic Health Record Contact		Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/07/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Emergency Part D Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Emergency Part D Contact (Secondary)	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Encounter Data & Risk Adjustment Operations Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/18/2023	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Enrollment Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	EOB Transfer Contact	Claims Manager	Mr.	Salgado	Miguel		8476968578				8008861082	Miguel.Salgado@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	10/04/2021	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Financial Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Financial Reporting Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Formulary Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3308886015	Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	General Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Government Relations Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510				3124290194	arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	HIPAA Privacy Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	HIPAA Security Officer	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539				8555158166	Eric.Annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Hospice Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Interoperability Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	MA Appeals/Grievances Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	MA Claims Processing Contact for Public Website	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Marketing Contact	VP of Marketing	Ms.	Branco	Margaret		7187957495					margaret.branco@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/06/2023	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Medical Director		Dr	Butt	Tariq		3125458471					tariq.butt@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	11/09/2021	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Medicare Compliance Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Medicare Coordinator	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Medicare Part D Opioid Overutilization Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	05/26/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Medication Therapy Management Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3304058084	Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	OffShore Subcontractor Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Online Enrollment Center Contact (Primary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 302	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Part C Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Part C Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Part D Appeals			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy	Suite 450	Dublin	OH	43017	12/28/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	8003443405	733326			PPO - BBA		C	Chicago
H9589	Part D Appeals Contact (Secondary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica							Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue		Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	7542085865				PPO - BBA		C	Chicago
H9589	Part D Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Part D Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Part D Claims Submission Contact			Dovico	Rosario		2012696398					Rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Part D Exceptions Contact			Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	6143363326				PPO - BBA		C	Chicago
H9589	Part D Price File Contact (Back-up)			Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Part D Price File Contact (Optional)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Part D Price File Contact (Primary)			Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Part D Quality Assurance Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Part D Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Patient Safety Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Payment Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Pharmacy Director	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Pharmacy Network Management Contact			Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Pharmacy Network Management Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Pharmacy Technical Help Desk Contact			Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	08/04/2021	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active	8009221557				PPO - BBA		C	Chicago
H9589	Plan Directory Contact for Public Website	Vice President, Provider Operations	Ms.	Cuevas	Elizabeth		7542085880					Elizabeth.Cuevas@clearspringhealthcare.com	250 South Northwest Highway Suite 302	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Plan to Plan Reconciliation Contact	Senior Accountant	Ms.	Wrenn	Alisa		2249855588				3124290194	Alisa.Wrenn@Clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Processor Contact			Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2020	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Quality Contact	Vice President, Quality Improvement/Health Service	Ms.	Martin	Aracelys		7542085870					amartin@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Reconciliation Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Recovery Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Surveillance Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	System Contact	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539					eric.annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Third Party Administrator (TPA) Liaison	Finance Manager, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Utilization Management Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9589	Utilization Review Contact	Vice President, UM & Transition of Care	Ms.	Reyes	Lourdes		8476968573					Lourdes.reyes@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH (GA), INC.	Local CCP	Clear Spring Health	Local PPO		Group 1001	689	Yes	Active					PPO - BBA		C	Chicago
H9590	Agent/Broker Compensation Data Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Automated TrOOP Balance Transfer Contact			Rush	Jamie		5616901134					ESITroopTransfer@express-scripts.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Backup User Access Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1, Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Best Available Evidence Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N 107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Bid Audit Contact			Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Bid Audit Site Contact			Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Bid Primary Contact		Mr.	Granow	Les		5614440709					Les.Granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	CAP Report Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	CEO - CMS Administrator Contact		Dr.	Lerer	Rene		5614440780					rene.lerer@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	CEO - Senior Official for Contracting		Ms.	Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Chief Financial Officer		Mr.	Granow	Les		5614440709					les.granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Chief Operating Officer		Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Chief Information Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Chief Information Security Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	CMS Casework Communication Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Complaints Tracking Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Contact for Fraud Investigations			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Coordination of Benefits Contact		Ms.	Burdelik	Dawn		5618153729					dawn.burdelik@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Corporate Mailing						5616901134					compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Coverage Gap Discount Program (CGDP) Payment Contact		Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	Longevity Health Plan	485 Madison Avenue Suite 202	New York	NY	10022	03/09/2021	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Customer Service Operations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	DIR Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	DIR Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Electronic Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Emergency Part D Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Emergency Part D Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Encounter Data & Risk Adjustment Operations Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Enrollment Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	EOB Transfer Contact		Ms.	Socoski	Beth		5616901134				5616901134	Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Financial Audit Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Financial Reporting Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Formulary Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Formulary Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	General Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Government Relations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	HIPAA Privacy Officer		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	HIPAA Security Officer		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Hospice Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Interoperability Contact	CIO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	MA Appeals/Grievances Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	MA Claims Processing Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Marketing Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Medical Director		Mr.	Orgain	Javette		3127206656					javette.orgain@longevityhealthplan.com	Longevity Health Plan	1611 Church Street	Evanston	IL	60201	02/15/2021	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Medicare Compliance Officer		Ms.	Lacey	Jennifer		8133677169					Jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Medicare Coordinator	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Medicare Part D Opioid Overutilization Contact	Director, Clinical & Trend Solutions	Ms.	Muralidharan	Adrienne		5616901134					amuralidharan@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Medication Therapy Management Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	OffShore Subcontractor Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Part C Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Part C Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Part D Appeals	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H9590	Part D Appeals Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H9590	Part D Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Part D Benefits Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		8002040016					Rosario_dovico@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H9590	Part D Exceptions Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H9590	Part D Price File Contact (Back-up)	Product Manager Advisor	Ms.	Williams	Stephanie		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Part D Price File Contact (Optional)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Part D Price File Contact (Primary)	sr mgr, Government Programs		Dolfi	Amanda		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Part D Quality Assurance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Part D Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Patient Safety Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Payment Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Personal Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Pharmacy Director	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra	Ms.	Kelly	Heather		8002040016					hakelly@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Pharmacy Network Management Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Pharmacy Technical Help Desk Contact	Director, Customer Service	Ms.	Moore	LaTasha						8882358551	LaTasha_Monroe@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H9590	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Account Manager	Ms.	Kolesar	Bhrena							Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H9590	Physician Incentive Contact		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Plan Directory Contact for Public Website	Medicare Compliance Director	Ms.	Socoski	Beth		8883133609					Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Plan to Plan Reconciliation Contact		Ms.	Zhai	Vicky		5616328915					Vicky.Zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Processor Contact		Ms.	Gibson	Sharon		6143766614					SGGibson@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Quality Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Reconciliation Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Reconciliation Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Recovery Audit Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	SNP Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	SNP State Contact		Ms.	Lacey	Jennifer		5614440706					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Surveillance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	System Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Third Party Administrator (TPA) Liaison	COO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	User Access Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Utilization Management Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9590	Utilization Review Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF ILLINOIS, INC.	Local CCP	Longevity Health	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9592	Automated TrOOP Balance Transfer Contact			Lyfoung	Tsuleng		6128072260					tlyfoung@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Backup User Access Contact	CEO		Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Best Available Evidence Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Sreet		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Bid Primary Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	CAP Report Contact for Public Website			Meronk	Cheryl		5594006420					cmeronk@innovativeih.com	2042 Kern St.		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	CEO - CMS Administrator Contact		Mr.	Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	CEO - Senior Official for Contracting		Mr.	Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Chief Financial Officer		Mr.	Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Chief Operating Officer		Mr.	Marouf	Ghanim		5594006420					gmarouf@fresnopace.org	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Chief Information Officer		Mr.	Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Sreet		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Chief Information Security Officer		Mr.	Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	CMS Casework Communication Contact			Meronk	Cheryl		5594006420					cmeronk@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Complaints Tracking Contact			Elser	Eva		5594006420					eelser@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Contact for Fraud Investigations			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Coordination of Benefits Contact			Shayan	Zohreh		9492925586					zshayan@fresnopace.org	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Corporate Mailing						5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Coverage Gap Discount Program (CGDP) Payment Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Customer Service Operations Contact		Ms.	Meronk	Cheryl		5594006420					cmeronk@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	DIR Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	DIR Contact (Secondary)			Lyfoung	Tsuleng		6128072260					tlyfoung@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Emergency Part D Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Emergency Part D Contact (Secondary)			Lyfoung	Tsuleng		6128072260					tlyfoung@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Encounter Data & Risk Adjustment Operations Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Enrollment Contact			Seita	Steve		5594006420					sseita@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	EOB Transfer Contact			Shayan	Zohreh		9492925586				8776410513	zshayan@fresnopace.org	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Financial Audit Contact	CEO	Mr.	Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Financial Reporting Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Formulary Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	General Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Government Relations Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	HIPAA Privacy Officer			Elser	Eva		5594006420					eelser@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	HIPAA Security Officer			Elser	Eva		7147989044					eelser@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Interoperability Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/10/2022	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	MA Appeals/Grievances Contact			Elser	Eva		7147989044					eelser@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	MA Claims Processing Contact for Public Website			Longoria	Daniel		5594006420					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	06/08/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Marketing Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Medical Director			Banipalsin	Sarkis		5594006420					sbanipalsin@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Medicare Compliance Officer		Ms	Elser	Eva		7147989044					eelser@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Medicare Coordinator			Meronk	Cheryl		9494396130					cmeronk@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/14/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Medicare Part D Opioid Overutilization Contact			Elser	Eva		7147989044					eelser@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Medication Therapy Management Contact			Meronk	Cheryl		7147989044					cmeronk@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Part C Application Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Part D Appeals			Longoria	Daniel							dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active	5125072010				PACE - Nat		C	San Francisco
H9592	Part D Appeals Contact (Secondary)			Elser	Eva							eelser@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active	7147989044				PACE - Nat		C	San Francisco
H9592	Part D Application Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Part D Benefits Contact			Longoria	Daniel		5594006420					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	06/08/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Part D Claims Submission Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Part D Exceptions Contact			Longoria	Daniel							dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active	5125072010				PACE - Nat		C	San Francisco
H9592	Part D Price File Contact (Back-up)			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Part D Price File Contact (Primary)			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Part D Quality Assurance Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Part D Reporting Contact			Longoria	Daniel		5125072010				8776410513	dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Patient Safety Contact			Elser	Eva		9492925586					eelser@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Payment Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Pharmacy Director			Masatsugu	Miles		9493759308					mmasatsugu@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Pharmacy Network Management Contact			Masatsugu	Miles		9493759308					mmasatsugu@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Pharmacy Technical Help Desk Contact			Masatsugu	Miles							mmasatsugu@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active	9493759308				PACE - Nat		C	San Francisco
H9592	Plan Directory Contact for Public Website			Longoria	Daniel		5594006420					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	06/08/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Plan to Plan Reconciliation Contact			Lyfoung	Tsuleng		6128072260					tlyfoung@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Processor Contact			Shayan	Zohreh		9492925586					zshayan@fresnopace.org	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Quality Contact			Vang	Anita		5594006420					anitav@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Reconciliation Contact			Longoria	Daniel		5125072010					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Recovery Audit Contact	CEO	Mr.	Longoria	Daniel		5594006420					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Surveillance Contact			Longoria	Daniel		5594006420					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	System Contact			Longoria	Daniel		5594006420					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Third Party Administrator (TPA) Liaison			Longoria	Daniel		5594006420					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	05/21/2021	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	User Access Contact			Longoria	Daniel		5594006420					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Utilization Management Contact			Longoria	Daniel		5594006420					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9592	Utilization Review Contact			Longoria	Daniel		5594006420					dlongoria@innovativeih.com	2042 Kern Street		Fresno	CA	93721	02/08/2023	2023	INNOVATIVE INTEGRATED HEALTH, INC.	National PACE	Innovative Integrated Health Inc.	National PACE		Innovative Integrated Health, Inc.	710	Yes	Active					PACE - Nat		C	San Francisco
H9614	Agent/Broker Compensation Data Contact	VP, Sales		Simonds	Kristina		6572187635					KSimonds@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Automated TrOOP Balance Transfer Contact	PBM - Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Backup User Access Contact	Compliance Director		Spitzer	Chandra		6572745530					CSpitzer@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Best Available Evidence Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Bid Audit Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Bid Audit Site Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Bid Primary Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	CAP Report Contact for Public Website	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	CEO - CMS Administrator Contact	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	CEO - Senior Official for Contracting	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Chief Financial Officer	Chief Financial Officer	Mr.	Freeman	Thomas		6572187604					TFreeman@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Chief Operating Officer	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Kardes	Hakan		6572187772					hkardes@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	03/29/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Chief Information Security Officer	VP, Technology & CISO	Mr.	MacLeod	David		3033967531					DMacleod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	CMMI Model Point of Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	CMS Casework Communication Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Complaints Tracking Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Contact for Fraud Investigations	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Coordination of Benefits Contact	AVP, Membership & Eligibility		Torres	Carrie		6572187409	2109				CArreola@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Corporate Mailing						6572187713				8443202247	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/15/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122			5622074634	adelatorre@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Customer Service Operations Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	DIR Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	DIR Contact (Secondary)	AVP, Pharmacy		Liu	Ruby		3237287232	2316				RLiu@AHCUSA.com	1100 W. Town & Country Rd., Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Electronic Health Record Contact	AVP, Platform Product		Brown Hayes	Michael		7144979628					MBrown-Hayes@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	04/01/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Emergency Part D Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Emergency Part D Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		3108667966				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Employer Waiver Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment		Bogdanov	Eyosef		5623666179					ebogdanov@ahcusa.com	1100 W. Town and Country Rd.	Suite 1600	Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Enrollment Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	EOB Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Financial Audit Contact	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Financial Reporting Contact	Sr. Director, Accounting & Reporting		Tran	Sue Anne		6572187673	7673				stran@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Formulary Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Formulary Contact (Secondary)	PBM - Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	General Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Government Relations Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	HIPAA Privacy Officer	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	HIPAA Security Officer	VP, Technology & CISO		MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Hospice Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Interoperability Contact	VP, Data Engineering & BI CTO Data and Al		Sam	Georgie		8188807212					gsam@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	MA Appeals/Grievances Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	MA Claims Processing Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Marketing Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Medical Director	SVP Market Management WCR	Dr.	Kim	John		6572187640				5622074617	JKim@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Medicare Compliance Officer	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy	B	6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Medicare Coordinator	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Medicare Part D Opioid Overutilization Contact	PBM - Supv Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Medication Therapy Management Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	OffShore Subcontractor Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	CLynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Online Enrollment Center Contact (Back-up)	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Online Enrollment Center Contact (Optional)	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Online Enrollment Center Contact (Primary)	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Part C Application Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Part C Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Part D Appeals	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6127775393				PPO - BBA		C	San Francisco
H9614	Part D Appeals Contact (Secondary)	Sr. Manager, Appeals & Grievance		Jimenez	Gudelia							GJimenez@ahcusa.com	1100 W. Town and Country Road, Suite #300		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6572187488	2188			PPO - BBA		C	San Francisco
H9614	Part D Application Contact	CEO		Maroney	Dawn		5623346192				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Part D Benefits Contact	PBM - Director, Benefit Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Part D Claims Submission Contact	PBM - Functional Business Consultant Govt Programs		Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	03/25/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Part D Exceptions Contact	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8006936651				PPO - BBA		C	San Francisco
H9614	Part D Exceptions Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali							AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	6572187709				PPO - BBA		C	San Francisco
H9614	Part D Price File Contact (Back-up)	PBM - Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Part D Price File Contact (Optional)	PBM - QA Analyst		Tastad	Emily		6127776931					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Part D Price File Contact (Primary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Part D Quality Assurance Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Part D Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Patient Safety Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Payment Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Personal Health Record Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Pharmacy Director	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Pharmacy Network Management Contact	PBM - AVP, Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	03/31/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Pharmacy Network Management Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/21/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				PPO - BBA		C	San Francisco
H9614	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	07/09/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				PPO - BBA		C	San Francisco
H9614	PHR Beneficiary Contact																	02/15/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO	Alignment Health Plan	Alignment Healthcare USA, LLC	612	Yes	Active	8666342247				PPO - BBA		C	San Francisco
H9614	Physician Incentive Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Plan Directory Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Plan to Plan Reconciliation Contact	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122			5622074266	adelatorre@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Processor Contact	Manager, PBM Operations		Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Quality Contact	Sr. Director, Quality Management/Credentialing		Lacock	Lisa		6572187638					LLacock@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Reconciliation Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Reconciliation Contact (Secondary)	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122				adelatorre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Recovery Audit Contact	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	SNP Application Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	SNP State Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Surveillance Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	System Contact	VP, AVA Health Plan Systems & Operations		Bates	Patrick		6572187636	7636				PBates@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	03/25/2021	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Third Party Administrator (TPA) Liaison	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122				adelatorre@ahcusa.com	1100 W. Town and Country Rd, Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	User Access Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Utilization Management Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9614	Utilization Review Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH INSURANCE COMPANY OF ARIZONA, INC	Local CCP	Alignment Health Plan	Local PPO		Alignment Healthcare USA, LLC	612	Yes	Active					PPO - BBA		C	San Francisco
H9615	Agent/Broker Compensation Data Contact	Medicare Sales & Broker		Osborn	Valerie		5183951245					vosborn@mvphealthcare.com	625 State Street		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Backup User Access Contact	Compliance Coordinator		Carter	Marlo		5189913814					mcarter@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Best Available Evidence Contact	Leader, Medicare Enrollment Operations		Moxley	Radija		5858852361				5853272227	RMoxley@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Bid Audit Contact	Corporate Compliance Officer		Borges	Linda		5189913803					mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Bid Audit Site Contact	Sr. Leader, Actuarial Services		Fish	Kathleen		5189913826				5183882311	kfish@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Bid Primary Contact	Sr. Leader, Medicare & Govt Programs Strategy		Hungate	Nicole		5858852394					nhungate@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	CAP Report Contact for Public Website	Corporate Compliance Officer		Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	CEO - CMS Administrator Contact	President and CEO	Mr.	Delvecchio	Chris		5189010624				5853272319	cdelvecchio@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	CEO - Senior Official for Contracting	President and CEO	Mr.	Delvecchio	Chris		5189010624				5853272319	cdelvecchio@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Chief Financial Officer	Chief Financial Officer	Ms.	Austen	Karla		5183882357					kausten@mvphealthcare.com	625 State Street		Schenectady	NY	12305	06/26/2014	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Chief Operating Officer	President and CEO	Mr.	Delvecchio	Chris		5189010624				5853272319	cdelvecchio@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Chief Information Officer	Sr Leader, Information Technology & Transformation	Mr.	Della Villa	Michael		5183882323					mdellavilla@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/22/2020	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Chief Information Security Officer	Sr, Leader, Information Technology & Transformatio	Mr.	Della Villa	Michael		5183882323					mdellavilla@mvphealthcare.com	625 State Street		Schenectady	NY	12305	09/07/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	CMS Casework Communication Contact	Leader, Medicare Appeals		Allen	Amy		5852588096				5853275724	aallen@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Complaints Tracking Contact	Leader, Medicare Appeals		Allen	Amy		5852588096				5853275724	aallen@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	11/24/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Contact for Fraud Investigations	Leader, Special Investigations Unit		Cordato	Rocco		5189010613					rcordato@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Coordination of Benefits Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Corporate Mailing						8006657924					memberservices@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	01/14/2013	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Coverage Gap Discount Program (CGDP) Payment Contact	Analyst, Revenue Data Management		Canlas	Natasha	M	9144298480					ncanlas@mvphealthcare.com	303 South Broadway	Suite 321	Tarrytown	NY	10591	08/07/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Customer Service Operations Contact	Sr. Leader, Customer Care & Support Services		Greenberg	Melissa		5189913731					mgreenberg@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	DIR Contact	Leader, State & Federal Plan BIlling		Marcus	Yael		9144298496					ymarcus@mvphealthcare.com	625 State Street		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	DIR Contact (Secondary)	Sr. Director, Actuarial		Jaiman	Rajshree		5189913834					rjaiman@mvphealthcare.com	625 State St.		Schenectady	NY	12305	02/28/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Emergency Part D Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Emergency Part D Contact (Secondary)	Leader, Pharmacy Clinical Operations		Massoudi	Layla		5188363126					lmassoudi@mvphealthcare.com	625 State St		Schenectady	NY	12305	09/27/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Encounter Data & Risk Adjustment Operations Contact	Director, Ops Vendor Compliance & Transaction Mgt		Shader	Michelle		5189913778					mshader@mvphealthcare.com	625 State Street		Schenectady	NY	12305	09/30/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Enrollment Contact	Leader, Medicare Enrollment Operations		Moxley	Radija		5858852361				5853272227	rmoxley@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	EOB Transfer Contact	Director, Pharmacy Management		Colin	Wendy		5858852435				8004010915	wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Financial Audit Contact	Sr. Director, Internal Audit	Mr.	Hillerman	Stephen		5189913995				5188363202	shillerman@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Financial Reporting Contact	Sr. Leader, Accounting & Assistant Controller		Cenzano	Jennifer		5189010623					jcenzano@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Formulary Contact	Professional, Pharmacy Program Management		Harrington	Courtney		5188363195					charrington@mvphealthcare.com	625 State St		Schenectady	NY	12305	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Formulary Contact (Secondary)	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	General Contact	Leader, Government Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Government Relations Contact	Medicare Compliance Officer		Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	HIPAA Privacy Officer	Corporate Compliance Officer		Borges	Linda		5189913803				5183882311	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	HIPAA Security Officer	Corporate Compliance Officer		Borges	Linda		5189913803				5183882311	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Hospice Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					WColin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Interoperability Contact	Leader, Gov''''''''t Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State St		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	MA Appeals/Grievances Contact	Leader, Medicare Appeals		Allen	Amy		5852588096				5853275724	aallen@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	MA Claims Processing Contact for Public Website	Sr. Leader, Govt Programs, Commercial & IH Claims		Santilli	RJ		5189913775					rsantilli@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Marketing Contact	Sr. Leader, Marketing & Communications		Wiseman	Sarah		5189913654					swiseman@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Medical Director	Chief Medical Officer		Cameron	Carl		5853272200					ccameron@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	11/24/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Medicare Coordinator	Leader, Government Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy Management		Colin	Wendy		5858852435				8004010915	wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Medication Therapy Management Contact	Leader, Pharmacy Clinical Operations - Medicare		Massoudi	Layla		5188363126					lmassoudi@mvphealthcare.com	625 State St.		Schenectady	NY	12305	11/09/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms	Borges	Linda		5189913803					mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Online Enrollment Center Contact (Back-up)	Leader, Medicare Enrollment Operations		Moxley	Radija		5858852361				5853272227	rmoxley@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Online Enrollment Center Contact (Primary)	Leader, Medicare Enrollment Operations		Moxley	Radija		5858852361				5853272227	rmoxley@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Part C Application Contact	Sr. Leader, Medicare & Govt Programs Strategy		Hungate	Nicole	M	5858852394					nhungate@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Part C Reporting Contact	Medicare Process Manager		Gallagher	Linda		5858852441					lgallagher@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Part D Appeals	Leader, Medicare Appeals		Allen	Amy						5853275724	aallen@mvphealthcare.com	220 Alexander  St		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active	5852588096				PPO - BBA		C	New York
H9615	Part D Appeals Contact (Secondary)	Compliance Coordinator, Medicare Appeals		Stepnowski	Ashley							astepnowski@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active	5857208126				PPO - BBA		C	New York
H9615	Part D Application Contact	Sr. Leader, Medicare & Govt Programs Strategy		Hungate	Nicole	M	5858852394					nhungate@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Part D Benefits Contact	Professional, Product Strategy		Hart	Andrew		5858852391					ahart@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Part D Claims Submission Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Part D Exceptions Contact	Director, Pharmacy Management		Colin	Wendy							wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active	5858852435				PPO - BBA		C	New York
H9615	Part D Exceptions Contact (Secondary)	Leader, Pharmacy Clinical Operations		Massoudi	Layla							lmassoudi@mvphealthcare.com	625 State St		Schenectady	NY	12305	09/27/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active	5188363126				PPO - BBA		C	New York
H9615	Part D Price File Contact (Back-up)	Leader, Pharmacy Clinical Operations		Massoudi	Layla		5188363126					lmassoudi@mvphealthcare.com	625 State St		Schenectady	NY	12305	09/27/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Part D Price File Contact (Optional)	Professional, Pharmacy Compliance Coordinator		Dunham	Kristina		5857208250					KDunham@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	05/24/2019	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Part D Price File Contact (Primary)	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Part D Quality Assurance Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Part D Reporting Contact	Professional, Pharmacy Compliance Coordinator		Dunham	Kristina		5857208250					Kdunham@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	05/24/2019	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Patient Safety Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Payment Contact	Leader, State & Federal Plan Billing		Marcus	Yael		9144298496					ymarcus@mvphealthcare.com	625 State Street		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Pharmacy Director	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Pharmacy Network Management Contact	Director Network Operations		Smith	Shawn		4803914844					shawn.smith@cvshealth.com	9501 E. Shea Blvd. MC 080		Scottsdale	AZ	85260	07/18/2018	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Pharmacy Technical Help Desk Contact	Director, Client Operations		Leeper	Shonda							Shonda.Leeper@CVSHealth.com	445 Great Circle Rd		Nashville	TN	37228	12/03/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active	8666934620				PPO - BBA		C	New York
H9615	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy Management		Colin	Wendy							wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active	5858852435				PPO - BBA		C	New York
H9615	Physician Incentive Contact	Sr. Leader, Network Management		MacKinnon	Matthew		5858852485					mmackinnon@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Plan Directory Contact for Public Website	Associate, Care Center Senior Representative		Garrett	Scott		5183867647					sgarrett@mvphealthcare.com	625 State St		Schenectady	NY	12305	12/27/2021	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Plan to Plan Reconciliation Contact	Leader, State & Federal Plan Billing		Marcus	Yael		9144298496					ymarcus@mvphealthcare.com	625 State Street		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Processor Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Quality Contact	Sr. Leader, Quality Performance & Reporting		Rocklein	Lisa		5858852510					lrocklein@mvphealthcare.com	220 Alexander Street		rochester	NY	14607	01/18/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Reconciliation Contact	Leader, State & Federal Plan Billing		Marcus	Yael		9144298496					YMarcus@mvphealthcare.com	625 State St		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Reconciliation Contact (Secondary)	Sr. Director, Actuarial		Jaiman	Rajshree		5189913834					rjaiman@mvphealthcare.com	625 State St.		Schenectady	NY	12305	02/28/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	SNP Application Contact	Sr. Leader, Medicare & Govt Programs Strategy		Hungate	Nicole	M	5858852394					nhungate@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Surveillance Contact	Medicare Compliance Officer		Borges	Linda		5189913803				5183882311	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	System Contact	Sr Leader, CISO and Enterprise Computer Svcs		Swits	David		5189913694					dswits@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Third Party Administrator (TPA) Liaison	Analyst, Revenue Data Management		Canlas	Natasha	M	9144298480					ncanlas@mvphealthcare.com	303 South Broadway	Suite 321	Tarrytown	NY	10591	08/07/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	User Access Contact	Leader, Government Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Utilization Management Contact	Sr. Leader Health and Medical Management		McCabe	Lisa		5189913854					lmccabe@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9615	Utilization Review Contact	Sr. Leader Health and Medical Management		McCabe	Lisa		5189913854					lmccabe@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	Local CCP	MVP HEALTH CARE	Local PPO		MVP Health Care, Inc.	197	Yes	Active					PPO - BBA		C	New York
H9616	Automated TrOOP Balance Transfer Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Backup User Access Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Best Available Evidence Contact	Director of Contracts	Mr.	Israel	Douglas		6196624100	4165				Disrael@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Bid Primary Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	CAP Report Contact for Public Website	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	03/31/2023	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	CEO - CMS Administrator Contact	President and CEO	Mr.	Mattson	Kevin		6196624100	6322				kmattson@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	CEO - Senior Official for Contracting	President and CEO	Mr.	Mattson	Kevin		6196624100	6322				kmattson@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Chief Financial Officer	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Chief Operating Officer	VP & COO	Mr.	Mejia	Art		6196624100	3488				Art.Mejia@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/26/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Chief Information Officer	VP & CIO	Mr.	Howard	Daniel		6196624100	1941				daniel.howard@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Chief Information Security Officer	VP & CIO	Mr.	Howard	Daniel		6196624100	1941				daniel.howard@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	CMS Casework Communication Contact	Director of Nursing	Mr.	Ballesteros	Alfredo		6196624100	3442				alfredo.ballasteros@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Complaints Tracking Contact	Executive Vice President	Ms.	Dela Rosa	Veronica		6196624100	3459				veronica.delarosa@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Contact for Fraud Investigations	Executive Vice President	Ms.	Dela Rosa	Veronica		6196624100	3459				veronica.delarosa@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Coordination of Benefits Contact	Director of Revenue Cycle	Mr.	Nubia	Charles		6196624100	4140				charles.nubia@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Corporate Mailing						6196624100					sdpace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Customer Service Operations Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	DIR Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	DIR Contact (Secondary)	Director of Finance/Controller	Ms.	Weisiger	Amy		6192056339					amy.weisiger@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Emergency Part D Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Emergency Part D Contact (Secondary)	Director of Finance/Controller	Ms.	Weisiger	Amy		6192056339					amy.weisiger@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Encounter Data & Risk Adjustment Operations Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Enrollment Contact	Director, Marketing & Enrollment	Mr.	Perez	Gerardo		6196624100	3578				gerardo.perez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	03/31/2023	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	EOB Transfer Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483			6192056373	alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Financial Audit Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Financial Reporting Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Formulary Contact	Pharmacy Manager	Mr.	Quigley	Warren		6196624100	4151				Wquigley@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	General Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Government Relations Contact	Vice President of External Affairs	Ms.	Melgoza	Ana		6196624100	6378				Amelgoza@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	HIPAA Privacy Officer	Chief Compliance Officer	Mr.	Maisonet	Robert		6196624100	3492				robert.maisonet@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	06/22/2023	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	HIPAA Security Officer	Chief Compliance Officer	Mr.	Maisonet	Robert		6196624100	3492				robert.maisonet@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	06/22/2023	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Interoperability Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	MA Appeals/Grievances Contact	Executive Vice President	Ms.	Dela Rosa	Veronica		6196624100	3459				veronica.delarosa@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	MA Claims Processing Contact for Public Website	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Marketing Contact	Director, Marketing & Enrollment	Mr.	Perez	Gerardo		6196624100	3578				gerardo.perez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	03/31/2023	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Medical Director	CMO	Dr.	Carriedo	Maria		6196624100	4103				Mcarriedo@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Medicare Compliance Officer	Chief Compliance Officer	Mr.	Maisonet	Robert		6196624100	3492				robert.maisonet@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	06/22/2023	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Medicare Coordinator	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Medicare Part D Opioid Overutilization Contact	PACE Pharmacy Manager	Ms.	Pham	Kim-Anh		6196624100	4008				kim-anh.pham@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	03/31/2023	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Medication Therapy Management Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Part C Application Contact	President and CEO	Mr.	Mattson	Kevin		6192056322				6192056373	kmattson@syhealth.ORG	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Part D Appeals	CFO	Mr.	Wallace	William	B						brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active	6192056339				PACE - Nat		C	San Francisco
H9616	Part D Appeals Contact (Secondary)	PACE Director	Ms.	Ramos	Elizabeth							eramos@syhealth.org	3364 Beyer Blvd.		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active	6196624100	4539			PACE - Nat		C	San Francisco
H9616	Part D Application Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Part D Benefits Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Part D Claims Submission Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Part D Exceptions Contact	PACE Pharmacy Supervisor	Ms.	Pham	Kim-Anh							kim-anh.pham@syhealth.org	3364 Beyer Blvd.		San Diego	CA	92173	03/31/2023	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active	6196624100	4008			PACE - Nat		C	San Francisco
H9616	Part D Exceptions Contact (Secondary)	PACE Medical Director	Dr.	DiazGonzelez	Vicente							vicente.diazgonzalez@syhealth.org	3364 Beyer Blvd.		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active	6196624100	4549			PACE - Nat		C	San Francisco
H9616	Part D Price File Contact (Back-up)	Director of Finance/Controller	Ms.	Weisiger	Amy		6192056339					amy.weisiger@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Part D Price File Contact (Optional)	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Part D Price File Contact (Primary)	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Part D Quality Assurance Contact	Executive Vice President	Ms.	Dela Rosa	Veronica		6196624100	3459				veronica.delarosa@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Part D Reporting Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Patient Safety Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Payment Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Pharmacy Director	Pharmacy Manager	Mr.	Quigley	Warren		6196624100	4151				Wquigley@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Pharmacy Network Management Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Pharmacy Technical Help Desk Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia							alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active	6196624100	3483			PACE - Nat		C	San Francisco
H9616	Plan Directory Contact for Public Website	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Plan to Plan Reconciliation Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Processor Contact	Director of Revenue Cycle	Mr.	Nubia	Charles		6196624100	4140				charles.nubia@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Quality Contact	Executive Vice President	Ms.	Dela Rosa	Veronica		6196624100	3459				veronica.delarosa@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Reconciliation Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Reconciliation Contact (Secondary)	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Recovery Audit Contact	CFO	Mr.	Wallace	William	B	6192056339					brian.wallace@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	12/06/2019	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Surveillance Contact	Executive Vice President	Ms.	Dela Rosa	Veronica		6196624100	3459				veronica.delarosa@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	System Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Third Party Administrator (TPA) Liaison	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	User Access Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Utilization Management Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9616	Utilization Review Contact	Vice President of Senior Health Services	Ms.	Rodriguez	Alicia		6196624100	3483				alicia.rodriguez@syhealth.org	1601 Precision Park Lane		San Diego	CA	92173	04/14/2022	2023	CENTRO DE SALUD DE LA COMUNIDAD DE SAN YSIDRO	National PACE	San Diego PACE	National PACE		Centro de Salud de la Comunidad de San Ysidro	610	Yes	Active					PACE - Nat		C	San Francisco
H9630	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H9630	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/15/2017	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Medical Director	Chief Medical Director	Mr.	Harmon	David		5124163782	22182				dharmon@centene.com	5900 E. Ben White Blvd.		Austin	TX	78741	03/30/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/03/2017	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H9630	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H9630	PHR Beneficiary Contact																	09/27/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8555659518				HMO - Health Maintenance Organization		C	Dallas
H9630	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Plan Directory Contact for Public Website			Services	Provider		8555659518					CorporateMedicareComplianceDept@CENTENE.COM	PO BOX 25438		Little Rock	AR	72221	03/31/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9630	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	ARKANSAS HEALTH AND WELLNESS HEALTH PLAN, INC	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9649	Automated TrOOP Balance Transfer Contact	Controller	Ms	Moores	Carla		9702557223					cmoores@hopewestco.org	2754 Compass Drive	Unit B	Grand Junction	CO	81506	07/26/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Backup User Access Contact	Director of Quality and Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@HopeWestCO.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Best Available Evidence Contact	Controller	Ms	Moores	Carla	J	9702572372					cmoores@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/01/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Bid Primary Contact	Chief Financial Officer/Chief Information Officer	Ms	Walsh	Sarah		9702572414					swalsh@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	CAP Report Contact for Public Website	Director, Executive Projects	Ms	Gallagher	Tierney		9702557252					tgallagher@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	CEO - CMS Administrator Contact	Chief Executive Officer	Ms	Mitchell	Cassie		9702572370	2370				cmitchell@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/17/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	CEO - Senior Official for Contracting	Chief Executive Officer	Ms	Mitchell	Cassie		9702572370					cmitchell@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/17/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Chief Financial Officer	Chief Financial Officer/Chief Information Officer	Ms	Walsh	Sarah		9702572414					swalsh@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Chief Operating Officer	Chief Operating Officer	Ms	Rock	Georgia		9702557220					grock@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	08/22/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Chief Information Officer	Chief Financial Officer/Chief Information Officer	Ms	Walsh	Sarah		9702572414					swalsh@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Chief Information Security Officer	Director of Information Technology	Mr	Facuri	Mark		9702572418					MFacuri@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	CMS Casework Communication Contact	Director of Quality and Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Complaints Tracking Contact	Director of Quality and Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Contact for Fraud Investigations	Sr. Vice President & Chief Administrative Officer	Ms	Walter	Terri		9702572363					twalter@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Coordination of Benefits Contact	Financial Analysis Manager	Ms	Moores	Carla		9702572372	2372				cmoores@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	09/07/2021	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Corporate Mailing						9702412212				9702572400	ccopp@hopewestco.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Executive Officer	Ms	Mitchell	Cassie		9702572370					cmitchell@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/17/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Customer Service Operations Contact	Director of Quality/Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	DIR Contact	Executive Director	Ms	Orrock	Jill		9702557247	7247				jorrock@hopewestco.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	09/07/2021	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	DIR Contact (Secondary)	Controller		Moores	Carla	K	9702572372				9702557208	cmoores@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	02/24/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Emergency Part D Contact	Controller	Ms	Moores	Carla		9702572372	2372				cmoores@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	02/15/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Emergency Part D Contact (Secondary)	Business Office Process Lead	Ms	Collins	Jeanette		9702557223					jcollins@hopewestco.org	2754 Compass Drive	Unit B	Grand Junction	CO	81506	07/26/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Encounter Data & Risk Adjustment Operations Contact	Controller	Ms	Moores	Carla		9702572372	2372				cmoores@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	02/15/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Enrollment Contact	Director, Marketing & Enrollment	Ms	DeCino	Mandy		9702484448					MDeCino@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	EOB Transfer Contact	Controller	Ms	Moores	Carla		9702572372	2372			9702572400	cmoores@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	01/19/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Financial Audit Contact	Chief Financial Officer/Chief Information Officer	Ms	Walsh	Sarah		9702572414					swalsh@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Financial Reporting Contact	Chief Financial Officer/Chief Information Officer	Ms	Walsh	Sarah		9702572414					swalsh@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Formulary Contact	PACE Executive Director	Ms	Orrock	Jill		9702557247	7247				jorrock@HopeWestCO.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Formulary Contact (Secondary)	Chief Medical Director	Dr.	Owens	Crystal		9702544021	4021				cowens@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	03/07/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	General Contact	Executive Director	Ms	Orrock	Jill		9702557247					jorrock@HopeWestCO.org	2754 Compass Dr		Grand Junction	CO	81506	09/13/2021	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Government Relations Contact	PACE Executive Director	Ms	Orrock	Jill		9702557223					jorrock@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	03/22/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	HIPAA Privacy Officer	Sr. Vice President & Chief Administrative Officer	Ms	Walter	Terri		9702572363					twalter@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	HIPAA Security Officer	Director of Information Technology	Mr	Facuri	Mark		9702572418					MFacuri@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Interoperability Contact	Controller	MS	Moores	Carla	J	9702572372					cmoores@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	06/01/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	MA Appeals/Grievances Contact	Director, Quality/Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	MA Claims Processing Contact for Public Website	Controller	Ms	Moores	Carla		9702572372					cmoores@hopewestco.org	2754 Compass Drive	Unit B	Grand Junction	CO	81506	07/26/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Marketing Contact	Director, Marketing & Enrollment	Ms	DeCino	Mandy		9702484448					MDeCino@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Medical Director	Chief Medical Director	Dr.	Owens	Crystal		9702412212	4021				cowens@HopeWestCO.org	2754 Compass Drive		Grand Junction	CO	81506	03/07/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Medicare Compliance Officer	PACE Executive Director	Mrs.	Orrock	Jill		9702557223					jorrock@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/01/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Medicare Coordinator	Director of Quality and Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Medicare Part D Opioid Overutilization Contact	Director of Quality and Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Medication Therapy Management Contact	Chief Medical Director	Dr.	Owens	Crystal		9702544021	4021				cowens@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Part C Application Contact	Chief Executive Officer	Ms	Mitchell	Cassie		9702572370					cmitchell@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/17/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Part D Appeals	Director of Quality and Compliance	Ms	Eldridge-Davies	Natasha							neldridgedavies@HopeWestCO.org	2754 Compass Dr		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active	9702632197	2197			PACE - Nat		C	Denver
H9649	Part D Appeals Contact (Secondary)	Executive Director	Ms	Orrock	Jill							jorrock@HopeWestCO.org	2754 Compass Dr		Grand Junction	CO	81506	09/13/2021	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active	9702557247				PACE - Nat		C	Denver
H9649	Part D Application Contact	Chief Executive Officer	Ms	Mitchell	Cassie		9702572370					cmitchell@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/17/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Part D Benefits Contact	Controller	Ms	Moores	Carla		9702572372	2372				cmoores@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	01/19/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Part D Claims Submission Contact	Controller	Ms	Moores	Carla		9702572372	2372				cmoores@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	01/19/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Part D Exceptions Contact	Chief Medical Director	Dr.	Owens	Crystal							cowens@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	03/07/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active	9702544021	4021			PACE - Nat		C	Denver
H9649	Part D Exceptions Contact (Secondary)	Executive Director	Ms	Orrock	Jill							jorrock@hopewestco.org	2754 Compass Dr		Grand Junction	CO	81506	09/13/2021	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active	9702557247				PACE - Nat		C	Denver
H9649	Part D Price File Contact (Back-up)	Chief Financial Officer/Chief Information Officer	Ms	Walsh	Sarah		9702572414					swalsh@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Part D Price File Contact (Optional)	Financial Analysis Manager	Ms	Moores	Carla		9702572372					cmoores@hopewestco.org	2754 Compass Dr		Grand Junction	CO	81506	09/13/2021	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Part D Price File Contact (Primary)	Chief Executive Officer	Ms	Mitchell	Cassie		9702572370					cmitchell@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/17/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Part D Quality Assurance Contact	Director of Quality and Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Part D Reporting Contact	Business Office Process Lead	Ms	Collins	Jeanette		9702557223					jcollins@HopeWestCO.org	2754 Compass Dr		Grand Junction	CO	81506	07/26/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Patient Safety Contact	Director of Quality and Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@HopeWestCO.org	2754 Compass Dr	Unit B	Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Payment Contact	Chief Financial Officer/Chief Information Officer	Ms	Walsh	Sarah		9702572414					swalsh@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Personal Health Record Contact	Director of Quality and Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@hopewestco.org	2754 Compas		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Pharmacy Director	Chief Medical Director	Dr.	Owens	Crystal		9702544021	4021				cowens@HopeWestCO.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Pharmacy Network Management Contact	PACE Executive Director	Ms	Orrock	Jill		9702557247	7247				jorrock@HopeWestCO.org	2754 Compass Drive		Grand Junction	CO	81506	01/19/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Pharmacy Network Management Contact (Secondary)	Chief Medical Director	Dr.	Owens	Crystal		9702544021	4021				cowens@hopewestco.org	2754 Compass Dr		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Pharmacy Technical Help Desk Contact	Sr. Dir of Clinical Services	Ms	Barrios	Tracy							Tbarrios@HopeWestCO.org	2754 compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active	9702557207	7207			PACE - Nat		C	Denver
H9649	Pharmacy Technical Help Desk Contact (Secondary)	Chief Medical Director	Dr.	Owens	Crystal							cowens@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active	9702544021	4021			PACE - Nat		C	Denver
H9649	Plan Directory Contact for Public Website	Sr. Dir of Marketing	Ms	DeCino	Mandy		9702557223	1836				mdecino@HopeWestCO.org	2754 Compass Drive		Grand Junction	CO	81506	01/19/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Plan to Plan Reconciliation Contact	Controller	Ms	Moores	Carla		9702572372	2372				cmoores@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	01/19/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Processor Contact	Controller	Ms	Moores	Carla		9702572372					cmoores@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	02/24/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Quality Contact	Director of Quality and Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Reconciliation Contact	Chief Financial Officer/Chief Information Officer	Ms	Walsh	Sarah		9702572414					swalsh@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/26/2020	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Reconciliation Contact (Secondary)	Controller	Ms	Moores	Carla		9702572372					cmoores@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	01/19/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Recovery Audit Contact	Chief Executive Officer	Ms	Mitchell	Cassie		9702572370					cmitchell@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	06/17/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Surveillance Contact	Sr. Dir of Marketing	Ms	DeCino	Mandy		9702557223					mdecino@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	03/22/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	System Contact	PACE Executive Director	Ms	Orrock	Jill		9702557247					jorrock@HopeWestCO.org	2754 Compass Drive		Grand Junction	CO	81506	01/19/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Third Party Administrator (TPA) Liaison	Controller	Ms	Moores	Carla		9702572372					cmoores@HopeWestCO.org	3090 North 12th Street	Unit B	Grand Junction	CO	81506	01/19/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	User Access Contact	PACE Executive Director	Ms	Orrock	Jill		9702557247					jorrock@HopeWestCO.org	2754 Compass Dr.		Grand Junction	CO	81506	06/17/2022	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Utilization Management Contact	Executive Director	Ms	Orrock	Jill		9702557247					jorrock@HopeWestCO.org	2754 Compass Dr		Grand Junction	CO	81506	09/13/2021	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9649	Utilization Review Contact	Director of Quality and Compliance	Ms	Eldridge-Davies	Natasha		9702632197	2197				neldridgedavies@hopewestco.org	2754 Compass Drive		Grand Junction	CO	81506	08/21/2023	2023	HOPEWEST	National PACE	HopeWest PACE	National PACE		Hopewest	766	Yes	Active					PACE - Nat		C	Denver
H9662	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H9662	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H9662	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H9662	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H9662	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H9662	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H9662	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9662	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF CALIFORNIA, INC.	Local CCP	Cigna	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9678	Agent/Broker Compensation Data Contact	VP, Associate General Counsel	Ms.	Jan	Munizeh		6467675166					mjan@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Automated TrOOP Balance Transfer Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Backup User Access Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Best Available Evidence Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Bid Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Bid Audit Site Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Bid Primary Contact	Manager, Product Implementation	Mr.	Buntin	Bryant		2125192962					bbuntin@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	CAP Report Contact for Public Website	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	CEO - CMS Administrator Contact	President & CEO	Ms.	Wang	Pat		2128011500					pwang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	01/04/2023	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	CEO - Senior Official for Contracting	President & CEO	Ms.	Wang	Pat		2128011500					pwang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Chief Financial Officer	Chief Financial Officer	Mr.	Bermel	John		2124792777					jbermel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Chief Operating Officer	SVP, Operations	Ms.	Weinseiss	Karen		6466773595					kweinseiss@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Chief Information Officer	SVP, CIO	Mr.	Sweeney	GT		6467675199					gtsweeney@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Chief Information Security Officer	VP, Chief Security Information Officer	Mr.	Miller	Brian		6467675750					bmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	CMS Casework Communication Contact	Complaints Manager	Ms.	Gabriel	Charisse		6467675697					cgabriel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Complaints Tracking Contact	Complaints Manager	Ms.	Gabriel	Charisse		6467675697					cgabriel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Contact for Fraud Investigations	VP, Associate General Counsel	Mr.	Kianovsky	Nahum		2128013240					nkianovsky@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Coordination of Benefits Contact	Director, Payment Integrity Team	Ms.	Hutchinson	Chris		9176982415					chutchinson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Corporate Mailing						6463138967					clogreira@healthfirst.org	Healthfirst Medicare Plan	100 Church Street, 18th Floor	New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Manager, Accounting	Ms.	Tyme	Denise		6462732814					dtyme@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Customer Service Operations Contact	VP,  Member Services	Ms.	O'Connor	Kimberly		2128011639					koconnor@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	DIR Contact	Sr. Manager, Pharmacy Finance	Mr.	Denman	Hunter		2128013297					hdenman@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	DIR Contact (Secondary)	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					Tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Emergency Part D Contact	VP, Pharmacy	Mr.	Modi	Bhavesh		9734494186					bmodi@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/28/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Emergency Part D Contact (Secondary)	Director, Pharmacy Regulatory & Compliance	Ms.	Andreu	Kim		3475743277					kandreu@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/28/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters	Mr.	Miller	Robert		2125193011					rmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Enrollment Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	EOB Transfer Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753				6463134645	jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Financial Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Financial Reporting Contact	Chief Financial Officer	Mr.	Bermel	John		2124792777					jbermel@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Formulary Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Formulary Contact (Secondary)	Medicare Clinical Pharmacist	Ms.	Baja	Melodie		6468565983					mbaja@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	General Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Government Relations Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	HIPAA Privacy Officer	AVP, Chief Privacy Officer	Ms.	Radler	Laurie		9172863902					lradler@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	HIPAA Security Officer	VP, Chief Security Information Officer	Mr.	Miller	Brian		6467675750					bmiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Hospice Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Interoperability Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	MA Appeals/Grievances Contact	VP, Appeals & Grievances	Ms.	Johnston	Meredith		6467674748					mjohnston@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	MA Claims Processing Contact for Public Website	VP, Claims	Mr.	Johnson	Eric		2127292245					ejohnson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Marketing Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Medical Director	Chief Clinical Officer	Dr.	Schechtman	Jay		2128016170					jschechtman@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Medicare Compliance Officer	Chief Compliance Officer & Head of Internal Audit	Mr.	Hackendorn	John		2124534495					jhackendorn@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Medicare Coordinator	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	12/05/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Medication Therapy Management Contact	Sr. Pharmacy Manager	Mr.	Wiggall	Alex		2125198212					awiggall@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Online Enrollment Center Contact (Primary)	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Part C Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Part C Reporting Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Part D Appeals	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah							hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active	8882601010				PPO - BBA		C	New York
H9678	Part D Appeals Contact (Secondary)	Sr. Manager, Pharmacy Regulatory & Compliance	Ms.	Alenkina	Karolina							kalenkina@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active	8882601010				PPO - BBA		C	New York
H9678	Part D Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Part D Benefits Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Part D Claims Submission Contact	Manager, Pharmacy Benefits	Ms.	Grodzitsky	Janet		6467675231					jparedes@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Part D Exceptions Contact	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah							hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active	8882601010				PPO - BBA		C	New York
H9678	Part D Exceptions Contact (Secondary)	Medicare Clinical Pharmacist	Ms.	Baja	Melodie							mbaja@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active	8882601010				PPO - BBA		C	New York
H9678	Part D Price File Contact (Back-up)	Senior Manager, PBM Financial Operations	Ms.	Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	CVS Health	9501 E. Shea Blvd	Scottsdale	AZ	85260	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Part D Price File Contact (Optional)	Advisor, Med D Finance	Mr.	Pertgen	Richard		8045258502					richard.pertgen@cvshealth.com	CVS Health	9501 E Shea Blvd, MC121	Scottsdale	AZ	85260	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Part D Price File Contact (Primary)	Director, Pharmacy Operations	Ms.	Lee Brown	Hannah		6464293818					hleebrown@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Part D Quality Assurance Contact	AVP, Pharmacy	Ms.	Kourlas	Helen		2122096456					hkourlas@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Part D Reporting Contact	Sr. Manager, Medicare Products	Ms.	Kennedy	Raine		2124018804					rkennedy@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Patient Safety Contact	Manager, Pharmacy	Ms.	Gandara Rodriguez	Alexandra		2124792775					agandararodriguez@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Payment Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Pharmacy Director	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Pharmacy Network Management Contact	Director, Pharmacy Operations	Mr.	Suri	Tarun		6463541168					tsuri@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Pharmacy Network Management Contact (Secondary)	Clinical Pharmacist	Ms.	An	Diana		3476911405					dan@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Pharmacy Technical Help Desk Contact	Director, Client Operations	Ms.	Dayoub	Joselyn							dayoubj@cvshealth.com	CVS Health	800 NW Chipman Rd, Ste 5830	Lees Summit	MO	64063	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active	8666934620				PPO - BBA		C	New York
H9678	Physician Incentive Contact	VP, Deputy General Counsel	Mr.	Schiller	Robert		2124974347					rschiller@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Plan Directory Contact for Public Website			Services	Provider		8888011660					hfprovsrvs@healthfirst.org	P.O. Box 5168		New York	NY	102745168	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Plan to Plan Reconciliation Contact	Sr. Manager, Enrollment & Billing	Mr.	Howell	Justin		6467675753					jhowell@healthfirst.org	100 Church Street, 18th Floor	Attn:  Treasury Department	New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Processor Contact	Director of Client Services Adjudication Solutions	Mr.	Mangin	Marty		3124981167					martin.mangin@cvshealth.com	CVS Health	2211 Sanders Road, 2215-5	Northbrook	IL	60062	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Quality Contact	VP, Clinical Quality	Ms.	Washington	Laisha		2128016186					lawashington@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Reconciliation Contact	VP, Actuarial Services	Ms.	Liang	Angela		2124535538					aliang@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Recovery Audit Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	SNP Application Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	SNP State Contact	VP, Regulatory Affairs	Ms.	Logreira	Christine		6463138967					clogreira@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Surveillance Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	System Contact	SVP, CIO	Mr.	Sweeney	GT		6467675199					gtsweeney@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Third Party Administrator (TPA) Liaison	Sr. Manager, Accounting	Ms.	Tyme	Denise		6462732814					dtyme@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	User Access Contact	AVP, Regulatory Affairs	Mr.	Husmann	Michael		2124534457					mhusmann@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Utilization Management Contact	VP, Utilization Management	Ms.	Gunderson	Christine		2123242688					cgunderson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9678	Utilization Review Contact	VP, Utilization Management	Ms.	Gunderson	Christine		2123242688					cgunderson@healthfirst.org	100 Church Street, 18th Floor		New York	NY	10007	11/08/2022	2023	HEALTHFIRST INSURANCE COMPANY, INC.	Local CCP	Healthfirst Medicare Plan	Local PPO		Healthfirst, Inc.	391	Yes	Active					PPO - BBA		C	New York
H9686	Agent/Broker Compensation Data Contact	VP, Sales		Simonds	Kristina		6572187635					KSimonds@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Automated TrOOP Balance Transfer Contact	PBM - Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Backup User Access Contact	Compliance Director		Spitzer	Chandra		6572745530					CSpitzer@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Best Available Evidence Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Bid Audit Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Bid Audit Site Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Bid Primary Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	CAP Report Contact for Public Website	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	CEO - CMS Administrator Contact	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	CEO - Senior Official for Contracting	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Chief Financial Officer	Chief Financial Officer	Mr.	Freeman	Thomas		6572187604					TFreeman@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Chief Operating Officer	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Kardes	Hakan		6572187772					hkardes@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	03/29/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Chief Information Security Officer	VP, Technology & CISO	Mr.	MacLeod	David		3033967531					DMacleod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	CMMI Model Point of Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	CMS Casework Communication Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Complaints Tracking Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Contact for Fraud Investigations	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Coordination of Benefits Contact	AVP, Membership & Eligibility		Torres	Carrie		6572187409	2109				CArreola@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Corporate Mailing						6572187713				8443202247	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/07/2020	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122			5622074634	adelatorre@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Customer Service Operations Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	DIR Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	DIR Contact (Secondary)	AVP, Pharmacy		Liu	Ruby		3237287232	2316				RLiu@AHCUSA.com	1100 W. Town & Country Rd., Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Electronic Health Record Contact	AVP, Platform Product		Brown Hayes	Michael		7144979628					MBrown-Hayes@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	04/01/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Emergency Part D Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Emergency Part D Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		3108667966				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Employer Waiver Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment		Bogdanov	Eyosef		5623666179					ebogdanov@ahcusa.com	1100 W. Town and Country Rd.	Suite 1600	Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Enrollment Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	EOB Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Financial Audit Contact	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Financial Reporting Contact	Sr. Director, Accounting & Reporting		Tran	Sue Anne		6572187673	7673				stran@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Formulary Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Formulary Contact (Secondary)	PBM - Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	General Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Government Relations Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	HIPAA Privacy Officer	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	HIPAA Security Officer	VP, Technology & CISO		MacLeod	David		3033967531					DMacleod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Hospice Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Interoperability Contact	VP, Data Engineering & BI CTO Data and Al		Sam	Georgie		8188807212					gsam@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/01/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	MA Appeals/Grievances Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	MA Claims Processing Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Marketing Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Medical Director	SVP Market Management WCR	Dr.	Kim	John		6572187640				5622074617	JKim@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Medicare Compliance Officer	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy	B	6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Medicare Coordinator	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Medicare Part D Opioid Overutilization Contact	PBM - Supv Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Medication Therapy Management Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	OffShore Subcontractor Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	CLynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Online Enrollment Center Contact (Back-up)	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Online Enrollment Center Contact (Optional)	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Online Enrollment Center Contact (Primary)	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Part C Application Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Part C Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Appeals	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Appeals Contact (Secondary)	Sr. Manager, Appeals & Grievance		Jimenez	Gudelia							GJimenez@ahcusa.com	1100 W. Town and Country Road, Suite #300		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187488	2188			HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Application Contact	CEO		Maroney	Dawn		5623346192				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Benefits Contact	PBM - Director, Benefit Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Claims Submission Contact	PBM - Functional Business Consultant Govt Programs		Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Exceptions Contact	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Exceptions Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali							AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187709				HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Price File Contact (Back-up)	PBM - Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Price File Contact (Optional)	PBM - QA Analyst		Tastad	Emily		6127776931					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Price File Contact (Primary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Quality Assurance Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Part D Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Patient Safety Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Payment Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Personal Health Record Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Pharmacy Director	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Pharmacy Network Management Contact	PBM - AVP, Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Pharmacy Network Management Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	06/07/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/21/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H9686	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	07/09/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H9686	PHR Beneficiary Contact																	02/07/2020	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS	Alignment Health Plan	Alignment Healthcare USA, LLC	612	Yes	Active	8666342247				HMO - Health Maintenance Organization		C	San Francisco
H9686	Physician Incentive Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Plan Directory Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Plan to Plan Reconciliation Contact	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122			5622074266	adelatorre@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Processor Contact	Manager, PBM Operations		Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Quality Contact	Sr. Director, Quality Management/Credentialing		Lacock	Lisa		6572187638					LLacock@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Reconciliation Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Reconciliation Contact (Secondary)	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122				adelatorre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Recovery Audit Contact	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	SNP Application Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	SNP State Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Surveillance Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	System Contact	VP, AVA Health Plan Systems & Operations		Bates	Patrick		6572187636	7636				PBates@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	03/25/2021	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Third Party Administrator (TPA) Liaison	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122				adelatorre@ahcusa.com	1100 W. Town and Country Rd, Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	User Access Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Utilization Management Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9686	Utilization Review Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF NEVADA, INC.	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9699	Agent/Broker Compensation Data Contact	Manager, Individual Sales Agent		Creasman	Matthew		5013993923					mdcreasman@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Automated TrOOP Balance Transfer Contact	Eligibility Supervisor		White	William		6127776736					eobp2p@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	12/05/2017	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Backup User Access Contact	Regulatory Compliance System Administrator		Coffman	Clay		5013782559					crcoffman@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/08/2018	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Best Available Evidence Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Bid Audit Contact	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Bid Audit Site Contact	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Bid Primary Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	06/12/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	CAP Report Contact for Public Website	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	CEO - CMS Administrator Contact	Lead Executive, Senior Products	Ms.	Dixon	Laurin	E	9016063429					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Vannatta	Matthew		5013785635					mdvannatta@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/01/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Chief Financial Officer	CFO	Mr.	Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	07/18/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Chief Operating Officer	Executive VP, Chief Operating Officer	Mr.	Dillard	Gray		5013782436					gddillard@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	07/18/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Chief Information Officer	Chief Information Officer	Ms.	Ryan	Kathy		5013782017					koryan@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	01/28/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Chief Information Security Officer	Chief Information Officer	Ms.	Ryan	Kathy		5013782017					koryan@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	01/28/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	CMS Casework Communication Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Complaints Tracking Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Contact for Fraud Investigations	Director, Performance Mgt. & Investigations		Gunter	Debbie		5013786610					dsgunter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/13/2017	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Coordination of Benefits Contact	Eligibility Supervisor		White	William		6127776736					cobmedd@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	12/05/2017	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Corporate Mailing						5013785635					mdvannatta@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/10/2020	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/15/2016	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Customer Service Operations Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	DIR Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	DIR Contact (Secondary)	CFO		Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	07/18/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Emergency Part D Contact	Lead Executive, Senior Products		Dixon	Laurin	E	9016063429					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Emergency Part D Contact (Secondary)	Manager, Senior Products		Sherer	Michael		5013786341					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Encounter Data & Risk Adjustment Operations Contact	Director Medicare Risk Adjustment		Serrano	Kacey		5013714238					klserrano@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	03/19/2021	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Enrollment Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	EOB Transfer Contact	Eligibility Supervisor		White	William		6127776736				8776772730	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	12/05/2017	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Financial Audit Contact	Medicare Compliance Officer	Mr.	Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	09/21/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Financial Reporting Contact	Financial Reporting Accountant		Russell	Holly		5013993954					hkrussell@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	07/05/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Formulary Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Formulary Contact (Secondary)			Wahl	Dan		6127776815					dwahl@primetherapeutics.com	Prime Therapeutics 1305 Corporate Drive		Eagan	MN	55121	12/05/2017	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	General Contact	Led Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Government Relations Contact	Sr Counsel Gov't Relation		Fenton	Janie		5013782103					jwfenton@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	01/28/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	HIPAA Privacy Officer	Sr Counsel Litigation		Roberts	Chet		5013782375					cxroberts@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	01/28/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	HIPAA Security Officer	Physical Security/Chief Security Officer		Shirley	Devin		5016880747					DMShirley@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	09/11/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Hospice Contact	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Interoperability Contact			Ritchey	Heather		5013782000					hrritchey@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	02/11/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	MA Appeals/Grievances Contact	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	MA Claims Processing Contact for Public Website	Supervisor, Medicare Claims		Pilkington Ross	Amanda		5013013452					ampilkington@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Marketing Contact	VP Consumer and Retail Markets	Mr.	Vannatta	Matthew		5013785635					mdvannatta@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	05/20/2021	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Medical Director	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/31/2020	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Medicare Coordinator	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Medicare Part D Opioid Overutilization Contact	Associate Medical Director	Dr.	Becker	Thomas		5013783100					tebecker@arkbluecross.com	601 S Gaines St.		Little Rock	AR	72201	06/12/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Medication Therapy Management Contact	Manager, Stars Pharmacy Lead		Walsh	Tyler		5013993975					trwalsh@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	06/07/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	OffShore Subcontractor Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	05/20/2021	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Online Enrollment Center Contact (Back-up)	Supervisor, Medicare Operations		Sherer	Michael		5013786341					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/10/2020	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Online Enrollment Center Contact (Optional)	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 S Gaines		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Online Enrollment Center Contact (Primary)	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Part C Application Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Part C Reporting Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Appeals			Review Dept.	Clinical						8006936703	CRUMed@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	12/05/2017	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Appeals Contact (Secondary)	Senior Counsel, Appeals		Phillips	Ashleigh						5013783366	adphillips@arkbluecross.com	PO Box 2181	Attn: Legal Appeals	Little Rock	AR	72203	01/11/2021	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active	5013782025				HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Application Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Benefits Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Claims Submission Contact			Brooke	Lance		4026862603				4029702545	lbrooke@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	12/05/2017	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Exceptions Contact			Review Audit & Regul	Clinical						8006936703	clinicalreviewclientinquiries@primetherapeutics.co	Centennial Crossings - Clinical Review 4401 West 76th S		Edina	MN	55435	12/05/2017	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Exceptions Contact (Secondary)			Review Dept Med D Au	Clinical						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Edina	MN	55435	12/16/2015	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Price File Contact (Back-up)	Database Reporting Analyst		Xu	Jake		6127776830					jake.xu@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	12/05/2017	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Price File Contact (Optional)	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Price File Contact (Primary)	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Quality Assurance Contact	Manager Metrics and Reporting		Luukkonen	Lynette		6127775574					lynette.luukkonen@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	01/28/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Part D Reporting Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Patient Safety Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Payment Contact	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/05/2015	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Pharmacy Director	Associate Medical Director	Dr.	Becker	Thomas		5013783100					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Pharmacy Network Management Contact	Senior Director Network Provider Relations		Grindsteinner	Bretta		6127774021					bgrinsteinner@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	12/16/2015	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Pharmacy Network Management Contact (Secondary)	Sr. Manager Pharmacy Provider Relations		Ecklund	Elisa		6127774308					eecklund@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	12/16/2015	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Pharmacy Technical Help Desk Contact			Pharmacy Help Desk	Prime						8882852242	MGarzarodriguez@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	04/15/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active	8006933815				HMO - Health Maintenance Organization		C	Dallas
H9699	Plan Directory Contact for Public Website			Service	Customer		8442014934					MediPakAdvRx@arkbluecross.com	P O Box 3648		Little Rock	AR	72203	11/10/2020	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Plan to Plan Reconciliation Contact	Financial Analyst		Holt	Susan		5013993958				5013783258	sbholt@arkbluecross.com	P O Box 8084		Little Rock	AR	72203	07/05/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Processor Contact	Director Business Service Ops - Govt Programs		Allie	Cindy		6127776772				6127776705	callie@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	12/05/2017	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Quality Contact	Director Quality Programs		Griffin	Brandon		5013782208					jbgriffin@arkbluecross.com	320 W Capitol		Little Rock	AR	72201	03/17/2020	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Reconciliation Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Reconciliation Contact (Secondary)	CFO		Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	07/18/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Recovery Audit Contact	Financial Analyst	Ms.	Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/05/2017	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Surveillance Contact	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	System Contact	Manager, Configuration		Spicer	Derek		5013013425					bdspicer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/17/2019	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Third Party Administrator (TPA) Liaison	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/15/2016	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	User Access Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387				5013017306	wlbradford@arkbluecross.com	601 Gaines Street	10-South	Little Rock	AR	72201	05/20/2021	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Utilization Management Contact	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/31/2020	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9699	Utilization Review Contact	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/31/2020	2023	HMO PARTNERS, INC.	Local CCP	Arkansas Blue Medicare	HMO/HMOPOS		USAble Mutual Insurance Company	421	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9706	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	01/30/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	11/06/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	11/06/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	11/06/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	11/27/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	08/09/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Encounter Data & Risk Adjustment Operations Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727664531					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	02/07/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	08/09/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	MA Appeals/Grievances Contact	DVP Customer Service	Ms.	Hoffman	Allison		3126534026				0000000000	Allison_L_Hoffman@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	03/04/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	MA Claims Processing Contact for Public Website	Deputy General Manager	Ms.	Dempsey	Caressa		5703822395	836195			0000000000	Caressa.Dempsey@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Medical Director	CMO Government Programs	Dr.	Alphs Jackson	Hannah		3126534318				0000000000	Hannah_Alphs_Jackson@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	12/22/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	05/09/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Part C Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Part C Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H9706	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H9706	Part D Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	02/14/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	08/09/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H9706	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	Denver
H9706	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	11/27/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/04/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/22/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	8772777898				HMO - Health Maintenance Organization		C	Denver
H9706	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/23/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active	0000000000				HMO - Health Maintenance Organization		C	Denver
H9706	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	02/07/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Quality Contact	DVP Government Performance	Ms.	Gonzalez	Eugenia		3126533413				3128199474	Eugenia_M_Gonzalez@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/12/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	SNP Application Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	SNP State Contact	Director, Medicare Solutions	Ms.	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/14/2022	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/04/2021	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	08/09/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	07/29/2020	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Utilization Management Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	02/07/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9706	Utilization Review Contact	DVP, Gov't Programs, Clinical Operations	Ms.	Spaulding	Felicia		5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	02/07/2019	2023	HCSC INSURANCE SERVICES COMPANY	Local CCP	Blue Cross and Blue Shield of Texas	HMO/HMOPOS		Health Care Service Corporation	110	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9712	Agent/Broker Compensation Data Contact	Director, Producer Relations		Howard	Michelle		2484438530					mhoward@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/23/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Automated TrOOP Balance Transfer Contact	Medicare Part D Manager		Smith	Leah		3136648724					lsmith17@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/04/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Backup User Access Contact	Compliance Specialist		Burks	Erica		2487763543					eburks@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Best Available Evidence Contact	Manager, Membership & Billing		Mullins	Rhonda		2484437532					rmullins@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Bid Audit Contact	Lead Product Consultant		Simerau	Jennie		8109558244					jsimerau@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/16/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Bid Audit Site Contact	Lead Product Consultant		Simerau	Jennie		8109558244					jsimerau@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/16/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Bid Primary Contact	Associate Actuary, Actuarial & HC Analytics	Ms.	Vrantsidis	Katherine	A	2484432022					KVrants1@HAP.ORG	1414 E Maple Road		Troy	MI	48083	05/25/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	CAP Report Contact for Public Website	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	CEO - CMS Administrator Contact	President and CEO	Dr.	Genord	Mike		3136648361					mgenord@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	CEO - Senior Official for Contracting	President and CEO	Dr.	Genord	Mike		3136648361					mgenord@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	02/07/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Chief Financial Officer	SVP, Chief Financial Officer	Mr.	Hausenfluck	Merrill		2487763530					mhausen1@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	08/02/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Chief Operating Officer	Chief Operating Officer	Mr	Treash	Mike		3136648855					mtreash@hap.org	2850 West Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Chief Information Officer	CIO	Ms	Marcath	Annette		3136648166					amarcath@hap.org	2850 W Grand Blvd		Detroit	MI	48202	07/23/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Chief Information Security Officer	Interim	Ms	Skolnik	Johanna		3138746635					jskolni1@hfhs.org	One Ford Place, 2A		Detroit	MI	48202	07/30/2018	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	CMS Casework Communication Contact	Appeals & Grievances Analyst	Ms.	Abazid	Wassan		3136648495				3136645845	wabazid@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/28/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Complaints Tracking Contact	Appeals & Grievances Analyst	Ms.	Abazid	Wassan		3136648495				3136645845	wabazid@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/28/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Contact for Fraud Investigations	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Coordination of Benefits Contact	VP- Claim Services		Palermo	Charles		2484438830					cpalermo@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Corporate Mailing						3136648048					kvanduse@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/23/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Manager	Ms.	Tran	Anh	K	2064533049					atran7@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Customer Service Operations Contact	Director	Ms	Pope	Venus		3136648933				3136648433	vpope@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/23/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	DIR Contact	Medicare Part D Manager		Smith	Leah		3136648724				3136645965	lsmith17@hap.org	2850 West Grand Blvd		Detroit	MI	48202	01/04/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	DIR Contact (Secondary)	Coor- Pharmacy Benefits		Peterson	Jennifer		3136648125					jpeterso@hap.org	2850 W Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Emergency Part D Contact	VP- Amb Clinical Pharmacy Svcs		Pirkola	Natalie		5865241175					npirkol2@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Emergency Part D Contact (Secondary)	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 West Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Employer Waiver Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Encounter Data & Risk Adjustment Operations Contact	Manager, RMRA Data Management & Analytics	Mr.	Voss	James		2487763480					jvoss3@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/27/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Enrollment Contact	Manager, Membership & Billing		Mullins	Rhonda		2484437532					rmullins@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/23/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	EOB Transfer Contact	Director, Producer Relations		Howard	Michelle		2484438530				2484438530	mhoward@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Financial Audit Contact	Director of Financial Operations	Mr.	Koslakiewicz	Glen		2484431094					gkoslaki@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Financial Reporting Contact	Principal Financial Analyst	Mr.	Puscas	Gerald		2484432023				2484431163	gpuscas@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Formulary Contact	Pharmacy Analyst		Wade	Marsalis		2487764726					mwade@hap.org	2850 West Grand Blvd		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Formulary Contact (Secondary)	Coordinator, Pharmacy Benefits		Yaldo	Traci		3136648607					tyaldo@hap.org	2850 West Grand Blvd		Detroit	MI	48202	07/23/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	General Contact	Director, Government Programs Compliance	Mr.	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/14/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Government Relations Contact	Director, Government Programs Compliance	Mr	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/17/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	HIPAA Privacy Officer	Interim	Ms	Skolnik	Johanna		3138746635					jskolni1@hfhs.org	One Ford Place, 2A		Detroit	MI	48202	07/30/2018	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	HIPAA Security Officer	Deputy Information Security Officer		Fowler	John		3138749150					jfowler2@hfhs.org	One Ford Place, 2A		Detroit	MI	48202	07/30/2018	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Hospice Contact	Medicare Part D Compliance Specialist		Smith	Leah		3136648724					lsmith17@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/31/2018	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Interoperability Contact	VP - Chief Information Officer		Marcath	Annette		3136648166					amarcath@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/12/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	MA Appeals/Grievances Contact	Interim Director		Krzyske	Heather		2485572370					hkrzyske@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/19/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	MA Claims Processing Contact for Public Website	Director, Claims Admin	Ms	Boyle	Therese		2484432035				3136648433	tboyle@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Marketing Contact	Dir- Digital Engagement		Donelko	Stephanie	C	2484434080					sdonelk1@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Medical Director	Chief Medical Officer	Dr.	Watson	Peter		2486633842					pwatson3@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	12/17/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Medicare Compliance Officer	Director	Mr.	Randle	Johnathan		5123507810					jrandle4@hap.org	1414 E Maple		Troy	MI	48303	08/25/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Medicare Coordinator	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Medicare Part D Opioid Overutilization Contact	Mgr. Pharmacy Benefits		Barta	Kelly		2487763556					kbarta@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Medication Therapy Management Contact	VP, Ambulatory Clinical Pharmacy Services		Pirkola	Natalie		2487764097					npirkol2@hap.org	2850 West Grand Blvd		Detroit	MI	48202	08/09/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	MMP Reporting Requirements Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@gmail.com	2850 W. Grand Blvd		Detroit	MI	48202	12/17/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	MMP Point of Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/17/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	OffShore Subcontractor Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Online Enrollment Center Contact (Back-up)	Dir, Commercial Enrollment		Rader	Tracie		2484431154					trader2@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	07/24/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Online Enrollment Center Contact (Optional)	Manager, Medicare Operations		Mullins	Rhonda		2484437532					rmullins@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	07/23/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Online Enrollment Center Contact (Primary)	Director, Producer Relations		Howard	Michelle		2484438530					mhoward@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/23/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part C Application Contact	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part C Reporting Contact	Director, Government Programs Compliance	Mr	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/17/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Appeals	Director - Utilization Management	Ms.	Krzyske	Heather							hkrzyske@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/08/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active	2485572370				Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Appeals Contact (Secondary)	Appeals and Grievance Manager		Baringhaus	Christophe							cbaringh@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active	2485573141				Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Application Contact	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Benefits Contact	Director-Product Development & Mgt.		Ems-McLaren	Angel		2484438583					amclaren@hap.org	2850 West Grand Blvd		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Claims Submission Contact	Medicare Part D Manager		Smith	Leah		3136648724					lsmith17@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/04/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Exceptions Contact	Medicare Part D Manager		Yaldo	Traci							tyaldo@hap.org	2850 West Grand Blvd		Detroit	MI	48202	01/04/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active	3136648607				Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Exceptions Contact (Secondary)	Mgr. Pharmacy Benefits		Barta	Kelly							kbarta@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active	2487763556				Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Price File Contact (Back-up)	Sr. Manager, Government Programs		Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/31/2018	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Price File Contact (Optional)	Coordinator, Pharmacy Benefits		Peterson	Jennifer		3136648125					jpeterso@hap.org	2850 West Grand Blvd.		Detroit	MI	48202	07/24/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Price File Contact (Primary)	Director, Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	7909 S Hardy Drive Suite 106		Tempe	AZ	85284	12/31/2018	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Quality Assurance Contact	Mgr. Pharmacy Benefits		Barta	Kelly		2487763556					kbarta@hap.org	2850 West Grand Blvd		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Part D Reporting Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 West Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Patient Safety Contact	VP-Amb Clinical Pharmacy Svcs		Pirkola	Natalie		3136648501					npirkol2@hap.org	2850 West Grand Blvd		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Payment Contact	VP-Financial Services		Ronan	Dianna		2484431093					dronan@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	05/10/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Personal Health Record Contact	Chief Information Officer		Marcath	Annette		3136648166					amarcath@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Pharmacy Director	VP, Pharmacy Health Plan Administration		Pirkola	Natalie		2487764097					npirkol2@hap.org	2850 West Grand Blvd		Detroit	MI	48202	12/14/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra		Kelly	Heather		3146921866					hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	12/31/2018	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Pharmacy Network Management Contact (Secondary)	Pharmacy Specialist		Webb	Marcia		3136648860					mwebb2@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	12/21/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Pharmacy Technical Help Desk Contact	Director of Customer Service		Monroe	LaTasha							latasha_monroe@express-scripts.com	13051 N. Telecom Parkway	Suite 150	Temple Terrace	FL	33637	12/14/2022	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active	8009221557				Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	PHR Beneficiary Contact																	07/23/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS	Health Alliance Plan of Michigan	Henry Ford Health System	122	Yes	Active	8008011770				Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Physician Incentive Contact	Director, Government Programs Compliance	Mr	Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/17/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Plan Directory Contact for Public Website	VP-Enterprise Operations		Spencer	Heather		2487763808					hspence2@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/03/2023	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Plan to Plan Reconciliation Contact	Financial Analyst	Ms.	NASSER	ZEINAT		2487764040					ZNASSER@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Processor Contact	Medicare Part D Manager		Smith	Leah		3136648724					lsmith17@hap.org	2850 West Grand Blvd		Detroit	MI	48202	01/04/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Quality Contact	Senior Director		Germain	Carrie		8102302299					cgermain@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	01/19/2021	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Reconciliation Contact	Director of Finance		Brennan	Mary		2484437849					mbrennan@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	03/18/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Reconciliation Contact (Secondary)	Finance Manager	Ms.	Tran	Anh	K	2064533049					atran7@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Recovery Audit Contact	Principal Financial Analyst	Mr.	Puscas	Gerald		2484432023				2484431163	gpuscas@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	SNP State Contact	Director, Medicaid		Davis	Nancy		2484438816					ndavis@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	12/17/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Surveillance Contact	Director, Government Programs Compliance		Randle	Johnathan		5123507810					jrandle4@hap.org	2850 W. Grand Blvd		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	System Contact	Chief Information Officer		Marcath	Annette		3136648166					amarcath@hap.org	2850 W. Grand Blvd.		Detroit	MI	48202	07/23/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Third Party Administrator (TPA) Liaison	Principal Financial Analyst	Mr.	Puscas	Gerald		2484432023					gpuscas@hap.org	1414 E MAPLE RD		TROY	MI	48083	09/14/2023	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	User Access Contact	Sr. Compliance Consultant		Burnett	Barb		8102302173					bburnett@hap.org	2050 S. Linden Road		Flint	MI	48532	10/15/2019	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Utilization Management Contact	VP Utilization Management		Bloom, M.D.	Charles		2485576298					cbloom@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9712	Utilization Review Contact	VP Utilization Management		Bloom, M.D.	Charles		2485576298					cbloom@hap.org	2850 West Grand Boulevard		Detroit	MI	48202	04/22/2020	2023	HAP EMPOWERED HEALTH PLAN, INC.	Demo	HAP Empowered MI Health Link	Medicare-Medicaid Plan HMO/HMOPOS		Henry Ford Health System	122	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	Chicago
H9725	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Backup User Access Contact	Administrative Assistant Senior Representative		Allen	Carolyn		6154287364					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Best Available Evidence Contact	Enrollment/Billing Manager	Ms.	Head	Ginean		6152349943					MAS.Reconciliation@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	1601 Chestnut St	Two Liberty	Philiadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	CEO - CMS Administrator Contact	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Chief Operating Officer	VP Operations	Mrs.	Caupp	Hollie	H	6367344252					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Chief Information Security Officer	SVP Chief Information Security Office	Mr	Beeson	James		8602260598					james.beeson@thecignagroup.com	900 Cottage Grove Rd		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Clarksville	TN	37042	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Contact for Fraud Investigations	Fraud Manager		Wentz	John		6156958962					john.wentz@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Coordination of Benefits Contact	Enrollment/Billing Manager		Holmes	Havannah		4436136304					havannah.holmes@healthspring.com	3601 O'Donnell Street		Baltimore	MD	21224	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Corporate Mailing						6155658100					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6232771178					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Customer Service Operations Contact	Customer Service Manager		Rich	Jared		6156364554					jared.rich@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Electronic Health Record Contact	Operations Director		McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cignahealthcare.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Encounter Data & Risk Adjustment Operations Contact	Business Analytics Sr Manager		White	Kevin		6152585176					kevin.white@cignahealthcare.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Enrollment Contact	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Hospice Contact	Enrollment/Billing Manager	Ms	Headd	Ginean		6152340043					Ginean.Headd@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	MA Appeals/Grievances Contact	Health Services Manager	Mr.	Starks	Jeffery		6156958988					Jeffrey.Starks@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	MA Claims Processing Contact for Public Website	Operations Senior Director	Mrs.	Gagnon	Nikki		8609076206					Nichole.Gagnon@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Marketing Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Online Enrollment Center Contact (Back-up)	Enrollment/Billing Senior Supervisor	Mrs.	Crawford	Lorraine		8609029598					Loraine.Crawford@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Online Enrollment Center Contact (Optional)	Compliance manager	Mrs.	Panich	Danielle		8049046922					Danielle.Panich@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Online Enrollment Center Contact (Primary)	Enrollment/Billing Senor manager	Mrs	Jackson	Tina		5714015655					Tina.Jackson@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Part C Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Part C Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H9725	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H9725	Part D Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	4805480643				HMO - Health Maintenance Organization		C	New York
H9725	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8609024668				HMO - Health Maintenance Organization		C	New York
H9725	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Part D Price File Contact (Primary)	Product Manager	Ms.	Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Personal Health Record Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H9725	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active	8603389867				HMO - Health Maintenance Organization		C	New York
H9725	Physician Incentive Contact	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Plan Directory Contact for Public Website	Customer Service Director	Mr.	Rich	Jared		8006683813				8887666403	LetUsHelpYou@healthspring.com	2800 North Loop West		Houston	TX	77092	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Processor Contact	Claims Manager		Cleere	Rebecca		7702613813					Rebecca.Cleere@Cigna.com	25500 Norterra Pkwy		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Quality Contact	Program Management Manager		Butler	Sean		8049046249					Shaun.Butler@Cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	SNP Application Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	SNP State Contact	Legal Compliance Manager	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Utilization Management Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9725	Utilization Review Contact	Operations Director	Mrs.	McCoy	Cindy		8045462626					Cynthia.McCoy@cigna.com	500 Great Circle Road		Nashville	TN	37228	08/10/2023	2023	CIGNA HEALTHCARE OF NORTH CAROLINA, INC.	Local CCP	Cigna Healthcare	HMO/HMOPOS		The Cigna Group	38	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9730	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/28/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/27/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H9730	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H9730	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8334449089				HMO - Health Maintenance Organization		C	Dallas
H9730	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9730	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH INSURANCE COMPANY OF KENTUCKY, INC	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9761	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/28/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H9761	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H9761	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H9761	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H9761	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H9761	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active	8555380454				PPO - BBA		C	Dallas
H9761	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8334449088				PPO - BBA		C	Dallas
H9761	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9761	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE HEALTH PLANS OF MASSACHUSETTS, INC.	Local CCP	Wellcare	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9763	Agent/Broker Compensation Data Contact	Vice President - Sales & Marketing		Redmann	Rick		5043543668					richard.redmann@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Automated TrOOP Balance Transfer Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Backup User Access Contact	AVP, Compliance & Privacy Officer		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Best Available Evidence Contact			Davis	Thomas		5709034772					thomas.davis@cognizant.com	Cognizant	25 Lakeview Dr.	Jessup	PA	18434	02/15/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Bid Audit Contact	Chief Financial Officer - OHP		Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/23/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Bid Audit Site Contact	Chief Financial Officer - OHP		Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/23/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Bid Primary Contact	Chief Financial Officer - OHP		Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/23/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	CAP Report Contact for Public Website	AVP, Compliance & Privacy Officer		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Fernandez	Jeffrey		5046099209					jeffrey.fernandez@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	10/24/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Fernandez	Jeffrey		5046099209					jeffrey.fernandez@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	10/24/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Chief Financial Officer	Chief Financial Officer - OHP	Ms.	Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/23/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Chief Operating Officer	Chief Financial Officer - OHP	Ms.	Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	09/01/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Chief Information Officer	AVP, Compliance & Privacy Officer	Ms.	Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	08/11/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Chief Information Security Officer	AVP, Compliance & Privacy Officer	Ms.	Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	08/11/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	CMS Casework Communication Contact	AVP, Compliance & Privacy Officer		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Complaints Tracking Contact	AVP, Compliance & Privacy		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Contact for Fraud Investigations	AVP, Compliance & Privacy		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Coordination of Benefits Contact	VP, Operations		Jennings	Donna		6784589830					donna.jennings@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Corporate Mailing						8666247637					OHPInfo@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer - OHP		Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/07/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Customer Service Operations Contact	VP, Operations		Jennings	Donna		6784589830					donna.jennings@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/01/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	DIR Contact	Chief Financial Officer  OHP		Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	02/04/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	DIR Contact (Secondary)	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	02/23/2023	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Emergency Part D Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Encounter Data & Risk Adjustment Operations Contact			Jallepalli	Arun Kumar		6025240780					ArunKumar.Jallepalli@Cognizant.com	Cognizant	25 Lakeview Dr.	Jessup	PA	18434	02/15/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Enrollment Contact	Enrollment Manager		Legette	Chaz		3154917909					chaz.legette@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	07/28/2023	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	EOB Transfer Contact	Medicare Program Manager		Perez	Mary		8582915238				8587906044	mary.perez@medimpact.com	MedImpact	10181 Scripps Gateway Ct.	San Diego	CA	92131	03/07/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Financial Audit Contact	Chief Financial Officer - OHP	Ms.	Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/23/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Financial Reporting Contact	Chief Financial Officer - OHP		Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/23/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Formulary Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Formulary Contact (Secondary)	Manager, Formulary Administration & Maintenance		Nyawabila	Christina		8587906297					FAS@MedImpact.com	MedImpact	10181 Scripps Gateway Ct	San Diego	CA	92131	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	General Contact	AVP, Compliance & Privacy Officer		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Government Relations Contact	AVP, Compliance & Privacy Officer		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	HIPAA Privacy Officer	AVP, Compliance & Privacy Officer		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	HIPAA Security Officer	AVP, Compliance & Privacy Officer		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Hospice Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Interoperability Contact	AVP, Compliance & Privacy Officer		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	MA Appeals/Grievances Contact	Manager, Appeals and Grievances		West	Melissa		5047547087					melissa.west@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/24/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	MA Claims Processing Contact for Public Website			Services	Member		8336742112					OHPInfo@ochsner.org	PO Box 3447		Scranton	PA	18505	02/14/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Marketing Contact	Vice President - Sales & Marketing		Redmann	Rick		5043543668					richard.redmann@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Medical Director	Interim Medical Director	Dr.	Raymond	Sidney	H	5043883496					sidney.raymond@ochsner.org	1450 Poydras St.	Suite 151	New Orleans	LA	70112	07/28/2023	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Medicare Compliance Officer	AVP, Compliance & Privacy Officer	Mrs.	Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Medicare Coordinator	Sr. Compliance Specialist		Vanover	Jessica		5049206024					jessica.vanover@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/07/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Medicare Part D Opioid Overutilization Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Medication Therapy Management Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	OffShore Subcontractor Contact	Sr. Compliance Specialist		Vanover	Jessica		5049206024					jessica.vanover@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Part C Application Contact	AVP, Compliance & Privacy Officer		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Part C Reporting Contact	Sr. Compliance Specialist		Vanover	Jessica		5049206024					jessica.vanover@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	09/01/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Part D Appeals	MedImpact Appeals & Grievances Manager		Martin	Dawn							dawn.martin@medimpact.com	MedImpact	10181 Scripps Gateway Ct.	San Diego	CA	92131	02/07/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active	8009101837				HMO - Health Maintenance Organization		C	Denver
H9763	Part D Application Contact	AVP, Compliance & Privacy Officer		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Part D Benefits Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Part D Claims Submission Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Part D Exceptions Contact	MedImpact Director PA & UM Programs		Emoto	Julianne							julianne.emoto@medimpact.com	MedImpact	10181 Scripps Gateway Ct.	San Diego	CA	92131	02/07/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active	8009101837				HMO - Health Maintenance Organization		C	Denver
H9763	Part D Price File Contact (Back-up)	Medicare Part D Project Manager		Niemi	Kirstin		8587906455					PlanFinderCommunications@MedImpact.com	MedImpact	10181 Scripps Gateway Ct	San Diego	CA	92131	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Part D Price File Contact (Optional)	Account Executive		Mellor	Cheri		8582264853					cheri.mellor@medimpact.com	MedImpact	10181 Scripps Gateway Ct	San Diego	CA	92131	07/07/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Part D Price File Contact (Primary)	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Part D Quality Assurance Contact	AVP, Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.com	1450 Poydras St.	Suite 110	New Orleans	LA	70112	07/28/2023	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Part D Reporting Contact	Sr. Compliance Specialist		Vanover	Jessica		5049206024					jessica.vanover@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	09/08/2023	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Patient Safety Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Payment Contact	Chief Financial Officer - OHP		Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Pharmacy Director	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Pharmacy Network Management Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Pharmacy Network Management Contact (Secondary)	Director Configuration Services		Dunnum	Shawn		8587907454					Shawndunnum@MedImpact.com	MedImpact	10181 Scripps Gateway Ct	San Diego	CA	92131	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Pharmacy Technical Help Desk Contact			Technical Help Desk	Pharmacy							Customerservice@Medimpact.com	MedImpact	10181 Scripps Gateway Ct.	San Diego	CA	92131	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active	8009101837				HMO - Health Maintenance Organization		C	Denver
H9763	Plan Directory Contact for Public Website			Services	Member		8336742112					OHPInfo@ochsner.org	PO Box 3447		Scranton	PA	18505	01/20/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Plan to Plan Reconciliation Contact	Chief Financial Officer - OHP		Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Processor Contact	VP, Operations		Jennings	Donna		6784589830					donna.jennings@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/01/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Quality Contact	AVP, Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	07/28/2023	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Reconciliation Contact	Chief Financial Officer - OHP		Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	02/23/2023	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Reconciliation Contact (Secondary)	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	02/23/2023	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Recovery Audit Contact	AVP, Compliance & Privacy Officer	Ms.	Geter	Stefani		5047034931					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	02/04/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Surveillance Contact	Vice President - Sales & Marketing		Redmann	Rick		5043543668					richard.redmann@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	System Contact	AVP, Compliance & Privacy Officer		Geter	Stefani		5047034937					stefani.geter@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Third Party Administrator (TPA) Liaison	Chief Financial Officer - OHP		Blume	Lisa		5043543718					lblume@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/23/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	User Access Contact	Sr. Compliance Specialist		Vanover	Jessica		5049206024					jessica.vanover@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Utilization Management Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	12/14/2021	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9763	Utilization Review Contact	AVP, OHP Medical Affairs		Bayham	Alan		5047033913					alan.bayham@ochsner.org	1450 Poydras St.	Suite 110	New Orleans	LA	70112	01/21/2022	2023	OCHSNER HEALTH PLAN, INC.	Local CCP	Ochsner Health Plan	HMO/HMOPOS		Ochsner Clinic Foundation	775	Yes	Active					HMO - Health Maintenance Organization		C	Denver
H9808	Agent/Broker Compensation Data Contact	Director, Sales & Marketing		Dunn	John		3363651395					jdunn@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Automated TrOOP Balance Transfer Contact	Manager, Business Systems & Data		Rao	Chanukya		5088046892					chanukya.rao@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Backup User Access Contact	Chief Pharmacy Officer	Dr	Homer	Deanna	M	3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Best Available Evidence Contact	Business Analyst		Bhupatiraju	Adarsh		5088047430	7260				Adarsh.Bhupatiraju@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Bid Audit Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Bid Primary Contact	Chief Financial Officer		Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	CAP Report Contact for Public Website	President & CEO		Hodges	Brendan		3367904392					bhodges@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	CEO - CMS Administrator Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	CEO - Senior Official for Contracting	President	Mr.	Hodges	Brendan		3367904392					bhodges@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Chief Financial Officer	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Chief Operating Officer	Vice President of Operations	Ms.	Katula	Joleen		3367904378					jkatula@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Chief Information Officer	Director of IT	Mr	Soomro	Sikander		8135028100					ssoomro@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Chief Information Security Officer	Director of IT	Mr	Soomro	Sikander		8135028100					ssoomro@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	CMS Casework Communication Contact	Director of Operations		Leppin	Amy		3366600562					aleppin@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Complaints Tracking Contact	Director of Operations		Leppin	Amy		3366600562					aleppin@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Contact for Fraud Investigations	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Coordination of Benefits Contact	Manager, Business Systems  & Data		Rao	Chanukya		5088046892					chanukya.rao@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Corporate Mailing						3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Customer Service Operations Contact	Director of Operations	Ms.	Velez	Ashley		8889651965					avelez@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	DIR Contact	Chief Administrative Officer		Wickremeratne	Aruna		5088046923					aruna.w@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	DIR Contact (Secondary)	Manager, Pharmacy Network Analytics		Chaudhary	Sudhakar		5085973931					sudhakar.chaudhary@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Emergency Part D Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Emergency Part D Contact (Secondary)	Pharmacy Manager	Dr.	Ruedinger	Kevin		3366602249					kruedinger@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Encounter Data & Risk Adjustment Operations Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Enrollment Contact	Manager, Business Systems & Data		Rao	Chanukya		5088046892					chanukya.rao@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	EOB Transfer Contact	Manager of Benefits & Implementations		Ika	Amit		5088046961				5088046961	amit.ika@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Financial Audit Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Financial Reporting Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Formulary Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna	M	9546127434					dhomer@htanc.com	300 East Wendover Avenue	STE 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Formulary Contact (Secondary)	Clinical Account Manager		Murray	Andy		7863018823					andy.murray@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	03/21/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	General Contact	President & CEO		Hodges	Brendan		3367904392					bhodges@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Government Relations Contact	President & CEO		Hodges	Brendan		3367904392					bhodges@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	HIPAA Privacy Officer	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	HIPAA Security Officer	Director of IT	Mr	Soomro	Sikander		8135028100					ssoomro@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Hospice Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Interoperability Contact	Director of IT	Mr	Soomro	Sikander		8135028100					ssoomro@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	MA Appeals/Grievances Contact	Director of Operations		Leppin	Amy		3366600562					aleppin@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	MA Claims Processing Contact for Public Website	Director of Operations		Leppin	Amy		3366600562					aleppin@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Marketing Contact	Medicare Marketing & Communications Manager		Robbins	Nan		3368604098					nrobbins@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Medical Director	Medical Director	Dr.	Evans	Stephen		3369006094					sevans@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Medicare Compliance Officer	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Medicare Coordinator	VP of Operations		Katula	Joleen		3367904378					jkatula@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Medicare Part D Opioid Overutilization Contact	Pharmacy Manager	Dr.	Ruedinger	Kevin		3366602249					kruedinger@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Medication Therapy Management Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna	M	3367904385					dhomer@htanc.com	300 East Wendover Avenue	STE 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	OffShore Subcontractor Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Online Enrollment Center Contact (Back-up)	Manager, Business Systems & Data		Rao	Chanukya		5088046892				5088046892	chanukya.rao@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Online Enrollment Center Contact (Primary)	Director, IT Operations		Inavilli	Ram		5088046964					ram.inavilli@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	01/11/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Part C Application Contact	Manager of Product Development		McCloy	Tracey		3367904525					tmccloy@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Part C Reporting Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Part D Appeals	Pharmacy Manager	Dr.	Ruedinger	Kevin							kruedinger@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active	3366602249				PPO - BBA		C	Atlanta
H9808	Part D Appeals Contact (Secondary)	Chief Pharmacy Officer	Dr	Homer	Deanna							dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active	3367904385				PPO - BBA		C	Atlanta
H9808	Part D Application Contact	Manager of Product Development		McCloy	Tracey		3367904525					tmccloy@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Part D Benefits Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Part D Claims Submission Contact	Manager, Business Systems & Data		Rao	Chanukya		5088046892					chanukya.rao@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Part D Exceptions Contact	Senior Manager, PA Operations		Davies	Brian						8668718565	Brian.davies@rxadvance.com	136 Turnpike Road		Southborough	MA	01772	05/24/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active	8002371992				PPO - BBA		C	Atlanta
H9808	Part D Exceptions Contact (Secondary)	Pharmacy Manager		Ruedinger	Kevin							kruedinger@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active	3366602249				PPO - BBA		C	Atlanta
H9808	Part D Price File Contact (Back-up)	Manager, Pharmacy Network Analytics		Chaudhary	Sudhakar		5085973931					sudhakar.chaudhary@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Part D Price File Contact (Optional)	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Part D Price File Contact (Primary)	Technical Business Analyst		Parmar	Vihan		5085973999					vihan.parmar@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Part D Quality Assurance Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Part D Reporting Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Patient Safety Contact	Pharmacy Manager		Ruedinger	Kevin		3366602249					kruedinger@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Payment Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Pharmacy Director	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Pharmacy Network Management Contact	Chief Administrative Officer		Wickremeratne	Aruna		5088046923					aruna.w@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Pharmacy Network Management Contact (Secondary)	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Pharmacy Technical Help Desk Contact	VP of Consumer Services		Kota	Rupa							rupa.kota@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active	8002371992				PPO - BBA		C	Atlanta
H9808	Pharmacy Technical Help Desk Contact (Secondary)	Chief Pharmacy Officer	Dr.	Homer	Deanna							dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active	3367904385				PPO - BBA		C	Atlanta
H9808	Plan Directory Contact for Public Website			Service	Customer		8889651965					conciergehta@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Plan to Plan Reconciliation Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Processor Contact	Technical Business Analyst		Vichare	Devyani		5088047328					devyani.vichare@nirvanahealth.com	136 Turnpike Road		Southborough	MA	01772	12/12/2022	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Quality Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Reconciliation Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Recovery Audit Contact	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	SNP Application Contact	Chief Pharmacy Officer	Dr.	Homer	Deanna		3367904385					dhomer@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Surveillance Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	System Contact	Director of IT	Mr	Soomro	Sikander		8135028100					ssoomro@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Ms.	Donoghue	Trish		3367904386					tdonoghue@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	User Access Contact	VP of Compliance	Mr	Tran	Triet		3072502082					ttran@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Utilization Management Contact	Medical Director	Dr.	Evans	Steve		3366606094					sevans@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9808	Utilization Review Contact	Medical Director	Dr.	Evans	Steve		3366606094					sevans@htanc.com	300 East Wendover Avenue	Suite 121	Greensboro	NC	27401	06/02/2023	2023	CARE N' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local CCP	CARE N'' CARE INSURANCE COMPANY OF NORTH CAROLINA	Local PPO		HTA Holdings, LLC	623	Yes	Active					PPO - BBA		C	Atlanta
H9811	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	04/02/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8778937277				HMO - Health Maintenance Organization		C	Dallas
H9811	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	08/14/2017	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	11/26/2019	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/15/2016	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/15/2016	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Medical Director	Chief Medical Director	Dr	Erwin	Jeremy		6018636724	66948				werwin@centene.com	11 East Capitol St	Suite 500	Jackson	MS	39201	03/30/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Part C Application Contact	Director, Medicare Strategy		Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Application Contact	Director, Medicare Strategy		Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	02/15/2016	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H9811	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8888656567				HMO - Health Maintenance Organization		C	Dallas
H9811	PHR Beneficiary Contact																	09/27/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8447867711				HMO - Health Maintenance Organization		C	Dallas
H9811	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Plan Directory Contact for Public Website			Services	Member		8779358023					CorporateMedicareComplianceDept@CENTENE.COM	5900 E. Ben White Blvd.		Austin	TX	78741	03/31/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	SNP Application Contact	Director, Medicare Strategy		Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9811	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	MAGNOLIA HEALTH PLAN, INC.	Local CCP	Wellcare by Allwell	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Agent/Broker Compensation Data Contact	VP, Business & Product Development	Ms.	Richardson	Deilasheun		7132952306					deilasheun.richardson@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	06/15/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Automated TrOOP Balance Transfer Contact		Mr.	Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	07/30/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Backup User Access Contact	Senior IT Security and Data Governance Coordinator		Hobbs	Richard		7132952313					richard.hobbs@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/23/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Best Available Evidence Contact	Director, Operations Strategy		Olatunbosun	Evelyn		7132952324				7132957041	evelyn.olatunbosun@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/23/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Bid Audit Contact	CFO	Ms.	Mateja	Anna		7132954733					anna.mateja@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	03/23/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Bid Audit Site Contact	Chief Financial Officer		Mateja	Anna		7132954733					anna.mateja@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	09/26/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Bid Primary Contact	VP, Product and Business Development		Richardson	DeiLaSheun		7132952306					deilasheun.richardson@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	06/15/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	CAP Report Contact for Public Website	Director of Compliance- Fedreal Programs	Ms.	Savoy	Vernisha		7133145669					vernisha.savoy@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	04/11/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	CEO - CMS Administrator Contact	President and CEO	Mrs.	Wright	Lisa		7132952410					lisa.wright@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	05/06/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	CEO - Senior Official for Contracting	President and CEO	Mrs.	Wright	Lisa		7132952410					lisa.wright@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	05/06/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Chief Financial Officer	Chief Financial Officer	Mrs.	Mateja	Anna		7132952238					Anna.Mateja@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/18/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Chief Operating Officer	Chief Operations Officer	Ms.	Levernmann	Laurie		7132955015					laurie.levermann@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	06/15/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Chief Information Officer	Chief Information Officer	Mrs.	Levermann	Laurie		7132955015					laurie.levermann@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/23/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Chief Information Security Officer	Information/HIPPA Security Officer	Mr.	Hobbs	Richard		7132952226					richard.hobbs@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	03/31/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	CMS Casework Communication Contact	Director of Compliance, Regulatory		Beene	Delwin		7132952232					delwin.beene@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/23/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Complaints Tracking Contact	Director of Compliance, Regulatory		Beene	Delwin		7132952232					delwin.beene@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/23/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Contact for Fraud Investigations	Director of Special Investigations		Lopez	Andrea		7132956753					andrea.lopez@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	04/15/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Coordination of Benefits Contact	Director of Claims		Dalcour	Gwendolyn		7132952384					gwendolyn.dalcour@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/23/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Corporate Mailing						7132952350					info@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/01/2019	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mrs.	Mateja	Anna		7132952238					Anna.Mateja@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/18/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Customer Service Operations Contact	Sr. Director, Contact Center	Mrs.	Ziegler	Tonie		7132952235					tonie.ziegler@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	09/26/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	DIR Contact	CFO	Ms.	Mateja	Anna		7132952238					anna.mateja@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	03/23/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	DIR Contact (Secondary)	Accounting Manager		Gulley	Bridget		7138486697					bridget.gulley@communityhealthchoice.org	2636 South Loop		Houston	TX	77049	06/15/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Electronic Health Record Contact	Director of Care Management		Greene	Celeste		7133145997					celeste.greene@communityhealthchoice.org	2636 S. Loop West	Ste 125	Houston	TX	77054	09/26/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Emergency Part D Contact	Pharmacy Director	Dr.	Tran-Tan	Khang		7132956791					Khang.Tran-Tan@CommunityHealthChoice.org	2636 S. Loop West	Ste 125	Houston	TX	77054	10/27/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Emergency Part D Contact (Secondary)	Chief Medical Officer	Dr.	Buyse	Marylou		7132954748					marylou.buyse@communityhealthchoice.org	2636 South Loop W FWY	Unit 125	Houston	TX	77054	10/27/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Encounter Data & Risk Adjustment Operations Contact	Senior Manager, EDI		Mickle	Kenny		7132952259					Kenny.Mickle@CommunityHealthChoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/03/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Enrollment Contact	Enrollment Manager		Byrd	Maria		7133145667					maria.byrd@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	07/23/2019	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	EOB Transfer Contact	Director of Claims		Dalcour	Gwendolyn		7132952384				7132957023	gwendolyn.dalcour@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/23/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Financial Audit Contact	CFO	Mrs.	Mateja	Anna		7132952238					Anna.Mateja@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	04/11/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Financial Reporting Contact	CFO	Mrs.	Meteja	Anna		7132952330					anna.mateja@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	03/23/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Formulary Contact	Pharmacy Director	Dr.	Tran-Tan	Khang		7132956791					Khang.Tran-Tan@CommunityHealthChoice.org	2636 S. Loop West	Ste 125	Houston	TX	77054	10/27/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Formulary Contact (Secondary)	Formualry Team Lead		Paddock	Deanna		6087291628				6087292628	deanna.paddock@navitus.com	361 Integrity Dr.		Madison	WI	53717	05/06/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	General Contact	Director of Compliance, Federal Programs	Mrs.	Savoy	Vernisha		7133145669					vernisha.savoy@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	10/05/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Government Relations Contact	Director of Compliance, Federal Programs	Ms.	Savoy	Vernisha		7133145669					vernisha.savoy@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	04/11/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	HIPAA Privacy Officer			Hobbs	Richard		7132952226					richard.hobbs@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	03/31/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	HIPAA Security Officer		Mr.	Hobbs	Richard		7132952226					richard.hobbs@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	03/31/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Hospice Contact	Director, Care Management		Green	Celeste		7132956791					celeste.green@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/03/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Interoperability Contact			Leverman	Laurie		7132955015					Laurie.Levermann@CommunityHealthChoice.org	2636 South Loop West		Houston	TX	77054	02/18/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	MA Appeals/Grievances Contact	Sr. Manager of Appeals & Complaints		Point	Beth		7132952350					beth.point@communityhealthchoice.org	2636 South Loop W	Suite 125	Houston	TX	77054	09/26/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	MA Claims Processing Contact for Public Website	Director of Claims		Dalcour	Gwendolyn		7132952384					gwendolyn.dalcour@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	09/21/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Marketing Contact	Sr. Director of Marketing		Pineda	Claudia		7132952327					claudia.pineda@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	06/15/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Medical Director	Chief Medical Officer	Dr.	Buyse	Marylou		7132954748					marylou.buyse@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	10/27/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Medicare Compliance Officer	Director of Compliance - Federal Programs	Ms.	Savoy	Vernisha	R	7133145669					vernisha.savoy@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	04/11/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Medicare Coordinator	Director of Compliance, Federal Programs	Ms.	Savoy	Vernisha		7133145669					vernisha.savoy@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	10/27/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Medicare Part D Opioid Overutilization Contact	Pharmacy Director	Dr.	Tran-Tan	Khang		7132956791					Khang.Tran-Tan@CommunityHealthChoice.org	2636 S. Loop West	Ste 125	Houston	TX	77054	10/27/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Medication Therapy Management Contact	Pharmacy Director	Dr.	Tran Tan	Khang		7132956791					Khang.tran-tan@communityhealthchoice.org	2636 S. Loop West	Ste 125	Houston	TX	77584	10/27/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	OffShore Subcontractor Contact	Chief Compliance Officer	Mr.	Barzman	Daniel		7133144735					daniel.barzman@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	09/26/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Online Enrollment Center Contact (Back-up)	Eligibility Supervisor		Bryd	Maria		7132954772					maria.bryd@communityhealthchoice.org	2636 S. Loop West	Ste 125	Houston	TX	77054	03/31/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Online Enrollment Center Contact (Optional)			Bryd	Maria		7132954772					maria.bryd@communityhealthchoice.org	2636 S. Loop West	Ste 125	Houston	TX	77054	03/31/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Online Enrollment Center Contact (Primary)	Enrollment Manager		Byrd	Maria		7133145667					maria.byrd@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	07/23/2019	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Part C Application Contact	Director of Compliance, Federal Programs	Ms.	Savoy	Vernisha		7132954735					vernisha.savoy@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	06/15/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Part C Reporting Contact	Senior Compliance Auditor	Ms.	Grimes	TaCillia		7133145669					tacilla.grimes@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	03/23/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Part D Appeals	Sr. Manager Appeals and Complaints	Mrs.	Point	Beth						7132957033	beth.point@communityhealthchoice.org	2636 S. Loop West	Suite 125	Houston	TX	77054	02/03/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active	7132952350				HMO - Health Maintenance Organization		C	Dallas
H9826	Part D Appeals Contact (Secondary)			Tran-Tan	Khang							khang.tran-tan@communityhealthchoice.org	2636 S. Loop West	Suite 125	Houston	TX	77054	12/31/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active	7132956791				HMO - Health Maintenance Organization		C	Dallas
H9826	Part D Application Contact	Chief Growth Officer	Mr.	Maddox	Sonya		7133144735					sonya.maddox@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/03/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Part D Benefits Contact	Pharmacy Director		Tran-Tan	Khang		7132956791					Khang.Tran-Tan@CommunityHealthChoice.org	2636 S. Loop West	Ste 125	Houston	TX	77054	04/15/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Part D Claims Submission Contact			Derks	Bob		9202214404				9202214904	pde@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/02/2019	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Part D Exceptions Contact			LeClair	Chris						9202214676	christopher.LeClair@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	07/30/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Dallas
H9826	Part D Price File Contact (Back-up)			Plan Finder	Navitus		6087291578				6087292578	plan.finder@navitus.com	2601 West Beltline Highway	Suite 600	Madison	WI	53713	02/02/2019	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	plan.finder@navitus.com	361 Integrity Drive		Madison	WI	53717	07/30/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Part D Quality Assurance Contact	Pharmacy Director		Tran-Tan	Khang		7132956791					Khang.Tran-Tan@CommunityHealthChoice.org	2636 S. Loop West	Ste 125	Houston	TX	77054	04/15/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Part D Reporting Contact	Pharmacy Director		Tran Tan	Khang		7132956791					Khang.Tran-Tan@CommunityHealthChoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/25/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Patient Safety Contact	Chief Medical Officer	Dr.	Buyse	Marylou		7132954748					marylou.buyse@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/03/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Payment Contact	Chief Financial Officer	Mrs.	Mateja	Anna		7132952238					Anna.Mateja@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/18/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Pharmacy Director	Pharmacy Director		Tran-Tan	Khang		7132956791					Khang.Tran-Tan@CommunityHealthChoice.org	2636 S. Loop West	Ste 125	Houston	TX	77054	04/15/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Pharmacy Network Management Contact	Associate Director, Pharmacy Network		Burdick	Tammy	~	9202214089				9202214589	tammy.burdick@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	07/30/2020	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Pharmacy Technical Help Desk Contact	Sr. Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/16/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Dallas
H9826	Plan Directory Contact for Public Website	Senior Technical Writer		Schoech	Tawnya		7133145667					tawnya.schoech@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	03/30/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Plan to Plan Reconciliation Contact	Manager of Financial Operations	Mrs.	Chan	Kimberly		7132952238					Kimberly.Chan@CommunityHealthChoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	04/11/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Processor Contact	Director of Compliance, Federal Programs	Ms.	Savoy	Vernisha		7132954735					vernisha.savoy@CommunityHealthChoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	04/11/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Quality Contact	Director of Quality		Otto	Melanye		7132955677					melanye.otto@CommunityHealthChoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	10/08/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Reconciliation Contact	Accounting Manager	Mrs.	Chan	Kim		7132952330					kimberly.chan@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	06/15/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Reconciliation Contact (Secondary)	Controller	Ms.	Nguyen	Sue		7132952330					sue.nguyen@communityhealthchoice.org	2636 S. Loop West	Suite 125	Houston	TX	77054	09/26/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Recovery Audit Contact	Director of Compliance - Federal Programs	Mr.	Savoy	Vernisha		7132956733					vernisha.savoy@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	04/11/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	SNP Application Contact	Director of Compliance- Federal Programs	Ms.	Savoy	Vernisha		7133145669					vernisha.savoy@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	04/11/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	SNP State Contact	Director of Compliance - Federal Programs	Ms.	Savoy	Vernisha		7133145669					vernisha.savoy@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	04/11/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Surveillance Contact	Director of Compliance- Federal Programs	Ms.	Savoy	Vernisha		7132954735					vernisha.savoy@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	04/11/2023	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	System Contact			Levermann	Laurie		7132955015					laurie.levermann@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	12/31/2019	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Third Party Administrator (TPA) Liaison		Mrs.	Mateja	Anna		7132952238					Anna.Mateja@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	02/18/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	User Access Contact	Director of Compliance, Federal Programs	Mrs.	Savoy	Vernisha		7133145669					vernisha.savoy@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	10/05/2021	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Utilization Management Contact	Director of Care Management	Mrs.	Greene	Celeste		7133145697					celeste.greene@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	09/26/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9826	Utilization Review Contact	Director of Care Management	Mrs.	Greene	Celeste		7133145697					celeste.greene@communityhealthchoice.org	2636 South Loop West	Suite 125	Houston	TX	77054	09/26/2022	2023	COMMUNITY HEALTH CHOICE TEXAS, INC.	Local CCP	Community Health Choice	HMO/HMOPOS		Harris County Hospital District	724	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9827	Agent/Broker Compensation Data Contact	Director of Sales		Dues	Travis		6145463157				6145463131	Travis.Dues@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Automated TrOOP Balance Transfer Contact	Part D Analyst		Houk	Kim		6145463183				6145463131	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Backup User Access Contact	Sr. Application Specialist		Crawford	Carl		6145463215				6145463144	ccrawford@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Best Available Evidence Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Bid Audit Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463211	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Bid Audit Site Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Bid Primary Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	CAP Report Contact for Public Website	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	CEO - CMS Administrator Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	Jack.Randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	CEO - Senior Official for Contracting	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Chief Financial Officer	Chief Financial Officer	Mr	Vis	David		6145463211				6145463131	david.vis@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Chief Operating Officer	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Chief Information Officer	VP Service Optimization	Mr.	Trimmer	Matt		3017547190					matt.trimmer@trinity-health.org	3100 Easton Square Place		Columbus	OH	43219	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Chief Information Security Officer	Sr Security Manager, Enterprise Information Securi	Mr.	Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	CMS Casework Communication Contact	Compliance Specialist	Mr.	Jordan	David	A	6147068474				6142348372	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Complaints Tracking Contact	Compliance Specialist	Mr	Jordan	David	A	6147068474					djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Contact for Fraud Investigations	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Coordination of Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Corporate Mailing						4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Coverage Gap Discount Program (CGDP) Payment Contact	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Customer Service Operations Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	DIR Contact	CEO		Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square  Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	DIR Contact (Secondary)	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Electronic Health Record Contact	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Emergency Part D Contact	Chief Compliance Officer		Suffern	Patricia		4124780244				6145463132	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	12/23/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Emergency Part D Contact (Secondary)	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Employer Waiver Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Reconciliation Analyst		Sloan	Mike		6145463134					mike.sloan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Enrollment Contact	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	EOB Transfer Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Financial Audit Contact	Chief Administration Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Financial Reporting Contact	CEO	Mr.	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Formulary Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Formulary Contact (Secondary)	Director, Pharmacy		Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	General Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Government Relations Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	HIPAA Privacy Officer	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	HIPAA Security Officer	Sr Security Manager, Enterprise Information Securi		Enneking	Tom		6145463668					tenneking@mchs.com	3100 Easton Square Place		Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Hospice Contact	Senior Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Interoperability Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	MA Appeals/Grievances Contact	Senior Director, Member and Provider Services		Schlabach	Marilyn		6145463180				6145463132	mschlabach@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	MA Claims Processing Contact for Public Website	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Marketing Contact	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Medical Director	MD	Dr.	Wise	Greg		6145463151				6145463131	gwise@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Medicare Compliance Officer	Chief Compliance Officer	Ms	Suffern	Patricia		4124780244					patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Medicare Coordinator	Chief Administrative Officer	Mr	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Medicare Part D Opioid Overutilization Contact	Pharmacy Data Analyst	Ms.	Houk	Kimberly		6145463183					kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Medication Therapy Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	OffShore Subcontractor Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Online Enrollment Center Contact (Back-up)	Supervisor, Enrollment	Ms	Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Online Enrollment Center Contact (Optional)	Director, Enrollment and Premium Billing		Caudle	Jeff		6145463224				6145463148	jcaudle@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Online Enrollment Center Contact (Primary)	Manager, Enrollment & Reconciliation		Buddell	Natasha		6145463222				6145463148	nbuddell@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Part C Application Contact	Director, Product Management and Business Devlpt		Mauck	Brandon		6145955681					brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Part C Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Part D Appeals	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H9827	Part D Appeals Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H9827	Part D Application Contact	Director, Product Management and Business Dvlpt		Mauck	Brandon		6145955681				6145463131	brandon.mauck@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	03/29/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Part D Benefits Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Part D Claims Submission Contact	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Part D Exceptions Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H9827	Part D Exceptions Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim						6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H9827	Part D Price File Contact (Back-up)	Formulary Consultant		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea		Scottsdale	AZ	85260	07/17/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Part D Price File Contact (Primary)	Pharmacy Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Part D Quality Assurance Contact	Director of Pharmacy, Health Plans		Turoff	Chris		6144030394				6142346481	chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Part D Reporting Contact	Compliance Specialist		Jordan	David		6145463431				6145463131	djordan@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Patient Safety Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Payment Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Pharmacy Director	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Pharmacy Network Management Contact	Director, Pharmacy	Mr	Turoff	Chris		6144030394					chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Pharmacy Network Management Contact (Secondary)	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Pharmacy Technical Help Desk Contact	Director, Pharmacy	Mr	Turoff	Chris							chris.turoff@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H9827	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Data Analyst	Mrs	Miller	Kim							kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Chicago
H9827	PHR Beneficiary Contact																	01/29/2021	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS	MediGold	Trinity Health Corporation	234	Yes	Active	8002403851				HMO - Health Maintenance Organization		C	Chicago
H9827	Physician Incentive Contact	Interim VP, Health Services	Ms	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Plan Directory Contact for Public Website	Medicare Compliance Officer		Suffern	Patricia		4124780244				6145463131	patricia.suffern@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Plan to Plan Reconciliation Contact	Pharmacy Data Analyst		Houk	Kim		6145463183				6145463132	kulrich@Medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Processor Contact	Director, Claims Operations & System Configuration	Mr.	Conner	Jason		7409721492					jconner@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	01/03/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Quality Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Reconciliation Contact	CEO	Mr	Randolph	John	C	6145463152				6145463131	jack.randolph@MediGold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Reconciliation Contact (Secondary)	Controller		Ndoye	Fatou		6145463707					fatou.ndoye@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Recovery Audit Contact	Chief Administrative Officer	Mr.	Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Surveillance Contact	Chief Administration Officer		Alvarado	Chuck		6145463794					Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	System Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	Chuck.Alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Third Party Administrator (TPA) Liaison	Sr Finance Analyst		Fountain	Lisa		6145463220					lfountain@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	09/14/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	User Access Contact	Chief Administration Officer		Alvarado	Chuck		6145463794				6145463131	chuck.alvarado@mchs.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	10/27/2022	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Utilization Management Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	Angela.Thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9827	Utilization Review Contact	Interim VP, Health Services	Ms.	Thomas	Angela	C	6145969891				6142348838	angela.thomas@medigold.com	3100 Easton Square Place	Suite 300-Health Plan	Columbus	OH	43219	04/07/2023	2023	MOUNT CARMEL HEALTH PLAN OF NEW YORK, INC.	Local CCP	MediGold	HMO/HMOPOS		Trinity Health Corporation	234	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9828	Agent/Broker Compensation Data Contact	Chief Development Officer		Pitera	Raymond		2487633252					raymond.pitera@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Automated TrOOP Balance Transfer Contact	Medicare Part D Program Manager		Zlotkus	Steve		8587906250					partdcat@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Backup User Access Contact	Manager of Medicare Operations		McMillan	Kyle		3135806282					kyle.mcmillan@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/23/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Best Available Evidence Contact	Manager of Medicare Operations		McMillan	Kyle		3135806282					kyle.mcmillan@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Bid Audit Contact	Director of Medicare Compliance	Mr.	Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Bid Primary Contact	Director of Medicare Compliance	Mr.	Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	CAP Report Contact for Public Website	Director of Medicare Compliance		Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract	8442790508	1006			HMO - Health Maintenance Organization		C	Chicago
H9828	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Cotton	Jon	B	3134078337					jon.cotton@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Cotton	Jon	B	3134078337					jon.cotton@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Chief Financial Officer	Chief Financial Officer	Mr.	Agnone	Matthew		3135107361					matthew.agnone@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Chief Operating Officer	Director of Medicare Operations	Ms.	McMillan	Kyle		3135806282					kyle.mcmillan@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/23/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Chief Information Officer		Mr.	Klassen	Joshua		5198164567					joshua.klassen@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Chief Information Security Officer		Mr.	Klassen	Joshua		5198164567					joshua.klassen@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	CMS Casework Communication Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Complaints Tracking Contact			Spencer	Stephanie		7345169101					stephanie.spencer@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/23/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Contact for Fraud Investigations	Director of Medicare Compliance		Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Coordination of Benefits Contact	Manager of Medicare Operations		McMillan	Kyle		3135806282					kyle.mcmillan@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Corporate Mailing						8442790508					info@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President of Finance		Dobrovolschi	Natalia		7343060443					natalia.dobrovolschi@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Customer Service Operations Contact	Sr. Manager of Concierge Services		Wolan	Elizabeth		3134458677					elizabeth.wolan@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	DIR Contact	Vice President of Finance		Dobrovolschi	Natalia		7343060443					natalia.dobrovolschi@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Emergency Part D Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Emergency Part D Contact (Secondary)			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Encounter Data & Risk Adjustment Operations Contact	Manager of Medicare Operations		McMillan	Kyle		3135806282					kyle.mcmillan@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Enrollment Contact	Manager of Medicare Operations		McMillan	Kyle		3135806282					kyle.mcmillan@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	EOB Transfer Contact	Vice President of Finance		Dobrovolschi	Natalia		7343060443				3135911130	natalia.dobrovolschi@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Financial Audit Contact	Vice President of Finance	Mrs.	Dobrovolschi	Natalia		7343060443					natalia.dobrovolschi@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Financial Reporting Contact	Vice President of Finance		Dobrovolschi	Natalia		7343060443					natalia.dobrovolschi@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Formulary Contact	Director of Medicare Compliance		Martin	Nathan		3132832346					rxoversight@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Formulary Contact (Secondary)	Manager, Formulary Administration & Maintenance		Nyawabila	Christina		8587906297					fas@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	General Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Government Relations Contact	Vice President of Legal Affairs		Muzingo	Joseph		3136177323					joseph.muzingo@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	HIPAA Privacy Officer	Vice President of Legal Affairs		Muzingo	Joseph		3136177323					joseph.muzingo@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	HIPAA Security Officer		Mr.	Klassen	Joshua		5198164567					joshua.klassen@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Hospice Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Interoperability Contact		Mr.	Klassen	Joshua		5198164567					joshua.klassen@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	MA Appeals/Grievances Contact			Spencer	Stephanie		7345169101					stephanie.spencer@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	MA Claims Processing Contact for Public Website	Vice President of Finance		Dobrovolschi	Natalia		7343060443					natalia.dobrovolschi@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Marketing Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Medical Director	Medical Director		Hadesman	Steven		3137197990					steven.hadesman@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Medicare Compliance Officer	Director of Medicare Compliance	Mr.	Martin	Nate		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Medicare Coordinator			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Medicare Part D Opioid Overutilization Contact			Spencer	Stephanie		7345169101					stephanie.spencer@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Medication Therapy Management Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	OffShore Subcontractor Contact	Director of Medicare Compliance		Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Online Enrollment Center Contact (Primary)	Manager of Medicare Operations		McMillan	Kyle		3135806282					kyle.mcmillan@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Part C Application Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Part C Reporting Contact	Director of Medicare Compliance		Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Appeals			Spencer	Stephanie							stephanie.spencer@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract	8442790508	1002			HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Appeals Contact (Secondary)	Manager, Appeals & Grievances		Martin	Dawn							dawn.martin@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract	8587907118				HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Application Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Benefits Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Claims Submission Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Exceptions Contact			Spencer	Stephanie							stephanie.spencer@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract	8442790508	1002			HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Exceptions Contact (Secondary)	Director, PA & UM Programs		Emoto	Julianne							julianne.emoto@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract	8587905846				HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Price File Contact (Back-up)			McMillan	Kyle		3135806282					kyle.mcmillan@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Price File Contact (Optional)	Medicare Part D Program Manager		Keller	Shannon		8587907104					planfindercommunications@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Price File Contact (Primary)	Director of Medicare Compliance		Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Quality Assurance Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Part D Reporting Contact	Director of Medicare Compliance		Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Patient Safety Contact			Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Payment Contact	Vice President of Finance		Dobrovolschi	Natalia		7343060443					natalia.dobrovolschi@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Pharmacy Director	Chief Development Officer		Pitera	Raymond		2487633252					raymond.pitera@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Pharmacy Network Management Contact	Chief Development Officer		Pitera	Raymond		2487633252					raymond.pitera@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Pharmacy Network Management Contact (Secondary)	Director Configuration Services		Moe	Kathlene		8587907454					kathlene.moe@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Pharmacy Technical Help Desk Contact	VP, Contact Center Services		Battle	Dorry							customerservice@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract	8884953102				HMO - Health Maintenance Organization		C	Chicago
H9828	Pharmacy Technical Help Desk Contact (Secondary)			Martin	Nathan							nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract	8442790508				HMO - Health Maintenance Organization		C	Chicago
H9828	Plan Directory Contact for Public Website			Services	Concierge		8442790508					conciergeservices@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Plan to Plan Reconciliation Contact	Vice President of Finance		Dobrovolschi	Natalia		7343060443					natalia.dobrovolschi@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Processor Contact	VP, Medicare Programs		Davis Jones	De'Lona		8587906229					delona.davis-jones@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Quality Contact			Spencer	Stephanie		7345169101					stephanie.spencer@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Reconciliation Contact	Vice President of Finance		Dobrovolschi	Natalia		7343060443					natalia.dobrovolschi@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Recovery Audit Contact	Vice President of Finance	Mrs.	Dobrovolschi	Natalia		7343060443					natalia.dobrovolschi@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	SNP Application Contact	Director of Medicare Compliance	Mr.	Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Surveillance Contact	Chief Development Officer		Pitera	Raymond		2487633252					raymond.pitera@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	System Contact	Manager of Information Technology	Mr.	Markowski	John		3133511080					john.markowski@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Third Party Administrator (TPA) Liaison	Vice President of Finance		Dobrovolschi	Natalia		7343060443					natalia.dobrovolschi@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	User Access Contact	Director of Medicare Compliance		Martin	Nathan		3132832346					nate.martin@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Utilization Management Contact	Director of Clinical Operations		Spencer	Stephanie		7345169101					stephanie.spencer@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9828	Utilization Review Contact	Director of Clinical Operations		Spencer	Stephanie		7345169101					stephanie.spencer@apexhealth.com	96 Kercheval Avenue	Suite 200	Grosse Pointe Farms	MI	48236	05/17/2023	2023	APEX HEALTH, INC.	Local CCP	ApexHealth	HMO/HMOPOS		J.B. Cotton & Company, LLC	729	Yes	Withdrawn Contract					HMO - Health Maintenance Organization		C	Chicago
H9830	Automated TrOOP Balance Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Backup User Access Contact	Chief Information Officer		Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Best Available Evidence Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Bid Primary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	CAP Report Contact for Public Website	VP of Clinical Compliance		Teter	Lezlie		7203929719				3039961600	lteter@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	CEO - CMS Administrator Contact	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	CEO - Senior Official for Contracting	CEO	Mr.	Blair	Patrick		7209746704				3039961600	pblair@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Chief Financial Officer	CFO	Mr	Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Chief Operating Officer	Senior Advisor	Ms.	Lozzano	Maria		9098902854				3039961600	mlozzano@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Chief Information Officer	Chief Information Officer	Ms.	Babachicos	Cara		7209746739				3039961600	cbabachicos@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Chief Information Security Officer	SVP of Information Technology	Mr.	Naus	Cole		7209210443				3039961600	MNaus@innovage.com	InnovAge	8950 East Lowry Blvd	Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	CMS Casework Communication Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356					adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Complaints Tracking Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356					adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Contact for Fraud Investigations	Chief Legal Officer		D'Amato	Nicole		6154732250				3039961600	NDAmato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Coordination of Benefits Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Corporate Mailing						3038694664				3039961600	cbabachicos@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Customer Service Operations Contact	Senior Advisor		Lozanno	Maria		9098902854				3039961600	mlozanno@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	DIR Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	DIR Contact (Secondary)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Emergency Part D Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Emergency Part D Contact (Secondary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Encounter Data & Risk Adjustment Operations Contact	Director of PACE Finance		Hewitt	Jessica		7209746767					jhewitt@innovage.com	8950 E Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Enrollment Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	EOB Transfer Contact	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Financial Audit Contact	Director of PACE Finance	Ms	Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Financial Reporting Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Formulary Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Formulary Contact (Secondary)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	General Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356					adickerson@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	08/24/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Government Relations Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	HIPAA Privacy Officer	Corporate Counsel		Moxon	Jeff		3038694664				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	HIPAA Security Officer	SVP of Information Technology		Naus	Cole		7209210443				3039961600	MNaus@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Interoperability Contact	SVP of Applications		Zierolf	Kris		7209742380					kzierolf@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	MA Appeals/Grievances Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356					adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	MA Claims Processing Contact for Public Website	Medicare Compliance Manager	Ms.	Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Marketing Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Medical Director	Medical Director		Ferrance	Randy		2159514586				3039961600	rferrance@innovage.com	8950 East Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Medicare Compliance Officer	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Medicare Coordinator	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Medicare Part D Opioid Overutilization Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 E. Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Medication Therapy Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Online Enrollment Center Contact (Back-up)	Finance and Compliance Analyst		Kizewski	Alex		7207896171				3039961600	akizewski@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Online Enrollment Center Contact (Primary)	Medicare Compliance Manager		Brown	Lauren		7209746031				3039961600	lbrown2@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Part C Application Contact	Government Relations Advisor		Steckel	Carol		7207896157				3039961600	csteckel@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Part D Appeals	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H9830	Part D Appeals Contact (Secondary)	Chief Legal Officer		D'Amato	Nicole						3039961600	NDAmato@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H9830	Part D Application Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Part D Benefits Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Part D Claims Submission Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Part D Exceptions Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H9830	Part D Exceptions Contact (Secondary)	Finance and Compliance Analyst	Mr.	Kizewski	Alex						3039961600	akizewski@myinnovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active	3038694664				PACE - Nat		C	Philadelphia
H9830	Part D Price File Contact (Back-up)	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Part D Price File Contact (Primary)	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Part D Quality Assurance Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Part D Reporting Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Patient Safety Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356					adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Payment Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Personal Health Record Contact	VP Associate of General Counsel		Moxon	Jeff		3033006930				3039961600	jmoxon@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Pharmacy Director	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Pharmacy Network Management Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael		7207444048				3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Pharmacy Technical Help Desk Contact	SVP, Clinical Strategic Partnerships Clinical Oper		Cinque	Michael						3039961600	mcinque@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active	7207444048				PACE - Nat		C	Philadelphia
H9830	Plan Directory Contact for Public Website	Director of Marketing		Stavros	Sarah		3033006904				3039961600	sstavros@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Plan to Plan Reconciliation Contact	Finance and Compliance Analyst		Kizewski	Alex		7207896171				7209173390	akizewski@innovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Processor Contact	Chief Financial Officer		Adams	Ben		9178423099				3039961600	badams@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Quality Contact	VP of Quality		Curry	Jill		2153782123				3039961600	jcurry@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Reconciliation Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Recovery Audit Contact	SVP, Clinical Strategic Partnerships Clinical Oper	Mr.	Cinque	Michael		7207444404					mcinque@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Surveillance Contact	Chief Sales and Marketing Officer		Borella	Robert		7202157392				3039961600	rborella@innovage.com	8950 E. Lowry Blvd.		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	System Contact	Director of PACE Finance		Hewitt	Jessica		7209746767				3039961600	jhewitt@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Third Party Administrator (TPA) Liaison	Medicare Compliance Manager		Brown	Lauren		7209746767				3039961600	lbrown2@myinnovage.com	8950 East Lowry Blvd		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	User Access Contact	Regional Director of Operational Compliance		Dickerson	Anzio		7208687356					adickerson@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	08/24/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Utilization Management Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9830	Utilization Review Contact	Regional Medical Officer		Ferrance	Randy		8048226797				3039961600	rferrance@innovage.com	8950 East Lowry Boulevard		Denver	CO	80230	07/28/2023	2023	INNOVAGE PENNSYLVANIA LIFE, LLC	National PACE	InnovAge Pennsylvania LIFE	National PACE		Total Community Options, Inc.	230	Yes	Active					PACE - Nat		C	Philadelphia
H9834	Agent/Broker Compensation Data Contact	Manager, Individual Sales		Schiro	Rick		6084714891					rick.schiro@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Automated TrOOP Balance Transfer Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Backup User Access Contact	Assistant Vice President Compliance & Government		Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Best Available Evidence Contact	Director of Enrollment		Krueger	Cindy		6084714900					cindy.krueger@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Bid Audit Contact	Director, Actuarial Services - Analytics		Felker	Matthew		6084714817					medicarebidspecialist@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Bid Audit Site Contact	Director, Actuarial Services - Analytics		Felker	Matthew		6084714817					medicarebidspecialist@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Bid Primary Contact	Director, Actuarial Services - Analytics		Felker	Matthew		6084714817					medicarebidspecialist@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	CAP Report Contact for Public Website	AVP Compliance and Government Regulatory Ops		Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	CEO - CMS Administrator Contact	President and CEO (Interim)	Ms	Senty, J.D.	Christine		6084714802					christine.senty@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/19/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	CEO - Senior Official for Contracting	President and CEO (Interim)	Ms	Senty, J.D.	Christine		6084714802					christine.senty@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/19/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Chief Financial Officer	Senior Vice President, CFO, Treasurer	Mr.	Butcher	Jeff		6084714771					jeffrey.butcher@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Chief Operating Officer	Vice President, Operations	Ms.	Schiffman	Debra		6086431408					debra.schiffman@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Chief Information Officer	Vice President and Chief Information Officer	Ms	Bay	Marybeth		6088269243					marybeth.bay@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Chief Information Security Officer	Vice President and Chief Information Officer	Ms.	Bay	Marybeth		6088269243					marybeth.bay@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	CMS Casework Communication Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Complaints Tracking Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Contact for Fraud Investigations	Assistant Vice President Compliance & Government	Ms.	Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Coordination of Benefits Contact	Director of Enrollment		Krueger	Cindy		6084714900					cindy.krueger@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Corporate Mailing						6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Cheung	Sheila		6088818082					sheila.cheung@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Customer Service Operations Contact	Senior Director of Customer Success		Greubel	Lori		6086441433					lori.greubel@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	DIR Contact	Senior Healthcare Informatics Analyst		Frank	Alice		6084714936					alice.frank@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	DIR Contact (Secondary)	Director, Actuarial Services - Analytics		Felker	Matthew		6084714817					matthew.felker@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Emergency Part D Contact	Pharmacy Manager		Suhr	Anessa		6083178565				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Emergency Part D Contact (Secondary)	Director of Clinical Pharmacy		Fejfar	Jeremy		6083851887				6088818308	jeremy.fejfar@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Encounter Data & Risk Adjustment Operations Contact	Lead Healthcare Informatics Analyst		Gault	Angie		6086048299					angie.gault@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Enrollment Contact	Director of Enrollment		Krueger	Cindy		6084714900					cindy.krueger@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	EOB Transfer Contact	Vice President, Operations		Schiffman	Debra		6086431408				6088818307	debra.schiffman@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Financial Audit Contact	Director, Actuarial Services - Analytics	Mr.	Felker	Matthew		6084714817					medicarebidspecialist@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Financial Reporting Contact	Senior Vice President, CFO, Treasurer	Mr.	Butcher	Jeff		6084714771					jeffrey.butcher@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Formulary Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Formulary Contact (Secondary)	Pharmacy Director of Government & Quality Programs		Fejfar	Jeremy		6088818603					jeremy.fejfar@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	General Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Government Relations Contact	Assistant Vice President Compliance & Government	Mrs.	Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	HIPAA Privacy Officer	Assistant Vice President Compliance & Government		Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	HIPAA Security Officer	Director of Business Intelligence & Data Warehouse		Pierce	Charlie		6088288584					charlie.pierce@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Hospice Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Interoperability Contact	AVP Compliance & Government Regulatory Operations		Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	MA Appeals/Grievances Contact	Manager, Appeals and Grievances		Salveson	Kate		6086431527					kathryn.salveson@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	MA Claims Processing Contact for Public Website			Service	Customer		8003945566					customerservice@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Marketing Contact	Director, Marketing Communications		Alexander	Cari		6084714864					cari.alexander@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Medical Director	Associate Chief Medical Officer	Dr.	Pak	Mary		6086404465					mary.pak@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Medicare Compliance Officer	Assistant Vice President Compliance & Government	Ms.	Skifton	Kelly	N	6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Medicare Coordinator	Director of Government Programs		Kirchberg	Mark		6086404461					mark.kirchberg@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Medicare Part D Opioid Overutilization Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Medication Therapy Management Contact	Pharmacy Director of Clinical Pharmacy	Mr	Fejfar	Jeremy		6088818603				6088818308	jeremy.fejfar@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Online Enrollment Center Contact (Back-up)	Enrollment Research Analyst		Petersen	Gerri		6088818197					geraldine.petersen@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Online Enrollment Center Contact (Optional)	Director of Enrollment		Krueger	Cindy		6084714900					cindy.krueger@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Online Enrollment Center Contact (Primary)	Enrollment Research Analyst		Petersen	Gerri		6088818197					geraldine.petersen@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Part C Application Contact	Director of Government Programs		Kirchberg	Mark		6086404461					mark.kirchberg@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Part C Reporting Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefis.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Part D Appeals	Appeals Manager		Salveson	Kate							kathryn.salveson@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active	6086431527				HMO - Health Maintenance Organization		C	Chicago
H9834	Part D Appeals Contact (Secondary)	Appeals Specialist		Specialists	Appeals						6086443500	appeals.specialists@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active	8003945566	308284			HMO - Health Maintenance Organization		C	Chicago
H9834	Part D Application Contact	Director of Government Programs		Kirchberg	Mark		6086404461					mark.kirchberg@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Part D Benefits Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Part D Claims Submission Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Part D Exceptions Contact	Pharmacy Manager		Suhr	Anessa						6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active	8003945566				HMO - Health Maintenance Organization		C	Chicago
H9834	Part D Price File Contact (Back-up)	Director of Pharmacy Government Programs		Fejfar	Jeremy		6088818603					jeremy.fejfar@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Part D Price File Contact (Optional)	Sr. Business Analyst, OptumRx		Kim	Kevin		6265334804					kevin.kim@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	06/23/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Part D Price File Contact (Primary)	Sr. Business Analyst, OptumRx		Kim	Kevin		6265334804					kevin.kim@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	09/20/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Part D Quality Assurance Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Part D Reporting Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Patient Safety Contact	Director of Pharmacy Government Programs	Mr	Fejfar	Jeremy		6088818603					jeremy.fejfar@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Payment Contact	Senior Vice President, CFO, Treasurer	Mr.	Butcher	Jeff		6084714771					jeffrey.butcher@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Pharmacy Director	Pharmacy Vice President		Gandhi	Jay		8477701300					jay.gandhi@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	06/15/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Pharmacy Network Management Contact	Pharmacy Manager		Suhr	Anessa		6088818616				6088818307	anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Pharmacy Network Management Contact (Secondary)	Pharmacy Program Director	Mr	Cory	Pat		6082621720					pat.cory@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	01/13/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Pharmacy Technical Help Desk Contact	Quartz Medicare Advantage Part D Help Desk		Medicare Advantage	Quartz							customerservice@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active	8887284689				HMO - Health Maintenance Organization		C	Chicago
H9834	Plan Directory Contact for Public Website			Service	Customer		8003945566					customerservice@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Plan to Plan Reconciliation Contact	Accountant		Cheung	Sheila		6088818082					sheila.cheung@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Processor Contact	Pharmacy Manager		Suhr	Anessa		6088818616					anessa.suhr@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Quality Contact	Supervisor, Provider Quality & Analytics		Traastad	Maggie		6088818609					maggie.traastad@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Reconciliation Contact	Director, Actuarial Services - Analytics		Felker	Matthew		6084714817					medicarebidspecialist@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Reconciliation Contact (Secondary)	Actuarial Analyst		Andersen	Maura		6088818619					maura.andersen@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Recovery Audit Contact	Assistant Vice President Compliance & Government	Ms.	Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	SNP Application Contact	Director of Government Programs		Kirchberg	Mark		6086404461					mark.kirchberg@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	SNP State Contact	Medicaid Products & Government Affairs Director		Moody	Jonathan		6084714756					jonathan.moody@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Surveillance Contact	Assistant Vice President Compliance & Government	Ms.	Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	System Contact	Compliance Analyst		Stanton	Jessica		6088818157					jessica.stanton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Third Party Administrator (TPA) Liaison	Accountant		Cheung	Sheila		6088818082					sheila.cheung@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	User Access Contact	Assistant Vice President Compliance & Regulatory		Skifton	Kelly		6088818151					kelly.skifton@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Utilization Management Contact	Senior Vice President, Health & Network Affairs	Dr.	Hanekom	David		6084714704					david.hanekom@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9834	Utilization Review Contact	Senior Vice President, Health & Network Affairs	Dr	Hanekom	David		6084714704					david.hanekom@quartzbenefits.com	2650 Novation Pkwy		Fitchburg	WI	53713	04/18/2023	2023	QUARTZ HEALTH PLAN MN CORPORATION	Local CCP	Quartz Medicare Advantage	HMO/HMOPOS		University of Wisconsin Hospitals and Clincs Autho	677	Yes	Active					HMO - Health Maintenance Organization		C	Chicago
H9842	Automated TrOOP Balance Transfer Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Backup User Access Contact	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Best Available Evidence Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Bid Primary Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	CAP Report Contact for Public Website	Executive Director		Huegel	Lori Anne		5742478763					Lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	11/17/2022	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	CEO - CMS Administrator Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	CEO - Senior Official for Contracting	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	11/17/2022	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Chief Financial Officer	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Chief Operating Officer	COO	Ms.	Lewis	Anne		4066472980					anne.lewis@trinity-health.org	20255 Victor Pkwy  MS-E3C		Livonia	MI	48152	09/22/2020	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Chief Information Officer	Director Enterprise IT Operations	Mr	Gillespie	Jeff		6142348636					gillespj@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Chief Information Security Officer	VP Information Security	Mr	Jennings	Preston		6105503083					Preston.Jennings@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	CMS Casework Communication Contact	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Complaints Tracking Contact	Director Quality & Compliance	Ms.	Anastasio	Michelle		5742478717					Michelle.Anastasio@Trinity-Health.org	250 E. Day Rd		Mishawaka	IN	46545	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Contact for Fraud Investigations	Director Quality & Compliance	Ms.	Anastasio	Michelle		5742478717					Michelle.Anastasio@Trinity-Health.org	250 E. Day Rd		Mishawaka	IN	46545	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Coordination of Benefits Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Corporate Mailing						5742478700					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Coverage Gap Discount Program (CGDP) Payment Contact	Executive Director	Ms	Huegel	Lorianne		5742478700					lorianne.huegel@trinity-health.org	250 E Day Rd		Mishawaka	IN	46545	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Customer Service Operations Contact	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	11/17/2022	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	DIR Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	DIR Contact (Secondary)	Chief Clinical & Compliance Officer	Ms	Hays McElroy	Carrie		7343432668					carrie.haysmcelroy@trinity-health.org	20255 Victor Parkway		Livonia	MI	48152	10/03/2022	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Emergency Part D Contact	Executive Director	Ms	Huegel	Lori Anne		5742478700					Lorianne.huegel@trinity-health.org	250 E. Day		Mishawaka	IN	46545	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Encounter Data & Risk Adjustment Operations Contact	Director of Coding and Documentation		Creaney	Emy		7343431939					creaneye@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Enrollment Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	EOB Transfer Contact	Regional Director Finance	Ms	Szymczyk	Dawn		4138274243				4134932024	Dawn.Szymczyk@trinity-health.org	200 Hillside Circle	Suite 1	West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Financial Audit Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Financial Reporting Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Formulary Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2679917601				2679917618	joseph.garbarino@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	General Contact	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	11/17/2022	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Government Relations Contact	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	HIPAA Privacy Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	HIPAA Security Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Interoperability Contact	Director Enterprise IT Operations		Gillespie	Jeff		7343433079					gillespj@trinity-health.org	20555 Victor Parkway	TH PACE	Livonia	MI	48152	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	MA Appeals/Grievances Contact	Director Quality & Compliance	Ms.	Anastasio	Michelle		5742478717					Michelle.Anastasio@Trinity-Health.org	250 E. Day Rd		Mishawaka	IN	46545	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	MA Claims Processing Contact for Public Website	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Marketing Contact	Director Marketing & Communications	Ms.	Lark	Azia		9735182754					azia.lark@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	02/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Medical Director	Medical Director		Quinn	Christophe		5742478700					christopher.quinn@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	02/24/2017	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Medicare Compliance Officer	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Medicare Coordinator	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	08/04/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Medicare Part D Opioid Overutilization Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	07/27/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Medication Therapy Management Contact	Manager Part D Compliance	Mr	Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	Mercy LIFE	1001 Baltimore Pike	Springfield	PA	19064	07/27/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Part C Application Contact	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Part D Appeals	Manager Part D Compliance		Garbarino	Joseph							Joseph.Garbarino@mercyhealth.org	1930 South Broad St	Unit 3	philadelphia	PA	19145	01/04/2021	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Chicago
H9842	Part D Application Contact	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Part D Benefits Contact	Regional Finance Director		Fuhrmeister	Nicole		2157788707					nicole.fuhrmeister@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Part D Claims Submission Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Part D Exceptions Contact	Manager Part D Compliance		Garbarino	Joseph							Joseph.Garbarino@mercyhealth.org	1930 South Broad St	Unit 3	Philadelphia	PA	19145	01/04/2021	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Chicago
H9842	Part D Price File Contact (Back-up)	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	11/17/2022	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Part D Price File Contact (Primary)	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Part D Quality Assurance Contact	Director Quality & Compliance	Ms.	Anastasio	Michelle		5742478717					Michelle.Anastasio@Trinity-Health.org	250 E. Day Rd		Mishawaka	IN	46545	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Part D Reporting Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Patient Safety Contact	Director Quality & Compliance	Ms.	Anastasio	Michelle		5742478717					Michelle.Anastasio@Trinity-Health.org	250 E. Day Rd		Mishawaka	IN	46545	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Payment Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Pharmacy Director	Manager Pharmacy, Part D Compliance		Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	10/03/2022	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Pharmacy Network Management Contact	Manager Pharmacy, Part D Compliance		Garbarino	Joseph		2153394362					joseph.garbarino@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	10/03/2022	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Pharmacy Technical Help Desk Contact	Manager Part D Compliance		Garbarino	Joseph							joseph.garbarino@trinity-health.org	2500 Northgate Road		Trevose	PA	19053	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active	2153394362				PACE - Nat		C	Chicago
H9842	Plan Directory Contact for Public Website	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	11/17/2022	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Plan to Plan Reconciliation Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Processor Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Quality Contact	Director Quality & Compliance	Ms.	Anastasio	Michelle		5742478717					Michelle.Anastasio@Trinity-Health.org	250 E. Day Rd		Mishawaka	IN	46545	09/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Reconciliation Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Recovery Audit Contact	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Surveillance Contact	Executive Director	Ms	Huegel	Lori Anne		5742478763					lorianne.huegel@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	11/17/2022	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	System Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Third Party Administrator (TPA) Liaison	Finance Directro	Ms	Szymczyk	Dawn		4138274231					Dawn.Szymczyk@trinity-health.org	200 Hillside Circle		West Springfield	MA	01089	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	User Access Contact	National Director QI/Compliance	Ms	Watts	Christina		2484206065					wattscl@trinity-health.org	20555 Victor Parkway		Livonia	MI	48152	08/15/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Utilization Management Contact	Medical Director		Quinn	Christophe		5742478700					christopher.quinn@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9842	Utilization Review Contact	Medical Director		Quinn	Christophe		5742478700					christopher.quinn@trinity-health.org	250 E. Day Rd.		Mishawaka	IN	46545	08/03/2023	2023	SAINT JOSEPH PACE	National PACE	Saint Joseph PACE	National PACE		Trinity Health Corporation	234	Yes	Active					PACE - Nat		C	Chicago
H9861	Agent/Broker Compensation Data Contact	Manager, Sales Operations	Mr.	Demos	John		6174260600					jdemos@commonwealthcare.org	30 Winter Street		Boston	MA	02108	04/22/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Automated TrOOP Balance Transfer Contact	General Manager		Keane	Brian		2487155410					bkeane@commonwealthcare.org	23900 Orchard Lake Rd.	Suite 210	Farmington Hills	MI	48336	12/31/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Backup User Access Contact	Director Health Plan Compliance		Dwinnells	Mark		6174260600	1239				mdwinnells@commonwealthcare.org	2 Avenue de Lafayette	5th Floor	Boston	MA	02111	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Best Available Evidence Contact	Director, Enrollment, Recon. & Retention		Andrade	Remo		6174260600	57931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Bid Audit Contact	Sr. Director, Actuarial Services		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Bid Audit Site Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Bid Primary Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/26/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	CAP Report Contact for Public Website	General Manager, Market Lead  MI		Keane	Brian		2487155410					bkeane@commonwealthcare.org	23900 Orchard Lake Rd. Suite 210		Farmington Hills	MI	48336	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	CEO - CMS Administrator Contact	President and Chief Executive Officer	Mr	Palmieri	Chris		8572468897					cpalmieri@commonwealthcare.org	30 Winter Street	12th Floor	Boston	MA	02108	09/16/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	CEO - Senior Official for Contracting	President of Markets	Ms	Murphy	Courtney		6174260600	53892				cmurphy@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/23/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Chief Financial Officer	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/12/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Chief Operating Officer	Chief Operating Officer	Mr.	Mudunuri	Sesha		6178757140					smudunuri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/22/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Chief Information Officer	SVP & Chief Information Officer	Ms.	O'Rorke	Beth		6174260600	2485				bororke@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/21/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Chief Information Security Officer	VP, IT Governance and Cyber Security	Mr.	Jacobs	Tim		6174260600	52258				tjacobs@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	CMMI Model Point of Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	2 Avenue de Lafayette		Boston	MA	02111	09/16/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	CMS Casework Communication Contact	Director, Appeals & Grievances	Mr.	Schenk	Tyrone		8573273320					tschenk@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Complaints Tracking Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320					tschenk@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Contact for Fraud Investigations	Director, FWA Program and SIU	Ms.	Vasconcelos	Nadia		6174260600	52733				nvasconcelos@commonwealthcare.org	2 Avenue de Lafayette	5th Floor	Boston	MA	02111	05/18/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Coordination of Benefits Contact	Director, Enrollment, Recon. & Retention		Andrade	Remo		6174260600	57931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Corporate Mailing						2487155410					BKeane@commonwealthcare.org	23900 Orchard Lake Rd.	Suite 210	Farmington Hills	MI	48336	04/14/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Treasury Operations		Harris	Maegan		2084127222					maharris@commonwealthcare.org	30 Winter St		Boston	MA	02108	06/08/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Customer Service Operations Contact	Director, Contact Center Strategy		Cuevas	Sabrina		6174260600	51004				scuevas@commonwealthcare.org	2 Avenue de Lafayette		Boston	MA	02111	05/05/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	DIR Contact	Director, Actuarial Service		Jesik	David		6174260600	1808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/14/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	DIR Contact (Secondary)	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/29/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Electronic Health Record Contact	DirectorEnterprise Clinical Informatics		Phan	Phuong		6174260600	52247				pphan@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	11/04/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Emergency Part D Contact	Medical Director	Dr.	Berger	Gregory		3139715547					gberger@commonwealthcare.org	23900 Orchard Lake Rd.	Suite 210	Farmington Hills	MI	48336	10/04/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Emergency Part D Contact (Secondary)	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/14/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Encounter Data & Risk Adjustment Operations Contact	Manager, Encounters and Risk		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/31/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Enrollment Contact	Director, Enrollment, Recon. & Retention		Andrade	Remo		6174260600	57931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	EOB Transfer Contact	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194			6174260600	elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Financial Audit Contact	Director, Regulatory Audit	Ms	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter St		Boston	MA	02108	12/12/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Financial Reporting Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Formulary Contact			Mehta	Anand		2242312280					Anand.Mehta@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	02/13/2019	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Formulary Contact (Secondary)	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	General Contact	General Manager, Market Lead  MI	Mr.	Keane	Brian		2488404583					BKeane@commonwealthcare.org	23900 Orchard Lake Road	Suite 210	Farmington Hills	MI	48336	09/16/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Government Relations Contact	VP, Government Relations		Preede	Ken		6174260600					kpreede@commonwealthcare.org	30 Winter St		Boston	MA	02108	09/20/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	HIPAA Privacy Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	HIPAA Security Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Hospice Contact	Medical Director	Dr.	Berger	Gregory		3139715547					gberger@commonwealthcare.org	23900 Orchard Lake Rd.	Suite 210	Farmington Hills	MI	48336	10/04/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Interoperability Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	MA Appeals/Grievances Contact	Director, Appeals & Grievances		Schenk	Tyrone		8573273320				8574534517	tschenk@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	MA Claims Processing Contact for Public Website	Director, Claims Operations		LaPointe	Elyssa		6174260600					elapointe@commonwealthcare.org	30 Winter St		Boston	MA	02108	10/05/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Marketing Contact	SVP, Marketing		Kubilus	Melissa		6174260600	52448			6174263019	mkubilus@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/03/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Medical Director	Medical Director	Dr.	Berger	Gregory		3139715547					gberger@commonwealthcare.org	23900 Orchard Lake Rd.	Suite 210	Farmington Hills	MI	48336	10/04/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Medicare Compliance Officer	Sr. Director, Medicare Compliance Officer	Ms.	Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Medicare Coordinator	General Manager, Market Lead  MI	Dr.	Keane	Brian		2488404583					BKeane@commonwealthcare.org	23900 Orchard Lake Rd.	Suite 210	Farmington Hills	MI	48336	09/16/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Berger	Gregory		3139715547					gberger@commonwealthcare.org	23900 Orchard Lake Rd.	Suite 210	Farmington Hills	MI	48336	10/04/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Medication Therapy Management Contact	MTM Program Manager		Liaqat	Tazeen		8663525305					tazeen.liaqat@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	11/14/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	OffShore Subcontractor Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Online Enrollment Center Contact (Back-up)	Manager, Member Enrollment and Retention		Taylor	Lena		6174260600	51126				ltaylor@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Online Enrollment Center Contact (Primary)	Director, Enrollment, Recon. & Retention		Andrade	Remo		6174260600	57931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Part C Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	Lafayette City Center	2 Lafayette	Boston	MA	02111	09/16/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Part C Reporting Contact	Manager Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Part D Appeals	Director, Appeals & Grievances		Schenk	Tyrone							tschenk@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8573273320				HMO - Health Maintenance Organization		C	Boston
H9861	Part D Appeals Contact (Secondary)	Manager Clinical Appeals and Grievances		Mancuso	Jeremiah							jmancuso@commonwealthcare.org	30 Winter St		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600	51222			HMO - Health Maintenance Organization		C	Boston
H9861	Part D Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	Lafayette City Center	2 Lafayette	Boston	MA	02111	09/16/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Part D Benefits Contact	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Part D Claims Submission Contact			Hartman	Lawrence		2407516036					Lawrence.hartman@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	02/13/2019	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Part D Exceptions Contact			Mourad	Hala							Hala.Mourad@optum.com	2441 Warrenville Rd		Lisle	IL	60532	02/13/2019	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	6303285837				HMO - Health Maintenance Organization		C	Boston
H9861	Part D Exceptions Contact (Secondary)	Medical Director, Market		Berger	Gregory							GBerger@commonwealthcare.org	23900 Orchard Lake Road	Suite 210	Farmington Hills	MI	48336	09/16/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	2487155410				HMO - Health Maintenance Organization		C	Boston
H9861	Part D Price File Contact (Back-up)			Rx	Optum		6514955363					medops_planfinder@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	12/06/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Part D Price File Contact (Primary)			Rx	Optum		6514955363					Medops_planfinder@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	12/06/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Part D Quality Assurance Contact	Manager, Benefit Audit Team		Greenwood	Dana		7633617232					Dana.Greenwood@optum.com	544 Bud Ford Dr		Cabot	AR	72023	01/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Part D Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Patient Safety Contact	Medical Director	Dr.	Berger	Gregory		3139715547					GBerger@commonwealthcare.org	23900 Orchard Lake Rd.	Suite 210	Farmington Hills	MI	48336	10/04/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Payment Contact	VP Revenue Cycle Management		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter St		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Pharmacy Director	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Pharmacy Network Management Contact			Pham	Katie		8178469722					Katie.Pham@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	02/13/2019	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy Services		Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Pharmacy Technical Help Desk Contact			Summers	Todd							Todd.Summers@optum.com	755 Research Pkwy		Oklahoma City	OK	73104	02/13/2019	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active	8664431095				HMO - Health Maintenance Organization		C	Boston
H9861	Physician Incentive Contact	VP, Provider Network Strategy	Mr.	Tirimacco	Robert		6174260600	1013				rtirimacco@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/20/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Plan Directory Contact for Public Website			Services	Member		8559595855					memberservices@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/09/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Plan to Plan Reconciliation Contact	Manager, Accounts Payable		Reeves	Jennifer		6174260600	51632				jreeves@commonwealthcare.org	30 Winter St		Boston	MA	02108	05/08/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Processor Contact	COO		Mudunuri	Sesha		6178757140					smudunuri@commonwealthcare.org	30 Winter St	Suite 210	Boston	MA	02108	01/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Quality Contact	VP, Quality		Feierstein	Anne		6174260600	56868				afeierstein@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/10/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Reconciliation Contact	Director, Actuarial Service		Jesik	David		6174260600	1808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/02/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Recovery Audit Contact	Director, Regulatory Audit	Ms.	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	SNP Application Contact	Sr. Director, Product Compliance		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter St		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	SNP State Contact	VP Corporate and Regulatory Compliance		Steffen	Elizabeth		6174260600	52376				esteffen@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Surveillance Contact	VP, National Sales		Spartano	Michael		6174260600	52179				mspartano@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/08/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	System Contact	Manager, Encounters and Risk Adjustment		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Third Party Administrator (TPA) Liaison	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter St		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	User Access Contact	Compliance Officer		Lavallee	Katherine		6176475780					klavalee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/21/2022	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Utilization Management Contact	VP, UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9861	Utilization Review Contact	VP, UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	CCA HEALTH MICHIGAN, INC.	Local CCP	CCA Health Michigan	HMO/HMOPOS		Commonwealth Care Alliance, Inc.	60	Yes	Active					HMO - Health Maintenance Organization		C	Boston
H9869	Agent/Broker Compensation Data Contact	Chief of Community Relations	Ms	Haines	Karleen	M	6468839901					khaines@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Automated TrOOP Balance Transfer Contact	Manager, Vendor Oversight & Special Projects		Carroccia	Kimberly		6468839034				6468924810	kcarroccia@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Backup User Access Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Best Available Evidence Contact	Chief Compliance Officer	Ms.	john	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Bid Audit Contact	Chief Financial Officer	Mr.	Masi	Chris		6468834171					cmasi@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Bid Audit Site Contact	Chief Financial Officer	Mr.	Masi	Chris		6468834171					cmasi@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Bid Primary Contact	Chief Financial Officer	Mr.	Masi	Chris		6468834171					cmasi@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	CAP Report Contact for Public Website	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Delaney	Kerry		9175836210					kdelaney@phpcares.og	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Delaney	Kerry		6468839903					kdelaney@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Chief Financial Officer	Chief Financial Officer	Mr.	Masi	Chris		6467719967					cmasi@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Chief Operating Officer	Chief Executive Officer	Ms.	Delaney	Kerry		6468839903					kdelaney@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Chief Information Officer	Chief Information Officer	Mr.	Lanoue	Kenneth		5182351888	7095			5182611621	klanoue@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Chief Information Security Officer		Mr.	Mogollon	Manuel		6464916497	4035			6464916945	manuel.mogollon@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	CMS Casework Communication Contact	Chief Administrative Officer	Ms.	O'Connor	Megan		6468839908					dmarrone@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Complaints Tracking Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Contact for Fraud Investigations	Chief Compliance Officer	Ms.	John	Lisa		5182351888					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Coordination of Benefits Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Corporate Mailing						5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Compliance Officer		John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Customer Service Operations Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	DIR Contact	Chief Financial Officer	Mr.	Masi	Chris		5189496627					cmasi@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	DIR Contact (Secondary)	Informatics Analyst		Corraro	Tracy		6468444020	1022				tcorraro@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Emergency Part D Contact	Chief Compliance Officer	Ms.	John	Lisa		5188473553					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Emergency Part D Contact (Secondary)	Manager, Vendor Oversight and Special Projects		Carroccia	Kimberly		6467931225					kcarroccia@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Encounter Data & Risk Adjustment Operations Contact	Manager, Vendor Oversight & Special Projects		Carroccia	Kimberly		6468839034				6468924810	kcarroccia@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Enrollment Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	EOB Transfer Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627				5189496627	ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Financial Audit Contact	Chief Financial Officer	Mr.	Masi	Chris		6468834171					cmasi@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Financial Reporting Contact	Chief Financial Officer	Mr.	Masi	Chris		6468834171					cmasi@phpcares.org	655 Third Avenue	2nd Floor	NY	NY	10017	02/08/2018	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Formulary Contact	Manager, Vendor Oversight & Special Projects		Carroccia	Kimberly		5189496627					kcarroccia@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	General Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Government Relations Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	HIPAA Privacy Officer	Chief Compliance Officer	Ms	John	Lisa		5189496627	7085				ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	HIPAA Security Officer	Information Security Engineer	Mr.	Mogollon	Manuel		6464916497	4035			6464916945	manuel.mogollon@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Hospice Contact	Chief Compliance Officer	Ms	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Interoperability Contact			Carter-Bridgeman	Alia		5183164823					acarter-bridgeman@phpcares.org	2500 Halsey Street		Bronx	NY	10461	04/22/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	MA Appeals/Grievances Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	MA Claims Processing Contact for Public Website	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Marketing Contact	Chief Compliance Officer25	Ms	John	Lisa	M	5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Medical Director	Medical Director		Deutsch	Stephen		6468839900					sdeutsch@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Medicare Compliance Officer	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Medicare Coordinator	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Medicare Part D Opioid Overutilization Contact	Manager, Vendor Oversight & Special Projects		Carroccia	Kimberly		6468839034				6468924810	kcarroccia@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Medication Therapy Management Contact	Manager, Vendor Oversight & Special Projects		Carroccia	Kimberly		6468839034				6468924810	kcarroccia@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	MMP Reporting Requirements Contact	Chief Compliance Officer	Ms	john	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	MMP Point of Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part C Application Contact	Chief Executive Officer	Ms.	Delaney	Kerry		6468839903					kdelaney@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part C Reporting Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part D Appeals			Redd Guinto	Karen						8587906060	karen.reddguinto@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/05/2021	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active	8886486759				Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part D Appeals Contact (Secondary)			Creasman	Kachiri						8587906060	kachiri.creasman@MedImpact.com	10181 Scripps Gateway Court	10181 Scripps Gateway CT.	San Diego	CA	92131	01/05/2021	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active	8886486759				Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part D Application Contact	Chief Executive Officer	Ms.	Delaney	Kerry		6468839903					kdelaney@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part D Benefits Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part D Claims Submission Contact	Manager, Vendor Oversight & Special Projects		Carroccia	Kimberly		6468839034				6468924810	kcarroccia@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part D Exceptions Contact	Manager, Vendor Oversight & Special Projects		Carroccia	Kimberly						6468924810	kcarroccia@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active	6468839034				Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part D Price File Contact (Back-up)	Manager, Vendor Oversight & Special Projects		Carroccia	Kimberly		6468839034				6468924810	kcarroccia@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part D Price File Contact (Primary)	Manager, Vendor Oversight & Special Projects	Ms.	Carroccia	Kimberly		6468839034				6468924810	kcarroccia@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part D Quality Assurance Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Part D Reporting Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Patient Safety Contact	Manager, Vendor Oversight & Special Projects		Carroccia	Kimberly		6468839034				6468924810	kcarroccia@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Payment Contact	Chief Financial Officer	Mr.	Masi	Chris		6468834171					cmasi@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Pharmacy Director	Chief Compliance Officer		John	Lisa		5188473553					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Pharmacy Network Management Contact	Director Configuration Services		Dunnum	Shawn		8587907454				2158635100	Shawndunnum@MedImpact.com	10181 Scripps Gateway Ct.	10181 Scripps Gateway CT.	San Diego	CA	92131	12/17/2020	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Pharmacy Technical Help Desk Contact	VP, Contact Center Services		Battle	Dorry							CustomerService@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/17/2020	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active	8886486759				Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Plan Directory Contact for Public Website	Chief of Member relations and Advocacy	Ms.	Haines	Karleen		6468839901					khaines@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Plan to Plan Reconciliation Contact	Chief Financial Officer	Mr.	Masi	Chris		6468834171					cmasi@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Processor Contact	VP, Medicare Programs		Davis-Jones	De'Lona		8587906229					DeLona.Davis-Jones@MedImpact.com	10181 Scripps Gateway Ct.	10181 Scripps Gateway CT.	San Diego	CA	92131	12/17/2020	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Quality Contact	Chief of Quality Programs	Ms	Kumar	Premila		6468444020	1004				pkumar@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Reconciliation Contact	Chief Financial Officer	Mr.	Masi	Chris		6468834171					cmasi@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Recovery Audit Contact	Chief Financial Officer	Mr.	Masi	Chris		6468834171					cmasi@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Surveillance Contact	Chief Compliance Officer	Ms.	John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	System Contact	Chief Compliance Officer		John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Third Party Administrator (TPA) Liaison	Chief Compliance Officer		John	Lisa		5189496627					ljohn@phpcares.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	User Access Contact	Chief Compliance Officer		John	Lisa		5189496627					ljohn@caredesignny.org	2500 Halsey Street		Bronx	NY	10461	01/24/2022	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Utilization Management Contact	Dir., PA&UM Programs		Emoto	Julianne		8587905846				2158635100	Julianne.emoto@MedImpact.com	10181 Scripps Gateway Ct.	10181 Scripps Gateway CT.	San Diego	CA	92131	12/17/2020	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9869	Utilization Review Contact	Dir., PA&UM Programs		Emoto	Julianne		8587905846				2158635100	Julianne.emoto@MedImpact.com	10181 Scripps Gateway Ct.	10181 Scripps Gateway CT.	San Diego	CA	92131	12/17/2020	2023	PARTNERS HEALTH PLAN, INC.	Demo	Partners Health Plan	Medicare-Medicaid Plan HMO/HMOPOS		PHSI, Inc.	595	Yes	Active					Demo Risk Option C	MMP HMO Demo	C	New York
H9876	Agent/Broker Compensation Data Contact	Manager, Sales Operations	Mr.	Demos	John		6174260600					jdemos@commonwealthcare.org	30 Winter Street		Boston	MA	02108	04/22/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment and Eligibility		Sherman	Mandy		9202214083				9202214583	Relay.Health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Backup User Access Contact	Director, Health Plan Compliance		Dwinnells	Mark		6174260600	1239				mdwinnells@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Best Available Evidence Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931				randrade@commonwealthcare.org	30 Winter St		Boston	MA	02108	02/05/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Bid Audit Contact	Sr. Director, Actuarial Services		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Bid Audit Site Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Bid Primary Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/26/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	CAP Report Contact for Public Website	General Manager, Market Lead - Rhode Island		McCarty	Corey		6174260600	52262				cmccarty@commonwealthcare.org	3 Davol Sq Suite C-300		Providence	RI	02903	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Palmieri	Chris	D	8572468897					cpalmieri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/05/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	CEO - Senior Official for Contracting	President of Markets	Ms	Murphy	Courtney		6174260600	53892				cmurphy@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/23/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Chief Financial Officer	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	06/12/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Chief Operating Officer	Chief Operating Officer	Mr.	Mudunuri	Sesha		6178757140					smudunuri@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/05/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Chief Information Officer	SVP & Chief Information Officer	Ms.	O'Rorke	Beth		6174260600	2485				bororke@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/21/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Chief Information Security Officer	VP, IT Governance and Cyber Security	Mr.	Jacobs	Tim		6174260600	52258				tjacobs@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	CMMI Model Point of Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	CMS Casework Communication Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320				8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Complaints Tracking Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320				8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Contact for Fraud Investigations	Director, FWA Program and SIU		Vasconcelos	Nadia		6174260600	52733				nvasconcelos@commonwealthcare.org	2 Lafayette	5th Floor	Boston	MA	02111	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Coordination of Benefits Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931			6174263109	randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/05/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Corporate Mailing						6174260600	1991				elgray@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Customer Service Operations Contact	Director, Contact Center Strategy		Cuevas	Sabrina		6174260600	51004				scuevas@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/05/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	DIR Contact	Sr. Director, Actuarial ServicesSr. Director, Actu		Jesik	David		6174260600	51808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	DIR Contact (Secondary)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Electronic Health Record Contact	Director, Enterprise Clinical Informatics		Phan	Phuong		6174260600	52247				pphan@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	11/04/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Emergency Part D Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Emergency Part D Contact (Secondary)	Manager, Pharmacy		Lee	Annie		6174260600	52792				alee@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	10/04/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Encounter Data & Risk Adjustment Operations Contact	Manager, Encounters and Risk		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter St		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Enrollment Contact	Director. Enrollment & Retention		Andrade	Remo		6174260600	7931			6174263109	randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	02/05/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	EOB Transfer Contact	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194			6174260600	elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Financial Audit Contact	Director, Regulatory Audit	Ms.	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Financial Reporting Contact	Chief Financial Officer	Mr.	Scalise	Frank		8605029592					fscalise@commonwealthcare.org	30 Winter Street		Boston	MA	02108	07/13/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Formulary Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Formulary Contact (Secondary)	Medicare Team Lead, Formulary Services		Paddock	Deanna		6087291628				6087292628	deanna.paddock@navitus.com	361 Integrity Drive		Madison	WI	53717	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	General Contact	General Manager, Market Lead - Rhode Island		McCarty	Corey		6174260600	52262				cmccarty@commonwealthcare.org	3 Davol Square, Suite C-300		Providence	RI	02903	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Government Relations Contact	VP, Government Relations		Preede	Ken		6174260600	51412				kpreede@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/30/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	HIPAA Privacy Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	HIPAA Security Officer	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Hospice Contact	Palliative Care Medical Director		Ragland	Julia		7815254203					jragland@commonwealthcare.org	Lafayette City Center		Boston	MA	02111	10/04/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Interoperability Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	MA Appeals/Grievances Contact	Director, Appeals& Grievances		Schenk	Tyrone		8573273320				8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	MA Claims Processing Contact for Public Website	Director, Claims Operations		LaPointe	Elyssa		6174260600	1194				elapointe@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Marketing Contact	SVP, Marketing		Kubilus	Melissa		6174260600	52448			6174263019	mkubilus@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/03/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Medical Director	Medical Director		Chittenden	Eva		6174260600	56924				echittenden@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/03/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Medicare Compliance Officer	Director, Medicare Compliance Officer	Ms.	Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/01/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Medicare Coordinator	General Manager, Market Lead - Rhode Island		McCarty	Corey		6174260600	52262				cmccarty@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	10/05/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Medication Therapy Management Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	OffShore Subcontractor Contact	VP, Chief Privacy & Security Officer		Burgess	James		6176452740					jburgess@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Online Enrollment Center Contact (Back-up)	Manager, Member Enrollment and Retention		Taylor	Lena		6174260600	51126				ltaylor@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Online Enrollment Center Contact (Optional)	VP, National Sales	Mr.	Spartano	Michael		6179139034					mspartano@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Online Enrollment Center Contact (Primary)	Director, Enrollment, Recon. & Retention	Mr	Andrade	Remo		6174260600	57931				randrade@commonwealthcare.org	30 Winter Street		Boston	MA	02108	12/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Part C Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Part C Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Part D Appeals	Director, Appeals & Grievances		Schenk	Tyrone						8574534517	tschenck@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/12/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active	8573273320				PPO - BBA		C	Boston
H9876	Part D Appeals Contact (Secondary)	Manager Clinical Appeals and Grievances		Mancuso	Jeremiah							jmancuso@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600	51222			PPO - BBA		C	Boston
H9876	Part D Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Part D Benefits Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Part D Claims Submission Contact	Manager, Technical Operations		Derks	Bob		9202214176				9202214676	DL-TO-PDE@navitus.com	1025 West Navitus Dr		Appleton	WI	54913	05/04/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Part D Exceptions Contact	Sr. Manager, Clinical Prior Auth		LeClair	Christophe						9202214676	Christopher.LeClair@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active	8662703877				PPO - BBA		C	Boston
H9876	Part D Exceptions Contact (Secondary)	Manager, Pharmacy Operations		Lee	Annie						6174263109	alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/09/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active	6174260600				PPO - BBA		C	Boston
H9876	Part D Price File Contact (Back-up)	Manager, Pharmacy Operations		Lee	Annie		6174260600					alee@commonwealthcare.org	30 Winter Street		Boston	MA	02108	05/09/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Part D Price File Contact (Optional)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Part D Price File Contact (Primary)	Navitus Plan Finder		Finder	Plan		6087291578					Plan.Finder@Navitus.com	2601 West Beltline Highway	Suite 600	Madison	WI	53713	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Part D Quality Assurance Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Part D Reporting Contact	Manager, Regulatory Reporting		Millette	Maria		4012563047					mmillette@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Patient Safety Contact	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Payment Contact	VP Revenue Cycle Management		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Personal Health Record Contact	Mgr, Health Information Management		Lopez	Robin		6174260600	5235				rlopez@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Pharmacy Director	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688				6087292688	Jan.Robinson@Navitus.com	361 Integrity Drive		Madison	WI	53713	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Pharmacy Network Management Contact (Secondary)	Director of Pharmacy Services	Ms.	Berman	Tova		6176554768					tberman@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/31/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Pharmacy Technical Help Desk Contact	Sr. Mgr, Customer Care Accounts		Nett	Danielle						9202214724	Danielle.Nett@navitus.com	1025 West Navitus Drive		Appleton	WI	53713	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active	8662703877	4224			PPO - BBA		C	Boston
H9876	PHR Beneficiary Contact																	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO	Commonwealth Care Alliance	Commonwealth Care Alliance, Inc.	60	Yes	Active	8666102273				PPO - BBA		C	Boston
H9876	Physician Incentive Contact	VP, Provider Network Strategy	Mr.	Tirimacco	Robert		6174260600	1013				rtirimacco@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/25/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Plan Directory Contact for Public Website			Services	Member		8334209332					memberservices@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/16/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Plan to Plan Reconciliation Contact	Manager, Accounts Payable		Reeves	Jennifer		6174260600	51632				jreeves@commonwealthcare.org	30 Winter St		Boston	MA	02108	05/08/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Processor Contact	VP, Claims and Provider Network Operations		Breen	Donna		6176804446					dbreen@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Quality Contact	VP, Quality		Feierstein	Anne		6174260600	56868				afeierstein@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/10/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Reconciliation Contact	Director, Actuarial Service		Jesik	David		6174260600	1808				djesik@commonwealthcare.org	30 Winter Street		Boston	MA	02108	03/01/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Reconciliation Contact (Secondary)	VP Revenue Cycle		New	Maraland		6174260600	3976				mnew@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Recovery Audit Contact	Director, Regulatory Audit	Ms.	Patterson	Kathryn		6174260600	51404				kpatterson@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	SNP Application Contact	Sr. Director, Product		Martel	AnneMarie		6174260600	56999				amartel@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	SNP State Contact	General Manager, Market Lead - Rhode Island		McCarty	Corey		6174260600	52262				cmccarty@commonwealthcare.org	3 Davol Square, Suite C-300		Providence	RI	02903	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Surveillance Contact	VP, National Sales		Spartano	Michael		6174260600	52179				mspartano@commonwealthcare.org	30 Winter Street		Boston	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	System Contact	Manager, Encounters and Risk Adjustment		Soones	Michael		6174260600	4925				msoones@commonwealthcare.org	30 Winter Street		Boston	MA	02108	01/21/2021	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Third Party Administrator (TPA) Liaison	Sr. Director Treasury Operations		Jabre	Joe		6175642953					jjabre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	User Access Contact	Director Medicare Compliance Officer		Lavallee	Katherine		6179475780					KLavalee@commonwealthcare.org	190 White Ave		Warwick	MA	02108	08/25/2022	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Utilization Management Contact	VP UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9876	Utilization Review Contact	VP UM and A&G		Dardompre	Donna		6175079344					ddardompre@commonwealthcare.org	30 Winter Street		Boston	MA	02108	09/11/2023	2023	Commonwealth Care Alliance Rhode Island, LLC	Local CCP	CCA Health Rhode Island	Local PPO		Commonwealth Care Alliance, Inc.	60	Yes	Active					PPO - BBA		C	Boston
H9877	Agent/Broker Compensation Data Contact	Director, Sales		McVey	Kathy		7574181231					kemcvey@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Benefits		Strickland	Brandi		7572528193				7579625575	RxBenefits@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Backup User Access Contact	Compliance Consultant		Harvey	Kimberly		8046134890	20178				kdharvey@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Best Available Evidence Contact	Director Enrollment & Disenrollment		Brown	Sheila		7572528015				7576925575	sxbrown29@sentara.com	4456 Corporation Lane	Suite 210	Virginia Beach	VA	23462	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Bid Audit Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Bid Audit Site Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Bid Primary Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	CAP Report Contact for Public Website	Medicare Contract Administrator		MEDICARE	OPTIMA		7576876160				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation	8009276048				HMO - Health Maintenance Organization		C	Philadelphia
H9877	CEO - CMS Administrator Contact	VP, Medicare Government Programs	Mrs	Gerald	Alicia		5704920915				7575527396	aagerald@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	CEO - Senior Official for Contracting	VP, Medicare Government Programs	Mrs	Gerald	Alicia		5704920915				7575527396	aagerald@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Chief Financial Officer	Director Medicare Finance	Ms.	Eagleson	Leigh		4438516654				7575527396	laeagles@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Chief Operating Officer	VP, Medicare Government Programs	Mrs	Gerald	Alicia		5704920915				7575527396	aagerald@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Chief Information Officer	VP Information Systems	Ms.	Kaszubowski	Natalie		7572520436					nakaszub@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Chief Information Security Officer	VP, Chief Information Security Officer	Mr.	Siddiqui	Zishan		7572520015				7579638689	zasiddiq@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	CMS Casework Communication Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Complaints Tracking Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Contact for Fraud Investigations	Director Finance & Risk Mgt		Robbins	Janet		7572528012					jlrobbin@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Coordination of Benefits Contact	Sr. Compliance Consultant	Ms	Goddette	Maricelis		8048195151				7576876231	mxcintro@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Corporate Mailing						5704920915				7575527116	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Coverage Gap Discount Program (CGDP) Payment Contact	Director Accounting Operations		Duncan	April		7572528055				7572528039	acmorgan@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Customer Service Operations Contact	Director, Customer Services		Lucas-Bain	Shenna		8133348871				7575527116	sxlucasb@sentara.com	10800 Nuckols Road		Glen Allen	VA	23060	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	DIR Contact	Director Pharmacy Performance		Hartzell	Lindsay		8048195179				7579625575	LEHARTZE@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	DIR Contact (Secondary)	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Emergency Part D Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park	Suite 210	Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Emergency Part D Contact (Secondary)	Manager Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Employer Waiver Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	08/04/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Encounter Data & Risk Adjustment Operations Contact	Director, Actuary		Ratzlaff	Dean		7576876018					daratzla@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Enrollment Contact	Director, Enrollment		Brown	Sheila		7572528015					sxbrown29@sentara.com	4456 Corporation Lane		Virginia Beach	VA	23462	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	EOB Transfer Contact	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625576	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Financial Audit Contact	Director, Medicare Compliance	Ms.	Green	Janet		8133682227					jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Financial Reporting Contact	VP & Controller		Snyder	Jeff		7572528023				7572528030	jcsnyder@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Formulary Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23462	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Formulary Contact (Secondary)	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	General Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Government Relations Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	HIPAA Privacy Officer	Director, Compliance	Ms.	Dajon	Sharon	M	7575527485				7575527116	smdajon@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	HIPAA Security Officer	VP, Chief Information Security Officer	Mr.	Siddiqui	Zishan		7572520015				7579638689	zasiddiq@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Hospice Contact	Director Pharmacy Ops & Compliance		May	Crystal		8666037514				7579625575	ccmay2@sentara.com	10800 Nuckols		Glen Allen	VA	23060	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Interoperability Contact	IT Project Manager		Larkins	Eddie		8048195151					ellarkin@sentara.com	4456 Corporation Lane		Virginia Beach	VA	23462	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	MA Appeals/Grievances Contact	Director Appeals & Grievance		Byrd	Natasha		8048195151				7576876232	nxbyrd@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	MA Claims Processing Contact for Public Website	Director Ops Support		Rodriguez	Joseph		7579834333				7572528030	jxrodr10@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Marketing Contact	Director Sales Enablement		Fiero	Asleigh		7572528505				7576876135	akfiero@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Medical Director	CMO Health Plan	Dr.	Greifer	Kristyn		6782748402				7575527108	KXGREIFE@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Medicare Compliance Officer	Director, Medicare Compliance	Ms.	Green	Janet		8133682227					jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Medicare Coordinator	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Medicare Part D Opioid Overutilization Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Medication Therapy Management Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Online Enrollment Center Contact (Back-up)	Sr. Business Analyst, Medicare		Ashar	Satish		8048195151	302				sdashar@sentara.com	4456 Corporate Lane		Virginia Beach	VA	23462	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Online Enrollment Center Contact (Primary)	Director, Enrollment		Brown	Sheila		7572528015					sxbrown29@sentara.com	4456 Corporation Lane		Virginia Beach	VA	23462	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part C Application Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part C Reporting Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Appeals	Manager Clinical Pharmacy		Snow	Michael						7579625576	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation	7579834243				HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Appeals Contact (Secondary)	Manager Pharmacy Compliance		Allen	Emily						7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation	8048144500				HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Application Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Benefits Contact	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Claims Submission Contact	Manager, Pharmacy Benefits		Strickland	Brandi		7572528193				7579625575	RxBenefits@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Exceptions Contact	Manager Clinical Pharmacy		Snow	Michael						7579625576	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation	7579834243				HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Exceptions Contact (Secondary)	Manager Pharmacy Compliance		Allen	Emily						7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation	8048144500				HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Price File Contact (Back-up)	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Price File Contact (Optional)	Director Pharmacy Performance		Hartzell	Lindsay		8048195179				7579625575	LEHARTZE@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Price File Contact (Primary)	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Quality Assurance Contact	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Part D Reporting Contact	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7576925576	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Patient Safety Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625576	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Payment Contact	Director, Accounting	Ms.	Albert	Rinda		7572528015					realbert@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Pharmacy Director	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Pharmacy Network Management Contact	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Pharmacy Technical Help Desk Contact	Director Customer Service		Monroe	LaTasha						8882358551	LaTasha_Monroe@express-scripts.com	11780 U.S. Hwy Suite N107		Palm Beach Gardens	FL	33408	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation	8009221557				HMO - Health Maintenance Organization		C	Philadelphia
H9877	Pharmacy Technical Help Desk Contact (Secondary)	Director Pharmacy Ops & Compliance		May	Crystal						7579625575	ccmay2@sentara.com	10800 Nuckols		Glen Allen	VA	23060	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation	8666037514				HMO - Health Maintenance Organization		C	Philadelphia
H9877	Physician Incentive Contact	VP Value Based Care		Krebbs	Robert		8045728832				7575527576	rlkrebbs@sentara.com	1300 Sentara Park		Virgnia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Plan Directory Contact for Public Website	Member Services		MEMBER SERVICES	OPTIMA		8009276048					members@optimahealth.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Plan to Plan Reconciliation Contact	Director Accounting Operations		Duncan	April		7572528055				7572528039	acmorgan@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Processor Contact	Director Ops Support		Rodriguez	Joseph		7579834333				7572528030	jxrodr10@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Quality Contact	Director Quality & Regulatory		Taylor	Tonya		8046136524				8048195186	tptaylor@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Reconciliation Contact	Director, Medicare Finance		Richardson	Scott		9542587586					sxricha3@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Reconciliation Contact (Secondary)	Manager Actuarial Support		Wimalendran	Shane		7575528944					uxwimale@sentara.com	4456 Corporation Lane	Suite 210	Virginia Beach	VA	23462	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Recovery Audit Contact	Director, Accounting	Ms.	Albert	Rinda		7572528015					realbert@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	SNP Application Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	SNP State Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Surveillance Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	System Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Third Party Administrator (TPA) Liaison	Director Accounting Operations		Duncan	April		7572528055				7572528039	acmorgan@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	User Access Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Utilization Management Contact	Director Utilization Management		Barton	Jamie		4342948816				7575527108	jcbarton@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9877	Utilization Review Contact	Director Utilization Management		Barton	Jamie		4342948816				7575527108	jcbarton@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	VIRGINIA PREMIER HEALTH PLAN, INC.	Local CCP	Virginia Premier	HMO/HMOPOS		Sentara Health Care (SHC)	345	Yes	Consolidation					HMO - Health Maintenance Organization		C	Philadelphia
H9884	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9884	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9884	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9884	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9884	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H9884	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9884	PHR Beneficiary Contact																	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H9884	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9884	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/23/2023	2023	DEVOTED HEALTH INSURANCE COMPANY	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Agent/Broker Compensation Data Contact	Director of Sales Operations		Shah	Rishi		2488422231					rshah@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Automated TrOOP Balance Transfer Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Backup User Access Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Best Available Evidence Contact	Program Manager Membership Ops		Mangat	Sunny		6178589484					enrollment@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Bid Audit Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Bid Audit Site Contact	Head of Product		Holway	Jonathan		5087357313					JHolway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Bid Primary Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	CAP Report Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	CEO - CMS Administrator Contact	Chief Executive  Officer	Mr.	Park	Ed		7818205992					Epark@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	CEO - Senior Official for Contracting	Chief Market President	Mr.	Quintana	Dariel		9546628946					dquintana@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Chief Financial Officer	Chief Financial Officer	Mr.	Yale	Bradley		7818108450					byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Chief Operating Officer	Chief Operating Officer	Mr.	Henry	Larry		5712394301					lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Chief Information Officer	co-Chief Technology Officer	Mr.	Nye	Jack		6172304584					jnye@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Chief Information Security Officer	Security Officer	Mr.	Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	CMMI Model Point of Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	CMS Casework Communication Contact	Director of Appeals and Grievances		Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Complaints Tracking Contact	Director of Part C Compliance	Ms.	Cagot	Janette		3049146913					JCagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Contact for Fraud Investigations	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Coordination of Benefits Contact	Manager Membership Operations		Ewing	David		6198844822					dewing@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Corporate Mailing						5083098193					Jdelinsky@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Coverage Gap Discount Program (CGDP) Payment Contact	Clinical Pharmacy		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Customer Service Operations Contact	Chief Member Experience Officer		Nanavati	Monna		3392037312					mnanavati@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	DIR Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	DIR Contact (Secondary)	Director of Part D Operations		Stearns	David		2072398200					dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Electronic Health Record Contact	Stars Program Manager	Ms	Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Emergency Part D Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Emergency Part D Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Employer Waiver Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment and Provider ops		Sherman	Rachel		6175197086					Rsherman@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Enrollment Contact	Director of Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	EOB Transfer Contact	Manager of Part D Operations		McDaniel	Jody		2072990251				6177024316	jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Financial Audit Contact	Chief Accounting Officer	Mr	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Financial Reporting Contact	Director of Stat Reporting	Mr.	Alfano	Joseph		8609169120					Joseph.Alfano@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Formulary Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Formulary Contact (Secondary)	Pharmacy Technician		Mendez	Kristen		6179702549					kristen.mendez@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	General Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Government Relations Contact	Chief Legal and External Affairs Office		Cowan	Mo		6174078110					mcowan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	HIPAA Privacy Officer	Privacy Officer		Jernigan	Paul		3462364999					Pjernigan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	HIPAA Security Officer	Information Security Officer		Martin	Tyler		9048531156					tyler.martin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Hospice Contact	Manager Enrollment Operations		Mangat	Sunny		6178589484					smangat@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Interoperability Contact	Product Leader-Core Operations		Erawan	Henky		6176698288					herawan@devoted.com	221 Crescent Street Suite 202 Waltham, MA 02453	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	MA Appeals/Grievances Contact	Director of Appeals and Grievance		Cagot	Janette		3049146913					jcagot@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	MA Claims Processing Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02053	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Marketing Contact	Marketing Manager		Hipp	Kristen		2036712418					KHipp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Medical Director	Medical Director	Dr.	Johnson	Dave		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Medicare Compliance Officer	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Medicare Coordinator	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Medication Therapy Management Contact	Pharmacist		Bioc	Justin		2405810317					jbioc@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	OffShore Subcontractor Contact	Head of Offshore contract		Tappan-deFrees	Beth		7812486936					Btappendefrees@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Online Enrollment Center Contact (Back-up)	Head of Membership Operations		Lepsevich	Katie		5084047626					klepsevich@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Online Enrollment Center Contact (Optional)	Program Manager, MemOps		Berk	Emily		8022995105					emily.berk@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Online Enrollment Center Contact (Primary)	Director, Enrollment & Quality		Quicker	Laura		6319013336					lquicker@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Part C Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Part C Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	PA	18966	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Part D Appeals	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9888	Part D Appeals Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9888	Part D Application Contact	Head of Product		Holway	Jonathan		5087357313					Jholway@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Part D Benefits Contact	Manager Part D Operations		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Part D Claims Submission Contact	Director of Part D Operations		Stearns	David		2072398200					Dstearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Part D Exceptions Contact	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9888	Part D Exceptions Contact (Secondary)	Manager of Part D Operations		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9888	Part D Price File Contact (Back-up)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Part D Price File Contact (Optional)	Director of Part D Operations		Tripp	Ginger		7442193868					Gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Part D Price File Contact (Primary)	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Part D Quality Assurance Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Part D Reporting Contact	Compliance Manager		Anderson	Abra		6074351005					aanderson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Patient Safety Contact	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Payment Contact	CFO	Mr.	Yale	Brad		7818108450					Byale@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Personal Health Record Contact	Stars Program Manager		Rosenbaum	Julia		2153137556					jrosenbaum@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Pharmacy Director	Director, Pharmacy		Cue	Anlly		9546102501					angie.cue@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Pharmacy Network Management Contact	Director of Part D Operations		Stearns	David		2072398200					DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Pharmacy Network Management Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody		2072990251					jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Pharmacy Technical Help Desk Contact	Director of Part D Operations		Stearns	David							DStearns@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	8666934620				PPO - BBA		C	New York
H9888	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Program Manager, Medicare Part D		McDaniel	Jody							jody.mcdaniel@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active	2072990251				PPO - BBA		C	New York
H9888	PHR Beneficiary Contact																	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO	Devoted Health	Devoted Health, Inc.	690	Yes	Active	8552927485				PPO - BBA		C	New York
H9888	Physician Incentive Contact	VP Provider Performance		Grijalba	Dunia		9545796191					dgrijalba@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Plan Directory Contact for Public Website	Chief Compliance Officer		O'Kane	Shannon		8003386833					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Plan to Plan Reconciliation Contact	Assistant Controller		Tran	Jessica		6175131910					p2padmin@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Processor Contact	Chief Operating Officer		Henry	Larry		5712394301					Lhenry@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Quality Contact	Director of Quality	Ms	Fluery	Christie		5083605071					christie.fluery@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Reconciliation Contact	Actuary		Quinn	Daniel		9788692163					dquinn@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Reconciliation Contact (Secondary)	Actuary		Baumstein	Michael		2016747341					michael.baumstein@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Recovery Audit Contact	Chief Accounting Officer	Mr.	Donovan	Glen		3139193837					glen.donovan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	SNP Application Contact	Head of Product		Holway	Jonathan		5087357313					jholway@devoted.com	221 Crescent Street	Suite 202 - Devoted Health	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	SNP State Contact	Compliance Director		Buchanan	Christy		2057182483					Christy.Buchanan@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Surveillance Contact	Chief Compliance Officer		O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	System Contact	Information Officer	Mr.	Gallant	David		6033205421					Dgallant@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Third Party Administrator (TPA) Liaison	Pharmacy Program Manager		Tripp	Ginger		7742193868					gtripp@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	User Access Contact	Chief Compliance Officer	Ms.	O'Kane	Shannon		2675304834					sokane@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Utilization Management Contact	Director of Utilization Management		Parks	Regina		2542203062					regina.parks@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9888	Utilization Review Contact	Medical Director	Dr.	Johnson	David		3612449130					David.Johnson@devoted.com	221 Crescent Street	Suite 202	Waltham	MA	02453	08/25/2023	2023	DEVOTED HEALTH INSURANCE COMPANY OF ALABAMA INC	Local CCP	Devoted Health	Local PPO		Devoted Health, Inc.	690	Yes	Active					PPO - BBA		C	New York
H9900	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/02/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	03/10/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/14/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Encounter Data & Risk Adjustment Operations Contact	Director, Reporting & Business Analytics		Herceg	Vanessa		8132067388					Encounters_Raps_Ops@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/28/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	09/26/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	06/14/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/14/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/27/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	06/28/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Part C Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132063350				HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132066534				HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	06/14/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8132067152				HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	6023080218				HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/02/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H9900	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Markhan	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	06/14/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active	8555380454				HMO - Health Maintenance Organization		C	Dallas
H9900	PHR Beneficiary Contact																	09/28/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS	Member Services	Centene Corporation	351	Yes	Active	8338530865				HMO - Health Maintenance Organization		C	Dallas
H9900	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/14/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	SNP Application Contact	Director, Medicare Strategy	Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/13/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/02/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9900	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/14/2022	2023	WELLCARE OF OKLAHOMA, INC.	Local CCP	Wellcare	HMO/HMOPOS		Centene Corporation	351	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9904	Agent/Broker Compensation Data Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Automated TrOOP Balance Transfer Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Backup User Access Contact	VP of Government Programs		Shirshac	Jeanne		5083340500					Jeanne.Shirshac@umassmemorial.org	365 Plantation Street	3rd floor	Worcester	MA	01605	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Best Available Evidence Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Bid Audit Contact	Chief Financial Officer	Mr.	Beermann	James		7747011437					james.beermann@massadvantage.com	365 Plantation St	3rd Floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Bid Audit Site Contact	Chief Financial Officer		Beermann	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Bid Primary Contact	Chief Financial Officer		Beermann	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	CEO - CMS Administrator Contact	President	Ms.	Trafton	Heather		7747011213					Heather.Trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	CEO - Senior Official for Contracting	President	Ms.	Trafton	Heather		7747011213					Heather.Trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Chief Financial Officer	Chief Financial Officer	Mr.	James	Beermann		7747011437					james.beermann@massadvantage.com	365 Plantation St	3rd Floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Chief Operating Officer	President	Ms.	Trafton	Heather		7747011213					heather.trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Chief Information Officer	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Chief Information Security Officer	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	CMMI Model Point of Contact	Senior Director, Government Programs		LeVecque	Lynn		5083340569					lynn.levecque@umassmemorial.org	365 Plantation Street	3rd floor	Worcester	MA	01605	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	CMS Casework Communication Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Complaints Tracking Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Contact for Fraud Investigations	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Coordination of Benefits Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Corporate Mailing						7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer		Beermann	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Customer Service Operations Contact	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W. 10th Street		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	DIR Contact	Chief Financial Officer		Beermann	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	DIR Contact (Secondary)	VP of Government Programs		Shirshac	Jeanne		5083340500					Jeanne.Shirshac@umassmemorial.org	365 Plantation Street	3rd floor	Worcester	MA	01605	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Electronic Health Record Contact	Medicare Compliance Officere	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active	7747011604				PPO - BBA		C	New York
H9904	Emergency Part D Contact	Medicare	Ms.	Hursey	Erica		7747011626					erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	12/21/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Emergency Part D Contact (Secondary)	Pharmacy Manager, Part D		Jones	Susan		7747011720					susan.jones@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	12/28/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Employer Waiver Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Encounter Data & Risk Adjustment Operations Contact	Director, Business Systems Analysis		Pedigo	Anne		6157723229					anne.pedigo@sscinc.com	210 W. 10th Street		Kansas CIty	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Enrollment Contact	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	EOB Transfer Contact	Vice President		Velten	Steve		8164357408				3607211381	svelten@dsthealth.com	210 W. 10th Street		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Financial Audit Contact	Chief Financial Officer	Mr.	Beermann	James		7747011437					james.beermann@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Financial Reporting Contact	Chief Financial Officer	Mr.	Beermann	James		7747011437					james.beermann@massadvantage.com	365 Plantation St	3rd Floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Formulary Contact	Pharmacy Manager, Part D		Jones	Susan		7747011720					susan.jones@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Formulary Contact (Secondary)	Medicare Pharmacy Program Director		Hursey	Erica		7747011626					erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	05/16/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	General Contact	Senior Vice President, Operations	Ms.	Turbett	Catherine		7747011724					catherine.turbett@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Government Relations Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	HIPAA Privacy Officer	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	HIPAA Security Officer	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Hospice Contact	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Interoperability Contact	IT Director		Carey	Cameron		9789356216					cam.carey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	05/16/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	MA Appeals/Grievances Contact	Medicare Compliance Officere	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	MA Claims Processing Contact for Public Website	Vice President		Veltan	Steve		8164357408					svelten@dsthealth.com	210 W. 10th Street		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Marketing Contact	VP of Sales and Marketing	Ms.	Mood	Margaret		7747011181					margaret.mood@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Medical Director	Chief Medical Officer		Cantor	Mike		7747011441					mike.cantor@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	11/11/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Medicare Coordinator	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Medicare Part D Opioid Overutilization Contact	Medicare Pharmacy Program Director		Hursey	Erica		7747011626					erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	05/16/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Medication Therapy Management Contact	Medicare Pharmacy Program Director		Hursey	Erica		7747011626					erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	05/16/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Online Enrollment Center Contact (Back-up)	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Online Enrollment Center Contact (Optional)	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Online Enrollment Center Contact (Primary)	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Part C Application Contact	Senior Manager of Network Management		McWilliams	Leah		7747011735					leah.mcwilliams@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	02/13/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Part C Reporting Contact	Senior Director, Government Programs		LeVecque	Lynn		5083340569					lynn.levecque@umassmemorial.org	365 Plantation Street	3rd floor	Worcester	MA	01605	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Part D Appeals	Sr Manager of Pharmacy Part D	Ms.	JOnes	Susan							susan.jones@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	05/16/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active	7747011720				PPO - BBA		C	New York
H9904	Part D Appeals Contact (Secondary)	Medicare Pharmacy Program Director	Ms.	Hursey	Erica							erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	10/24/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active	7747011626				PPO - BBA		C	New York
H9904	Part D Application Contact	Medicare Compliance Officer		Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	02/13/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Part D Benefits Contact	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Part D Claims Submission Contact	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Part D Exceptions Contact	Vice President, Compliance & Contracting		Cone	Mark							mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active	8168436461				PPO - BBA		C	New York
H9904	Part D Exceptions Contact (Secondary)	Vice President, Compliance & Contracting		Cone	Mark							mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active	8168436461				PPO - BBA		C	New York
H9904	Part D Price File Contact (Back-up)	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Part D Price File Contact (Optional)	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Part D Price File Contact (Primary)	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Part D Quality Assurance Contact	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Part D Reporting Contact	Vice President, Compliance & Contracting		Cone	Mark		8168436461					mark.cone@sscinc.com	210 W. 10th Street		Kansas City	MO	64105	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Patient Safety Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Payment Contact	Chief Financial Officer	Mr.	Beermann	James		7747011437					james.beermann@massadvantage.com	365 Plantation St	3rd Floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Personal Health Record Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Pharmacy Director	Sr Director Pharmacy Network Analytics and Pricing		Huffman	Greg		8164352471					ghuffman@sscinc.com	210 W 10th St		Kansas City	MO	64105	10/18/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Pharmacy Network Management Contact	Sr Director Pharmacy Network Analytics and Pricing		Huffman	Greg		8164352471					ghuffman@sscinc.com	210 W 10th St		Kansas City	MO	64105	10/18/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Pharmacy Network Management Contact (Secondary)	Sr Director Pharmacy Network Analytics and Pricing		Huffman	Greg		8164352471					ghuffman@sscinc.com	210 W 10th St		Kansas City	MO	64105	10/18/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Pharmacy Technical Help Desk Contact	Sr Director Pharmacy Network Analytics and Pricing		Huffman	Greg							ghuffman@sscinc.com	210 W 10th St		Kansas City	MO	64105	10/24/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active	8449150234				PPO - BBA		C	New York
H9904	Pharmacy Technical Help Desk Contact (Secondary)	Sr Director Pharmacy Network Analytics and Pricing		Huffman	Greg							ghuffman@sscinc.com	210 W 10th St		Kansas City	MO	64105	10/24/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active	8449150234				PPO - BBA		C	New York
H9904	PHR Beneficiary Contact																	04/09/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO	Central Mass Health Holding LLC	Central Mass Health Holding LLC	773	Yes	Active	8164352412				PPO - BBA		C	New York
H9904	Physician Incentive Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Plan Directory Contact for Public Website	President	Ms.	Trafton	Heather		7747011213					heather.trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Plan to Plan Reconciliation Contact	Medicare Pharmacy Program Director		Hursey	Erica		7747011626					erica.hursey@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	06/21/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Processor Contact	Vice President		Velten	Steve		8164357408					svelten@dsthealth.com	210 W 10th St		Kansas City	MO	64105	06/08/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Quality Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Reconciliation Contact	Chief Financial Officer	Mr.	Beermann	James		7747011437					james.beermann@massadvantage.com	365 Plantation St	3rd Floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Reconciliation Contact (Secondary)	Comptroller		Natarajan	Gayatri		7747011731					gayatri.natarajan@massadvantage.com	365 Plantation St	3rd Floor	Worcester	MA	01605	02/16/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	SNP Application Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	SNP State Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Surveillance Contact	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	System Contact	President	Ms.	Trafton	Heather		7747011213					Heather.Trafton@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/31/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Third Party Administrator (TPA) Liaison	Medicare Compliance Officer	Ms.	Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	08/26/2021	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	User Access Contact	Chief Strategy Officer		Perritt	Maggie		7747011604					maggie.perritt@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	05/16/2023	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Utilization Management Contact	Chief Medical Officer		Cantor	Mike		7747011441					mike.cantor@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9904	Utilization Review Contact	Chief Medical Officer		Cantor	Mike		7747011441					mike.cantor@massadvantage.com	365 Plantation Street	3rd floor	Worcester	MA	01605	01/10/2022	2023	CENTRAL MASS HEALTH, LLC	Local CCP	Mass Advantage	Local PPO		Central Mass Health Holding LLC	773	Yes	Active					PPO - BBA		C	New York
H9907	Agent/Broker Compensation Data Contact	Vice President, Medicare Sales & Marketing	Ms.	McManus	Marie		6179729400	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Automated TrOOP Balance Transfer Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Backup User Access Contact	Medicare Compliance Program Manager		Tran	Brenda		7816121000	85880				brenda.tran@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Best Available Evidence Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Bid Audit Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Bid Audit Site Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Bid Primary Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852	84759				taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Chief Financial Officer	SVP Chief Financial Officer	Mr.	Walker	Scott		7816126840					r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Chief Operating Officer	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Chief Information Officer	SVP and Chief Information Officer	Ms.	Ferhatbegovic	Selma		7816121000	84633				Selma.Ferhatbegovic@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	CMS Casework Communication Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Complaints Tracking Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Contact for Fraud Investigations	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Coordination of Benefits Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Corporate Mailing						7816121000					Cain.Hayes@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Customer Service Operations Contact	Manager, Member Services	Ms.	Villatoro	Yesly		7816121000	54152				yesly.villatoro@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	DIR Contact	Senior Manager, Pharmacy reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	DIR Contact (Secondary)	Pharmacy Analyst Senior	Ms.	Santino	Cristina		7816121000	82560				cristina.santino@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Emergency Part D Contact	Director, Pharmacy Operations		Bonica	Joseph		7816123342					joseph.bonica@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Emergency Part D Contact (Secondary)	Manager, Pharmacy Compliance		Lake	Matthew		7816123976					matthew.lake@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Employer Waiver Contact	Manager, Client Service	Ms.	Bartkiewicz	Mary		7816121000	83937				mary.bartkiewicz@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Encounter Data & Risk Adjustment Operations Contact	Risk Adjustment Data Analyst Lead	Ms.	Quinlan	Judith		7816121000	83377				judith.quinlan@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Enrollment Contact	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	EOB Transfer Contact	Manager, Business Implementation		Nesmith	Tanisha		7816124861				6176730286	tanisha.nesmith@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Financial Audit Contact	Chief Financial Officer	Mr.	Walker	Scott		7816121000	86840				r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Financial Reporting Contact	SVP Finance & Chief Accounting Officer	Mr.	Porter	Mark		6179729400	85536				mark.porter@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Formulary Contact	Clinical Pharmacist Senior	Mr.	Kowalski	Alec		7816121000	82045				alec.kowalski@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Formulary Contact (Secondary)	Clinical Pharmacist Senior		Shafir	Frances		7816122897					frances.shafir@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	General Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Government Relations Contact	Chief Government Affairs Officer	Ms.	Lewis	Kristin		7816121000	83621				kristin.lewis@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	HIPAA Privacy Officer	VP Privacy & Special Investigation	Mr.	Walsh	Chris		7816121000	82508				Christopher.walsh@point32health.org	1600 Crown Colony Drive		Quincy	MA	02169	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	HIPAA Security Officer	VP Chief  Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Hospice Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Interoperability Contact	Vice President & Chief Technology Officer		Querusio	David		7816122629					david.querusio@point32health.org	One Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	MA Appeals/Grievances Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	MA Claims Processing Contact for Public Website	Vice President, Claims	Mr.	Fernandez	David		6175844884					david.fernandez@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Marketing Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Medical Director	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Medicare Compliance Officer	Medicaid Compliance Officer	Mrs	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Medicare Coordinator	SVP, President Medicare	Ms.	Blake	Patty		7816124287					Patty.Blake@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Dohan	David		7816121000	82615				David.Dohan@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Medication Therapy Management Contact	Sr Pharmacy Program Manager		Burns	Ashlyn		7816122239					ashlyn.burns@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	OffShore Subcontractor Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Online Enrollment Center Contact (Back-up)	Director, Enrollment & Payment - Senior Products	Ms.	Bullock	Jennifer		7816121000	83183				jennifer.bullock@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Online Enrollment Center Contact (Optional)	Supervisor, Enrollment	Ms.	Van De Mortel	Migdalia		7816121000	84104				Migdalia.Van.De.Mortel@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Online Enrollment Center Contact (Primary)	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Part C Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Part C Reporting Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Part D Appeals	Director, Appeals & Grievances	Ms.	Evans	Kathleen							Kathleen.Evans@point32health.org	1 Wellness Way		Canton	MA	02021	09/20/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active	6179729400	87204			PPO - BBA		C	Boston
H9907	Part D Appeals Contact (Secondary)	Program Manager Senior	Ms.	Mello	Sheri							sheri.mello@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active	7816121000	84862			PPO - BBA		C	Boston
H9907	Part D Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Part D Benefits Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Part D Claims Submission Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Chan	Bryan							bryan.chan@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active	7816121000	82370			PPO - BBA		C	Boston
H9907	Part D Exceptions Contact (Secondary)	Supervisor, Pharmacy Utilization Management	Ms.	Griffith	Samantha							samantha.griffith@point32health.org	1 Wellness Way		Canton	MA	02021	02/04/2022	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active	7816121000	84551			PPO - BBA		C	Boston
H9907	Part D Price File Contact (Back-up)	Advisor, Medicare Operations		Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	60173	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Part D Price File Contact (Optional)	Sr. Pharmacy Implementation Specialist		Sullivan	Tim		7816124922					tim.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Part D Price File Contact (Primary)	Sr Business Analyst		Moore-Elliott	Shalandria		7637974305					shalandria.moore-elliott@optum.com	1600 McConnor Pwy.		Schaumburg	IL	60173	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Part D Quality Assurance Contact	Vice President, Behavioral Health	Ms.	Borrelli	Jill		6179729400	85397				jill.borrelli@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Part D Reporting Contact	Director, Pharmacy Financial & Reporting	Mr.	Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Patient Safety Contact	Sr Pharmacy Implementation Specialist		von Fritzinger	Lisa		7816123778					lisa.vonfritzinger@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Payment Contact	Program Manager III	Ms.	Cook	Tiffany		7816121000	84908				Tiffany.Cook@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Pharmacy Director	Vice President, Pharmacy	Ms.	Sullivan	Miriam		7816121000	84116				miriam.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations		Ashby	JoLynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Pharmacy Technical Help Desk Contact	Sr. Manager		Villaneuva	Juan							Juan.Villanueva@optum.com	3515 S Harbor Blvd.		Costa Mesa	CA	92626	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active	7148253761				PPO - BBA		C	Boston
H9907	Pharmacy Technical Help Desk Contact (Secondary)	Associate Director, Pharmacy Help Desk		Betten	Brad							bradley.betten@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active	8555240380				PPO - BBA		C	Boston
H9907	Plan Directory Contact for Public Website	Supervisor, Marketing Materials Production	Mr.	Kayser	Kenneth		7816121000	83518				kenneth.kayser@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Plan to Plan Reconciliation Contact	Manager, Finance Operations	Ms.	Olson	Rachel		7816121000	84360				rachel.olson@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Processor Contact	Director, Claims	Ms.	Patel	Monal		7816121000	88187				monal.patel@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Quality Contact	Senior Manager, Quality Informatics	Ms.	McCoy	Kelly		7816121000	83515				kelly.mccoy@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Reconciliation Contact	Senior Manager, Pharmacy Reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Reconciliation Contact (Secondary)	Director, Pharmacy Financial & Reporting		Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	09/11/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Recovery Audit Contact	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	SNP Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	SNP State Contact	Director Business Implementation		Chukwu	Matthew		7816123967					matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	07/19/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Surveillance Contact	Director, Sales Operations		McManus	Marie		6117972940	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	System Contact	Senior Manager, Business Account Management	Mr.	Allen	Jeffrey		7816121000	83167			6179729008	Jeffrey.Allen@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Third Party Administrator (TPA) Liaison	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	User Access Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/04/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Utilization Management Contact	Director, Care Management	Ms.	Menery	Maureen		7816121000	83994				maureen.menery@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9907	Utilization Review Contact	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	07/31/2023	2023	TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION	Local CCP	Tufts Health Plan	Local PPO		Point32Health, Inc.	398	Yes	Active					PPO - BBA		C	Boston
H9909	Agent/Broker Compensation Data Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Automated TrOOP Balance Transfer Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Backup User Access Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Best Available Evidence Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Bid Audit Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Bid Audit Site Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Bid Primary Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	CAP Report Contact for Public Website	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	CEO - CMS Administrator Contact	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	CEO - Senior Official for Contracting	CEO	Mr.	Bailey	Michael	D	6157518131				8442805360	mbailey@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Chief Financial Officer	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Chief Operating Officer	Chief Operating Officer	Ms.	Bradley	Robin		6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Chief Information Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Chief Information Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	CMMI Model Point of Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	CMS Casework Communication Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Complaints Tracking Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Contact for Fraud Investigations	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Coordination of Benefits Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Corporate Mailing						6156148404				8442805360	rbradley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Coverage Gap Discount Program (CGDP) Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Customer Service Operations Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	05/18/2020	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	DIR Contact	VP Formulary & Rebate Economics		Ellermeir	Nicole		9133875120					nellermeir@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	DIR Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Electronic Health Record Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Emergency Part D Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Emergency Part D Contact (Secondary)	Pharmacy Operations	Mrs.	Sanchez	Lynn		4056014429				8442805360	lsanchez@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Encounter Data & Risk Adjustment Operations Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Enrollment Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	EOB Transfer Contact	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Financial Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Financial Reporting Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Formulary Contact	Clinical Formulary Pharmacist	Ms.	Quinn	Kelsey		3304864954					kquinn@elixirsolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Formulary Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	General Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Government Relations Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	HIPAA Privacy Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	HIPAA Security Officer	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Hospice Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Interoperability Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	MA Appeals/Grievances Contact	A&G Team Lead	Mrs.	Henderson	Maya		6156268442				8442805360	mhenderson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	MA Claims Processing Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		8003997524				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Marketing Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Medical Director	Medical Director	Dr.	Misra	Sumathi		6156365478					SMisra@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/17/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Medicare Compliance Officer	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Medicare Coordinator	Executive Director	Ms.	Voigtmann	Kari		6156036996				8442805360	kvoigtmann@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Medicare Part D Opioid Overutilization Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Medication Therapy Management Contact	Director of Clinical Product Development and Strat	Ms.	Miller	Holly		3304866457				3304058094	hrmiller@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	OffShore Subcontractor Contact	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Online Enrollment Center Contact (Back-up)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Online Enrollment Center Contact (Primary)	Manager, Enrollment	Ms.	Mohning	Kathleen		6154650182				8442805360	kmohning@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Part C Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Part C Reporting Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Appeals	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Appeals Contact (Secondary)	Appeals Supervisor, Clinical Operations	Mr	Binegar	Sam						3304058081	appeals@ElixirSolutions.com	2181 E Aurora Road	Building B, Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8003997524				HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Benefits Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Claims Submission Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Exceptions Contact	Associate VP of Clinical Operations	Ms.	Lavignette	Amanda						3304864801	alavignette@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	3308886079				HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Exceptions Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa						8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8443211763				HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Price File Contact (Back-up)	Sr Financial Manager Reporting & Analytics	Mr	Campbell	Tim		3308886988					tcampbell@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Price File Contact (Optional)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Price File Contact (Primary)	Senior Director Rebates, Trade Relations	Mr.	Bonus	Jason		3304864841				3304864801	jbonus@ElixirSolutions.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Quality Assurance Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Part D Reporting Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Patient Safety Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Payment Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Pharmacy Director	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Pharmacy Network Management Contact	Director of Pharmacy Network Development and Ops	Ms	Profio	Lauren		3304864864				3304058094	lprofio@EnvisionRx.com	2181 East Aurora Rd	Suite 201	Twinsburg	OH	44087	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Pharmacy Network Management Contact (Secondary)	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Pharmacy Technical Help Desk Contact	Vice President Operations	Mr.	Conn	Todd							tconn@EnvisionRx.com	2181 East Aurora Road	Suite 201	Twinsburg	OH	44087	09/07/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8336611993				HMO - Health Maintenance Organization		C	Dallas
H9909	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Technician		Sanchez	Lynn						6157610920	lsanchez@amhealthplans.com	909 S Meridian Avenue	Ste 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active	8449170642				HMO - Health Maintenance Organization		C	Dallas
H9909	Plan Directory Contact for Public Website	Director, Health Plan Administration	Ms.	Bridgeforth	Jennifer		6159055424				8442805360	jbridgeforth@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Plan to Plan Reconciliation Contact	Sr. Manager,  Financial Accounting	Ms.	Tilley	Stephanie		9312420499					stilley@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	08/30/2023	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Processor Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	909 South Meridian Avenue	Suite 425	Oklahoma City	OK	73108	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Quality Contact	R.Ph, Vice President, Health Services	Ms.	Roper	Lisa		4056012482				8442805360	lroper@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	02/16/2022	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Reconciliation Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Reconciliation Contact (Secondary)	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Recovery Audit Contact	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	SNP Application Contact	VP Health Plan Administration & Analytics	Ms.	Foote	Denise		6156568049				8442805360	dfoote@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	SNP State Contact	Executive Director	Ms.	Voigtmann	Kari		6156036996				8442805360	kvoigtmann@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Surveillance Contact	Compliance Officer	Mrs.	Ward	Debbie		4054046691				8442805360	dward@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	01/18/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	System Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Third Party Administrator (TPA) Liaison	Vice President, Finance	Mr.	Harris	Richard		7135575987				8442805360	rharris@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	User Access Contact	Chief Information Officer	Mr.	Shermer	Barry		6156967173				8442805360	bshermer@AmHealthPartners.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Utilization Management Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9909	Utilization Review Contact	Director, Health Services	Ms.	Nelson	Susie		6156365478				8442805360	snelson@AmHealthPlans.com	201 Jordan Road	Suite 200	Franklin	TN	37067	06/25/2021	2023	AMERICAN HEALTH PLAN OF MS, INC.	Local CCP	American Health Advantage of MS	HMO/HMOPOS		Mitchell Family Office	795	Yes	Active					HMO - Health Maintenance Organization		C	Dallas
H9917	Agent/Broker Compensation Data Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	relay.health@navitus.com	Navitus Health Solutions, LLC	1025 West Navitus Drive	Appleton	WI	54913	01/10/2020	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Backup User Access Contact	Medicare Compliance Officer, Plan Partner Support	Ms.	Bouyer	Valorie		6159161254					valorie.bouyer@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Best Available Evidence Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/10/2020	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Bid Audit Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Bid Audit Site Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Bid Primary Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	CEO - CMS Administrator Contact	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	CEO - Senior Official for Contracting	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Chief Financial Officer	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Chief Operating Officer	Chief Operating Officer/General Manager	Mr.	Emami	John		7038837508					john.emami@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Chief Information Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Chief Information Security Officer	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	CMS Casework Communication Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Complaints Tracking Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Contact for Fraud Investigations	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Coordination of Benefits Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/10/2020	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Corporate Mailing						8447888935					customerservice@alignseniorcare.com	PO BOX 4440		Glen Allen	VA	23058	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Coverage Gap Discount Program (CGDP) Payment Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Customer Service Operations Contact			Davis	Damon		8043325134					damon.davis@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	DIR Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	DIR Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	07/12/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Emergency Part D Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Emergency Part D Contact (Secondary)	Manager, Part D Pharmacy Services	Ms.	Shamis	Julia		5167260010					julia.shamis@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	07/12/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Encounter Data & Risk Adjustment Operations Contact	VP of Risk Adjustment	Mr.	Hassenstab	Mark		5072697711					Mark.Hassenstab@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Enrollment Contact			Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/10/2020	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	EOB Transfer Contact			Lowry	Kristy		8447888935				8336102390	kristy.lowry@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Financial Audit Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Financial Reporting Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Formulary Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Formulary Contact (Secondary)	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@Navitus.com	361 Integrity Drive		Madison	WI	53717	01/10/2020	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	General Contact	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Government Relations Contact			Landahl	Darryl		8323845949					darryl.landahl@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	HIPAA Privacy Officer	Chief Compliance Officer and HIPAA Privacy Officer	Ms.	Crowe	Melanie		4049330409					melanie.crowe@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	HIPAA Security Officer	Sr. Director Cybersecurity	Mr	Brogdon	Clevelen		6158094476					Clevelen.Brogdon@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Hospice Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Interoperability Contact			Valluripalli	Sai		7034855714					sai.valluripalli@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	MA Appeals/Grievances Contact	Director - Grievance/Appeals & CTMs		Fernandez	Erik		7862398513					Erik.Fernandez@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	MA Claims Processing Contact for Public Website	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Marketing Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Medical Director	VP Medical Affairs		Dahlgren	Andrew		8042968288					Andrew.Dahlgren@allyalign.com	10900 Nuckols Road		Glen Allen	VA	23060	06/14/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Medicare Coordinator	CEO/President	Mr.	Dressen	Jeremy		6127474241					jeremy.dressen@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Medicare Part D Opioid Overutilization Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	02/14/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Medication Therapy Management Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	OffShore Subcontractor Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	03/09/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part C Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part C Reporting Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Appeals	Supervisor, Grievance and Appeals		LaCrosse	Justin						8442689791	Justin.LaCrosse@navitus.com	Navitus Health Solutions,	P.O. Box 1039	Appleton	WI	54912	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	9202214149				HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Appeals Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Application Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Benefits Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Claims Submission Contact	Manager,Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	Navitus Health Solutions, LLC 1025 W. Navitus Drive	1025 W. Navitus Drive	Appleton	WI	54913	01/10/2020	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Exceptions Contact			LeClair	Christophe						9202214676	christopher.leclair@Navitus.com	Navitus Health Solutions	361 Integrity Dr	Madison	WI	53717	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	9202214176				HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Exceptions Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Price File Contact (Back-up)			Buie	Megan		5122313140				6087292584	megan.buie@Navitus.com	Navitus Health Solutions, LLC 2601 W. Beltline Hwy.	361 Integrity Drive	Madison	WI	53717	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Price File Contact (Optional)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	Plan.Finder@Navitus.com	361 Integrity Dr.		Madison	WI	53717	01/10/2020	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Quality Assurance Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Part D Reporting Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Patient Safety Contact	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Payment Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road, Suite 110		Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Pharmacy Director	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Pharmacy Network Management Contact			Robinson	Jan		6087291688					jan.robinson@navitus.com	Navitus Health Solutions	1025 West Navitus Drive	Appleton	WI	54913	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Pharmacy Network Management Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor		3476835717					victor.sone@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						9202214724	danielle.nett@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/10/2020	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	8662703877	4224			HMO - Health Maintenance Organization		C	Philadelphia
H9917	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director Part D Operations	Mr.	Sone	Victor							victor.sone@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	01/06/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active	3476835717				HMO - Health Maintenance Organization		C	Philadelphia
H9917	Physician Incentive Contact	Executive Director	Mr.	Dunn	Jamie		8048140844					jamie.dunn@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Plan Directory Contact for Public Website			Sindlinger	Rocio		8447888935					rocio.sindlinger@allyalign.com	PO BOX 4440		Glen Allen	VA	23058	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Plan to Plan Reconciliation Contact	VP Business Service Operations	Mr.	Henke	Charles		6122423610					Charles.Henke@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Processor Contact			Vanden Heuvel	Sherry		9202214359				9202214595	sherry.vandenheuvel@navitus.com	Navitus Health Solutions, LLC	1025 W. Navitus Drive	Appleton	WI	54913	01/10/2020	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Quality Contact	VP of Quality		Ferguson	Laura		8042206174					laura.ferguson@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	03/09/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Reconciliation Contact		Mr.	Lowry	Kristy		8043325119					kristy.lowry@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	01/10/2020	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Reconciliation Contact (Secondary)	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Recovery Audit Contact	CFO/VP of Finance	Ms.	Martin	Rachel		7755448314					Rachel.Martin@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	09/27/2023	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	SNP Application Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	AllyAlign Health, Inc. 10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	SNP State Contact			Mayhew	Kaitlin		8046908271					kaitlin.mayhew@allyalign.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Surveillance Contact	Sales Admin Manager		Clark	David		8034464921					David.Clark@allyalign.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	System Contact	Chief Information Officer	Mr.	Tyler	Todd		5037205641					todd.tyler@curanahealth.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Third Party Administrator (TPA) Liaison	Manager of Regulatory Accounting	Ms.	Weis	Katelyn		6073294042					kate.weis@curanahealth.com	10900 Nuckols Rd	Suite 110	Glen Allen	VA	23060	09/28/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	User Access Contact	Medicare Compliance Officer	Ms.	Kotun	Gillian		6154811897					gillian.kotun@curanahealth.com	10900 Nuckols Road	Suite 110	Glen Allen	VA	23060	08/10/2022	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Utilization Management Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9917	Utilization Review Contact		Ms.	Delipar	Joy		2817867778					joy.delipar@allyalign.com	10900 Nuckols Rd.	Suite 110	Glen Allen	VA	23060	12/23/2021	2023	ALIGN SENIOR CARE FLORIDA, INC.	Local CCP	Align Senior Care	HMO/HMOPOS		Innovative Long Term Care Management, Inc.	733	Yes	Active					HMO - Health Maintenance Organization		C	Philadelphia
H9940	Agent/Broker Compensation Data Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Automated TrOOP Balance Transfer Contact			Rush	Jamie		5616901134					ESITroopTransfer@express-scripts.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Backup User Access Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1, Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Best Available Evidence Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N 107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Bid Audit Contact			Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Bid Audit Site Contact			Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Bid Primary Contact		Mr.	Granow	Les		5614440709					Les.Granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	CAP Report Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	CEO - CMS Administrator Contact		Dr.	Lerer	Rene		5614440780					rene.lerer@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	CEO - Senior Official for Contracting		Ms.	Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Chief Financial Officer		Mr.	Granow	Les		5614440709					les.granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Chief Operating Officer		Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Chief Information Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Chief Information Security Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	CMS Casework Communication Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Complaints Tracking Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Contact for Fraud Investigations			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Coordination of Benefits Contact		Ms.	Burdelik	Dawn		5618153729					dawn.burdelik@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Corporate Mailing						5616901134					compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Coverage Gap Discount Program (CGDP) Payment Contact		Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	Longevity Health Plan	485 Madison Avenue Suite 202	New York	NY	10022	02/15/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Customer Service Operations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	DIR Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	DIR Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Electronic Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Emergency Part D Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Emergency Part D Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Encounter Data & Risk Adjustment Operations Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Enrollment Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	EOB Transfer Contact		Ms.	Socoski	Beth		5616901134				5616901134	Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Financial Audit Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Financial Reporting Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Formulary Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Formulary Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	General Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Government Relations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	HIPAA Privacy Officer		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	HIPAA Security Officer		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Hospice Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Interoperability Contact	CIO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	MA Appeals/Grievances Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	MA Claims Processing Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Marketing Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Medical Director		Mr.	Orgain	Javette		3127206656					javette.orgain@longevityhealthplan.com	Longevity Health Plan	1611 Church Street	Evanston	IL	60201	02/15/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Medicare Compliance Officer		Ms.	Lacey	Jennifer		8133677169					Jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Medicare Coordinator	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Medicare Part D Opioid Overutilization Contact	Director, Clinical & Trend Solutions	Ms.	Muralidharan	Adrienne		5616901134					amuralidharan@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	10/11/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Medication Therapy Management Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	OffShore Subcontractor Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Part C Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Part C Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Part D Appeals	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H9940	Part D Appeals Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H9940	Part D Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Part D Benefits Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		8002040016					Rosario_dovico@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H9940	Part D Exceptions Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H9940	Part D Price File Contact (Back-up)	Product Manager Advisor	Ms.	Williams	Stephanie		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Part D Price File Contact (Optional)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Part D Price File Contact (Primary)	sr mgr, Government Programs		Dolfi	Amanda		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Part D Quality Assurance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Part D Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Patient Safety Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Payment Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Personal Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Pharmacy Director	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra	Ms.	Kelly	Heather		8002040016					hakelly@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Pharmacy Network Management Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Pharmacy Technical Help Desk Contact	Director, Customer Service	Ms.	Moore	LaTasha						8882358551	LaTasha_Monroe@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	New York
H9940	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Account Manager	Ms.	Kolesar	Bhrena							Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active	8002040016				HMO - Health Maintenance Organization		C	New York
H9940	Physician Incentive Contact		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Plan Directory Contact for Public Website	Medicare Compliance Director	Ms.	Socoski	Beth		8883133609					Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Plan to Plan Reconciliation Contact		Ms.	Zhai	Vicky		5616328915					Vicky.Zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Processor Contact		Ms.	Gibson	Sharon		6143766614					SGGibson@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Quality Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Reconciliation Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Reconciliation Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Recovery Audit Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	SNP Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	SNP State Contact		Ms.	Lacey	Jennifer		5614440706					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Surveillance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	System Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Third Party Administrator (TPA) Liaison	COO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	User Access Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Utilization Management Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9940	Utilization Review Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF MASSACHUSETTS INC	Local CCP	Longevity Health Plan of Massachusetts	HMO/HMOPOS		Longevity Health Founders, LLC	697	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9942	Agent/Broker Compensation Data Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Automated TrOOP Balance Transfer Contact			Rush	Jamie		5616901134					ESITroopTransfer@express-scripts.com	11780 U.S. Highway 1	Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Backup User Access Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1, Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Best Available Evidence Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1	Suite N 107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Bid Audit Contact			Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Bid Audit Site Contact			Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Bid Primary Contact		Mr.	Granow	Les		5614440709					Les.Granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	CAP Report Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	CEO - CMS Administrator Contact		Dr.	Lerer	Rene		5614440780					rene.lerer@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	CEO - Senior Official for Contracting		Ms.	Lacey	Jennifer		5617886541					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Chief Financial Officer		Mr.	Granow	Les		5614440709					les.granow@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Chief Operating Officer		Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Chief Information Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Chief Information Security Officer	CIO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	CMS Casework Communication Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Complaints Tracking Contact			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Contact for Fraud Investigations			Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Coordination of Benefits Contact		Ms.	Burdelik	Dawn		5618153729					dawn.burdelik@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Corporate Mailing						5616901134					compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Coverage Gap Discount Program (CGDP) Payment Contact		Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	Longevity Health Plan	485 Madison Avenue Suite 202	New York	NY	10022	03/09/2021	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Customer Service Operations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	DIR Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	DIR Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Electronic Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Emergency Part D Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Emergency Part D Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Encounter Data & Risk Adjustment Operations Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Enrollment Contact	COO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	EOB Transfer Contact		Ms.	Socoski	Beth		5616901134				5616901134	Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Financial Audit Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Financial Reporting Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Formulary Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Formulary Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	General Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Government Relations Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	HIPAA Privacy Officer		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	HIPAA Security Officer		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Hospice Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Interoperability Contact	CIO		Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	MA Appeals/Grievances Contact	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	MA Claims Processing Contact for Public Website	Medicare Compliance Director		Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Marketing Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Medical Director		Mr.	Orgain	Javette		3127206656					javette.orgain@longevityhealthplan.com	Longevity Health Plan	1611 Church Street	Evanston	IL	60201	02/15/2021	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Medicare Compliance Officer		Ms.	Lacey	Jennifer		8133677169					Jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Medicare Coordinator	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Medicare Part D Opioid Overutilization Contact	Director, Clinical & Trend Solutions	Ms.	Muralidharan	Adrienne		5616901134					amuralidharan@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Medication Therapy Management Contact	Chief Clinical Officer	Ms	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	OffShore Subcontractor Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Part C Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Part C Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Part D Appeals	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active	8002040016				PPO - BBA		C	New York
H9942	Part D Appeals Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active	8002040016				PPO - BBA		C	New York
H9942	Part D Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Part D Benefits Contact		Ms.	Kolesar	Bhrena		6143766614					Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Part D Claims Submission Contact	Director  Regulated Markets Medicare Solutions	Ms.	Dovico	Rosario		8002040016					Rosario_dovico@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Part D Exceptions Contact	Sr. Pharmacy Manager	Mr.	Schumm	Brian						8882358551	Brian_Schumm@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active	8002040016				PPO - BBA		C	New York
H9942	Part D Exceptions Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth							beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active	8002040016				PPO - BBA		C	New York
H9942	Part D Price File Contact (Back-up)	Product Manager Advisor	Ms.	Williams	Stephanie		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Part D Price File Contact (Optional)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Part D Price File Contact (Primary)	sr mgr, Government Programs		Dolfi	Amanda		8002040016				8882358551	medicarewebsitefiles@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	07/11/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Part D Quality Assurance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Part D Reporting Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Patient Safety Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Payment Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Personal Health Record Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Pharmacy Director	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra	Ms.	Kelly	Heather		8002040016					hakelly@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Pharmacy Network Management Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Pharmacy Technical Help Desk Contact	Director, Customer Service	Ms.	Moore	LaTasha						8882358551	LaTasha_Monroe@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active	8009221557				PPO - BBA		C	New York
H9942	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Account Manager	Ms.	Kolesar	Bhrena							Bhrena_Kolesar@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active	8002040016				PPO - BBA		C	New York
H9942	Physician Incentive Contact		Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Plan Directory Contact for Public Website	Medicare Compliance Director	Ms.	Socoski	Beth		8883133609					Compliance@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Plan to Plan Reconciliation Contact		Ms.	Zhai	Vicky		5616328915					Vicky.Zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Processor Contact		Ms.	Gibson	Sharon		6143766614					SGGibson@express-scripts.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Quality Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Reconciliation Contact	Controller	Ms.	Zhai	Vicky		5616328915					vicky.zhai@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Reconciliation Contact (Secondary)	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Recovery Audit Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	SNP Application Contact		Ms.	Lacey	Jennifer		8133677169					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	SNP State Contact		Ms.	Lacey	Jennifer		5614440706					jennifer.lacey@longevityhealthplan.com	Longevity Health Plan	11780 U.S. Highway 1 Suite N107	Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Surveillance Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	System Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Third Party Administrator (TPA) Liaison	COO	Mr.	Bharadwaj	Sri		9494390333					sri.bharadwaj@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	User Access Contact	Medicare Compliance Director	Ms.	Socoski	Beth		5616901134					beth.socoski@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Utilization Management Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9942	Utilization Review Contact	Chief Clinical Officer	Ms.	Wold	Heidi		8134047233					hwold@longevityhealthplan.com	11780 U.S. Highway 1 Suite N107		Palm Beach Gardens	FL	33408	05/03/2022	2023	LONGEVITY HEALTH PLAN OF NEW JERSEY INSURANCE COMP	Local CCP	Longevity Health Plan	Local PPO		Longevity Health Founders, LLC	697	Yes	Active					PPO - BBA		C	New York
H9943	Agent/Broker Compensation Data Contact	VP, Sales		Simonds	Kristina		6572187635					KSimonds@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Automated TrOOP Balance Transfer Contact	PBM - Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Backup User Access Contact	Compliance Director		Spitzer	Chandra		6572745530					CSpitzer@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Best Available Evidence Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Bid Audit Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Bid Audit Site Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Bid Primary Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	CAP Report Contact for Public Website	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	CEO - CMS Administrator Contact	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	CEO - Senior Official for Contracting	CEO	Ms.	Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Chief Financial Officer	Chief Financial Officer	Mr.	Freeman	Thomas		6572187604					TFreeman@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Chief Operating Officer	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Chief Information Officer	SVP, Chief Technology Officer	Mr.	Kardes	Hakan		6572187772					hkardes@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Chief Information Security Officer	VP, Technology & CISO	Mr.	MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	CMMI Model Point of Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	CMS Casework Communication Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Complaints Tracking Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Contact for Fraud Investigations	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Coordination of Benefits Contact	AVP, Membership & Eligibility		Torres	Carrie		6572187409	2109				CArreola@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Corporate Mailing						6572187713				8443202247	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122			5622074634	adelatorre@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Customer Service Operations Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	DIR Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd., Ste. 300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	DIR Contact (Secondary)	AVP, Pharmacy		Liu	Ruby		3237287232	2316				RLiu@AHCUSA.com	1100 W. Town & Country Rd., Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Electronic Health Record Contact	AVP, Platform Product		Brown Hayes	Michael		7144979628					MBrown-Hayes@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Emergency Part D Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Emergency Part D Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		3108667966				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Employer Waiver Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Encounter Data & Risk Adjustment Operations Contact	VP, Risk Adjustment		Bogdanov	Eyosef		5623666179					ebogdanov@ahcusa.com	1100 W. Town and Country Rd.	Suite 1600	Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Enrollment Contact	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	EOB Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Financial Audit Contact	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Financial Reporting Contact	Sr. Director, Accounting & Reporting		Tran	Sue Anne		6572187673	7673				stran@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Formulary Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Formulary Contact (Secondary)	PBM - Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	General Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Government Relations Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	HIPAA Privacy Officer	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	HIPAA Security Officer	VP, Technology & CISO		MacLeod	David		3033967531					DMacLeod@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Hospice Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Interoperability Contact	VP, Data Engineering & BI CTO Data and Al		Sam	Georgie		8188807212					gsam@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	MA Appeals/Grievances Contact	AVP, Member Experience		Wendt	Lily		5622074530					LWendt@ahcusa.com	1100  W. Town and Country Road #300		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	MA Claims Processing Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Marketing Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Medical Director	SVP Market Management WCR	Dr.	Kim	John		6572187640				5622074617	JKim@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Medicare Compliance Officer	SVP, Chief Compliance Officer	Ms.	Lynch	Cindy	B	6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Medicare Coordinator	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Medicare Part D Opioid Overutilization Contact	PBM - Supv Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Medication Therapy Management Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	OffShore Subcontractor Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	CLynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Online Enrollment Center Contact (Back-up)	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Online Enrollment Center Contact (Optional)	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394				5622074621	clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Online Enrollment Center Contact (Primary)	AVP, Membership & Eligibility		Torres	Carrie		5622074509				5622074623	CArreola@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Part C Application Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Part C Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Appeals	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6127775393				HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Appeals Contact (Secondary)	Sr. Manager, Appeals & Grievance		Jimenez	Gudelia							GJimenez@ahcusa.com	1100 W. Town and Country Road, Suite #300		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187488	2188			HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Application Contact	CEO		Maroney	Dawn		5623346192				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Benefits Contact	PBM - Director, Benefit Operations		Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Claims Submission Contact	PBM - Functional Business Consultant Govt Programs		Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Exceptions Contact	PBM - Director, Regulatory and Audit Response		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8006936651				HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Exceptions Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali							AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	6572187709				HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Price File Contact (Back-up)	PBM - Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Price File Contact (Optional)	PBM - QA Analyst		Tastad	Emily		6127776931					emily.tastad@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	02/03/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Price File Contact (Primary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Quality Assurance Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Part D Reporting Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Patient Safety Contact	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country #1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Payment Contact	CEO		Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Personal Health Record Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Pharmacy Director	SVP, Medicare Programs		Farrokhroo	Ali		6572187709				5622074630	AFarrokhroo@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Pharmacy Network Management Contact	PBM - AVP, Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Pharmacy Network Management Contact (Secondary)	SVP, Medicare Programs		Farrokhroo	Ali		6572187709	7709				AFarrokhroo@ahcusa.com	1100 W. Town and Country Rd #1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H9943	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops		Bunch	Jon							jonathon.bunch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active	8554570622				HMO - Health Maintenance Organization		C	San Francisco
H9943	PHR Beneficiary Contact																	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS	Alignment Health Plan	Alignment Healthcare USA, LLC	612	Yes	Active	8666342247				HMO - Health Maintenance Organization		C	San Francisco
H9943	Physician Incentive Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Plan Directory Contact for Public Website	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Plan to Plan Reconciliation Contact	Manager, Financial Operations		De La Torre	Angelo		3237287232	2122			5622074266	adelatorre@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Processor Contact	Manager, PBM Operations		Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Quality Contact	Sr. Director, Quality Management/Credentialing		Lacock	Lisa		6572187638					LLacock@ahcusa.com	1100 W. Town and Country Road #300		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Reconciliation Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Reconciliation Contact (Secondary)	Sr. Financial Analyst		De La Torre	Angelo		3237287232	2122				adelatorre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Recovery Audit Contact	CEO	Mrs.	Maroney	Dawn		8443102247				8443202247	DMaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	SNP Application Contact	Director, Product Management		Aguirre	Christian		6572187634					CAguirre@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	02/14/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	SNP State Contact	CEO		Maroney	Dawn		8443102247				8443202247	dmaroney@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	09/22/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Surveillance Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	System Contact	VP, AVA Health Plan Systems & Operations		Bates	Patrick		6572187636	7636				PBates@ahcusa.com	1100 W. Town & Country Road, Suite 1600		Orange	CA	92868	01/20/2022	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Third Party Administrator (TPA) Liaison	Manager, Financial Operations		De La Torre	Angelo		8443102247	2122				adelatorre@ahcusa.com	1100 W. Town and Country Rd, Suite 1600		Orange	CA	92868	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	User Access Contact	SVP, Chief Compliance Officer		Lynch	Cindy		6573835394					clynch@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Utilization Management Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9943	Utilization Review Contact	AVP, Utilization Management		Moore	Lorena		6572187671	7671				LMoore@ahcusa.com	1100 W. Town and Country Road #1600		Orange	CA	928684600	01/11/2023	2023	ALIGNMENT HEALTH PLAN OF FLORIDA INC	Local CCP	Alignment Health Plan	HMO/HMOPOS		Alignment Healthcare USA, LLC	612	Yes	Active					HMO - Health Maintenance Organization		C	San Francisco
H9952	Agent/Broker Compensation Data Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Automated TrOOP Balance Transfer Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Backup User Access Contact			Berg	Lynnsey		6126326655					lynnsey.berg@optum.com	P.O. Box 9472		Minneapolis	MN	554409472	11/30/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Best Available Evidence Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Bid Audit Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Bid Audit Site Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Bid Primary Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	CAP Report Contact for Public Website			Jacobson	Marissa		9529922093					marissa.jacobson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	CEO - CMS Administrator Contact	Interm President & CFO	Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	CEO - Senior Official for Contracting		Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/06/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Chief Financial Officer		Ms	Quist	Mary		9529922058					mary.quist@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Chief Operating Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Chief Information Officer		Mr	Geyer	Rob		9529923962					robert.geyer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Chief Information Security Officer		Mr	Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/12/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	CMMI Model Point of Contact			Schaefer	Jennifer		9529912803					jennifer.schaefer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	CMS Casework Communication Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Complaints Tracking Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Contact for Fraud Investigations			Monson	Peter		9529921149					peter.monson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/03/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Coordination of Benefits Contact			Vilendrer	Krista		9529923252					krista.vilendrer@medica.com	301 Carlson Parkway		Minnetonka	MN	55305	04/22/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Corporate Mailing						9529922900					ann.kinsella@medica.com	401 Carlson Parkway	P.O. Box 9310 CP320	Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Coverage Gap Discount Program (CGDP) Payment Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Customer Service Operations Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	11/10/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	DIR Contact			Selden	Neil		9529923768					neil.selden@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	DIR Contact (Secondary)			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	03/13/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Emergency Part D Contact			Bock	Kelly		9529928379					kelly.bock@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Emergency Part D Contact (Secondary)			Janes	Kathy		9529928989					kathy.janes@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Employer Waiver Contact			Alness	Stacy		9529923825					stacy.alness@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/19/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Encounter Data & Risk Adjustment Operations Contact			Leth	Maria		9529928366					Maria.Leth@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/29/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Enrollment Contact			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/28/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	EOB Transfer Contact			Bourdages	Kathy		9529923653				9529923636	kathy.bourdages@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Financial Audit Contact	Director Finance & Strategy	Mr	Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/11/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Financial Reporting Contact			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Formulary Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Formulary Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	General Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Government Relations Contact			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	HIPAA Privacy Officer			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/20/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	HIPAA Security Officer			Young	Dave		9529922316					david.young@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Hospice Contact			Bourdages	Kathy		9529923653				9529923636	PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Interoperability Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/14/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	MA Appeals/Grievances Contact			Sikorski	TJ		9529928542				9529928492	thomas.sikorski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/04/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	MA Claims Processing Contact for Public Website			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Marketing Contact			Teff	Melissa		9529923972					melissa.teff@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Medical Director	Chief Clinical & Provider Strategy Officer		Webster	David		9529922801					david.webster@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/15/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Medicare Compliance Officer		Mrs	Koranteng	Milly		9529922090					mildred.koranteng@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/22/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Medicare Coordinator			Kinsella	Ann		9529923832					ann.kinsella@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/21/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Medicare Part D Opioid Overutilization Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Medication Therapy Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	OffShore Subcontractor Contact			Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Online Enrollment Center Contact (Primary)			Wood	Donna		9529923843					donna.wood@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Part C Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Part C Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Appeals			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529922353				HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Appeals Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529923448				HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Benefits Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/09/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Claims Submission Contact			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Exceptions Contact			Rodine	Bridget							bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529922353				HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Exceptions Contact (Secondary)			Dornbrook-Lavender	Kimberly							kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	9529923448				HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Price File Contact (Back-up)			Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Farifield	OH	45014	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Price File Contact (Optional)			Bourdages	Kathy		9529923653					PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	06/28/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Price File Contact (Primary)			Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Quality Assurance Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Part D Reporting Contact			Lashinski	Brian		9529923637					brian.lashinski@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Patient Safety Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Payment Contact			Stauffer	David		9529922616					david.stauffer@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	12/11/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Pharmacy Director			Gansen	Nate		9529923512					Nathaniel.Gansen@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/10/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Pharmacy Network Management Contact			Dornbrook-Lavender	Kimberly		9529923448					kimberly.dornbrook-lavender@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Pharmacy Network Management Contact (Secondary)			Rodine	Bridget		9529922353					bridget.rodine@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	La Tasha							LaTasha_Monroe@expressscripts.com	13051 N. Telecom Pkwy		Temple Terrace	FL	33637	11/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Kansas City
H9952	Pharmacy Technical Help Desk Contact (Secondary)			Bourdages	Kathy							PharmacySrvcGovtProg@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/09/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active	8009221557				HMO - Health Maintenance Organization		C	Kansas City
H9952	Plan Directory Contact for Public Website			Service	Customer		8002348755					AskGovtPrograms@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Plan to Plan Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Processor Contact			Bean	Danielle		9529922864					danielle.bean@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Quality Contact			Klumpyan	Jennifer		9529923642					jennifer.klumpyan@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/28/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Reconciliation Contact			Ricaurte	Angela		9529923748					Angela.Ricaurte@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	05/16/2023	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Reconciliation Contact (Secondary)			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Recovery Audit Contact	Manager Claims Operations	Mr	Foley	Steve		9529924160					steven.foley@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/17/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	SNP Application Contact			Olmscheid	Becky		9529923737					rebecca.olmscheid@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	10/17/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	SNP State Contact			Zillhardt	John		9529922290					John.Zillhardt@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/15/2021	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Surveillance Contact			Swanson	Renee		9529922064					Renee.Swanson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	07/26/2019	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	System Contact			Schwartz	Pamela		9529922584					pamela.schwartz@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	08/01/2022	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Third Party Administrator (TPA) Liaison			Schenten	Paul		9529928875					paul.schenten@medica.com	401 Carlson Parkway CP330		Minnetonka	MN	55305	08/05/2020	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	User Access Contact			Sherman	Autumn		9529923483					autumn.sherman@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Utilization Management Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9952	Utilization Review Contact			Boushee	Suzanne		9529923931				9529923680	suzanne.boushee@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/13/2018	2023	MEDICA HEALTH PLANS	Local CCP	Medica	HMO/HMOPOS		Medica Holding Company	439	Yes	Active					HMO - Health Maintenance Organization		C	Kansas City
H9955	Agent/Broker Compensation Data Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Automated TrOOP Balance Transfer Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Backup User Access Contact	AVP, Medicare Compliance		McDaniel	Heather	M	2036857419					Heather.McDaniel@molinahealthcare.com	2 Osprey Drive		Seymour	CT	06483	06/05/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Best Available Evidence Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Bid Audit Contact	MHI- Senior Vice President, Chief Actuary		Lynam	Ben		5625194904					benjamin.lynam@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Bid Audit Site Contact	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Bid Primary Contact	Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareProductDevelopment@MolinaHealthCare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	CAP Report Contact for Public Website			Services	Member		8664724584					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	CEO - CMS Administrator Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	CEO - Senior Official for Contracting	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Chief Financial Officer	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Chief Operating Officer	MHI- Vice President, Medicare Operations	Mrs.	Woodruff	Staci Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Chief Information Officer	MHI - Chief Information Officer	Mr.	Desai	Amir		5625170801					amir.desai@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Chief Information Security Officer	Chief Information Security Officer	Mr.	Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate Ave	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	CMS Casework Communication Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Complaints Tracking Contact	Director, Medicare A&G		Bennett	Kimberly		2488549474					Kimberly.Bennett@molinahealthcare.com	24121 Rosewood St		Oak Park	MI	48237	01/21/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Contact for Fraud Investigations	MHI- Director, FWA Vendor Oversight		Tiernan	Shane		8885625442	113158				shane.tiernan@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Coordination of Benefits Contact	Director, Payment Integrity		Hartberger	Jake		4842691480					Jake.Hartberger@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/27/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Corporate Mailing						5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	08/01/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr, Financial Plng & Analysis		Althen	James		5625422027					James.Althen@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Customer Service Operations Contact	Vice President, Core Operations		Ireland	Scott		5623802252					Scott.Ireland@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	09/13/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	DIR Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	DIR Contact (Secondary)	Senior Finance Analyst		Verhaar	Paul		5629518384					Paul.Verhaar@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Emergency Part D Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	01/04/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Emergency Part D Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Aryal	Sabina		5625069069					sabina.aryal@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Enrollment Contact	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	EOB Transfer Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706				8013162770	an.vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Financial Audit Contact	CFO, Medicare	Mr.	Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Financial Reporting Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Formulary Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Formulary Contact (Secondary)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E.Shea Blvd.		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	General Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Government Relations Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	HIPAA Privacy Officer	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	HIPAA Security Officer	Chief Information Security Officer		Wilson	Michael		5627063968					michael.wilson1@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Hospice Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Interoperability Contact	VP, Enterprise Architecture		Haines	George		5625170210					George.Haines@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	MA Appeals/Grievances Contact	Vice President, Medicare Operations		Woodruff	Staci-Ann		8608060065					staci-ann.woodruff@molinahealthcare.com	762 Charlestown Rd.		Acworth	NH	03601	01/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	MA Claims Processing Contact for Public Website			Services	Member		8664724584					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Marketing Contact	MHI- Executive Vice President, Medicare		Bacon	Debra		5624564066					MedicareMember.Materials@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Medical Director	Chief Medical Officer	Dr.	Babos	Karen		6303810658					Karen.Babos@molinahealthcare.com	1520 Kensington Rd		Oak Brook	IL	60523	11/04/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Medicare Compliance Officer	MHI- Vice President, Compliance	Mr.	Gupta	Rohit		5629511594					MedicareComplianceOfficer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Medicare Coordinator	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Medicare Part D Opioid Overutilization Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Medication Therapy Management Contact	Director, Clinical Pharmacy/MTM		Osborn	Stefen		8019870041					Stefen.Osborn@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	OffShore Subcontractor Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Online Enrollment Center Contact (Back-up)	AVP, Medicare Enrollment		Thorpe	Melissa		5625422116					Melissa.Thorpe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	04/05/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Online Enrollment Center Contact (Primary)	Vice President, Core Operations		Simcoe	Suma		5627145475					Suma.Simcoe@molinahealthcare.com	604 Pine Ave		Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Part C Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Part C Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Part D Appeals	Director, Medicare Pharmacy Services		Knowles	Chris							Christopher.Knowles@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5625170246				HMO - Health Maintenance Organization		C	New York
H9955	Part D Appeals Contact (Secondary)	Regional Account Manager, Pharmacy Services		Ramirez	Danielle							Danielle.Ramirez@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8018580400	172067			HMO - Health Maintenance Organization		C	New York
H9955	Part D Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Part D Benefits Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Part D Claims Submission Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Part D Exceptions Contact	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H9955	Part D Exceptions Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin							Erin.Gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	5708612665				HMO - Health Maintenance Organization		C	New York
H9955	Part D Price File Contact (Back-up)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					Erin.Gordon@molinahealthcare.com	7050 South Union Park Center Suite 200		Midvale	UT	84047	11/03/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Part D Price File Contact (Optional)	Senior Consultant, CVS Health		Loveland	Chet		4806064873					chet.loveland@cvshealth.com	9501 E. Shea Blvd,		Scottsdale	AZ	85260	02/07/2020	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Part D Price File Contact (Primary)	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Part D Quality Assurance Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Part D Reporting Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Patient Safety Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Payment Contact	Associate Vice President, Data Analytics		Sancheti	Alok		5629011054					alok.sancheti@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Personal Health Record Contact	MHI - Vice President, Compliance		Zevnik	Timothy		9493151837					timothy.zevnik@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Pharmacy Director	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Pharmacy Network Management Contact	Director, Medicare Pharmacy Services		Vu	John		8012525706					An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Pharmacy Network Management Contact (Secondary)	Vice President, Medicare Pharmacy Services		Gordon	Erin		5708612665					erin.gordon@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/31/2020	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Pharmacy Technical Help Desk Contact	Director, Client Operations		Help Desk	Pharmacy						4803146077	dayoubj@cvshealth.com	445 Great Circle Road		Nashville	TN	37228	12/12/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	New York
H9955	Pharmacy Technical Help Desk Contact (Secondary)	Director, Medicare Pharmacy Services		Vu	John							An.Vu@molinahealthcare.com	7050 South Union Park Center	Suite 200	Midvale	UT	84047	12/06/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active	8012525706				HMO - Health Maintenance Organization		C	New York
H9955	Physician Incentive Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Plan Directory Contact for Public Website			Services	Member		8664724584					CentralizedOps.Medicare@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/18/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Plan to Plan Reconciliation Contact	CFO, Medicare		Wilson	David		5629511568					David.S.Wilson@MolinaHealthCare.Com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Processor Contact	MHI- Senior Vice President, Corporate Operations		Bell	Del		8885625442	116712				del.bell@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/03/2020	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Quality Contact	Vice President, Quality		Wheeler	Deborah		5625285523					deborah.wheeler@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Reconciliation Contact	AVP, Actuarial Services		Hanna	Maxwell		5625285586					maxwell.hanna@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	02/15/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Gutzmer	Josh		5625061257					Josh.Gutzmer@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	03/02/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Recovery Audit Contact	MHI - Director, Compliance External Audits	Ms.	Van Woert	Kristen		5624996131	126131				kristen.vanwoert@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/03/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	SNP Application Contact	Director, Medicare Product Development		Harrell	Jo-Anne		8885625442					MedicareProductDevelopment@molinahealthcare.com	300 Oceangate		Long Beach	CA	90802	05/25/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	SNP State Contact	MHI- Executive Vice President, Medicare	Ms.	Bacon	Debra		5624564066					debra.bacon@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	07/20/2023	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Surveillance Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	System Contact	AVP, IT Product Line Support		Carrera	Michele		5625170372					Michele.Carrera@molinahealthcare.com	650 Pine Ave		Long Beach	CA	90802	11/04/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Third Party Administrator (TPA) Liaison	Dir, Fin Plan & Analysis		Cook	Keith		5625422024					Keith.Cook@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	04/19/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	User Access Contact	MHI- Vice President, Compliance		Gupta	Rohit		5629511594					MedicareComplianceOfficer@Molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	12/21/2022	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Utilization Management Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9955	Utilization Review Contact	VP, Healthcare Services		Haase	Melissa		6028300205					Melissa.Haase@molinahealthcare.com	200 Oceangate	Suite 100	Long Beach	CA	90802	11/02/2021	2023	MOLINA HEALTHCARE OF OHIO, INC.	Local CCP	Molina Healthcare of Ohio	HMO/HMOPOS		Molina Healthcare, Inc.,	165	Yes	Active					HMO - Health Maintenance Organization		C	New York
H9959	Automated TrOOP Balance Transfer Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Backup User Access Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Best Available Evidence Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Bid Primary Contact	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		FLushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	CAP Report Contact for Public Website	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371				5592389224	GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Atlanta
H9959	CEO - CMS Administrator Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	CEO - Senior Official for Contracting	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Chief Financial Officer	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Chief Operating Officer	Chief Strategy Officer	Ms	Kohn	Judy		9172700599					Jkohn@kinshiphs.com	260 Pearsall Place		Lawrence	NY	11559	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Chief Information Officer	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Chief Information Security Officer	CEO	Mrs	Buonocore-Rut	Tara		5166407669					tbrut@centerlight.org	136-65 37th AVe		Flushing	NY	11354	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	CMS Casework Communication Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Complaints Tracking Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Contact for Fraud Investigations	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Coordination of Benefits Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Corporate Mailing						8006391305				5592389224	ahulon@kinshiphs.com	136-65 37th Ave		Flushing	NY	11354	09/07/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Coverage Gap Discount Program (CGDP) Payment Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Customer Service Operations Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	DIR Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Emergency Part D Contact	Director of Operations and Implementation	Mr	Beijer	David		8287029191					dbeijer@kinshiphs.com	14 Berry Lane		Fletcher	NC	28732	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Encounter Data & Risk Adjustment Operations Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Enrollment Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	EOB Transfer Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371				5592389224	GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Financial Audit Contact	Regional Program Director	Mrs.	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Financial Reporting Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Formulary Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	General Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Government Relations Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	HIPAA Privacy Officer	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	HIPAA Security Officer	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Interoperability Contact	Regional Director of Operations	Mrs	Hulon	Amber		7274175819					ahulon@kinshiphs.com	9907 NE 138th Ct		Vancouver	WA	98682	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	MA Appeals/Grievances Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	MA Claims Processing Contact for Public Website	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Marketing Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Medical Director	Medical Director	Dr.	Ogando	Heather		5165516345					hogando@centerlight.org	8275 Allison Pointe Trail, Suite 370		Indianapolis	IN	46250	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Medicare Compliance Officer	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Medicare Coordinator	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Medicare Part D Opioid Overutilization Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Medication Therapy Management Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Part C Application Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Part D Appeals	Regional Director of Operations	Mrs	KornBlatt	Georgia							GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Atlanta
H9959	Part D Application Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Part D Benefits Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Part D Claims Submission Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Part D Exceptions Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia							GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Atlanta
H9959	Part D Price File Contact (Back-up)	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Part D Price File Contact (Primary)	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Part D Quality Assurance Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Part D Reporting Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Patient Safety Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Payment Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Pharmacy Director	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Pharmacy Network Management Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Pharmacy Technical Help Desk Contact	Regional Program Director	Mrs	KornBlatt	Georgia						5592389224	GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending	5703717371				PACE - Nat		C	Atlanta
H9959	Plan Directory Contact for Public Website	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Plan to Plan Reconciliation Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Processor Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Quality Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Reconciliation Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Reconciliation Contact (Secondary)	Director of Operations and Implementation	Mr	Beijer	David		8287029191					dbeijer@kinshiphs.com	14 Berry Lane		Fletcher	NC	28732	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Recovery Audit Contact	Regional Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Surveillance Contact	Reginal Program Director	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	System Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Third Party Administrator (TPA) Liaison	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	User Access Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Utilization Management Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9959	Utilization Review Contact	Regional Director of Operations	Mrs	KornBlatt	Georgia		5703717371					GKornblatt@kinshiphs.com	1529 Garfield Ave		Reading	PA	19610	06/18/2023	2023	KINSHIP PACE OF SOUTH FLORIDA, LLC	National PACE	Kinship PACE of South Florida, LLC	National PACE				Yes	Pending					PACE - Nat		C	Atlanta
H9976	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Best Available Evidence Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	CAP Report Contact for Public Website	Vice President, Regulatory Compliance	Ms.	Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8778937277				PPO - BBA		C	Dallas
H9976	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Chief Financial Officer	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Chief Information Officer	Senior Vice President, Chief Information Officer	Mr.	Brooks	Mark		3147254477					Mark.Brooks@centene.com	7700 Forsyth Boulevard		St. Louis	MO	63105	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	CMS Casework Communication Contact	Manager, Grievance & Appeals	Ms	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Complaints Tracking Contact	Manager, Grievance & Appeals	Ms.	McCline	Keshia		3144846350					RhodeKeshia.Q.McCline@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Contact for Fraud Investigations	Counsel, Special Investigations Unit	Ms	Fisher	Haley		3145056804					hfisher@centene.com	1390 Timberlake Manor Parkway	Suite 450	Chesterfield	MO	63017	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Corporate Mailing						8662464358					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth Blvd		St. Louis	MO	63105	01/27/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Customer Service Operations Contact	Director, Call Center Operations	Mr.	Vargus	Tom		4805874894					tom.vargus@centene.com	1665 West Alameda Drive	Ste 110	Tempe	AZ	85282	01/27/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Electronic Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/27/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Program Management	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	04/02/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Employer Waiver Contact	Senior Manager, Medicare Product Development		Pulido	Griselda		8133566423					griselda.pulido@centene.com	21281 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Encounter Data & Risk Adjustment Operations Contact	Director, Encounters		Yella	Inaja		7183936122					inaja.yella@centene.com	25-01 Jackson Ave.		Long Island City	NY	11101	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	EOB Transfer Contact	Claims Accumulators Manger	Ms.	Moore	Liza		3143202578				8777795220	elizabeth.m.moore@centene.com	12443 Olive Blvd.		Creve Coeur	MO	63141	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949	47759				Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washingtom	DC	20036	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	HIPAA Privacy Officer	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/27/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	MA Appeals/Grievances Contact	Regional VP, Claims Operations	Mr.	Main	Blake		3143262099					Blake.Main@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	03/28/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	MA Claims Processing Contact for Public Website	Manager, Compliance		Nelson	Curt		7155635188					jon.c.nelson@centene.com	10811 International Dr		Rancho Cordova	CA	95670	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Medical Director	Chief Medical Director	Dr.	Shankar	Latha		5058866243					Latha.RajaShankar@WesternSkyCommunitycare.com	5300 Homestead road NE		Alburqerque	NM	87110	03/30/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	03/28/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Online Enrollment Center Contact (Back-up)	Manager, Membership & Accounting		Starks	Heather		8166766477					Heather.B.Starks@CENTENE.COM	21271 Burbank Blvd.		Woodland Hills	CA	91367	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Online Enrollment Center Contact (Optional)	Sr. Manager, Operations		Demirchyan	Ovsanna		8186766079					ovsanna.demirchyan@centene.com	21271 Burbank Blvd		Woodland Hills	CA	91367	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Online Enrollment Center Contact (Primary)	Business Compliance Consultant		Oh	Sonja		8186766028					sonja.oh@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Part C Application Contact		Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Part C Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132063350				PPO - BBA		C	Dallas
H9976	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132066534				PPO - BBA		C	Dallas
H9976	Part D Application Contact		Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		Houston	TX	77027	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8132067152				PPO - BBA		C	Dallas
H9976	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	6023080218				PPO - BBA		C	Dallas
H9976	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Patient Safety Contact	Sr. Vice President, Pharmacy Clinical Operations		Ballew	Angel		8132062086					Angel.Ballew@wellcare.com	4110 George Rd.		Tampa	FL	33634	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Personal Health Record Contact	Director, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	01/27/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@healthnet.com	2868 Prospect Park Drive, Suite 230	Mailstop: CA-162-02-01	Rancho Cordova	CA	95670	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Pharmacy Technical Help Desk Contact	VP, Contact Centers		Bollent	Jason							Jason.Bollent@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	03/26/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H9976	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service	Ms	Makram	Katherine							Katherine.Lugge@wellcare.com	5519 Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active	8888656567				PPO - BBA		C	Dallas
H9976	PHR Beneficiary Contact																	09/27/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO	Member Services	Centene Corporation	351	Yes	Active	8335430246				PPO - BBA		C	Dallas
H9976	Physician Incentive Contact	Regional Vice President, Payment Innovation	Mr.	Chervitz	Charles		3145190321					Charles.D.Chervitz@centene.com	7700 Forsyth Blvd		St. Louis	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Plan Directory Contact for Public Website			Services	Provider		8662968731					CorporateMedicareComplianceDept@CENTENE.COM	4349 Easton Parkway	Suite 200	Columbus	OH	43219	03/31/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Quality Contact	Manager, Ethics & Compliance		Stolzer	Mark		3142368360					Mark.J.Stolzer@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Recovery Audit Contact	Senior Director, Claims Operations	Mr.	Everett	Thomas		8132065748					thomas.everett@wellcare.com	5301 W Idlewild Ave		Tampa	FL	33634	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	SNP Application Contact		Mr.	Ramsey	Kevin		8132454950					kevin.ramsey@wellcare.com	8725 Henderson Rd		Tampa	FL	33634	12/12/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	SNP State Contact	Director, Compliance	Ms.	Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	03/11/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	System Contact	Regional VP, Information Technology	Ms.	Robles	Jaimee		3143493227					jaimee.e.robles@centene.com	12443 Olive Blvd.		St. Louis	MO	63141	03/30/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Utilization Management Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9976	Utilization Review Contact	RVP, UM Strategy and Operations		Howard	Lori		9133334673					lori.a.howard@centene.com	7676 Forsyth Blvd.		Clayton	MO	63105	06/09/2022	2023	WESTERN SKY COMMUNITY CARE, INC.	Local CCP	Wellcare by Allwell	Local PPO		Centene Corporation	351	Yes	Active					PPO - BBA		C	Dallas
H9986	Agent/Broker Compensation Data Contact	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Automated TrOOP Balance Transfer Contact	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Backup User Access Contact	Compliance Consultant		Sharpe	April		7865261284					asharpe@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	11/12/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Best Available Evidence Contact	Sr. VP of Operations		Gutwald	David		6318812404	801304				dgutwald@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	02/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Bid Audit Contact	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Bid Audit Site Contact	Chief Compliance Officer		Santamaria	Cary		7867594387					csantamaria@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	11/12/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Bid Primary Contact	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	CAP Report Contact for Public Website	Chief Compliance Officer		Santamaria	Cary		7867594387					csantamaria@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	11/12/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	CEO - CMS Administrator Contact	CEO	Mr.	Plana	Nestor		8882621292	107941				nplana@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	01/04/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	CEO - Senior Official for Contracting	CEO	Mr.	Plana	Nestor		8882621292	107941				nplana@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	01/04/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Chief Financial Officer	CFO	Mr	Thomas	Tarlton		3052621292	106643				tthomas@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	01/04/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Chief Operating Officer	President and COO	Ms.	Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Chief Information Officer	Chief Information Officer	Mr.	Singh	Manjinder		3052621292	103844				msingh@ilshealth.com	4601 NW 77 Avenue		Miami	FL	33166	02/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Chief Information Security Officer	Sr. Director, IT and Information Security Officer	Mr.	Gomez	Edward		3052621292	103850				egomez@ilshealth.com	4601 NW 77 Avenue		Miami	FL	33166	02/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	CMMI Model Point of Contact	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	CMS Casework Communication Contact	Senior Director of Medicare Operations		Fagundo	Jenny		7865435229					JFagundo@ilshealth.com	4601 N.W. 77th Avenue		Miami	FL	33166	12/02/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Complaints Tracking Contact	Senior Director of Medicare Operations		Fagundo	Jenny		7865435229					JFagundo@ilshealth.com	4601 N.W. 77th Avenue		Miami	FL	33166	12/02/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Contact for Fraud Investigations	Special Investigations Unit Director		Benett	Jill		7867423391					JBennett@ilshealth.com	201 East Park Avenue	Suite 400B	Tallahassee	FL	32301	02/21/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Coordination of Benefits Contact	Sr. VP of Operations		Gutwald	David		6318812404	801304				dgutwald@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	04/12/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Corporate Mailing						8882621292					ariddle@ilshealth.com	4601 N.W. 77th Avenue		Miami	FL	33166	02/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Coverage Gap Discount Program (CGDP) Payment Contact	AVP & Controller		Rankin	Krystal		6467750693					KRankin@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	12/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Customer Service Operations Contact	National Director of Call Center Operations		Perez	Lizette	T	8333227526					ltperez@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	05/05/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	DIR Contact	AVP & Controller		Rankin	Krystal		6467750693					KRankin@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	12/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	DIR Contact (Secondary)	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Electronic Health Record Contact	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Emergency Part D Contact	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Emergency Part D Contact (Secondary)	Medical Director	Dr.	Barrial	Rafael		7862391451					rbarrial@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/15/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Encounter Data & Risk Adjustment Operations Contact	Sr. VP of Operations		Gutwald	David		6318812404	801304				dgutwald@ilshealth.com	1 Computer Associates Plaza		Islandia	NY	11749	02/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Enrollment Contact	Director of Enrollment		Caulfield	Anne		9176547790					acaulfield@ilshealth.com	1377 Motor Parkway		Islandia	NY	11749	12/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	EOB Transfer Contact	Vice President, Claims & Call Center		Chacon	Pela		3052621292				3053057005	pchacon@ilshealth.com	4601 N.W. 77th Avenue		Miami	FL	33166	02/10/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Financial Audit Contact	AVP & Controller	Ms.	Rankin	Krystal		6467750693					KRankin@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	12/10/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Financial Reporting Contact	AVP & Controller	Ms.	Rankin	Krystal		6467750693					KRankin@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	12/10/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Formulary Contact	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Formulary Contact (Secondary)	Medical Director	Dr.	Barrial	Rafael		7862391451					rbarrial@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/15/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	General Contact	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Government Relations Contact	VP, Government Affairs		Gormley	Carol		3052257266					cgormley@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee,	FL	32301	02/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	HIPAA Privacy Officer	Assistant General Counsel & Privacy Officer		Cabrera	Susy		7869185857					scabrera@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	12/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	HIPAA Security Officer	Chief Information Officer	Mr.	Singh	Manjinder		3052621292	103844				msingh@ilshealth.com	4601 NW 77 Avenue		Miami	FL	33166	01/10/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Hospice Contact	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Interoperability Contact	Chief Information Officer	Mr.	Singh	Manjinder		3052621292	103844				msingh@ilshealth.com	4601 NW 77 Avenue		Miami	FL	33166	12/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	MA Appeals/Grievances Contact	Senior Director of Medicare Operations	Ms	Fagundo	Jenny		7868773149					jfagundo@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	04/27/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	MA Claims Processing Contact for Public Website	Sr. VP of Operations		Gutwald	David		8333227526					dgutwald@ilshealth.com	1 Computer Associates Plaza		Islandia	NY	11749	01/06/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Marketing Contact	Compliance Consultant		Sharpe	April		7865261284					asharpee@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	10/01/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Medical Director	Medical Director	Dr.	Barrial	Rafael		7862391451					rbarrial@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/15/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Medicare Compliance Officer	Chief Compliance Officer	Ms	Santamaria	Cary		7867594387					csantamaria@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	11/12/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Medicare Coordinator	Director of Delegation Oversight		Diaz	Emma		5616961749					EDiaz01@ilshealth.com	4601 N.W. 77th Avenue		Miami	FL	33166	06/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Medicare Part D Opioid Overutilization Contact	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	05/06/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Medication Therapy Management Contact	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Part C Application Contact	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Part C Reporting Contact	Director, Regulatory & Operational Reporting	Mr.	Green	Robert		6313588280					rgreen@ilshealth.com	1377 Motor Parkway	Suite 307	Islandia	NY	11749	01/26/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Appeals	Part D Prescription Drug Appeals		IRE Contact Group	ALJ and						7326914838	_ALJandIREContactGroup@CVSHealth.com	620 Epsilon Dr		Pittsburgh	PA	15238	09/19/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active	4219672300	71910			HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Appeals Contact (Secondary)	Medical Director	Dr.	Barrial	Rafael							rbarrial@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/15/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active	7862391451				HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Application Contact	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Benefits Contact	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Claims Submission Contact	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Exceptions Contact	Director of Pharmacy Benefits	Dr	Prados	Yesenia						7866796899	yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	01/10/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active	8553440930				HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Exceptions Contact (Secondary)	Corporate Chief Medical Officer	Dr.	Barrial	Rafael							rbarrial@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/15/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active	7862391451	103501			HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Price File Contact (Back-up)	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Price File Contact (Optional)	Corporate Chief Medical Officer	Dr.	Barrial	Rafael		7862391451					rbarrial@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/15/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Price File Contact (Primary)	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Quality Assurance Contact	Corporate Chief Medical Officer	Dr.	Barrial	Rafael		7862391451					rbarrial@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/15/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Part D Reporting Contact	Director, Regulatory & Operational Reporting	Mr.	Green	Robert		6313588280					rgreen@ilshealth.com	1377 Motor Parkway	Suite 307	Islandia	NY	11749	01/26/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Patient Safety Contact	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Payment Contact	CFO	Mr	Thomas	Tarlton		3052621292	106643				tthomas@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	01/04/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Personal Health Record Contact	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Pharmacy Director	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Pharmacy Network Management Contact	Director of Pharmacy Benefits	Dr.	Prados	Yesenia		7866796899					yprados@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/31/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Pharmacy Technical Help Desk Contact	Pharmacy Helpdesk		Helpdesk	Pharmacy						3054027827	cara.cox@cvshealth.com	2401 Cherahala Blvd.		Knoxville	TN	37932	05/16/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active	8666934620				HMO - Health Maintenance Organization		C	Atlanta
H9986	PHR Beneficiary Contact																	02/12/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS	HPMP of Florida Inc dba Florida Complete Care	Independent Living Systems, LLC	695	Yes	Active	8885261292				HMO - Health Maintenance Organization		C	Atlanta
H9986	Physician Incentive Contact	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/14/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Plan Directory Contact for Public Website	President and COO		Riddle	Abby		8333227526					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	02/04/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Plan to Plan Reconciliation Contact	AVP & Controller		Rankin	Krystal		6467750693					KRankin@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	12/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Processor Contact	Sr. VP of Operations		Gutwald	David		6318812404	801304				dgutwald@ilshealth.com	1 Computer Associates Plaza		Islandia	NY	11749	02/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Quality Contact	VP of Quality Improvement		Sub Laban	Grace	M	3052621292	103504				gsublaban@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	01/13/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Reconciliation Contact	AVP & Controller	Ms.	Rankin	Krystal		6467750693					KRankin@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	12/10/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Reconciliation Contact (Secondary)	CFO	Mr	Thomas	Tarlton		8882621292					tthomas@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	05/06/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Recovery Audit Contact	AVP & Controller	Ms.	Rankin	Krystal		6467750693					KRankin@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	12/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	SNP Application Contact	President and COO		Riddle	Abby		8505095998					ariddle@ilshealth.com	201 East Park Ave	Suite 400B	Tallahassee	FL	32301	12/15/2022	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Surveillance Contact	Chief Compliance Officer		Santamaria	Cary		7867594387					csantamaria@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	11/12/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	System Contact	Chief Information Officer	Mr.	Singh	Manjinder		3052621292	103844				msingh@ilshealth.com	4601 NW 77 Avenue		Miami	FL	33166	02/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Third Party Administrator (TPA) Liaison	Sr. VP of Operations		Gutwald	David		6318812404	801304				dgutwald@ilshealth.com	4601 NW 77 Avenue  FL		Miami,	FL	33166	08/09/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	User Access Contact	Compliance Consultant		Sharpe	April		7865261284					asharpe@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	11/12/2021	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Utilization Management Contact	Corporate Chief Medical Officer	Dr.	Barrial	Rafael		7862391451					rbarrial@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/15/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9986	Utilization Review Contact	Corporate Chief Medical Officer	Dr.	Barrial	Rafael		7862391451					rbarrial@ilshealth.com	4601 NW 77th Ave		Miami	FL	33166	03/15/2023	2023	HPMP OF FLORIDA, INC.	Local CCP	Florida Complete Care	HMO/HMOPOS		Independent Living Systems, LLC	695	Yes	Active					HMO - Health Maintenance Organization		C	Atlanta
H9998	Automated TrOOP Balance Transfer Contact	Director of Data Management		Shell	Brian	C	8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Backup User Access Contact	System Adminstrator		Smith	Daniel		8067660230				8067660250	dasmith@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	04/07/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Best Available Evidence Contact	Director of Data Management		Shell	Brian	C	8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Bid Primary Contact	Director of Data Management		Shell	Brian	C	8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	CAP Report Contact for Public Website	Director of Data Management		Shell	Brian	C	8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	CEO - CMS Administrator Contact	CEO	MRS	Lawson	Beth		8067671648					blawson@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	09/29/2017	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	CEO - Senior Official for Contracting	CEO	MRS	Lawson	Beth		8067671648					blawson@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	09/29/2017	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Chief Financial Officer	CFO	MR.	CANNADAY	JASON		8067671650				8067660250	jcannaday@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	06/02/2016	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Chief Operating Officer	Associate Chief Executive Officer for Programs	MS.	BAKER	SHERYL		2546313067				8067660250	sbaker@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Chief Information Officer	CHIEF INFORMATION OFFICER	MS	Potitadkul	Wendy		8067660272				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Chief Information Security Officer	Part D Compliance Officer	MS.	HARRIS	KAREN		8067401407				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	08/25/2020	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	CMS Casework Communication Contact	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Complaints Tracking Contact	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Contact for Fraud Investigations	Part D Compliance Officer	MS.	HARRIS	KAREN		8067401407				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	08/25/2020	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Coordination of Benefits Contact	Director of Data Management	Mr	SHELL	BRIAN		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	04/07/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Corporate Mailing						8067737857				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Data Management	Mr	SHELL	BRIAN		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Customer Service Operations Contact	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	DIR Contact	Director of Data Management	Mr	SHELL	BRIAN		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	DIR Contact (Secondary)	CFO	MR.	CANNADAY	JASON		8067671650				8067660250	jcannaday@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	06/02/2016	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Emergency Part D Contact	Part D Compliance Officer	MS.	HARRIS	KAREN		8067401407				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	08/25/2020	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Emergency Part D Contact (Secondary)	Director of Data Management	Mr	SHELL	BRIAN		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Encounter Data & Risk Adjustment Operations Contact	Director of Data Management	Mr	Shell	Brian		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	10/24/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Enrollment Contact	Enrollment Coordinator	Mrs	Ewing	Cheryl		8067671736				8067910578	chewing@silverstar.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	EOB Transfer Contact	Director of Data Management	Mr	Shell	Brian		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Financial Audit Contact	CFO	MR.	CANNADAY	JASON		8067671650				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Financial Reporting Contact	CFO	MR.	CANNADAY	JASON		8067671650				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Formulary Contact	CFO	MR.	CANNADAY	JASON		8067671650				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Formulary Contact (Secondary)	Part D Compliance Officer	MS.	HARRIS	KAREN		8067401407				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	08/25/2020	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	General Contact	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Government Relations Contact	CEO	MRS	Lawson	Beth		8067671648					blawson@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	09/29/2017	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	HIPAA Privacy Officer	Part D Compliance Officer	MS.	HARRIS	KAREN		8067401407				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	08/25/2020	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	HIPAA Security Officer	CHIEF INFORMATION OFFICER	MS	Potitadkul	Wendy		8067660272				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Interoperability Contact	Director of Data Management		Shell	Brian	C	8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	06/01/2022	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	MA Appeals/Grievances Contact	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	MA Claims Processing Contact for Public Website	CFO	MR.	CANNADAY	JASON		8067671650				8067660250	jcannaday@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	06/02/2016	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Marketing Contact	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Medical Director	Medical Director	Dr.	Rodriguez	Enrique		8067671718					erodrigu@silverstar.org	P.O. Box 2828		Lubbock	TX	79408	04/03/2013	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Medicare Compliance Officer	Part D Compliance Officer	MS.	HARRIS	KAREN		8067401407				8067660250	Kharris@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	08/28/2020	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Medicare Coordinator	CFO	MR.	CANNADAY	JASON		8067671650				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Medicare Part D Opioid Overutilization Contact	Part D Compliance Officer	MS.	HARRIS	KAREN		8067401407				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	06/01/2022	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Medication Therapy Management Contact	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Online Enrollment Center Contact (Back-up)	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Online Enrollment Center Contact (Primary)	Director of Data Management	Mr	Shell	Brian		8067671726					PACEdatateam@starcarelubbock.org	PO Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Part C Application Contact	Director of Data Management	Mr	Shell	Brian		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Part D Appeals	CFO	MR.	CANNADAY	JASON						8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active	8067671650				PACE - Nat		C	Denver
H9998	Part D Appeals Contact (Secondary)	Part D Compliance Officer	Mrs	HARRIS	KAREN						8067660250	PACEdatateam@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	08/25/2020	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active	8067401407				PACE - Nat		C	Denver
H9998	Part D Application Contact	Director of Data Management	Mr	Shell	Brian		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Part D Benefits Contact	Director of Data Management	Mr	Shell	Brian		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Part D Claims Submission Contact	Director of Data Management	MR	SHELL	BRIAN		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Part D Exceptions Contact	CFO	MR.	CANNADAY	JASON						8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active	8067671650				PACE - Nat		C	Denver
H9998	Part D Exceptions Contact (Secondary)	Director of Data Management	Mr	SHELL	BRIAN						8067910578	bshell@silverstar.org	P.O. Box 2828		Lubbock	TX	79408	04/03/2013	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active	8067671726				PACE - Nat		C	Denver
H9998	Part D Price File Contact (Back-up)	Director of Data Management		Shell	Brian		8067671726				8067910578	bshell@silverstar.org	P.O. Box 2828		Lubbock	TX	79408	12/30/2013	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Part D Price File Contact (Primary)	CFO	MR.	CANNADAY	JASON		8067671650				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Part D Quality Assurance Contact	Part D Compliance Officer	MS.	HARRIS	KAREN		8067401407				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	08/25/2020	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Part D Reporting Contact	CFO	MR.	CANNADAY	JASON		8067671650				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Patient Safety Contact	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Payment Contact	Director of Data Management	MR	SHELL	BRIAN		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Personal Health Record Contact	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Pharmacy Director	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Pharmacy Network Management Contact	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Pharmacy Network Management Contact (Secondary)	Silver Star QAPI Coordinator	Ms.	Heck	Shelly		5127362666				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	10/26/2021	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Pharmacy Technical Help Desk Contact	CFO	MR.	CANNADAY	JASON						8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	04/07/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active	8067671650				PACE - Nat		C	Denver
H9998	Pharmacy Technical Help Desk Contact (Secondary)	CFO	MR.	CANNADAY	JASON						8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	04/07/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active	8067671650				PACE - Nat		C	Denver
H9998	PHR Beneficiary Contact																	04/03/2013	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE	Silver Star Health Network	Lubbock Regional Mental Health	356	Yes	Active	8067401500				PACE - Nat		C	Denver
H9998	Plan Directory Contact for Public Website	Director of Data Management	MR	SHELL	BRIAN		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Plan to Plan Reconciliation Contact	Director of Data Management	MR	SHELL	BRIAN		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Processor Contact	Director of Data Management		SHELL	BRIAN		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Quality Contact	Silver Star PACE Program Director	MS.	FORD	MARCELLA		8067874824				8067671726	mford@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	09/20/2023	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Reconciliation Contact	Director of Data Management	MR.	SHELL	BRIAN		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Reconciliation Contact (Secondary)	CFO	MR.	CANNADAY	JASON		8067671650				8067660250	jcannaday@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	06/02/2016	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Recovery Audit Contact	CFO	MR.	CANNADAY	JASON		8067671650				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Surveillance Contact	Plant Operation Director	MR.	HARWOOD	CHRIS		8065436421				8067660250	charwood@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	04/03/2013	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	System Contact	CHIEF INFORMATION OFFICER	MS	Potitadkul	Wendy		8067660272				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Third Party Administrator (TPA) Liaison	SeniorScript Account Manager		Bautista	Anna		6304453500					anna.bautista@optum.com	1600 McConnor Parkway		Schaumberg	IL	60173	05/27/2016	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	User Access Contact	CHIEF INFORMATION OFFICER	MS	Potitadkul	Wendy		8067660272				8067660250	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Utilization Management Contact	Director of Data Management	Mr	Shell	Brian		8067671726				8067660250	PACEdatateam@starcarelubbock.org	PO BOX 2828		LUBBOCK	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
H9998	Utilization Review Contact	Director of Data Management	MR	SHELL	BRIAN		8067671726				8067910578	PACEdatateam@starcarelubbock.org	P.O. Box 2828		Lubbock	TX	79408	01/18/2019	2023	LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION	National PACE	Silver Star	National PACE		Lubbock Regional Mental Health	356	Yes	Active					PACE - Nat		C	Denver
R0110	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R0110	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R0110	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R0110	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R0110	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R0110	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R0110	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0110	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0759	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				Regional PPO		C	San Francisco
R0759	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				Regional PPO		C	San Francisco
R0759	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Regional PPO		C	San Francisco
R0759	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				Regional PPO		C	San Francisco
R0759	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0759	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R0865	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R0865	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R0865	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R0865	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R0865	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R0865	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R0865	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0865	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R0923	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R0923	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R0923	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R0923	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R0923	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R0923	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R0923	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R1390	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R1390	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R1390	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R1390	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R1390	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R1390	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1390	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R1532	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R1532	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R1532	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R1532	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R1532	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R1532	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R1532	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R2604	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				Regional PPO		C	San Francisco
R2604	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				Regional PPO		C	San Francisco
R2604	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Regional PPO		C	San Francisco
R2604	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				Regional PPO		C	San Francisco
R2604	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R2604	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Agent/Broker Compensation Data Contact	VP, Finance		State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Automated TrOOP Balance Transfer Contact	Director, Business Process		Scally	Michael		4438961222					mike_scally@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Backup User Access Contact	Manager, Regulatory Affairs		Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Best Available Evidence Contact	Supervisor, Enrollment & Eligibility		Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Bid Audit Contact	Director, Business Process		McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Bid Primary Contact	VP, Actuary		Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	CEO - CMS Administrator Contact	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	CEO - Senior Official for Contracting	Business Segment CEO	Mr.	Spilker	Timothy		2128988342					chief_exec_officer@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Chief Financial Officer	Business Segment CFO	Mr.	Hansen	Paul	D	9529796312					paul_d_hansen@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Chief Information Officer	VP, CIO	Ms.	Zmuda	Jennifer		9529065328					jennifer_zmuda@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	CMMI Model Point of Contact	Regulatory Affairs Consultant		Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Contact for Fraud Investigations	VP, Compliance		Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Consultant		Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	DIR Contact	Director, Accounting		Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Employer Waiver Contact	Regulatory Affairs Consultant		Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Encounter Data & Risk Adjustment Operations Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Enrollment Contact	Assoc. Director, Business Process		Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	EOB Transfer Contact	Director, Business Process		Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Financial Audit Contact	Compliance Audit Officer	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Financial Reporting Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Formulary Contact	Director, Clinical Pharmacy		Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Hospice Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Marketing Contact	Assoc. Director, Sales Operations		Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Medical Director	Medical Director		Price	Richard		9702488729					richard.price@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Medicare Coordinator	Business Segment COO		Byrnes	Chris	A	2182796720					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Medicare Part D Opioid Overutilization Contact	Senior Clinical Pharmacist		Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Medication Therapy Management Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	OffShore Subcontractor Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Online Enrollment Center Contact (Back-up)	Sr. Business Process Analyst		Birky	Danielle	M	7158520479					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Online Enrollment Center Contact (Primary)	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Part C Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Part D Appeals	Director, Claims		Trabold	Debbie							debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8889037587				Regional PPO		C	San Francisco
R3175	Part D Appeals Contact (Secondary)	Manager, Appeals		Zarazoga	William							william_zarazoga@uhc.com	9800 Health Care Lane		Minnesota	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8138185552				Regional PPO		C	San Francisco
R3175	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Part D Benefits Contact	VP, Clinical Pharmacy		Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Part D Claims Submission Contact	Director, Finance		Rancourt	Timothy		2159048672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Regional PPO		C	San Francisco
R3175	Part D Price File Contact (Back-up)	Senior Business Analyst		Vargas	Danielle		4437101262					danielle.wooten@optum.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Part D Price File Contact (Optional)	Business Process Analyst		Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	P.O. Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Part D Price File Contact (Primary)	Sr. Business Process Analyst		Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Part D Quality Assurance Contact	VP, General Management		Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Part D Reporting Contact	Director, Business Process		Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Patient Safety Contact	Director, Clinical Pharmacy		Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Payment Contact	VP, Finance		Bainbridge	Jason		4438969074					jason_e_bainbridge@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Pharmacy Director	VP, Clinical Pharmacy		Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Pharmacy Technical Help Desk Contact	Director, Business Process		Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8558733493				Regional PPO		C	San Francisco
R3175	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Plan to Plan Reconciliation Contact	Manager, Accounting		Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Reconciliation Contact	Director, Finance		Rancourt	Timothy		2159028672					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	03/27/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	System Contact	Assoc. Director, Business Process		Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Third Party Administrator (TPA) Liaison	Director, Finance		Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	User Access Contact	Regulatory Affairs Consultant		Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Utilization Management Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3175	Utilization Review Contact	Manager, Utilization Management		Kitka	Tiffany		9702485070					tiffany.kikta@uhc.com	PO Box 10600		Grand Junction	CO	81502	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3332	Agent/Broker Compensation Data Contact	VP FBM Growth Strat & Enable		Davis	Andrea		8478265793					andrea.davis@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	11/29/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Automated TrOOP Balance Transfer Contact	Manager, PBM operations	Ms.	Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/27/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Backup User Access Contact	Corporate Compliance Specialist		Figueroa	Carmen		9049056658					carmen.figueroa@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Best Available Evidence Contact	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	07/16/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Bid Audit Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Bid Audit Site Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Bid Primary Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	CAP Report Contact for Public Website	Sr. Director Govt Programs & Products Compliance		Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	CEO - CMS Administrator Contact	EVP Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 400	Jacksonville	FL	32246	01/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	CEO - Senior Official for Contracting	EVP, Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 100, 8th Flr	Jacksonville	FL	32246	01/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Chief Financial Officer	SVP and CFO	Mr.	Justice	Thurman		9049055085					Thurman.Justice@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 8th Floor	Jacksonville	FL	32246	08/21/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Chief Operating Officer	EVP, Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 100, 8th Flr	Jacksonville	FL	32246	11/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Chief Information Officer	SVP Chief Information Officer	Mr.	Anderson	Gary		9049050180					gary.anderson@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 8th Floor	Jacksonville	FL	32246	01/27/2016	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Chief Information Security Officer	VP Chief Information & Security Officer	Mr.	Raymond	Jason		9049050070					jason.raymond@floridablue.com	4800 Deewood Campus Parkway	DCC Building 600, 2nd Floor	Jacksonville	FL	32246	08/11/2016	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	CMS Casework Communication Contact	Sr Manager Med Ops & Integrity		Irizarry	Haydee		3212330635					Haydee.Irizarry@bcbsfl.com	4800 Deerwood Campus Parkway	Bldg. 400 2nd Floor	Jacksonville	FL	32246	04/25/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Complaints Tracking Contact	Sr Manager Med Ops & Integrity		Irizarry	Haydee		3212330635					Haydee Irizarry@bcbsfl.com	4800 Deerwood Campus Parkway	Bldg. 400 2nd Floor	Jacksonville	FL	32246	04/25/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Contact for Fraud Investigations	Manager II Data Integrity & SIU		Ramos	Jose		9049055835					jose.romas@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 400, 6th Floor	Jacksonville	FL	32246	11/27/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Coordination of Benefits Contact	Manager PBM Operations		Hanson	Michelle		6127776755				3127776706	COBMedD@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	02/16/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Corporate Mailing						9049054668					Hillary.Simpson@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	03/16/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant III, Corporate Receivables		Avis	Tammi		9049054034					Tammi.Avis@bcbsfl.com	4800 Deerwood Campus Pkwy	Bldg 100, 5th Floor	Jacksonville	FL	32246	04/25/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Customer Service Operations Contact	Sr Director Member Contact		Gamble	LaTonya		9049052057					latonya.gamble@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	DIR Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	DIR Contact (Secondary)	VP Medicare Chief Actuary		Phelps	Joshua		8048557732					joshua.phelps@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 6th Floor	Jacksonville	FL	32246	02/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Emergency Part D Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9045259651					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	12/23/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Emergency Part D Contact (Secondary)	Sr. Director Govt Programs & Products Compliance		Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Employer Waiver Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4thFloor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Encounter Data & Risk Adjustment Operations Contact	FBM Sr. Dir. Risk Adjustment		York	Dawn		9044636818					dawn.york@bcbsfl.com	4800 Deerwood Parkway		Jacksonville	FL	32246	07/18/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Enrollment Contact	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	EOB Transfer Contact	Sr Director Member Contact		Gamble	LaTonya		9049052057				9043576121	latonya.gamble@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Financial Audit Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Financial Reporting Contact	VP Medicare CFO		Dorsett	Kareen		9049051754					Kareen.Dorsett@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400	Jacksonville	FL	32246	08/20/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Formulary Contact	Medicare Clinical Pharmacist		Shore	Stephanie		9049050114					stephanie.shore@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	08/08/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	General Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Government Relations Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	HIPAA Privacy Officer	Asst. General Counsel & Privacy Officer		Resnick	Steven		9049055025					steven.resnick@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	HIPAA Security Officer	VP Chief Information Security Officer		Raymond	Jason		9049050070					jason.raymond@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 600, 2nd Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Hospice Contact	Medical Clinical Pharmacist Pharmacy Govt Prog		Adams	Tangela		9049050002					tangela.adams@floridablue.com	4800 Deerwood Campus Pkwy	DCC 900, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Interoperability Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th FL	Jacksonville	FL	32246	01/26/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	MA Appeals/Grievances Contact	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	MA Claims Processing Contact for Public Website	FBM Sr. Dir. Claims		Allen	Jessica		9049053152					Jessica.Allen2@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	11/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Marketing Contact	FBM Spec.IV Product Operations		Lilly	Wanda		9043573900					wanda.lilly@bcbsfl.com	4800 Deerwood Campus Parkway	Building 400, 3rd Floor	Jacksonville	FL	32246	04/27/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Medical Director	VP Medicare Solutions		Malko	Elizabeth		9049050491					Elizabeth.Malko@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	10/15/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Medicare Compliance Officer	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Medicare Coordinator	EVP, Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 100, 8th Flr	Jacksonville	FL	32246	11/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Medication Therapy Management Contact	Director Government Pharmacy Programs		Bryant-Riggins	Victoria		9049050194					victoria.bryant-riggins@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	08/27/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	OffShore Subcontractor Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Online Enrollment Center Contact (Back-up)	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@floridablue.com	4800 Deerwood Campus Pkwy	DCC Building 300, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Online Enrollment Center Contact (Optional)	Sr. Manager		Hogan	Kate		9049055131					kate.hogan@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 300 4th Flr	Jacksonville	FL	32246	05/06/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Online Enrollment Center Contact (Primary)			EMB Analysts	FBM Ops		9049051711					FB_Medicare_Ops_EMB_Analysts@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 2nd Floor	Jacksonville	FL	32246	05/06/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Part C Application Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Part C Reporting Contact	Corporate Compliance Specialist		Figueroa	Carmen		9049056658					carmen.figueroa@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Part D Appeals	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia							cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773736	56307			Regional PPO		C	Atlanta
R3332	Part D Appeals Contact (Secondary)	Director Government Pharmacy Programs		Bryant-Riggins	Victoria							victoria.bryant-riggins@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	12/29/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773636	50194			Regional PPO		C	Atlanta
R3332	Part D Application Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Part D Benefits Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	07/16/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Part D Claims Submission Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Part D Exceptions Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia							cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773736	56307			Regional PPO		C	Atlanta
R3332	Part D Exceptions Contact (Secondary)	Regulatory Manager & Audit Response		Gonzales	Santiago						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55120	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	8006936651				Regional PPO		C	Atlanta
R3332	Part D Price File Contact (Back-up)	QA Analyst		Tastad	Emily		6127772557					emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Part D Price File Contact (Optional)	Director Government Pharmacy Programs		Bryant-Riggins	Victoria		9049050194					victoria.bryant-riggins@floridablue.com	4800 Deerwood Campus Parkway	Building 900, 4th Floor	Jacksonville	FL	32246	08/27/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Part D Price File Contact (Primary)	Delivery System Coordinator		Rodriguez	Janina		3059217232					Janina.Rodriguez@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	08/04/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Part D Quality Assurance Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 5th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Part D Reporting Contact	Corporate Compliance Specialist		Figueroa	Carmen		9049056658					carmen.figueroa@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Patient Safety Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 5th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Payment Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Pharmacy Director	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Pharmacy Network Management Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services		Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55122	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Pharmacy Technical Help Desk Contact	Director, Member Services		Pretlow	Jennifer							jennifer.pretlow@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	8888776420				Regional PPO		C	Atlanta
R3332	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Member Services		Garza-Rodriguez	Melissa							MGarzarodriguez@primetherapeutics.com	1305 Corporate Center Drive		Eagan	MN	55121	07/30/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active	2143366770				Regional PPO		C	Atlanta
R3332	Plan Directory Contact for Public Website			Mbr Svcs	Medicare		8009266565					Chrissy.This@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	05/05/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Plan to Plan Reconciliation Contact	Accounting Specialist		Williams	Lynn		9049054568					lynn.williams@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 3rd Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Processor Contact	FBM Sr. Dir. Claims		Allen	Jessica		9049053152					Jessica.Allen2@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	11/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Quality Contact	Sr. Dir. Medicare Quality Improvement		Wright	Carole		3059217224					carole.wright@bcbsfl.com	8600 NW 36th St.		Doral	FL	33166	07/17/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Reconciliation Contact	VP Medicare Chief Actuary		Phelps	Joshua		8048557732					joshua.phelps@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	02/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Reconciliation Contact (Secondary)	VP Medicare CFO		Dorsett	Kareen		9049051754					Kareen.Dorsett@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400	Jacksonville	FL	32246	09/10/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Recovery Audit Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	SNP Application Contact	Sr. Director SNP		De Llano	Yisel		3059217225					yisel.dellano@floridablue.com	8400 NW 33rd Street Suite 100		Miami	FL	33122	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	SNP State Contact	Sr. Director Special Projects		Salo	Dan		2134488616					Dan.Salo@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	08/04/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Surveillance Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	System Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Third Party Administrator (TPA) Liaison	Medical Clinical Pharmacist Pharmacy Govt Prog		Adams	Tangela		9049050002					tangela.adams@floridablue.com	4800 Deerwood Campus Pkwy	DCC 900,  4th Floor	Jacksonville	FL	32246	12/09/2016	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	User Access Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Utilization Management Contact	GWCS Sr Dir Clinical Ops		Sparandeo	Dominick		9049055332					Dominick.Sparandeo@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	10/15/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3332	Utilization Review Contact	GWCS Sr Dir Clinical Ops		Sparandeo	Dominick		9049055332					Dominick.Sparandeo@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	10/15/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	Regional CCP	Florida Blue	Regional PPO		Guidewell Mutual Holding Corporation	594	Yes	Active					Regional PPO		C	Atlanta
R3392	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R3392	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R3392	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R3392	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R3392	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R3392	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R3392	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3392	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3444	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				Regional PPO		C	San Francisco
R3444	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				Regional PPO		C	San Francisco
R3444	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Regional PPO		C	San Francisco
R3444	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				Regional PPO		C	San Francisco
R3444	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3444	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R3887	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R3887	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R3887	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R3887	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R3887	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R3887	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R3887	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R3887	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R4182	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R4182	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R4182	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R4182	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R4182	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R4182	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4182	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4487	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/28/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/10/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				Regional PPO		C	Chicago
R4487	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				Regional PPO		C	Chicago
R4487	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				Regional PPO		C	Chicago
R4487	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				Regional PPO		C	Chicago
R4487	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				Regional PPO		C	Chicago
R4487	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				Regional PPO		C	Chicago
R4487	PHR Beneficiary Contact																	03/30/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				Regional PPO		C	Chicago
R4487	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4487	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R4845	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R4845	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R4845	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R4845	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R4845	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R4845	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R4845	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R4845	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5329	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				Regional PPO		C	San Francisco
R5329	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				Regional PPO		C	San Francisco
R5329	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Regional PPO		C	San Francisco
R5329	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				Regional PPO		C	San Francisco
R5329	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5329	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				Regional PPO		C	San Francisco
R5342	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				Regional PPO		C	San Francisco
R5342	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Regional PPO		C	San Francisco
R5342	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				Regional PPO		C	San Francisco
R5342	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5342	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R5361	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R5361	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R5361	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R5361	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R5361	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R5361	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R5361	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5361	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R5495	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R5495	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R5495	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R5495	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R5495	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R5495	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5495	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R5826	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R5826	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R5826	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R5826	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R5826	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R5826	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5826	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R5941	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/28/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/10/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Bid Audit Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Bid Audit Site Contact	Director/Actuary III		Lemming	Chris		3173734891					chris.lemming@anthem.com	220 Virginia Avenue	IN0205-A351	Indianapolis	IN	46204	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Bid Primary Contact	Product Management Director		McKee	Heather		9043474771					Heather.McKee@anthem.com	5211 Pine Rockland Ave.		Lithia	FL	33547	10/08/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Encounter Data & Risk Adjustment Operations Contact	Director Systems Support & Programs,GBD Encounters		Cotter	Len		4103709774					len.cotter@anthem.com	5800 Northampton Blvd.	Maildrop VA28	Norfolk	VA	23502	11/04/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	EOB Transfer Contact	QM Acred/Reg Review Analyst Sr		Pollack	Kristy		9204103749				9209237572	kristy.pollack@bcbswi.com	4361 Irwin Simpson Road	Bldg I	Mason	OH	45040	10/05/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	MA Appeals/Grievances Contact	Staff VP Medicare Complaints & Appeals		Kerry Winston	LeAnne	D	7573190130				8884581406	leanne.kerry-winston@amerigroup.com	500 Northampton Blvd.		Norfolk	VA	23502	10/26/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	MA Claims Processing Contact for Public Website			Service	Customer		8882307338					MedicareAdvantageAssistance@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Part C Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Part C Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				Regional PPO		C	Chicago
R5941	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	8144498744				Regional PPO		C	Chicago
R5941	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	5133167654				Regional PPO		C	Chicago
R5941	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	5407984087				Regional PPO		C	Chicago
R5941	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	8333774266				Regional PPO		C	Chicago
R5941	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active	3135973173				Regional PPO		C	Chicago
R5941	PHR Beneficiary Contact																	11/05/2015	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				Regional PPO		C	Chicago
R5941	Physician Incentive Contact	Compliance Director		Schoop	Jeff		5185306334					jeff.schoop@elevancehealth.com	4200 W. Cypress St.		Tampa	FL	33607	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Quality Contact	Clinical Quality Program Director		Richardson	Michelle		7249444338					michelle.richardson@anthem.com	704 Woodbridge Drive		Oakdale	PA	15071	05/26/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	SNP Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	SNP State Contact	Staff VP, Medicare Compliance		McMillan	Anne		2243407929					anne.mcmillan@elevancehealth.com	1001 Pennsylvania Avenue NW		Washington	DC	20004	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Utilization Management Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/16/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R5941	Utilization Review Contact	Health Services Director, UM Operations		Heapes	Mary		7322152000					mary.heapes@empireblue.com	17 Cornell Drive		East Brunswick	NJ	08816	01/17/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	Regional CCP	Anthem Blue Cross and Blue Shield	Regional PPO		Elevance Health, Inc.	1	Yes	Active					Regional PPO		C	Chicago
R6694	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Best Available Evidence Contact	Manager, Plan Sponsor Support		Kinsey, Jr.	Wayne		8002386279				8886656296	BAE/LISMailbox@aetna.com	Attn: BAE	P.O. Box 14088	Lexington	KY	405124088	06/12/2018	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Bid Audit Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Bid Audit Site Contact	Lead Director, Actuarial		Foster	Mikaela		9132025086					FosterM1@aetna.com	9401 Indian Creek Parkway, Suite 1300		Overland Park	KS	66210	06/30/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Bid Primary Contact	Exec. Dir., Product Mgmt. & Dev, Medicare Product		Goble	Kelly		7346797784					GobleK@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	09/15/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	CAP Report Contact for Public Website	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	01/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	CEO - CMS Administrator Contact	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	CEO - Senior Official for Contracting	Senior Vice President, CEO of Medicare	Ms.	Swanson	Terri		8602738766				8602738880	swansont@aetna.com	151 Farmington Ave., Mail Code RT52		Hartford	CT	06156	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Chief Operating Officer	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	12/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	CMS Casework Communication Contact	Executive Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Complaints Tracking Contact	Executive Director Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	Lorraine.Diamond@Aetna.com	1 CVS Drive		Woonsocket	RI	02895	12/19/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Contact for Fraud Investigations	Sr. Director Special Investigation		Statchen	Richard		8602738109				8609759719	statchenr1@cvshealth.com	151 Farmington Ave.		Hartford	CT	06156	09/16/2021	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Coordination of Benefits Contact	Manager, Client Operations		Maples	Zaneta		2145528104					MedicareCOBPharmacy@AETNA.com	1405 Xenium Lane North	Suite 140	Plymouth	MN	55441	05/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Corporate Mailing						4806612030				8554548052	MedicareCO@aetna.com	151 Farmington Avenue	Mail Code RC61	Hartford	CT	06156	07/08/2019	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Planning & Analysis Consultant		Griswold	Magdalena		7175262949					GriswoldM2@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	03/04/2021	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Customer Service Operations Contact	AVP,  Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Encounter Data & Risk Adjustment Operations Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	EOB Transfer Contact	Senior Director, Finance		Passuello	Clifford		7177292378				7247417216	capassuello@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Formulary Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	01/07/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/05/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TompkinsT@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/07/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	MA Appeals/Grievances Contact	Executive Director		Ross, MD	Jeffrey	A	2124570767				8602627455	RossJ2@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	MA Claims Processing Contact for Public Website	AVP, Medicare Service Operations		Knight	Meg		8002825366					MKnight@aetna.com	14955 Heathrow Forest Pkwy		Houston	TX	77032	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Medical Director	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Medicare Coordinator	AVP, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	09/15/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Online Enrollment Center Contact (Primary)	Senior Manager, Project Management		Fitzpatrick	Bethany		7175262768				8886656296	bcfitzpatrick@cvshealth.com	3721 TechPort Drive		Harrisburg	PA	17106	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Part C Application Contact	Exec Dir, Product Mgt. & Dev., Medicare Product		Goble	Kelly		7346797784					mapdapp@aetna.com	28588 Northwestern Highway		Southfield	MI	48034	10/27/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Part C Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active	8042966237				Regional PPO		C	Philadelphia
R6694	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active	7132085765				Regional PPO		C	Philadelphia
R6694	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Part D Claims Submission Contact	Business Project Progam Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	02/10/2015	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active	6026183945				Regional PPO		C	Philadelphia
R6694	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active	6122633491				Regional PPO		C	Philadelphia
R6694	Part D Price File Contact (Back-up)	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	11/30/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Part D Price File Contact (Primary)	Senior Consultant		Smith	Jonathan		4129524541					SmithJ335F51@aetna.com	730 Holiday Drive, Bldg 8	Mail Code: F219	Pittsburg	PA	15220	11/30/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/08/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Personal Health Record Contact	Manager, Medicare Compliance		Simonsen	Dee		2157756407				8609759699	SimonsenDM@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/23/2019	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active	8002386279				Regional PPO		C	Philadelphia
R6694	PHR Beneficiary Contact																	02/10/2015	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO	Aetna Medicare Customer Service	CVS Health Corporation	49	Yes	Active	8002825366				Regional PPO		C	Philadelphia
R6694	Physician Incentive Contact	Lead Director, Compliance		Benitez	Bernadette		2105253588				8554548052	BLBenitez@aetna.com	15400 Calhoun Drive, Suite 300		Rockville	MD	20855	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Plan Directory Contact for Public Website			Customer Service	Aetna		8006240756					CustomerService@aetna.com	151 Farmington Avenue		Hartford	CT	06156	08/12/2015	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/24/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Processor Contact	Director Service Operations		Painting	Melissa		5408725497				8602738880	mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	07/07/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Quality Contact	Lead Director, Quality Management		Flores	Kimberly	N	6149335605					FloresK2@aetna.com	3200 Highland Ave., MCF661		Downers Grove	IL	60515	12/19/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Reconciliation Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	08/02/2019	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	SNP Application Contact	VP, Medicare Duals		Esslinger	Laura	A	9548583070					EsslingerL@aetna.com	261 N. University Drive	Suite 200	Plantation	FL	33324	12/19/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	SNP State Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	System Contact	Executive Director, Application Development		Hepner	Mark		4123279231					mahepner@aetna.com	2222 Ewing Road		Moon Township	PA	15108	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Utilization Management Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6694	Utilization Review Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	AETNA LIFE INSURANCE COMPANY	Regional CCP	Aetna Medicare	Regional PPO		CVS Health Corporation	49	Yes	Active					Regional PPO		C	Philadelphia
R6801	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				Regional PPO		C	San Francisco
R6801	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				Regional PPO		C	San Francisco
R6801	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Regional PPO		C	San Francisco
R6801	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				Regional PPO		C	San Francisco
R6801	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R6801	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7220	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R7220	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R7220	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R7220	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R7220	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R7220	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R7220	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7220	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Bid Primary Contact	Actuary, Risk and Compliance		Chung	Denward		5025805926					mabptcontact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Encounter Data & Risk Adjustment Operations Contact	Director, Health Info Management		Lenfert	Matthew		5024766717					mlenfert1@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	MA Appeals/Grievances Contact	Risk Management Lead		Mammone	Danielle		5025804849					dmammone@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	MA Claims Processing Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Part C Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 West Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Part C Reporting Contact	Sr Compliance Professional		Troxell	Christie		5025807177					ctroxell@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R7315	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025807929				Regional PPO		C	Kansas City
R7315	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025809138				Regional PPO		C	Kansas City
R7315	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5024682494				Regional PPO		C	Kansas City
R7315	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	8008658715				Regional PPO		C	Kansas City
R7315	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active	5025800475				Regional PPO		C	Kansas City
R7315	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Quality Contact	Director		Shephard	Angela		3124415345					ashephard@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	SNP Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	SNP State Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Utilization Management Contact	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7315	Utilization Review Contact		Dr.	McGuire-Dunn	Cindy		5853199156					cmcguiredunn@humana.com	515 West Market Street	c/o Joni Votaw	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	Regional CCP	Humana	Regional PPO		Humana Inc.	128	Yes	Active					Regional PPO		C	Kansas City
R7444	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Encounter Data & Risk Adjustment Operations Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	MA Appeals/Grievances Contact	Director, Regulatory Adherance		Santos	Kally		7142266951					kally.santos@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	MA Claims Processing Contact for Public Website	VP, Claims		Barber	Joseph		8157824911					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Part C Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Part C Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				Regional PPO		C	San Francisco
R7444	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				Regional PPO		C	San Francisco
R7444	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Regional PPO		C	San Francisco
R7444	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				Regional PPO		C	San Francisco
R7444	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Quality Contact	SVP Quality & Performance Improvement		Brady	Will		3092754475					will.brady@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	SNP Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Utilization Management Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
R7444	Utilization Review Contact			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	CARE IMPROVEMENT PLUS SOUTH CENTRAL INSURANCE CO.	Regional CCP	UnitedHealthcare	Regional PPO		UnitedHealth Group, Inc.	239	Yes	Active					Regional PPO		C	San Francisco
S0156	Agent/Broker Compensation Data Contact	Consumer Sales Manager		Nichol	James (JD)		7012772846					james.nichol@bcbsnd.com	4510 13th Ave S		Fargo	ND	58121	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Automated TrOOP Balance Transfer Contact	Manager, Business Process		Diaz	Mario		7143172628					OptumRx-SupportServices@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Backup User Access Contact	Manager Performance & Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Best Available Evidence Contact	Manager, Enrollment and Billing		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road Suite 200		Glen Allen	VA	23060	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Bid Audit Contact	Director		Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Bid Audit Site Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Bid Primary Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	CAP Report Contact for Public Website	Managing Director		Pickens	Veronica		2483955887					vpickens@bcsbm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	CEO - CMS Administrator Contact	Plan President	Ms.	West	Beth		7012821593					BethAnn.West@NextBlueND.com	4510 13th Ave S		Fargo	ND	58121	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	CEO - Senior Official for Contracting	Plan President	Ms.	West	Beth		7012821593					BethAnn.West@NextBlueND.com	4510 13th Ave S		Fargo	ND	58121	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Chief Financial Officer	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Chief Operating Officer	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Chief Information Officer	IT Director II	Mrs.	Krause	Amy		3132256638					akrause@bcbsm.com	600 East Lafayette Blvd. MC 0506		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Cieszynski	Brent		3132258766					bcieszynski@bcbsm.com	600 Lafayette East		Detroit	MI	48226	08/22/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	CMMI Model Point of Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	CMS Casework Communication Contact	Compliance Consultant		White	Jasmin		2486654235					JWhite4@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Complaints Tracking Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Contact for Fraud Investigations	Manager		Zasadny	Brian		3132255956					bzasadny@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Coordination of Benefits Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Corporate Mailing						7012821593					BethAnn.West@NextBlueND.com	4510 13th Ave S		Fargo	ND	58121	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Supervisor		Cole	Terrence	A	5177086127					terrence.cole@emergentholdingsinc.com	200 North Grand Avenue, PO Box 40790		Lansing	MI	48901	12/28/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Customer Service Operations Contact	Director, Workforce Management, Analytics, & Supp		Weber	Julie		3132250555					jweber@bcbsm.com	600 East Lafayette		Detroit	MI	48226	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	DIR Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	DIR Contact (Secondary)	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Emergency Part D Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Emergency Part D Contact (Secondary)	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Employer Waiver Contact	Manager, Functional Operations		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center	TC1505	Southfeld	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Enrollment Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	EOB Transfer Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880				9528375607	Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/08/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Financial Audit Contact	Director	Mr.	Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Financial Reporting Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Formulary Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Formulary Contact (Secondary)	Manager, Functional Operations		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center	TC1505	Southfeld	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	General Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Government Relations Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	HIPAA Privacy Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	HIPAA Security Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Hospice Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/08/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Interoperability Contact	Manager, Functional Operations		Kingsley	Chris		2484444160					Christopher.kingsley@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Marketing Contact	Plan President		West	Beth		7012821593					BethAnn.West@NextBlueND.com	4510 13th Ave S		Fargo	ND	58121	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Medical Director	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Medicare Compliance Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/23/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Medicare Coordinator	Managing Director, Medicare Advantage Compliance		Pickens	Veronica		2483955887					vpickens@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Medicare Part D Opioid Overutilization Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Medication Therapy Management Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	OffShore Subcontractor Contact	Manager	Mrs.	Stretch	Kaitlin		2486654275					kstretch@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Online Enrollment Center Contact (Back-up)	Enrollment Business Lead		Schulz	Bryan		5084390769					Bryan.Schulz@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Online Enrollment Center Contact (Optional)	Manager		Woods	Cheyenne		2484173449					cheyenne.woods@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Online Enrollment Center Contact (Primary)	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Appeals	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8558124306				Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Appeals Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8003443405	733326			Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Application Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Benefits Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Claims Submission Contact	Manager, Business Process		Diaz	Mario		7143172628					OptumRx-SupportServices@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Exceptions Contact	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8558124306				Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Exceptions Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	6143363326				Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Price File Contact (Back-up)	Vice President		Siuta	Lori		2242312298					lori.siuta@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Price File Contact (Optional)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Price File Contact (Primary)	Sr. Business Analyst, Medicare Operations		Vargas	Danielle		4437101262					danielle.wooten@optum.com	11000 Optum Circle	Suite 106	Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Quality Assurance Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Part D Reporting Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Patient Safety Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Payment Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Personal Health Record Contact	Medical Director		Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Pharmacy Director	Medical Director		Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Pharmacy Network Management Contact	Sr. Account Manager, Network Account Management		Brown	Casey		6126427367					casey.brown@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Pharmacy Network Management Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Pharmacy Technical Help Desk Contact	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8558124306				Medicare Prescription Drug Plan		5	Chicago
S0156	Pharmacy Technical Help Desk Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	Chicago
S0156	Plan Directory Contact for Public Website	Work Track Project Manager		Nelson	Jessica		8447538039					Jessica.Nelson@emergient.com	4510 13th Ave S		Fargo	ND	58121	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Plan to Plan Reconciliation Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Processor Contact	Manager, Coordination of Benefits		Griffin	Suzanne		2486212356					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Reconciliation Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	06/01/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Reconciliation Contact (Secondary)	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Recovery Audit Contact	Manager, Performance and Oversight	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Surveillance Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	System Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	Third Party Administrator (TPA) Liaison	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	200 North Grand Avenue	PO Box 40790	Lansing	MI	48901	12/28/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0156	User Access Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/24/2022	2023	NEXTBLUE OF NORTH DAKOTA INSURANCE COMPANY	PDP	NextBlue of North Dakota	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S0586	Agent/Broker Compensation Data Contact	Medicare Sales & Broker		Osborn	Valerie		5183951245					vosborn@mvphealthcare.com	625 State Street		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Backup User Access Contact	Compliance Coordinator		Carter	Marlo		5189913814					mcarter@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Best Available Evidence Contact	Leader, Medicare Enrollment Operations		Moxley	Radija		5858852361				5853272227	RMoxley@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Bid Audit Contact	Corporate Compliance Officer		Borges	Linda		5189913803					mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Bid Audit Site Contact	Sr. Leader, Actuarial Services		Fish	Kathleen		5189913826				5183882311	kfish@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Bid Primary Contact	Leader, Market Innovation & Ancillary Products	Mr	Hartman	Robert		5858852392					bhartman@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	CAP Report Contact for Public Website	Corporate Compliance Officer		Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	CEO - CMS Administrator Contact	President and CEO	Mr.	Delvecchio	Chris		5189010624				5853272319	cdelvecchio@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	CEO - Senior Official for Contracting	President and CEO	Mr.	Delvecchio	Chris		5189010624				5853272319	cdelvecchio@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Chief Financial Officer	Chief Financial Officer	Ms.	Austen	Karla		5183882357					kausten@mvphealthcare.com	625 State Street		Schenectady	NY	12305	06/26/2014	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Chief Operating Officer	President and CEO	Mr.	Delvecchio	Chris		5189010624				5853272319	cdelvecchio@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Chief Information Officer	Sr Leader, Information Technology & Transformation	Mr.	Della Villa	Michael		5183882323					mdellavilla@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/22/2020	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Chief Information Security Officer	Sr, Leader, Information Technology & Transformatio	Mr.	Della Villa	Michael		5183882323					mdellavilla@mvphealthcare.com	625 State Street		Schenectady	NY	12305	09/07/2021	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	CMS Casework Communication Contact	Leader, Medicare Appeals		Allen	Amy		5852588096				5853275724	aallen@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Complaints Tracking Contact	Leader, Medicare Appeals	Ms	Allen	Amy		5852588096				5853275724	aallen@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Contact for Fraud Investigations	Leader, Special Investigations Unit		Cordato	Rocco		5189010613					rcordato@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Coordination of Benefits Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Corporate Mailing						8006657924					memberservices@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	01/13/2010	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Coverage Gap Discount Program (CGDP) Payment Contact	Analyst, Revenue Data Management		Canlas	Natasha	M	9144298480					ncanlas@mvphealthcare.com	303 South Broadway	Suite 321	Tarrytown	NY	10591	08/07/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Customer Service Operations Contact	Sr. Leader, Customer Care & Support Services		Greenberg	Melissa		5189913731					mgreenberg@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	DIR Contact	Leader, State & Federal Plan BIlling		Marcus	Yael		9144298496					ymarcus@mvphealthcare.com	625 State Street		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	DIR Contact (Secondary)	Sr. Director, Actuarial		Jaiman	Rajshree		5189913834					rjaiman@mvphealthcare.com	625 State St.		Schenectady	NY	12305	02/28/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Emergency Part D Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Emergency Part D Contact (Secondary)	Leader, Pharmacy Clinical Operations		Massoudi	Layla		5188363126					lmassoudi@mvphealthcare.com	625 State St		Schenectady	NY	12305	09/27/2021	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Enrollment Contact	Leader, Medicare Enrollment Operations		Moxley	Radija		5858852361				5853272227	rmoxley@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	EOB Transfer Contact	Director, Pharmacy Management		Colin	Wendy		5858852435				8004010915	wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Financial Audit Contact	Sr. Director, Internal Audit	Mr.	Hillerman	Stephen		5189913995				5188363202	shillerman@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Financial Reporting Contact	Sr. Leader, Accounting & Assistant Controller		Cenzano	Jennifer		5189010623					jcenzano@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Formulary Contact	Professional, Pharmacy Program Management		Harrington	Courtney		5188363195					charrington@mvphealthcare.com	625 State St		Schenectady	NY	12305	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Formulary Contact (Secondary)	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	General Contact	Leader, Government Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Government Relations Contact	Medicare Compliance Officer		Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	HIPAA Privacy Officer	Corporate Compliance Officer		Borges	Linda		5189913803				5183882311	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	HIPAA Security Officer	Corporate Compliance Officer		Borges	Linda		5189913803				5183882311	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Hospice Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					WColin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Interoperability Contact	Leader, Gov''''''''t Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State St		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Marketing Contact	Sr. Leader, Marketing & Communications		Wiseman	Sarah		5189913654					swiseman@mvphealthcare.com	625 State Street		Schenectady	NY	12305	01/18/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Medical Director	Vice President Medical Affairs &Medical Direction		Cameron	Carl		5853272200					ccameron@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	03/02/2020	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Medicare Coordinator	Leader, Government Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Medicare Part D Opioid Overutilization Contact	Director, Pharmacy Management		Colin	Wendy		5858852435				8004010915	wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Medication Therapy Management Contact	Leader, Pharmacy Clinical Operations - Medicare		Massoudi	Layla		5188363126					lmassoudi@mvphealthcare.com	625 State St.		Schenectady	NY	12305	11/09/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms	Borges	Linda		5189913803					mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Online Enrollment Center Contact (Back-up)	Supervisor, Government Programs Enrollment		Moxley	Radija		5858852361				5853272227	rmoxley@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Online Enrollment Center Contact (Primary)	Leader, Medicare Enrollment Operations		Moxley	Radija		5858852361				5853272227	rmoxley@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Part D Appeals	Leader, Medicare Appeals		Allen	Amy						5853275724	aallen@mvphealthcare.com	220 Alexander  St		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active	5852588096				Medicare Prescription Drug Plan		5	New York
S0586	Part D Appeals Contact (Secondary)	Compliance Coordinator, Medicare Appeals		Stepnowski	Ashley							astepnowski@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	09/07/2021	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active	5857208126				Medicare Prescription Drug Plan		5	New York
S0586	Part D Application Contact	Sr. Leader, Medicare & Govt Programs Strategy		Hungate	Nicole	M	5858852394					nhungate@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Part D Benefits Contact	Professional, Product Strategy		Hart	Andrew		5858852391					ahart@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Part D Claims Submission Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Part D Exceptions Contact	Director, Pharmacy Management		Colin	Wendy							wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active	5858852435				Medicare Prescription Drug Plan		5	New York
S0586	Part D Exceptions Contact (Secondary)	Leader, Pharmacy Clinical Operations		Massoudi	Layla							lmassoudi@mvphealthcare.com	625 State St		Schenectady	NY	12305	09/27/2021	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active	5188363126				Medicare Prescription Drug Plan		5	New York
S0586	Part D Price File Contact (Back-up)	Leader, Pharmacy Clinical Operations		Massoudi	Layla		5188363126					lmassoudi@mvphealthcare.com	625 State St		Schenectady	NY	12305	09/27/2021	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Part D Price File Contact (Optional)	Professional, Pharmacy Compliance Coordinator		Dunham	Kristina		5857208250					KDunham@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	05/24/2019	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Part D Price File Contact (Primary)	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Part D Quality Assurance Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Part D Reporting Contact	Professional, Pharmacy Compliance Coordinator		Dunham	Kristina		5857208250					Kdunham@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	05/24/2019	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Patient Safety Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Payment Contact	Leader, State & Federal Plan Billing		Marcus	Yael		9144298496					ymarcus@mvphealthcare.com	625 State Street		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Pharmacy Director	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Pharmacy Network Management Contact	Director Network Operations		Smith	Shawn		4803914844					shawn.smith@cvshealth.com	9501 E. Shea Blvd. MC 080		Scottsdale	AZ	85260	02/27/2019	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander St.		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Pharmacy Technical Help Desk Contact	Director, Client Operations		Leeper	Shonda							Shonda.Leeper@CVSHealth.com	445 Great Circle Rd		Nashville	TN	37228	12/03/2021	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active	8666934620				Medicare Prescription Drug Plan		5	New York
S0586	Pharmacy Technical Help Desk Contact (Secondary)	Director, Pharmacy Management		Colin	Wendy							wcolin@mvphealthcare.com	220 Alexander St		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active	5858852435				Medicare Prescription Drug Plan		5	New York
S0586	Plan Directory Contact for Public Website	Associate, Care Center Senior Representative		Garrett	Scott		5183867647					sgarrett@mvphealthcare.com	625 State St		Schenectady	NY	12305	12/27/2021	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Plan to Plan Reconciliation Contact	Leader, State & Federal Plan Billing		Marcus	Yael		9144298496					ymarcus@mvphealthcare.com	625 State Street		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Processor Contact	Director, Pharmacy Management		Colin	Wendy		5858852435					wcolin@mvphealthcare.com	220 Alexander Street		Rochester	NY	14607	11/08/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Reconciliation Contact	Leader, State & Federal Plan Billing		Marcus	Yael		9144298496					ymarcus@mvphealthcare.com	625 State St		Schenectady	NY	12305	10/04/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Reconciliation Contact (Secondary)	Sr. Director, Actuarial		Jaiman	Rajshree		5189913834					rjaiman@mvphealthcare.com	625 State St.		Schenectady	NY	12305	02/28/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Borges	Linda		5189913803				5188363202	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Surveillance Contact	Medicare Compliance Officer		Borges	Linda		5189913803				5183882311	mco@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	System Contact	Sr Leader, CISO and Enterprise Computer Svcs		Swits	David		5189913694					dswits@mvphealthcare.com	625 State Street		Schenectady	NY	12305	08/23/2022	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	Third Party Administrator (TPA) Liaison	Analyst, Revenue Data Management		Canlas	Natasha	M	9144298480					ncanlas@mvphealthcare.com	303 South Broadway	Suite 321	Tarrytown	NY	10591	08/07/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0586	User Access Contact	Leader, Government Programs Operations Liaison		Schlesinger	Faith		5189913569					fschlesinger@mvphealthcare.com	625 State Street		Schenectady	NY	12305	03/29/2023	2023	MVP HEALTH PLAN, INC.	PDP	MVP Health Care	Medicare Prescription Drug Plan		MVP Health Care, Inc.	197	Yes	Active					Medicare Prescription Drug Plan		5	New York
S0655	Agent/Broker Compensation Data Contact	Vice President, Medicare Sales & Marketing	Ms.	McManus	Marie		6179729400	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Automated TrOOP Balance Transfer Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Backup User Access Contact	Medicare Compliance Program Manager		Tran	Brenda		7816121000	85880				brenda.tran@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Best Available Evidence Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Bid Audit Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Bid Audit Site Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Bid Primary Contact	Manager Actuarial Services-Credentialed		Bartel	Emily		7816128937					emily.bartel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852	84759				taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Chief Financial Officer	SVP Chief Financial Officer	Mr.	Walker	Scott		7816126840					r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Chief Operating Officer	Chief Executive Officer	Mr.	Hayes	Cain		6175841084					cain.hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Chief Information Officer	SVP and Chief Information Officer	Ms.	Ferhatbegovic	Selma		7816121000	84633				Selma.Ferhatbegovic@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	CMS Casework Communication Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Complaints Tracking Contact	Director, Appeals & Grievances	Ms.	Evans	Kathleen		6179729400	87204				kathleen.evans@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Contact for Fraud Investigations	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Coordination of Benefits Contact	Manager, Membership Accounting & Capitation	Ms.	Zakrzewski	Elaine		7816121000	82780				Elaine.Zakrzewski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Corporate Mailing						7816121000					Cain.Hayes@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Customer Service Operations Contact	Manager, Member Services	Ms.	Villatoro	Yesly		7816121000	54152				yesly.villatoro@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	DIR Contact	Senior Manager, Pharmacy reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	DIR Contact (Secondary)	Pharmacy Analyst Senior	Ms.	Santino	Cristina		7816121000	82560				cristina.santino@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Emergency Part D Contact	Director, Pharmacy Operations		Bonica	Joseph		7816123342					joseph.bonica@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Emergency Part D Contact (Secondary)	Manager, Pharmacy Compliance		Lake	Matthew		7816123976					matthew.lake@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Employer Waiver Contact	Manager, Client Service	Ms.	Bartkiewicz	Mary		7816121000	83937				mary.bartkiewicz@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Enrollment Contact	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	EOB Transfer Contact	Manager, Business Implementation		Nesmith	Tanisha		7816124861				6176730286	tanisha.nesmith@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Financial Audit Contact	Chief Financial Officer	Mr.	Walker	Scott		7816121000	86840				r.scott.walker@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Financial Reporting Contact	SVP Finance & Chief Accounting Officer	Mr.	Porter	Mark		6179729400	85536				mark.porter@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Formulary Contact	Clinical Pharmacist Senior	Mr.	Kowalski	Alec		7816121000	82045				alec.kowalski@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Formulary Contact (Secondary)	Clinical Pharmacist Senior		Shafir	Frances		7816122897					frances.shafir@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	General Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Government Relations Contact	Chief Government Affairs Officer	Ms.	Lewis	Kristin		7816121000	83621				kristin.lewis@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	HIPAA Privacy Officer	VP Privacy & Special Investigation	Mr.	Walsh	Chris		7816121000	82508				Christopher.walsh@point32health.org	1600 Crown Colony Drive		Quincy	MA	02169	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	HIPAA Security Officer	VP Chief  Information Security Officer	Mr.	Faria	Tony		7816121000	88611				Tony.Faria@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Hospice Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Interoperability Contact	Vice President & Chief Technology Officer		Querusio	David		7816122629					david.querusio@point32health.org	One Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Marketing Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Medical Director	Medical Director Senior	Dr.	Harding	Jonathan		7816121000	83331				jonathan.harding@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Medicare Compliance Officer	Medicaid Compliance Officer	Mrs	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/31/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Medicare Coordinator	SVP, President Medicare	Ms.	Blake	Patty		7816124287					Patty.Blake@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Medicare Part D Opioid Overutilization Contact	Medical Director	Dr.	Dohan	David		7816121000	82615				David.Dohan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Medication Therapy Management Contact	Sr Pharmacy Program Manager		Burns	Ashlyn		7816122239					ashlyn.burns@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	OffShore Subcontractor Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Online Enrollment Center Contact (Back-up)	Director, Enrollment & Payment - Senior Products	Ms.	Bullock	Jennifer		7816121000	83183				jennifer.bullock@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Online Enrollment Center Contact (Optional)	Supervisor, Enrollment	Ms.	Van De Mortel	Migdalia		7816121000	84104				Migdalia.Van.De.Mortel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Online Enrollment Center Contact (Primary)	Senior Manager, Operations	Ms.	Sarazen	Kristen		7816121000	83611				Kristen.Sarazen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Part D Appeals	Director, Appeals & Grievances	Ms.	Evans	Kathleen							Kathleen.Evans@point32health.org	1 Wellness Way		Canton	MA	02021	09/20/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active	6179729400	87204			Medicare Prescription Drug Plan		5	Boston
S0655	Part D Appeals Contact (Secondary)	Program Manager Senior	Ms.	Mello	Sheri							sheri.mello@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active	7816121000	84862			Medicare Prescription Drug Plan		5	Boston
S0655	Part D Application Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Part D Benefits Contact	Director, Product Strategy	Mr.	Chukwu	Matthew		7816121000	83967				matthew.chukwu@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Part D Claims Submission Contact	Manager, Pharmacy Operations & Programs	Ms.	MacAuley	Jacqueline		7816121000	83059				jacqueline.macauley@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Part D Exceptions Contact	Director, Pharmacy Utilization Management	Mr.	Chan	Bryan							bryan.chan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active	7816121000	82370			Medicare Prescription Drug Plan		5	Boston
S0655	Part D Exceptions Contact (Secondary)	Supervisor, Pharmacy Utilization Management	Ms.	Griffith	Samantha							samantha.griffith@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active	7816121000	84551			Medicare Prescription Drug Plan		5	Boston
S0655	Part D Price File Contact (Back-up)	Advisor, Medicare Operations		Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Part D Price File Contact (Optional)	Sr. Pharmacy Implementation Specialist		Sullivan	Tim		7816124922					tim.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Part D Price File Contact (Primary)	Sr Business Analyst		Moore-Elliott	Shalandria		7637974305					shalandria.moore-elliott@optum.com	1600 McConnor Pwy.		Schaumburg	IL	60173	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Part D Quality Assurance Contact	Vice President, Behavioral Health	Ms.	Borrelli	Jill		6179729400	85397				jill.borrelli@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Part D Reporting Contact	Director, Pharmacy Financial & Reporting	Mr.	Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Patient Safety Contact	Sr Pharmacy Implementation Specialist		von Fritzinger	Lisa		7816123778					lisa.vonfritzinger@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Payment Contact	Program Manager III	Ms.	Cook	Tiffany		7816121000	84908				Tiffany.Cook@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Pharmacy Director	Vice President, Pharmacy	Ms.	Sullivan	Miriam		7816121000	84116				miriam.sullivan@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Pharmacy Network Management Contact	Manager, Retail Network Operations	Mr.	Hagan	Kyle		3039895828					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations		Ashby	JoLynn		7637326364					JAshby@CastiaRx.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Pharmacy Technical Help Desk Contact	Sr. Manager		Villaneuva	Juan							Juan.Villanueva@optum.com	3515 S Harbor Blvd.		Costa Mesa	CA	92626	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active	7148253761				Medicare Prescription Drug Plan		5	Boston
S0655	Pharmacy Technical Help Desk Contact (Secondary)	Associate Director, Pharmacy Help Desk		Betten	Brad							bradley.betten@optum.com	1600 McConnor Parkway		Schaumburg	IL	601736801	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active	8555240380				Medicare Prescription Drug Plan		5	Boston
S0655	Plan Directory Contact for Public Website	Supervisor, Marketing Materials Production	Mr.	Kayser	Kenneth		7816121000	83518				kenneth.kayser@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Plan to Plan Reconciliation Contact	Manager, Finance Operations	Ms.	Olson	Rachel		7816121000	84360				rachel.olson@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Processor Contact	Director, Claims	Ms.	Patel	Monal		7816121000	88187				monal.patel@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Reconciliation Contact	Senior Manager, Pharmacy Reporting & Analysis		Keating	Melissa		7816121000	84020				Melissa.Keating@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Reconciliation Contact (Secondary)	Director, Pharmacy Financial & Reporting		Cimino	Rocco		7816121000	84485				rocco.cimino@point32health.org	1 Wellness Way		Canton	MA	02021	09/11/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Recovery Audit Contact	Director, Special Investigation Unit and Assoc GC	Mr.	Orr	Joshua		6175848328					Joshua.Orr@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Surveillance Contact	Director, Sales Operations		McManus	Marie		6117972940	87793				marie.mcmanus@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	System Contact	Senior Manager, Business Account Management	Mr.	Allen	Jeffrey		7816121000	83167			6179729008	Jeffrey.Allen@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	Third Party Administrator (TPA) Liaison	Manager, Accounting	Ms.	Parikh	Roshni		7816121000	84512				roshni.parikh@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S0655	User Access Contact	Medicare Compliance Officer	Mrs.	Avakian	Taline		7816124852					taline.avakian@point32health.org	1 Wellness Way		Canton	MA	02021	08/22/2023	2023	TUFTS INSURANCE COMPANY	PDP	Tufts Health Plan	Medicare Prescription Drug Plan		Point32Health, Inc.	398	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S1030	Agent/Broker Compensation Data Contact	Department Mgr Comp & Benefits		Vollenweider	Laurie		2052207486					lvollenweider@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/15/2011	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Automated TrOOP Balance Transfer Contact	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Backup User Access Contact	Compliance Analyst I		Goodlett	Dominique		2052206984					dgoodlett@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Best Available Evidence Contact	Sr. Business Analyst		Johnson	Geraldine		2052206077					gejohnson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/11/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Bid Audit Contact	Dept Manager Internal Audit		Echols	Molly		2052207036					mechols@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	12/10/2014	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Bid Audit Site Contact	Dept Manager Internal Audit		Echols	Molly		2052207036					mechols@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	12/10/2014	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Bid Primary Contact	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	CAP Report Contact for Public Website	Director Internal Audit/Corp Compliance		Miller	Keith		2052206123					kbmiller@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	12/03/2013	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	CEO - CMS Administrator Contact	President and Chief Executive Officer	Mr	Vines	Tim		2052206363					TVines@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	07/14/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	CEO - Senior Official for Contracting	Executive Vice President	Mr.	Briggs III	Dick	D	2052206952					dbriggs@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	07/01/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Chief Financial Officer	SVP & Chief Financial Officer	Mr.	Carden	Noel		2052207741					ncarden@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/18/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Chief Operating Officer	SVP Business Operations	Mr.	Hill	James	S	2052202196					Jim.Hill@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/24/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Chief Information Officer	SVP and CIO	Mr.	McGlaun	Scott		2052207300					SMcGlaun@bcbsal.org	450 Riverchase Pkwy East		Birmingham	AL	35244	02/26/2016	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Chief Information Security Officer	Chief Info Security Officer	Mr.	Parton	Chris		2052207421					cparton@bcbsal.org	450 Riverchase Pkwy East		Birmingham	AL	35244	02/26/2016	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	CMMI Model Point of Contact	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	CMS Casework Communication Contact	Senior Compliance Analyst		Jones	Kimberly		2052207077					kwjones@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	03/30/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Complaints Tracking Contact	Senior Compliance Analyst		Jones	Kimberly		2052207077					kwjones@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Contact for Fraud Investigations	Network Integrity Operations Manager		Ellison	Amy		2052202573					aellison@bcbsal.org	450 Riverchase Parkway		Birmingham	AL	35244	11/10/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Coordination of Benefits Contact	Manager Claims Processing		Cole	Jason		2052202490					Jason.Cole@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	05/02/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Corporate Mailing						2052205915					O65ProdMgmt@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/26/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant		Lambert	Christophe		2052206593					CLambert@bcbsal.org	450 Riverchase Pkwy East		Birmingham	AL	35244	04/19/2016	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Customer Service Operations Contact	Dept Manager Customer Service		Pearson	Latreta		2052202601					llpearson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	01/13/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	DIR Contact	VP Controller		DeLawrence	Jennifer		2052207282				2052202795	JDeLawrence@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/12/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	DIR Contact (Secondary)	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	03/04/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Emergency Part D Contact	Pharmacy Operations Coordinator		Sevens	Andrew		2052202593					WStevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Emergency Part D Contact (Secondary)	Pharmacy Services Manager		Matthews	Ginny		2052206558					Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Employer Waiver Contact	Manager Enrollment Service		Sexton	Missy		2052206589					Melissa.Sexton@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/02/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Enrollment Contact	Manager Enrollment Service		Sexton	Missy		2052206589					Melissa.Sexton@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/18/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	EOB Transfer Contact	Pharmacy Services Manager		Matthews	Ginny		2052206558				2052200803	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Financial Audit Contact	Dept Manager Internal Audit	Ms.	Echols	Molly		2052207036					mechols@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	12/10/2014	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Financial Reporting Contact	Dept Mgr Accounting/Reporting		O'Neal	Keith		2052206202					Keith.ONeal@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	01/13/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Formulary Contact	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/13/2018	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	04/08/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	General Contact	Dept Mgr Corporate Compliance		Gregg	Roger		2052207480					RGregg@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Government Relations Contact	Manager Product Management	Mrs	Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	HIPAA Privacy Officer	Dept Mgr Corporate Compliance		Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	HIPAA Security Officer	Dept Mgr Corporate Compliance		Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Hospice Contact	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					WStevens@bcbsal.org	450 Riverchase Pkwy East		Hoover	AL	35244	04/17/2019	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Interoperability Contact	Dept Mgr Corporate Compliance		Gregg	Roger		2052207480					rgregg@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Marketing Contact	Department Manager Marketing		Glass	Carol		2052204124					Carol.Glass@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	09/17/2012	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Medical Director	Associate Medical Director	Dr.	Darden	Barry		2052206605					James.Darden@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	12/11/2018	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Medicare Compliance Officer	Dept Mgr Corporate Compliance	Mr.	Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Medicare Coordinator	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacist		Anderson	Ally		8554570763					partdoverutil@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	06/13/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Medication Therapy Management Contact	VP Pharmacy Services		Cale	Dorinda		2052202655					dcale@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	OffShore Subcontractor Contact	Senior Compliance Analyst		Richardson	Misty		2052204366					misty.richardson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	11/10/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Online Enrollment Center Contact (Back-up)	Sr. Business Analyst		Johnson	Geraldine		2052206077					gejohnson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/08/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Online Enrollment Center Contact (Optional)	Manager Enrollment Service		Sexton	Missy		2052207276					Melissa.Sexton@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	04/18/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Online Enrollment Center Contact (Primary)	Sr Business Analyst		Hurst	Terri		2052202695					Terri.Hurst@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Appeals	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/10/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936651	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	06/13/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active	8006936703				Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Application Contact	Manager Product Management		Bradley	Melody		2052206509					Melody.Bradley@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/09/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Benefits Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558					Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Claims Submission Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558					Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Exceptions Contact	Regulatory Director		Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Mendota Heights	MN	55120	04/08/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Exceptions Contact (Secondary)	Pharmacy Services Manager		Matthews	Ginny							Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active	2052206558				Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Price File Contact (Back-up)	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593				2052202939	Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/13/2018	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Price File Contact (Optional)	Price File Analyst Sr		Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	2900 Ames Crossing Road		Mendota Heights	MN	55120	04/08/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Price File Contact (Primary)	Pharmacy Services Mgr		Matthew	Ginny		2052206558				2057337486	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Quality Assurance Contact	MAQM Clinical Analyst		Davis	Janice		2052204066					jddavis@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	01/13/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Part D Reporting Contact	Senior Compliance Analyst		Parham	Andrea		2052207206					aparham@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	11/10/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Patient Safety Contact	VP Pharmacy Services		Cale	Dorinda		2052202655				2052208739	dcale@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Payment Contact	VP Controller		DeLawrence	Jennifer		2052207282					JDeLawrence@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	02/12/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Pharmacy Director	VP Pharmacy Services		Cale	Dorinda		2052202655					dcale@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Pharmacy Network Management Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558				2054034052	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Pharmacy Network Management Contact (Secondary)	VP Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55122	04/08/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Pharmacy Technical Help Desk Contact	Pharmacy Services Mgr		Matthews	Ginny							Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active	8778788668				Medicare Prescription Drug Plan		5	Atlanta
S1030	Pharmacy Technical Help Desk Contact (Secondary)	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	01/06/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active	8778788668				Medicare Prescription Drug Plan		5	Atlanta
S1030	Plan Directory Contact for Public Website	Manager Claims Operations		Corley	Jeff		8005176425					OpsCompliance@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	09/10/2013	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Plan to Plan Reconciliation Contact	Sr Analyst-Cash Management		Buford	Julie		2052207316					julie.buford@bcbsal.org	450 Riverchase Parkway		Birmingham	AL	35244	12/08/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Processor Contact	Pharmacy Services Mgr		Matthews	Ginny		2052206558				2052208739	Ginny.Matthews@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	10/13/2020	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Reconciliation Contact	Manager Financial Accounting		Williamson	Amanda		2052207289					Amanda.Williamson@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	03/20/2018	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Reconciliation Contact (Secondary)	Sr. Accountant		Lambert	Christophe		2052206593				2052202795	CLambert@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/15/2021	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Recovery Audit Contact	Dept Mgr Corporate Compliance	Mr.	Gregg	Roger		2052207480					RGREGG@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Surveillance Contact	Consumer Sales Manager		Carter	Brent		2052207681					bcarter@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	System Contact	Dept Mgr Corporate Compliance		Gregg	Roger		2052207480					RGregg@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/23/2023	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	Third Party Administrator (TPA) Liaison	Pharmacy Operations Coordinator		Stevens	Andrew		2052202593					Wstevens@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	08/13/2018	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1030	User Access Contact	Regulatory Compliance Manager		O'Dell	Laney		2052206655					laney.odell@bcbsal.org	450 Riverchase Parkway East		Birmingham	AL	35244	06/03/2022	2023	BCBS OF ALABAMA & UTIC INSURANCE COMPANY	PDP	BlueRx (PDP)	Medicare Prescription Drug Plan		BlueCross BlueShield of Alabama	32	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S1140	Agent/Broker Compensation Data Contact	Manager, Sales Support & Operations	Mr.	Thompson	Seth		4128883167					Seth.Thompson@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	10/03/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Backup User Access Contact	Sr. Risk and Regulatory Intelligence Analyst	Ms.	Hegedus	Emily		6078219034					emily.hegedus@highmarkhealth.org	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Best Available Evidence Contact	Manager		Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Bid Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	03/18/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Bid Audit Site Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	03/21/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Bid Primary Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	08/03/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	07/28/2021	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	CEO - CMS Administrator Contact	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	CEO - Senior Official for Contracting	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Chief Financial Officer	CFO Highmark Health Plan	Mr.	Bridges	Ja'Ron		4125441452					JaRon.Bridges@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/27/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Chief Operating Officer	SVP, Government Business Segment President	Ms.	Miller	Alexis	A	4125447389					Alexis.Miller@Highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/10/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Chief Information Officer	Senior Vice President, Infrastructure & Architectu	Mr.	Krebs	Mark		7173026255					mark.krebs@goenGen.com	120 Fifth Avenue		Pittsbrugh	PA	15222	09/25/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Chief Information Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	CMMI Model Point of Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/15/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	CMS Casework Communication Contact	Manager, Government Programs Enrollment & Billing		Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Complaints Tracking Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne		4125444579				7176354209	Lynne.Walsh@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Contact for Fraud Investigations	VP Financial Investigation & Provider Review	Mr.	Spear	Kurt		4125447069					Kurt.Spear@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	03/21/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Coordination of Benefits Contact	Sr. Process Analyst	Ms.	Cassidy	Christina		4125444417					Christina.Cassidy@highmark.com	120 Fifth Avenue	PAP P5111	Pittsburgh	PA	15222	06/03/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Corporate Mailing						7168877169				7168877911	amy.mcdonald@highmarkhealth.org	257 West Genesee Street		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Pricing & Risk Revenue Analytics		DePonceau	Aaron		7168877124					Aaron.Deponceau@highmark.com	257 West Genesee Street		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Customer Service Operations Contact	Manager, Member Customer Service		Sheridan	Rebecca	L	5182205661				5184232294	rebecca.sheridan@highmark.com	40 Century Hill Drive		Latham	NY	12110	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	DIR Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	DIR Contact (Secondary)	Senior Risk & Compliance Case Manager		Stetson	Kelsey		4125445816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	02/23/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Emergency Part D Contact	Manager, Member Customer Service		Sheridan	Rebecca	L	5182205661				5184232294	rebecca.sheridan@highmark.com	40 Century Hill Drive		Latham	NY	12110	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Emergency Part D Contact (Secondary)	Supervisor, Pharmacy Customer Service	Ms.	Bouck	Sarah	R	5182205632					sarah.bouck@highmark.com	40 Century Hill Drive		Latham	NY	12110	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Employer Waiver Contact	Manager, Product Development & Management		Connors	Vince		7168877129				7168877022	Vincent.Connors@highmark.com	257 West Genesee Street		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Enrollment Contact	Federal Programs Eligibility & Billing Manager		Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	EOB Transfer Contact	Manager, Claims	Ms.	Johannes	Karin		7168876875				7168876875	karin.johannes@highmark.com	257 West Genesee St.		Buffalo	NY	14202	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Financial Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156				4125447156	kathleen.carl@highmark.com	120 5th Avenue Pittsburgh		Pittsburgh	PA	15222	07/31/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Financial Reporting Contact	Vice President, Accounting & Reportin	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	10/06/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Formulary Contact	Senior Pharmacist, Clinical Pharmacy Services		DiTullio	Kelly		4128884336					Kelly.DiTullio@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Formulary Contact (Secondary)	Senior Pharmacist, Clinical Pharmacy Services		Humphries	Jessica		4128884890					jessica.humphries@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	General Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Government Relations Contact	SVP, Government Affiars	Mr.	Warfel	Michael	G	7173023979					michael.warfel@highmark.com	1800 Center St.		Camp Hill	PA	17011	03/18/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	HIPAA Privacy Officer	Chief Privacy and Data Ethics Officer	Ms.	Patrick	Justine		4125444643					Justine.Patrick@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	HIPAA Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Hospice Contact	Intake Coordinator		Welker	Jessica		7178883043					DrugHelp_Authorizations@highmark.com	120 5th Avenue Place		Pittsburgh	PA	15222	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Interoperability Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Marketing Contact	Government Compliance		Gormley	Megan	E	7168878968					Megan.Gormley@highmarkhealth.org	257 West Genesee Street		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Medical Director	VP, Executive Medical Director	Dr,	Law	Timothy		4125446445					timothy.law@highmark.com	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	07/28/2021	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Medicare Coordinator	Director, Government Compliance	Ms.	Carl	Kathleen	A	4125447156					Kathleen.Carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Medicare Part D Opioid Overutilization Contact	Pharmacist	Ms.	Ali	Dewaa		4129040214					Dewaa.ali@highmark.com	120 Fifth Avenue PAP P4207		Pittsburgh	PA	15222	07/31/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Medication Therapy Management Contact	Senior Pharmacist	Ms.	Adlesic	Meredith		4128883749					Meredith.Adlesic@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	OffShore Subcontractor Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Online Enrollment Center Contact (Back-up)	Sr. Rep		Shear	Sally		6077663075				8882822583	Sally.Shear@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Online Enrollment Center Contact (Optional)			Kolb	laure		7168871370					mcdonald.Amy@healthnow.org	257 West Genesee St		Buffalo	NY	14202	08/12/2019	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Online Enrollment Center Contact (Primary)	Manager		Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Appeals	Manager, Member Appeals & Grievances	Ms.	Walsh	Lynne	M					7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	4125444579				Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Appeals Contact (Secondary)	Supervisor, Appeals & Grievances	Ms.	Miller	Rachel	M					7176354209	Rachel.Miller@highmark.com	Fifth Ave Place	120 Fifth Avenue, Ste 5322	Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	4125441596				Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Benefits Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Claims Submission Contact	Director Regulated Marketing Medicare Solutions		Dovico	Rosario		9145896300				8882822583	Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Exceptions Contact			Affairs	Pharmacy							drughelp@highmark.com	120 Fifth Avenue	Suite SPECARE	Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	8006002227				Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Exceptions Contact (Secondary)	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	8003443405	733326			Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Price File Contact (Back-up)	Director, Government Programs	Ms	Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/08/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Price File Contact (Optional)	Pharmacy Analyst		Nolder	Tomothy		4125448137					timothy.nolder@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/14/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Price File Contact (Primary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Quality Assurance Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Part D Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	08/04/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Patient Safety Contact	Director, Clinical Pharmacy Operations	Mr.	Causer	Derek		4125445835					Derek.Causer@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	12/20/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Payment Contact	Federal Programs Eligibility & Billing Manager	Ms.	Smith	Kimberly		6077663043				8882822583	kimberly.r.smith@highmark.com	1701 North Street		Endicott	NY	13760	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Personal Health Record Contact	Compliance Manager, Government Programs		McDonald	Amy	R	7168878968				7168876056	mcdonald.amy@healthnow.org	257 West Genesee Street		Buffalo	NY	14202	08/12/2019	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Pharmacy Director	Manager, Pharmacy Programs		Winterhalter	Christa		4128884108					Christa.Winterhalter@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Pharmacy Network Management Contact	Network Account Director, Retail Strategy&Contract		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	11/09/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	12/17/2021	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	Philadelphia
S1140	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Government Operations	Ms	Lynn Schill	Jodie							Jodie.LynnSchill@highmark.com	120 Fifth Avenue Pittsburgh, PA 15222		Pittsburgh	PA	15222	08/16/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	5705783579				Medicare Prescription Drug Plan		5	Philadelphia
S1140	PHR Beneficiary Contact																	10/28/2021	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan	Highmark Western and Northeastern New York Inc	Highmark Health	123	Yes	Active	8003292792				Medicare Prescription Drug Plan		5	Philadelphia
S1140	Plan Directory Contact for Public Website			Service	Customer		8773271395					customerservice@bcbswny.com	PO Box 13599		Albany	NY	12212	02/21/2020	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Plan to Plan Reconciliation Contact	Manager, Operational Accounting		Stehr	Brett		7173022748					P2Precon@highmark.com	Highmark Inc. Attn: Cashier	PO Box 898820	Camp Hill	PA	17089	06/28/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Processor Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Reconciliation Contact	Director, Pricing & Risk Revenue & EI & Analytics		Deponceau	Aaron		7168877124					Aaron.Deponceau@highmark.com	257 West Genesee St.		Buffalo	NY	14202	03/07/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Reconciliation Contact (Secondary)	Senior Risk * Compliance Case manager		Stetson	Kelsey		4125448816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	02/23/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Recovery Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Surveillance Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					jillian.pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	System Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	Third Party Administrator (TPA) Liaison	Accountant		Jurgiewicz	Kimberly		5707807969					kimberly.jurgiewicz@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/02/2023	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1140	User Access Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/28/2022	2023	Highmark Western and Northeastern New York Inc.	PDP	Highmark Blue Cross Blue Shield or Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S1822	Agent/Broker Compensation Data Contact	VP Government Programs		Clelland	Jennifer	J	9529675119					jennifer.j.clelland@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	11/04/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Automated TrOOP Balance Transfer Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Backup User Access Contact	Coordinator Government Programs		Yu	Chao		9528837240					chao.x.yu@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	04/20/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Best Available Evidence Contact	Manager Membership Accounting		Marty	Amanda	E	9529677685					amanda.e.marty@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/05/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Bid Audit Contact	VP Internal Audit Comp Officer		Bunde	Steven	D	9528836541				9528835522	steven.d.bunde@healthpartners.com	8170 33rd Avenue South		Bloomington	MN	55425	12/03/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Bid Audit Site Contact	Director Monitoring and Compliance		Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS:  21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Bid Primary Contact	Corporate Actuary		Stewart	Sara	M	9528835049					sara.m.stewart@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21105H	Minneapolis	MN	554401309	07/24/2019	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	CAP Report Contact for Public Website	Senior Manager Medicare Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/05/2014	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	CEO - CMS Administrator Contact	President and CEO	Ms.	Walsh	Andrea	M	9528835343				9528835350	wendy.r.kobe@healthpartners.com	8170 33rd Avenue South	MS: 21110A	Minneapolis	MN	55425	01/05/2023	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	CEO - Senior Official for Contracting	President and CEO	Ms.	Walsh	Andrea	M	9528835343				9528835350	wendy.r.kobe@healthpartners.com	8170 33rd Avenue South	MS: 21110A	Minneapolis	MN	55425	01/04/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Chief Financial Officer	SVP & Chief Financial Officer	Ms.	Johnson	Kathleen	A	9528836531					kathy.a.johnson1@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110T	Minneapolis	MN	554401309	03/29/2023	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Chief Operating Officer	EVP and Chief Health Plan Officer	Ms.	Danielson	Jennifer	B	9528835573					victoria.j.slates@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110A	Minneapolis	MN	554401309	07/06/2023	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Chief Information Officer	Senior Vice President and CTO	Mr.	Zuzek	Dennis	M	9528837045					dennis.m.zuzek@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Chief Information Security Officer	VP Technology Infrastructure & Security	Mr.	Muller	Frank	J	9529676070					frank.j.muller@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	CMS Casework Communication Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Complaints Tracking Contact	Manager Member Rights and Benefits		Kruse	Morgan	L	9529677679					Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS: 21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Contact for Fraud Investigations	Senior Manager Claims Cost Management		Hove	Ryan	M	6512651573					ryan.m.hove@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  25510F	Minneapolis	MN	55101	07/24/2019	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Coordination of Benefits Contact	Manager, Claims Production		Prine	Chantelle	M	9529677335					RVSCCOBTECHS@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	04/20/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Corporate Mailing						9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/05/2014	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Accountant		Knights	Michelle	M	9528836532					michelle.m.knights@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21109A	Minneapolis	MN	554401309	12/03/2020	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Customer Service Operations Contact	Director Member Services		Renneke	Alison		9529677668					alison.m.renneke@healthpartners.com	8170 33rd Avenue South, PO Box 9463	MS:  21103R	Minneapolis	MN	554409463	01/29/2020	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	DIR Contact	Pharmacy Plan Contract Manager		Reinhardt	Sandra	L	9528836739					sandra.l.reinhardt@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/29/2020	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	DIR Contact (Secondary)	Health Informatics Analyst Pcp		Binsfeld	David	T	9529675950					david.t.binsfeld@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS 21108Q	Minneapolis	MN	554401309	05/09/2013	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Emergency Part D Contact	Sr. Director Pharmacy Services		Strahl	Christine	L	9528835022				9529676667	christine.l.strahl@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/04/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Emergency Part D Contact (Secondary)	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9529675826				9529676667	dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/29/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Employer Waiver Contact	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Enrollment Contact	Director Membership Accounting		McWell	Carrie	J	9529675487					carrie.j.mcwell@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	11/30/2017	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	EOB Transfer Contact	Sr. Manager Claims Production		Huseby	Pam	J	9529675530				9528837666	pam.j.huseby@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103R	Minneapolis	MN	554401309	08/30/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Financial Audit Contact	Director Monitoring and Compliance	Ms.	Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Financial Reporting Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21109A	Minneapolis	MN	554401309	07/24/2019	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Formulary Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Formulary Contact (Secondary)	Formulary Administration Pharmacist		Savage	Robert		8587906426					robert.savage@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	07/24/2019	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	General Contact	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Government Relations Contact	VP Government Programs		Clelland	Jennifer	J	9529675119					jennifer.j.clelland@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	08/30/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	HIPAA Privacy Officer	Sr. Director Integrity Compliance Privacy Officer		Wells	Prasanta	K	9528837325					prasanta.k.wells@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103K	Minneapolis	MN	554401309	05/27/2015	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	HIPAA Security Officer	VP Technology Infrastructure & Security	Mr.	Muller	Frank	J	9529676070					frank.j.muller@healthpartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	09/10/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Hospice Contact	Pharmacy Compliance Specialist		Riggs	Ben	H	9528518421					benjamin.h.riggs@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Interoperability Contact	Program Manager		Geisler	Chris	J	6122479067					Chris.J.Geisler@HealthPartners.Com	8170 33rd Ave S		Bloomington	MN	55425	06/20/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Marketing Contact	Mgr Govt Prog Materials & Regulatory Comm		Her-Vang	Xong		9529675061					xong.x.hervang@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	11/16/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Medical Director	Health Plan Chief Medical Officer	Dr.	Kakacek	Virginia	L	9528837120					virginia.l.kakacek@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21110Q	Minneapolis	MN	554401309	09/21/2023	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Medicare Compliance Officer	VP Internal Audit Comp Officer	Mr.	Bunde	Steven	D	9528836541				9528835522	steven.d.bunde@healthpartners.com	8170 33rd Avenue South		Bloomington	MN	55425	12/03/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Medicare Coordinator	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Medicare Part D Opioid Overutilization Contact	Pharmacy Compliance Specialist		Riggs	Ben		9528518421					Benjamin.H.Riggs@HealthPartners.Com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/29/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Medication Therapy Management Contact	Senior Manager Med Therapy Management Program		Rehrauer	Daniel	J	9529675133					daniel.j.rehrauer@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	01/11/2018	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Online Enrollment Center Contact (Back-up)	Director Membership Accounting		McWell	Carrie	J	9529675487					carrie.j.mcwell@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/30/2017	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Online Enrollment Center Contact (Optional)	Admin Product Implementation Manager		Wessel	Sara	C	9529677623					sara.c.wessel@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	11/29/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Online Enrollment Center Contact (Primary)	Manager Membership Accounting		Marty	Amanda	E	9529677685					amanda.e.marty@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103R	Minneapolis	MN	554401309	01/09/2018	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Part D Appeals	Manager Member Rights and Benefits		Kruse	Morgan	L						Morgan.L.Kruse@HealthPartners.Com	P.O. Box 9463	MS:  21103R	Minneapolis	MN	554409463	12/02/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active	8007963806				Medicare Prescription Drug Plan		5	Chicago
S1822	Part D Appeals Contact (Secondary)	Senior Rights & Benefits Project Lead		Schneider	Crystal	L						crystal.l.schneider@healthpartners.com	8170 33rd Avenue South	MS: 21103R	Bloomington	MN	55425	01/05/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active	8007963806				Medicare Prescription Drug Plan		5	Chicago
S1822	Part D Application Contact	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Part D Benefits Contact	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Part D Claims Submission Contact	Manager, Regulated Products & Configuration Servic		Spassova	Dina	P	9528836536					dina.p.spassova@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Part D Exceptions Contact	Supervisor, Clinical Review		Whelan	Hillary	A					8888835434	hillary.a.whelan@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active	8004927259				Medicare Prescription Drug Plan		5	Chicago
S1822	Part D Price File Contact (Back-up)			Communications	Planfinder		8587905849				8587906052	PlanFinderCommunications@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	08/17/2015	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Part D Price File Contact (Primary)	Pharmacy Compliance Specialist		Riggs	Ben	H	9528518421					benjamin.h.riggs@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/03/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Part D Quality Assurance Contact	Senior Manager Quality and Compliance		Book	Anne	M	9528835128					anne.m.book@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21108T	Minneapolis	MN	554401309	01/09/2018	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Part D Reporting Contact	Director of Medicare and Government Programs		Schultz	Amy	L	9529675117					amy.l.schultz@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21103C	Minneapolis	MN	554401309	12/02/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Patient Safety Contact	Senior Manager Med Therapy Management Program		Rehrauer	Daniel	J	9529675133					daniel.j.rehrauer@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	12/14/2018	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Payment Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/09/2013	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Pharmacy Director	VP Pharmacy		Busch	David	L	9529675049					david.l.busch@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21111B	Minneapolis	MN	554401309	06/25/2020	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Pharmacy Network Management Contact	Director Pharmacy Sales & Product Support		Friday	Ken	R	9529675826				9529676667	kenneth.r.friday@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Administration		Hunt	Brian		8587907092					Brian.Hunt@MedImpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/29/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Pharmacy Technical Help Desk Contact	Manager Health Plan Pharmacy Customer Service		Whelan	Hillary	A					8888835434	Hillary.A.Whelan@HealthPartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	12/19/2022	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active	8004927259				Medicare Prescription Drug Plan		5	Chicago
S1822	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Contact Services		Brewer	Kathy							Customerservice@Medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct.	San Diego	CA	92131	12/15/2017	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active	8887831779				Medicare Prescription Drug Plan		5	Chicago
S1822	Plan Directory Contact for Public Website			Services	Provider		9528837699					RVSCProviderInquiry@HealthPartners.com	8170 33rd Avenue South, PO Box 1309		Minneapolis	MN	554401309	06/10/2013	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Plan to Plan Reconciliation Contact	Director Corporate Financial Reporting and Tax		Brandt	Kevin	J	9528836584				9528836500	kevin.j.brandt@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/09/2013	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Processor Contact	Director Pharmacy Sales & Product Support		Friday	Ken	R	9529675826				9529676667	kenneth.r.friday@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21111B	Minneapolis	MN	554401309	11/23/2020	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Reconciliation Contact	Director Financial Reporting and Tax		Brandt	Kevin	J	9528836584					kevin.j.brandt@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/21/2015	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Reconciliation Contact (Secondary)	Senior Accountant		Knights	Michelle	M	9528833532					michelle.m.knights@healthpartners.com	8170 33rd  Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/19/2020	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Recovery Audit Contact	Director Monitoring and Compliance	Ms.	Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Surveillance Contact	Director Monitoring and Compliance		Lockner	Laurena	S	9529677650					laurena.s.lockner@healthpartners.com	8170 33rd Avenue South	MS: 21103C	Minneapolis	MN	55425	08/24/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	System Contact	Senior Director Operational Integrity		Anderson	Larin	D	9528835796					larin.d.anderson@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21193J	Minneapolis	MN	554401309	05/09/2013	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	Third Party Administrator (TPA) Liaison	Senior Accountant		Knights	Michelle	M	9528833532					michelle.m.knights@healthpartners.com	8170 33rd Avenue South, P.O. Box 1309	MS: 21109A	Minneapolis	MN	554401309	05/19/2020	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S1822	User Access Contact	Mgr Govt Prog Materials & Regulatory Comm		Her-Vang	Xong		9529675061					xong.x.hervang@healthpartners.com	8170 33rd Avenue South, PO Box 1309	MS:  21103C	Minneapolis	MN	554401309	11/16/2021	2023	HEALTHPARTNERS, INC.	PDP	HealthPartners	Medicare Prescription Drug Plan		HealthPartners, Inc.	117	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S2465	Agent/Broker Compensation Data Contact	Director, Sales		McVey	Kathy		7574181231					kemcvey@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Benefits		Strickland	Brandi		7572528193				7579625575	RxBenefits@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Backup User Access Contact	Compliance Consultant		Harvey	Kimberly		8046134890	20178				kdharvey@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Best Available Evidence Contact	Director Enrollment & Disenrollment		Brown	Sheila		7572528015				7576925575	sxbrown29@sentara.com	4456 Corporation Lane	Suite 210	Virginia Beach	VA	23462	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Bid Audit Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Bid Audit Site Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Bid Primary Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	CAP Report Contact for Public Website	Medicare Contract Administrator		MEDICARE	OPTIMA		7576876160				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active	8009276048				Medicare Prescription Drug Plan		5	Philadelphia
S2465	CEO - CMS Administrator Contact	VP, Medicare Government Programs	Mrs	Gerald	Alicia		5704920915				7575527396	aagerald@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	CEO - Senior Official for Contracting	VP, Medicare Government Programs	Mrs	Gerald	Alicia		5704920915				7575527396	aagerald@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Chief Financial Officer	Director Medicare Finance	Ms.	Eagleson	Leigh		4438516654				7575527396	laeagles@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Chief Operating Officer	VP, Medicare Government Programs	Mrs	Gerald	Alicia		5704920915				7575527396	aagerald@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Chief Information Officer	VP Information Systems	Ms.	Kaszubowski	Natalie		7572520436					nakaszub@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Chief Information Security Officer	VP, Chief Information Security Officer	Mr.	Siddiqui	Zishan		7572520015				7579638689	zasiddiq@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	CMS Casework Communication Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Complaints Tracking Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Contact for Fraud Investigations	Director Finance & Risk Mgt		Robbins	Janet		7572528012					jlrobbin@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Coordination of Benefits Contact	Sr. Compliance Consultant	Ms	Goddette	Maricelis		8048195151				7576876231	mxcintro@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Corporate Mailing						5704920915				7575527116	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Coverage Gap Discount Program (CGDP) Payment Contact	Director Accounting Operations		Duncan	April		7572528055				7572528039	acmorgan@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Customer Service Operations Contact	Director, Customer Services		Lucas-Bain	Shenna		8133348871				7575527116	sxlucasb@sentara.com	10800 Nuckols Road		Glen Allen	VA	23060	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	DIR Contact	Director Pharmacy Performance		Hartzell	Lindsay		8048195179				7579625575	LEHARTZE@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	DIR Contact (Secondary)	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Emergency Part D Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park	Suite 210	Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Emergency Part D Contact (Secondary)	Manager Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Employer Waiver Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	4417 Corporation Lane		Virginia Beach	VA	23462	11/12/2021	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Enrollment Contact	Director, Enrollment		Brown	Sheila		7572528015					sxbrown29@sentara.com	4456 Corporation Lane		Virginia Beach	VA	23462	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	EOB Transfer Contact	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625576	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Financial Audit Contact	Director, Medicare Compliance	Ms.	Green	Janet		8133682227					jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Financial Reporting Contact	VP & Controller		Snyder	Jeff		7572528023				7572528030	jcsnyder@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Formulary Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23462	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Formulary Contact (Secondary)	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	General Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Government Relations Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	HIPAA Privacy Officer	Director, Compliance	Ms.	Dajon	Sharon	M	7575527485				7575527116	smdajon@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	HIPAA Security Officer	VP, Chief Information Security Officer	Mr.	Siddiqui	Zishan		7572520015				7579638689	zasiddiq@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Hospice Contact	Director Pharmacy Ops & Compliance		May	Crystal		8666037514				7579625575	ccmay2@sentara.com	10800 Nuckols		Glen Allen	VA	23060	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Interoperability Contact	IT Project Manager		Larkins	Eddie		8048195151					ellarkin@sentara.com	4456 Corporation Lane		Virginia Beach	VA	23462	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Marketing Contact	Director Sales Enablement		Fiero	Asleigh		7572528505				7576876135	akfiero@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Medical Director	CMO Health Plan	Dr.	Greifer	Kristyn		6782748402				7575527108	KXGREIFE@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Medicare Compliance Officer	Director, Medicare Compliance	Ms.	Green	Janet		8133682227					jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Medicare Coordinator	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Medicare Part D Opioid Overutilization Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Medication Therapy Management Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625575	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Online Enrollment Center Contact (Back-up)	Sr. Business Analyst, Medicare		Ashar	Satish		8048195151	302				sdashar@sentara.com	4456 Corporate Lane		Virginia Beach	VA	23462	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Online Enrollment Center Contact (Primary)	Director, Enrollment		Brown	Sheila		7572528015					sxbrown29@sentara.com	4456 Corporation Lane		Virginia Beach	VA	23462	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Appeals	Manager Clinical Pharmacy		Snow	Michael						7579625576	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active	7579834243				Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Appeals Contact (Secondary)	Manager Pharmacy Compliance		Allen	Emily						7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active	8048144500				Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Application Contact	Director Government Programs - Medicare		Hoffman	Daniel		7579832540				7575527396	dehoffma@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Benefits Contact	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Claims Submission Contact	Manager, Pharmacy Benefits		Strickland	Brandi		7572528193				7579625575	RxBenefits@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Exceptions Contact	Manager Clinical Pharmacy		Snow	Michael						7579625576	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active	7579834243				Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Exceptions Contact (Secondary)	Manager Pharmacy Compliance		Allen	Emily						7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active	8048144500				Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Price File Contact (Back-up)	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Price File Contact (Optional)	Director Pharmacy Performance		Hartzell	Lindsay		8048195179				7579625575	LEHARTZE@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Price File Contact (Primary)	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Quality Assurance Contact	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Part D Reporting Contact	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7576925576	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Patient Safety Contact	Manager Clinical Pharmacy		Snow	Michael		7579834243				7579625576	mzsnow@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Payment Contact	Director, Accounting	Ms.	Albert	Rinda		7572528015					realbert@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Pharmacy Director	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Pharmacy Network Management Contact	VP, Pharmacy		Daw	Jessica		7572528181				7579625575	jrdaw@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Compliance		Allen	Emily		8048144500				7579625575	RxCompliance@sentara.com	10800 Nuckols Rd.		Glen Allen	VA	23060	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Pharmacy Technical Help Desk Contact	Director Customer Service		Monroe	LaTasha						8882358551	LaTasha_Monroe@express-scripts.com	11780 U.S. Hwy Suite N107		Palm Beach Gardens	FL	33408	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	Philadelphia
S2465	Pharmacy Technical Help Desk Contact (Secondary)	Director Pharmacy Ops & Compliance		May	Crystal						7579625575	ccmay2@sentara.com	10800 Nuckols		Glen Allen	VA	23060	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active	8666037514				Medicare Prescription Drug Plan		5	Philadelphia
S2465	Plan Directory Contact for Public Website	Member Services		MEMBER SERVICES	OPTIMA		8009276048					members@optimahealth.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Plan to Plan Reconciliation Contact	Director Accounting Operations		Duncan	April		7572528055				7572528039	acmorgan@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Processor Contact	Director Ops Support		Rodriguez	Joseph		7579834333				7572528030	jxrodr10@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Reconciliation Contact	Director, Medicare Finance		Richardson	Scott		9542587586					sxricha3@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Reconciliation Contact (Secondary)	Manager Actuarial Support		Wimalendran	Shane		7575528944					uxwimale@sentara.com	4456 Corporation Lane	Suite 210	Virginia Beach	VA	23462	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Recovery Audit Contact	Director, Accounting	Ms.	Albert	Rinda		7572528015					realbert@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Surveillance Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	System Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	Third Party Administrator (TPA) Liaison	Director Accounting Operations		Duncan	April		7572528055				7572528039	acmorgan@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2465	User Access Contact	Director Medicare Compliance		Green	Janet		8133682227				7575527116	jlgree13@sentara.com	1300 Sentara Park		Virginia Beach	VA	23464	09/13/2023	2023	OPTIMA HEALTH PLAN	PDP	Optima Medicare	Medicare Prescription Drug Plan		Sentara Health Care (SHC)	345	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S2468	Agent/Broker Compensation Data Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Automated TrOOP Balance Transfer Contact	Senior Manager, Medicare Operations		Halley	Derek		8182286374					Derek.Halley@blueshieldca.com	6300 Canoga Ave,		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Backup User Access Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Best Available Evidence Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Bid Audit Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Bid Audit Site Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Bid Primary Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	CAP Report Contact for Public Website	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active	5625806482				Medicare Prescription Drug Plan		5	San Francisco
S2468	CEO - CMS Administrator Contact	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	CEO - Senior Official for Contracting	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Chief Financial Officer	Senior Director, Medicare Finance	Mr.	Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Chief Operating Officer	Vice President, Senior Markets	Mr.	McMahon	Jim		5625806391					Jim.McMahon@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	05/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Chief Information Officer	Chief Information Officer	Ms.	Davis	Lisa		5106073600					Lisa.Davis@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Chief Information Security Officer	Chief Information Officer	Ms.	Davis	Lisa		5106073600					Lisa.Davis@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	CMS Casework Communication Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Complaints Tracking Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Contact for Fraud Investigations	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					marcos.mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Coordination of Benefits Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					alfonso.loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	11/02/2017	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Corporate Mailing						5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Coverage Gap Discount Program (CGDP) Payment Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Customer Service Operations Contact	Director		Mathews	Carolyn		5626135004					Carolyn.Mathews@blueshieldca.com	3021 Reynolds Ranch Pkwy		Lodi	CA	95240	09/07/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	DIR Contact	VP Pharmacy Services		Lum	Alison		5106073697					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	03/02/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	DIR Contact (Secondary)	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/02/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Emergency Part D Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Emergency Part D Contact (Secondary)	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Employer Waiver Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland HIlls	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Enrollment Contact	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	EOB Transfer Contact	Medicare Project & Program Manager		Zuehlke	Erica		2093713036				8558953519	zuehlke@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/07/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Financial Audit Contact	Senior Manager, Medicare Compliance	Mr.	Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Ave		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Financial Reporting Contact	Senior Director, Medicare Finance		Ballou	Taylor		5625806311					Taylor.ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Formulary Contact	Director, Formulary Strategy and P&T		Nguyen	Nhi		9168410342					Nhi.Nguyen@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Formulary Contact (Secondary)	Principal Pharmacist, Formulary Management		Trinh	Andy		3238276322					Andy.Trinh@blueshieldca.com	601 Potrero Grande Drive		Monterey Park	CA	91755	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	General Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Ave		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Government Relations Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	HIPAA Privacy Officer	Chief Privacy Officer		Keystone	David		5103013363					david.keystone@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/27/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	HIPAA Security Officer	Chief Privacy Officer		Keystone	David		5103013363					david.keystone@blueshieldca.com	601 12th Street		Oakland	CA	94607	09/27/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Hospice Contact	Senior Program Manager		Fields	Torrie		4152295839					Torrie.Fields@blueshieldca.com	50 Beale St.		San Francisco	CA	94105	02/02/2018	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Interoperability Contact	VP Enterprise Digital Growth		Grimm	David		6196864233					david.grimm@blueshieldca.com	2275 Rio Bonito Way	Suite 250	San Diego	CA	92108	02/15/2022	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Marketing Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Medical Director	Medicare Medical Director	Dr.	Siddiq	Khaliq		5627137953					Khaliq.Siddiq@blueshieldca.com	555 Anton Boulevard	Suite 800	Costa Mesa	CA	92626	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Medicare Compliance Officer	Senior Director, Medicare Compliance	Mr.	Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Medicare Coordinator	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					Sheri.Lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Medicare Part D Opioid Overutilization Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					OpioidDUR@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/13/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Medication Therapy Management Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					Dawn.Becker-Ellison@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	OffShore Subcontractor Contact	Senior Director, Medicare Compliance		Robinson	Richard		5625806482					MedicareComplOfficer@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	06/16/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Online Enrollment Center Contact (Back-up)	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					marcos.mata@blueshieldca.com	6300 Canoga Ave		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Online Enrollment Center Contact (Optional)	WH Application Development and Support		Miller	Terri		8182282155					terri.miller@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	08/22/2013	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Online Enrollment Center Contact (Primary)	Manager, Medicare Operations		Loreto	Alfonso		8182287005					Alfonso.Loreto@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Appeals	Supervisor, Medicare Appeals and Grievances		Lopez	Celina						9163506593	celina.lopez@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/18/2016	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active	8007764466				Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Appeals Contact (Secondary)	Senior Manager, Operations		Salam	Shahid							Shahid.Salam@blueshieldca.com	4203 Town Center Boulevard		El Dorado Hills	CA	95762	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active	8007764466				Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Application Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Benefits Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Claims Submission Contact	Lead Medicare Rx Benefits & Claims Specialist		Campbell	Leslie		5306263838					leslie.campbell@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/18/2016	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Exceptions Contact	Director, Pharmacy Prior Authorization		March	Nancee							nancee.march@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active	8007764466				Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Exceptions Contact (Secondary)	Senior Manager, Medicare Compliance		Mata	Marcos							Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active	8007764466				Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Price File Contact (Back-up)	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106072901					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Price File Contact (Optional)	Business Analyst, Rx Benefit/Claims Implementation		Ng	Alvin		5106072964					alvin.ng@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/14/2020	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Price File Contact (Primary)	Business Analyst, Rx Benefit/Claims Implementation		Ng	Alvin		5106072964					Alvin.Ng@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Quality Assurance Contact	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Part D Reporting Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					marcos.mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Patient Safety Contact	Sr. Pharmacist, Medicare Rx Program Manager		Becker-Ellison	Dawn		9168410330					dawn.becker-ellison@blueshieldca.com	3300 Zinfandel Drive		Rancho Cordova	CA	95670	01/18/2016	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Payment Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Pharmacy Director	VP, Pharmacy Services		Lum	Alison	K	4159902891					Alison.Lum@blueshieldca.com	601 12th Street		Oakland	CA	94607	06/13/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Pharmacy Network Management Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106072901					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Pharmacy Network Management Contact (Secondary)	Senior Program Manager, Medicare Rx Compliance		Nelson	Kimberly	C	5106073281					Kim.Nelson@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Pharmacy Technical Help Desk Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik							Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active	8889700933				Medicare Prescription Drug Plan		5	San Francisco
S2468	Plan Directory Contact for Public Website			Services	Member		8007764466					membersvcs@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Plan to Plan Reconciliation Contact	Financial Analyst Consultant		Dahl	Chris		8182282575					BSCP2PRecon@blueshieldca.com	3021 Reynolds Ranch Parkway		Lodi	CA	95240	05/24/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Processor Contact	Senior Manager, Rx Benefit & Claims Operations		Hartley	Erik		5106073281					Erik.Hartley@blueshieldca.com	601 12th Street		Oakland	CA	94607	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Reconciliation Contact	Senior Director, Medicare Finance		Ballou	Taylor		8182286697					Taylor.Ballou@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Reconciliation Contact (Secondary)	Senior Director, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/11/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Recovery Audit Contact	Senior Manager, Medicare Compliance	Mr.	Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Surveillance Contact	Senior Manager, Medicare Compliance		Mata	Marcos		8182286048					Marcos.Mata@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	System Contact	Sr. Director, IT Product Management		Chambers	Shelley		1916866073					Shelley.Chambers@blueshieldca.com	4203 Town Center Boulevard		El Dorado Hills	CA	95762	09/07/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	Third Party Administrator (TPA) Liaison	Senior Manager, Finance Analytics		Chen	Jacob		3107442819					Jacob.Chen@blueshieldca.com	100 N. Sepulveda Boulevard		El Segundo	CA	90245	01/04/2021	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2468	User Access Contact	Senior Manager, Medicare Compliance		Lester	Sheri		5623641860					sheri.lester@blueshieldca.com	6300 Canoga Avenue		Woodland Hills	CA	91367	03/22/2023	2023	CALIFORNIA PHYSICIANS' SERVICE	PDP	Blue Shield of California	Medicare Prescription Drug Plan		California Physicians' Service	30	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S2668	Agent/Broker Compensation Data Contact	General Counsel	Mr	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	07/01/2018	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Automated TrOOP Balance Transfer Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Backup User Access Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Best Available Evidence Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Bid Audit Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Bid Primary Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	CAP Report Contact for Public Website	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Kimbrough	Anthony	C	9316982218					akimbrough@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	12/19/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Kimbrough	Anthony	C	9315600041	2817				akimbrough@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Chief Financial Officer	Chief Financial Officer	Mrs.	Adams	Renee		9315600041	3108				radams@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	04/26/2017	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Chief Operating Officer	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206				mgraham@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	01/07/2021	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Chief Information Officer	Vice President of Information Technology	Mr.	Alberd	Scott		9315600041	3130				salberd@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Chief Information Security Officer	Vice President of Information Technology	Mr.	Alberd	Scott		9315600041	3130				salberd@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	CMS Casework Communication Contact	Compliance Officer	Mr.	Beard	Jason	C	9315600041	3125				jbeard@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	08/13/2019	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Complaints Tracking Contact	Compliance Officer	Mr.	Beard	Jason	C	9315600041	3125				jbeard@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	08/13/2019	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Contact for Fraud Investigations	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Coordination of Benefits Contact	Manager, Business Process	Mr.	Diaz	Mario		9494753517					mario.diaz@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	06/01/2020	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Corporate Mailing						9315600041	3125				jbeard@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/10/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Coverage Gap Discount Program (CGDP) Payment Contact	Chief Financial Officer	Mrs.	Adams	Renee		9315600041	3108				radams@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	07/06/2017	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Customer Service Operations Contact	Service Account Manager	Ms.	Banks	Tracy		5209189825					tracy.banks@optum.com	PO Box 9472		Minneapolis	MN	55440	06/01/2020	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	DIR Contact	Chief Financial Officer	Mrs.	Adams	Renee		9315600041	3108				radams@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	03/04/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	DIR Contact (Secondary)	Medicare Compliance Officer	Mr.	Tutaj	Thomas	J	9319829090					ttutaj@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Emergency Part D Contact	General Counsel	Mr.	Brown	Ryan	D	9319820597					rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	12/19/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Emergency Part D Contact (Secondary)	Medicare Compliance Officer	Mr.	Tutaj	Thomas	J	9319829090					ttutaj@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Enrollment Contact	Chief Operating Officer	Mrs.	Graham	Miranda		9315600041	6206				mgraham@fbhp.com	147 Bear Creek Pike		Columbia	TN	38402	04/03/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	EOB Transfer Contact	Manager, Reporting	Ms.	Devereux	Mary		6302005745				2242311912	Government.ProgramsEOB@optum.com	1600 McConnor Parkway		Schaumburg,	IL	601736801	08/15/2018	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Financial Audit Contact	Manager of Internal Audit	Ms.	King	Lea		9315600041	2261				LKing@fbhp.com	P.O. Box 313		Columbia	TN	38402	08/11/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Financial Reporting Contact	Chief Financial Officer	Mrs.	Adams	Renee		9315600041	3108				radams@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	04/26/2017	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Formulary Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Formulary Contact (Secondary)			Mehta	Anand		2242312280					Anand.Mehta@optum.com	1600 McConnor Pkwy		Schaumburg	IL	601736801	06/29/2018	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	General Contact	Compliance Officer	Mr.	Beard	Jason	C	9315600041	3125				jbeard@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	08/13/2019	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Government Relations Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	HIPAA Privacy Officer	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	HIPAA Security Officer	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Hospice Contact	Pharmacist		Marks	Iny		4122189916					iny.marks@optum.com	PO Box 9472		Minneapolis	MN	55440	06/01/2020	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Interoperability Contact	Chief Information Officer	Mr.	Alberd	Scott		9315600041	3130				salberd@fbhp.com	P.O. Box 313		Columbia	TN	38402	02/10/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Marketing Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	07/01/2018	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Medical Director	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Medicare Compliance Officer	Compliance Officer	Mr.	Tutaj	Thomas		9315600041	6461				ttutaj@fbhp.com	P.O. Box 313		Columbia	TN	38402	05/04/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Medicare Coordinator	Asst. V.P of Medicare Strategy	Ms.	Bradley	Sally		9315600041	6496				SBradley@fbhp.com	P.O. Box 313		Columbia	TN	38402	08/22/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Medicare Part D Opioid Overutilization Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Medication Therapy Management Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Online Enrollment Center Contact (Back-up)	Infrastructure and Software Manager	Mr.	Thurston	Josh		9315600041	3128				JThurston@FBHP.com	147 Bear Creek Pike		Columbia	TN	38402	04/03/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Online Enrollment Center Contact (Primary)	Chief Information Officer	Mr.	Alberd	Scott		9315600041	3130				SAlberd@fbhp.com	147 Bear Creek Pike		Columbia	TN	38402	04/03/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Part D Appeals	Manager, Prior Authorization		Bricker	Bryce							bryce.m.bricker@optum.com	9040 S. Rita Road		Tucsan	AZ	85747	06/03/2020	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active	6126326838				Medicare Prescription Drug Plan		5	Atlanta
S2668	Part D Application Contact		Mr.	Brown	Ryan		9315600041					RBrown@fbhealthplans.com	147 Bear Creek Pike		Columbia	TN	38401	11/13/2015	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Part D Benefits Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Part D Claims Submission Contact		Ms.	Vastine	Elaine		3012964932	64932				elaine.vastine@optum.com	1600 McConnor Pkwy		Schaumburg	IL	60173	04/26/2021	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Part D Exceptions Contact	Manager, Prior Authorization		Mourad	Hala							Hala.Mourad@optum.com	2441 Warrenville Rd	Suite 400	Lisle	IL	60532	06/29/2018	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active	6303285837				Medicare Prescription Drug Plan		5	Atlanta
S2668	Part D Price File Contact (Back-up)	Business Analyst	Ms.	Vargas	Danielle		4437101262					MedOps-Planfinder_DL@ds.uhc.com	1600 McConnor Parkway		Schaumburg	IL	601736801	10/09/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Part D Price File Contact (Optional)	Director of Part D Operations	Ms.	Ballard	Amy		9315600041	6259				aballard@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	08/13/2019	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Part D Price File Contact (Primary)	Business Analyst	Ms.	Moore-Elliott	Shalandria		7637974305					shalandria.moore-elliott@optum.com	1600 McConner Pkwy		Schaumburg	IL	60173	10/09/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Part D Quality Assurance Contact	Compliance Officer	Mr.	Beard	Jason	C	9315600041	3125				jbeard@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	08/13/2019	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Part D Reporting Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Patient Safety Contact	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Payment Contact	Chief Financial Officer	Mrs.	Adams	Renee		9315600041	3108				radams@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	03/04/2022	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Pharmacy Director	Chief Medical Officer	Dr.	Stallworth	Catherine		6159732923					CStallworth@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Pharmacy Network Management Contact			Pham	Katie		8178468722					Katie.Pham@optum.com	2290 Prairie Wind Path, Lewisville, TX 75056		Lewisville	TX	75056	06/03/2020	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Pharmacy Network Management Contact (Secondary)			Hagan	Kyle		3039895828					kyle.hagan@optum.com	7120 W Iowa Ave		Lake Wood	CO	80232	06/01/2020	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk		Summers	Todd							Todd.Summers@optum.com	755 Research Parkway	Suite 300	Oklahoma City	OK	73104	05/15/2019	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active	8666436924				Medicare Prescription Drug Plan		5	Atlanta
S2668	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Advocacy, Customer Service		Willis	Tracy							tracy.willis@optum.com	6860 W. 115th Street		Overland Park	KS	66211	12/10/2018	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active	8664431095				Medicare Prescription Drug Plan		5	Atlanta
S2668	Plan Directory Contact for Public Website	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Plan to Plan Reconciliation Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Processor Contact	Supervisor, Benefit Administration	Ms.	Lievanos	Cassandra		7637974205					cassandra.lievanos@optum.com	5701 Katella Ave		Cypress	CA	90630	06/03/2020	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Reconciliation Contact	Chief Financial Officer	Ms.	Adams	Renee		9315600041	3108				RAdams@fbhp.com	P.O. Box 313		Columbia	TN	38402	03/06/2023	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Reconciliation Contact (Secondary)	Medicare Compliance Officer	Mr.	Tutaj	Thomas	J	9319829090					ttutaj@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Recovery Audit Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Surveillance Contact	General Counsel	Mr.	Brown	Ryan	D	9315600041	2449				rbrown@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	02/15/2016	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	System Contact	Director of Medicare Part D Operations	Ms.	Ballard	Amy		9315600041	6259				aballard@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	05/15/2019	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	Third Party Administrator (TPA) Liaison	Chief Financial Officer	Mrs.	Adams	Renee		9315600041	3108				radams@fbhealthplans.com	P.O. Box 313		Columbia	TN	38402	07/06/2017	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2668	User Access Contact	Medicare Compliance Officer	Mr.	Tutaj	Thomas	J	9319829090					ttutaj@fbhp.com	P.O. Box 313		Columbia	TN	384020313	08/09/2023	2023	MEMBERS HEALTH INSURANCE COMPANY	PDP	Farm Bureau Health Plans	Medicare Prescription Drug Plan		Tennessee Rural Health Improvement Association	651	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S2874	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Bid Primary Contact	Director, Actuarial Risk and Compliance		Welch	Dianna		2624084726					PDBPTContact@humana.com	500 West Main Street		Louisville	KY	40202	09/19/2022	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Appeals			Cardona	Solcire							G_APuertoRicoTeam@humana.com	PO Box 195560		San Jaun	PR	00919	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	8005950462				Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Appeals Contact (Secondary)			Torres	Frank							FTorres6@humana.com	11430 N W 20th Street	Suite 200	Miami	FL	33172	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5024763947				Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5025809138				Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5024682494				Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5028811161					jpowell13@humana.com	500 West Market Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	8008658715				Medicare Prescription Drug Plan		5	Kansas City
S2874	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5025800475				Medicare Prescription Drug Plan		5	Kansas City
S2874	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2874	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/13/2023	2023	HUMANA INSURANCE OF PUERTO RICO, INC.	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S2893	Agent/Broker Compensation Data Contact	Director, Broker and Sales Commissions		Newcomb	Stephen		6172469980					Stephen.Newcomb@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/07/2018	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Automated TrOOP Balance Transfer Contact	Manager Strategic Accounts		Pityou	Sean		6022458871					JEAccountManagement@CVSCaremark.com	9501 E. Shea BLVD		Scottsdale	AZ	85260	06/16/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Backup User Access Contact	Manager		Donovan	Gerard		6172468466					Gerard.Donovan@bcbsma.com	25 Technology Place		Hingham	MA	020434359	08/05/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Best Available Evidence Contact	Manager		Mondhink	Tiffany		4806147228					Tiffany.Mondhink@CVSHealth.com	9501 E. Shea Blvd, MC125		Scottsdale	AZ	85260	11/14/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Bid Audit Contact	Actuarial Analyst		West	Gregory		6172465077					Gregory.West@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	02/17/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Bid Audit Site Contact	Actuarial Analyst		West	Gregory		6172465077					Gregory.West@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	02/17/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Bid Primary Contact	Actuarial Analyst		West	Gregory		6172465077					Gregory.West@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	02/17/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	CAP Report Contact for Public Website	Medicare Compliance Manager		Sullivan	Christina		7816038012					Medicarecompliance@bcbsma.com	25 Technology Place		Hingham	MA	020434359	04/15/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	CEO - CMS Administrator Contact	Chief Executive Officer	Ms.	Iselin	Sarah		6172463805					sarah.iselin@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	021997611	12/21/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	CEO - Senior Official for Contracting	Chief Executive Officer	Ms.	Iselin	Sarah		6172463805					sarah.iselin@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	021997611	12/21/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Chief Financial Officer	Interim Chief Financial Officer	Mr.	Centrella	Anthony		6172465067					Anthony.Centrella@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	04/19/2023	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Chief Operating Officer	Executive Vice President, Chief Operating Officer	Mr.	Lynch	Richard		6172465000					Richard.Lynch@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/16/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Chief Information Officer	Chief Information Officer	Ms.	Hildebrand	Victoria		6172465000					victoria.hildebrand@bcbsma.com	101 Huntington Ave	Suite 1300	Boston	MA	021997611	02/01/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Chief Information Security Officer	Chief Information Security Officer	Mr.	Baggett	Sean		6172465824					sean.baggett@bcbsma.com	101 Huntington Avenue, Suite 1300		Boston	MA	021997611	10/24/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	CMS Casework Communication Contact	Supervisor, Medicare Part D Operations		Rocco	Lori		4803927135					Lori.Rocco@CVSHealth.com	9501 E. Shea BLVD, MC121		Scottsdale	AZ	85260	01/27/2023	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Complaints Tracking Contact	Sr. PDP Analyst, Customer Service, CTM, Group,		White	Stephen		6172467670					Stephen.White@BCBSMA.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	11/14/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Contact for Fraud Investigations	Associate General Counsel		Stewart	Jennifer		6172463527					Jennifer.Stewart@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	06/25/2018	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Coordination of Benefits Contact	Manager, MED D Financial Reconciliation		Viana	Silvia		4802980166					Silvia.Viana@cvshealth.com	9501 E.Shea BLVD,	MC121	Scottsdale	AZ	85260	06/08/2020	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Corporate Mailing						8002004255					placeholder@cms.hhs.gov	P. O. Box 55007		Boston	MA	022055007	06/16/2010	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Accounting & Finance		Fu	Chee		4012156716					Chee.Fu@CVSHealth.com	One CVS Drive		Woonsocket	RI	02895	12/16/2020	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Customer Service Operations Contact	Lead Director, Client Operations		Dayoub	Joselyn		4128757137					dayoubj@cvshealth.com	315 Cloisterbane Drive		St. Johns	FL	32259	10/11/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	DIR Contact	Reporting Sr. Analyst		Kovalski	Robin		6172468586				6172468506	Robin.Kovalski@BCBSMA.com	25 Technology Place		Hingham	MA	02043	08/05/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	DIR Contact (Secondary)	Sr. Accounting Consultant	Mr	Setzer	Bryan		6172466261					Bryan.Setzer@BCBSMA.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	11/14/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Emergency Part D Contact	Medicare Compliance Manager		Sullivan	Christina		7816038012				6172468506	medicarecompliance@bcbsma.com	25 Technology Place	Mailstop 03-04	Hingham	MA	020434359	04/15/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Employer Waiver Contact	Senior Product Manager		Hasan	Sayeema		6172466307					Sayeema.Hasan@BCBSMA.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	06/16/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Enrollment Contact	Med D Ops Enrollment		Mondhink	Tiffany		4806147228					Tiffany.Mondhink@CVSHealth.com	9501 E. Shea Blvd	MC125	Scottsdale	AZ	85260	11/14/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	EOB Transfer Contact	Director, Member Communications, PDP Plan Ops		Weingardt	Alesa		3309574321				4803582668	Alesa.Weingardt@CVSHealth.com	9501 E. Shea BLVD	MC 146	Scottsdale	AZ	85260	01/27/2023	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Financial Audit Contact	Audit and Risk Management	Mr	Bulman	Tim		6172468038					Timothy.Bulman@bcbsma.com	101 Huntington Avenue	Suite 1300	Boston	MA	021997611	09/20/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Financial Reporting Contact	Financial Reporting Manager		Goveia	Ross		6172465000					Ross.Goveia@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	12/07/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Formulary Contact	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Formulary Contact (Secondary)	Clinical Pharmacist		Schraut	David		6172465762					David.Schraut@bcbsma.com	25 Technology Place		Hingham	MA	02043	11/04/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	General Contact	Medicare Compliance Manager		Sullivan	Christina		7816038012				6172468506	Medicarecompliance@bcbsma.com	25 Technology Place		Hingham	MA	02043	04/15/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Government Relations Contact	Senior Director of Federal and National Affairs		Savage	Deirdre		6172463359					deirdre.savage@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	10/24/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	HIPAA Privacy Officer	Privacy Officer		Abdel-Samed	Jennifer		4042424614					Jennifer.Abdel-Samed@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	06/16/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	HIPAA Security Officer	Vice President and Chief Information Security Offi		Baggett	Sean		6172465824					Sean.Baggett@bcbsma.com	101 Huntington Ave, Suite 1300		Boston	MA	021997611	11/16/2020	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Hospice Contact	Manager Strategic Accounts		Pityou	Sean		6022458871					JEAccountManagement@CVSHealth.com	9501 E.Shea BLVD		Scottsdale	AZ	85260	06/16/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Interoperability Contact			Sullivan	Christina		6172462507					christina.sullivan@bcbsma.com	25 Technology Place		Hingham	MA	02043	04/13/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Marketing Contact	Senior Product Manager		Hasan	Sayeema		6172466307					Sayeema.Hasan@BCBSMA.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	11/20/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Medical Director	Sr. Medical Director, Clinical Support Svc		Catero	Martin		4803163732					Martin.Catero@CVSHealth.com	4755 South 44th Place	MC 145	Phoenix	AZ	85040	11/09/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Medicare Compliance Officer	Director, Medicare Compliance	Ms.	Sullivan	Christina		7816038012					NEJECompliance@bcbsma.com	25 Technology Place	Mail stop 03/04	Hingham	MA	020434359	04/28/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Medicare Coordinator	Director Operations		Bentley	Melanie		6172468403					melanie.bentley@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	02/25/2020	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist, Pharmacy Operations		Schraut	David		6172465762					David.Schraut@bcbsma.com	25 Technology Place		Hingham	MA	02043	10/24/2018	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Medication Therapy Management Contact	Clinical Advisor		Reed	Monica		2817025942					Monica.Reed@CVSHealth.com	750 W John Carpenter Fwy #1200		Irving	TX	75039	06/16/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Online Enrollment Center Contact (Back-up)	Sr. Analyst		Lisy	Derrick		2165704911					Derrick.Lisy@CVSHealth.com	29100 Aurora RD		Solon	OH	44139	07/27/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Online Enrollment Center Contact (Optional)	Sr. Analyst		Lisy	Derrick		2165704911					Derrick.Lisy@CVSHealth.com	29100 Aurora Rd		Solon	OH	44139	07/27/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Online Enrollment Center Contact (Primary)	Application Development Manager		Braxter	Sarah		2162157288					Sarah.Braxter@CVSHealth.com	29100 Aurora RD		Solon	OH	44139	07/27/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Part D Appeals	Manager RPh, Medicare Part D CD&A Client Support		Moran	Vickie							Vickie.Moran@CVSHealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	11/09/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active	4125263320				Medicare Prescription Drug Plan		5	Boston
S2893	Part D Appeals Contact (Secondary)	Director, Medicare Part D CD&A Client Support		Christensen	Ann							Ann.Christensen@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	11/09/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active	6023883829				Medicare Prescription Drug Plan		5	Boston
S2893	Part D Application Contact	Senior Product Manager		Hasan	Sayeema		6172466307					Sayeema.Hasan@BCBSMA.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	11/18/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Part D Benefits Contact	Senior Product Manager		Hasan	Sayeema		6172466307					Sayeema.Hasan@BCBSMA.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	06/16/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Part D Claims Submission Contact	Director, Medicare Ops		Steinke	Sydney		6024057057					Sydney.Steinke@CVSHealth.com	8801 E. Raintree Drive	MC 121	Scottsdale	AZ	85260	01/27/2023	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Part D Exceptions Contact	Manager RPh, Medicare Part D CD&A Client Support		Moran	Vickie							Vickie.Moran@CVSHealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	11/09/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active	4125263320				Medicare Prescription Drug Plan		5	Boston
S2893	Part D Exceptions Contact (Secondary)	Director, Medicare Part D CD&A Client Support		Christensen	Ann							Ann.Christensen@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	11/09/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active	6023883829				Medicare Prescription Drug Plan		5	Boston
S2893	Part D Price File Contact (Back-up)	Clinical Pharmacy Manager		Wong	Timothy		6172466927					Timothy.Wong@bcbsma.com	25 Technology Place		Hingham	MA	02043	03/29/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Part D Price File Contact (Optional)	Clinical Pharmacist		Schraut	David		6172465762					David.Schraut@BCBSMA.com	25 Technology Place		Hingham	MA	02043	07/10/2020	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Part D Price File Contact (Primary)	Director, Medicare Operations		Steinke	Sydney		6024057057				4013357984	Sydney.Steinke@CVSHealth.com	8801 E. Raintree Drive	MC 121	Scottsdale	AZ	85260	06/16/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Part D Quality Assurance Contact	Lead Director, Medicare Quality/Audit		Brauner	Lyle		6026183945					Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/16/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Part D Reporting Contact	Program Manager		MacDougall	Erin		6172469714					Erin.MacDougall@bcbsma.com	25 Technology Place	Mail Stop 03-04	Hingham	MA	020434359	11/14/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Patient Safety Contact	Clinical Advisor		Reed	Monica		2817025942					Monica.Reed@CVSHealth.com	750 W John Carpenter Fwy #1200		Irving	TX	75039	06/16/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Payment Contact	Director, Accounting & Finance		Fu	Chee		4012156716					Chee.Fu@CVSHealth.com	CVS Caremark, One CVS Dr.		Woonsocket	RI	02895	12/16/2020	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Pharmacy Director	Director, Pharmacy Operations		Nelhuebel	Melinda		6172464407					Melinda.Nelhuebel@bcbsma.com	25 Technology Place		Hingham	MA	02043	05/29/2018	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Pharmacy Network Management Contact	Director, Network Operations		Smith	Shawn		4806529980					Shawn.Smith@CVSHealth.com	9501 E. Shea BLVD		Scottsdale	AZ	85260	12/16/2020	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Pharmacy Network Management Contact (Secondary)	Senior Director, Pharmacy Services		Erwin	Mary Beth		6172463276					MaryBeth.Erwin@bcbsma.com	One Enterprise Dr		N. Quincy	MA	02171	10/24/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Pharmacy Technical Help Desk Contact			Helpdesk	Pharmacy							dayoubj@cvshealth.com	800 NW Chipman, Rd. Suite 5830		Lee''s Summit	MO	64086	10/11/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active	8666934620				Medicare Prescription Drug Plan		5	Boston
S2893	Plan Directory Contact for Public Website	Blue MedicareRx (PDP)		Care	Customer		8885434917					JEAccountManagement@CVSCaremark.com	Blue MedicareRx (PDP)	PO Box 280200	Nashville	TN	37228	11/14/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Plan to Plan Reconciliation Contact	Sr. Consultant, Finance Med D		Spradlin	Eun-Jung		6022997668					eun-jung.spradlin@cvshealth.com	PO Box 842237		Dallas	TX	752842237	02/03/2023	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Processor Contact	Director Network Systems & Standards		Graham	Heather		2145370421					Heather.Graham@cvshealth.com	750 W John Carpenter Freeway, Suite 1200		Irving	TX	75039	11/09/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Reconciliation Contact	Director Accounting & Finance		Fu	Chee		4012156716					Chee.Fu@CVSHealth.com	One CVS Drive		Woonsocket	RI	02895	12/16/2020	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Reconciliation Contact (Secondary)	Sr. Accounting Consultant		Setzer	Bryan		6172466261					Bryan.Setzer@bcbsma.com	101 Huntington Avenue Suite 1300		Boston	MA	021997611	10/24/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Recovery Audit Contact	Sr. Accounting Consultant	Mr	Setzer	Bryan		6172466261					Bryan.Setzer@BCBSMA.com	101 Huntington Avenue	Suite 1300	Boston	MA	02199	11/14/2019	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Surveillance Contact	Medicare Compliance Manager		Sullivan	Christina		7816038012				6172468506	medicarecompliance@bcbsma.com	25 Technology Place	Mailstop 03-03	Hingham	MA	020434359	04/15/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	System Contact	Manager Strategic Accounts		Pityou	Sean		6022458871					JEAccountManagement@cvshealth.com	9501 E.Shea BLVD		Scottsdale	AZ	85260	06/16/2022	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	Third Party Administrator (TPA) Liaison	Director Accounting & Finance		Fu	Chee		4012156716					Chee.Fu@CVSHealth.com	One CVS Drive		Woonsocket	RI	02895	12/16/2020	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S2893	User Access Contact	Manager		Sullivan	Christina		6172462507					Christina.Sullivan@bcbsma.com	25 Technology Place		Hingham	MA	020434359	08/05/2021	2023	ANTHEM INSURANCE CO. & BCBSMA & BCBSRI & BCBSVT	PDP	Blue MedicareRx	Medicare Prescription Drug Plan		Elevance Health, Inc. & BCBSMA & BCBSRI & BCBSVT	386	Yes	Active					Medicare Prescription Drug Plan		5	Boston
S3147	Agent/Broker Compensation Data Contact	Medicare Sales Operations Director	Ms	Perry	Danielle		6024004768					Danielle.Perry@bannerhealth.com	2901 N Central Ave	Ste. 160	Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Automated TrOOP Balance Transfer Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N. Central Ave Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Backup User Access Contact	Compliance Senior Director	Ms	Corlette	Kristina		6027472431					BMAComplianceOfficer@BannerHealth.com	2901 N Central Ave., Ste 160		Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Best Available Evidence Contact	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Bid Audit Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Bid Audit Site Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Bid Primary Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	CAP Report Contact for Public Website	Chief Operations Officer	Mrs	Spiekermeier	Sarah		5208745520				5208747083	Sarah.Spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	CEO - CMS Administrator Contact	Chief Executive Officer	Mr	Stringham	James		6025684179				5208747083	James.Stringham2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	CEO - Senior Official for Contracting	Chief Executive Officer	Mr	Stringham	James		6025684179				5208747083	James.Stringham2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Chief Financial Officer	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Chief Operating Officer	Chief Operations Officer	Mrs	Spiekermeier	Sarah		5208745520				5208747083	Sarah.Spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Chief Information Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Chief Information Security Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	CMS Casework Communication Contact	Director, Grievance and Appeals	Mr	Maccioli	James		5208743247				5208747083	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Complaints Tracking Contact	Director, Grievance and Appeals	Mr	Maccioli	James		5208743247				5208747083	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Contact for Fraud Investigations	Director of Compliance	Ms	Dorazio	Terri		5208742847				5208747072	Theresa.Dorazio@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Coordination of Benefits Contact	Director Reimbursement Services		Groves	Lori		6024692249					Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Corporate Mailing						5208745550				5208747083	silvia.parra@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant		Cosentino	Rebekah		5208502776					Rebekah.Cosentino@bannerhealth.com	2901 N Central Ave. Ste 160		Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Customer Service Operations Contact	Customer Care Director	Mrs	Carrillo	Veronica		5208745349				5208747083	Veronica.Carrillo@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	DIR Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	DIR Contact (Secondary)	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave. Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Emergency Part D Contact	Pharmacy On Call Cell Phone		On Call	Pharmacy		5202601860				5208747083	BUHPgovernmentprograms@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Emergency Part D Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Enrollment Contact	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	EOB Transfer Contact	Director Reimbursement Services		Groves	Lori		6024692254				5208747083	Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Financial Audit Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Financial Reporting Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Formulary Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Formulary Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	General Contact	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Government Relations Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	HIPAA Privacy Officer	Director of Compliance	Ms	Dorazio	Terri		5208742847				5208747072	Theresa.Dorazio@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	HIPAA Security Officer	Executive Director, IT	Mr.	Hall	Matt		4802805577					Matt.Hall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Hospice Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Interoperability Contact	Interoperability Healthcare Leader	Mr	Mathew	Rakesh		6027277420					Rakesh.Mathew@bannerhealth.com	2901 N Central Ave. Ste 160		Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Marketing Contact	Marketing Manager	Ms	Medina	AnaMaria		5208745082				5208747083	AnaMaria.Medina@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Medical Director	Chief Medical Officer	Dr	Stein	Sandra		5209040346					Sandra.Stein@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	09/05/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Medicare Compliance Officer	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Medicare Coordinator	Senior Manager Government Programs	Ms	Flores	Vanessa		5208745781				5208747083	buhpgovernmentprograms@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Medicare Part D Opioid Overutilization Contact	Express Scripts Director Clinical & Trend Solution		Muralidharan	Adrienne		3143131932					amuralidharan@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Medication Therapy Management Contact	Director (Clinical & Trend Solutions)		Muralidharan	Adrienne		3143131932				8587906052	amuralidharan@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	OffShore Subcontractor Contact	Compliance Director	Ms	Chapman	Raquel		6027471194					BMAComplianceOfficer@BannerHealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Online Enrollment Center Contact (Back-up)	Medicare Sales Operations Director	Ms	Perry	Danielle		6024004768					Danielle.Perry@bannerhealth.com	2901 N Central Ave	Ste. 160	Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Online Enrollment Center Contact (Optional)	Enrollment Supervisor	Ms	Espinoza	Brianna		5208744192				5205855252	Brianna.Espinoza@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Online Enrollment Center Contact (Primary)	Medicare Enrollment Sr. Mgr.	Mrs	Paredes	Nadya		5208745964				5208747083	Nadya.Paredes@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Appeals	Director, Grievance and Appeals	Mr	Maccioli	James						8664658340	James.Maccioli2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract	8778743930				Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Appeals Contact (Secondary)	Associate Director, Grievance & Appeals	Mrs	Garcia	Renee						5208743462	Renee.Garcia2@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract	8778743930				Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Application Contact	Sr Director, Medicare Administrator	Ms	Chaydez	Myrna		6024355378					Myrna.Chaydez@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Benefits Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Claims Submission Contact	Director Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	Express Scripts	One Express Way	St Louis	MO	63121	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Exceptions Contact	Express Scripts Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	Express Scripts	5151 Blazer Pkwy	Dublin	OH	43017	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract	8003443405	733326			Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Exceptions Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael							Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract	8888075695				Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Price File Contact (Back-up)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Price File Contact (Optional)	Express Scripts Product Manager Advisor		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	Express Scripts	4865 Dixie Hwy	Fairfield	OH	45014	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Price File Contact (Primary)	Express Scripts Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	Express Scripts	5151 Blazer Pkwy	Dublin	OH	43017	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Quality Assurance Contact	Sr. Director Quality Management	Mrs	Robles Caraveo	Sandra		6233266425					sandra.roblescaraveo@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Part D Reporting Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Patient Safety Contact	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Payment Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Personal Health Record Contact	Sr. Director Quality Management	Mrs	Robles Caraveo	Sandra		6233266425					sandra.roblescaraveo@bannerhealth.com	2901 N Central Ave		Phoenix	AZ	85012	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Pharmacy Director	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Pharmacy Network Management Contact	Express Scripts Network Accountant Director		Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	Express Scripts	One Express Way	St. Louis	MO	63121	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Pharmacy Network Management Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael		4806508341					Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 360		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Pharmacy Technical Help Desk Contact	Express Scripts (Director, Customer Services)		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	Express Scripts	13051 N Telecom PKWY STE 150	Temple Terrace	FL	33637	08/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract	8666620295				Medicare Prescription Drug Plan		5	San Francisco
S3147	Pharmacy Technical Help Desk Contact (Secondary)	Director, Managed Pharmacy Solutions	Mr	Ramsey	Michael							Michael.Ramsey@bannerhealth.com	2901 N. Central Ave., Ste 160		Phoenix	AZ	85012	09/13/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract	8888075695				Medicare Prescription Drug Plan		5	San Francisco
S3147	PHR Beneficiary Contact																	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan	Express Scripts	Banner Health	389	Yes	Withdrawn Contract	3143131932				Medicare Prescription Drug Plan		5	San Francisco
S3147	Plan Directory Contact for Public Website	Customer Care		Care	Customer		5208743930				5208743434	memberservicesinquiries@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Plan to Plan Reconciliation Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Processor Contact	Director Reimbursement Services		Groves	Lori		6024692249					Lori.Groves@BannerHealth.com	525 W Brown Rd		Mesa	AZ	85201	05/02/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Reconciliation Contact	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Reconciliation Contact (Secondary)	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave. Ste. 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Recovery Audit Contact	Finance CRU Director	Mr	Schreiber	Thomas		5208745240				5208747083	thomas.schreiber@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Surveillance Contact	Marketing Associate Director	Ms.	Medina	AnaMaria		5208745082					AnaMaria.Medina@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	System Contact	Government Programs Sr. Director	Mr.	Thomsen	Ryan		5207808310					ryan.thomsen@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	Third Party Administrator (TPA) Liaison	Interim Chief Financial Officer	Mr	Marshall	Gregory		4806845209					Gregory.Marshall@bannerhealth.com	2901 N Central Ave, Ste 160		Phoenix	AZ	85012	08/30/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3147	User Access Contact	Chief Operations Officer	Mrs	Spiekermeier	Sarah		6237554652					sarah.spiekermeier@bannerhealth.com	5255 E Williams Circle, Ste 2050		Tucson	AZ	85711	07/27/2023	2023	BANNER HEALTH INSURANCE GROUP	PDP	Banner Medicare Rx	Medicare Prescription Drug Plan		Banner Health	389	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	San Francisco
S3285	Agent/Broker Compensation Data Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	05/26/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Automated TrOOP Balance Transfer Contact	Medicare Operations Supervisor	Mr.	Distel	Chris		8587906376					PartDCAT@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/23/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Backup User Access Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Best Available Evidence Contact	Program Associate	Ms.	Mays	Dara		8587905710					dara.mays@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	02/15/2022	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Bid Audit Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Bid Audit Site Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Bid Primary Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	CAP Report Contact for Public Website	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	CEO - CMS Administrator Contact	President, MG Insurance Company	Mr.	Barr	Damien		8587906330					damien.barr@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	11/25/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	CEO - Senior Official for Contracting	President, MG Insurance Company	Mr.	Barr	Damien		8587906330					damien.barr@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	11/25/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Chief Financial Officer	President, MG Insurance Company	Mr.	Barr	Damien		8587906330					damien.barr@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	11/25/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Chief Operating Officer	President, MG Insurance Company	Mr.	Barr	Damien		8587906330					damien.barr@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	11/25/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Chief Information Officer	Software Engineer IV	Mr.	Cuarto	Jojo		8587907184					jojo.cuarto@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/23/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Chief Information Security Officer	Software Engineer IV	Mr.	Cuarto	Jojo		8587907184					jojo.cuarto@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/23/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	CMS Casework Communication Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Complaints Tracking Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Contact for Fraud Investigations	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Coordination of Benefits Contact	Program Associate	Ms.	Mays	Dara		8587905710					dara.mays@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	02/15/2022	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Corporate Mailing						8587906294					niejadd.evans@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	11/20/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Coverage Gap Discount Program (CGDP) Payment Contact	Blake Hallman	Mr.	Hallman	Blake		8587907493					blake.hallman@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	11/20/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Customer Service Operations Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	DIR Contact	Financial Data Recon Analyst	Mr.	Hallman	Blake		8587907493					blake.hallman@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	11/20/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	DIR Contact (Secondary)	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	05/26/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Emergency Part D Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Emergency Part D Contact (Secondary)	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Employer Waiver Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Enrollment Contact	Program Manager	Ms.	Stokes	Janelle		6199806944					janelle.stokes@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	02/15/2022	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	EOB Transfer Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323				8583572494	michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	07/01/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Financial Audit Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Financial Reporting Contact	Financial Data Recon Analyst	Mr.	Hallman	Blake		8587907493					blake.hallman@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/27/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Formulary Contact	Mgr Formulary Admin & Maintenance	Ms.	Nyawablia	Christina		8587906279					FMT@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Formulary Contact (Secondary)	Pharmacy Director	Ms.	Benson	Tara		8587907069					tara.benson@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/31/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	General Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Government Relations Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	HIPAA Privacy Officer	Privacy Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	HIPAA Security Officer	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Hospice Contact	Program Associate	Ms.	Mays	Dara		8587905710					dara.mays@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	02/15/2022	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Interoperability Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Ct		SAN DIEGO	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Marketing Contact	Manager, PDP Marketing	Ms.	Lewis	Karina		8587907062					karina.lewis@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/24/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Medical Director	Medical Director	Dr.	Jimenez	Rick		8582915360					rick.jimenez@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	11/20/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Medicare Compliance Officer	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Medicare Coordinator	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Medicare Part D Opioid Overutilization Contact	Pharmacy Director	Ms.	Benson	Tara		8587907069					tara.benson@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	10/17/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Medication Therapy Management Contact	Clinical Solutions Manager III	Ms.	Nguyen	Linh		8587906627					MTMP@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	02/02/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	OffShore Subcontractor Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Online Enrollment Center Contact (Back-up)	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Appeals	Compliance Officer	Mrs.	Koja-Volk	Jordana							jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active	8587905653				Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Appeals Contact (Secondary)	Manager, Appeals & Grievances	Ms.	Martin	Dawn						8587906118	dawn.martin@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/23/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active	8587905653				Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Application Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	05/26/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Benefits Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Claims Submission Contact	Medicare Part D Program Manager	Ms.	Stockes	Janele		8587906682					janelle.stokes@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/23/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Exceptions Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana							jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active	8587905653				Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Exceptions Contact (Secondary)	Director, PA & UM Programs	Ms.	Emoto	Julianne						8587905846	julianne.emoto@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/23/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active	8587905846				Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Price File Contact (Back-up)	Medicare Part D Program Manager	Ms.	Niemi	Kirstin		8587906455					PlanFinderCommunications@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	02/02/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Price File Contact (Optional)	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Price File Contact (Primary)	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	07/01/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Quality Assurance Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	07/01/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Part D Reporting Contact	PDP Program Manager I	Ms.	Williams	Valencia		8587903028					valencia.williams@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	02/15/2022	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Patient Safety Contact	Pharmacy Director	Ms.	Benson	Tara		8587907069					tara.benson@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/24/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Payment Contact	Financial Data Recon Analyst	Mr.	Hallman	Blake		8587907493					blake.hallman@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	11/20/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Personal Health Record Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Pharmacy Director	Pharmacy Director	Ms.	Benson	Tara		8587907069					tara.benson@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/24/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Pharmacy Network Management Contact	Director, Pharmacy Network Administration	Mr.	Hunt	Brian		8587907092					brian.hunt@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/23/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Pharmacy Network Management Contact (Secondary)	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services	Ms.	Brewer	Kathy							customerservice@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/18/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active	8448263451				Medicare Prescription Drug Plan		5	San Francisco
S3285	Plan Directory Contact for Public Website			Service	Customer		8448263451					karina.lewis@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	10/25/2019	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Plan to Plan Reconciliation Contact	Financial Data Recon Analyst	Mr.	Hallman	Blake		8587907493					blake.hallman@medimpact.com	PO Box 78606		Milwaukee	WI	532788606	07/11/2019	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Processor Contact	Vice President, Government Programs & Services	Ms.	Davis	Delona		8587906229					MedicarePartDProjectManagers@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	02/02/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Reconciliation Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Reconciliation Contact (Secondary)	Financial Data Recon Analyst	Mr.	Hallman	Blake		8587907493					blake.hallman@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	01/24/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Recovery Audit Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Surveillance Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	System Contact	Director, PDP Operations	Ms.	Bossert	Michele		8587906323					michele.bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	Third Party Administrator (TPA) Liaison	Financial Data Recon Analyst	Mr.	Hallman	Blake		8587907493					blake.hallman@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	11/20/2018	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3285	User Access Contact	Compliance Officer	Mrs.	Koja-Volk	Jordana		8587905653					jordana.koja-volk@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	08/01/2023	2023	MG INSURANCE COMPANY	PDP	MG Insurance Company	Medicare Prescription Drug Plan		MedImpact Holdings, Inc.	698	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3375	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/28/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Bid Audit Contact	Actuarial Director		Hart	Mary		3175819752					mary.a.hart@anthem.com	220 Virginia Avenue	Mail Drop: IN205-A351	Indianapolis	IN	46204	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Bid Audit Site Contact	Actuarial Director		Hart	Mary		3175819752					mary.a.hart@anthem.com	220 Virginia Avenue	Mail Drop: IN205-A351	Indianapolis	IN	46204	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Bid Primary Contact	Director, Product Development		Floyd	Cari		5407984087					Cari.Floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	EOB Transfer Contact	Compliance Director, Med Part D/Pharm Oversight		Doss	Jennifer		5137484736				8558419706	jennifer.doss@anthem.com	4361 Irwin Simpson Road		Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5133167654				Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	8144498744				Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5133167654				Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5407984087				Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	8333774266				Medicare Prescription Drug Plan		5	Chicago
S3375	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	3135973173				Medicare Prescription Drug Plan		5	Chicago
S3375	PHR Beneficiary Contact																	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Withdrawn Contract	8004671199				Medicare Prescription Drug Plan		5	Chicago
S3375	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3375	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	EMPIRE HEALTHCHOICE ASSURANCE, INC.	PDP	BlueCross BlueShield: Empire, Excellus, WNY & NENY	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S3389	Agent/Broker Compensation Data Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Automated TrOOP Balance Transfer Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2021	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Backup User Access Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Best Available Evidence Contact	Customer Service		Health Plan	UPMC		8775393080					upmchp@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Bid Audit Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Bid Audit Site Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Bid Primary Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	CAP Report Contact for Public Website	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	CEO - CMS Administrator Contact	President	Ms.	Holder	Diane	P	4124547640				4124547750	holderd@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/04/2023	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	CEO - Senior Official for Contracting	President	Ms.	Holder	Diane	P	4124547640				4124547750	holderd@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	01/04/2023	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Chief Financial Officer	Chief Financial Officer	Mr.	Gebbens	Gordon		4124545559					gebbgx@UPMC.EDU	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	07/18/2016	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Chief Operating Officer	Chief Operating Officer	Ms.	Jenkins	Mary Beth	L	4124547764					jenkinsml@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	12/09/2015	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Chief Information Officer	Chief Information Officer	Mr.	McCallister	Ed		4124547711					mccallisterew@upmc.edu	USX Tower, 60th Floor	600 Grant Street	Pittsburgh	PA	15219	03/14/2016	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Chief Information Security Officer	Vice President, ISD	Mr	Haas	Scott		4124546162					haassm@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	03/14/2016	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	CMS Casework Communication Contact	Sr. Administrator, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Complaints Tracking Contact	Sr. Administrator, Medicare Compliance	Ms.	McGough	Amber		4124545250					russellal@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Contact for Fraud Investigations	Sr. Director Fraud & Abuse		Workman	Craig		4124545524					workmanc@upmc.edu	USX Tower, 47th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Coordination of Benefits Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Corporate Mailing						4124547500					upmchp@upmc.edu	USX Tower, 55th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst		Kelly	Alexis		4124547856				4124542110	kellya9@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Customer Service Operations Contact	Customer Service		Health Plan	UPMC		8775393080					upmchp@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	DIR Contact	Director, Pharmacy Finance		Bovier	Jacqueline		4124547584					bovierjd@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	06/18/2015	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	DIR Contact (Secondary)	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Emergency Part D Contact	Vice President, Customer Engagement & Enrollment		Palmerine	Anne		4129777828					palmerineac3@upmc.edu	USX Tower, 23rd Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Emergency Part D Contact (Secondary)	Sr. Director, Pharmacy Operations		Kienzle	Paul		7242070388					kienzlepa@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Enrollment Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	EOB Transfer Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Financial Audit Contact	Sr. Director, Medicare Operations	Mr.	Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Financial Reporting Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Formulary Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Formulary Contact (Secondary)	Specialist, Pharmacy Operations	Ms.	Lindemuth	Nicole		4124548589					lindemuthnl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	08/29/2012	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	General Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Government Relations Contact	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	HIPAA Privacy Officer	Chief Privacy Officer	Ms.	Grumbine	Megan		7034021772					grumbinem@upmc.edu	USX Tower, 41st Floor	600 Grant St.	Pittsburgh	PA	15219	11/03/2020	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	HIPAA Security Officer	Chief Privacy Officer	Ms.	Grumbine	Megan		7034021772					grumbinem@upmc.edu	USX Tower, 41st Floor	600 Grant St.	Pittsburgh	PA	15219	11/03/2020	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Hospice Contact	Pharmacy Coordinator	Ms.	Lindemuth	Nicole		4124548589					lindemuthnl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	06/24/2020	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Interoperability Contact	Sr. Director, Medicare Operations		Cain	John		4124545539					cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	02/16/2022	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Marketing Contact	Director, Medicare Marketing		McVey	Alicia		4124545525					mcveyal@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	08/03/2017	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Medical Director	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Vybiral	Erin		4124545247				4124542110	mccomplianceofficer@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	12/15/2021	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Medicare Coordinator	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Medicare Part D Opioid Overutilization Contact	Sr. Manager, Clinical Pharmacy		Zandier	Lauren		4124542950				4124545295	craigl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	10/23/2018	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Medication Therapy Management Contact	Sr. Manager Clinical Pharmacy		Zandier	Lauren		4124542950				4124545295	craigl@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	10/23/2018	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Online Enrollment Center Contact (Back-up)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Online Enrollment Center Contact (Optional)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Online Enrollment Center Contact (Primary)	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Part D Appeals	Manager, C&G		Richards	Rebecca						4124547920	richardsr3@upmc.edu	USX Tower, 42nd Floor	600 Grant Street	Pittsburgh	PA	15219	02/25/2021	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active	4124540116				Medicare Prescription Drug Plan		5	Philadelphia
S3389	Part D Appeals Contact (Secondary)	Manager, Pharmacy Compliance		Chaussinand	Matt							chaussinandm@upmc.edu	600 Grant St., USX, 12th Floor		Pittsburgh	PA	15219	02/25/2021	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active	4124545914				Medicare Prescription Drug Plan		5	Philadelphia
S3389	Part D Application Contact	Project Manager		Clawson	Jeff		4124545192				4124542110	clawsonjw@upmc.edu	US Steel Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	11/01/2017	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Part D Benefits Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Part D Claims Submission Contact	Director, Regulated Markets Medicare Solutions		Dovico	Rosario		2012696398					rosario_dovico@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	04/23/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Part D Exceptions Contact			Services	Pharmacy							upmchp@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	08/29/2012	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active	8003964139				Medicare Prescription Drug Plan		5	Philadelphia
S3389	Part D Price File Contact (Back-up)	Sr. Manager, Government Programs		Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	01/12/2018	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Part D Price File Contact (Optional)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Part D Price File Contact (Primary)	Director, Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107 St. #11202		Overland	KS	66207	07/28/2020	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Part D Quality Assurance Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Part D Reporting Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Patient Safety Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Payment Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Personal Health Record Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Pharmacy Director	Sr. Director, Pharmacy Operations		Kienzle	Paul		7242070388					kienzlepa@upmc.edu	USX Tower, 12th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Pharmacy Network Management Contact	Network Account Director		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	10/31/2016	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Pharmacy Technical Help Desk Contact	DIrector, Customer Service		Warren	Mark							MWarren@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	07/29/2021	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	Philadelphia
S3389	PHR Beneficiary Contact																	12/21/2007	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan	MyHealth	UPMC Health System	249	Yes	Active	4128032065				Medicare Prescription Drug Plan		5	Philadelphia
S3389	Plan Directory Contact for Public Website			Marketing	Medicare		8773813765					upmchp@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/23/2012	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Plan to Plan Reconciliation Contact	Business Analyst		Michalski	Jeff		4124545715				4124542110	medicarereporting@upmc.edu	c/o UPMC Health Plan Attn: Jeff Michalski P2P	US Steel Tower, 600 Grant Street, 9th Floor	Pittsburgh	PA	15219	06/22/2020	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Processor Contact	Sr Director - Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	01/12/2018	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Reconciliation Contact	Chief Actuary		Wisniewski	John		4124545180					wisniewskijc@upmc.edu	USX Tower, 14th Floor	600 Grant Street	Pittsburgh	PA	15219	02/28/2017	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Reconciliation Contact (Secondary)	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Recovery Audit Contact	Sr. Director, Medicare Operations	Mr.	Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Surveillance Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	System Contact	Director, Enrollment & COB		Aber	Kelly		4124547664					aberkn@upmc.edu	USX Tower, 5th Floor	600 Grant Street	Pittsburgh	PA	15219	05/20/2015	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	Third Party Administrator (TPA) Liaison	Business Analyst		Kelly	Alexis		4124547856				4124542110	kellya9@upmc.edu	c/o UPMC Health Plan Attn: Alexis Kelly P2P	US Steel Tower, 600 Grant Street, 9th Floor	Pittsburgh	PA	15219	04/16/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3389	User Access Contact	Sr. Director, Medicare Operations		Cain	John		4124545539				4124542110	cainjo@upmc.edu	USX Tower, 9th Floor	600 Grant Street	Pittsburgh	PA	15219	03/12/2019	2023	UPMC HEALTH BENEFITS, INC.	PDP	UPMC Health Plan	Medicare Prescription Drug Plan		UPMC Health System	249	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S3521	Agent/Broker Compensation Data Contact	Manager, Broker Administration and Operations		McBride	Kelly		5857396683					Kelly.McBride@Excellus.com	165 Court Street		Rochester	NY	14647	04/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Automated TrOOP Balance Transfer Contact	Medicare Product Operations Specialist		Laird	Jennifer		5853397717					Jennifer.Laird@excellus.com	165 Court Street		Rochester	NY	14647	04/28/2014	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Backup User Access Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court Street		Rochester	NY	14647	11/02/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Best Available Evidence Contact	Supervisor Medicare Operations		Piershalski	Dana		7168574435				7168576160	medicare.reconciliation.unit@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Bid Audit Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	09/14/2020	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Bid Audit Site Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	09/14/2020	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Bid Primary Contact	Actuarial Director, Government Programs		Hackel	Susan		5857942328					Susan.Hackel@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	CAP Report Contact for Public Website	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	CEO - CMS Administrator Contact	Executive Vice President & Chief Financial Officer	Mr	Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	CEO - Senior Official for Contracting	President and Chief Executive Officer	Mr.	Reed	Jim		3156716406					Jim.Reed@excellus.com	333 Butternut Drive		Syracuse	NY	13214	05/19/2021	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Chief Financial Officer	Executive Vice President & Chief Financial Officer	Mr.	Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Chief Operating Officer	President and Chief Executive Officer	Mr.	Reed	Jim		3156716406					Jim.Reed@excellus.com	333 Butternut Drive		Syracuse	NY	13214	05/19/2021	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Chief Information Officer	Vice President, IT Finance and Corporate System	Ms	Walker	Angela		5853276529					Angela.Walker@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Chief Information Security Officer	Vice President, Chief Information Security Officer	Mr.	Pickup	Jason		5853397620	25511				Jason.Pickup@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	CMS Casework Communication Contact	Medicare Compliance Program Administrator		Gomez	Rafael		7168576226					Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Complaints Tracking Contact	Medicare Compliance Program Administrator		Gomez	Rafael		7168576226					Rafael.Gomez@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Contact for Fraud Investigations	Corporate Director of Special Investigations		Paris	Meg		5852384425				5854536346	Meg.Paris@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Coordination of Benefits Contact	Manager, Analysis and Recovery		May	Mary		3157928873					Mary.May@excellus.com	12 Rhoads Dr.		Utica	NY	13502	07/17/2023	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Corporate Mailing						5852384505					CCiardi@excellus.com	165 Court Street		Rochester	NY	14647	02/07/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Coverage Gap Discount Program (CGDP) Payment Contact	Director Treasury Business Process Management		Weiser	Heidi		5853397791					Heidi.Weiser@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Customer Service Operations Contact	Vice President, Customer Care		Levi	Alexander		5853996683					Alexander.Levi@excellus.com	300 Main St.		East Rochester	NY	14445	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	DIR Contact	Actuarial Analyst		LaMantia	John		8726007942					John.LaMantia@excellus.com	165 Court Street		Rochester	NY	14647	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	DIR Contact (Secondary)	Manager, Actuarial Services		Khaper	Susan		3156716451					Susan.Khaper@excellus.com	333 Butternut Drive		Syracuse	NY	13214	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Emergency Part D Contact	Executive Vice President & Chief Financial Officer		Gorecki	Christophe	M	4809935254					Christopher.Gorecki@excellus.com	165 Court St		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Emergency Part D Contact (Secondary)	Director, Pharmacy Operations		Rocco	Darlene		5852613857				8778125306	Darlene.Rocco@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Enrollment Contact	Director, Medicare Enrollment and Reconciliation		Della Rocco	Kimberly		5853393876					Kimberly.DellaRocco@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	EOB Transfer Contact	Pharmacy Product Ops Specialist		Ammons	Andrea		5853397986				8778125306	Andrea.Ammons@excellus.com	165 Court Street		Rochester	NY	14647	09/14/2020	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Financial Audit Contact	Manager Financial Compliance	Mr.	Mau	Ahren		5854785535					Ahren.Mau@excellus.com	165 Court Street		Rochester	NY	14647	08/26/2021	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Financial Reporting Contact	Manager, Medicare and SN Finance		Stalzer	Virginia		5852384428					Virginia.Stalzer@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Formulary Contact	Medicare Part D Formulary Manager		Woodruff	Eric		7167832740					Eric.Woodruff@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Formulary Contact (Secondary)	Medicare Part D Formulary Manager		Banaszak	Danielle		7166145704					Danielle.Banaszak@excellus.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	General Contact	VP Retail Markets Operations		Bodley	Karen		5854559038					Karen.Bodley@excellus.com	165 Court Street		Rochester	NY	14647	08/05/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Government Relations Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	HIPAA Privacy Officer	VP, Ethics & Privacy Officer		Hill	Timothy	J	3156716663					Timothy.Hill@excellus.com	333 Butternut Drive		Dewitt	NY	13214	08/01/2023	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	HIPAA Security Officer	Vice President, Chief Information Security Officer		Pickup	Jason		5853397620					Jason.Pickup@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Hospice Contact	Manager, Pharmacy Utilization Management		Khan	Joe		7168437881					Joe.Khan@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	09/29/2020	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Interoperability Contact	Program Manager		Ozminkowski	David		5855305532					David.Ozminkowski@excellus.com	165 Court Street		Rochester	NY	14647	02/07/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Marketing Contact	Marketing Manager		Reardon	Elizabeth		5853276504					Elizabeth.Reardon@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Medical Director	Senior VP and Corporate Medical Director		Cohen	Stephen		5854536366					Stephen.Cohen@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Medicare Coordinator	VP Retail Markets Operations		Bodley	Karen		5854559038					Karen.Bodley@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Medicare Part D Opioid Overutilization Contact	Quality Improvement Clinical Pharmacist		Morano	Melissa		7166145705					melissa.morano@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	06/15/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Medication Therapy Management Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Online Enrollment Center Contact (Back-up)	Enrollment Operation Project Manager II		Abiusi	Amy		7166145787					Amy.Abiusi@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Online Enrollment Center Contact (Optional)	Manager, EDI & Enrollment Governance		Field	Eric		3154360215					Eric.Field@excellus.com	333 Butternut Drive		Syracuse	NY	13214	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Online Enrollment Center Contact (Primary)	Enrollment Operations Analyst II		Conway	Michael		7165045512					Michael.Conway@univerahealthcare.com	205 Park Club Lane		Williamsville	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Part D Appeals	Compliance Program Administrator III		Gomez	Rafael							Rafael.Gomez@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active	7168576226				Medicare Prescription Drug Plan		5	New York
S3521	Part D Appeals Contact (Secondary)	Manager of Advocacy and Compliance Ops		Jobe	Jessica							Jessica.Jobe@excellus.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active	7162902570				Medicare Prescription Drug Plan		5	New York
S3521	Part D Application Contact	Product Implementation and Operations Project Mgr		McParlane	Kelli		7164910233					Kelli.McParlane@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	11/19/2021	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Part D Benefits Contact	Medicare Product Operations Specialist		Laird	Jennifer		5853397717					Jennifer.Laird@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Part D Claims Submission Contact	Medicare Product Operations Specialist		Kohlmeier	Charity		5853277540				8778125306	Charity.Kohlmeier@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Part D Exceptions Contact	Manager, Pharmacy Utiization Management		Khan	Joe							Joe.Khan@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	09/29/2020	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active	7168437881				Medicare Prescription Drug Plan		5	New York
S3521	Part D Exceptions Contact (Secondary)	Clinical Pharmacist		Murajda	Lauren							Lauren.Murajda@excellus.Com	165 Court Street		Rochester	NY	14647	10/31/2018	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active	5853397607				Medicare Prescription Drug Plan		5	New York
S3521	Part D Price File Contact (Back-up)	Pharmacy Product Ops Specialist		Kohlmeier	charity		5854536463					Charity.Kohlmeier@excellus.com	165 Court Street		Rochester	NY	14647	07/05/2023	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Part D Price File Contact (Optional)	Director of Government Programs		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	4225 W. 107th St.	#11202	Overland Park	KS	66207	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Part D Price File Contact (Primary)	Medicare Product Operations Specilist		Ciaramaglia	Shannon		5852384506					shannon.ciaramaglia@excellus.com	165 Court Street		Rocheser	NY	14647	05/03/2023	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Part D Quality Assurance Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Part D Reporting Contact	Medicare Compliance Program Administrator		Dewa	Renate		3155732791					Renate.Dewa@excellus.com	165 Court Street		Rochester	NY	14647	01/04/2023	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Patient Safety Contact	Manager, Clinical Pharmacy Programs		Diehl	Christophe		5855305648					Christopher.Diehl@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Payment Contact	Director, Medicare Enrollment and Reconciliation		Della Rocco	Kimberly		5853393876					Kimberly.DellaRocco@excellus.com	165 Court Street		Rochester	NY	14647	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Pharmacy Director	Director, Pharmacy Operations		Rocco	Darlene		5853277544					Darlene.Rocco@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Pharmacy Network Management Contact	Pharmacy Operations Support		Brown	Burt		5853277530				5853396640	Burt.Brown@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Pharmacy Network Management Contact (Secondary)	Network Account Directory Retail Strategy and Cont		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		ST Louis	MO	63121	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkway	Ste 150	Temple Terrace	FL	33637	12/28/2021	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	New York
S3521	Pharmacy Technical Help Desk Contact (Secondary)	SR Director Goverment Programs, Medicare		Gibson	Sharon							SGGibson@Express-scripts.Com	One Express Way		St Louis	MO	63121	12/31/2019	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	New York
S3521	Plan Directory Contact for Public Website	Manager, Customer Operations		Myrto	Colleen		3156718498					Colleen.Myrto@Excellus.com	333 Butternut Drive		Dewitt	NY	13214	08/24/2023	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Plan to Plan Reconciliation Contact	Manager, Finance Operations		Simmons	Jennifer		5852316874					Jennifer.Simmons@excellus.com	165 Court Street		Rochester	NY	14647	12/08/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Processor Contact	SR Directory Government Programs, Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St Louis	MO	63121	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Reconciliation Contact	Actuarial Analyst		LaMantia	John		8726007942					John.LaMantia@excellus.com	165 Court Street		Rochester	NY	14647	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Reconciliation Contact (Secondary)	Manager, Actuarial Services		Khaper	Susan		3156716451					Susan.Khaper@excellus.com	333 Butternut Drive		Syracuse	NY	13214	02/17/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Recovery Audit Contact	Manager Financial Compliance	Mr.	Mau	Ahren		5854785535					Ahren.Mau@excellus.com	165 Court St		Rochester	NY	14647	08/26/2021	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Surveillance Contact	Medicare Compliance Officer	Mrs.	Dibble	Laura		5853397745					Laura.Dibble@excellus.com	165 Court St.		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	System Contact	VP Information Technology		Leonard	LaRhonda		5854142258					LaRhonda.Leonard@excellus.com	300 Main St.		East Rochester	NY	14445	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	Third Party Administrator (TPA) Liaison	Financial Analyst		McManus	Michael		5853397789					Michael.Mcmanus@excellus.com	165 Court Street		Rochester	NY	14647	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3521	User Access Contact	Medicare Compliance Program Administrator		Conte	Elva		7163168569					Elva.Conte@univerahealthcare.com	205 Park Club Lane		Buffalo	NY	14221	01/18/2022	2023	EXCELLUS HEALTH PLAN, INC.	PDP	Excellus Health Plan, Inc	Medicare Prescription Drug Plan		Lifetime Healthcare, Inc.	87	Yes	Active					Medicare Prescription Drug Plan		5	New York
S3875	Agent/Broker Compensation Data Contact	Chief Financial Officer	Ms	Tveit	Kristen		4079674642				8886568099	KETveit@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Automated TrOOP Balance Transfer Contact	Dir, Project and Program Management		Arinsberg	Valerie		8555862573				8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Backup User Access Contact	Senior Director Pharmacy and Medicare Compliance		Lang	Larissa		4012398035				8886568099	llang@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Best Available Evidence Contact	Sr Mgr, Part D Services	Mr.	Valdivia	Luguer		8555862573				8886568099	SLCEnrollment@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Bid Audit Contact	Mgr, Client Services		Ibenskis	Sara		8015030117				8886568099	ibenskissn@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Bid Primary Contact	Mgr, Client Services		Ibenskis	Sara		8015030117				8886568099	ibenskissn@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	CAP Report Contact for Public Website	Compliance Officer		Lang	Larissa		4012398035					llang@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Kamal	Mostafa		9735157011				8886568099	mmkamal@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Kamal	Mostafa		9735157011					mmkamal@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Chief Financial Officer	Chief Financial Officer	Ms	Tveit	Kristen		4079674642				8886568099	KETveit@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Chief Operating Officer	Cheif Operations and Technology Officer	Mr.	Mertel	Matthew		4806249222					MMMertel@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Chief Information Officer	Chief Operations and Technology Officer	Mr.	Mertel	Matthew		4806249222					MMMertel@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Chief Information Security Officer	Chief Information Security Officer	Mr.	Kracke	Cam		6127774109					Ckracke@primetherapeutics.com	2900 Ames Cross Road		Eagan	MN	55121	01/30/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	CMS Casework Communication Contact	Compliance Officer		Lang	Larissa		4012398035					llang@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Complaints Tracking Contact	Compliance Officer		Lang	Larissa		4012398035					llang@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Contact for Fraud Investigations	Compliance Officer		Lang	Larissa		4012398035					llang@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Coordination of Benefits Contact	Senior Manager, Part D Services	Mr	Valdivia	Luguer		8015030117				8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Corporate Mailing						8555862573				8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst II		Yan	Kwok Cheun		4806249271					yank@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Customer Service Operations Contact	Dir, Medicare Operations		DiBiase	Joseph		4013441059				8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	DIR Contact	Manager Med D Finance	Mrs	Tressler	Nataliya		4806249383					ntressler@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	DIR Contact (Secondary)			Anderson	Brent		4806249295				8886568099	BAnderson2@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Emergency Part D Contact		Ms.	Ibenskis	Sara		8015030117				8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Emergency Part D Contact (Secondary)			Ahern	Vikki		4109163575				8886568099	ahernv@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Employer Waiver Contact		Ms.	Ibenskis	Sara		8015030117				8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Enrollment Contact		Mr.	Valdivia	Luguer		8015030118				8886568099	SLCEnrollment@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	EOB Transfer Contact			Jenkins	Erica		8555862573				8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Financial Audit Contact	Chief Financial Officer	Ms	Tveit	Kristen		4079874642				8886568099	KETveit@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Financial Reporting Contact	Chief Financial Officer	Ms	Tveit	Kristen		4079674642				8886568099	KETveit@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Formulary Contact	Sr. Director, Clinical Pharmacy Operations		Nunnally	Jilliann		8045434280					nunnallyj@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Formulary Contact (Secondary)	Clinical Pharmacy Operations Analyst		Miller	Steven		4806249491					millers2@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	General Contact	Compliance Officer		Lang	Larissa		4012398035					llang@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Government Relations Contact	Compliance Officer		Lang	Larissa		4012398035					llang@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	HIPAA Privacy Officer	HIPAA Privacy Officer		Toy	Grace		5622928150					toyg@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	HIPAA Security Officer	HIPAA Security Officer	Mr.	Kracke	Cam		6127774109					Ckracke@primetherapeutics.com	2900 Ames Cross Road		Eagan	MN	55121	01/30/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Hospice Contact		Ms.	Ibenskis	Sara	N	8015030117				8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Interoperability Contact			Stark	Sean		8555862573					SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Marketing Contact			Jenkins	Erica		8015030117				8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Medical Director	Medical Director	Dr.	Chodroff	Marci		8015030117				8886568099	mchodroff@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Medicare Compliance Officer	Compliance Officer	Ms.	Lang	Larissa		4012398035				8886568099	llang@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Medicare Coordinator		Ms.	Ibenskis	Sara		8015030117				8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Medicare Part D Opioid Overutilization Contact	Dir, Clinical Pharmacy Operations		Boyer	Todd		8014336230				8886568099	boyert2@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Medication Therapy Management Contact	Senior Director Clinical Pharmacy Programs MTM		Ferro	Christina		4013441063				8886562207	cferro@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Part D Appeals	Dir, Clinical Pharmacy Operations		DiBiase	Joseph						8886567791	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active	4013441059				Medicare Prescription Drug Plan		5	Dallas
S3875	Part D Appeals Contact (Secondary)	Supervisor, Clinical Pharmacy	Ms	Tunstall	Aaliyah						8555862573	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active	8015030117				Medicare Prescription Drug Plan		5	Dallas
S3875	Part D Application Contact	Mgr, Client Services		Ibenskis	Sara		8015030117				8886568099	ibenskissn@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Part D Benefits Contact	Mgr, Client Services		Ibenskis	Sara		8015030117				8886568099	ibenskissn@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Part D Claims Submission Contact			Arinsberg	Valerie		8555862573				8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Part D Exceptions Contact	Manager Clinical Pharmacy Operations		DiBiase	Joseph						8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active	4013441059				Medicare Prescription Drug Plan		5	Dallas
S3875	Part D Exceptions Contact (Secondary)	Supervisor, Clinical Pharmacy		Tunstall	Aaliyah						8886568099	SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active	8555862573				Medicare Prescription Drug Plan		5	Dallas
S3875	Part D Price File Contact (Back-up)			Gimm	Joy		6026153241					JGimm@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Part D Price File Contact (Primary)			Ahern	Vikki		4109163575					ahernv@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Part D Quality Assurance Contact		Ms.	Jaco	Tame		3143874922					TAJaco@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Part D Reporting Contact	Dir, Clinical Pharmacy Operations	Ms.	Boyer	Todd		8015030117					boyert2@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Patient Safety Contact	Dir, Clinical Pharmacy Operations		Boyer	Todd		8014336230				8886568099	boyert2@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Payment Contact	Chief Financial Officer	M	Tveit	Kristen		4079674642				8886568099	KETveit@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Pharmacy Director	Dir, Clinical Pharmacy Operations		Boyer	Todd		8015030354				8886568099	boyert2@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Pharmacy Network Management Contact			Gimm	Joy		6026153241					JGimm@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Pharmacy Network Management Contact (Secondary)		Mrs.	Ibenskis	Sara		8015030117					SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Pharmacy Technical Help Desk Contact			DiBiase	Joseph								2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active	8045480494				Medicare Prescription Drug Plan		5	Dallas
S3875	Pharmacy Technical Help Desk Contact (Secondary)	Supervisor, Clinical Pharmacy		Mendoza	Samantha							SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active	8555862573				Medicare Prescription Drug Plan		5	Dallas
S3875	Plan Directory Contact for Public Website	Dir, Correspondence and Marketing	Mrs.	Jenkins	Erica		8015030117					hansonjenkinse@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Plan to Plan Reconciliation Contact	Manager Finance Med D		Nataliya	Tressler		4806249383					ntressler@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Processor Contact	Dir, Project and Program Management		Arinsberg	Valerie		4806249424					SLCPDP@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Reconciliation Contact	Manager Med D Finance	Mrs	Tressler	Nataliya		4806249383					ntressler@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Reconciliation Contact (Secondary)	Financial Analyst		Yan	Kwok Cheun		4806249271					yank@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Recovery Audit Contact	Finance	Mr	Anderson	Brent		4012398035				8886568099	SLCAccounting2@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Surveillance Contact	Compliance Officer		Lang	Larissa		4012398035					llang@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	System Contact	Sr. Director Compliance		Lang	Larissa		4107469722					llang@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	02/07/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	Third Party Administrator (TPA) Liaison	VP Finance		Anderson	Brent		2163748869					banderson2@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	03/09/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3875	User Access Contact	Compliance Officer		Lang	Larissa		4012398035					llang@magellanhealth.com	2900 Ames Cross Road		Eagan	MN	55121	01/23/2023	2023	GRANITE ALLIANCE INSURANCE COMPANY	PDP	Granite Alliance	Medicare Prescription Drug Plan		Prime Therapeutics, LLC.	803	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S3994	Agent/Broker Compensation Data Contact	Supervisor, Medicare Sales		Guzman	Tati		8089485463				8089486585	tati_guzman@hmsa.com	P.O. Box 860	8 AMS	Honolulu	HI	96808	04/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Automated TrOOP Balance Transfer Contact	Senior Business Analyst		Kalino	Karen		8089486262				8089486585	karen_apiki_kalino@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	11/27/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Backup User Access Contact	VP, Chief Compliance Officer		Nakamura	Carrie		8089485369					carrie_nakamura@hmsa.com	P.O. Box 860	10-CE	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Best Available Evidence Contact	Manager, Membership Services		Makio	Lani		8089486215				8089486285	lani_makio@hmsa.com	P.O. Box 860	7 - MS	Honolulu	HI	96808	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Bid Audit Contact	EVP, Chief Financial Officer		Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Bid Audit Site Contact	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Bid Primary Contact	President & Consulting Actuary		Swain	Gavin		8089527931					Gavin_Swain@hmsa.com	2333 Kapiolani Blvd	gXs Consulting, LLC	Honolulu	HI	96826	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Rivad	Maila		8089485767				8089486585	MCO@hmsa.com	P.O. Box 860	10-CE	Honolulu	HI	96808	01/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	CEO - CMS Administrator Contact	President and CEO	Mr.	Mugiishi	Mark		8089485021				8089485999	mark_mugiishi@hmsa.com	P.O. Box 860	11-EXEC	Honolulu	HI	96808	01/05/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	CEO - Senior Official for Contracting	President and CEO	Mr.	Mugiishi	Mark		8089485021				8089485999	mark_mugiishi@hmsa.com	P.O. Box 860	11-EXEC	Honolulu	HI	96808	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Chief Financial Officer	EVP, Chief Financial Officer	Ms.	Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Chief Operating Officer	EVP, Chief Business Operations Officer	Mr.	Herndon	David		8089485099					David_Herndon@hmsa.com	P.O. Box 860	11-EXEC	Honolulu	HI	96808	11/27/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Chief Information Officer	SVP and Chief Information Officer	Mr.	Hopfer	Rick		8089486025				8089485999	rick_hopfer@hmsa.com	P.O. Box 860	11-EXEC	Honolulu	HI	96808	07/13/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Chief Information Security Officer	CISO and Privacy Officer	Mr.	Gummadi	Sudhakar		8089485737				8089527580	sudhakar_gummadi@hmsa.com	P.O. Box 860	10-IPP	Honolulu	HI	96808	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	CMS Casework Communication Contact	Medicare Grievance & Appeal Coordinator		Hartenstein	Renee		8089485347				8089527546	Renee_Hartenstein@hmsa.com	P.O. Box 860	KB-MAA	Honolulu	HI	96808	12/29/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Complaints Tracking Contact	Medicare Grievance & Appeal Coordinator		Hartenstein	Renee		8089485347				8089527546	renee_hartenstein@hmsa.com	P.O. Box 860	KB-MAA	Honolulu	HI	96808	11/24/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Contact for Fraud Investigations	Director, Special Investigations Unit		Aronson	Virginya		8089528548					virginya_aronson@hmsa.com	P.O. Box 860	10 SIU	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Coordination of Benefits Contact	Sr Mgr, Internal Operations		Shimamura	Ross		8089486294					ross_shimamura@hmsa.com	P.O. Box 860	7-CA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Corporate Mailing						8089486000					!MedicarePrograms@hmsa.com	P.O. Box 860	9 - MP	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Coverage Gap Discount Program (CGDP) Payment Contact	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Customer Service Operations Contact	Manager, Customer Relations Operations		Unger	Kevin		8089486186				8089485567	Customer-service@hmsa.com	P.O. Box 860	7 CR	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	DIR Contact	EVP, Chief Financial Officer		Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	DIR Contact (Secondary)	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Emergency Part D Contact	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Emergency Part D Contact (Secondary)	Health Management Operations Compliance Analyst		Iwaishi	Brandon		8089485618					brandon_iwaishi@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Enrollment Contact	Manager, Membership Services		Makio	Lani		8089486215				8089486285	lani_makio@hmsa.com	P.O. Box 860	7 - MS	Honolulu	HI	96808	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	EOB Transfer Contact	Senior Business Analyst, Medicare Programs		Refuerzo	Marilou		8084970295				8089486585	marilou_refuerzo@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Financial Audit Contact	Director, Government Accounting and Reporting	Ms.	Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Financial Reporting Contact	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Formulary Contact	Health Management Operations Compliance Analyst		Iwaishi	Brandon		8089485618					brandon_iwaishi@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	05/10/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Formulary Contact (Secondary)	Manager, Clinical Pharmacy		Kuniyoshi	Derek		8089486723				8089488298	derek_kuniyoshi@hmsa.com	1601 Kapiolani Blvd.	10-KB-PM	Honolulu	HI	96814	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	General Contact	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Government Relations Contact	SVP, Government		Diesman	Jennifer		8085616397				8089486860	jennifer_diesman@hmsa.com	P.O. Box 860	11 EXEC	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	HIPAA Privacy Officer	CISO and Privacy Officer	Mr.	Gummadi	Sudhakar		8089485737				8089527580	sudhakar_gummadi@hmsa.com	P.O. Box 860	10-IPP	Honolulu	HI	96808	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	HIPAA Security Officer	CISO and Privacy Officer	Mr.	Gummadi	Sudhakar		8089485737				8089527580	sudhakar_gummadi@hmsa.com	P.O. Box 860	10-IPP	Honolulu	HI	96808	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Hospice Contact	Business Analyst - Medicare Part D		Pagura	Herch		8089486559				8089485611	herch_pagura@hmsa.com	PO Box 860	PM - Administration	Honolulu	HI	96808	11/03/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Interoperability Contact	VP, Health Data Integ & Analytic		Dobbs	David	C	8089486030					david_dobbs@hmsa.com	P.O. Box 860	6 CORP	Honolulu	HI	96808	04/08/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Marketing Contact	Bus Analyst II - Medicare		England	Belle		8089481064					belle_england@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Medical Director	Medicare Medical Director		Percy	David		8089486252				8089486340	david_percy@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Rivad	Maila		8089485767				8089486585	MCO@hmsa.com	P.O. Box 860	10-CE	Honolulu	HI	96808	01/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Medicare Coordinator	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Medicare Part D Opioid Overutilization Contact	Manager, Clinical Pharmacy		Kuniyoshi	Derek		8089486723				8089488298	derek_kuniyoshi@hmsa.com	1601 Kapiolani Blvd.	10-KB-PM	Honolulu	HI	96814	04/08/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Medication Therapy Management Contact	BH Business Analyst		Francis	Teesha		8089527564					teesha_francis@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Online Enrollment Center Contact (Back-up)	Business Analyst, TIQI, Enrollment		Del Toro	Chris		8089527848					Chris_Del_Toro@hmsa.com	P.O. Box 860	7-CR	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Online Enrollment Center Contact (Optional)	Bus Analyst II - Medicare		England	Belle		8089481064					belle_england@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Online Enrollment Center Contact (Primary)	Manager, Membership Services		Makio	Lani		8089486215				8089486285	lani_makio@hmsa.com	P.O. Box 860	7 MS	Honolulu	HI	96808	10/19/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Part D Appeals	Senior Manager, Member Advocacy & Appeals		Dureg	Jeron						8089527546	jeron_dureg@hmsa.com	P.O. Box 860	KB-MAA	Honolulu	HI	96808	11/27/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active	8089485180				Medicare Prescription Drug Plan		5	San Francisco
S3994	Part D Appeals Contact (Secondary)	Senior Business Analyst		Kalino	Karen						8089486585	karen_apiki_kalino@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	11/27/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active	8089486262				Medicare Prescription Drug Plan		5	San Francisco
S3994	Part D Application Contact	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Part D Benefits Contact	AVP, Medicare Programs		Takata Endo	Kimberly		8089528522				8089486887	kim_takata@hmsa.com	P.O. Box 860	8 - MP	Honolulu	HI	96808	01/26/2023	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Part D Claims Submission Contact	EVP, Chief Financial Officer		Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Part D Exceptions Contact	Manager, Clinical Pharmacy		Kuniyoshi	Derek						8089488298	derek_kuniyoshi@hmsa.com	1601 Kapiolani Blvd.	10-KB-PM	Honolulu	HI	96814	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active	8004622085				Medicare Prescription Drug Plan		5	San Francisco
S3994	Part D Price File Contact (Back-up)	Manager		Loveland	Chet		4806064873				4013357984	chet.loveland@CVSHealth.com	9501 E Shea Blvd	CVS Caremark	Scottsdale	AZ	85260	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Part D Price File Contact (Optional)	Program Manager  PBM Finance Operations		Pertgen	Richard		8045258502					Richard.Pertgen@cvshealth.com	9501 E. Shea Blvd. MC080	CVS Caremark	Scottsdale	AZ	85260	12/29/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Part D Price File Contact (Primary)	Sr. Manager		Okrie	Courtney		4803181864				4013357984	courtney.okrie@cvshealth.com	9501 E. Shea Blvd. MC080	CVS Caremark	Scottsdale	AZ	85260	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Part D Quality Assurance Contact	Health Management Operations Compliance Analyst		Iwaishi	Brandon		8089485618					brandon_iwaishi@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Part D Reporting Contact	Medicare Compliance Officer	Ms.	Rivad	Maila		8089485767				8089486585	MCO@hmsa.com	P.O. Box 860	10-CE	Honolulu	HI	96808	10/09/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Patient Safety Contact	Manager, Clinical Pharmacy		Kuniyoshi	Derek		8089486723				8089488298	derek_kuniyoshi@hmsa.com	1601 Kapiolani Blvd.	10-KB-PM	Honolulu	HI	96814	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Payment Contact	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Pharmacy Director	VP, Chief Medical Officer		Park	Stefanie		8089486792					stefanie_park@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	05/03/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Pharmacy Network Management Contact	Director		Smith	Shawn		4803914844					shawn.smith@cvshealth.com	9501 E. Shea Blvd., MC080	CVS Caremark	Scottsdale	AZ	85260	12/20/2019	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Pharmacy Network Management Contact (Secondary)	VP, Chief Medical Officer		Park	Stefanie		8089486792					stefanie_park@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	05/03/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Pharmacy Technical Help Desk Contact	Lead Director, Client Operations Customer Care		Neiman	Beth							Beth.Neiman@CVSHealth.com	100 Mall Blvd	CVS Specialty	Monroeville	PA	15146	11/07/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active	8666934620				Medicare Prescription Drug Plan		5	San Francisco
S3994	Pharmacy Technical Help Desk Contact (Secondary)	Health Management Operations Compliance Analyst		Iwaishi	Brandon							brandon_iwaishi@hmsa.com	P.O. Box 860	10-KB-MM	Honolulu	HI	96808	05/10/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active	8089485618				Medicare Prescription Drug Plan		5	San Francisco
S3994	Plan Directory Contact for Public Website	Manager, Customer Relations Operations		Unger	Kevin		8089486186				8089485567	Customer-service@hmsa.com	P.O. Box 860	7 CR	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Plan to Plan Reconciliation Contact	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Processor Contact	Director, Payment Integrity & Quality Assurance		Nagao	Traci		8089485599				8089486210	traci_nagao@hmsa.com	P.O. Box 860	7 - CA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Reconciliation Contact	EVP, Chief Financial Officer		Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Reconciliation Contact (Secondary)	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Recovery Audit Contact	EVP, Chief Financial Officer	Ms.	Marting	Gina		8089485696				8089485999	gina_marting@hmsa.com	P.O. Box 860	11 - EXEC	Honolulu	HI	968080860	12/23/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Surveillance Contact	Supervisor, Medicare Sales		Guzman	Tati		8089485463				8089486585	tati_guzman@hmsa.com	P.O. Box 860	8 AMS	Honolulu	HI	96808	12/04/2020	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	System Contact	Solution Delivery Advisor		Ng	Philip		8089486688				8089486799	philip_ng@hmsa.com	P.O. Box 860	5 - IS	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	Third Party Administrator (TPA) Liaison	Director, Government Accounting and Reporting		Nakashima	Marla		8089486020				8089485063	marla_nakashima@hmsa.com	P.O. Box 860	6 FA	Honolulu	HI	96808	10/27/2022	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S3994	User Access Contact	Medicare Compliance Officer	Ms.	Rivad	Maila		8089485767				8089486585	MCO@hmsa.com	P.O. Box 860	10-CE	Honolulu	HI	96808	06/08/2021	2023	HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)	PDP	HMSAs Medicare Rx Plan	Medicare Prescription Drug Plan		Hawaii Medical Service Association	107	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S4219	Agent/Broker Compensation Data Contact	Director of Consumer Sales and Retention		Jones	Jeremy		2179028167					Jeremy.Jones@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Automated TrOOP Balance Transfer Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Backup User Access Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Best Available Evidence Contact	Medicare Enrollment Manager		Kirby	Rae		2179029108					rae.kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Bid Audit Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Bid Audit Site Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Bid Primary Contact	Director of Product Development and Market Intel		Snyder	Rachel		2179029452					Rachel.Snyder@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/08/2023	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	CAP Report Contact for Public Website	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active	8009654022				Medicare Prescription Drug Plan		5	Chicago
S4219	CEO - CMS Administrator Contact	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	CEO - Senior Official for Contracting	CEO	Mrs.	Madigan	Sinead		2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/13/2023	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Chief Financial Officer	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/18/2021	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Chief Operating Officer	Chief Operating Officer	Mr.	McPhearson	Les		2179029740				2179029740	Les.McPhearson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Chief Information Officer		Ms.	Griffith	Kim		2179029004				2179029740	kim.griffith@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/22/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Chief Information Security Officer	Director of Information Security	Mr.	Martin	Trevor		2179025130					Trevor.Martin@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	06/09/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	CMS Casework Communication Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Complaints Tracking Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Contact for Fraud Investigations	Corporate Compliance and ERM Mgr		Adamson	Susan		2179029137					Susan.Adamson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Coordination of Benefits Contact	Director of Claims & Recovery		Parker	Lisa		2179028353				2179029786	lisa.parker@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Corporate Mailing						2179028301				2179029740	Sinead.Madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/22/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Coverage Gap Discount Program (CGDP) Payment Contact			Boyce	Heather		2179029467					heather.boyce@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Customer Service Operations Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	DIR Contact	Director of Accounting		Deane	Laura		2179078322				2179029740	laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	DIR Contact (Secondary)			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Emergency Part D Contact	VP, Chief Compliance Officer		Wilson	Hollie		2176214156				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Emergency Part D Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368					Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Employer Waiver Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224					Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Enrollment Contact	Medicare Enrollment Manager		Kirby	Rae		2179029108					rae.kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	EOB Transfer Contact	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Financial Audit Contact	Executive Director of Finance	Mr.	Maxwell	Jamey		2179028321				2179029740	jamey.maxwell@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Financial Reporting Contact	Chief Financial Officer	Mr.	Bradford	Jerry		2179029002				2179029740	Jerry.Bradford@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	10/18/2021	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Formulary Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Formulary Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368				2179029798	Jena.Deschler@healthalliance.org	3310 Fields South		Champaign	IL	61822	11/19/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	General Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Government Relations Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	HIPAA Privacy Officer	Director, Corporate Compliance and Privacy Officer		Jensen	Traci		2179029152				2179029794	traci.jensen@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	HIPAA Security Officer		Mr.	Scheiding	Wyatt		2179025387				2179029740	wyatt.scheiding@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/22/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Hospice Contact	Director of Pharmacy		Buhr	Aimee		2179029366					Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Interoperability Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Marketing Contact	VP, Products and Marketing		Perry	Jana	L	2179028101				2179029740	jana.perry@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Medical Director	Associate Chief Medical Officer	Dr.	Revai	Krystal		2179028301				2179029740	Krystal.Revai@healthalliance.org	3310 Fields South Drive		Champaign	IL	61821	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Medicare Compliance Officer	Medicare Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	Hollie.Wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/02/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Medicare Coordinator	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Medicare Part D Opioid Overutilization Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Medication Therapy Management Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	OffShore Subcontractor Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Online Enrollment Center Contact (Back-up)	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Online Enrollment Center Contact (Optional)	Medicare Enrollment Manager		Kirby	Rae		2179029108					Rae.Kirby@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Online Enrollment Center Contact (Primary)	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Appeals	Member / Provider Relations Manager		Regal	Wendi						2179029708	Wendi.Regal@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active	2179028017				Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Appeals Contact (Secondary)	CEO		Madigan	Sinead						2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active	8008513379				Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Application Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Benefits Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029740	Hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Claims Submission Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Exceptions Contact	VP, Chief Compliance Officer		Wilson	Hollie						2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active	2179028224				Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Exceptions Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena						2179029798	Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active	2179029368				Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Price File Contact (Back-up)	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Price File Contact (Optional)	PBM Contact		Lyman	Dorothy		6126326265					DL-MedOpsPlanFinder@catamaranrx.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Price File Contact (Primary)	Lead IT Operations		Walker	Kathy		2179025198				2173378189	kathy.walker@healthalliance.org	3310 Fields South		Champaign	IL	61822	01/22/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Quality Assurance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Part D Reporting Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Patient Safety Contact	Medicare Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	09/25/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Payment Contact	Director of BECS		Kleinert	Traci		2179029508				2179029797	Traci.Kleinert@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Pharmacy Director	Director of Pharmacy		Buhr	Aimee		2179029366				2179029798	Aimee.Buhr@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Pharmacy Network Management Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Pharmacy Network Management Contact (Secondary)	Managed Care Pharmacist		Deschler	Jena		2179029368				2179029798	Jena.Deschler@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Pharmacy Technical Help Desk Contact	VP, Chief Compliance Officer		Wilson	Hollie						2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active	8442651876				Medicare Prescription Drug Plan		5	Chicago
S4219	Plan Directory Contact for Public Website	Director of Customer Solutions		Marquardt	Jennifer		2179029229				2179029705	Jennifer.Marquardt@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Plan to Plan Reconciliation Contact			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Dr		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Processor Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029497	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Reconciliation Contact	Director of Accounting		Deane	Laura		2179078322				2179029740	laura.deane@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	05/30/2018	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Reconciliation Contact (Secondary)			Tizora	Elizabeth		2179029469					elizabeth.tizora@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	03/14/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Recovery Audit Contact	VP, Chief Compliance Officer	Mrs.	Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Surveillance Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	System Contact	CEO		Madigan	Sinead		2179028301				2179029740	sinead.madigan@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	Third Party Administrator (TPA) Liaison			Johnson	Danica		2179028322				2173657494	danica.johnson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	01/22/2019	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4219	User Access Contact	VP, Chief Compliance Officer		Wilson	Hollie		2179028224				2179029794	hollie.wilson@healthalliance.org	3310 Fields South Drive		Champaign	IL	61822	08/22/2022	2023	HEALTH ALLIANCE MEDICAL PLANS	PDP	Health Alliance Medicare Prescription Plan	Medicare Prescription Drug Plan		The Carle Foundation	583	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S4501	Agent/Broker Compensation Data Contact	Director Government Sales		Aquino	Cathy		7166354948				7166318857	cathy.aquino@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/29/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Automated TrOOP Balance Transfer Contact	Directory-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Backup User Access Contact	Risk Operations Analyst		Carr	Sarah Jane		7166313001					SarahJane.Carr@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/19/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Best Available Evidence Contact	Manager - Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Bid Audit Contact	Director - Underwriting		Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/04/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Bid Audit Site Contact	Chief Compliance Officer		Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Bid Primary Contact	Director - Underwriting		Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/04/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	CAP Report Contact for Public Website	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	CEO - CMS Administrator Contact	President, CEO	Dr.	Cropp, MD	Michael		7166353995				7162507135	Michael.Cropp@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/03/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	CEO - Senior Official for Contracting	President, CEO	Dr.	Cropp, MD	Michael		7166353995				7162507135	Michael.Cropp@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/10/2014	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Chief Financial Officer	Executive Vice President - Chief Financial Officer	Mr.	Dunlop	James		7166313001					James.Dunlop@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	07/06/2021	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Chief Operating Officer	Exec Vice President and Chief Operating Officer	Mr.	Rodgers	John		7166353630					john.rodgers@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/12/2014	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Chief Information Officer	Chief Information Security Officer	Mr.	Jabrucki	Peter		7162507383					Peter.Jabrucki@Independenthealth.com	511 Farber lakes		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Chief Information Security Officer	Chief Information Security Officer	Mr.	Jabrucki	Peter		7162507383					Peter.Jabrucki@Independenthealth.com	511 Farber lakes		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	CMS Casework Communication Contact	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Complaints Tracking Contact	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Contact for Fraud Investigations	Vice President, Claims and Recovery Operations		Shute	David		7166354814					David.Shute@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/12/2015	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Coordination of Benefits Contact	Manager - Corporate Recoveries		Abou-Said	Kelly		7166353758					Kelly.Abou-Said@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/07/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Corporate Mailing						7166313001					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Coverage Gap Discount Program (CGDP) Payment Contact	Manager - Treasury Services		Fisher	Dave		7166353561					Dave.Fisher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/28/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Customer Service Operations Contact	Manager - Provider & Member Services		Bogacz	Lindsay		7166353973					Lindsay.Bogacz@pbdrx.com	511 Farber Lakes Drive		Buffalo	NY	14221	05/08/2020	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	DIR Contact	Director - Pharmacy Services and Operations		Malcolm	Jillian		7165121604					jillian.malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/03/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	DIR Contact (Secondary)	VP - Pharmacy Services		Burruano	Martin		7162257559				7166310149	martin.burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/03/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Emergency Part D Contact	VP Pharmacy Services		Burruano	Martin		7162257559				7166319636	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Emergency Part D Contact (Secondary)	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Employer Waiver Contact	VP, Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Enrollment Contact	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	EOB Transfer Contact	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604				7166319636	Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Financial Audit Contact	Director-Underwriting	Ms.	Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/23/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Financial Reporting Contact	Accountant Regulatory Reporting-Senior		Smith	Evan		7166353798					Evan.Smith@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/01/2021	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Formulary Contact	Clinical Pharmacist		Waite	Rebecca		7166353825				7162507163	Rebecca.Waite@pbdrx.com	511 Farber Lakes Drive		Buffalo	NY	14221	06/06/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Formulary Contact (Secondary)	Pharmacy Services Compliance & Product Specialist		Basher	Lindsay		7166353547					Lindsay.Basher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	05/21/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	General Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Government Relations Contact	SVP Government Programs		Tracy	Robert		7166354904					Robert.Tracy@independenthealth.com	511 Farber Lakes Drive		Williamsville	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	HIPAA Privacy Officer	Chief Information Security Officer		Jabrucki	Peter		7162507383				7162507115	peter.jabrucki@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	HIPAA Security Officer	Chief Information Security Officer		Jabrucki	Peter		7162507383				7162507115	peter.jabrucki@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Hospice Contact	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Interoperability Contact	VP-IT Application Delivery		Haak	Lesley		7162504443					Lesley.Haak@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Marketing Contact	Director Government Sales		Aquino	Cathy		7166354948				7166318857	cathy.aquino@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Medical Director	EVP - Chief Medical Officer	Dr.	Billittier, MD	Anthony		7166353635					Anthony.Billittier@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	06/19/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Medicare Compliance Officer	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/20/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Medicare Coordinator	VP Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Brim	Karen		7166353617					karen.brim@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/29/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Medication Therapy Management Contact	Director Pharmacy, Quality and MTM		Verrall	Kelly		7166354885				7166310149	kelly.verrall@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	OffShore Subcontractor Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354980					Dawn.Odrzywolski@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Online Enrollment Center Contact (Back-up)	Operations and System Analyst-Mbrs Operations		Cole	Jenn		7166353960	2274				Jenn.cole@independenthealth.com	511 Farber Lakes Drive		Williamsville	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Online Enrollment Center Contact (Optional)	Supervisor-Enrollment		Kindred	Amanda		7166352157					Amanda.Kindred@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Online Enrollment Center Contact (Primary)	Manager Enrollment Operations		Sell	Melanie		7162507321				7162507162	melanie.sell@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	11/09/2017	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Part D Appeals	Director - Benefit Administration and Compliance		Kieser	Michelle							michelle.kieser@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/13/2015	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active	8006651502				Medicare Prescription Drug Plan		5	New York
S4501	Part D Appeals Contact (Secondary)	Director, Benefit Administration and Compliance		Kieser	Michelle							Michelle.Kieser@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/13/2017	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active	8007365771				Medicare Prescription Drug Plan		5	New York
S4501	Part D Application Contact	Product Manager		Morgan	Evan		7166353740					Evan.Morgan@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/12/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Part D Benefits Contact	VP, Pharmacy Services		Burruano	Martin		7162257559				7166319636	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Part D Claims Submission Contact	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Part D Exceptions Contact	VP- Pharmacy Services		Burruano	Martin						7166310149	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active	8002471466	5311			Medicare Prescription Drug Plan		5	New York
S4501	Part D Exceptions Contact (Secondary)	Director-Pharmacy Services and Operations		Malcolm	Jillian						7166310149	Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active	8002471466	5311			Medicare Prescription Drug Plan		5	New York
S4501	Part D Price File Contact (Back-up)	Pharmacy Services Compliance & Product Specialist		Basher	Lindsay		7166353547					Lindsay.Basher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	05/21/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Part D Price File Contact (Optional)	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Part D Price File Contact (Primary)	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Part D Quality Assurance Contact	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Part D Reporting Contact	Medicare Programs Implementation Manager		Laubacker	Jeremy		7166354994				7162507197	jeremy.laubacker@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/06/2020	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Patient Safety Contact	Director, Pharmacy, Quality and MTM		Verrall	Kelly		7166354885				7162507121	kelly.verrall@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Payment Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354980				7162507197	Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Pharmacy Director	VP Pharmacy Services		Burruano	Martin		7162257559				7166310149	martin.burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Pharmacy Network Management Contact	VP Pharmacy Services		Burruano	Martin		7162257559				7166319636	Martin.Burruano@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Pharmacy Network Management Contact (Secondary)	Director-Pharmacy Services and Operations		Malcolm	Jillian		7165121604					Jillian.Malcolm@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/06/2023	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Pharmacy Technical Help Desk Contact	Supervisor-Member Servicing		Bates	Taylor							Taylor.Bates@pbdrx.com	511 Farber Lakes Drive		Buffalo	NY	14221	12/02/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active	8009939898				Medicare Prescription Drug Plan		5	New York
S4501	Pharmacy Technical Help Desk Contact (Secondary)	VP-Pharmacy Services		Burruano	Martin							Martin.Burruano@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/15/2016	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active	8009939898				Medicare Prescription Drug Plan		5	New York
S4501	PHR Beneficiary Contact																	02/10/2014	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan	Independent Health - Member Services	Independent Health Association, Inc.	131	Yes	Active	8006651502				Medicare Prescription Drug Plan		5	New York
S4501	Plan Directory Contact for Public Website			Services	Member		8006651502					wnyms@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/10/2014	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Plan to Plan Reconciliation Contact	Pharmacy Systems Gov. Programs Manager		Miszuk	Jane		7166357857					Jane.Miszuk@pbdrx.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/11/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Processor Contact	VP-Claims & Recovery Operations		Shute	David		7166354814					David.Shute@Independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/15/2016	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Reconciliation Contact	Director - Underwriting		Pasieka	Andrea		7166353672					Andrea.Pasieka@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/16/2022	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Reconciliation Contact (Secondary)	VP - Medicare Programs		Odrzywolski	Dawn		7166354980					dawn.odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Recovery Audit Contact	VP Medicare Programs	Mrs.	Odrzywolski	Dawn		7166354980				7162507197	Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Surveillance Contact	Chief Compliance Officer	Mrs.	Britton	Nicole		7166354874					Nicole.Britton@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	02/27/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	System Contact	VP Medicare Programs		Odrzywolski	Dawn		7166354980				7162507197	Dawn.Odrzywolski@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	01/14/2019	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	Third Party Administrator (TPA) Liaison	Manager - Treasury Services		Fisher	Dave		7166353561					Dave.Fisher@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	03/28/2018	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4501	User Access Contact	Medicare Programs Implementation Manager		Laubacker	Jeremy		7166354994				7162507197	Jeremy.Laubacker@independenthealth.com	511 Farber Lakes Drive		Buffalo	NY	14221	04/06/2020	2023	INDEPENDENT HEALTH BENEFITS CORPORATION	PDP	Pharmacy Benefit Dimensions PDP	Medicare Prescription Drug Plan		Independent Health Association, Inc.	131	Yes	Active					Medicare Prescription Drug Plan		5	New York
S4802	Agent/Broker Compensation Data Contact	Supervisor, Broker Commissions		Furman	Benjamin		8132066502					Benjamin.Furman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Automated TrOOP Balance Transfer Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Backup User Access Contact	Senior Compliance Analyst		Smith	Robert		3143493085					Robert.K.Smith@CENTENE.COM	7676 Forsyth Blvd.		St. Louis	MO	63105	11/09/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Best Available Evidence Contact	Supervisor, Operations		Steadman	Denethia		8132067131					.LISOVR@WELLCARE.COM	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Bid Audit Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Bid Audit Site Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Bid Primary Contact	Vice President, Actuarial Services		Yannick	Michael		8132064988					Michael.D.Yannick@CENTENE.COM	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	CAP Report Contact for Public Website	VP, Ethics and Compliance Monitoring & Oversight	Ms.	Myles	Alicia		3144450457					almyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	CEO - CMS Administrator Contact	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	CEO - Senior Official for Contracting	Sr VP, Medicare Solutions & CEO	Mr.	Fisher	Richard		8132061544					Richard.Fisher@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Chief Financial Officer	Vice President, Finance	Mr.	Palmer	Clinton		5592443873					Clinton.J.Palmer@CENTENE.COM	8725 Henderson Road		Tampa	FL	33624	08/23/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Chief Operating Officer	VP, Medicare Markets and Operations	Mr.	Smith	Randall	W	8132064977					Randall.Smith@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Chief Information Officer	Executive VP, Chief Information Officer	Mr.	Brooks	Mark		3145056076					Mark.Brooks@centene.com	7700 Forsyth Boulevard		Clayton	MO	63105	02/03/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Chief Information Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	CMS Casework Communication Contact	Service Escalation Unit		Casework	CMS		8666758573					ctm_box@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Complaints Tracking Contact	Director, Customer Service	Mr	Langan	Grant		8132067417					grant.langan@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/03/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Contact for Fraud Investigations	Sr. Director, Special Investigations Unit (SIU)		Peters	Lori		8132063624					Lori.Peters@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Coordination of Benefits Contact	Senior Director, Claims Operations		Everett	Thomas		8134958381					thomas.everett@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Corporate Mailing						3147254477					CorporateMedicareComplianceDept@CENTENE.COM	7700 Forsyth  Blvd		Clayton	MO	63105	11/05/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Coverage Gap Discount Program (CGDP) Payment Contact	Business Analyst III		Gaskin-Rivera	Dahira		8132065620					dahira.gaskin-rivera@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/05/2022	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Customer Service Operations Contact	Senior Director, Customer Service		Morrison	Matthew		8132063618					matthew.morrison@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/03/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	DIR Contact	Lead Contract Analyst	Ms.	Arellano	Suzanne		9168538728					Suzanne.Arellano@EnvolveHealth.com	2868 Prospect Park Drive, Suite 230		Rancho Cordova	CA	95670	02/28/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	DIR Contact (Secondary)	VP, Medicare Actuarial Services Lead		Viel	Leonel		8132063820					leonel.viel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Emergency Part D Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Emergency Part D Contact (Secondary)	VP, Prescription Drug Plan	Ms.	Nichols	Michele		9169265096					michele.nichols@envolvehealth.com	4201 E Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Employer Waiver Contact	Director, Product Management		Henao	Angela		8132063757					product_SNP@wellcare.com	8725 Henderson Road	Ren 1	Tampa	FL	33634	02/03/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Enrollment Contact	Manager, Membership & Accounting		Starks	Heather		8186766477					heather.b.starks@centene.com	21281 Burbank Boulevard		Woodland Hills	CA	91367	03/04/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	EOB Transfer Contact	Director, Pharmacy Operations	Mr.	Patel	Rushil		7133492605				8132835698	rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	06/28/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Financial Audit Contact	Senior Manager,  Ethics and Compliance	Ms.	Liebnau	Susan		3146047254					SLIEBNAU@CENTENE.COM	7676 Forsyth Blvd		Clayton	MO	63105	08/16/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Financial Reporting Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Formulary Contact	Director, Pharmacy	Ms.	Tong	Emily		9169265003	8051003				emily.tong@envolvehealth.com	4151 E. Commerce Way, Bldg B		Sacramento	CA	95834	03/09/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Formulary Contact (Secondary)	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Drive		Houston	TX	77027	03/09/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	General Contact	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/09/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Government Relations Contact	Director, Health Policy	Ms.	Fairman	Brittney		2022537949					Brittney.Fairman@wellcare.com	1150 Connecticut Ave NW Suite 100		Washington	DC	20036	09/29/2022	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	HIPAA Privacy Officer	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/04/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	HIPAA Security Officer	Security Risk Group	Mr.	Berry	Alan		3145190574					alan.r.berry@centene.com	7711 Carondelet Avenue		Clayton	MO	63105	03/04/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Hospice Contact	Director, Pharmacy Operations	Mr.	Borowiecki	Jeff		3143493212					jeffrey.borowiecki@envolvehealth.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Interoperability Contact	Staff Vice President, Digital Initiatives		Siddanati	Mahesh		3145191936					mahesh.siddanati@centene.com	7700 Forsyth Blvd.		Clayton	MO	63105	02/07/2022	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Marketing Contact	Manager, Compliance		Elliott	Wendy		8132062149					wendy.elliott@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Medical Director	Chief Medical Director	Dr.	Profumo	Robert		6366988678					Robert.Profumo@wellcare.com	7700 Forsyth Blvd		St. Louis	MO	63105	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Medicare Compliance Officer	Vice President, Ethics & Compliance	Ms.	Gregory	Lori-Don		7276982780					LoriDon.M.Gregory@CENTENE.COM	7700 Forsyth Boulevard Clayton		Clayton	MO	63105	02/28/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Medicare Coordinator	Director, Compliance		Pessah	Sheryl		8186768767					sheryl.d.pessah@healthnet.com	21271 Burbank Blvd		Woodland Hills	CA	91367	11/07/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Medicare Part D Opioid Overutilization Contact	Sr Director, Clinical Pharmacy Services	Ms.	Smith	Jill		8663392787				8883446554	RxCaseManagement@wellcare.com	1850 W. Rio Salado Pkwy, Ste 211		Tempe	AZ	85281	02/20/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Medication Therapy Management Contact	Senior Director, Clinical Pharmacy		Smith	Jill		6028833209					Jill.L.Smith@Centene.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	OffShore Subcontractor Contact	Manager, Compliance		Johnson	Lisa		8132061756					Lisa.Johnson@wellcare.com	8725 Henderson Road		Tampa	FL	33436	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Online Enrollment Center Contact (Back-up)	Senior Manager, Operations		McKenzie	Shakira		8132061838					shakira.mckenzie@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Online Enrollment Center Contact (Optional)	Director, Information Technology		Jain	Sidhartha		8132066783					sidhartha.jain@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Online Enrollment Center Contact (Primary)	Operations Analyst II		Arteaga	Veronica		8132063198					veronica.arteaga@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Appeals	Sr. Manager, Operations	Ms.	Hatchman	Erika						8132061716	erika.hatchman@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active	8132063350				Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Appeals Contact (Secondary)	Supervisor, Pharmacy Technicians	Ms.	Moore	Ashley							ashley.moore@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active	8132066534				Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Application Contact	Manager, Product Development		Macklin	Tia		8132841525					Tia.D.Macklin@CENTENE.COM	5130 Sun Forest Drive	Suite 175	Tampa	FL	33634	10/30/2020	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Benefits Contact	Director, Pharmacy	Mr.	Patel	Rushil		7133492605					rushil.patel@wellcare.com	4888 Loop Central Dr		h	TX	77027	09/29/2022	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Claims Submission Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Exceptions Contact	Sr. Director, Pharmacy Operations		Patel	Ronak							ronak.patel@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active	8132067152				Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Exceptions Contact (Secondary)	Director, Clinical Pharmacy Operations	Ms.	Barnes	Lauren							lauren.barnes@wellcare.com	1870 W Rio Salado Pkwy		Tempe	AZ	85281	03/09/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active	6023080218				Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Price File Contact (Back-up)	Director, Pharmacy Network Operations	Ms.	Drelick	Dana		2256635738					Dana.Drelick@CENTENE.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Price File Contact (Optional)	Senior Manager, Pharmacy Networks	Mrs	Taylor	Pamela	J	9169265529					PAMELAJ.TAYLOR@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	10/28/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Price File Contact (Primary)	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Quality Assurance Contact	Senior Director, Pharmacy Program Management	Mr.	Nimtz	Ryan		8132065165					Ryan.Nimtz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Part D Reporting Contact	Director, Compliance		Dibwe	Besa		3144450076					Besa.Dibwe@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	03/09/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Patient Safety Contact	Sr. VP, Pharmacy Clinical Operations		Ballew	Angel		8132062086					angel.ballew@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Payment Contact	Senior Vice President, Product Chief Actuary & Chi	Mr.	Viel	Leonel		8132063820					leonel.viel@centene.com	8725 Henderson Road		Tampa	FL	33624	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Personal Health Record Contact	VP, Ethics and Compliance	Mr.	Deutschmann	Brian		3145056711					bdeutschmann@centene.com	7676 Forsyth Blvd		St. Louis	MO	63105	03/09/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Pharmacy Director	VP, Pharmacy Benefit Relations		Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Pharmacy Network Management Contact	Sr. Director, Pharmacy Program Management	Mr.	Swartz	Adam		8132063708					adam.swartz@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Pharmacy Network Management Contact (Secondary)	Director, Pharmacy Network Operations	Ms.	Cooke	Kathy		9168538726					kathy.cooke@envolvehealth.com	4151 E. Commerce Way		Sacramento	CA	95834	03/09/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Pharmacy Technical Help Desk Contact	Vice President, Contact Centers	Mr.	Bollent	Jason							Jason.Bollent@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	02/03/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active	8555380453				Medicare Prescription Drug Plan		5	Dallas
S4802	Pharmacy Technical Help Desk Contact (Secondary)	Director, Customer Service		Makram	Katherine							katherine.lugge@wellcare.com	5519 W. Idlewild Avenue		Tampa	FL	33634	01/12/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active	8555380453				Medicare Prescription Drug Plan		5	Dallas
S4802	Plan Directory Contact for Public Website			Inquiries	Website		8888889355					contactus@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Plan to Plan Reconciliation Contact	Senior Manager, Revenue Reconciliation		Rosado	Frank		8132066231				8132833302	P2P-CASH@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Processor Contact	VP, Pharmacy Benefit Relations	Mr.	Champagne	Robert		8132267775				8138656701	Robert.Champagne@wellcare.com	8725 Henderson Road		Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Reconciliation Contact	Director, Actuarial Services		Liu	Mandy		8132064578					Mandy.Liu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Reconciliation Contact (Secondary)	Staff Vice President Actuarial Services		Lu	Di		8132067328					Di.Lu@CENTENE.COM	7700 Forsyth Blvd		Clayton	MO	63105	02/28/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Recovery Audit Contact	Director, Claims Administration	Mr.	Brown	Jeff		8132062122					Jeffrey.Brown@wellcare.com	8725 Henderson Road		Tampa	FL	33634	09/17/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Surveillance Contact	VP, Ethics and Compliance Monitoring & Oversight		Myles	Alicia		3144450457					amyles@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	09/29/2022	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	System Contact	Vice President, Information Technology		Lera	Fernando		8132063729					fernando.lera@wellcare.com	3901 Premier North Drive		Tampa	FL	33618	02/03/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	Third Party Administrator (TPA) Liaison	Business Analyst II		Patel	Chandni		8132065179					chandni.patel@wellcare.com	8725 Henderson Road	Attn: P2P Department	Tampa	FL	33634	08/18/2023	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S4802	User Access Contact	Manager, Core Compliance		Wilson	Ashley	L	3145056491					ashley.l.wilson@centene.com	7676 Forsyth Blvd		Clayton	MO	63105	11/09/2021	2023	WELLCARE PRESCRIPTION INSURANCE, INC.	PDP	Wellcare	Medicare Prescription Drug Plan		Centene Corporation	351	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5450	Agent/Broker Compensation Data Contact	Manager Broker Administration		Logan	Lynne		4235356550				4235353178	Lynne_Logan@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/16/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Automated TrOOP Balance Transfer Contact	Advisor Business CVS		Davis	Brittany		4806064613					FIRSupport@CVSHealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	12/21/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Backup User Access Contact	Medicare Compliance Officer	Ms.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Best Available Evidence Contact	Manager MedAdv Member & Recon		Mills	Aaron		4235353848					Aaron_Mills@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/16/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Bid Audit Contact	Medicare Compliance Officer	Ms.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	08/02/2023	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Bid Primary Contact	Product Manager		Case	Taylor		4235354013					Taylor_Case@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	CAP Report Contact for Public Website	Medicare Compliance Officer		Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	CEO - CMS Administrator Contact	CEO Security Care Inc	MS	Young	Robin		4235356377					Robin_Young@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	CEO - Senior Official for Contracting	CEO Security Care, Inc	Ms	Young	Robin		4235356377					Robin_Young@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/01/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Chief Financial Officer	VP Controller & Chief Accounting Officer	Mr	Gregory	Daniel		4235358224					Daniel_Gregory@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	08/02/2023	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Chief Operating Officer	SVP Government Programs	Ms	Ray	Joseph		4235356829					Joseph_Ray@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	08/02/2023	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Chief Information Officer	VP Infrastructure & Operations	Ms	Weaver	Jennifer		4235355173				4235359109	Jennifer_Weaver@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/16/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Chief Information Security Officer	VP Infrastructure & Operations	Ms	Weaver	Jennifer		4235355173				4235359109	Jennifer_Weaver@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/16/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	CMS Casework Communication Contact	Manager Operations		Flagg	Kendra		4235357524				4235355498	Kendra_Flagg@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Complaints Tracking Contact	Business Analyst II		Morgan	Christi		4235358872				4235355270	Christi_Morgan@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/11/2019	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Contact for Fraud Investigations	Director Special Investigations Unit	Mr.	Tidwell	Norman		6153483005				4235357024	Norman_Tidwell@bcbst.com	1 Cameron Hill Circle, Bldg 1.4		Chattanooga	TN	37402	05/02/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Coordination of Benefits Contact	Manager Revenue Reconciliation		Camp	Jan		4235353639					Jan_Camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/11/2019	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Corporate Mailing						4235355600					Dana_Shull@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/16/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Coverage Gap Discount Program (CGDP) Payment Contact	Mgr Investments & Financial Mgt		Conway	Kendrick		4236819483					Kendrick_Conway@BCBST.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/10/2023	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Customer Service Operations Contact	Manager Operations		Walters	Karen		4235357696					Karen_Walters@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	07/15/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	DIR Contact	Pharmacy Analyst II	Mrs	Moore	Mary-Marga		4235356116					Mary-Margaret_Moore@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/19/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	DIR Contact (Secondary)	Director Pharmacy Operations	Mrs	Owen	Rebecca		4235358347					Rebecca_Owen@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/19/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Emergency Part D Contact	VP of Pharmacy		Tate	Natalie		4234437868				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/20/2016	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Emergency Part D Contact (Secondary)	Sr Account Manager CVS		Hale	Amy		4803277718					Amy.Hale2@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Enrollment Contact	Manager MedAdv Member & Recon		Mills	Aaron		4235353848					Aaron_Mills@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/16/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	EOB Transfer Contact	Mgr Ops & Claims		Dobbs	Damon		4235355374				4235353558	Damon_Dobbs@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	07/15/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Financial Audit Contact	External Audit Coordinator	Ms	Adkins	Bethany		4235356832					Bethany_Adkins@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	04/06/2018	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Financial Reporting Contact	Principal Consultant, Financial Reporting		Harris	Bernard		4235353829					Bernard_Harris@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	04/17/2020	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Formulary Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Formulary Contact (Secondary)	Clinical Advisor Med D CVS		Tolbert	Myla		4698656265					Myla.Tolbert@CVSHealth.com	750 W John Carpenter Frwy		Irving	TX	75039	12/20/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	General Contact	Medicare Compliance Officer	Ms.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Government Relations Contact	Medicare Compliance Officer	Ms.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	HIPAA Privacy Officer	Chief Privacy Officer and Director Privacy Office	Mr.	Setterlund	Daniel		4235355045					Eric_Setterlund@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/02/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	HIPAA Security Officer	Chief Information Security Officer	Ms	Ball	Diane		4235355960					Diane_Ball@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Hospice Contact	Supervisor MA Reconciliation		Hicks	Brandon		4235353006	3006			4235355498	Brandon_Hicks@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/15/2023	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Interoperability Contact	Application Manager		Foust	Adam		4235356672					Adam_Foust@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/28/2023	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Marketing Contact	Ethics & Compliance Manager		Womble	Charriet		6153479580					Charriet_Womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	04/20/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Medical Director	Medical Director	Dr	Brunetto	Angeline		4235358629					angeline_brunetto@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	08/02/2023	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Medicare Coordinator	Director Medicare Advantage Service Operations		Dobbs	Damon		4235355374					Damon_Dobbs@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	01/03/2020	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Medicare Part D Opioid Overutilization Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/19/2018	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Medication Therapy Management Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	OffShore Subcontractor Contact	Medicare Compliance Officer	Mrs	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Online Enrollment Center Contact (Back-up)	Business Analyst		Sharp	Dana		4235354453					Dana_Sharp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/16/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Online Enrollment Center Contact (Optional)	Manager MedAdv Member & Recon		Mills	Aaron		4235353848					Aaron_Mills@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/16/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Online Enrollment Center Contact (Primary)	Operations Supervisor II (QIP)		Bowling	Jameekah		4235356646					Jameekah_Bowling@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	09/15/2023	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Appeals	Clinical Pharmacy Director		Moss	Portia							Portia_Moss@bcbst.com	1 Cameron Hill Circle	Suite 51	Chattanooga	TN	37402	09/22/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Appeals Contact (Secondary)	Coverage Review Pharmacist		Holloway	Angela							Angela_Holloway@BCBST.com	1 Cameron Hill Circle	Suite 51	Chattanooga	TN	37402	12/31/2020	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Application Contact	Product Manager		Case	Taylor		4235354013					Taylor_Case@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	03/22/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Benefits Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Claims Submission Contact	Sr Account Manager CVS		Mesa	Samantha		4803492867					Samantha.Mesa@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Exceptions Contact	Manager Coverage Reviews 1		Moss	Portia							Portia_Moss@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/08/2019	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Exceptions Contact (Secondary)	Coverage Review Pharmacist		Dillon	Celia							Celia_Dillon@BCBST.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/12/2020	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Price File Contact (Back-up)	Manager PBM Finance Operations CVS		Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea Blvd	Mail Code 121	Scottsdale	AZ	85260	12/20/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Price File Contact (Optional)	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Price File Contact (Primary)	Pharmacy Operations Manager		Moore	Mary	M	4235356116				4235357599	Mary-Margaret_Moore@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	07/12/2019	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Quality Assurance Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Part D Reporting Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Patient Safety Contact	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Payment Contact	Manager Revenue Reconciliation		Camp	Jan		4235353639					Jan_Camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Pharmacy Director	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Pharmacy Network Management Contact	Advisor Network Products CVS		Lowe	David		4807449231				8773875800	David.Lowe2@CVSHealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	12/20/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Pharmacy Network Management Contact (Secondary)	VP of Pharmacy		Tate	Natalie		4235353124				4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Pharmacy Technical Help Desk Contact	Vendor Management		Horton	Kasena							Kasena.Horton@CVSHealth.com	2401 Cherahala  Blvd		Knoxville	TN	37932	12/21/2021	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active	8666934620				Medicare Prescription Drug Plan		5	Atlanta
S5450	Pharmacy Technical Help Desk Contact (Secondary)	VP of Pharmacy		Tate	Natalie						4235355100	Natalie_Tate@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	11/03/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active	8008312583				Medicare Prescription Drug Plan		5	Atlanta
S5450	Plan Directory Contact for Public Website	Director Operations		Service	Customer		8008312583					BlueAdvantageCS_GM@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Plan to Plan Reconciliation Contact	Business Analyst Associate		Stinnett	James		4235351624					P2PAdministration_GM@bcbst.com	Attn: P2P Coordinator	1 Cameron Hill Circle Suite 0050	Chattanooga	TN	374020050	02/07/2018	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Processor Contact	Mgr Ops & Claims		Dobbs	Damon		4235355374				4235353558	Damon_Dobbs@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	07/15/2015	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Reconciliation Contact	Manager Revenue Reconciliation		Camp	Jan		4235353639					Jan_Camp@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	05/02/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Reconciliation Contact (Secondary)	Acturial Consultant		Styga	Chris		4235353276				4235353467	Christopher_Styga@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	03/08/2016	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Surveillance Contact	Medicare Compliance Officer	Ms.	Womble	Charriet		6153479580					charriet_womble@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/31/2022	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	System Contact	Director Applications Solutions		Jackson	Barbara		4235357380					Barbara_Jackson@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	02/04/2019	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	Third Party Administrator (TPA) Liaison	Accountant		Gillenwater	Jonathan		4235351259					Jonathan_Gillenwater@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	10/06/2020	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5450	User Access Contact	Sr Ethics & Compliance Specialist		Underwood	Jackie		4235354424					Jackie_Underwood@bcbst.com	1 Cameron Hill Circle		Chattanooga	TN	37402	12/17/2019	2023	SECURITYCARE OF TENNESSEE, INC.	PDP	BlueScripts	Medicare Prescription Drug Plan		BlueCross BlueShield of Tennessee	34	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Agent/Broker Compensation Data Contact	Director, Financial Systems		Lazar	Lisa		9197653359					Lisa.Lazar@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	09/28/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Automated TrOOP Balance Transfer Contact	Manager, PBM Operations		Hanson	Michelle		6127776706					eobp2p@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Backup User Access Contact	EDI Analyst		Umstead	Kamala		9197654363					kamala.umstead@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27707	09/26/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Best Available Evidence Contact	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Bid Audit Contact	Director, Actuarial Services		Turner	Danica		9847775665					danica.turner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/27/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Bid Audit Site Contact	Director, Actuarial Services		Turner	Danica		9847775665					danica.turner@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/27/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Bid Primary Contact	Director, Actuarial Services		Vander Berg	Lucas		9842193485					Lucas.VanderBerg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	CAP Report Contact for Public Website	Sr Communications Advisor		Stinneford	Mark		9197653005					media.inquiry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/31/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	CEO - CMS Administrator Contact	President and CEO	Mr.	Sotunde	Tunde		9198159089					Tunde.Sotunde@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/28/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	CEO - Senior Official for Contracting	President and CEO	Mr.	Sotunde	Tunde		9198159089					Tunde.Sotunde@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/28/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Chief Financial Officer	SVP, Chief Financial Officer and Treasurer	Mr.	Perry	Mitchell	W	9197653923					mitch.perry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/21/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Chief Operating Officer	SVP, Chief Operations & Member Experience Officer	Ms.	Mizelle	Karla		9849603787					karla.mizelle@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Chief Information Officer	Chief Information Officer	Ms.	Abernathy	Jo		9197652383					Jo.Abernathy@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	277022291	01/15/2016	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Chief Information Security Officer	Chief Information Security Officer	Mr.	Chilton	Richard		9197652021					Rick.Chilton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	277022291	01/15/2016	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	CMS Casework Communication Contact	Director, Stakeholder Escalations		Holder	Nicole		9197651320					Caseworker@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/28/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Complaints Tracking Contact	Director, Stakeholder Escalations		Holder	Nicole		9197651320					Nicole.Holder@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/28/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Contact for Fraud Investigations	VP, Audit		Bennett	Tracy		3362014290					tracyr.bennett@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Coordination of Benefits Contact	Team Lead, Operations		Pridgen	David		3362014141					David. Pridgen@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Corporate Mailing						3362014460				3366592969	deborah.washington-mcneill@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Coverage Gap Discount Program (CGDP) Payment Contact	Principal Financial Accounting & Reporting Analyst		Varshney	Monisha		3528705750					Monisha.Varshney@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	12/04/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Customer Service Operations Contact	Sr. Manager, Contact Center		Woods	Renita		9197657057					Renita.Woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	07/18/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	DIR Contact	Director, Actuarial Services		Pigg	Ryland		9196168313					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P. O. Box 2291	Durham	NC	27702	03/15/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	DIR Contact (Secondary)	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Emergency Part D Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Emergency Part D Contact (Secondary)	Director, Government Markets CFO		Perry	Endya		9197775504					endya.perry@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Employer Waiver Contact	Manager, Medicare Plan Administration		Brown	Alison		9196728994					alison.brown@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/28/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Enrollment Contact	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	EOB Transfer Contact	Medicare Pharmacy Operations Admin		Edwards	Chrissie		9197653536				9197657291	Corporate.pharmacy@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	11/20/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Financial Audit Contact	Director, Audit	Ms.	Ferrell	Kim		3362014038					kim.ferrell@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Financial Reporting Contact	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Formulary Contact	Clinical Pharmacist		Hiller	Debra		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/31/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics Inc	2900 Ames Crossing Road	Eagan	MN	55121	10/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	General Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Government Relations Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	HIPAA Privacy Officer	Director, Privacy, Ethics & Corp Policies		Hamlet	Lynn		9197657416					lynn.hamlet@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/24/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	HIPAA Security Officer	Chief Information Security Official		Chilton	Rick		9197652021					rick.chilton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/30/2014	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Hospice Contact	Pharmacy Services Coordinator		Leggett	Ursula		9197654599					Ursula.Leggett@bcbsnc.com	PO Box 2291		Durham	NC	27702	02/01/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Interoperability Contact	Director, Corporate Compliance Official		Haith	Elenor		9842125897					Elenor.Haith@bcbsnc.com	PO Box 2291		Durham	NC	27702	07/20/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Marketing Contact	Manager, Medicare Plan Administration		Brown	Alison		9196728994					alison.brown@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/28/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Medical Director	Lead Medical Director	Dr.	Campbell	John		9197652718					john.campbell@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	09/05/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Medicare Compliance Officer	Director, Corporate Compliance	Mrs.	Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/09/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Medicare Coordinator	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Medicare Part D Opioid Overutilization Contact	Medicare Part D Operations Administrator		Edwards	Chrissie		9197653536					chrissie.edwards@bcbsnc.com	Blue Cross Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	03/31/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Medication Therapy Management Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	OffShore Subcontractor Contact	Director, Corporate Compliance		Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Online Enrollment Center Contact (Back-up)	Business Solutions Architect		Povathingal	Raj		9197654138					Raj.Povathingal@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	10/17/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Online Enrollment Center Contact (Optional)	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Online Enrollment Center Contact (Primary)	Director, Member Enrollment & Operations		Clayton	Beth		9197652438					Beth.Clayton@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/19/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Appeals	Director, Commercial and Medicare Appeals & Griev		McFall	Adonna							Adonna.McFall@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	05/08/2018	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882987520				Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Appeals Contact (Secondary)	Mgr, MA and PDP Appeals and Grievances		Lanier	Paige						8883758836	paige.lanier@bcbsnc.com	P.O. Box 2291		Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8774947647				Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Application Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3366923556				3366592969	deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Benefits Contact	Team Leader, Clinical Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Claims Submission Contact	Functional Business Consultant - Govt Prgms		Brooke	Lance		4026862603					lbrooke@primetherapeutics.com	Prime Therapeutics LLC	2900  Ames Crossing Road	Eagan	MN	55121	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Exceptions Contact	Manager		Swanson	Ryan							PartDExceptions@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	12/30/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882969790				Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Exceptions Contact (Secondary)	Team Leader, Clinical Pharmacy Reviews - Medicare		Parikh	Swati							PartDExceptions@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	01/04/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8882969790				Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Price File Contact (Back-up)	Team Leader, Clinical Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Price File Contact (Optional)	Price File Analyst Sr		Trudeau	Ashley		6127771338					ashley.trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Price File Contact (Primary)	Medicare Pharmacy Operations Administrator		Edwards	Chrissie		9197653536					chrissie.edwards@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Quality Assurance Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Part D Reporting Contact	Director, CMS Contract Administration		Washington-McNeill	Deborah		3362014460					deborah.washington-mcneill@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Patient Safety Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/10/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Payment Contact	AVP, Head of Actuarial Services & Valuation		Pigg Jr.	Ryland		9847776107					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/11/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Pharmacy Director	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Pharmacy Network Management Contact	AVP, Pharmacy Government Programs		Geter	Joseph		9197657733					joseph.geter@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Pharmacy Network Management Contact (Secondary)	Team Leader, Clinical Pharmacy		Hiller	Debbie		9197651931					debra.hiller@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Pharmacy Technical Help Desk Contact			Helpdesk	Pharmacy							MGarzarodriguez@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active	8772777893				Medicare Prescription Drug Plan		5	Atlanta
S5540	Plan Directory Contact for Public Website	Call Center support		Services	Member		8882969790					renita.woods@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Plan to Plan Reconciliation Contact	Manager, Financial Accounting & Reporting		Hitchcock	Grace		9197657999					grace.hitchcock@bcbsnc.com	ATTN:  Sheila Adams or Yvonne Stancil (Medicare P2P)	PO Box 30060 Mailstop 700-1AP	Durham	NC	27702	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Processor Contact	Dir Govt Programs & Ops		Zeien	Daniel		6127776775					daniel.zeien@primetherapeutics.com	Prime Therapeutics, LLC	2655 Eagan Woods Drive	Eagan	MN	55122	05/31/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Reconciliation Contact	Director, Actuarial Services		Pigg	Ryland		9196168313					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P. O. Box 2291	Durham	NC	27702	03/11/2021	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Reconciliation Contact (Secondary)	Director, Corporate Financial Reporting		Lindsey	Elizabeth		5022108328					Elizabeth.Lindsey@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Recovery Audit Contact	Director, Corporate Compliance	Mrs	Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina,	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Surveillance Contact	Director, Corporate Compliance		Haith	Elenor		9842125897					elenor.haith@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27702	06/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	System Contact	Director, IT Solution Delivery		Holbrook	Janice		3362014101					janice.holbrook@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	07/13/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	Third Party Administrator (TPA) Liaison	AVP, Head of Actuarial Services & Valuation		Pigg Jr.	Ryland		9847776107					Ryland.Pigg@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	P.O. Box 2291	Durham	NC	27702	05/11/2023	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5540	User Access Contact	Electronic Data Interchange Analyst		Dunn	Lorrie		9197653669					lorrie.dunn@bcbsnc.com	Blue Cross and Blue Shield of North Carolina	PO Box 2291	Durham	NC	27707	09/26/2019	2023	BLUE CROSS AND BLUE SHIELD OF NORTH CAROLINA	PDP	Blue Cross and Blue Shield of North Carolina	Medicare Prescription Drug Plan		Blue Cross and Blue Shield of North Carolina	265	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5552	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Bid Primary Contact	Director, Actuarial Risk and Compliance		Welch	Dianna		2624084726					PDBPTContact@humana.com	500 West Main Street		Louisville	KY	40202	09/19/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	02/16/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5025809138				Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5025807929				Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5025809138				Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5024682494				Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5024761473					jpowell13@humana.com	515 West Market Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	8008658715				Medicare Prescription Drug Plan		5	Kansas City
S5552	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5025800475				Medicare Prescription Drug Plan		5	Kansas City
S5552	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5552	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	HUMANA INSURANCE COMPANY OF NEW YORK	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5584	Agent/Broker Compensation Data Contact	Manager	Mr.	Delaney	Brandon		3134482712					bdelaney@bcbsm.com	600 East Lafayette Blvd.	MC 520J	Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Automated TrOOP Balance Transfer Contact	Manager	Mr.	Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Backup User Access Contact	Manager	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/18/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Best Available Evidence Contact	Business Systems Analyst Sr		Hall	Barbara		3132256662					BHall@bcbsm.com	600 East Lafayette Blvd.	MC 1602	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Bid Audit Contact	Director		Weicker	Brian		3132259571					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Bid Audit Site Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Bid Primary Contact	Director	Ms.	Munoz	Karen		2486654020					kmunoz@bcbsm.com	600 East Lafayette Blvd.	TC 1516	Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	CAP Report Contact for Public Website	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	09/13/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	CEO - CMS Administrator Contact	President and CEO	Mr.	Loepp	Daniel	J	3132256822					BlueCrossBlueShieldofMichiganCEO@bcbsm.com	600 East Lafayette Blvd.	MC 2001	Detroit	MI	48226	01/06/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	CEO - Senior Official for Contracting	President and CEO	Mr.	Loepp	Daniel	J	3132256822					BlueCrossBlueShieldofMichiganCEO@bcbsm.com	600 East Lafayette Blvd.	MC 2001	Detroit	MI	48226	05/26/2017	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Chief Financial Officer	Executive Vice President CFO	Mr.	Mozak	Paul	L	3132257939					pmozak@bcbsm.com	600 East Lafayette Blvd.	MC 2122	Detroit	MI	48226	01/11/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Chief Operating Officer	Executive Vice President COO & President Emerg Mkt	Ms.	Keith	Tricia		3132250452					TKeith@bcbsm.com	600 East Lafayette Blvd.	MC 2000	Detroit	MI	48226	02/09/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Chief Information Officer	Senior Vice President	Mr.	Fandrich	William		3132255800					Wfandrich@bcbsm.com	600 East Lafayette Blvd.	MC 2010	Detroit	MI	48226	11/15/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Chief Information Security Officer	Senior Vice President	Mr.	Fandrich	William		3132255800					Wfandrich@bcbsm.com	600 East Lafayette Blvd.	MC 2010	Detroit	MI	48226	11/15/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	CMS Casework Communication Contact	Senior Analyst		Whitener	David		3136546885					DWhitener@bcbsm.com	1000 Town Center, Mail Code: TC1301		Southfield	MI	48075	09/19/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Complaints Tracking Contact	Senior Analyst		Whitener	David		3136546885					DWhitener@bcbsm.com	1000 Town Center, Mail Code: TC1301		Southfield	MI	48075	09/19/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Contact for Fraud Investigations	Manager, Fraud Investigation	Mr.	Zasadny	Brian		3132255956					BZasadny@bcbsm.com	600 East Lafayette Blvd.	MC 1825	Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Coordination of Benefits Contact	Manager	Ms.	Lang	Michelle		3132255662					mlang@bcbsm.com	600 East Lafayette Blvd.	TC 1515	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Corporate Mailing						2483955887					vpickens@bcbsm.com	600 East Lafayette Blvd.	MC TC1301	Detroit	MI	48226	03/14/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Coordinator		Jovanovska	Natasa		2486654558					njovanovska@bcbsm.com	600 East Lafayette Blvd.	TC 1500	Detroit	MI	48226	03/22/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Customer Service Operations Contact	Director	Ms.	Judson	Johanna		3132255856					jjudson@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	DIR Contact	Manager	Mr.	Nalamolu	Chandra		3132256810					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	MC 1705	Detroit	MI	48226	12/18/2012	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	DIR Contact (Secondary)	Senior Health Care Analyst	Ms.	Desaraju	Vidhya		2486654514					vdesaraju@bcbsm.com	600 East Lafayette Blvd.	MC 1705	Detroit	MI	48226	11/18/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Emergency Part D Contact	Manager	Mr.	Nalamolu	Chandra		3132256810					hnalamolu@bcbsm.com	600 East Lafayette Blvd		Detroit	MI	48226	01/04/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Emergency Part D Contact (Secondary)	Director	Mrs.	Underhill	Molly		6163753398					MUnderhill@bcbsm.com	600 East Lafayette Blvd.	TC 1300	Detroit	MI	48226	12/28/2020	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Enrollment Contact	Manager		Carlisle-Brant	Terrie		3132256881					Tbrant@bcbsm.com	600 East Lafayette Blvd.	MC 1602	Detroit	MI	48226	09/20/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	EOB Transfer Contact	Manager	Mrs.	Rawson	Lori		6169565796				8773459942	lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Financial Audit Contact	Director	Mr.	Weicker	Brian		3132259571					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Financial Reporting Contact	Director	Mr.	Nehls	Paul		2486654471					pnehls@bcbsm.com	600 East Lafayette Blvd.	TC 1500	Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Formulary Contact	Manager	Ms.	Facchini	Victoria		2486654657					VFacchini@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	03/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Formulary Contact (Secondary)	Supervisor	Ms.	Lota	Amardeep		2486654537					Alota@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	03/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	General Contact	Compliance Consultant	Ms.	White	Jasmin		2486654235					jwhite4@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/15/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Government Relations Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/14/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	HIPAA Privacy Officer	VP, Enterprise Compliance and Privacy Official	Ms.	Lange	Kelly		3132258554					KLange@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	12/27/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	HIPAA Security Officer	VP, Enterprise Compliance and Privacy Official	Ms.	Lange	Kelly		3132258554					KLange@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	12/27/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Hospice Contact	Manager	Mrs.	Rawson	Lori		6169565796					Lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Interoperability Contact	Director	Mr.	Kett	James		3132250224					jkett@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	02/11/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Marketing Contact	Director		Parrish	Loralie		5173254050					lparrish1@bcbsm.com	600 East Lafayette Blvd.	MC 1401	Detroit	MI	48226	09/19/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Medical Director	Vice President	Dr.	Jois, MD	Preeti		3132256585					pjois@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	12/01/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Medicare Compliance Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/03/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Medicare Coordinator	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	09/13/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Medicare Part D Opioid Overutilization Contact	Pharmacist		Mott	Krystyna		8002874163				8778958667	MedicarePartDOverutilizationMonitoring@bcbsm.com	1000 Town Center	MC TC1309	Southfield	MI	48075	12/27/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Medication Therapy Management Contact	Manager	Ms.	Moon	Kim		3132695657					kmoon@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	09/19/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	OffShore Subcontractor Contact	Manager	Mrs.	Stretch	Kaitlin		2486654275					kstretch@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Online Enrollment Center Contact (Back-up)	Manager		Carlisle-Brant	Terrie		3132256881					Tbrant@bcbsm.com	600 East Lafayette Blvd.	MC 1602	Detroit	MI	48226	09/20/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Online Enrollment Center Contact (Primary)	Business Systems Analyst Sr		Hall	Barbara		3132256662					BHall@bcbsm.com	600 East Lafayette Blvd.	MC 1602	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Appeals	Manager	Mr.	Petkoff	Ryan						8666014428	dramspriorauthmedicareD@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	01/07/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8004373803				Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Appeals Contact (Secondary)	Supervisor	Ms.	Agnew	Amber						8666014428	Aagnew@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	01/07/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8004373803				Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Application Contact	Manager	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	11/18/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Benefits Contact	Manager	Mrs.	Rawson	Lori		6169565796					lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	11/15/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Claims Submission Contact	Manager		Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Exceptions Contact	Manager	Mr.	Petkoff	Ryan						8004598027	dramspriorauthmedicareD@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/16/2020	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8004373803				Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Exceptions Contact (Secondary)	Supervisor	Ms.	Jones	Amber						8666014428	dramspriorauthmedicare@bcbsm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/15/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8004373803				Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Price File Contact (Back-up)	Senior Health Care Analyst		Khinchuk	Emily		2486654545					ekhinchuk@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Price File Contact (Optional)		Mr.	Westrum	Josh		4807363132					Medicarewebsitefiles@express-scripts.com	7909 S. Hardy Drive #106		Tempe	AZ	85284	06/07/2016	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Price File Contact (Primary)	Manager	Mr.	Nalamolu	Chandra		3132256810					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Quality Assurance Contact	Director	Ms.	Underhill	Molly		2483955505					munderhill@bcbm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/16/2020	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Part D Reporting Contact	Manager	Mr.	Nalamolu	Chandra		2486654549					hnalamolu@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Patient Safety Contact	Director		Connelly	Theresa		2483955529					Tconnelly@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	09/19/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Payment Contact	Director	Mr.	Nehls	Paul		2486654471					pnehls@bcbsm.com	600 East Lafayette Blvd.	TC 1500	Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Pharmacy Director	Director	Ms.	Underhill	Molly		6163753398					munderhill@bcbm.com	600 East Lafayette Blvd.	TC 1308	Detroit	MI	48226	11/18/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Pharmacy Network Management Contact	Director	Mr.	Perry	Glen	A	3134485949					gperry1@bcbsm.com	600 East Lafayette Blvd.	512H	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Pharmacy Network Management Contact (Secondary)	Manager	Mrs.	Rawson	Lori		6169565796					Lrawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Pharmacy Technical Help Desk Contact	Mgr	Mr.	Nalamolu	Chandra							hnalamolu@bcbsm.com	600 East Lafayette Blvd	TC 1309	Detroit	MI	48226	01/04/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	Chicago
S5584	Pharmacy Technical Help Desk Contact (Secondary)	Manager	Ms.	Rawson	Lori							lrawson@bcbsm.com	600 East Lafayette Blvd	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	Chicago
S5584	Plan Directory Contact for Public Website	Director	Ms.	Judson	Johanna		8663091719					jjudson@bcbsm.com	600 East Lafayette Blvd.		Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Plan to Plan Reconciliation Contact	Financial Coordinator		Jovanovska	Natasa		2486654558					njovanovska@bcbsm.com	600 East Lafayette Blvd.	Attn: P2P Mail Code 0807 -  S English	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Processor Contact	Manager	Mrs.	Rawson	Lori		6169565796					LRawson@bcbsm.com	600 East Lafayette Blvd.	TC 1309	Detroit	MI	48226	10/16/2019	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Reconciliation Contact	Manager	Ms.	Cullen	Lynne		2486654562					lcullen@bcbsm.com	600 East Lafayette Blvd.	TC 1414	Detroit	MI	48226	03/02/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Reconciliation Contact (Secondary)	Financial Coordinator		Jovanovska	Natasa		2486654558					njovanovska@bcbsm.com	600 East Lafayette Blvd.	TC 1414	Detroit	MI	48226	03/02/2023	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Recovery Audit Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/14/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Surveillance Contact	Director		Crawford	Constance		2486654231					ccrawford@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	06/17/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	System Contact	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	09/13/2021	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	Third Party Administrator (TPA) Liaison	Financial Coordinator		Jovanovska	Natasa		2486654558					njovanovska@bcbsm.com	600 East Lafayette Blvd.	TC 1500	Detroit	MI	48226	03/22/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5584	User Access Contact	Analyst	Mr.	Teklinski	Greg		2486654284					gteklinski@bcbsm.com	600 East Lafayette Blvd.	MC S140	Detroit	MI	48226	03/16/2022	2023	BCBS OF MICHIGAN MUTUAL INSURANCE COMPANY	PDP	Blue Cross Blue Shield of Michigan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Agent/Broker Compensation Data Contact	Sr. Sales Coordinator	Mr.	Hilfinger	George		4198872423				4198872017	george.hilfinger@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Automated TrOOP Balance Transfer Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Backup User Access Contact	Analyst III	Ms.	Stilwell	Denise		4198872711				4198872019	denise.stilwell@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Best Available Evidence Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872040	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Bid Audit Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Bid Audit Site Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Bid Primary Contact	Actuary	Mr.	Talmage	David		4198872915				4198872020	david.talmage@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	CAP Report Contact for Public Website	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	Nicole.Beadle@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	CEO - CMS Administrator Contact	President	Ms.	Johnston	Lori		4198872960				4198872030	Lori.Johnston@Promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	01/04/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	CEO - Senior Official for Contracting	President	Ms.	Johnston	Lori		4198872960				4198872030	Lori.Johnston@Promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Chief Financial Officer	Chief Financial Officer	Mr.	Martin	Jeff		4198872959				4198872031	jeff.martin@promedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Chief Operating Officer	Chief Operating Officer	Mr.	Wilson	Jered		4198872970				4198872030	Jered.Wilson@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Chief Information Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O. Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Chief Information Security Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	CMS Casework Communication Contact	Member Services Team Leader	Ms.	Harper	Leslie		4198872410				4198872047	leslie.harper@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Complaints Tracking Contact	Member Services Team Leader	Ms.	Harper	Leslie		4198872410				4198872047	leslie.harper@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Contact for Fraud Investigations	Senior Risk Analyst	Ms.	Bylow	Janet		4198872121				4198872036	janet.bylow@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Coordination of Benefits Contact	Director Risk Adjustment & Recoveries	Ms.	Curry	Deborah		4198872215				4198872398	Deborah.Curry@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Corporate Mailing						4198872500				4198872025	paramounthealthcare@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43597	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Coverage Gap Discount Program (CGDP) Payment Contact	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Customer Service Operations Contact	Operations Manager, Member Services	Ms.	Trivedi	Kyle		4198872424				4198872047	kyle.trivedi@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	DIR Contact	Finance Supervisor	Mr.	DeHoff	Timothy		4198872947				5674024477	Timothy.DeHoff@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	DIR Contact (Secondary)	Director of Finance	Mr.	Potter	Rich		4198872006				5674024477	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Emergency Part D Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Emergency Part D Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	01/04/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Employer Waiver Contact	Sr. Medicare Project Coordinator	Ms.	Keys	Linda		4198872322				4198872017	linda.keys@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Enrollment Contact	Director, Operational Services	Mr.	Gottfried	Kevin		4198872937				4198872016	kevin.gottfried@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	EOB Transfer Contact	Analyst II	Ms.	Ballinger	Tracy		4198872902				4198872020	tracy.ballinger@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Financial Audit Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Financial Reporting Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Formulary Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Formulary Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	General Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Government Relations Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	HIPAA Privacy Officer	Director, System Privacy	Ms.	Winterhalter	Sandy		5675859132				5675859640	sandy.winterhalter@promedica.org	100 Madison Avenue		Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	HIPAA Security Officer	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872036	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Hospice Contact	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Interoperability Contact	CIO, ProMedica Insurance Corp, PHS-Administration	Mr.	Brackett	David		4198872102					david.brackett@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Marketing Contact	Sr. Medicare Project Coordinator	Ms.	Keys	Linda		4198872322				4198872017	linda.keys@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Medical Director	Chief Medical Officer	Dr.	Bialecki-Haase	Dee		4198872296				4198872032	Dee.Bialecki-HaaseMD@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Medicare Compliance Officer	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Medicare Coordinator	Regulatory Coordinator	Ms.	Borell	Grace	C	4198872844				4198872011	grace.borell@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Medicare Part D Opioid Overutilization Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Medication Therapy Management Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Online Enrollment Center Contact (Back-up)	Marketing Account Executive	Mr.	Rivera Jr.	Mike		4198872484				4198872017	mike.riverajr@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Online Enrollment Center Contact (Optional)	Federal Program Enrollment Service Coordinator	Ms.	Bettinger	Suzanne		4198872487				4198872039	Suzanne.Bettinger@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Online Enrollment Center Contact (Primary)	Sr. Medicare Project Coordinator	Ms.	Keys	Linda		4198872322				4198872017	linda.keys@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Appeals	Senior Pharmacist	Mr.	Bogner	Craig	M					5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active	8004623589				Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Appeals Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian						5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active	4198872204				Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Application Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Benefits Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Claims Submission Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Exceptions Contact	Senior Pharmacist	Mr.	Bogner	Craig	M					5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active	8004623589				Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Exceptions Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian						5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active	4198872204				Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Price File Contact (Back-up)	Senior Consultant, Finance Med D	Mr.	Loveland	Chet		4806064873					Chet.Loveland@cvshealth.com	9501 E. Shea Blvd MC121		Scottsdale	AZ	85260	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Price File Contact (Optional)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Price File Contact (Primary)	Senior Manager, PBM Financial Operations	Ms.	Okrie	Courtney		4803181864					Courtney.Okrie@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Quality Assurance Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Part D Reporting Contact	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	12/28/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Patient Safety Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Payment Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872030	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Pharmacy Director	Director, Pharmacy	Ms.	Zuber	Amber		4198872248				5675859454	amber.zuber@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Pharmacy Network Management Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Pharmacy Network Management Contact (Secondary)	Pharmacy Regulatory Compliance Coordinator	Mr.	Ingman	Brian		4198872204				5675859454	Brian.Ingman@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Pharmacy Technical Help Desk Contact	Manager, Vendor Management	Mr.	Palmieri	Mike							Mike.Palmieri@Caremark.com	2401 Cherahala Blvd		Knoxville	TN	37932	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active	8666934620				Medicare Prescription Drug Plan		5	Chicago
S5588	Plan Directory Contact for Public Website	Member Services Dept.		Services	Member		8004623589				4198872047	paramounthealthcare@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Plan to Plan Reconciliation Contact	Sr. Analyst		Lumbrezer	Cathy		4198872907					Cathy.Lumbrezer@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	03/24/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Processor Contact	Senior Pharmacist	Mr.	Bogner	Craig	M	4198872249				5675859454	Craig.Bogner@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/25/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Reconciliation Contact	Director of Finance	Mr.	Potter	Rich		4198872006				4198872020	Rich.Potter@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Reconciliation Contact (Secondary)	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Recovery Audit Contact	Manager, Risk Adjustment	Ms.	Curry	Deb		4198872215				4198872398	Deborah.Curry@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Surveillance Contact	Sr. Medicare Project Coordinator	Ms.	Keys	Linda		4198872322				4198872017	linda.keys@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	System Contact	Chief Information Officer	Mr.	Brackett	David		4198872102				4198872019	David.Brackett@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	Third Party Administrator (TPA) Liaison	Analyst	Ms.	Klatt	Donni		4198872940				4198872020	Donni.Klatt@ProMedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	04/26/2023	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5588	User Access Contact	Manager, Regulatory Affairs	Ms.	Beadle	Nicole		4198872859				4198872011	nicole.beadle@promedica.org	300 Madison Ave. Suite 270	P.O Box 928 Toledo, OH 43697	Toledo	OH	43604	11/04/2022	2023	PARAMOUNT INSURANCE COMPANY	PDP	Paramount Prescription Drug Plan	Medicare Prescription Drug Plan		Promedica Health System, Inc.	191	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5593	Agent/Broker Compensation Data Contact	Manager, Sales Support & Operations	Mr.	Thompson	Seth		4128883167					Seth.Thompson@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Automated TrOOP Balance Transfer Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Backup User Access Contact	Sr. Risk and Regulatory Intelligence Analyst	Ms.	Hegedus	Emily		6078219034					emily.hegedus@highmarkhealth.org	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Best Available Evidence Contact	Manager, Government Business Enrollment	Mr.	Stanhoff	David		4125445689					LISBAE@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Bid Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Bid Audit Site Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Bid Primary Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	01/13/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	12/05/2017	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	CEO - CMS Administrator Contact	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	CEO - Senior Official for Contracting	President, Highmark Health Plan	Mr.	Doran	Thomas		4125442221					Thomas.Doran@highmark.com	120 Fifth Avenue, Ste. 3032		Pittsburgh	PA	15222	02/10/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Chief Financial Officer	CFO Highmark Health Plan	Mr.	Bridges	Ja'Ron		4125441452					JaRon.Bridges@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/27/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Chief Operating Officer	SVP, Government Business Segment President	Ms.	Miller	Alexis	A	4125447389					Alexis.Miller@Highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	02/10/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Chief Information Officer	Senior Vice President, Infrastructure & Architectu	Mr.	Krebs	Mark		7173026255					mark.krebs@goenGen.com	120 Fifth Avenue		Pittsbrugh	PA	15222	09/25/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Chief Information Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	CMMI Model Point of Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	08/15/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	CMS Casework Communication Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne	M	4125444579				7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	01/06/2020	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Complaints Tracking Contact	Manager, Appeals and Grievances	Ms.	Walsh	Lynne		4125444579				7176354209	Lynne.Walsh@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	01/06/2020	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Contact for Fraud Investigations	VP Financial Investigation & Provider Review	Mr.	Spear	Kurt		4125447069					Kurt.Spear@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	12/05/2017	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Coordination of Benefits Contact	Sr. Process Analyst	Ms.	Cassidy	Christina		4125444417					Christina.Cassidy@highmark.com	120 Fifth Avenue	PAP P5111	Pittsburgh	PA	15222	12/26/2019	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Corporate Mailing						4125447031					Thomas.Boettler@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	01/26/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Coverage Gap Discount Program (CGDP) Payment Contact	Sr. Accountant	Mr.	DeVan	Walter		7173026609					Walter.DeVanJr@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/05/2017	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Customer Service Operations Contact	Director, Member & Provider Services		Scarnati	Chris		8148716712					Chris.Scarnati@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/09/2020	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	DIR Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	DIR Contact (Secondary)	Senior Risk & Compliance Case Manager		Stetson	Kelsey		4125445816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Emergency Part D Contact	Director, Customer Experience		Scarnati	Chris		8148716712					Chris.Scarnati@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Emergency Part D Contact (Secondary)	Manager, Customer Service		Merritt	Meggan		3042992512					Meggan.Hostuttler@highmark.com	120 Fifth Avenue Place	Suite PKSB-2	Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Employer Waiver Contact	Manager, Health Plan Product	Mr.	Zambino	Anthony		3024213122					Anthony.Zambino@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Enrollment Contact	Director, Enrollment and Billing	Mr.	Palmer	David		4125446384					David.Palmer@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	EOB Transfer Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	bob.opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	12/26/2019	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Financial Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Financial Reporting Contact	Vice President, Accounting & Reportin	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Formulary Contact	Senior Pharmacist, Clinical Pharmacy Services		DiTullio	Kelly		4128884336					Kelly.DiTullio@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/09/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Formulary Contact (Secondary)	Senior Pharmacist, Clinical Pharmacy Services		Humphries	Jessica		4128884890					jessica.humphries@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	152223099	11/09/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	General Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Government Relations Contact	SVP, Government Affiars	Mr.	Warfel	Michael	G	7173023979					michael.warfel@highmark.com	1800 Center St.		Camp Hill	PA	17011	03/18/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	HIPAA Privacy Officer	Chief Privacy and Data Ethics Officer	Ms.	Patrick	Justine		4125444643					Justine.Patrick@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	HIPAA Security Officer	Chief Information Security Officer	Mr.	Barnes	Gregory		4125448000					gregory.barnes@hmhs.com	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Hospice Contact	Intake Coordinator		Welker	Jessica		7178883043					DrugHelp_Authorizations@highmark.com	120 5th Avenue Place		Pittsburgh	PA	15222	10/25/2019	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Interoperability Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/25/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Marketing Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					Jillian.Pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	10/14/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Medical Director	VP, Executive Medical Director	Dr,	Law	Timothy		4125446445					timothy.law@highmark.com	120 Fifth Ave.		Pittsburgh	PA	15222	12/20/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Boettler	Thomas		4125447031					Thomas.Boettler@highmark.com	120 5th Avenue	Suite 1833	Pittsburgh	PA	15222	12/05/2017	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Medicare Coordinator	Director, Government Compliance	Ms.	Carl	Kathleen	A	4125447156					Kathleen.Carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Medicare Part D Opioid Overutilization Contact	Pharmacist	Ms.	Ali	Dewaa		4129040214					Dewaa.ali@highmark.com	120 Fifth Avenue PAP P4207		Pittsburgh	PA	15222	07/31/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Medication Therapy Management Contact	Senior Pharmacist	Ms.	Adlesic	Meredith		4128883749					Meredith.Adlesic@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	OffShore Subcontractor Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Online Enrollment Center Contact (Back-up)	Manager Enrollment & Billing	Mr.	Stanhoff	David		4125445689					LISBAE@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/16/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Online Enrollment Center Contact (Optional)	Manager, Business Platform	Mr.	Hudson	Brian		7173025964					Brian.Hudson@highmark.com	1800 Center St.		Camp Hill	PA	17011	07/22/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Online Enrollment Center Contact (Primary)	Director, Enrollment and Billing	Mr.	Palmer	David		4125446384					David.Palmer@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/22/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Appeals	Manager, Member Appeals & Grievances	Ms.	Walsh	Lynne	M					7176354209	Lynne.Walsh@highmark.com	120 Fifth Avenue	Suite P5501	Pittsburgh	PA	15222	12/31/2020	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	4125444579				Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Appeals Contact (Secondary)	Supervisor, Appeals & Grievances	Ms.	Miller	Rachel	M					7176354209	Rachel.Miller@highmark.com	Fifth Ave Place	120 Fifth Avenue, Ste 5322	Pittsburgh	PA	15222	09/06/2018	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	4125441596				Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Application Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Benefits Contact	VP, Product Strategy & Portfolio Development	Mr.	Lightner	Timothy		4125440952					timothy.lightner@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Claims Submission Contact	Director Regulated Marketing Medicare Solutions		Dovico	Rosario		9145896300				8882822583	Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	11/09/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Exceptions Contact			Affairs	Pharmacy							drughelp@highmark.com	120 Fifth Avenue	Suite SPECARE	Pittsburgh	PA	15222	08/04/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	8006002227				Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Exceptions Contact (Secondary)	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	08/04/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	8003443405	733326			Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Price File Contact (Back-up)	Pharmacy Analyst	Mr.	Nolder	Tim		4124398263					timothy.nolder@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Price File Contact (Optional)	Director, Government Programs	Mr.	Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	02/14/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Price File Contact (Primary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Quality Assurance Contact	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Part D Reporting Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Patient Safety Contact	Director, Clinical Pharmacy Operations	Mr.	Causer	Derek		4125445835					Derek.Causer@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	12/20/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Payment Contact	Vice President, Accounting and Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Pharmacy Director	Manager, Pharmacy Programs		Winterhalter	Christa		4128884108					Christa.Winterhalter@highmark.com	120 Fifth Avenue Place		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Pharmacy Network Management Contact	Network Account Director, Retail Strat & Contract	Ms.	Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	01/12/2018	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Pharmacy Network Management Contact (Secondary)	Manager, Pharmacy Government Operations	Ms.	Lynn Schill	Jodie		5705783579					Jodie.LynnSchill@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	11/09/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	Philadelphia
S5593	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Government Operations	Ms	Lynn Schill	Jodie							Jodie.LynnSchill@highmark.com	120 Fifth Avenue Pittsburgh, PA 15222		Pittsburgh	PA	15222	08/16/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active	5705783579				Medicare Prescription Drug Plan		5	Philadelphia
S5593	PHR Beneficiary Contact																	07/23/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan	Highmark Inc	Highmark Health	123	Yes	Active	8665886967				Medicare Prescription Drug Plan		5	Philadelphia
S5593	Plan Directory Contact for Public Website			Service	Provider		8665886967					resourcecenter@highmark.com	120 Fifth Ave		Pittsburgh	PA	15222	12/05/2017	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Plan to Plan Reconciliation Contact	Manager, Operational Accounting	Mr.	Stehr	Brett	J	7173022748					P2Precon@highmark.com	Highmark Inc. Attn: Cashier	PO Box 898820	Camp Hill	PA	170890407	06/28/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Processor Contact	Manager, Claims	Mr.	Opal	Bob		4125445022				4125442111	Bob.Opal@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Reconciliation Contact	Vice President, Accounting & Reporting	Mr.	Bazzani	Matthew	B	4125448338					Matthew.Bazzani@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	09/06/2018	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Reconciliation Contact (Secondary)	Senior Risk * Compliance Case manager		Stetson	Kelsey		4125448816					kelsey.stetson@highmarkhealth.org	120 Fifth Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Recovery Audit Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Surveillance Contact	Senior Monitoring Analyst	Ms.	Pawlos	Jillian		4125445702					jillian.pawlos@highmarkhealth.org	120 5th Avenue		Pittsburgh	PA	15222	04/25/2022	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	System Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	Third Party Administrator (TPA) Liaison	Accountant		Jurgiewicz	Kimberly		5707807969					kimberly.jurgiewicz@highmark.com	120 Fifth Avenue		Pittsburgh	PA	15222	08/01/2023	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5593	User Access Contact	Senior Risk Partner	Ms.	Carl	Kathleen		4125447156					kathleen.carl@highmark.com	120 5th Avenue		Pittsburgh	PA	15222	07/28/2021	2023	HM HEALTH INSURANCE COMPANY	PDP	Highmark Blue Shield	Medicare Prescription Drug Plan		Highmark Health	123	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5596	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/28/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/10/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Bid Audit Contact	Actuarial Director		Hart	Mary		3175819752					mary.a.hart@anthem.com	220 Virginia Avenue	Mail Drop: IN205-A351	Indianapolis	IN	46204	01/18/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Bid Audit Site Contact	Actuarial Director		Hart	Mary		3175819752					mary.a.hart@anthem.com	220 Virginia Avenue	Mail Drop: IN205-A351	Indianapolis	IN	46204	01/18/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Bid Primary Contact	Director, Product Development		Floyd	Cari		5407984087					Cari.Floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/07/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	EOB Transfer Contact	Compliance Director, Med Part D/Pharm Oversight		Doss	Jennifer		5137484736				8558419706	jennifer.doss@anthem.com	4361 Irwin Simpson Road		Mason	OH	45040	10/08/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	5133167654				Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	8144498744				Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	5133167654				Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	5407984087				Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	8333774266				Medicare Prescription Drug Plan		5	Chicago
S5596	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	3135973173				Medicare Prescription Drug Plan		5	Chicago
S5596	PHR Beneficiary Contact																	11/05/2015	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Active	8004671199				Medicare Prescription Drug Plan		5	Chicago
S5596	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5596	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	ANTHEM INSURANCE COMPANIES, INC.	PDP	Anthem / Anthem or Blue KC in Missouri	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5601	Agent/Broker Compensation Data Contact	Sr. Manager, Project Program Management		Philips	Elissa		7026017491					ebcolalella@aetna.com	141 County Line Road		New Galilee	PA	16141	03/24/2023	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Automated TrOOP Balance Transfer Contact	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Backup User Access Contact	Executive Director, Compliance		Johnson	Meegan		7634799853					JohnsonM8@AETNA.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	06/24/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Best Available Evidence Contact	Sr. Manager Enrollment Operations		Lisowski	Susan		4802986117				8665526205	Susan.Lisowski@CVSHealth.com	9501 E Shea Boulevard		Scottsdale	AZ	85260	05/04/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Bid Audit Contact	Director, Actuarial Services		Randall	James		5133497156					RandallJ@Aetna.com	9829 Rolling Pines Dr.		Brighton	MI	48116	07/06/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Bid Audit Site Contact	Director, Actuarial Services		Randall	James		5133497156					RandallJ@Aetna.com	9829 Rolling Pines Dr.		Brighton	MI	48116	07/06/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Bid Primary Contact	Director, Actuarial Services Aetna		Schoening	Bradley		4022126350					BLSchoening@aetna.com	11415 S 173 Ave		Gretna	NE	68028	12/16/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	CAP Report Contact for Public Website	SilverScript, Chief Compliance Officer	Mr.	Jeswald	Patrick	J	4806612030				4803146974	Patrick.Jeswald@CVSHealth.com	9501 E. Shea Blvd, MC016		Scottsdale	AZ	85260	09/18/2014	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	CEO - CMS Administrator Contact	Vice President,  Medicare Part D	Ms.	Swanson	Terri		8602738766				8602738880	SwansonT@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	10/30/2019	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	CEO - Senior Official for Contracting	Vice President,  Medicare Part D	Ms.	Swanson	Terri		8602738766				8602738880	SwansonT@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	10/30/2019	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Chief Financial Officer	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/03/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Chief Operating Officer	Vice President,  Medicare Part D	Mr.	Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	07/06/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Chief Information Officer	SVP, HCB IT	Mr.	Frank	Nathan	C	6307372008					nathan.frank@cvshealth.com	3200 Highland Ave.		Downers Grove	IL	60515	09/28/2023	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Chief Information Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TimT@CVSHealth.com	151 Farmington Ave.		Hartford	CT	06156	12/16/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	CMS Casework Communication Contact	Director, Medicare Complaints		Diamond	Lorraine		7247785042				8607545693	cmscasework@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	05/21/2021	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Complaints Tracking Contact	Supervisor, Medicare Operations		Benage	Melissa		4806450637					Melissa.Benage@CVSHealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	05/31/2019	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Contact for Fraud Investigations	Director, Medicare Compliance	Mr.	Will	William	A	4806612383				4803582946	William.Will@CVSHealth.com	9501 E. Shea Blvd		Scottsdale	AZ	85260	05/04/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Coordination of Benefits Contact	Manager, Med D Financial Reconciliation	Ms.	Viana	Silvia		4802980166					Silvia.Viana@CVSHealth.com	9501 E. Shea Blvd, MC121		Scottsdale	AZ	85260	05/04/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Corporate Mailing						8602738766				8602734603	SwansonT@aetna.com	151 Farmington Ave.	Mail Code: RC61	Hartford	CT	06156	01/03/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Coverage Gap Discount Program (CGDP) Payment Contact	Director Medicare Finance	Mr.	Fu	Chee		4017701970					Chee.Fu@CVSHealth.com	One CVS Drive		Woonsocket	RI	02895	02/18/2021	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Customer Service Operations Contact	Director Customer Care		Swanger	Rachel		4405424056					Rachel.Swanger@CVSHealth.com	29100 Aurora Road		Solon	OH	44139	11/04/2019	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	DIR Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	BurkholderB@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/24/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	DIR Contact (Secondary)	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Emergency Part D Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	12/30/2021	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Emergency Part D Contact (Secondary)	Exec. Dir.,  Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	06/15/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Employer Waiver Contact	Vice President, COO of Medicare	Ms.	Giudice	Lucia	A	6175997282					giudicel@aetna.com	333 W. Wacker Frive		Chicago	IL	60606	02/22/2023	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Enrollment Contact	Executive Director, Service Operations		Blakeman	Andrea		4124326200				4128653896	amblakeman@aetna.com	2222 Ewing Road	Mail Code F233	Moon Township	PA	15108	06/24/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	EOB Transfer Contact	Executive Director, FP&A		Passuello	Clifford		7177292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17106	12/02/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Financial Audit Contact	Senior Manager FP&A	Ms.	Phillips	Karrie	E	8602736236					PhillipsKE@aetna.com	151 Farmington Avenue	Mail Code AS32	Hartford	CT	06156	01/03/2023	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Financial Reporting Contact	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/03/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Formulary Contact	Executive Director, Medical Affairs		Wilson	Laura		2168709760					Laura.Wilson@CVSHealth.com	29100 Aurora Road		Solon	OH	44139	12/16/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Formulary Contact (Secondary)	Medicare Operations Leader		Vanlandingham	Mary		8044366121					mcvanlanding@aetna.com	9881 Mayland Drive		Richmond	VA	23233	01/03/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	General Contact	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	Patrick.Jeswald@CVSHealth.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	10/28/2019	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Government Relations Contact	Executive Dir., Govt. Affairs, Public Policy		Jones	Greg	A	2022855320					JonesG2@CVSHealth.com	1275 Pennsylvania Ave. NW, Suite 700		Washington	DC	20004	06/24/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	HIPAA Privacy Officer	Senior Counsel		Dorazio	Jesisica		8602734006					DorazioJ1@aetna.com	151 Farmington Avenue		Hartford	CT	06156	06/24/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	HIPAA Security Officer	Deputy Chief Information Security Officer	Mr.	Tompkins	Timothy		8602735070					TimT@CVSHealth.com	151 Farmington Ave.		Hartford	CT	06156	12/16/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Hospice Contact	Sr, Manager, Medicare Part D Finance		Bernard	Alexander		4802435453				8442994547	HospiceProviderRelationsTeam@CVSCaremark.com	9501 E. Shea Blvd, MC 143		Scottsdale	AZ	85260	06/24/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Interoperability Contact	Exec. Dir. , Interoperability & Transpcy		Rackley-Cuda	Colleen		5022974233					rackley-cudac@cvshealth.com	151 Farmington Avenue, Mail Stop RC5B		Hartford	CT	06156	04/01/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Marketing Contact	Sr. Director of Operations Integrity		Hayes	Cheryl	R	5152043059					crbarkau@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	12/22/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Medical Director	Executive Medical Director - Medical Affairs	Dr.	Catero, MD	Martin		4803163732					Martin.Catero@CVSHealth.com	4755 South 44 Place  NC145		Phoenix	AZ	85040	12/16/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Medicare Compliance Officer	Chief Medicare Compliance Officer	Mr	Jeswald	Patrick	J	4806612030				8554548052	MedicareCO@aetna.com	9501 E Shea Blvd.	MC-016	Scottsdale	AZ	85260	05/14/2019	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Medicare Coordinator	Executive Director, Service Operations		Ellison	Christine		4124326289					EllisonC1@aetna.com	2222 Ewing Road		Moon Township	PA	15108	02/18/2021	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Medicare Part D Opioid Overutilization Contact	Director Clinical Pharmacy		McCann	Herbert	G	7178292347					MedicareRDUR@Aetna.com	3721 TecPort Drive		Harrisburg	PA	171067103	02/07/2023	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Medication Therapy Management Contact	Manager, Clinical Pharmacy		Haynes	Kathleen		8609006476					HaynesK@aetna.com	8910 Purdue Road		Indianapolis	IN	46268	01/03/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	OffShore Subcontractor Contact	Sr. Director, Operations Integrity		Gabbert	Tonya		8597790852					trgabbert@aetna.com	151 Farmington Ave.		Hartford	CT	06156	09/21/2021	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Online Enrollment Center Contact (Back-up)	Sr. Analyst Business Analytics		Stank	Tom		7176492572				2157754150	StankT@aetna.com	1425 Union Meeting Road		Blue Bell	PA	19422	01/03/2023	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Online Enrollment Center Contact (Primary)	Manager-Strategic Projects-Enrollment Ops		Clifton	Kimberly		4806613703				4806614614	Kimberly.Clifton@CVSHealth.com	9501 E Shea Boulevard MC 125		Scottsdale	AZ	85260	09/25/2018	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Appeals	Supervisor, Operations		Allen	Karyn						7326914838	allenk10@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active	8042966237				Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Appeals Contact (Secondary)	Manager, Pharmacy RPh		Vo	Binh						7326914838	binh.vo@cvshealth.com	620 Epsilon Drive		Pittsburgh	PA	15238	12/20/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active	7132085765				Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Application Contact	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					pdpapp@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Benefits Contact	Exec. Dir. , Part D Product Development		Bohrer	Christophe		8609165704				8602738880	BohrerC@aetna.com	151 Farmington Avenue	Mail Code RW4A	Hartford	CT	06156	01/18/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Claims Submission Contact	Business Project Program Manager		Shoiock	Mitchell		2157750114					ShoiockM@AETNA.com	1425 Union Meeting Road	Mail Code U22S	Blue Bell	PA	19422	12/20/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Exceptions Contact	Lead Dir., Medicare Quality and Audit		Brauner	Lyle							Lyle.Brauner@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	06/24/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active	6026183945				Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Exceptions Contact (Secondary)	Director, Medicare Clinical Operations		Samuel	George							Samuel.George@CVSHealth.com	1440 Valley Estates Road		Mondovi	WI	54755	01/11/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active	6122633491				Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Price File Contact (Back-up)	Sr. Manager, PBM Financial Operations		Okrie	Courtney		4803181864					courtney.okrie@cvshealth.com	9501 E. Shea Blvd	MC-121	Scottsdale	AZ	85260	09/23/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Price File Contact (Optional)	Sr. Manager, Compliance		Wilson	Michael	L	4806147698					michael.wilson@cvshealth.com	9501 E Shea Blvd		Scottsdale	AZ	85260	12/16/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Price File Contact (Primary)	Sr. Consultant, Medicare Finance		Loveland	Chet		4806064873					Chet.Loveland@CVSHealth.com	9501 E. Shea Blvd	MC-121	Scottsdale	AZ	85260	07/16/2019	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Quality Assurance Contact	VP, Medicare Medical Operations		Sharp, MD	Jamie		2124570335					sharpj@aetna.com	101 Park Ave., 15th Floor		New York	NY	10178	09/21/2021	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Part D Reporting Contact	Lead Dir., Bus. Compliance, Medicare Ops. Int.		Jones	Kristy		4126045089					JonesK2@CVSHealth.com	2222 Ewing Road		Coraopolis	PA	15108	06/24/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Patient Safety Contact	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Payment Contact	Sr. Director, Finance		Earley	Jim		2157750064					earleyj@aetna.com	1425 Union Meeting Road	Mail Code U12N	Blue Bell	PA	19422	07/15/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Pharmacy Director	Executive Director, Clinical Pharmacy		McKenna	Erin		4125924308					EKMcKenna@aetna.com	11 Stanwix Street	Suite 2300	Pittsburgh	PA	152221344	07/08/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Pharmacy Network Management Contact	Exec Director, Strategic Programs		Bishel	Lynn	E	8602732196					bishell@aetna.com	151 Farmington Avenue		Hartford	CT	06156	01/03/2023	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Pharmacy Network Management Contact (Secondary)	Exec. Dir., Prod. STRAT & Mgmt, MCR Part D Bus.		Amnott	Glenn		8609006940					AmnottG@aetna.com	1324 Upper City Road		Pittsfield	NH	03263	01/03/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Pharmacy Technical Help Desk Contact	Sr.Director, Medicare Service Operations	Mr.	Howarth	James							JFHowarth@aetna.com	7034 Alamo Downs Pkwy		San Antonio	TX	78238	01/03/2023	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active	8002386279				Medicare Prescription Drug Plan		5	Philadelphia
S5601	Plan Directory Contact for Public Website	Advisor, Medicare Plan Management		Devine	Kelly		8662355660				8448021415	CVSCaremark.EmailManager@CVSHealth.com	SilverScript Insurance	P.O. Box 30001	Pittsburgh	PA	152220330	04/28/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Plan to Plan Reconciliation Contact	Manager, Financial Accounting Services	Ms.	Burkholder	Brianna		7175262860				7247417216	P2P@aetna.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	17111	06/24/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Processor Contact	Director Service Operations		Painting	Melissa		5408725497					mcpainting@aetna.com	151 Farmington Avenue	Mail Code RT52	Hartford	CT	06156	01/03/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Reconciliation Contact	Exec Advisor, PBM Accounting	Mr.	Fu	Chee		4017701970					Chee.Fu@CVSHealth.com	200 Highland Corporate Drive		Cumberland	RI	02864	02/18/2021	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Reconciliation Contact (Secondary)	Vice President, CFO, Medicare	Mr.	Grozio	Kevin		8602731068					Groziok@aetna.com	151 Farmington Ave.		Hartford	CT	06156	01/03/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Recovery Audit Contact	Executive Director, FP&A	Mr	Passuello	Clifford	A	7178292378				7247417216	capassuello@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	12/02/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Surveillance Contact	Sr. Compliance Lead		Williams	Brooke	E	8137751411					WilliamsB6@aetna.com	4630 Woodland Corporate Blvd.		Tampa	FL	33634	11/17/2020	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	System Contact	Director, Med D IT	Mr.	Bish	Charles		2169702881					charles.bish@cvshealth.com	29100 Aurora Road		Solon	OH	44139	11/29/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	Third Party Administrator (TPA) Liaison	Manager, Financial Planning and Analysis	Mr.	Hoffer	Jason		7175262745					jwhoffer@cvshealth.com	3721 TecPort Drive	PO Box 67103	Harrisburg	PA	171067103	01/10/2022	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5601	User Access Contact	Executive Assistant		Yedgarlof	Mary	B	3015815862				8554548052	mbyedgarlof@aetna.com	15400 Calhoun Drive	Suite 300	Rockville	MD	20855	01/03/2023	2023	SILVERSCRIPT INSURANCE COMPANY	PDP	Aetna Medicare	Medicare Prescription Drug Plan		CVS Health Corporation	49	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S5609	Agent/Broker Compensation Data Contact	VP Medicare Sales	Mr.	Hess	Brent		8013336143					Brent.Hess@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	07/06/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Automated TrOOP Balance Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Backup User Access Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St.	MS:E15A	Portland	OR	97201	12/31/2020	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Best Available Evidence Contact	Membership Ambassador	Ms.	Neufeld	Jeri		8006621470	2526			8883352988	ORMEMMEDAmbassador@regence.com	PO Box 1827		Medford	OR	97501	02/16/2018	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Bid Audit Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Bid Audit Site Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Bid Primary Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	CAP Report Contact for Public Website	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	CEO - CMS Administrator Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/04/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	CEO - Senior Official for Contracting	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	12/27/2022	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Chief Financial Officer	SVP & CFO	Mr.	Rains	Mike		2063326521					Mike.Rains@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Chief Operating Officer	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	12/31/2020	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Chief Information Officer	SVP STRATEGIC TECH SOL & CIO	Mr	Rotival	Laurent		2063325034					Laurent.Rotival@cambiahealth.com	200 SW Market St		Portland	OR	97201	04/12/2016	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Chief Information Security Officer	VP & CHIEF INFO SEC OFFICER	Mr	Anderson	Kirk		5037251608					Kirk.Anderson@cambiahealth.com	100 SW Market St		Portland	OR	97201	04/12/2016	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	CMMI Model Point of Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	CMS Casework Communication Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Complaints Tracking Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Contact for Fraud Investigations	Senior Audit Investigator	Ms.	Grimes-Burke	Jennifer		5035873355					Jennifer.Grimes-Burke@regence.com	100 SW Market St	M/S E12B	Portland	OR	97201	06/16/2022	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Coordination of Benefits Contact	Manager, Member Services	Ms	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	PO Box 1827	MS: B32M	Medford	OR	97501	07/09/2016	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Corporate Mailing						5032206237				5035884350	Jennifer.DelVillar@regence.com	100 SW Market Street		Portland	OR	97201	01/07/2013	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Sr I	Mr.	Gerken	Matthew		2063324809					Matthew.Gerken@cambiahealth.com	1800 9th Ave		Seattle	WA	98101	04/19/2016	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Customer Service Operations Contact	Manager Member Services	Ms	Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	DIR Contact	Manager Pharmacy Informatics		Kidd	Vicki		2083957739				2083337874	vicki.kidd@regence.com	1211 West Myrtle, Suite 110		Boise	ID	83702	01/08/2018	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	DIR Contact (Secondary)	Dir. Gov. Pro Compliance / Medicare Compliance Off	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street E10C		Portland	OR	97201	07/22/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Emergency Part D Contact	VP Pharm Ops & Compliance	Mr.	Weiss	Justin		5032256677					Justin.Weiss@cambiahealth.com	200 SW Market St		Portland	OR	97201	12/20/2022	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Emergency Part D Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Employer Waiver Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Enrollment Contact	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	EOB Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Financial Audit Contact	Government Programs Audit Consultant	Mr.	Hutt	Brian		5032206160					Brian.Hutt@regence.com	200 SW Market Street	MS: E10C	Portland	OR	97201	05/09/2019	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Financial Reporting Contact	Fin Acctg & Reporting, Assistant Director	Mr	Striplin	Daniel	W	5032256069					Dan.Striplin@regence.com	200 SW Market		Portland	OR	97201	01/29/2018	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Formulary Contact	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Ave		Portland	OR	97201	01/18/2018	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	General Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Government Relations Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St.	MS:E10C	Portland	OR	97201	04/18/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	HIPAA Privacy Officer	VP Chief Compliance & Privacy Officer	Ms.	Erbes	Kristen		5035256533					kristen.erbes@regence.com	200 SW Market St	M/S: E14A	Portland	OR	97201	02/25/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	HIPAA Security Officer	Chief Information Security Officer	Mr.	Person	Steve		5037251654					Steve.Person@regence.com	1621 SW First Ave.		Portland	OR	97201	02/25/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Hospice Contact	Pharmacy Ops Oversight Specialist	Ms.	Pickens	Spring		5032255240					Spring.Pickens@regence.com	100 SW Market St	MS: WW5-56	Portland	OR	97201	02/05/2018	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Interoperability Contact	VP Chief Tech Officer		Anderson	Kirk		5037251608					kirk.anderson@cambiahealth.com	Cambia Health Solutions	200 SW Market Street	Portland	OR	97201	02/09/2022	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Marketing Contact	Compliance Analyst		Meirose	Robyn		5033918668					robyn.meirose@regence.com	200 SW Market St  MS: E10C		Portland	OR	97201	09/15/2015	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Medical Director	SVP Chief Medical Officer	Ms.	Milavetz	Donna		8013336740					Donna.Milavetz@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	12/05/2022	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Medicare Compliance Officer	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	07/14/2022	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Medicare Coordinator	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827		Medford	OR	97501	09/14/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Medicare Part D Opioid Overutilization Contact	Drug Management Program	Ms.	Anderson	Ally		8557297221					partdoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/14/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Medication Therapy Management Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Online Enrollment Center Contact (Back-up)	Dir Medicare Planning & Performance	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Online Enrollment Center Contact (Optional)	Manager Member Services	Ms.	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	2057 Commerce Dr		Medford	OR	97504	11/06/2017	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Online Enrollment Center Contact (Primary)	Spv Membership, GP OR Medicare Ops & Billing	Ms.	Cromwell	Krista		5416181286					Krista.Cromwell@regence.com	PO Box 1827	M/S: B32M	Medford	OR	97501	03/07/2018	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossig Rd	Eagan	MN	55120	03/21/2022	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Benefits Contact	Product Manager III	Ms.	Holliston	Danica		5032254871					Danica.Holliston@regence.com	200 SW Market St  M/S: E10M		Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Claims Submission Contact	Functional Business Consultant - Government Prgrms	Mr.	Brook	Lance		4026862603					LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	08/05/2019	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Exceptions Contact (Secondary)	Asst Director Pharmacy Operations	Ms.	Yi	Edie							edie.yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	972071271	12/15/2022	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	5032254801				Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Price File Contact (Back-up)	Database Reporting Analyst	Ms	Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2020	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Price File Contact (Optional)	QA Analyst Sr	Ms.	Tastad	Emily		6127772557					emily.tastad@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/03/2022	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Price File Contact (Primary)	AD Pharmacy Informatics	Ms.	Kidd	Vicki		2083957739					Vicki.Kidd@regence.com	1211 West Myrtle		Boise	ID	83702	07/22/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Quality Assurance Contact	Assistant Dir Pharmacy Operations	Ms.	Yi	Edie		5032254801				2083957744	Edie. Yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	97201	12/27/2022	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Part D Reporting Contact	Director Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	12/23/2020	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Patient Safety Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Payment Contact	Asst Director Fin Acctg & Reporting	Mr.	Striplin	Dan		5032256069					Dan.Striplin@cambiahealth.com	100 SW Market St	M/S: C2A	Portland	OR	97201	01/14/2014	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Pharmacy Director	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Avenue, M/S PDX - WW3-33		Portland	OR	97201	01/29/2018	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Pharmacy Network Management Contact	AVP, Network Mangement	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/18/2020	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Management Relations		Lenhart	Alicia		6127773969				8778236373	Alicia.Lenhart@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	09/11/2020	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Pharmacy Technical Help Desk Contact	Director, Member Services Government Programs	Mr.	Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				Medicare Prescription Drug Plan		5	Seattle
S5609	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jon							jonathan.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				Medicare Prescription Drug Plan		5	Seattle
S5609	Plan Directory Contact for Public Website	Manager Member Services		Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Plan to Plan Reconciliation Contact	Pharmacy Operations Oversight Specialist, Sr.	Ms.	Manzer	Amy		5032255368					Amy.Manzer@regence.com	200 SW Market St	M/S: PDX-ZOF WW3-33	Portland	OR	97201	08/26/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing	Egan	MN	55121	04/19/2023	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Reconciliation Contact	VP Finance Controller		Vannoy	Anjie		5032761865					Anjie.Vannoy@cambiahealth.com	100 SW Market St.	MS:PDX-WW2-21	Portland	OR	97201	01/08/2018	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Reconciliation Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS:E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Recovery Audit Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Surveillance Contact	Government Programs Compliance Officer		Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St  M/S: E10C		Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	System Contact	Medicare Business Operations, Product Owner	Ms.	Fredinburg	Deana		5033754426					Deana.Fredinburg@regence.com	PO BOX 1827	M/S: B32AG	Medford	OR	97501	06/24/2022	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	Third Party Administrator (TPA) Liaison	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St		Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5609	User Access Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	ASURIS NORTHWEST HEALTH	PDP	Asuris Northwest Health	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5617	Agent/Broker Compensation Data Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	05/19/2022	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Automated TrOOP Balance Transfer Contact	Operations Advisor	Mrs.	Fertig	Nancy		8609024553					nancy.fertig@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06512	03/15/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Backup User Access Contact	Legal Compliance Sr. Analyst		Allen	Carolyn		8609024552					Carolyn.Allen@cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Best Available Evidence Contact	Operations Analyst		Abdur-Rashid	Krystle		8609045380					Krystle.abdur-rashid@cignahealthcare.com	900 Cottage Grove Road		Bloomfield	CT	06512	09/12/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Bid Audit Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Bid Audit Site Contact	Legal Compliance Advisor		Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	500 Great Circle Road		Nashville	TN	37228	11/09/2022	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	CAP Report Contact for Public Website	Legal Compliance Manager		Wilson	Tyra		8607877417					tyra.wilson@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	CEO - CMS Administrator Contact	Sr. VP Government Programs	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 E Raintree dr		Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	CEO - Senior Official for Contracting	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Chief Financial Officer	Chief Financial Officer	Mr.	Czar	Greg		2157611880	1880				gregory.czar@cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	08/30/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Chief Operating Officer	Sr. VP Government Programs	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 E Raintree dr		Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Chief Information Officer	SVP Information Technology	Mr.	Lepre	Christophe		8602262757					Christopher.Lepre@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Chief Information Security Officer		Mr	Beeson	James		8602261761					james.beeson@cigna.com	900 Cottage Grove Rd		Bloomfield	CT	06152	12/06/2017	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	CMMI Model Point of Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Rd		Clarksville	TN	37042	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	CMS Casework Communication Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	01/07/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Complaints Tracking Contact	Customer Service Manager	Mrs.	Fischbach	Susan		8049046277					Susan.Fischbach@healthspring.com	3700 O'Donnell Street		Baltimore	MD	21224	01/07/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Contact for Fraud Investigations	Fraud Manager		Nielson	Valerie		3146845432					VJNielson@express-scripts.com	4600 North Hanley		St Louis	MO	63134	01/07/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Coordination of Benefits Contact	Operations Senior Manager		Rodrigue	Jacquelyn		8602264165					jacquelyn.rodrigue@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06512	03/15/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Corporate Mailing						6155658100					Hollie.Caupp@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Analyst	Mrs	Havlicek	Amanda		6014544965					amanda.havlicek@express-scripts.com	500 Great Circle Rd		Nashville	TN	37228	08/01/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Customer Service Operations Contact	Operations Senior Manager	Mrs.	Weber	Ashleigh		8609029968					ashleigh.weber@cigna.com	900 Cottage Grove Rd		Bloomfield	CT	06512	03/15/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	DIR Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	DIR Contact (Secondary)	Business Finance Director		Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Emergency Part D Contact	Operations Senior Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Emergency Part D Contact (Secondary)	VP Government Pharmacy	Mr.	Rooker	Todd		6232771870					todd.rooker@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Employer Waiver Contact	Client Account Support Senior Manager	Ms.	Tant	Shelly		8609024561					shelly.tant@cigna.com	500 Great Circle Rd		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Enrollment Contact	Operations Senior Manager		Rodrigue	Jacquelyn		8602264165					jacquelyn.rodrigue@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06512	03/15/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	EOB Transfer Contact	Business Project Sr Specialist		Porter	Deborah		8609024586				8602266000	deborah.porter@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06002	09/05/2018	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Financial Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Financial Reporting Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	12/29/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Formulary Contact	Clinical Program Director	Mr.	Baldwin	Vincent		8609025498					vincent.baldwin@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Formulary Contact (Secondary)	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					Ann.Schuster@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	General Contact	Legacl Compliance Senior Director		Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Government Relations Contact	Government Affairs Snr Principle		Michel	James		6166356537					JAMES.MICHEL@Cigna.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	HIPAA Privacy Officer	Medicare Privacy Officer	Mrs.	Duncan	Jenn		6152340329					jennifer.duncan@healthspring.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Hospice Contact	Operations Senior Manager		Rodrigue	Jacquelyn	P	8602264165					Jacquelyn.Rodrigue@Cigna.com	900 Cottage Grove Road		Bloomfield	CT	06512	12/15/2022	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Interoperability Contact	Legal Compliance Senior Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Marketing Contact	Legal Compliance Lead Analyst	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive	Bldg B	Phoenix	AZ	85085	02/02/2019	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Medical Director	Chief Medical Director	Dr.	Reardon	Michael		2152660681					MICHAEL.REARDON@Cigna.com	500 Great Circle Road		Nashville	TN	37228	12/29/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Medicare Coordinator	President, Medicare Advantage	Mr	DeRosa	Christophe		9492551436					christopher.derosa@cignahealthcare.com	26 Executive Park		Irvine	CA	92614	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Medicare Part D Opioid Overutilization Contact	Clinical Program Senior Manager	Mrs	Patel	Shivani		8607877901					NarcoticCaseManagement@cigna.com	500 Great Circle		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Medication Therapy Management Contact	Clinical Program Senior Manager	Mrs.	Patel	Shivani		8607877901					Shivani.Patel@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	OffShore Subcontractor Contact	Compliance Manager	Mrs	Kidd	Amanda		8049044317					Amanda.Karwin@healthspring.com	500 Great Circle Road		Nashville	TN	37228	02/17/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Online Enrollment Center Contact (Back-up)			Rodrigue	Jacquelyn		8602264165					jacquelyn.rodrigue@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06512	04/13/2018	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Online Enrollment Center Contact (Optional)	Software Development Director		De La Torre	Maria		9549035169					mdelatorre@conveyhs.com	100 SE 3rd Avenue	14th Floor	Fort Lauderdale	FL	33394	03/15/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Online Enrollment Center Contact (Primary)	Operations Senior Manager	Mrs.	Rodrigue	Jaquelyn		8602264165					jacquelyn.rodrigue@cigna.com	900 Cottage Grove Road		Bloomfield	CT	06512	03/15/2021	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Part D Appeals	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active	4805480643				Medicare Prescription Drug Plan		5	New York
S5617	Part D Appeals Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active	8609024668				Medicare Prescription Drug Plan		5	New York
S5617	Part D Application Contact	Legal Compliance Advisor	Ms.	Wilson	Tyra		8607877417				6152342154	tyra.wilson@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	02/02/2019	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Part D Benefits Contact	Business Development Sr. Director		Turner	Kelle		6123941302					kelle.turner@cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Part D Claims Submission Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Part D Exceptions Contact	Operations Senior Manager	Mr.	Erkens	Ronald							ronald.erkens@cigna.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active	4805480643				Medicare Prescription Drug Plan		5	New York
S5617	Part D Exceptions Contact (Secondary)	Operation Manager	Mrs	Johnson	Yarmeka							Yarmeka.Johnson@Cigna.com	1601 Chestnut St		Philadelphia	PA	19192	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active	8609024668				Medicare Prescription Drug Plan		5	New York
S5617	Part D Price File Contact (Back-up)	Business Project Sr. Spec.		Ustach	Beth		8602263190					Beth.Ustach@Cigna.com	900 Cottage Grove Road Wilde		Bloomfield	CT	06152	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Part D Price File Contact (Optional)	Legal Compliance Advisor		Dwyer	Sherri		7244254657					Sherri.Dwyer@Cigna.com	500 Great Circle Road		Nasvhille	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Part D Price File Contact (Primary)	Product Manager		Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	376 Monterey Drive		Dublin	OH	43017	12/13/2019	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Part D Quality Assurance Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Part D Reporting Contact	Data Measurement & Reporting Manager	Mrs	Stokes	Tammy		4805781204					Tammy.Stokes@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Patient Safety Contact	Clinical Program Senior Director	Mrs.	Schuster	Annie		6156951241					ann.schuster@healthspring.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Payment Contact	Chief Financial Officer	Mr.	Czar	Greg		2157611880					Gregory.Czar@Cigna.com	1601 Chestnut St -Two Liberty		Philadelphia	PA	19192	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Personal Health Record Contact	Operations Senior Manager	Mr.	Erkens	Ronald		4805480643					ronald.erkens@cigna.com	8888 Raintree Dr	3rd floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Pharmacy Director	Operations Sr Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	8888 Raintree Dr	3rd Floor	Scottsdale	AZ	85260	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Pharmacy Network Management Contact	Provider Contract Sr Manager	Mrs.	Bourdier	MaryAnne		8603389867					Maryanne.Bourdier@Cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Pharmacy Network Management Contact (Secondary)	Provider Contracting Advisor		Ruggiero	June		8608035631					june.ruggiero@cigna.com	900 Cottage Grove Road B5PHR		Hartford	CT	06152	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Pharmacy Technical Help Desk Contact			Scripts	Express								1 Express Way		St. Louis	MO	63121	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	New York
S5617	Pharmacy Technical Help Desk Contact (Secondary)	Provider Contract Sr Manager	Mrs.	Bourdier	Maryanne							Maryanne.Bourdier@Cigna.com	500 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active	8603389867				Medicare Prescription Drug Plan		5	New York
S5617	Plan Directory Contact for Public Website	Operations Director	Mr	Meadows	Russ		8002226700				8007351469	LetUsHelpYou@healthspring.com	P.O. Box 269005		Weston	FL	33326	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Plan to Plan Reconciliation Contact			Thomas	Andrea		6152346776				6152917025	P2P@CignaHealthcare.com	P.O. Box 11407	Dept#8277	Birmingham	AL	35246	08/10/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Processor Contact	Operations Director	Mr.	Meadows	Russ		6232994317					russell.meadows@healthspring.com	25500 N Norterra Drive		Phoenix	AZ	85085	02/02/2019	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Reconciliation Contact	Financial Analysis Senior Advisor		Wright	Kimberly		9145234965					kimberly.wright2@cigna.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Reconciliation Contact (Secondary)	Business Finance Director	Mr.	Miller	Ian		6155643473					ian.miller@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Recovery Audit Contact	Legal Compliance Advisor	MR	Finn	Matt		8007115672					matt.finn@cigna.com	8455 University Place Dr		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Surveillance Contact	Legal Compliance Manager	Mrs.	Hafstrom	Kim		6232771478					kimberly.hafstrom@cigna.com	25500 N Norterra Drive		Phoenix	AZ	85085	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	System Contact	Legal Compliance Senior Director	Mr	Crognale	Louis		8607877395					louis.crognale@healthspring.com	500 Great Circle Road		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	Third Party Administrator (TPA) Liaison	Accounting Director	Ms.	Kirkpatrick	Mercy		3053025896					mercy.kirkpatrick@express-scripts.com	One Express Way		St Louis	MO	63121	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5617	User Access Contact	Compliance Sr Manager		Parker	Marcie		6157884297					marcie.parker@healthspring.com	530 Great Circle Rd		Nashville	TN	37228	07/28/2023	2023	CIGNA HEALTH AND LIFE INSURANCE COMPANY	PDP	Cigna	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Agent/Broker Compensation Data Contact	Director		Tierney	Dan		2018191561					daniel_tierney@express-scripts.com	100 Parsons Pond Dr		Franklin Lakes	NJ	07417	12/30/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Automated TrOOP Balance Transfer Contact	Director		Tierney	Dan		2018191561					ESITroopTransfer@express-scripts.com	100 Parsons Pond Dr.		Franklin Lakes	NJ	07417	12/30/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Backup User Access Contact	Product Owner		Robertson	Char		8175285868					char_Robertson@express-scripts.com	6025 Saddle Bag Dr		Fort Worth	TX	76179	07/31/2020	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Best Available Evidence Contact	Director		Tierney	Dan		2018191561					daniel_tierney@express-scripts.com	100 Parsons Pond Dr		Franklin Lakes	NJ	07417	12/30/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Bid Audit Contact	Compliance Officer		Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	03/08/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Bid Audit Site Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	500 Great Circle Road		Nashville	TN	37228	03/08/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Bid Primary Contact	Actuarial Managing Director	Mr.	Au	Andrew		2157612327				6152917011	Andrew.Au@Cigna.com	500 Great Circle Road		Nashville	TN	37228	03/08/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	CAP Report Contact for Public Website	Medicare Compliance Officer		Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	03/08/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	CEO - CMS Administrator Contact	VP - Express Scripts PDP	Ms.	Leech	Laura		4042901745					Laura_Leech@express-scripts.com	10833 Brandie Meadow Lane		Huntersville	NC	28078	07/27/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	CEO - Senior Official for Contracting	VP - Express Scripts PDP	Mrs.	Leech	Laura		4042901745					Laura_Leech@express-scripts.com	10833 Brandie Meadow Lane		Huntersville	NC	28078	07/27/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Chief Financial Officer		Mr.	Phillips	Bradley		3146146784					BPhillips@express-scripts.com	One Express Way		St. Louis	MO	63121	03/17/2020	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Chief Operating Officer	VP - Express Scripts PDP	Ms.	Leech	Laura		4042901745					Laura_Leech@express-scripts.com	10833 Brandie Meadow Lane		Huntersville	NC	28078	12/20/2019	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Chief Information Officer	VP Information Technology	Mr.	McLaughlin	Bill		8455580265				3148476601	bill_mclaughlin@express-scripts.com	115 Tabor Road		Morris Plains	NJ	07950	08/25/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Chief Information Security Officer		Mr	Beeson	James		8602261761					james.beeson@cigna.com	900 Cottage Grove Rd		Bloomfield	CT	06152	03/08/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	CMS Casework Communication Contact	Manager		Anderson	Angela		9729156108					angela_anderson@express-scripts.com	1707 Market Place Blvd	Suite 390	Irving	TX	75063	03/23/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Complaints Tracking Contact	Manager		Anderson	Angela		9729156108					angela_anderson@express-scripts.com	1707 Market Place Blvd	Suite 390	Irving	TX	75063	03/23/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Contact for Fraud Investigations	Product Owner		Robertson	Char		8175285868					char_Robertson@express-scripts.com	6025 Saddle Bag Dr  TX		Fort Worth	TX	76179	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Coordination of Benefits Contact	Director		Proper	Rob		6142144681					MedDCOBTeam@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	04/08/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Corporate Mailing						3146846701				8666852758	blake_simon@express-scripts.com	One Express Way		St. Louis	MO	63121	03/07/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Lead Analyst		Havlicek	Amanda		6014544965					Amanda.Havlicek@express-scripts.com	One Express Way	Mailstop S12NA	St Louis	MO	63121	08/01/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Customer Service Operations Contact	Manager		Davidson	Regina		7728128436					Regina_Davidson@express-scripts.com	One Express Way		St. Louis	MO	63121	04/10/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	DIR Contact	Director		Simon	Blake		2146207186					blake_simon@express-scripts.com	One Express Way		St. Louis	MO	63122	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	DIR Contact (Secondary)	Senior Manager		Katzman	James		7326855436					James_Katzman@express-scripts.com	569 Sylvan Road		River Vale	NJ	07675	02/16/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Emergency Part D Contact	VP - Express Scripts PDP	Ms.	Leech	Laura		4042901745					Laura_Leech@express-scripts.com	10833 Brandie Meadow Lane		Huntersville	NC	28078	12/20/2019	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Emergency Part D Contact (Secondary)			McAfoos	Hannah		6188232375					HCMcAfoos@express-scripts.com	One Express Way		St. Louis	MO	63121	12/30/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Employer Waiver Contact	Senior Manager		Farrell	Funda		3473343367					Funda_Farrell@express-scripts.com	One Express Way		St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Enrollment Contact	Director		Tierney	Dan		2018191561					daniel_tierney@express-scripts.com	100 Parsons Pond Dr		Franklin Lakes	NJ	07417	12/30/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	EOB Transfer Contact	Director		Farrell	Funda		3473343367				8666287139	Funda_Farrell@express-scripts.com	One Express Way		St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Financial Audit Contact	Senior Manager	Mrs.	Haley	Rhonda		9085834351					randerson3@express-scripts.com	One Express Way		St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Financial Reporting Contact	Accounting Manager		Ansley	Connie		6155643480					Connie.Ansley@healthspring.com	530 Great Circle Road		Nashville	TN	37228	11/01/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Formulary Contact	Client Benefit Analyst		Calderwood	Christophe		9142614463					CCalderwood@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	03/17/2020	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Formulary Contact (Secondary)	Client Benefit Team Lead		Borra	Danielle		8457426680					Dborra@express-scripts.com	53 Maple Lane		Monroe	NY	10950	03/17/2020	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	General Contact	Senior Manager		Farrell	Funda		3473343367					Funda_Farrell@express-scripts.com	One Express Way		St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Government Relations Contact	Senior Principal - Federal Government Affairs		Michel	James		6166356537					James.Michel@Cigna.com	701 Pennsylvania Ave NW	Ste. 720	Washington	DC	20004	01/13/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	HIPAA Privacy Officer	Privacy Officer		Piant	Kim		3146517109					kpiant@express-scripts.com	One Express Way		St. Louis	MO	63121	12/30/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	HIPAA Security Officer	Information Protection Senior Advisor	Mr.	Robinson	Richard		8609075925					Richard.Robinson@cigna.com	500 Great Circle Road		Nashville	TN	37228	03/08/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Hospice Contact	Product Management Manager		Holdren	Frank		6143909546					HP-HospiceBAE@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	05/23/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Interoperability Contact	Senior Manager		Haley	Rhonda		9085834351					randerson3@express-scripts.com	One Express Way		St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Marketing Contact	Senior Manager		Haley	Rhonda		9085834351					randerson3@express-scripts.com	One Express Way		St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Medical Director	Medical Director		Rower	Jeremy		5039277667					Jeremy.Rower@evernorth.com	6625 West 78th Street	BL0675	Bloomington	MN	55439	04/05/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Medicare Compliance Officer	Medicare Compliance Officer	Mrs	Cox	Courtney		8133349377					Courtney.Cox@cigna.com	500 Great Circle Road		Nashville	TN	37228	03/08/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Medicare Coordinator	VP - Express Scripts PDP	Mrs.	Leech	Laura		4042901745					Laura_Leech@express-scripts.com	10833 Brandie Meadow Lane		Huntersville	NC	28078	07/27/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Medicare Part D Opioid Overutilization Contact	Clinical Program Advisor		Plath	Brian		7326704655					BPlath@express-scripts.com	100 Parsons Pond Rd		Franklin Lakes	NJ	07417	01/30/2020	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Medication Therapy Management Contact	Director-Product Management		Muralidharan	Adrienne		3143131932					AMuralidharan@express-scripts.com	One Express Way		St. Louis	MO	63121	03/17/2020	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	OffShore Subcontractor Contact	Director		Simon	Blake		2146207186					blake_simon@express-scripts.com	One Express Way		St. Louis	MO	63122	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Online Enrollment Center Contact (Back-up)	Director		Simon	Blake		2146207186					blake_simon@express-scripts.com	1707 Market Place Blvd. Suite 390		Irving	TX	75063	08/11/2020	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Online Enrollment Center Contact (Primary)	Director		Tierney	Dan		2018191561					daniel_tierney@express-scripts.com	100 Parsons Pond Dr		Franklin Lakes	NJ	07417	12/30/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Part D Appeals			Schumm	Brian							brian_schumm@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	02/03/2016	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active	8003443405	733326			Medicare Prescription Drug Plan		5	New York
S5660	Part D Appeals Contact (Secondary)			Beard	Pat							pat_beard@express-scripts.com	8455 University Place	# HQ2L-04 Attention: Leslie Smith	St. Louis	MO	63121	01/06/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active	2012692208				Medicare Prescription Drug Plan		5	New York
S5660	Part D Application Contact	Director		Simon	Blake		2146207186					blake_simon@express-scripts.com	One Express Way	Mail Stop 3W03	St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Part D Benefits Contact	Senior Manager		Farrell	Funda		3473343367					Funda_Farrell@express-scripts.com	One Express Way		St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Part D Claims Submission Contact	Director		Dovico	Rosario		9145896300					Rosario_Dovico@express-scripts.com	100 Parsons Pond Dr.		Franklin Lakes	NJ	07417	04/29/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Part D Exceptions Contact			Schumm	Brian							brian_schumm@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	04/29/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active	8003443405	733326			Medicare Prescription Drug Plan		5	New York
S5660	Part D Price File Contact (Back-up)	Manager, Regulated  Markets Product		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	04/10/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Part D Price File Contact (Optional)			Robertson	Char		8175285868					Char_Robertson@express-scripts.com	6025 Saddle Bag Dr.		Fort Worth	TX	76179	06/21/2019	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Part D Price File Contact (Primary)	Sr. Manager,  Regulated Markets		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	04/10/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Part D Quality Assurance Contact	Director		Simon	Blake		2146207186					blake_simon@express-scripts.com	One Express Way		St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Part D Reporting Contact	Senior Manager		Haley	Rhonda		9085834351					randerson3@express-scripts.com	One Express Way	Mail Stop 3W03	St. Louis	MO	63121	07/26/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Patient Safety Contact	Director		Strednak	Suzanne		2016697462					suzanne_strednak@express-scripts.com	100 Parsons Pond		Franklin Lakes	NJ	07417	03/17/2020	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Payment Contact	Director		Woldt	Jennifer		2019706121					Jennifer_Woldt@express-scripts.com	54B Hawthorne Ave.		Park Ridge	NJ	07656	02/16/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Pharmacy Director	VP - Express Scripts PDP	Mrs.	Leech	Laura		4042901745					Laura_Leech@express-scripts.com	10833 Brandie Meadow Lane		Huntersville	NC	28078	07/27/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Pharmacy Network Management Contact			Kelly	Heather		3146921866					hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	11/30/2016	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Pharmacy Technical Help Desk Contact	Director Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	11/17/2021	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	New York
S5660	Plan Directory Contact for Public Website			Service	Customer		8007584574					mhayden@express-scripts.com	One Express Way	Mail Stop 3W03	St. Louis	MO	63121	12/22/2015	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Plan to Plan Reconciliation Contact	Accounting Lead Analyst		Benage	David		3148478133					DBenage@express-scripts.com	One Express Way	Mailstop S12NA	Saint Louis	MO	63121	08/01/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Processor Contact	Senior Director		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St Louis	MO	63121	10/17/2017	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Reconciliation Contact	Director		Woldt	Jennifer		2019706121					Jennifer_Woldt@express-scripts.com	54B Hawthorne Ave.		Park Ridge	NJ	07656	02/16/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Recovery Audit Contact	Senior Manager	Mrs	Haley	Rhonda		9085834351					randerson3@express-scripts.com	One Express Way		St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Surveillance Contact	Director		Simon	Blake		2146207186					blake_simon@express-scripts.com	One Express Way		St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	System Contact	Senior Manager		Haley	Rhonda		3473343367					randerson3@express-scripts.com	One Express Way		St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	Third Party Administrator (TPA) Liaison	Accounting Lead Analyst		Havlicek	Amanda		6014544965					Amanda.Havlicek@express-scripts.com	One Express Way	Mailstop S12NA	St. Louis	MO	63121	08/01/2023	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5660	User Access Contact	Senior Manager		Haley	Rhonda		9085834351					randerson3@express-scripts.com	One Express Way	Mail Stop 3W03	St. Louis	MO	63121	05/19/2022	2023	MEDCO CONTAINMENT LIFE AND MEDCO CONTAINMENT NY	PDP	Express Scripts Medicare	Medicare Prescription Drug Plan		The Cigna Group	38	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5715	Agent/Broker Compensation Data Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673				0000000000	Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 31st Street	Downers Grove	IL	60515	01/30/2020	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Automated TrOOP Balance Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Backup User Access Contact	Sr. Business Consultant	Ms.	Davis	Kassandra		3126531351				0000000000	kassandra_davis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Best Available Evidence Contact	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Bid Audit Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	11/06/2020	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Bid Audit Site Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Bid Primary Contact	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	11/06/2020	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	CAP Report Contact for Public Website	Executive Director Medicare Performance & Delivery	Ms.	Romero	Shawnna		5058164072					Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	CEO - CMS Administrator Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/04/2023	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	CEO - Senior Official for Contracting	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Chief Financial Officer	Director & Actuary	Mr.	Eifler	Adam		3126535482				0000000000	Adam_Eifler@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	11/06/2020	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Chief Operating Officer	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Chief Information Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Chief Information Security Officer	Executive Director Portfolio Delivery	Ms.	Floyd	Kris		9727663856					Kris_Floyd@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	CMMI Model Point of Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	CMS Casework Communication Contact	Manager Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Complaints Tracking Contact	Manager, Medicare Operations & Oversight	Ms.	Smith	Tawanna		6308245090				0000000000	Tawanna_Smith@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	12/08/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Contact for Fraud Investigations	Director, Special Investigations, Gov't Programs	Ms.	O'Dea	Lynn	M	3126533579				0000000000	Lynn_M_Odea@bcbsil.com	Blue Cross Blue Shield of Illinois	300 East Randolph Street	Chicago	IL	60601	11/27/2019	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Coordination of Benefits Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	COBMedD@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Corporate Mailing						3126535521				0000000000	Rebecca_Beasley@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/21/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Coverage Gap Discount Program (CGDP) Payment Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Customer Service Operations Contact	AVP Medicare Program Mgmt	Ms.	Katsoulis	Kate		9727665122				0000000000	mohrk@bcbsil.com	Health Care Service Corporation	1001 East Lookout Drive	Richardson	TX	75082	02/05/2020	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	DIR Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	DIR Contact (Secondary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Emergency Part D Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/04/2023	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Emergency Part D Contact (Secondary)	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2023	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Employer Waiver Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	12/30/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Enrollment Contact	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	EOB Transfer Contact	Director, PBM Operation	Ms.	Cain	Christina		6127776722				6127771330	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/25/2023	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Financial Audit Contact	Executive Dir Internal Audit	Mr.	Kolodziej	Dave		3126532483					David_L_Kolodziej@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/30/2020	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Financial Reporting Contact	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/03/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Formulary Contact	Sr Director Ent Pharmacy Government Programs	Ms.	Chavez	Alicia		5058163041				0000000000	alicia_chavez@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE, Suite 300	Albuquerque	NM	87109	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773				0000000000	martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	General Contact	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Government Relations Contact	DVP Health Policy Government Programs	Ms.	Mott-Bronson	Dana		2022497214				0000000000	Dana_Mott-bronson@hcsc.net	Health Care Service Corporation	1001 Pennsylvania NW	Washington	DC	20004	12/04/2018	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	HIPAA Privacy Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	HIPAA Security Officer	Manager Medicaid Operations	Ms.	Britt	Shekitta		4053167588					Shekitta_Britt@bcbsok.com	Health Care Service Corporation	3817 Northwest Expressway	Oklahoma City	OK	73112	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Hospice Contact	Govt Prog Clinical Ops Dvisional Vice President	Ms.	Thomas-Spaulding	Felicia	S	5058162717				0000000000	Felicia_Spaulding@bcbsnm.com	Blue Cross Blue Shield of New Mexico	4411 The 25 Way NE	Albuquerque	NM	87109	02/27/2019	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Interoperability Contact	Head of DAS Platform Ops	Mr.	Padiyar	Satish		9727668983					Satish_Padiyar@bcbstx.com	1001 East Lookout Drive	Building A	Richardson	TX	75082	02/14/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Marketing Contact	Dir Government Programs Marketing	Ms.	Beasley	Rebecca		3126535521				0000000000	CMSSubmissions@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Medical Director	VP Medical Policy	Dr.	Reed	Kim		3126535487				0000000000	ReedK@bcbsil.com	Health Care Service Corporation	300 E. Randolph	Chicago	IL	60601	05/08/2020	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Medicare Compliance Officer	VP, Government Programs Compliance Officer	Ms.	Green	Kim	A	3126535110				3128199474	Kim_Green@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Medicare Coordinator	Executive Director Delivery & Performance	Ms.	Romero	Shawnna		5058164072				0000000000	Shawnna_Romero@bcbsnm.com	Health Care Service Corporation	5701 Balloon Fiesta Parkway	Albuquerque	NM	87113	06/17/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists	Ms.	Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Medication Therapy Management Contact	Manager, MTM and Case/Care Management	Mr.	Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	OffShore Subcontractor Contact	Ex Dir Delegation Oversight	Ms.	Morales	Pamela		3126534173					Pamela_Morales@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Online Enrollment Center Contact (Back-up)	Associate Director - Projects	Mr.	Roberts	Dan		7035684213					Daniel.Roberts@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Online Enrollment Center Contact (Optional)	Director Program Oversight	Ms.	Lester	Roberta		5058163070					Roberta_Lester@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way N.E.	Albuquerque	NM	87109	01/10/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Online Enrollment Center Contact (Primary)	Deputy General Manager, Digital Operations	Mr.	Davis	Tom		5703449237	73545			0000000000	Thomas.Davis@cognizant.com	Cognizant	25 Lakeview Drive	Jessup	PA	18434	01/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Denver
S5715	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Denver
S5715	Part D Application Contact	Manager, Medicare Product Development	Ms	Bradley	Kelly		9727665146				0000000000	Kelly_Bradley@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	12/22/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Part D Benefits Contact	Director, Benefit Operations	Ms	Gergen	Ashley		5073018360				0000000000	agergen@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/12/2023	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Part D Claims Submission Contact	Functional Business Consultant	Mr	Brooke	Lance		4026862603				0000000000	LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Drive	Eagan	MN	55122	08/09/2019	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Part D Exceptions Contact	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/01/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Denver
S5715	Part D Exceptions Contact (Secondary)	Regulatory Manager & Audit Response		Gonzales	Santiago						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	04/01/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Denver
S5715	Part D Price File Contact (Back-up)	Price File Analyst	Ms.	Tastad	Emily		6127771699				0000000000	emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Part D Price File Contact (Optional)	Business Solution Analyst Sr.	Ms.	Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	01/12/2023	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Part D Price File Contact (Primary)	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Part D Quality Assurance Contact	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Part D Reporting Contact	Sr. Dir Divisional Data	Mr.	Jorge	Victor		9727662424				0000000000	Victor_Jorge@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building B	Richardson	TX	75082	02/05/2020	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Patient Safety Contact	Clinical Program Pharmacist Prin	Ms.	Leland	Ann		6127775221				0000000000	ALeland@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	11/27/2019	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Payment Contact	President Medicare	Ms.	Kourouklis	Christine		3126532211				0000000000	Christine_Kourouklis@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Personal Health Record Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316					Lorenzo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/04/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Pharmacy Director	Director Pharmacy Medicare	Mr.	El-Emawy	Mahmoud		5058162913					Mahmoud_El-emawy@bcbsnm.com	Health Care Service Corporation	4411 The 25 Way NE	Albuquerque	NM	87109	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Pharmacy Network Management Contact	VP, Network Management	Ms.	Conlin	Marci		6127772837				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2023	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services	Ms.	Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55122	12/29/2020	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Pharmacy Technical Help Desk Contact	Director, Member Services	Mr.	Schultz	Bret						0000000000	bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active	8006936704				Medicare Prescription Drug Plan		5	Denver
S5715	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jonathon						0000000000	jonathon.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	03/22/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active	0000000000				Medicare Prescription Drug Plan		5	Denver
S5715	Plan Directory Contact for Public Website			Service	Customer		8778956448				0000000000	MedicareContractsOffice@bcbstx.com	P.O. Box 4109		Scranton	PA	18505	09/21/2018	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Plan to Plan Reconciliation Contact	Accountant	Ms.	Nipabi	Ola		9727661324				9727664360	P2P_HCSCO@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, 2A Finance	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/04/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Reconciliation Contact	Sr. Manager Actuary	Mr.	Fimoff	Brian		3126538419				0000000000	brian_fimoff@bcbsil.com	Health Care Service Corporation	300 E. Randolph Street	Chicago	IL	60601	08/05/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Reconciliation Contact (Secondary)	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				0000000000	Mark_Larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	01/06/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Recovery Audit Contact	DVP Encounters Analytics & Solutions	Mr.	Varjian	Richard		9727665146					Richard_Varjian@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	02/02/2022	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Surveillance Contact	DVP Consumer Sales & Bus Dev	Ms.	Kruse	Genevieve		6308245673					Gen_Kruse@bcbsil.com	Health Care Service Corporation	1020 West 31st Street	Downers Grove	IL	60515	02/05/2020	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	System Contact	Sr. Dir Business Solutions	Mr.	Gholston	Lorenzo		3126531316				0000000000	Lorezo_Gholston@bcbsil.com	Health Care Service Corporation	300 East Randolph Street	Chicago	IL	60601	06/04/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	Third Party Administrator (TPA) Liaison	Director HMO Financial Reporting	Mr.	Larson	Mark		9727664350				9727664360	mark_larson@bcbstx.com	Health Care Service Corporation	1001 East Lookout Drive, Building A	Richardson	TX	75082	03/25/2019	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5715	User Access Contact	Sr. Business Consultant	Ms.	Perry-Barker	Chandra		9727662120				0000000000	Chandra_Perry-barker@bcbstx.com	Health Care Service Corporation	1001 E. Lookout Drive	Richardson	TX	75082	12/21/2021	2023	HCSC INSURANCE SERVICES COMPANY	PDP	Blue Cross and Blue Shield of IL, NM, OK, TX	Medicare Prescription Drug Plan		Health Care Service Corporation	110	Yes	Active					Medicare Prescription Drug Plan		5	Denver
S5726	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Automated TrOOP Balance Transfer Contact	Director II Membership		Nunez	Lupe		3032903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	03/15/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/10/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Bid Audit Contact	Actuarial Director		Hart	Mary		3175819752					mary.a.hart@anthem.com	220 Virginia Avenue	Mail Drop: IN205-A351	Indianapolis	IN	46204	01/18/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Bid Audit Site Contact	Actuarial Director		Hart	Mary		3175819752					mary.a.hart@anthem.com	220 Virginia Avenue	Mail Drop: IN205-A351	Indianapolis	IN	46204	01/18/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Bid Primary Contact	Director, Product Development		Floyd	Cari		5407984087					Cari.Floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/07/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	CEO - CMS Administrator Contact	President and CEO	Mr.	All	Matthew	D	7852917631					matt.all@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	01/04/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	CEO - Senior Official for Contracting	President and CEO	Mr.	All	Matthew	D	7852917631				7852918997	matt.all@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	01/04/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Chief Financial Officer	Chief Financial Officer	Mr.	Bergman	Jeff		7852917263					jeff.bergman@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	06/01/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Chief Operating Officer		Mrs.	Graves	Holly		7852917953					holly.graves@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	66629	09/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Chief Information Officer	VP Information Teachnology/CIO	Mr	Langdon	Matt		7852918426					matt.langdon@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	66629	02/28/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Chief Information Security Officer		Mr	Allphin	Matt		7852916781					Matt.Allphin@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	66629	06/26/2017	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Contact for Fraud Investigations	Manager Special Investigations Unit		Zimmerman	Tina		7852917693					tina.zimmerman@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	11/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Corporate Mailing						7852918624				7852900701	Compliance@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	11/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Customer Service Operations Contact	Director I, Customer Care		Villanueva	Graciela		3467180156					graciela.villanueva2@elevancehealth.com	5959 Corporate Drive		Houston	TX	77036	08/23/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Emergency Part D Contact	Compliance Officer		Pewe	Michelle		7859694652					michelle.pewe@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	01/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Emergency Part D Contact (Secondary)	Chief Compliance Officer		Roehler	Dan		7856336072				7852900701	Compliance@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	11/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Employer Waiver Contact	VP EGR Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	06/30/2017	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway		Denver	CO	80273	02/08/2019	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	EOB Transfer Contact	Compliance Director, Med Part D/Pharm Oversight		Doss	Jennifer		5137484736				8558419706	jennifer.doss@anthem.com	4361 Irwin Simpson Road		Mason	OH	45040	10/08/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Financial Audit Contact	Compliance Manager	Ms.	Pisano	Dana		2034949554					dana.pisano@anthem.com	108 Leigus Road		Wallingford	CT	06492	08/17/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Financial Reporting Contact	Chief Financial Officer		Bergman	Jeff		7852917263				7852918465	jeff.bergman@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	666290001	06/01/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	General Contact	Compliance Officer		Pewe	Michelle		7852916947					michelle.pewe@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	01/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Government Relations Contact	Chief Compliance Officer	Mr.	Roehler	Dan		7852918624					Compliance@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	11/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	HIPAA Privacy Officer	Chief Compliance Officer /Privacy Officer	Mr.	Roehler	Dan		7856336072				7852900701	Compliance@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	11/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	HIPAA Security Officer	Chief Information Security Officer	Mr.	Allphin	Matt		7852916781				7852900701	Compliance@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	11/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					sheryl.turney@anthem.com	3080 Bristol Street	Suite 200	Costa Mesa	CA	92626	01/12/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Medicare Compliance Officer	Compliance Officer	Mrs.	Pewe	Michelle		7852916947				7852900701	michelle.pewe@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	01/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Medicare Coordinator	Compliance Officer		Pewe	Michelle		7852916947					michelle.pewe@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	01/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	OffShore Subcontractor Contact	Director Compliance		Granada	Erik		5623025042					erik.granada@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	03/15/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/11/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active	5133167654				Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active	8144498744				Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Application Contact	Chief Compliance Officer	Mr.	Roehler	Dan		7852918624				7852900701	Compliance@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	11/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Benefits Contact	Chief Compliance Officer	Mr.	Roehler	Dan		7852918624					Compliance@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	11/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active	5133167654				Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active	5407984087				Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Price File Contact (Back-up)	Senior Manager		Schilcher	Sydney		4806064615					sydney.schilcher@cvshealth.com	8801 E Raintree Drive		Scottsdale	AZ	85260	04/09/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Price File Contact (Optional)	Compliance Officer		Pewe	Michelle		7852916947					michelle.pewe@bcbsks.com	1133 SW Topeka Blvd		Topeka	KS	66612	01/09/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@ingenio-rx.com	2716 Brewer St		Lakewood	CA	90712	11/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Quality Assurance Contact	Chief Compliance Officer	Mr.	Roehler	Dan		7852918624					Compliance@bcbsks.com	1133 SW Topeka Blvd.		Topeka	KS	666290001	11/16/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active	8333774266				Medicare Prescription Drug Plan		5	Kansas City
S5726	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active	3135973173				Medicare Prescription Drug Plan		5	Kansas City
S5726	PHR Beneficiary Contact																	07/28/2009	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan	Blue Cross Blue Shield of Kansas	Blue Cross Blue Shield of Kansas	310	Yes	Active	8667552776				Medicare Prescription Drug Plan		5	Kansas City
S5726	Plan Directory Contact for Public Website			Service	Customer		8882307338					Medicare.Service.Experience@Anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	03/29/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Recovery Audit Contact	Staff VP, Reg Acct Mngmt & Audit Cntr of Expertise		Howard	Gail		2144221303					gail.howard@anthem.com	2505 N State Highway 360		Grand Prairie	TX	75050	12/15/2020	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5726	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	BLUE CROSS AND BLUE SHIELD OF KANSAS	PDP	Blue Cross and Blue Shield of Kansas or Blue KC	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Kansas	310	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Agent/Broker Compensation Data Contact			Happe	Paul		6516621234					paul.happe@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	11/24/2020	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Automated TrOOP Balance Transfer Contact			Pharmacy Operations	ClearStone		6516627412					clearstone.pharmacy.operations@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Backup User Access Contact			Davis	Cheryl		6516624864					cheryl.davis@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Best Available Evidence Contact	Enrollment Manager		Williams	Carrie		5704683079					CST-enrollment@ramtechinc.com	2410 Summit Point		Scranton	PA	18508	09/29/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Bid Audit Contact	Pt D Managing Actuary		Legatt	Sarah		6516626757					sarah.legatt@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Bid Audit Site Contact	Pt D Managing Actuary		Legatt	Sarah		6516626757					sarah.legatt@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Bid Primary Contact	HealthCare Analyst Pr, Actuarial		Kieffer	Ryan		6516624405					ryan.kieffer@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	CAP Report Contact for Public Website	Compliance Officer		Happe	Paul		6516621234				6516620648	paul.happe@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	CEO - CMS Administrator Contact	CMS Administrator Contact	Ms	Sheehan	Nancy		6516622701					nancy.sheehan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	CEO - Senior Official for Contracting	Senior Official for Contracting	Ms	Sheehan	Nancy		6516622701					nancy.sheehan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Chief Financial Officer		Ms	Ferlita	Carrie		6516629037					carrie.ferlita@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Chief Operating Officer	Vice President - Operations	Ms	Sheehan	Nancy		6516622701					nancy.sheehan@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Chief Information Officer		Mr.	Hopkins	Scott		6516627045					scott.hopkins@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Chief Information Security Officer	VP Digital Platforms & Cybersecurity	Mr	Groshong	Chris		6516628786					Christopher.Groshong@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	06/12/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	CMS Casework Communication Contact	Senior Business Analyst		Blake	Tracy		6516623509					tracy.blake@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	03/22/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Complaints Tracking Contact	Senior Business Analyst		Blake	Tracy		6516623509					tracy.blake@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	03/22/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Contact for Fraud Investigations	Compliance Director		Hogan	Carrie		6516621900					carrie.hogan@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Coordination of Benefits Contact			Schmeling	Amy		6516624919					amy.schmeling@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Corporate Mailing						6516622701					nancy.sheehan@clearstonesolutions.com	Blue Cross Blue Shield Northern Plains Alliance	3400 Yankee Drive	Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Coverage Gap Discount Program (CGDP) Payment Contact			Voves	Alex		6516623606					Alex.Voves@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Customer Service Operations Contact	Customer Service & Grievances Manager		Vang	Vanessa		6516627154					vanessa.vang@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	03/22/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	DIR Contact			Voves	Alex		6516623606					alex.voves@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	DIR Contact (Secondary)			Brumbaugh	Jim		6516622886				6516623500	Jim.Brumbaugh@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Emergency Part D Contact	Enrollment Manager		Williams	Carrie		5704683079					CST-enrollment@ramtechinc.com	2410 Summit Point		Scranton	PA	18508	09/29/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Emergency Part D Contact (Secondary)	Manager of Customer Service		Shanks	Megan		4235305290					CST-enrollment@ramtechinc.com	PO Box 981705		El Paso	TX	799981705	09/29/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Enrollment Contact	Enrollment Manager		Williams	Julie		6516621736					julie.williams@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	03/22/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	EOB Transfer Contact			Schmeling	Amy		6516624919				6516623500	Amy.Schmeling@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Financial Audit Contact	Compliance Manager	Miss	Kraus	Kathleen	M	6516621878					kathleen.kraus@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Financial Reporting Contact	Principal Financial Analyst		Harrelson	Michael		6516628490					michael.harrelson@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Formulary Contact			Pharmacy Operations	ClearStone		6516627412					clearstone.pharmacy.operations@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	07/27/2022	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Formulary Contact (Secondary)	Director, Pharmacy Operations		Mitchell	Angela		6516623607					Angela.Mitchell@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	General Contact	Vice President - Operations		Sheehan	Nancy		6516622701					nancy.sheehan@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Government Relations Contact	Vice President - Operations		Sheehan	Nancy		6516622701					nancy.sheehan@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	HIPAA Privacy Officer	Compliance Officer		Happe	Paul		6516621234					paul.happe@bluecrossmn.com	Blue Cross Blue Shield Northern Plains Alliance	3400 Yankee Drive	Eagan	MN	55121	09/19/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	HIPAA Security Officer	Compliance Officer		Happe	Paul		6516621234					paul.happe@bluecrossmn.com	Blue Cross Blue Shield Northern Plains Alliance	3400 Yankee Drive	Eagan	MN	55121	09/19/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Hospice Contact			Schmeling	Amy		6516624919				6516623500	Amy.Schmeling@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Interoperability Contact			Hopkins	Scott		6516627045					Scott.Hopkins@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	04/13/2022	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Marketing Contact	Compliance Manager - Government Markets		Danisch	Gary		6516622072					Gary.danisch@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	09/14/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Medical Director	Senior Medical Director	Dr.	Fendrich	Amy		6516620584					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/16/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Medicare Compliance Officer	Compliance Officer	Mr	Happe	Paul	M	6516621234					paul.happe@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	03/01/2022	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Medicare Coordinator			Mitchell	Angela		6516623607					Angela.Mitchell@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Medicare Part D Opioid Overutilization Contact	Supv Pharmacist		Anderson	Ally		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics	2900 Ames Crossing Rd	Eagan	MN	55121	12/15/2022	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Medication Therapy Management Contact			Pharmacy Operations	ClearStone		6516627412					clearstone.pharmacy.operations@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	07/27/2022	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Online Enrollment Center Contact (Back-up)	Enrollment Manager		Williams	Carrie		5704683079					CST-enrollment@ramtechinc.com	2410 Summit Point		Scranton	PA	18508	09/29/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Online Enrollment Center Contact (Primary)	Director of Operations		Buck	Kevin		5708851291					CST-enrollment@ramtechinc.com	1536 Penn Ave		Scranton	PA	18509	09/29/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Part D Appeals			Ibrahim	Sonya							sonya.ibrahim@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active	6516627412				Medicare Prescription Drug Plan		5	Kansas City
S5743	Part D Appeals Contact (Secondary)			Aschoff	Ted							theodore.aschoff@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active	6516628777				Medicare Prescription Drug Plan		5	Kansas City
S5743	Part D Application Contact			Ferlita	Carrie		6516629037					carrie.ferlita@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Part D Benefits Contact			Mitchell	Angela		6516623607					Angela.Mitchell@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Part D Claims Submission Contact	Functional Business Consultant		Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/16/2022	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Part D Exceptions Contact			Ibrahim	Sonya							sonya.ibrahim@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active	6516627412				Medicare Prescription Drug Plan		5	Kansas City
S5743	Part D Price File Contact (Back-up)	Sr Pharmacy Analyst		Aschoff	Ted		6516628777					theodore.aschoff@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Part D Price File Contact (Optional)	Sr Pharmacy Analyst		Aschoff	Theodore		6516628777					theodore.aschoff@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Part D Price File Contact (Primary)			Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/16/2022	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Part D Quality Assurance Contact			Mitchell	Angela		6516623607					Angela.Mitchell@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Part D Reporting Contact	Sr Pharmacy Analyst		Aschoff	Ted		6516628777					theodore.aschoff@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Patient Safety Contact	Senior Medical Director	Dr.	Fendrich	Amy		6516620584					amy.fendrich@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	02/16/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Payment Contact	Principal Financial Analyst		Harrelson	Michael		6516628490					michael.harrelson@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	09/19/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Pharmacy Director			Mitchell	Angela		6516623607					Angela.Mitchell@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Pharmacy Network Management Contact	VP, Network Management		Conlin	Marci		6127772842				8778236373	marci.conlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/16/2022	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Pharmacy Network Management Contact (Secondary)	Sr Dir, Network Client Services		Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	12/16/2022	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Pharmacy Technical Help Desk Contact	Senior Business Analyst		Lopez Diaz	David							david.lopezdiaz@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	03/22/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active	8662185002				Medicare Prescription Drug Plan		5	Kansas City
S5743	Pharmacy Technical Help Desk Contact (Secondary)	Customer Service & Grievances Manager		Vang	Vanessa							vanessa.vang@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	03/22/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active	8662185002				Medicare Prescription Drug Plan		5	Kansas City
S5743	Plan Directory Contact for Public Website			Service	Customer		8888320075					CST-enrollment@ramtechinc.com	MedicareBlue Rx Customer Service	PO Box 981705	El Paso	TX	799981705	09/29/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Plan to Plan Reconciliation Contact			Voves	Alex		6516623606					Alex.Voves@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Processor Contact	Director, PBM Operations		Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/16/2022	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Reconciliation Contact			Brumbaugh	Jim		6516622886				6516623500	Jim.Brumbaugh@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Reconciliation Contact (Secondary)			Voves	Alex		6516623606					Alex.Voves@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Recovery Audit Contact	Compliance Officer	Mr	Happe	Paul		6516621234					paul.happe@bluecrossmn.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Surveillance Contact	Compliance Manager	Miss	Kraus	Kathleen		6516621878					kathleen.kraus@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	System Contact			Hopkins	Scott		6516627045					scott.hopkins@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	Third Party Administrator (TPA) Liaison			Voves	Alex		6516623606					alex.voves@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	06/23/2023	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5743	User Access Contact	Compliance Manager		Danisch	Gary		6516622072					gary.danisch@clearstonesolutions.com	3400 Yankee Drive		Eagan	MN	55121	12/06/2021	2023	WELLMARK  IA & SD, & BCBS MN, MT, NE, ND,& WY	PDP	MedicareBlue Rx	Medicare Prescription Drug Plan		BCBS MN, MT, NE, ND, WY, Wellmark IA and SD	28	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5795	Agent/Broker Compensation Data Contact	Manager, Individual Sales Agent		Creasman	Matthew		5013993923					mdcreasman@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Automated TrOOP Balance Transfer Contact	Eligibility Supervisor		White	William		6127776736					eobp2p@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	11/08/2018	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Backup User Access Contact	Regulatory Compliance System Administrator		Coffman	Clay		5013782559					crcoffman@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/08/2018	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Best Available Evidence Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Bid Audit Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 S Gaines St		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Bid Audit Site Contact	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Bid Primary Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	CAP Report Contact for Public Website	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	CEO - CMS Administrator Contact	Lead Executive, Senior Products	Ms.	Dixon	Laurin	E	9016063429					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	CEO - Senior Official for Contracting	CEO	Mr.	Barnett	Curtis		5013782007					cebarnett@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	05/20/2021	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Chief Financial Officer	CFO	Mr.	Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	07/18/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Chief Operating Officer	Executive VP, Chief Operating Officer	Mr.	Dillard	Gray		5013782436					gddillard@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	07/18/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Chief Information Officer	Chief Information Officer	Ms.	Ryan	Kathy		5013782017					koryan@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	01/28/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Chief Information Security Officer	Chief Information Officer	Ms.	Ryan	Kathy		5013782017					koryan@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	01/28/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	CMS Casework Communication Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Complaints Tracking Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Contact for Fraud Investigations	Director, Performance Mgt. & Investigations		Gunter	Debbie		5013786610					dsgunter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/13/2017	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Coordination of Benefits Contact	Eligibility Supervisor		White	William		6127776736					cobmedd@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	11/08/2018	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Corporate Mailing						5013785635					mdvannatta@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/10/2020	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/15/2016	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Customer Service Operations Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	DIR Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	DIR Contact (Secondary)	CFO		Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	07/18/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Emergency Part D Contact	Lead Executive, Senior Products		Dixon	Laurin	E	9016063429					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Emergency Part D Contact (Secondary)	Manager, Senior Products		Sherer	Michael		5013786341					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Enrollment Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	EOB Transfer Contact	Eligibility Supervisor		White	William		6127776736				8776772730	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	11/08/2018	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Financial Audit Contact	Medicare Compliance Officer	Mr.	Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	09/21/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Financial Reporting Contact	Financial Reporting Accountant		Russell	Holly		5013993954					hkrussell@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	07/05/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Formulary Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Formulary Contact (Secondary)			Wahl	Dan		6127776815					dwahl@primetherapeutics.com	Prime Therapeutics 1305 Corporate Drive		Eagan	MN	55121	11/08/2018	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	General Contact	Led Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Government Relations Contact	Sr Counsel Gov't Relation		Fenton	Janie		5013782103					jwfenton@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	01/28/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	HIPAA Privacy Officer	Sr Counsel Litigation		Roberts	Chet		5013782375					cxroberts@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	01/28/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	HIPAA Security Officer	Physical Security/Chief Security Officer		Shirley	Devin		5016880747					DMShirley@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	09/11/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Hospice Contact	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Interoperability Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 S Gaines St		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Marketing Contact	VP Consumer and Retail Markets	Mr.	Vannatta	Matthew		5013785635					mdvannatta@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	05/20/2021	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Medical Director	Associate Medical Director	Dr.	Becker	Thomas		5013964196					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/10/2020	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Medicare Coordinator	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Medicare Part D Opioid Overutilization Contact	Associate Medical Director	Dr.	Becker	Thomas		5013783100					tebecker@arkbluecross.com	601 S Gaines St.		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Medication Therapy Management Contact	Manager, Stars Pharmacy Lead		Walsh	Tyler		5013993975					trwalsh@arkbluecross.com	601 S. Gaines St.		Little Rock	AR	72201	06/07/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	OffShore Subcontractor Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	05/20/2021	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Online Enrollment Center Contact (Back-up)	Supervisor, Medicare Operations		Sherer	Michael		5013786341					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	11/10/2020	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Online Enrollment Center Contact (Optional)	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 S Gaines		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Online Enrollment Center Contact (Primary)	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Appeals			Review Dept.	Clinical						8006936703	CRUMed@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	11/08/2018	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Appeals Contact (Secondary)	Senior Counsel, Appeals		Phillips	Ashleigh						5013783366	adphillips@arkbluecross.com	PO Box 2181	Attn: Legal Appeals	Little Rock	AR	72203	01/11/2021	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active	5013782025				Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Application Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Benefits Contact	Manager, Senior Products		Sherer	Michael		5013783641					mcsherer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Claims Submission Contact			Brooke	Lance		4026862603				4029702545	lbrooke@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	09/05/2017	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Exceptions Contact			Review Audit & Regul	Clinical						8006936703	clinicalreviewclientinquiries@primetherapeutics.co	Centennial Crossings - Clinical Review 4401 West 76th S		Edina	MN	55435	11/08/2018	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Exceptions Contact (Secondary)			Review Dept Med D Au	Clinical						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Edina	MN	55435	12/16/2015	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Price File Contact (Back-up)	Database Reporting Analyst		Xu	Jake		6127776830					jake.xu@primetherapeutics.com	Prime Therapeutics 1305 Corporate Center Drive		Eagan	MN	55121	11/08/2018	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Price File Contact (Optional)	Supervisor, Medicare Member Services		Taylor	Alicia		5013783743					aataylor@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/18/2021	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Price File Contact (Primary)	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Quality Assurance Contact	Manager Metrics and Reporting		Luukkonen	Lynette		6127775574					lynette.luukkonen@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	01/28/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Part D Reporting Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387					wlbradford@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Patient Safety Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/04/2022	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Payment Contact	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	08/05/2015	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Pharmacy Director	Associate Medical Director	Dr.	Becker	Thomas		5013783100					tebecker@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Pharmacy Network Management Contact	Senior Director Network Provider Relations		Grindsteinner	Bretta		6127774021					bgrinsteinner@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	12/16/2015	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Pharmacy Network Management Contact (Secondary)	Sr. Manager Pharmacy Provider Relations		Ecklund	Elisa		6127774308					eecklund@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Drive		Eagan	MN	55121	12/16/2015	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Pharmacy Technical Help Desk Contact			Pharmacy Help Desk	Prime						8882852242	MGarzarodriguez@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	04/15/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active	8006933815				Medicare Prescription Drug Plan		5	Dallas
S5795	Plan Directory Contact for Public Website			Service	Customer		8442014934					MediPakAdvRx@arkbluecross.com	P O Box 3648		Little Rock	AR	72203	11/10/2020	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Plan to Plan Reconciliation Contact	Financial Analyst		Holt	Susan		5013993958				5013783258	sbholt@arkbluecross.com	P O Box 8084		Little Rock	AR	72203	07/05/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Processor Contact	Director Business Service Ops - Govt Programs		Allie	Cindy		6127776772				6127776705	callie@primetherapeutics.com	Prime Therapeutics LLC 1305 Corporate Center Dr		Eagan	MN	55121	11/08/2018	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Reconciliation Contact	Lead Executive, Medicare		Dixon	Laurin		5013783117					ledixon@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/12/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Reconciliation Contact (Secondary)	CFO		Winter	Scott		5013993951					sbwinter@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	07/18/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Recovery Audit Contact	Financial Analyst	Ms.	Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	12/20/2016	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Surveillance Contact	Medicare Compliance Officer		Kirsch	Nick		5013409589					nkirsch@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	06/06/2023	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	System Contact	Manager, Configuration		Spicer	Derek		5013013425					bdspicer@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/17/2019	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	Third Party Administrator (TPA) Liaison	Financial Analyst		Holt	Susan		5013993958					sbholt@arkbluecross.com	601 Gaines Street		Little Rock	AR	72201	04/15/2016	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5795	User Access Contact	Manager, Medicare Compliance		Bradford	Wanda		5013782387				5013017306	wlbradford@arkbluecross.com	601 Gaines Street	10-South	Little Rock	AR	72201	05/20/2021	2023	USABLE MUTUAL INSURANCE COMPANY	PDP	Arkansas Blue Medicare	Medicare Prescription Drug Plan		USAble Mutual Insurance Company	421	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5805	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				Medicare Prescription Drug Plan		5	San Francisco
S5805	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				Medicare Prescription Drug Plan		5	San Francisco
S5805	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Medicare Prescription Drug Plan		5	San Francisco
S5805	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				Medicare Prescription Drug Plan		5	San Francisco
S5805	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5805	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY OF NEW YORK	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				Medicare Prescription Drug Plan		5	San Francisco
S5820	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				Medicare Prescription Drug Plan		5	San Francisco
S5820	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Medicare Prescription Drug Plan		5	San Francisco
S5820	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				Medicare Prescription Drug Plan		5	San Francisco
S5820	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5820	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INSURANCE COMPANY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5857	Agent/Broker Compensation Data Contact	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Automated TrOOP Balance Transfer Contact	Enrollment Coordinator		Rice	Lori		6164648667					PH-MedicareTrOOPContact@PriorityHealth.com	1231 East Beltline Ave NE	MS 1175	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Backup User Access Contact	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Best Available Evidence Contact	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Bid Audit Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Bid Audit Site Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Bid Primary Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	CAP Report Contact for Public Website	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648824					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active	6164648424				Medicare Prescription Drug Plan		5	Chicago
S5857	CEO - CMS Administrator Contact	CEO	Mr	Thandani	Praveen		6164949365				6169421150	CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	CEO - Senior Official for Contracting	Vice President Medicare	Mr	Norman	Scott		2488803191					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Chief Financial Officer	Chief Financial Officer	Mr	Gates	Nick	P	6164648144					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Chief Operating Officer	CEO	Mr	Thandani	Praveen		6164649365					CEOMedicare@priorityhealth.com	1231 East Beltine NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Chief Information Officer	Chief Information Officer	Mr	Crook	Chris		6164649939					CEOMedicare@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Chief Information Security Officer	SVP, IS Technology Services	Mr	Dresen	Scott		6164864277					CEOMedicare@priorityhealth.com	100 Michigan Street NE	MC 843	Grand Rapids	MI	49503	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	CMMI Model Point of Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	CMS Casework Communication Contact	Manager for Business Monitoring - G & A		LaBelle	Julie		9178417869					Radha.LaBelle@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Complaints Tracking Contact	Manager for Business Monitoring - G & A		LaBelle	Julie		9178417869					Radha.LaBelle@priorityhealth.com	1231 East Beltline Ave NE	MS 1115	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Contact for Fraud Investigations	Manager, Special Investigations Unit		Gross	Brenda		6164648152					Brenda.Gross@PriorityHealth.com	1231 E Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Coordination of Benefits Contact	Claims Manager		Ball	Jill		8883896648					CEOMedicare@priorityhealth.com	1239 East Beltline Ave NE	MS2205	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Corporate Mailing						6169420954				6164640145	PH-DistributionSE@PriorityHealth.com	1231 East Beltline Ave, NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Coverage Gap Discount Program (CGDP) Payment Contact	Operations Supervisor		Johnston	Adam		6164648915					adam.johnston@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Customer Service Operations Contact	Customer Care Center Manager, Medicare		Storment	Joe		5033309550					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	DIR Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	DIR Contact (Secondary)	Senior Financial Analyst		McZee	Nikki		6164648205					nikki.mczee@corewellhealth.org	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Emergency Part D Contact	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Emergency Part D Contact (Secondary)	Manager, Medicare Pharmacy Operations		VanLoenen	Amanda		6164648750					Amanda.VanLoenen@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Employer Waiver Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Enrollment Contact	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	EOB Transfer Contact	Claims Manager		Ball	Jill		6164648044				6169750247	CEOMedicare@priorityhealth.com	1239 East Beltline Ave NE	MS 2205	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Financial Audit Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Financial Reporting Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Formulary Contact	Medicare Part D Operations Manager		Van Loenen	Amanda		6164648750					PH-MedicareFormularyContact@PriorityHealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	General Contact	Vice President Medicare	Mr	Norman	Scott		2488803191					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Government Relations Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	HIPAA Privacy Officer	VP, Compliance & Privacy Officer		Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS1155	Grand Rapids	MI	49525	08/24/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	HIPAA Security Officer			Dresen	Scott		6164864277					CEOMedicare@priorityhealth.com	100 Michigan Street NE		Grand Rapids	MI	49503	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Hospice Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Interoperability Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Marketing Contact	Sr. Markets & Product Development Director		Brown	Samia		6164648002					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Medical Director	Medicare Director		Forshee	James		6164644873					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Medicare Compliance Officer	Vice President Compliance and Privacy Officer	Mrs	Rollenhagen	Cindy		6164648855					cindy.rollenhagen@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Medicare Coordinator	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Medicare Part D Opioid Overutilization Contact	Medicare Quality Manager		Gutierrez	Salvador		6165757622					salvador.gutierrez@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Medication Therapy Management Contact	Director of Pharmacy Operations		Chaffee	Jacob		6168261329					jacob.chaffee@priorityhealth.com	1231 East Beltline Dr Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	OffShore Subcontractor Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Online Enrollment Center Contact (Optional)	Government Programs Enrollment Coordinator		Rice	Lori		6164648667					lori.rice@priorityhealth.com	1231 East Beltline Ave NE	MS 1180	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Online Enrollment Center Contact (Primary)	Manager, Medicare Enrollment		Thomas	Sabrina		6164648578					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Appeals	Supervisor, Medicare Part D Appeals		Anderson	Melissa							PHMedicarePartDAPPLS@spectrumhealth.org	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active	6164648547				Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Appeals Contact (Secondary)	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy							CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active	6164648424				Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Application Contact	Product Development Director	Mrs.	Bishop	Janine		6163185715					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Benefits Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Claims Submission Contact	Manager, Medicare Part D Operations		Van Loenen	Amanda		6164648750					part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Exceptions Contact			Help Desk	Pharmacy							part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active	8004666642				Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Exceptions Contact (Secondary)	Mgr, Medicare Part D Operations	Ms.	Van Loenen	Amanda							amanda.vanloenen@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active	6164648750				Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Price File Contact (Back-up)	Product Manager Advisor		Williams	Stephanie		5135091549					Medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Price File Contact (Optional)	Manager, Medicare Part D Operations		Van Loenen	Amanda		6164648750					part.d.ops@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Price File Contact (Primary)	Sr. Manager, Government Programs		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Quality Assurance Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Part D Reporting Contact	Sr. Compliance Analyst		Eizinger	Eric		2178400871					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Patient Safety Contact	Clinical Pharmacy Program Manager	Mr	Chaffee	Jacob		6165756149					CEOMedicare@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Payment Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Personal Health Record Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Pharmacy Director	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Pharmacy Network Management Contact	Director Pharmacy Operations		Chaffee	Jacob		6165756149					jacob.chaffee@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Pharmacy Network Management Contact (Secondary)	Manager, Medicare Pharmacy Operations		Van Loenen	Amanda		6164648750					amanda.vanloenen@priorityhealth.com	1231 E. Beltline Avenue NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Pharmacy Technical Help Desk Contact			Help Desk	Pharmacy							part.d.ops@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active	8004666642				Medicare Prescription Drug Plan		5	Chicago
S5857	Pharmacy Technical Help Desk Contact (Secondary)	Mgr, Medicare Part D Ops	Ms.	Van Loenen	Amanda							amanda.vanloenen@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active	6164648750				Medicare Prescription Drug Plan		5	Chicago
S5857	Plan Directory Contact for Public Website			Service	Customer		8883896648					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Plan to Plan Reconciliation Contact	Reconciliation & Billing Specialist		Bentley-Brown	Linda		6164648582				6169573420	linda.bentley-brown@priorityhealth.com	1231 East Beltline Ave NE	MS 1190	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Processor Contact	ESI Sr Dir - Product Management Medicare		Mahon	Snezana		3146846361					SMahon@express-scripts.com	ESI	One Express Way	St. Louis	MO	63121	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Reconciliation Contact	Manager Financial Reporting		Mcglynn	Sara		3132936466					sara.mcglynn@priorityhealth.com	1231 E. Beltline Ave Ne		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Reconciliation Contact (Secondary)	Manager, Finance Reporting		Hendricks	Rachel		6164648205					rachel.hendricks@priorityhealth.com	1231 East Beltline NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Recovery Audit Contact	Manager Cost Recovery	Ms	Gross	Brenda		6164648152					brenda.gross@priorityhealth.com	1231 East Beltline NE	Mail Stop 2305	Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Surveillance Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	System Contact	Data Analytics Analyst-Senior, Sr Markets		Johnson	Joshua		6165755760					PH-MedicareSystemsContact@PriorityHealth.com	1231 East Beltline Ave NE		Grand Rapids	MI	49525	05/17/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	Third Party Administrator (TPA) Liaison	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					cindy.rollenhagen@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/06/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5857	User Access Contact	VP, Compliance & Privacy Officer	Mrs.	Rollenhagen	Cindy		6164648424					CEOMedicare@priorityhealth.com	1231 East Beltline Ave NE	MS 1155	Grand Rapids	MI	49525	06/02/2023	2023	PRIORITY HEALTH INSURANCE COMPANY	PDP	Priority Health Medicare	Medicare Prescription Drug Plan		Corewell Health	190	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5877	Agent/Broker Compensation Data Contact			Lowther	Ryan		8012702963					rlowther@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Automated TrOOP Balance Transfer Contact	Director, Pharmacy and Medicare Services	Mr.	Gedge	Nathan		8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Backup User Access Contact			Proctor	Roger		8012627476					rproctor@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Best Available Evidence Contact	Director, Pharmacy and Medicare Services	Mr.	Gedge	Nathan	D	8012702974				8012699734	ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Bid Audit Contact	Director, Pharamcy and Medicare Services	Mr.	Gedge	Nathan		8012702974				8012699734	ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Bid Audit Site Contact	Director, Pharmacy and Medicare Services	Mr.	Gedge	Nathan		8012702974				8012699734	ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Bid Primary Contact			Pingree	Mark		8012702938				8012699734	mpingree@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	CAP Report Contact for Public Website	Compliance Officer		Smart	Brandon		8012627476	2981				bsmart@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	CEO - CMS Administrator Contact	President CEO	Mr.	Morrison	Steve		8012627476					smorrison@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	CEO - Senior Official for Contracting	President CEO	Mr.	Morrison	Steve		8012627476				8012703075	smorrison@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Chief Financial Officer	Chief Financial Officer	Mr.	Greenhalgh	Mike		8012627476					mgreenhalgh@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Chief Operating Officer	COO	Mr.	Lowther	Ryan		8012702963				8012699734	rlowther@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Chief Information Officer		Mr	Campbell	Joseph		8012702933					jcampbell@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Chief Information Security Officer	Chief Compliance Officer	Mr.	Smart	Brandon		8012702981					bsmart@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	CMS Casework Communication Contact	Director, Pharmacy and Medicare Services		Gedge	Nate		8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Complaints Tracking Contact	Director, Pharmacy and Medicare Services		Gedge	Nathan		8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Contact for Fraud Investigations	Chief Compliance Officer		Smart	Brandon		8012627476	2981				bsmart@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Coordination of Benefits Contact	Director, Pharmacy and Medicare Services		Gedge	Nate		8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Corporate Mailing						8012627476					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Coverage Gap Discount Program (CGDP) Payment Contact	Director of Pharmacy and Medicare Services		Gedge	Nathan	D	8012702974				8012699734	ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Customer Service Operations Contact	Sr. Manager - Contact Center		Bloomfield	Peggy		7722362738					Peggy_Bloomfield@Express-Scripts.com	10045 South Federal Highway		Port St. Lucie	FL	34952	03/30/2017	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	DIR Contact	Director, Pharmacy & Medicare Services		Gedge	Nathan		8012702974				8012699734	ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Emergency Part D Contact	Director, Pharmacy and Medicare Services		Gedge	Nate		8019794107					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Enrollment Contact	Director, Pharmacy and Medicare		Gedge	Nathan	D	8012627476					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	05/18/2023	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	EOB Transfer Contact	Director, Pharmacy and Medicare Services		Gedge	Nate		8012702974				8012699734	ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Financial Audit Contact	Actuary	Mr.	Pingree	Mark		8012627476	2938			8012699734	mpingree@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Financial Reporting Contact			Pingree	Mark		8012627476	2938			8012699734	mpingree@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Formulary Contact	Director, Pharmacy and Medicare Services		Gedge	Nathan		8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	General Contact	Director, Pharmacy and Medicare Services		Gedge	Nathan		8012702974				8012699734	ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Government Relations Contact	Director, Pharmacy and Medicare Services		Gedge	Nate		8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	HIPAA Privacy Officer	Compliance Officer		Smart	Brandon		8012627476	2981				bsmart@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	HIPAA Security Officer	Compliance Officer		Smart	Brandon		8012627476	2981				bsmart@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Hospice Contact	Director of Pharmacy and Medicare Services	Mr.	Gedge	Nathan		8012702974				8012699734	ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Interoperability Contact			Gedge	Nathan		8012702974					ngedge@emihealth.com	5101 S COMMERCE DRIVE		Murray	UT	84107	02/28/2022	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Marketing Contact	VP Marketing		Dunnavant	Cindy		8012627476					ctovey@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Medical Director	Medical Director		Rower	Jeremy		9528375511					JARower@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	12/08/2016	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Medicare Compliance Officer	Compliance Officer	Mr.	Smart	Brandon		8012702981					bsmart@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Medicare Coordinator	COO	Mr.	Lowther	Ryan		8012702963					rlowther@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Medicare Part D Opioid Overutilization Contact	Director, Medicare Clincal Product Management		Blair	Kelcey		3147971473					KABlair@express-scripts.com	One Express Way		St. Louis	MO	63121	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Medication Therapy Management Contact	Director, Medicare Clinical Product Management		Blair	Kelcey		3147971473					KABlair@express-scripts.com	One Express Way		St. Louis	MO	63121	03/30/2017	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Online Enrollment Center Contact (Back-up)	Director, Pharmacy and Medicare Services		Gedge	Nate		8012627476					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Online Enrollment Center Contact (Optional)			Proctor	Roger		8012627476					rproctor@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Online Enrollment Center Contact (Primary)	VP Customer Service		Bermingham	Tiffany		8012627476					tbermingham@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Part D Appeals	Senior Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scriptss.com	5151 Blazer Pkwy		Dublin	OH	43017	12/08/2016	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active	8003443405	733326			Medicare Prescription Drug Plan		5	Dallas
S5877	Part D Application Contact	Director, Pharmacy and Medicare Services		Gedge	Nathan		8012702974				8012699734	ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Part D Benefits Contact			Gedge	Natahn	D	8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Part D Claims Submission Contact	Director - Product Management		Etherton	Jim		5133163889					jbetherton@express-scripts.com	8990 Duke Drive		Mason	OH	45040	06/16/2017	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Part D Exceptions Contact	Senior Pharmacy Manager		Schumm	Brian							brian_schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	12/08/2016	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active	6143363326				Medicare Prescription Drug Plan		5	Dallas
S5877	Part D Price File Contact (Back-up)	Sr. Manager - Government Programs		Dolfi	Amanda		6147613606					amanda_dolfi@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	03/30/2017	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Part D Price File Contact (Optional)	Director, Pharmacy and Medicare Services		Gedge	Nate		8012627476					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Part D Price File Contact (Primary)	Director-Government Program		Westrum	Josh		4807363132	433132				JWestrum@express-scripts.com	7909 S Hardy Drive Suite 106		Tempe	AZ	85284	12/08/2016	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Part D Quality Assurance Contact	Director, Pharamcy and Medicare Services		Gedge	Nathan		8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Part D Reporting Contact	Director, Pharmacy and Medicare Services		Gedge	Nathan		8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Patient Safety Contact			Gedge	Nathan		8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Payment Contact	Chief Financial Officer		Greenhalgh	Mike		8012627476					mgreenhalgh@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Pharmacy Director	Director, Pharamcy and Medicare Services		Gedge	Nate		8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Pharmacy Network Management Contact	Network Account Director, Retail Strategy & Contra		Kelly	Heather		3146921866					hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	03/30/2017	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Pharmacy Technical Help Desk Contact	Director - Contact Center		Roberts	Robin							RRoberts2@express-scripts.com	6625 West 78th Street		Bloomington	MN	55439	06/16/2017	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	Dallas
S5877	Plan Directory Contact for Public Website	Director, Pharmacy and Medicare Services	Mr.	Gedge	Nathan	D	8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/04/2019	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Plan to Plan Reconciliation Contact			Clark	Anthony		8012627476	2965				aclark@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Processor Contact	Senior Director - Goverment Program, Medicare		Gibson	Sharon		8057779130					SGGibson@express-scripts.com	One Express Wasy		St. Louis	MO	63121	12/08/2016	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Reconciliation Contact	Medicare specialist		Clark	Anthony		8012627475	2965			8012699734	aclark@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Reconciliation Contact (Secondary)			Gedge	Nathan	D	8012702974					ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Recovery Audit Contact	Actuary	Mr.	Pingree	Mark		8012627476	2938			8012699734	mpingree@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Surveillance Contact	Medco Exceptions and Appeals		Exceptions Appeals	Medco		8012627476					ngedge@emihealth.com	852 East Arrowhead Lane		Murray	UT	84107	07/18/2017	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	System Contact			Proctor	Roger		8012627476					rproctor@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	Third Party Administrator (TPA) Liaison	Director of Pharmacy and Medicare Services		Gedge	Nathan	D	8012702974				8012699734	ngedge@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5877	User Access Contact	Actuary		Pingree	Mark		8012627476					mpingree@emihealth.com	5101 S Commerce Drive		Murray	UT	84107	06/18/2018	2023	EDUCATORS MUTUAL INSURANCE ASSOCIATION	PDP	EMI Health	Medicare Prescription Drug Plan		Educators Mutual Insurance Association	79	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S5884	Agent/Broker Compensation Data Contact	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Best Available Evidence Contact	Manager, Enrollment		McKim	Simon		5024764002					HumanaBAEReviewTeam@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Bid Audit Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Bid Audit Site Contact	Associate Vice President, Acturarial		Larsen	Marie		5025803682					mlarsen2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Bid Primary Contact	Director, Actuarial Risk and Compliance		Welch	Dianna		2624084726					PDBPTContact@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	CMS Casework Communication Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Complaints Tracking Contact	Manager		Hanke	Cindy		9203375667					HumanaCTMCasework@humana.com	1100 Employers Blvd.		Green Bay	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Customer Service Operations Contact	Director, Inbound Contacts		Gillis	Tamra		5024769797					trhodes2@humana.com	500 W Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Employer Waiver Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Financial Audit Contact	Associate Director, Regulatory Audit Coordination	Mr	Fruit	Aaron		7155057272					auditcoordination@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Financial Reporting Contact	Business Support		Wentworth	Julia		5025802091					jwentworth1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Formulary Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Formulary Contact (Secondary)	Clinical Pharmacy Lead		Tucker	Michael		5024688635					mtucker10@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Interoperability Contact	AVP, Enterprise transformation		Walker	Chris		5024760699					cwwalker@humana.com	500 West Main Street		Louisville	KY	40204	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Marketing Contact	Director Insurance Product Compliance		Medley	Michael		5025801646					mmedley@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Medication Therapy Management Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	OffShore Subcontractor Contact	Compliance Lead		Thielmeier	Penny		5025724821					pthielmeier@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Online Enrollment Center Contact (Back-up)	Manager, Tech Solution Implementation		Foland	John		5025807650					jfoland@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Online Enrollment Center Contact (Optional)	Associate Director, Compliance		Blythe	Mathew		5025802765					mblythe@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Online Enrollment Center Contact (Primary)	Tech Solutions Professional		Bruce	Darin		5025807079					dbruce@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5025809138				Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5025807929				Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5025809138				Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5024682494				Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Price File Contact (Back-up)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Price File Contact (Optional)	Senior Pharmacy Professional		Powell	Joseph		5024761473					jpowell13@humana.com	515 West Market Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Price File Contact (Primary)	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Pharmacy Network Management Contact	Sr Compliance Professional		Stevens	Debra		5025800475					dstevens25@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Pharmacy Network Management Contact (Secondary)	Senior Compliance Professional		Gsell	Mike		5023023120					mgsell@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	8008658715				Medicare Prescription Drug Plan		5	Kansas City
S5884	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active	5025800475				Medicare Prescription Drug Plan		5	Kansas City
S5884	Plan Directory Contact for Public Website	Associate Director		Richter	Lisa		8004486262					lrichter@humana.com	101 East Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Recovery Audit Contact	Sr. Compliance Professional	Mr.	Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5884	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	07/14/2023	2023	HUMANA INSURANCE COMPANY	PDP	Humana	Medicare Prescription Drug Plan		Humana Inc.	128	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S5904	Agent/Broker Compensation Data Contact	VP FBM Growth Strat & Enable		Davis	Andrea		8478265793					andrea.davis@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	11/29/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Automated TrOOP Balance Transfer Contact	Manager, PBM operations	Ms.	Hanson	Michelle		6127776755				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	10/27/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Backup User Access Contact	Corporate Compliance Specialist		Figueroa	Carmen		9049056658					carmen.figueroa@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Best Available Evidence Contact	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	07/16/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Bid Audit Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Bid Audit Site Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Bid Primary Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	CAP Report Contact for Public Website	Sr. Director Govt Programs & Products Compliance		Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	CEO - CMS Administrator Contact	EVP Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 400	Jacksonville	FL	32246	01/05/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	CEO - Senior Official for Contracting	EVP, Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 100, 8th Flr	Jacksonville	FL	32246	01/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Chief Financial Officer	SVP and CFO	Mr.	Justice	Thurman		9049055085					Thurman.Justice@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 8th Floor	Jacksonville	FL	32246	08/21/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Chief Operating Officer	EVP, Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 100, 8th Flr	Jacksonville	FL	32246	11/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Chief Information Officer	SVP Chief Information Officer	Mr.	Anderson	Gary		9049050180					gary.anderson@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 8th Floor	Jacksonville	FL	32246	01/27/2016	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Chief Information Security Officer	VP Chief Information & Security Officer	Mr.	Raymond	Jason		9049050070					jason.raymond@floridablue.com	4800 Deewood Campus Parkway	DCC Building 600, 2nd Floor	Jacksonville	FL	32246	08/11/2016	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	CMS Casework Communication Contact	Sr Manager Med Ops & Integrity		Irizarry	Haydee		3212330635					Haydee.Irizarry@bcbsfl.com	4800 Deerwood Campus Parkway	Bldg. 400 2nd Floor	Jacksonville	FL	32246	04/25/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Complaints Tracking Contact	Sr Manager Med Ops & Integrity		Irizarry	Haydee		3212330635					Haydee Irizarry@bcbsfl.com	4800 Deerwood Campus Parkway	Bldg. 400 2nd Floor	Jacksonville	FL	32246	04/25/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Contact for Fraud Investigations	Manager II Data Integrity & SIU		Ramos	Jose		9049055835					jose.romas@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 400, 6th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Coordination of Benefits Contact	Manager PBM Operations		Hanson	Michelle		6127776755				3127776706	COBMedD@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	02/16/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Corporate Mailing						9049054668					Hillary.Simpson@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	03/16/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant III, Corporate Receivables		Avis	Tammi		9049054034					Tammi.Avis@bcbsfl.com	4800 Deerwood Campus Pkwy	Bldg 100, 5th Floor	Jacksonville	FL	32246	04/25/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Customer Service Operations Contact	Sr Director Member Contact		Gamble	LaTonya		9049052057					latonya.gamble@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	DIR Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	DIR Contact (Secondary)	VP Medicare Chief Actuary		Phelps	Joshua		8048557732					joshua.phelps@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 6th Floor	Jacksonville	FL	32246	02/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Emergency Part D Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9045259651					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	12/23/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Emergency Part D Contact (Secondary)	Sr. Director Govt Programs & Products Compliance		Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Employer Waiver Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4thFloor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Enrollment Contact	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	EOB Transfer Contact	Sr Director Member Contact		Gamble	LaTonya		9049052057				9043576121	latonya.gamble@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 300, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Financial Audit Contact	Director External & Regulatory Audits	Mr.	Livingston	Matt		9049050168					matt.livingston@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	09/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Financial Reporting Contact	VP Medicare CFO		Dorsett	Kareen		9049051754					Kareen.Dorsett@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400	Jacksonville	FL	32246	08/20/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Formulary Contact	Medicare Clinical Pharmacist		Shore	Stephanie		9049050114					stephanie.shore@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	08/08/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	General Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Government Relations Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	HIPAA Privacy Officer	Asst. General Counsel & Privacy Officer		Resnick	Steven		9049055025					steven.resnick@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	HIPAA Security Officer	VP Chief Information Security Officer		Raymond	Jason		9049050070					jason.raymond@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 600, 2nd Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Hospice Contact	Medical Clinical Pharmacist Pharmacy Govt Prog		Adams	Tangela		9049050002					tangela.adams@floridablue.com	4800 Deerwood Campus Pkwy	DCC 900, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Interoperability Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th FL	Jacksonville	FL	32246	01/26/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Marketing Contact	FBM Spec.IV Product Operations		Lilly	Wanda		9043573900					wanda.lilly@bcbsfl.com	4800 Deerwood Campus Parkway	Building 400, 3rd Floor	Jacksonville	FL	32246	04/27/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Medical Director	VP Medicare Solutions		Malko	Elizabeth		9049050491					Elizabeth.Malko@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	10/15/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Medicare Compliance Officer	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9044458502					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Medicare Coordinator	EVP, Medicare, Chief Innovation&Experience Officer	Mrs.	Harrison	Camille		9049051801					camille.harrison@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 100, 8th Flr	Jacksonville	FL	32246	11/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Medicare Part D Opioid Overutilization Contact	Supervisor Pharmacists		Schons	Allison		8554570763				8557297221	partdoverutil@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Medication Therapy Management Contact	Director Government Pharmacy Programs		Bryant-Riggins	Victoria		9049050194					victoria.bryant-riggins@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	08/27/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	OffShore Subcontractor Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					hillary.simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Online Enrollment Center Contact (Back-up)	Sr. Director EMB		Chick	Benjamin		9049051711					benjamin.chick@floridablue.com	4800 Deerwood Campus Pkwy	DCC Building 300, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Online Enrollment Center Contact (Optional)	Sr. Manager		Hogan	Kate		9049055131					kate.hogan@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Bldg 300 4th Flr	Jacksonville	FL	32246	05/06/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Online Enrollment Center Contact (Primary)			EMB Analysts	FBM Ops		9049051711					FB_Medicare_Ops_EMB_Analysts@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 2nd Floor	Jacksonville	FL	32246	05/06/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Appeals	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia							cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773736	56307			Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Appeals Contact (Secondary)	Director Government Pharmacy Programs		Bryant-Riggins	Victoria							victoria.bryant-riggins@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	12/29/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773636	50194			Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Application Contact	FBM Program Manger		Kinard	Ronda		9049053018					ronda.kinard@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 200, 4th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Benefits Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	07/16/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Claims Submission Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Exceptions Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia							cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active	8004773736	56307			Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Exceptions Contact (Secondary)	Regulatory Manager & Audit Response		Gonzales	Santiago						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55120	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Price File Contact (Back-up)	QA Analyst		Tastad	Emily		6127772557					emily.tastad@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	12/29/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Price File Contact (Optional)	Director Government Pharmacy Programs		Bryant-Riggins	Victoria		9049050194					victoria.bryant-riggins@floridablue.com	4800 Deerwood Campus Parkway	Building 900, 4th Floor	Jacksonville	FL	32246	08/27/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Price File Contact (Primary)	Delivery System Coordinator		Rodriguez	Janina		3059217232					Janina.Rodriguez@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	08/04/2020	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Quality Assurance Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 5th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Part D Reporting Contact	Corporate Compliance Specialist		Figueroa	Carmen		9049056658					carmen.figueroa@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Patient Safety Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 5th Floor	Jacksonville	FL	32246	05/10/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Payment Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Pharmacy Director	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Pharmacy Network Management Contact	VP Government Pharmacy Programs	Dr.	Griffin	Cynthia		9049056307					cynthia.griffin@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 900, 4th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Client Services		Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55122	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Pharmacy Technical Help Desk Contact	Director, Member Services		Pretlow	Jennifer							jennifer.pretlow@primetherapeutics.com	Prime Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55121	07/19/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active	8888776420				Medicare Prescription Drug Plan		5	Atlanta
S5904	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Member Services		Garza-Rodriguez	Melissa							MGarzarodriguez@primetherapeutics.com	1305 Corporate Center Drive		Eagan	MN	55121	07/30/2018	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active	2143366770				Medicare Prescription Drug Plan		5	Atlanta
S5904	Plan Directory Contact for Public Website			Mbr Svcs	Medicare		8009266565					Chrissy.This@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	05/05/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Plan to Plan Reconciliation Contact	Accounting Specialist		Williams	Lynn		9049054568					lynn.williams@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 3rd Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Processor Contact	FBM Sr. Dir. Claims		Allen	Jessica		9049053152					Jessica.Allen2@bcbsfl.com	4800 Deerwood Campus Parkway		Jacksonville	FL	32246	11/17/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Reconciliation Contact	VP Medicare Chief Actuary		Phelps	Joshua		8048557732					joshua.phelps@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400, 3rd Floor	Jacksonville	FL	32246	02/21/2023	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Reconciliation Contact (Secondary)	VP Medicare CFO		Dorsett	Kareen		9049051754					Kareen.Dorsett@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 400	Jacksonville	FL	32246	09/10/2021	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Recovery Audit Contact	Sr. Director Govt Programs & Products Compliance	Mrs.	Simpson	Hillary		9049054668					Hillary.Simpson@bcbsfl.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	06/13/2022	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Surveillance Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	System Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	Third Party Administrator (TPA) Liaison	Medical Clinical Pharmacist Pharmacy Govt Prog		Adams	Tangela		9049050002					tangela.adams@floridablue.com	4800 Deerwood Campus Pkwy	DCC 900,  4th Floor	Jacksonville	FL	32246	12/09/2016	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5904	User Access Contact	Consultant Corporate Compliance		Morant	Rolanda		9049059037					rolanda.morant@floridablue.com	4800 Deerwood Campus Parkway	DCC Building 100, 7th Floor	Jacksonville	FL	32246	01/04/2019	2023	BLUE CROSS AND BLUE SHIELD OF FLORIDA, INC.	PDP	Florida Blue	Medicare Prescription Drug Plan		Guidewell Mutual Holding Corporation	594	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5916	Agent/Broker Compensation Data Contact	VP Medicare Sales	Mr.	Hess	Brent		8013336143					Brent.Hess@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	07/06/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Automated TrOOP Balance Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Backup User Access Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St.	MS:E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Best Available Evidence Contact	Membership Ambassador	Ms.	Neufeld	Jeri		8006621470	2526			8883352988	ORMEMMEDAmbassador@regence.com	PO Box 1827		Medford	OR	97501	02/16/2018	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Bid Audit Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Bid Audit Site Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Bid Primary Contact	Vice President Actuarial Pricing	Mr	Akopyan	Armen		2063323998					Armen.Akopyan@regence.com	1800 9th Ave		Seattle	WA	98101	06/30/2020	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	CAP Report Contact for Public Website	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	CEO - CMS Administrator Contact	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/04/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	CEO - Senior Official for Contracting	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	01/09/2022	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Chief Financial Officer	SVP & CFO	Mr.	Rains	Mike		2063326521					Mike.Rains@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Chief Operating Officer	Cambia President and CEO	Mr	Short	Jared		5032761870					Jared.Short@regence.com	200 SW Market St	M/S E15A	Portland	OR	97201	12/31/2020	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Chief Information Officer	SVP STRATEGIC TECH SOL & CIO	Mr	Rotival	Laurent		2063325034					Laurent.Rotival@cambiahealth.com	200 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Chief Information Security Officer	VP & CHIEF INFO SEC OFFICER	Mr	Anderson	Kirk		5037251608					Kirk.Anderson@cambiahealth.com	100 SW Market St		Portland	OR	97201	04/12/2016	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	CMMI Model Point of Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	CMS Casework Communication Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Complaints Tracking Contact	Appeals Specialist	Ms.	Aime	Cathleen		8667490355	2653			8883098784	cathleen.aime@regence.com	M/S: B32AG	PO Box 1827	Medford	OR	97501	10/01/2014	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Contact for Fraud Investigations	Senior Audit Investigator	Ms.	Grimes-Burke	Jennifer		5035873355					Jennifer.Grimes-Burke@regence.com	100 SW Market St	M/S E12B	Portland	OR	97201	06/16/2022	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Coordination of Benefits Contact	Manager, Member Services	Ms	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	PO Box 1827	MS: B32M	Medford	OR	97501	07/09/2016	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Corporate Mailing						5032206237				5035884350	Jennifer.DelVillar@regence.com	100 SW Market Street		Portland	OR	97201	01/07/2013	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant Sr I	Mr.	Gerken	Matthew		2063324809					Matthew.Gerken@cambiahealth.com	1800 9th Ave		Seattle	WA	98101	04/19/2016	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Customer Service Operations Contact	Manager Member Services	Ms	Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	DIR Contact	Manager Pharmacy Informatics		Kidd	Vicki		2083957739				2083337874	vicki.kidd@regence.com	1211 West Myrtle, Suite 110		Boise	ID	83702	01/08/2018	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	DIR Contact (Secondary)	Dir. Gov. Pro Compliance / Medicare Compliance Off	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street E10C		Portland	OR	97201	07/22/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Emergency Part D Contact	VP Pharm Ops & Compliance	Mr.	Weiss	Justin		5032256677					Justin.Weiss@cambiahealth.com	200 SW Market St		Portland	OR	97201	12/20/2022	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Emergency Part D Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Employer Waiver Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Enrollment Contact	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	EOB Transfer Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Financial Audit Contact	Government Programs Audit Consultant	Mr.	Hutt	Brian		5032206160					Brian.Hutt@regence.com	200 SW Market Street	MS: E10C	Portland	OR	97201	05/09/2019	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Financial Reporting Contact	Fin Acctg & Reporting, Assistant Director	Mr	Striplin	Daniel	W	5032256069					Dan.Striplin@regence.com	200 SW Market		Portland	OR	97201	01/29/2018	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Formulary Contact	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Ave		Portland	OR	97201	01/18/2018	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Formulary Contact (Secondary)	Supervisor, Formulary Operations	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	General Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Government Relations Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@regence.com	200 SW Market St.	MS:E10C	Portland	OR	97201	04/18/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	HIPAA Privacy Officer	VP Chief Compliance & Privacy Officer	Ms.	Erbes	Kristen		5035256533					kristen.erbes@regence.com	200 SW Market St	M/S: E14A	Portland	OR	97201	02/25/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	HIPAA Security Officer	Chief Information Security Officer	Mr.	Person	Steve		5037251654					Steve.Person@regence.com	1621 SW First Ave.		Portland	OR	97201	02/25/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Hospice Contact	Pharmacy Ops Oversight Specialist	Ms.	Pickens	Spring		5032255240					Spring.Pickens@regence.com	100 SW Market St	MS: WW5-56	Portland	OR	97201	02/05/2018	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Interoperability Contact	VP Chief Tech Officer		Anderson	Kirk		5037251608					kirk.anderson@cambiahealth.com	Cambia Health Solutions	200 SW Market Street	Portland	OR	97201	02/09/2022	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Marketing Contact	Compliance Analyst		Meirose	Robyn		5033918668					robyn.meirose@regence.com	200 SW Market St  MS: E10C		Portland	OR	97201	09/15/2015	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Medical Director	SVP Chief Medical Officer	Ms.	Milavetz	Donna		8013336740					Donna.Milavetz@regence.com	2890 E Cottonwood Pkwy.		Salt Lake City	UT	84121	12/05/2022	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Medicare Compliance Officer	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					Jennifer.DelVillar@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	07/14/2022	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Medicare Coordinator	Dir Medicare Operations	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827		Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Medicare Part D Opioid Overutilization Contact	Drug Management Program	Ms.	Anderson	Ally		8557297221					partdoverutil@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Medication Therapy Management Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Online Enrollment Center Contact (Back-up)	Dir Medicare Planning & Performance	Ms.	Franke	Dana		5037251641					Dana.Franke@regence.com	PO Box 1827	M/S: B32AG	Medford	OR	97501	09/14/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Online Enrollment Center Contact (Optional)	Manager Member Services	Ms.	Christiansen	Stacy		5416181240					Stacy.Christiansen@regence.com	2057 Commerce Dr		Medford	OR	97504	11/06/2017	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Online Enrollment Center Contact (Primary)	Spv Membership, GP OR Medicare Ops & Billing	Ms.	Cromwell	Krista		5416181286					Krista.Cromwell@regence.com	PO Box 1827	M/S: B32M	Medford	OR	97501	03/07/2018	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Appeals	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Appeals Contact (Secondary)	Regulatory Pharmacist	Ms.	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossig Rd	Eagan	MN	55120	03/21/2022	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Application Contact	VP Medicare Product Development	Ms.	Brewer	Dana		5037214095					Dana.Brewer@regence.com	1800 Ninth Avenue		Seattle	WA	98101	09/29/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Benefits Contact	Product Manager III	Ms.	Holliston	Danica		5032254871					Danica.Holliston@regence.com	200 SW Market St  M/S: E10M		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Claims Submission Contact	Functional Business Consultant - Government Prgrms	Mr.	Brook	Lance		4026862603					LBrooke@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	08/05/2019	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Exceptions Contact	Director, Regulatory and Audit Response	Ms.	Davis	Megan							clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/11/2020	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	6127775393				Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Exceptions Contact (Secondary)	Asst Director Pharmacy Operations	Ms.	Yi	Edie							edie.yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	972071271	12/15/2022	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	5032254801				Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Price File Contact (Back-up)	Database Reporting Analyst	Ms	Trudeau	Ashley		6127771338					Ashley.Trudeau@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	09/23/2020	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Price File Contact (Optional)	QA Analyst Sr	Ms.	Tastad	Emily		6127772557					emily.tastad@PrimeTherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	01/03/2022	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Price File Contact (Primary)	AD Pharmacy Informatics	Ms.	Kidd	Vicki		2083957739					Vicki.Kidd@regence.com	1211 West Myrtle		Boise	ID	83702	07/22/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Quality Assurance Contact	Assistant Dir Pharmacy Operations	Ms.	Yi	Edie		5032254801				2083957744	Edie. Yi@regence.com	100 SW Market St	MS: WW3-33	Portland	OR	97201	12/27/2022	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Part D Reporting Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market Street	MS E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Patient Safety Contact	Pharmacy Clinical Program Manager	Ms.	Chuang	Amy		2063325046					Amy.Chuang@regence.com	1800 Ninth Ave		Seattle	WA	98101	04/12/2019	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Payment Contact	Asst Director Fin Acctg & Reporting	Mr.	Striplin	Dan		5032256069					Dan.Striplin@cambiahealth.com	100 SW Market St	M/S: C2A	Portland	OR	97201	01/14/2014	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Pharmacy Director	Director Clinical Pharmacy Services	Mr.	Robertson	David	W	5032268761					david.w.robertson@regence.com	1621 SW First Avenue, M/S PDX - WW3-33		Portland	OR	97201	01/29/2018	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Pharmacy Network Management Contact	AVP, Network Mangement	Ms.	Conlin	Marci		6127772842				8778236373	MConlin@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Rd	Eagan	MN	55121	03/18/2020	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Pharmacy Network Management Contact (Secondary)	Sr. Dir, Network Management Relations		Lenhart	Alicia		6127773969				8778236373	Alicia.Lenhart@primetherapeutics.com	Prime Therapeutics LLC	2655 Eagan Woods Dr	Eagan	MN	55122	09/11/2020	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Pharmacy Technical Help Desk Contact	Director, Member Services Government Programs	Mr.	Schultz	Bret							bret.schultz@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				Medicare Prescription Drug Plan		5	Seattle
S5916	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Experience and Member Ops	Mr.	Bunch	Jon							jonathan.bunch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active	8447656826				Medicare Prescription Drug Plan		5	Seattle
S5916	Plan Directory Contact for Public Website	Manager Member Services		Ciuro	Catina		5416181268					Catina.Ciuro@regence.com	2057 Commerce Dr		Medford	OR	97504	02/07/2019	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Plan to Plan Reconciliation Contact	Pharmacy Operations Oversight Specialist, Sr.	Ms.	Manzer	Amy		5032255368					Amy.Manzer@regence.com	200 SW Market St	M/S: PDX-ZOF WW3-33	Portland	OR	97201	08/26/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Processor Contact	Director, PBM Operations	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing	Egan	MN	55121	04/19/2023	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Reconciliation Contact	VP Finance Controller		Vannoy	Anjie		5032761865					Anjie.Vannoy@cambiahealth.com	100 SW Market St.	MS:PDX-WW2-21	Portland	OR	97201	01/08/2018	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Reconciliation Contact (Secondary)	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS:E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Recovery Audit Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Surveillance Contact	Government Programs Compliance Officer		Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St  M/S: E10C		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	System Contact	Medicare Business Operations, Product Owner	Ms.	Fredinburg	Deana		5033754426					Deana.Fredinburg@regence.com	PO BOX 1827	M/S: B32AG	Medford	OR	97501	06/24/2022	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	Third Party Administrator (TPA) Liaison	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					jennifer.delvillar@cambiahealth.com	200 SW Market St		Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5916	User Access Contact	Government Programs Compliance Officer	Ms.	Del Villar	Jennifer		5032206237					MedCompOfcr@cambiahealth.com	200 SW Market St	MS: E10C	Portland	OR	97201	02/19/2021	2023	REGENCE BLUESHIELD OF IDAHO AND REGENCE BC BS UTAH	PDP	Regence BlueShield of Idaho and Regence BC BS Utah	Medicare Prescription Drug Plan		Cambia Health Solutions, Inc.	227	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5921	Agent/Broker Compensation Data Contact			State	Tonya		9529314166					tonya_l_state@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Automated TrOOP Balance Transfer Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Backup User Access Contact			Boyd	Lisa		7158585125					lisa_m_herman@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Best Available Evidence Contact			Prince	Shelli		7158585748					bae_requests@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Bid Audit Contact			McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Bid Primary Contact			Sporney	Aimee		9529316254					aimee.sporney@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	CAP Report Contact for Public Website	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	CEO - CMS Administrator Contact		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	CEO - Senior Official for Contracting		Mr.	Noel	Timothy		9529314172					chief_exec_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Chief Financial Officer		Mr.	Eklo	Benjamin		9529314168					benjamin_n_eklo@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Chief Operating Officer	Business Segment COO	Mr.	Fulton	Ryan		9529795503					ryan.fulton@uhc.com	9700 Health Care Lane		Minnetonka	MN	55343	09/13/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Chief Information Officer		Mr.	Davit	Mukesh		8478995620					mukesh.davit@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Chief Information Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	CMMI Model Point of Contact			Smith	Gretchen		7633213772					gretchen.smith@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	CMS Casework Communication Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Complaints Tracking Contact	Claims Bus Process Analyst		Padero	Kathryn		9522026694					UHCCTM_POC@uhc.com	6200 Northwest Parkway		San Antonio	TX	78249	05/15/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Contact for Fraud Investigations			Munson	Richard		9529316132					rick_e_munson@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Coordination of Benefits Contact	Director, Business Process		Busby	Nathanael		4438961223					nathanael.busbee@uhc.com	PO Box 2789		Warminster	PA	18974	09/19/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Corporate Mailing						9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Coverage Gap Discount Program (CGDP) Payment Contact			Ibrahim	Sadek		9522056655					sadek.ibrahim@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Customer Service Operations Contact	VP, Regulatory Adherance		Britton	Mark		2182607034					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	DIR Contact			Gerbuz	Michael		9529315736					michael_v_gerbuz@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Emergency Part D Contact	West Region CEO & SVP Part D/Gov Prog. Pharm Serv.		Monical	Kent		7033005214					kmonical@uhc.com	1 East Washington Street		Phoenix	AZ	85004	08/07/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Employer Waiver Contact			Haverstick	Chiaki		7145037919					chiaki.haverstick@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Enrollment Contact			Smith	Charlotte		7158585653					charlotte_a_smith@uhc.com	2725 Mall Drive		Eau Claire	WI	54701	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	EOB Transfer Contact			Busbee	Nathanael		4438961223				8444832968	nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Financial Audit Contact	Dir Bus Process	Ms.	McCleary	Lisa		9529315543					lisa_mccleary@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Financial Reporting Contact	Director, Finance		Walczak	Rachel		9529314930					rachel.walczak@uhc.com	9800 Healthcare Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Formulary Contact			Degen	Paul		9529315783					paul.degen@uhc.com	9800 Health Care Lane		Minneapolis	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	General Contact	Chief Compliance Officer		Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Government Relations Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	HIPAA Privacy Officer	Sr. Assoc. Gen. Counsel & Deputy Chief Privacy Off		Heiden	Randy		5036037431					uhc_privacy_office@uhc.com	4550 Kruse Way	Attn: Randy Heiden	Lake Oswego	OR	97035	08/07/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	HIPAA Security Officer	CISO UHC and SVP Enterprise Security	Ms.	Block	Gretchen		5632102785					gretchen_d_block@optum.com	11000 Optum Circle	Building 2	Eden Prairie	MN	55344	08/07/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Hospice Contact			Busbee	Nathanael		4438961223					nathanael.busbee@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Interoperability Contact	Chief Compliance Officer		Furlong	Erin		9529315444					erin.furlong@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Marketing Contact			Proudfit	Susan		9529314230					Sales_Oversight@uhc.com	9800 Health Care Lane	MN006-W700	Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Medical Director			Painter	Philip		6514148328					philip_painter@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Medicare Compliance Officer	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Medicare Coordinator			Byrnes	Chris	A	2182609617					chris_a_byrnes@uhc.com	4316 Rice Lake Rd.		Duluth	MN	55811	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Medicare Part D Opioid Overutilization Contact			Berkowicz	Teresa		4438961235					uhcmr_op@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/29/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Medication Therapy Management Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	OffShore Subcontractor Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Online Enrollment Center Contact (Back-up)			Birky	Danielle	M	7633213818					danielle_m_birky@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Online Enrollment Center Contact (Primary)			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Part D Appeals			Trabold	Debbie							Debbie_m_trabold@uhc.com	10 Little Moose Lane		Saugerties	NY	12477	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	6126562187				Medicare Prescription Drug Plan		5	San Francisco
S5921	Part D Appeals Contact (Secondary)			Zaragoza	William							william_zaragoza@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	7632832653				Medicare Prescription Drug Plan		5	San Francisco
S5921	Part D Application Contact	Director, Product		Becker	Laura		9527698714					laura_e_becker@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Part D Benefits Contact			Tran	Nhu		7633614406					josephine.tran@uhg.com	6378 Sombrero Ave		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Part D Claims Submission Contact			Rancourt	Timothy		2159048234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Part D Exceptions Contact	Assoc. Director, Part D A&G Audit Readiness		Seely	Kate							kathryn.seely@uhc.com	PO Box 9472		Minneapolis	MN	554409472	06/29/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	8005959532				Medicare Prescription Drug Plan		5	San Francisco
S5921	Part D Price File Contact (Back-up)			Vargas	Danielle		4437101262					danielle_wooten@optum.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Part D Price File Contact (Optional)			Gazmey	Odalys		8138183394					odalys_gazmey@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Part D Price File Contact (Primary)			Connor	Dana		4438961226					dana_connor@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Part D Quality Assurance Contact			Fitzgibbons	Michael		6303249806					michael_d_fitzgibbons@uhc.com	2655 Warrenville Road		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Part D Reporting Contact			Kamehaiku	Tracy		7633613962					tracy.kamehaiku@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Patient Safety Contact			Milne	Erika		9529315293					erika_milne@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Payment Contact			St. Martin	Brian		9529314279					brian.st-martin@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Pharmacy Director			Horner	Deanna		9522022891					Deanna_horner@uhc.com	4333 Roslyn Rd		Downers Grove	IL	60515	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Pharmacy Network Management Contact	Manager, Business Process		Fernandez	Marilyn		7633615037					marilyn_fernandez@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Pharmacy Technical Help Desk Contact			Pham	Brittany							brittany_pham@uhc.com	10175 Little Patuxent Parkway		Columbia	MD	21044	06/08/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	8007887871				Medicare Prescription Drug Plan		5	San Francisco
S5921	Plan Directory Contact for Public Website	VP, Regulatory Adherance		Britton	Mark		9529126668					mark_d_britton@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Plan to Plan Reconciliation Contact			Crone	David		9529315204					p2padmin@uhc.com	Lockbox 5818		Carol Stream	IL	601975818	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Processor Contact	VP, Claims		Barber	Joseph		3128030121					joseph_barber@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Reconciliation Contact			Rancourt	Timothy		2159028234					timothy_a_rancourt@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Reconciliation Contact (Secondary)			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Recovery Audit Contact	Chief Compliance Officer	Ms.	Furlong	Erin		9529315444					compliance_officer@uhc.com	9800 Health Care Lane		Minnetonka	MN	55343	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Surveillance Contact	Assoc. Director, Compliance		Golibart	Carlos		7145037919					Carlos.Golibart@uhc.com	5701 Katella Avenue		Cypress	CA	90630	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	System Contact			Weingarten	Heather		7158520479					heather_weingarten@uhc.com	PO Box 9472		Minneapolis	MN	554409472	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	Third Party Administrator (TPA) Liaison			Eibel	Maureen		2159028234					maureen_m_eibel@uhc.com	680 Blair Mill Road		Horsham	PA	19044	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5921	User Access Contact			Freese	Lynn		9529315765					lynn.freese@uhc.com	PO Box 9472		Minneapolis	MN	55440	05/11/2023	2023	UNITEDHEALTHCARE INS. CO. & UHC INS. CO. OF NY	PDP	UnitedHealthcare	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S5953	Agent/Broker Compensation Data Contact	AVP -  Medicare Advantage Operations		Edwards	Don		8032649482					Don.Edwards@bcbssc.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	12/14/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Automated TrOOP Balance Transfer Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	03/15/2017	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Backup User Access Contact	Manager - Medicare Advantage Operations		Morris	Charles		8032641799					charles.morris@bcbssc.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Best Available Evidence Contact	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Bid Audit Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/05/2014	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Bid Audit Site Contact	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Bid Primary Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/05/2014	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	CAP Report Contact for Public Website	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	CEO - CMS Administrator Contact	CEO	Mr.	Mizeur	Michael	J	8032646000					CEO@BCBSSC.com	I-20 at Alpine Road	AA-X01	Columbia	SC	29219	01/03/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	CEO - Senior Official for Contracting	CEO	Mr.	Mizeur	Michael	J	8032646000					CEO@BCBSSC.com	I-20 at Alpine Road	AA-X01	Columbia	SC	29219	01/03/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Chief Financial Officer	VP & CFO, BCBS Div	Mrs.	Srulevich	Heather		8032649488					Heather.Srulevich@BCBSSC.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	10/26/2017	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Chief Operating Officer	President, BlueCross BlueShield of SC	Mr	Graves	Scott		8033825114					SCOTT.GRAVES@bcbssc.com	I-20 Apline Road	AA-X18	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Chief Information Officer	Senior VP, CIO	Mrs.	McCormick	Renee		8032642369					Renee.McCormick@bcbssc.com	1-20 Alpine Road	AA-X01	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Chief Information Security Officer	Senior VP, CIO	Mrs.	McCormick	Renee		8032642369					Renee.McCormick@bcbssc.com	1-20 Alpine Road	AA-X01	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	CMS Casework Communication Contact	Manager - Medicare Advantage Operations		Dewitt	Tanika		8032641103					Tanika.Dewitt@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Complaints Tracking Contact	Manager - Medicare Advantage Operations		Dewitt	Tanika		8032641103					Tanika.Dewitt@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Contact for Fraud Investigations	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Coordination of Benefits Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	03/15/2017	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Corporate Mailing						8032642944				8032649581	katrina.gesh-wilson@bcbssc.com	PO Box 100191		Columbia	SC	29202	11/15/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Coverage Gap Discount Program (CGDP) Payment Contact	Director - Private Business Accounting		Campbell	Newt		8032640357					CGDP_REPORTING@bcbssc.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	11/10/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Customer Service Operations Contact	Director Operations		Rodillo-Fowler	Ellen		8032640965					ellen.rodillo-fowler@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	DIR Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris		8032644347				8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	02/09/2015	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	DIR Contact (Secondary)	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/05/2014	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Emergency Part D Contact	AVP - Medicare Advantage Operations		Boggero	Laurin		8034224440				8032649581	Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Emergency Part D Contact (Secondary)	VP Medicare Advantage		Gesh-Wilson	Kat		2816841626					kat.gesh-wilson@bcbssc.com	I-20 at Alpine Road	Mail Code AG-770	Columbia	SC	29219	12/13/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Employer Waiver Contact	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AG - 780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Enrollment Contact	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	EOB Transfer Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	03/15/2017	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Financial Audit Contact	Compliance Officer	Mr.	Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Financial Reporting Contact	Director - Financial Reporting		Haile	Karin		8032642089					Karin.Haile@bcbssc.com	1-20 at Alpine Road	AX-200	Columbia	SC	29219	08/09/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Formulary Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris		8032644347				8038708162	Chris.Puffenbarger@bcbssc.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Formulary Contact (Secondary)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	General Contact	AVP - Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Government Relations Contact	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	HIPAA Privacy Officer	Privacy Compliance Officer		Weeks	Linda		8032643562					linda.weeks@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	02/21/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	HIPAA Security Officer	AVP, I/S Goverance		Hubbard	Elizabeth		8032646146					Elizabeth.Hubbard@bcbssc.com	I-20 at Alpine Road	AA-225	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Hospice Contact			DeWitt	Tanika		8032641103					tanika.dewitt@bcbssc.com	1-20 @ Alpine Rd. AX-155		Columbia	SC	29223	04/11/2018	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Interoperability Contact	VP Medicare Operations		Boggero	Laurin		8032646635					laurin.boggero@bcbssc.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	10/27/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Marketing Contact	AVP -  Medicare Advantage Operations		Edwards	Don		8032649482					Don.Edwards@bcbssc.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	12/14/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Medical Director	Chief Medical Officer		Sungurov	Max		8032645729					max.sungurov@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	05/18/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Medicare Compliance Officer	Compliance Officer	Mr.	Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	01/05/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Medicare Coordinator	Manager Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	tanika.dewitt@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Medicare Part D Opioid Overutilization Contact	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Medication Therapy Management Contact	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	OffShore Subcontractor Contact	AVP	Ms.	Boggero	Laurin		8032646635				8032649581	Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Online Enrollment Center Contact (Back-up)	VP Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	Laurin.Boggero@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Online Enrollment Center Contact (Optional)	Manager Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	Tanika.Dewitt@BCBSSC.com	I-20 at Alpine Road	AG-A10	Columbia	SC	29219	03/11/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Online Enrollment Center Contact (Primary)	Director Operations		Morris	Charles		8032641799				8032649581	charles.morris@bcbssc.com	I-20 at Alpine Road	AG-780	Columbia	SC	29219	04/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Part D Appeals	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris						8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/31/2020	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032645355				Medicare Prescription Drug Plan		5	Atlanta
S5953	Part D Appeals Contact (Secondary)	Supervisor - Medicare Advantage Operations		Dewitt	Tanika						8032649581	Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	03/15/2017	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032641103				Medicare Prescription Drug Plan		5	Atlanta
S5953	Part D Application Contact			Gesh-Wilson	Katrina		8032642944					kat.gesh-wilson@bcbssc.com	I-20 @ Alpine Rd	AG-770	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Part D Benefits Contact	Sr. Director - Medicare Pharmacy		Coleman	Terrica		8032642728				8032649581	terrica.coleman@bcbssc.com	I-20 at Alpine Road	AG-770	Columbia	SC	29219	07/12/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Part D Claims Submission Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	03/15/2017	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Part D Exceptions Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris						8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032644347				Medicare Prescription Drug Plan		5	Atlanta
S5953	Part D Exceptions Contact (Secondary)	Supervisor - Medicare Advantage Operations		Dewitt	Tanika							Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	03/15/2017	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8032641103				Medicare Prescription Drug Plan		5	Atlanta
S5953	Part D Price File Contact (Back-up)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Part D Price File Contact (Primary)	Manager, MA Pharmacy Management		Puffenbarger	Chris		8032644347					Chris.Puffenbarger@bcbssc.com	1-20 Alpine Road	AX-740	Columbia	SC	29219	12/27/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Part D Quality Assurance Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103				8032649581	Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	03/15/2017	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Part D Reporting Contact	Corporate Compliance Manager		Ramsey	Ryan		8032642735					BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	01/02/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Patient Safety Contact	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Payment Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/05/2014	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Personal Health Record Contact	AVP, Medicare Advantage Operations		Boggero	Laurin		8032646635				8032649581	Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Pharmacy Director	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Pharmacy Network Management Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris		8032644347				8038708162	Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Pharmacy Network Management Contact (Secondary)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica		8032642728					terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Pharmacy Technical Help Desk Contact	Manager - Medicare Part D Pharmacy Contracting		Puffenbarger	Chris							Chris.Puffenbarger@BCBSSC.com	I-20 at Alpine Road	AX-740	Columbia	SC	29219	12/31/2019	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8555405951				Medicare Prescription Drug Plan		5	Atlanta
S5953	Pharmacy Technical Help Desk Contact (Secondary)	Sr. Director, Medicare Pharmacy Management		Coleman	Terrica							terrica.coleman@bcbssc.com	1-20 at Alpine Road	AX-740	Columbia	SC	29219	07/22/2022	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8555405951				Medicare Prescription Drug Plan		5	Atlanta
S5953	PHR Beneficiary Contact																	05/14/2015	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan	BlueCross BlueShield of South Carolina, Medicare Advantage	BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active	8886456025				Medicare Prescription Drug Plan		5	Atlanta
S5953	Plan Directory Contact for Public Website			Services	Provider		8003342583					Provider.Education@BCBSSC.com	I-20 at Alpine Road	AX-624	Columbia	SC	29219	08/01/2011	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Plan to Plan Reconciliation Contact	Director, Accounting		Campbell	Newt		8032640357				8038708623	Newt.Campbell@bcbssc.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	04/13/2023	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Processor Contact	Supervisor - Medicare Advantage Operations		Dewitt	Tanika		8032641103					Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	03/15/2017	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Reconciliation Contact	Manager - Actuarial		Philips	Jeff		8032640783				8037361296	Jeff.Philips@BCBSSC.com	I-20 at Alpine Road	AX-555	Columbia	SC	29219	12/05/2014	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Reconciliation Contact (Secondary)	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Recovery Audit Contact	AVP	Ms.	Boggero	Laurin		8032646635				8032649581	Med.Partd@BCBSSC.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Surveillance Contact	AVP -  Medicare Advantage Operations		Edwards	Don		8032649482					Don.Edwards@bcbssc.com	I-20 at Alpine Road	AX-155	Columbia	SC	29219	12/14/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	System Contact	Assistant Vice President - Information Systems		Britton	John		8032640657					John.Britton@bcbssc.com	I-20 at Alpine Road	AF-123	Columbia	SC	29219	12/22/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	Third Party Administrator (TPA) Liaison	Director - Private Business Accounting		Campbell	Newt		8032640357					CGDP_REPORTING@bcbssc.com	I-20 at Alpine Road	AX-200	Columbia	SC	29219	08/29/2016	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5953	User Access Contact	Compliance Officer		Pierstorff	Joel		8032641971				8032644050	BCBSSC.MA.COMPLIANCE@bcbssc.com	I-20 at Alpine Road	AC-200	Columbia	SC	29219	12/01/2021	2023	BLUECROSS AND BLUESHIELD OF SOUTH CAROLINA	PDP	Blue Cross Blue Shield of South Carolina	Medicare Prescription Drug Plan		BlueCross BlueShield of South Carolina (BCBSSC)	2	Yes	Active					Medicare Prescription Drug Plan		5	Atlanta
S5960	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	10/26/2018	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/28/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/10/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/10/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Bid Audit Contact	Actuarial Director		Hart	Mary		3175819752					mary.a.hart@anthem.com	220 Virginia Avenue	Mail Drop: IN205-A351	Indianapolis	IN	46204	01/18/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Bid Audit Site Contact	Actuarial Director		Hart	Mary		3175819752					mary.a.hart@anthem.com	220 Virginia Avenue	Mail Drop: IN205-A351	Indianapolis	IN	46204	01/18/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Bid Primary Contact	Director, Product Development		Floyd	Cari		5407984087					Cari.Floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/07/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/28/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	03/03/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	02/01/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	06/08/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/06/2020	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/02/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	02/28/2019	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	10/06/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/16/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	03/30/2018	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	02/03/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	06/08/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	01/17/2020	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	EOB Transfer Contact	Compliance Director, Med Part D/Pharm Oversight		Doss	Jennifer		5137484736				8558419706	jennifer.doss@anthem.com	4361 Irwin Simpson Road		Mason	OH	45040	10/08/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	04/04/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	02/03/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	04/15/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	07/15/2020	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	03/15/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/09/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	06/08/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	03/15/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	01/22/2020	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	11/14/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	02/03/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	5133167654				Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	01/07/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	8144498744				Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	10/26/2020	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	07/22/2020	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	02/03/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	5133167654				Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	06/08/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	5407984087				Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	10/07/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Personal Health Record Contact	VP IT Assoc Exper Chief Technology  Office		Wilson	Geeta		5133792409					geeta.wilson@anthem.com	4241 Irwin Simpson Road		Mason	OH	45040	02/03/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/01/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	8333774266				Medicare Prescription Drug Plan		5	Chicago
S5960	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	11/14/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active	3135973173				Medicare Prescription Drug Plan		5	Chicago
S5960	PHR Beneficiary Contact																	11/05/2015	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan	Unicare	Elevance Health, Inc.	1	Yes	Active	8004671199				Medicare Prescription Drug Plan		5	Chicago
S5960	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/23/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/10/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	07/23/2020	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	11/04/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	01/23/2023	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	10/07/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	08/02/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/06/2021	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5960	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	09/22/2022	2023	UNICARE LIFE & HEALTH INSURANCE COMPANY	PDP	Wellpoint	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S5966	Agent/Broker Compensation Data Contact	Medicare Sales Director		Casas	Edward		3472138107					ecasas@emblemhealth.com	55 Water Street		New York	NY	10041	06/02/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Automated TrOOP Balance Transfer Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					JEwen@emblemhealth.com	55 Water St		New York	NY	10041	06/25/2021	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Backup User Access Contact	Director, Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Best Available Evidence Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Bid Audit Contact	Director, Medicare Audit & Assessment		Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	12/03/2014	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Bid Audit Site Contact	Sr. Medicare Audit Spec.		Chan	Tat		6464470218					tchan@emblemhealth.com	55 Water Street		New York	NY	10041	05/28/2020	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Bid Primary Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	CAP Report Contact for Public Website	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	CEO - CMS Administrator Contact	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin-Corp Exec. Office	New York	NY	10041	12/14/2015	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	CEO - Senior Official for Contracting	President & CEO	Ms.	Ignagni	Karen	M	6464476107					KIgnagni@emblemhealth.com	55 Water Street	Admin - Corp Exec. Office	New York	NY	10041	05/09/2019	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Chief Financial Officer	Chief Financial Officer	Ms.	Tamborino	Heather		6464476174					htamborino@emblemhealth.com	55 Water Street		New York	NY	10041	07/02/2020	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Chief Operating Officer	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Chief Information Officer	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Chief Information Security Officer	AVP, IT Governance	Mr.	McDermott	Thomas	M	6464474110					tmcdermott@emblemhealth.com	55 Water Street		New York	NY	10041	06/29/2018	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	CMMI Model Point of Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	CMS Casework Communication Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/25/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Complaints Tracking Contact	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A	6464477215				2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	07/25/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Contact for Fraud Investigations	Director, Special Investigations		Lupo	Chris		6318442453					Clupo@EmblemHealth.com	395 North Service Road		Melville	NY	11747	03/02/2017	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Coordination of Benefits Contact	Director, Payment Integrity & Financial Recovery		LaPlante	Brian		8606742840					blaplante@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	01/10/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Corporate Mailing						6464475044					Cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Coverage Gap Discount Program (CGDP) Payment Contact	Treasury Operations Analyst		Saint-Hilaire	Ana		6464474279					ASaint-Hilaire@emblemhealth.com	55 Water St		New York	NY	10041	04/01/2020	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Customer Service Operations Contact	VP, Ops Strategy & Service Delivery		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	DIR Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	DIR Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Emergency Part D Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Emergency Part D Contact (Secondary)	Pharm. Govt. Programs Manager		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Employer Waiver Contact	AVP, Product Dev., Admin., & Perf. Analysis		Averyanova	Nataliya		6464475044					naveryanova@emblemhealth.com	55 Water Street		New York	NY	10041	04/18/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Enrollment Contact	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	EOB Transfer Contact	Director, Claims Processing & Provider File Mgmt		Meka	Joann		8604098915				8604098455	jmeka@connecticare.com	175 South Swamp Road		Farmington	CT	06034	05/28/2020	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Financial Audit Contact	Director, Medicare Audit & Assessment	Mr	Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road	6th Floor	Albany	NY	12205	12/03/2014	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Financial Reporting Contact	Director, Financial Reporting		Heitzer	Frances		6464477885					FHeitzer@emblemhealth.com	55 Water Street		New York	NY	10041	07/18/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Formulary Contact	Sr. Formulary Specialist		Sitilides Cimino	Irene		6864477926					isitilidescimino@emblemhealth.com	55 Water Street		New York	NY	10041	11/15/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Formulary Contact (Secondary)	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	05/12/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	General Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Government Relations Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	HIPAA Privacy Officer	VP, Corporate Compliance		Lurin	Joseph		6464475203					jlurin@emblemhealth.com	55 Water Street		New York	NY	10041	07/30/2019	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	HIPAA Security Officer	VP, Technology and CISO		McDermott	Thomas		6464474110					TMcDermott@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Hospice Contact	Senior Medicare Pharmacy Specialist		Der Weer	J'Nisha		6464477198					jderweer@emblemhealth.com	55 Water Street		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Interoperability Contact	Dir,, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Marketing Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Medical Director	Chief Medical Officer		Dal Col	Richard		6464470070					rdalcol@emblemhealth.com	55 Water Street		New York	NY	10041	05/28/2020	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Medicare Compliance Officer	Director, Medicare Compliance/MCO	Ms.	Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Medicare Coordinator	VP, Medicare	Mr.	Walsh	Eric		6464477893					ericwalsh@emblemhealth.com	55 Water Street		New York	NY	10041	09/06/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Medicare Part D Opioid Overutilization Contact	Dir., Pharm. Quality Provider and Safety Prgms.		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road		Farmington	CT	06034	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Medication Therapy Management Contact	Clinical Pharmacy Program Leader		Mhajan	Ruby		6464477632					rumhajan@emblemhealth.com	55 Water Street		New York	NY	10041	12/20/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	OffShore Subcontractor Contact	Lead Admin., Regulatory Pgm.		Kelly	Veronica		6464477494					vkelly@emblemhealth.com	55 Water Street		New York	NY	10041	11/26/2019	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Online Enrollment Center Contact (Back-up)	Knowledge Manager, Enroll. & Bill.		Gonzalez	Gabriel		6464477722					gabriel.gonzalez@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Online Enrollment Center Contact (Optional)	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Online Enrollment Center Contact (Primary)	Dir., Enrollment & Billing		Ewen	Jillian		8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Part D Appeals	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active	6464477215				Medicare Prescription Drug Plan		5	New York
S5966	Part D Appeals Contact (Secondary)	Dir., G & A and Pharmacy Ops.		Marie	Jacqueline	A					2125108130	jmarie@emblemhealth.com	55 Water Street		New York	NY	10041	03/12/2021	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active	6464477215				Medicare Prescription Drug Plan		5	New York
S5966	Part D Application Contact	Medicare Product Strategy Leader		Benoit	Theresa		8604096415					tbenoit@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	11/08/2021	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Part D Benefits Contact	Sr. Pharm. Gov't. Prog. Spec		Dean	Wendy		8604098966					wdean@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	07/18/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Part D Claims Submission Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Part D Exceptions Contact	VP, Pharmacy Solutions		Colby	Andrew							acolby@emblemhealth.com	55 Water street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active	6464473340				Medicare Prescription Drug Plan		5	New York
S5966	Part D Exceptions Contact (Secondary)	Sr.  Govt Prog. Pharm. Spec.		Kerman	Jeff							jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	05/12/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active	6464477698				Medicare Prescription Drug Plan		5	New York
S5966	Part D Price File Contact (Back-up)	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Part D Price File Contact (Optional)	Sr. Govt Prog. Pharm Spec.		Kerman	Jeff		6464477698					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	07/25/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Part D Price File Contact (Primary)	Sr. Manager Regulated Markets		Dolfi	Amanda		6147349264					Medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	11/11/2021	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Part D Quality Assurance Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Part D Reporting Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		3479784977					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Patient Safety Contact	Dir., Pharm. Quality Provider and Safety Prgms.		Lemieux	Sheryl		8606745829					slemieux@connecticare.com	175 Scott Swamp Road	P.O. Box 4050	Farmington	CT	060344050	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Payment Contact	VP, Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Personal Health Record Contact	Director, Medicare Compliance/MCO		Borenkind	Carly		6464477141					cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Pharmacy Director	VP, Pharmacy Solutions		Colby	Andrew		6464473340					acolby@emblemhealth.com	55 Water St		New York	NY	10041	07/11/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Pharmacy Network Management Contact	Pharmacy Client Ops Director		Brown	Gregory		4015251683					GrBrown@emblemhealth.com	55 Water St		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Pharmacy Network Management Contact (Secondary)	Sr. Govt Prog. Pharm. Specialist		Kerman	Jeff		6464477698					jkerman@emblemhealth.com	55 Water Street		New York	NY	10041	02/17/2021	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Pharmacy Technical Help Desk Contact	Director, Customer Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom PKWY STE 150		Temple Terrace	FL	33637	01/12/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active	8009221557	2			Medicare Prescription Drug Plan		5	New York
S5966	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Client Ops Director		Brown	Gregory							grbrown@emblemhealth.com	55 Water street		New York	NY	10041	10/10/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active	4015251683				Medicare Prescription Drug Plan		5	New York
S5966	PHR Beneficiary Contact																	04/20/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan	EmblemHealth	EmblemHealth, Inc.	361	Yes	Active	8773447364				Medicare Prescription Drug Plan		5	New York
S5966	Plan Directory Contact for Public Website	VP, Ops Strategy & Service Delivery		Pandey	Priyank		6464477543					ppandey@emblemhealth.com	55 Water Street		New York	NY	10041	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Plan to Plan Reconciliation Contact	Accounts Payable Manager		Siozios	Jacqueline		6464473017					jsiozios@emblemhealth.com	55 Water Street		New York	NY	10041	08/16/2022	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Processor Contact	AVP, Claims Operations		Gauthier	Kathleen	H	8604096435					kgauthier@connecticare.com	175 Scott Swamp Road		Farmington	CT	06032	07/18/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Reconciliation Contact	Dir., Enrollment & Billing		Ewen	Jillian	L	8606745780					jewen@emblemhealth.com	55 Water Street		New York	NY	10041	07/15/2021	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Reconciliation Contact (Secondary)	VP Case Installation & Maintenance		May	Tamara		6318442559					tmay@emblemhealth.com	55 Water Street		New York	NY	10041	07/15/2021	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Recovery Audit Contact	Director, Medicare Audit & Assessment	Mr.	Greene	Joseph		5184468045					JGreene@emblemhealth.com	80 Wolf Road		Albany	NY	12205	12/03/2014	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Surveillance Contact	Director, Medicare Compliance/ MCO	Ms.	Borenkind	Carly		3479784977					Cborenkind@emblemhealth.com	55 Water Street		New York	NY	10041	09/08/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	System Contact	Chief Information Officer	Mr.	MacMillan	Thomas	A	6464474401	34401				tmacmillan@emblemhealth.com	55 Water Street		New York	NY	10041	05/09/2019	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	Third Party Administrator (TPA) Liaison	Lead Accountant		Simochkina	Ludmila		7185599146					lsimochkina@emblemhealth.com	2151 Ocean Ave	apt 2 B	Brooklyn	NY	11229	05/24/2023	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5966	User Access Contact	Lead Medicare Regulatory Spec.		Handy	Michelle		5184466949					mhandy@EmblemHealth.com	80 Wolf Road		Albany	NY	12205	03/23/2020	2023	EMBLEMHEALTH PLAN, INC	PDP	EmblemHealth	Medicare Prescription Drug Plan		EmblemHealth, Inc.	361	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5975	Agent/Broker Compensation Data Contact	Senior Medicare Product Manager	Mrs.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	11/15/2019	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Automated TrOOP Balance Transfer Contact	Supervisor, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	Relay.Health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/04/2020	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Backup User Access Contact	Medicare Compliance Auditor		Siegfried-Roads	Carey		5032654719				5032654790	carey.siegfriedroads@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	11/03/2014	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Best Available Evidence Contact	Supervisor Membership Accounting		Black	Colby		5032655606					colby.black@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Bid Audit Contact	Senior Medicare Product Manager	Mrs.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/08/2020	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Bid Audit Site Contact	Actuarial Pricing Manager	Mr.	Danburg-Wyld	Mark		5039525020					mark.danburgwyld@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	02/11/2019	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Bid Primary Contact	Senior Medicare Product Manager	Mrs.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/08/2020	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	CAP Report Contact for Public Website	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	CEO - CMS Administrator Contact	CEO	Mr.	Gootee	Robert		5032434491					robert.gootee@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/16/2023	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	CEO - Senior Official for Contracting	CEO	Mr.	Gootee	Robert		5032434491				5032654790	robert.gootee@modahealth.com	601 S.W. Second Ave Suite 900		Portland	OR	97204	01/07/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Chief Financial Officer	Sr VP CFO	Mr.	Evans	Dave		5032433952				5039485557	dave.evans@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	07/11/2018	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Chief Operating Officer	VP Claims, Customer Service and Configuration	Ms.	Thornburg	Margaret		5032654787					margaret.thornburg@modahealth.com	601 S.W. Second Ave Suite 900		Portland	OR	97204	11/10/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Chief Information Officer	Chief Information Officer	Ms.	Hansen	Sue		5032655705	5705				sue.hansen@modahealth.com	601 SW Second Ave.		Portland	OR	97204	01/25/2016	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Chief Information Security Officer	Director, Information Security	Mr	James	Dale		5039485597					dayle.james@modahealth.com	601 SW Second Ave.		Portland	OR	97204	06/24/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	CMS Casework Communication Contact	Lead Appeals Coordinator	Ms.	Shattuck	Mica		5034124021				8339491888	mica.shattuck@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/11/2020	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Complaints Tracking Contact	Lead Appeals Coordinator	Ms.	Shattuck	Mica		5034124021				8339491888	mica.shattuck@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/11/2020	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Contact for Fraud Investigations	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Coordination of Benefits Contact			Service	Customer		8772999062				5039485577	PharmacyMedicare@modahealth.com	PO Box 40327		Portland	OR	97240	04/19/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Corporate Mailing						8772999062				5039485577	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/25/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Coverage Gap Discount Program (CGDP) Payment Contact	Corporate Controller	Ms.	Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 SW Second Ave		Portland	OR	97204	08/17/2016	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Customer Service Operations Contact	Customer Service Manager	Ms.	Duncan	Colleen		5037653424					colleen.duncan@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	02/11/2019	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	DIR Contact	Manager, Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	DIR Contact (Secondary)	Rx Government Programs Analyst		Beebe	Colin		5034124175					colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	02/23/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Emergency Part D Contact	Manager Pharmacy Operations		Kraemer	Laura		5034688790					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/13/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Emergency Part D Contact (Secondary)	Pharmacy PAC Govt Programs II		Beebe	Colin		7276566998					colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/13/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Employer Waiver Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Enrollment Contact	Membership Accounting Supervisor	=	Black	Colby		5032655606					colby.black@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	EOB Transfer Contact	Supervisor, Rx Quality and Compliance		Brokaw	Katie		5032654771				8339491891	katie.brokaw@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Financial Audit Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Financial Reporting Contact	Corporate Controller	Ms.	Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	09/01/2016	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Formulary Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					RXGovernmentPrograms@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Formulary Contact (Secondary)	Medicare Team Lead, Formulary Services		Paddock	Deanna		6087291628				6087292628	deanna.paddock@navitus.com	2601 West Beltline Highway, Suite 600		Madison	WI	53713	01/21/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	General Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Government Relations Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	HIPAA Privacy Officer	Privacy Officer	Mr.	White	Scott		5039525044					scott.white@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	06/24/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	HIPAA Security Officer	Director, Information Security		James	Dayle		5039485597					dayle.james@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	06/24/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Hospice Contact	Rx Government Programs Analyst	Mr.	Beebe	Colin		5034124175	4175			8002078235	colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	06/04/2020	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Interoperability Contact	Director Regulatory Affairs and Privacy Officer	Mr	White	Scott		5039525044					scott.white@modahealth.com	601 SW Second Ave		Portland	OR	97204	04/17/2023	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Marketing Contact	Manager Market Intelligence, Medicare	Mr.	Skyba	Richard		5034124215					richard.skyba@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	03/30/2018	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Medical Director	Medical Director	Dr.	Popowich	Yale		5039525022					Yale.Popowich@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/06/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Medicare Compliance Officer	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Medicare Coordinator	Medicare Compliance Analyst	Ms.	Seon Hye	Jangmie		5039525245	5245				jangmie.seonhyemcinnes@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/08/2020	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Medication Therapy Management Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Online Enrollment Center Contact (Back-up)	Membership Accounting Trainer	Mr.	Schamber	Jacob		5032286554	1518				jacob.schamber@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	08/16/2019	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Online Enrollment Center Contact (Optional)	Membership Accounting Specialist II		Pahlka	Chelsea		5032654729					chelsea.pahlka@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Online Enrollment Center Contact (Primary)	Supervisor Membership Accounting		Black	Colby		5032655606					colby.black@modahealth.com	601 SW 2nd Avenue		Portland	OR	97204	04/01/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Part D Appeals	Manager Medical Claims		Craft	Jessica							jessica.craft@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/30/2020	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active	5032193675				Medicare Prescription Drug Plan		5	Seattle
S5975	Part D Appeals Contact (Secondary)	Lead Appeals Coordinator	Ms.	Shattuck	Mica						8339491888	mica.shattuck@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	05/11/2020	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active	8772999062				Medicare Prescription Drug Plan		5	Seattle
S5975	Part D Application Contact	Senior Medicare Product Manager	Mrs.	Camp	Emily		5039525228					emily.camp@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	11/15/2019	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Part D Benefits Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Part D Claims Submission Contact	Manager, Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/04/2020	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Part D Exceptions Contact	Pharmacy, Customer Service		Service	Customer						8002078235	PharmacyMedicare@modahealth.com	601 S.W. Second Ave.		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active	8887867509				Medicare Prescription Drug Plan		5	Seattle
S5975	Part D Exceptions Contact (Secondary)	Manager Pharmacy Operations		Kraemer	Laura							Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active	5032654759				Medicare Prescription Drug Plan		5	Seattle
S5975	Part D Price File Contact (Back-up)	Supervisor Pharmacy Operations	Mr.	Beebe	Colin		5034124175	4175			8339491889	colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Part D Price File Contact (Primary)	Supervisor	Mr.	Beebe	Colin		5034124175	4175			8002078235	colin.beebe@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	03/30/2018	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Part D Quality Assurance Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Part D Reporting Contact	Medicare Compliance Analyst		Seon Hye	Jangmie	T	5039525245	5245				jangmie.seonhyemcinnes@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	11/15/2019	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Patient Safety Contact	Manager Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 SW Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Payment Contact	Corporate Controller		Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Pharmacy Director	Director, Pharmacy		Rodriguez	Carly		5039525011					carly.rodriguez@modahealth.com	601 SW Second Ave		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688				6087292688	Jan.Robinson@navitus.com	361 Integrity Drive		Madison	WI	53717	03/31/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Pharmacy Network Management Contact (Secondary)	Supervisor, Pharmacy Network Support		Burke	Sharon		8587907148				8587906011	Sharon.Burke@MedImpact.com	10181 Scripps Gateway Ct.		San Diego	CA	92131	12/28/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Pharmacy Technical Help Desk Contact	Sr. Manager, Customer Care Accounts		Nett	Danielle						9202214724	Danielle.Nett@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/04/2020	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active	8662703877	4224			Medicare Prescription Drug Plan		5	Seattle
S5975	Plan Directory Contact for Public Website			Service	Customer		8772999062				5039485577	MedicalMedicare@modahealth.com	PO Box 40384		Portland	OR	972400384	01/25/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Plan to Plan Reconciliation Contact	Lead Pharmacy Benefit Formulary Coordinator	Ms	Brokaw	Katie		5032654771	4771				katie.brokaw@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	10/29/2019	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Processor Contact	Manager, Pharmacy Operations		Kraemer	Laura		5032654759					Laura.Kraemer@modahealth.com	601 S.W. Second Ave		Portland	OR	97204	12/28/2021	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Reconciliation Contact	Supervisor, Rx Quality and Compliance		Brokaw	Katie		5032654771					katie.brokaw@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	02/23/2022	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Reconciliation Contact (Secondary)	Manager, Underwriting	Mr.	Danburg-Wyld	Mark		5039525020					mark.danburgwyld@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	07/12/2019	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Recovery Audit Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Surveillance Contact	Medicare Compliance Officer		McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	System Contact	Medicare Compliance Officer		McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue		Portland	OR	97204	01/25/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	Third Party Administrator (TPA) Liaison	Corporate Controller	Ms.	Stalsberg	Katie		5034124030					katie.stalsberg@modahealth.com	601 SW Second Ave		Portland	OR	97204	08/18/2016	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5975	User Access Contact	Medicare Compliance Officer	Mr.	McWhorter	Gary		5039525075					gary.mcwhorter@modahealth.com	601 S.W. Second Avenue Suite 900		Portland	OR	97204	12/27/2017	2023	MODA HEALTH PLAN, INC.	PDP	Moda Health Plan, Inc.	Medicare Prescription Drug Plan		Moda Partners, Inc.	226	Yes	Active					Medicare Prescription Drug Plan		5	Seattle
S5993	Agent/Broker Compensation Data Contact	Medicare Program Analyst		Wilbanks	Dasha		9734665601					dasha_wilbanks@horizonblue.com	3 Penn Plaza	16-C	Newark	NJ	07105	04/19/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Automated TrOOP Balance Transfer Contact	Director, PBM Ops.	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/28/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Backup User Access Contact	Medicare Program Analyst		Vargas	Mario		9734666379					mario_vargas@horizonblue.com	3 Penn Plaza East	16-C	Newark	NJ	07105	07/23/2019	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Best Available Evidence Contact	Supervisor, Govt. Programs		Achoe	Kisha		9734667328					Kisha_Achoe@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	07/27/2023	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Bid Audit Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319					jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	02/21/2013	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Bid Audit Site Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319					jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	02/21/2013	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Bid Primary Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319					jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	02/21/2013	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	CAP Report Contact for Public Website	VP, Reg. Compliance/MCO	Mr	McGrady	Daniel		6095372317					daniel_mcgrady@horizonblue.com	3 Penn Plaza East	PP-16	Newark	NJ	07105	04/06/2023	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	CEO - CMS Administrator Contact	Executive VP, Service	Mr.	Barnard	Mark		9734666380					Mark_Barnard@horizonblue.com	3 Penn Plaza	PP-16	Newark	NJ	07105	12/04/2018	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	CEO - Senior Official for Contracting	Executive VP, Service	Mr.	Barnard	Mark		9734666380					Mark_Barnard@horizonblue.com	3  Penn Plaza	PP-16	Newark	NJ	07105	12/04/2018	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Chief Financial Officer	SVP & Chief Financial Offcr.	Mr.	Rosenberg	David		9734664600					david_rosenberg@horizonblue.com	3 Penn Plaza	PP-16	Newark	NJ	07105	11/02/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Chief Operating Officer	Executive VP, Service	Mr.	Barnard	Mark		9734666380					Mark_Barnard@horizonblue.com	3 Penn Plaza	PP-16	Newark	NJ	07105	12/04/2018	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Chief Information Officer	Chief Information Officer	Ms.	Machemer	Michelle		9734664188					Michelle_Machemer@horizonblue.com	3 Penn Plaza East	PP-10	Newark	NJ	07105	04/22/2020	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Chief Information Security Officer	Chief Information Security Officer	Mr.	Constantino	Daniel		9734665127					Daniel_Constantino@horizonblue.com	3 Penn Plaza	PP-16K	Newark	NJ	07105	01/04/2023	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	CMS Casework Communication Contact	Director, GP Operations		Maramraju	Venkata		6095372113					venkata.maramraju@horizonblue.com	1700 American Boulevard		Pennington	NJ	08534	01/03/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Complaints Tracking Contact	Mgr, Exec DOBI Compl & Appls		Mestres	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	06/15/2020	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Contact for Fraud Investigations	Director, Special Investigations		Dineen	Timothy		9734668723					timothy_dineen@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	08/29/2013	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Coordination of Benefits Contact	Director, PBM Ops	Ms.	Allie	Cindy		6127776722				6127776706	COBMedD@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	09/28/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Corporate Mailing						6095372317					daniel_mcgrady@horizonblue.com	3 Penn Plaza East	PP-16	Newark	NJ	07105	04/06/2023	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Financial Reporting		Griffin	Kevin		6095372464					kevin_griffin@horizonblue.com	1700 American Blvd	HL-03Q	Pennington	NJ	08534	01/12/2018	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Customer Service Operations Contact	Director, Service Operations	Mr.	Yanek	John		5182208000					john_yanek@horizonblue.com	3 Penn Plaza		Newark	NJ	07105	06/13/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	DIR Contact	Director, Clinical Pharm. Programs		Patrikios	Athena		9734666542				9734664665	athena_patrikios@horizonblue.com	3 Penn Plaza East,  PP-12Q		Newark	NJ	07105	10/14/2016	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	DIR Contact (Secondary)	Pharmacy Analyst II		Farber	Keri	A	9734668995					keri_farber@horizonblue.com	3 Penn Plaza East	PP-12	Newark	NJ	07105	06/11/2020	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Emergency Part D Contact	Pharmacy Analyst II		Farber	Keri	A	9734668995					keri_farber@horizonblue.com	3 Penn Plaza	PP -12	Newark	NJ	07105	06/11/2020	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Emergency Part D Contact (Secondary)	Manager, Clinical Pharmacy		Sun	Jane		9734665044					jane_sun@horizonblue.com	3 Penn Plaza	PP 12-Q	Newark	NJ	07105	12/11/2018	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Enrollment Contact	Director, G. P. Operations		Maramraju	Venkata		6095372113					venkata_maramraju@horizonblue.com	1700 American Blvd. HL-03		Pennington	NJ	08534	10/31/2017	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	EOB Transfer Contact	Director, PBM Ops.	Ms.	Allie	Cindy		6127776722				6127776706	EOBP2P@primetherapeutics.com	2990 Ames Crossing Rd		Eagan	MN	55121	09/28/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Financial Audit Contact	Director, Regulatory Compliance/ MCO	Mr.	McGrady	Daniel		7325393680					daniel_mcgrady@horizonblue.com	1700 American Blvd	HL-03	Pennington	NJ	08534	02/25/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Financial Reporting Contact	Corporate Controller		Concepcion	Ivan		9734664188					Ivan_Concepcion@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	05/01/2023	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Formulary Contact	Director, Clinical Pharm Prg & Op - Medicare		Patrikios	Athena		9734666542					athena_patrikios@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	09/27/2016	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Formulary Contact (Secondary)	Supervisor, Formulary Ops.	Ms.	Negash	Martha		6127772773					martha.negash@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	10/06/2020	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	General Contact	Director, Regulatory Compliance/ MCO	Mr.	McGrady	Daniel		7325393680					daniel_mcgrady@horizonblue.com	1700 American Blvd.	HL-03	Pennington	NJ	08534	02/25/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Government Relations Contact	Director, Regulatory Compliance/ MCO	Mr.	McGrady	Daniel		7325393680					daniel_mcgrady@horizonblue.com	1700 American Blvd.	HL-03	Pennington	NJ	08534	02/25/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	HIPAA Privacy Officer	Privacy Official		Dates	Chris	A	9734667669					chris_dates@horizonblue.com	3 Penn Plaza East, PP-16C		Newark	NJ	07105	07/07/2015	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	HIPAA Security Officer	Chief Information Security Officer	Mr.	Constantino	Daniel		9734665127					Daniel_Constantino@horizonblue.com	3 Penn Plaza	PP-16K	Newark	NJ	07105	01/04/2023	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Hospice Contact	Manager, Clinical Pharmacy		Sun	Jane		9734665044					Jane_Sun@horizonblue.com	3 Penn Plaza	12-Q	Newark	NJ	07105	02/15/2018	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Interoperability Contact	Director, Mandate Implementation		Gregory	Stacey		9734668278					Stacey_Gregory@horizonblue.com	3 Penn Plaza	PP-09	Newark	NJ	07105	01/04/2023	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Marketing Contact	Sales Manager II		Cennamo	Steven	P	9084160480					steven_cennamo@horizonblue.com	3 Penn Plaza East	PP-12F	Newark	NJ	07105	02/09/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Medical Director	Medical Director III, Govt. Programs	Dr.	Johnson	Terry		6095372097					terry_johnson@horizonblue.com	1700 American Blvd	HL-02	Pennington	NJ	08534	07/13/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Medicare Compliance Officer	Director, Reg. Requirements/ MCO	Mr	McGrady	Daniel		7325393680					daniel_mcgrady@horizonblue.com	1700 American Blvd.	HL-03	Pennington	NJ	08534	07/12/2021	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Medicare Coordinator	VP, Reg. Compliance/MCO	Mr.	McGrady	Daniel		6095372317					daniel_mcgrady@horizonblue.com	3 Penn Plaza East	PP-16	Newark	NJ	07105	04/06/2023	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Medicare Part D Opioid Overutilization Contact	Supervisor, Pharmacists		Anderson	Ally		8554570763				8557297221	PartDoverutil@primetherapeutics.com	2900 Ames Crossing Rd	PRIME Therapeutics	Eagan	MN	55121	03/21/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Medication Therapy Management Contact	Manager, MTM and Case/Care Management		Helbling	Matthew		8666862223				8666862220	MTM.Leadership@primetherapeutics.com	PRIME Therapeutics, LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	OffShore Subcontractor Contact	Manager, Medicaid Regulatory Requirements		McGrady	Daniel		6095372617					daniel_mcgrady@horizonblue.com	1700 American Blvd	HL-03P	Pennington	NJ	08534	12/11/2018	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Online Enrollment Center Contact (Back-up)	Supervisor		Johnson	Cheryl		9734666931					cheryl_johnson@horizonblue.com	3 Penn Plaza East, PP-12L		Newark	NJ	07105	12/22/2016	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Online Enrollment Center Contact (Optional)	Team Leader		Johnson	Cheryl		9734666931					Cheryl_Johnson@horizonblue.com	3 Penn Plaza - PP12L		Newark	NJ	07105	04/18/2016	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Online Enrollment Center Contact (Primary)	Manager, Medicare Operations		Santiago-Mercado	Nitza		9734667346					Nitza_Santiago-mercado@horizonblue.com	3 Penn Plaza East, PP-12L		Newark	NJ	07105	09/13/2018	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd	PRIME Therapeutics	Eagan	MN	55121	03/21/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	New York
S5993	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd	Clinical Review	Eagan	MN	55121	03/21/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	New York
S5993	Part D Application Contact	Director, Product Administration		Duddy	Jacqueline		9734665169					jacqueline_duddy@horizonblue.com	3 Penn Plaza	PP-12	Newark	NJ	07105	01/13/2020	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Part D Benefits Contact	Director, Benefits Ops.	Ms.	Gergen	Ashley		6127772506					agergen@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	10/06/2020	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Part D Claims Submission Contact	Functional Business Consultant - Govt. Programs	Mr.	Brooke	Lance		4026862603					LBrooke@primetherapeutics.com	PRIME Therapeutics, LLC	2655 Eagan Woods Drive	Eagan	MN	55122	04/09/2019	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Part D Exceptions Contact	Director, Reg/Audit Response	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Rd		Eagan,	MN	55121	04/15/2021	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	New York
S5993	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55120	03/21/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	New York
S5993	Part D Price File Contact (Back-up)	Bus. Solutions Analyst Lead		Bushman	John		6134599623					John.Bushman@PrimeTherapeutics.com	Prime Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	09/28/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Part D Price File Contact (Optional)	Sr. Price File Analyst		Trudeau	Ashley		6127771338					Ashley.Trudeau@primetherapeutics.com	Prime Therapeutics LLC	2900 Ames Crossing Road	Eagan	MN	55121	09/28/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Part D Price File Contact (Primary)	Manager, Pharmacy Operations	Ms.	Farber	Keri	A	9734668995					Keri_Farber@horizonblue.com	3 Penn Plaza East	PP-12	Newark	NJ	07105	08/20/2020	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Part D Quality Assurance Contact	Director, Clinical Pharm Prg & Op - Medicare		Patrikios	Athena		9734666542					Athena_Patrikios@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	01/03/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Part D Reporting Contact	Medicare Program Analyst		Wilbanks	Dasha	N	9734665601					dasha_wilbanks@horizonblue.com	3 Penn Plaza	16-C	Newark	NJ	07105	04/19/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Patient Safety Contact	Director, Clinical Pharm Prg & Op - Medicare		Patrikios	Athena		9734666542					Athena_Patrikios@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	01/03/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Payment Contact	Manager, Financial Reporting		Griffin	Kevin		6095372464					kevin_griffin@horizonblue.com	1700 American Blvd	HL-03Q	Pennington	NJ	08534	01/12/2018	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Pharmacy Director	Director, Clinical Pharmacy Programs		Patrikios	Athena		9734664654					athena_patrikios@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	01/23/2017	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Pharmacy Network Management Contact	AVP, Network Mgmt	Ms	Conlin	Marci		6127772842					Marci.Conlin@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55121	04/15/2021	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Pharmacy Network Management Contact (Secondary)	Sr. Director Network Client Svcs.	Ms	Hanley	Megan		6127773969				8778236373	Megan.Hanley@primetherapeutics.com	2900 Ames Crossing Rd		Eagan	MN	55122	01/05/2021	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Pharmacy Technical Help Desk Contact	Director, Member Services		Schultz	Bret							bret.schultz@primetherapeutics.com	PRIME Therapeutics	2900 Ames Crossing Road	Eagan	MN	55121	09/28/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active	8003911926				Medicare Prescription Drug Plan		5	New York
S5993	Pharmacy Technical Help Desk Contact (Secondary)	AVP, Customer Exp. & Member Ops.		Bunch	Jonathan							jonathan.bunch@primetherapeutics.com	2655 Eagan Woods Drive		Eagan	MN	55122	09/28/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active	8003911926				Medicare Prescription Drug Plan		5	New York
S5993	Plan Directory Contact for Public Website	Mgr, Exec DOBI Compl & Appls		Mestres	Suze		9734665503					suze_mestres@horizonblue.com	3 Penn Plaza East	PP-14	Newark	NJ	07105	06/15/2020	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Plan to Plan Reconciliation Contact	Pharmacy Business Admin		Cunningham	Theresa		9734667886				9734664665	theresa_cunningham@horizonblue.com	3 Penn Plaza East, PP-12Q		Newark	NJ	07105	10/14/2016	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Processor Contact	Director, PBM Ops.	Ms.	Allie	Cindy		6127776722				6127776706	MedicareClaimResearch@primetherapeutics.com	2900 Ames Crossing Rd	PRIME Therapeutics	Eagan	MN	55121	09/28/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Reconciliation Contact	Director, Actuarial Services		Schindler	Jeffrey	P	7322565319				7322565428	jeffrey_p_schindler@horizonblue.com	1427 Wyckoff Road   WL-03R		Wall	NJ	07727	03/26/2014	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Reconciliation Contact (Secondary)	Manager, Actuarial		Muellers	Barbara		7322565313				7322565428	barbara_muellers@horizonblue.com	1427 Wyckoff Road	WL-03R	Wall	NJ	07727	03/26/2014	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Recovery Audit Contact	Director, Special Investigations	Mr.	Dineen	Timothy		9734668723					timothy_dineen@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	09/10/2014	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Surveillance Contact	VP, Reg. Compliance/MCO	Mr.	McGrady	Daniel		6095372317					daniel_mcgrady@horizonblue.com	3 Penn Plaza East		Newark	NJ	07105	04/06/2023	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	System Contact	Director, Information Security		Andreano	Matthew		9734667330					Matthew_Andreano@horizonblue.com	3 Penn Plaza East, PP-16K		Newark	NJ	07105	05/19/2022	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	Third Party Administrator (TPA) Liaison	Director, Pharmacy (Medicare)		Patrikios	Athena		9734666542					athena_patrikios@horizonblue.com	3 Penn Plaza East	PP-12	Newark	NJ	07105	05/06/2021	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S5993	User Access Contact	Medicare Program Analyst		Wilbanks	Dasha	N	6095372613					Dasha_Wilbanks@horizonblue.com	1700 American Blvd. HL-01	Hopewell Campus	Pennington	NJ	08534	10/30/2017	2023	HORIZON INSURANCE COMPANY	PDP	Horizon Blue Cross Blue Shield of New Jersey	Medicare Prescription Drug Plan		Horizon Mutual Holdings, Inc	126	Yes	Active					Medicare Prescription Drug Plan		5	New York
S6506	Agent/Broker Compensation Data Contact	Medicare Sales Compliance & Audit Oversight Specia	Ms.	Aguayo	Nancy		6029168515					nancy.aguayo@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	05/29/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Automated TrOOP Balance Transfer Contact	Medicare Part D Project Manager		Zlotkus	Steve		8587906250					PartDCAT@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct	San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Backup User Access Contact	Information Security Specialist		O'Brien	Debi		6029167939					Debi.o'brien@azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	12/21/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Best Available Evidence Contact	Medicare Part D Program Manager III		Gaynor	Donna		8587907458					donna.gaynor@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Bid Audit Contact	Staff Vice President, Corp & Medicare Compliance	Mr.	Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N. 23rd Ave.		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Bid Primary Contact	Actuary Assoc		Hart	Jason		2066833581					jason.hart@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	06/25/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	CAP Report Contact for Public Website	Staff Vice President, Corp & Medicare Compliance	Ms.	Moore	Veronica		6028644432				6028644427	veronica.moore@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active	6023367600				Medicare Prescription Drug Plan		5	San Francisco
S6506	CEO - CMS Administrator Contact	President and CEO	Ms.	Kehaly	Pam		6028644610					Pam.Kehaly@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	CEO - Senior Official for Contracting	President and CEO	Ms.	Kehaly	Pam		6028644610					Pam.Kehaly@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Chief Financial Officer	Senior Vice President and CFO	Mr.	El-Tawil	Mark		6028645700					Mark.El-Tawil@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Chief Operating Officer	Chief of Operations	Mr.	Greenberg	Joe		6029166930					paige.rothermel@azblue.com	8220 N. 23rd Ave		Phoenix	AZ	85021	08/25/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Chief Information Officer	Chief Information Officer	Mr.	Pencek	Michael		6029166728					Michael.Pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Chief Information Security Officer	Senior Manager, Information Security Services	Mr.	Pencek	Michael		6029166728					Michael.Pencek@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	CMS Casework Communication Contact	Director, PDP Operations		Bossert	Michele		8587906323					Michele.Bossert@medimpact.com	10181 Scripps Gateway Court		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Complaints Tracking Contact	Director, PDP Operations		Bossert	Michele		8587906323					Michele.Bossert@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Contact for Fraud Investigations	Staff Vice President, Corp & Medicare Compliance	Ms.	Moore	Veronica		6023367600				6028643152	veronica.moore@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Coordination of Benefits Contact	Medicare Part D Program Manager I		Williams	Valencia		8587903028					valencia.williams@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	04/18/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Corporate Mailing						6028644391					Stacy.Weideman@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Analyst/Accountant		Westphal	Robert		4804013833					robert.westphal@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	12/14/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Customer Service Operations Contact	Director, PDP Operations		Langum	Becca		6029166742					rebecca.langum@azblue.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct	San Diego	CA	92131	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	DIR Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	DIR Contact (Secondary)	Mgr- Medicare Finance		Nguyen	Peter		6024272128					peter.nguyen@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	12/14/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Emergency Part D Contact	Director, PDP Operations		Bossert	Michele		8587906323					Michele.Bossert@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct	San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Emergency Part D Contact (Secondary)			Throop	John		5705070070					John.Throop@cognizant.com	TMG Health	25 Lakeview Dr	Jessup	PA	18434	10/18/2018	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Enrollment Contact	Medicare Part D Program Manager III		Gaynor	Donna		8587907458					donna.gaynor@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	EOB Transfer Contact	Director, PDP Operations		Bossert	Michele		8587906323				8583572494	Michele.Bossert@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Financial Audit Contact	Chief Audit Executive	Mrs.	Lohse	Deepa		6028644452					deepa.lohse@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	09/20/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Financial Reporting Contact	Senior Vice President and CFO	Mr.	El-Tawil	Mark		6028645700					Mark.El-Tawil@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Formulary Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Formulary Contact (Secondary)	Mgr Formulary Admin & Maintenance		Nyawablia	Christina		8587906279					FMT@MedImpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	General Contact	VP Pharmacy Management		Napoli	Jim		6028645410					jim.napoli@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Government Relations Contact	VP & General Manager Medicare & FEP	Mr.	Bowers	krista		4803034439					krista.bowers@azblue.com	8220 N. 23rd Ave.		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	HIPAA Privacy Officer	Director of Legal and Privacy Officer		Schrock	Anne		6028644315					anne.schrock@azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	05/14/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	HIPAA Security Officer	Senior Manager, Information Security Services	Mr.	Pencek	Michael		6029166728					Michael.Pencek@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Hospice Contact	Medicare Part D Program Manager III		Meade	Karen		8587906121					karen.meade@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Interoperability Contact	Staff Vice President, Corp & Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Marketing Contact	Marketing Manager		Johnson	Nichelle		6028645215					MedSalesHPMSMaterial@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Medical Director	Corporate Medical Director - Government	Dr.	Raja	Rubina		6028642176					rubina.raja@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Medicare Compliance Officer	Director, Corporate and Medicare Compliance	Mrs.	Moore	Veronica		6023367600				6028643152	veronica.moore@azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	02/11/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Medicare Coordinator	Director, PDP Operations		Bossert	Michele		8587906323					Michele.Bossert@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Medicare Part D Opioid Overutilization Contact	Manager, Medication Management		Hendricks	Jennifer		8582915493					Jennifer.Hendricks@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Medication Therapy Management Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Online Enrollment Center Contact (Back-up)	Service Delivery Manager, Enrollment		Throop	John		5703449237	71056				John.Throop@cognizant.com	TMG Health	25 Lakeview Dr	Jessup	PA	18434	12/27/2019	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Online Enrollment Center Contact (Optional)	Medicare Part D Program Manager III		Gaynor	Donna		8587907458					donna.gaynor@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Online Enrollment Center Contact (Primary)			Barnick	Kristi		5705070066					Kristi.Barnick@cognizant.com	TMG Health	25 Lakeview Dr	Jessup	PA	18434	10/18/2018	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Part D Appeals	Manager, Appeals & G		Martin	Dawn							Dawn.Martin@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct	San Diego	CA	92131	02/22/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active	8587907118				Medicare Prescription Drug Plan		5	San Francisco
S6506	Part D Appeals Contact (Secondary)	Sr Mgr, Government Rx Programs		Weideman	Stacy							stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	02/22/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active	6028644391				Medicare Prescription Drug Plan		5	San Francisco
S6506	Part D Application Contact	VP, Pharmacy Management		Napoli	Jim		6028645410					jim.napoli@azblue.com	8220 N 23rd Ave	Blue Cross Blue Shield of Arizona	Phoenix	AZ	85021	08/23/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Part D Benefits Contact	Director, PDP Operations		Bossert	Michele		8587906323					Michele.Bossert@medimpact.com	10181 Scripps Gateway Ct	1750 Yankee Doodle Road	San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Part D Claims Submission Contact	Director, PDP Operations		Bossert	Michele		8587906323				4803146130	Michele.Bossert@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct	San Diego	CA	92131	12/21/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Part D Exceptions Contact	Director, PDP Operations		Bossert	Michele							Michele.Bossert@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active	8587906323				Medicare Prescription Drug Plan		5	San Francisco
S6506	Part D Price File Contact (Back-up)	Medicare Part D Project Manager		Niemi	Kristin		8587906416					planfindercommunications@medimpact.com	MedImpact	10181 Scripps Gateway Ct	San Diego	CA	92131	06/11/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Part D Price File Contact (Optional)	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Part D Price File Contact (Primary)	Manager, PDP Programs		Gaynor	Donna		8587907458					PDPOpsTeam@MedImpact.com	MedImpact	10181 Scripps Gateway Ct	San Diego	CA	92131	09/14/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Part D Quality Assurance Contact	Director, PDP Operations		Bossert	Michele		8587906323					Michele.Bossert@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Part D Reporting Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Patient Safety Contact	Director Clinical Pharmacy Program	Dr.	Weideman	Stacy		6028644391					stacy.weideman@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Payment Contact	Mgr- Medicare Finance		Nguyen	Peter		6024272128					peter.nguyen@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	12/14/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Pharmacy Director	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Pharmacy Network Management Contact	Dir - Clinical Pharmacy Program		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	12/16/2022	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Pharmacy Network Management Contact (Secondary)	Director Configuration Services	Mr	Dunnum	Shawn		8587907454					Shawndunnum@MedImpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct	San Diego	CA	92131	12/21/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Pharmacy Technical Help Desk Contact	Director, Customer Contact Services		Brewer	Kathy							Customerservice@Medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	01/15/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active	8332293593				Medicare Prescription Drug Plan		5	San Francisco
S6506	Plan Directory Contact for Public Website	Sr Manager Government Rx Programs		Weideman	Stacy		6028644391					stacy.weideman@azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	12/21/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Plan to Plan Reconciliation Contact	Director, Financial Reporting		Acquafredda	Brandy		6028644683					brandy.acquafredda@azblue.com	PO Box 81049		Phoenix	AZ	85069	12/14/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Processor Contact	Director, PDP Operations		Bossert	Michele		8587906323					Michele.Bossert@medimpact.com	MedImpact Healthcare Systems, Inc.	10181 Scripps Gateway Ct	San Diego	CA	92131	12/21/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Reconciliation Contact	Mgr- Medicare Finance		Nguyen	Peter		6024272128					peter.nguyen@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	02/18/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Reconciliation Contact (Secondary)	Director, Financial Reporting		Acquafredda	Brandy		6028644683					brandy.acquafredda@azblue.com	8220 N 23rd Ave		Phoenix	AZ	85021	02/18/2021	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Recovery Audit Contact	Staff Vice President, Corp & Medicare Compliance	Ms.	Moore	Veronica		6023367600				6028643152	veronica.moore@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Surveillance Contact	Staff Vice President, Corp & Medicare Compliance	Ms.	Moore	Veronica		6023367600				6028644427	veronica.moore@azblue.com	Blue Cross and Blue Shield of Arizona	8220 N 23rd Ave	Phoenix	AZ	85021	09/06/2023	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	System Contact	Director, PDP Operations		Bossert	Michele		8587906232					Michele.Bossert@medimpact.com	10181 Scripps Gateway Ct		San Diego	CA	92131	12/30/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	Third Party Administrator (TPA) Liaison	Financial Analyst/Accountant		Westphal	Robert		4804013833					robert.westphal@azblue.com	8220 N 23rd Ave	MS C211	Phoenix	AZ	85021	12/14/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6506	User Access Contact	Director, Corporate and Medicare Compliance		Moore	Veronica		6023367600					veronica.moore@azblue.com	8220 N 23rd Avenue		Phoenix	AZ	85021	12/21/2020	2023	BLUE CROSS AND BLUE SHIELD ARIZONA, INC.	PDP	Blue Cross Blue Shield of Arizona (AZ Blue)	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Arizona	447	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S6875	Agent/Broker Compensation Data Contact	Director Gov. Markets Sales & Marketing Enablement		Curcio	Chris		2676751808					chris.curcio@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	12/22/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Automated TrOOP Balance Transfer Contact	Lead Business Systems Support Admin		Jimenez	Barbara		2676751825					barbara.jimenez@ibx.com	1901 Market Street	16th Floor	Philadelphia	PA	19103	02/27/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Backup User Access Contact	Reg. Performance Mgmt. Analyst II		Smith	Janet		2152419308					janet.smith@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	02/27/2020	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Best Available Evidence Contact	Sr. Business Analyst		Caldwell	Geraldine		2676751809					Geraldine.Caldwell@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/16/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Bid Audit Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Bid Audit Site Contact	Actuarial Associate and Manager		Smith	William	R	2152412812					William.Smith@ibx.com	1901 Market Street	40th Floor	Philadelphia	PA	19103	01/02/2020	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Bid Primary Contact	Actuarial Associate and Manager		Smith	William	R	2152412812					William.Smith@ibx.com	1901 Market Street,	40th Floor	Philadelphia	PA	19103	04/27/2018	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	CAP Report Contact for Public Website	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	CEO - CMS Administrator Contact	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		6094050539					Juan.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/15/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	CEO - Senior Official for Contracting	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		2152414614	24614				Juan.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/15/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Chief Financial Officer	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		2152414614	24614				Juan.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/15/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Chief Operating Officer	EVP, CFO, & Treasurer	Mr.	Lopez	Juan		2152414614	24614				Jaun.Lopez@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	06/15/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Chief Information Officer	EVP and Chief Strategy, Corp. Dev., & Info Officer	Mr.	Vennera	Michael		2152419525					Michael.Vennera@ibx.com	1901 Market Street	45th Floor	Philadelphia	PA	19103	04/24/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Chief Information Security Officer	Chief Information Security Leader	Mr.	Abella	John		2676759865					John.Abella@ibx.com	1901 Market Street	8th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	CMS Casework Communication Contact	Manager, Medicare Operations		Zonies	Melissa		2676751633					Melissa.Zonies@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	01/26/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Complaints Tracking Contact	Manager, Medicare Operations		Zonies	Melissa		2676751633					Melissa.Zonies@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	01/26/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Contact for Fraud Investigations	Director, Financial Investigations		Deery	Christophe	E	2156407302	27302			2152382287	christopher.deery@ibx.com	1901 Market Street	42nd Floor	Philadelphia	PA	19103	12/30/2015	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Coordination of Benefits Contact	Manager, COB/OPL		Hawkins	Veronica		2156407507	27507				Veronica.Hawkins@ibx.com	1901 Market Street	17th Floor	Philadelphia	PA	19103	12/24/2020	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Corporate Mailing						2152412400					mitchell.goldberg@ibx.com	1901 Market Street		Philadelphia	PA	19103	02/27/2012	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Coverage Gap Discount Program (CGDP) Payment Contact	CPA		Murphy	Stacey		2152413522	23522				Stacey.Murphy@ibx.com	1901 Market Street, 36th Floor	Corporate Accounting	Philadelphia	PA	19103	06/28/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Customer Service Operations Contact	Director, Contact Center		Lentz	Michael		2157933262	63262				michael.lentz@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	11/01/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	DIR Contact	Manager Gov. Markets - Commercial Risk Adjustment		Sanders	Sean		2152419420					Sean.Sanders@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	06/29/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	DIR Contact (Secondary)	Lead GM Data Audit & Sub Analyst		Wyher	Geoffrey		2152417265					Geoffrey.Wyher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	06/29/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Emergency Part D Contact	Vice President, Operations		Gold	Nicole		2673193327					Nicole.Gold@ibx.com	1901 Market Street	7th Floor	Philadelphia	PA	19103	02/24/2020	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Emergency Part D Contact (Secondary)	Manager, Regulatory Performance Management		Adams	Desiree		2153279829					Desiree.Adams@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	02/24/2020	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Employer Waiver Contact	SVP Government Markets, Sales & Marketing Leadersh	Ms.	Cruz	Kortney		2152414762					Kortney.Cruz@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	12/16/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Enrollment Contact	Sr. Business Analyst		Caldwell	Geraldine		2676751809					Geraldine.Caldwell@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/16/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	EOB Transfer Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Financial Audit Contact	Director of Audit, Regulatory Audit & Compliance	Ms.	Kovach	Lauren		2152412506				2155674542	Lauren.Kovach@ibx.com	1901 Market Street		Philadelphia	PA	19103	04/19/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Financial Reporting Contact	VP Tax		Robinson	Ken		2152414065					ken.robinson@ibx.com	1901 Market Street	39th Floor	Philadelphia	PA	19103	12/22/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Formulary Contact	Clinical Pharmacist		Urbanek	Michael		2152419003				2152413526	Michael.Urbanek@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	10/01/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Formulary Contact (Secondary)	Clinical Consultant OptumRx		Malhi	Paramveer		6124768526					paramveer.malhi@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	General Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Government Relations Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	HIPAA Privacy Officer	VP Corporate Compliance		Zipfel	Michael		2152414908					michael.zipfel@ibx.com	1901 Market Street		Philadelphia	PA	19013	04/19/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	HIPAA Security Officer	Chief Information Security Leader		Abella	John		2676759865					John.Abella@ibx.com	1901 Market Street	8th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Hospice Contact	Pharmacy Service Process & Governance Director		Erdman	Kathy		2152412654					kathy.erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	06/29/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Interoperability Contact	Director Information Governance		Denyer	James		2152410858					james.denyer@ibx.com	1901 Market Street	20th Floor	Philadelphia	PA	19103	11/29/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Marketing Contact	RPM Analyst II, NJMA Government		Dunn	Devonda		2152413837					devonda.dunn@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/26/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Medical Director	Medical Director		Syropoulos	Heidi	J	2152414511					Heidi.Syropoulos@ibx.com	1901 Market Street		Philadelphia	PA	19103	04/25/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Medicare Compliance Officer	Dir,Corp. Compl, Privacy & Medicare Compl Officer	Mr.	Goldberg	Mitchell		2152419516				2155674542	Mitchell.Goldberg@ibx.com	1901 Market Street	42nd Floor	Philadelphia	PA	19103	04/29/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Medicare Coordinator	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Steffes	Michael		2156407557				2152413526	Michael.Steffes@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	12/22/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Medication Therapy Management Contact	Clinical Pharmacist		Steffes	Michael		2156407557				2152413526	Michael.Steffes@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	12/22/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Online Enrollment Center Contact (Back-up)	Manager, Enrollment Services		Kelley	Josh		2152414829					Joshua.Kelley@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/19/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Online Enrollment Center Contact (Optional)	Regulatory Performance Mgmt. Analyst II		Smith	Janet		2152419308					janet.smith@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	12/19/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Online Enrollment Center Contact (Primary)	Sr. Business Analyst		Caldwell	Geraldine		2676751809					Geraldine.Caldwell@ibx.com	1901 Market Street, 16th Floor		Philadelphia	PA	19103	12/16/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Appeals	Manager, Medicare Member Appeals and Grievances		Tobias	Bobbi							Bobbi.Tobias@ibx.com	1901 Market Street	Mailstop, 12TH floor	Philadelphia	PA	19103	04/19/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active	8887183333				Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Appeals Contact (Secondary)	Supervisor, Medicare Member Appeals and Grievances		Byrd	Kelly							Kelly.Byrd@ibx.com	1901 Market Street	Mailstop, 12TH floor	Philadelphia	PA	19103	06/28/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active	8887183333				Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Application Contact	Senior Product and Capability Mgr.		Keenan	Kate		2152419495					kate.keenan@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	02/28/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Benefits Contact	Pharmacy Services Process & Governace Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Claims Submission Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Exceptions Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy						2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active	8886787015				Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Exceptions Contact (Secondary)	Manager, Prior Authorization		Mourad	Hala							Hala.Mourad@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active	8886787015				Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Price File Contact (Back-up)	Senior Business Analyst, Plan Finder		Moore-Elliott	Shalandria		7637974305					Mshalandria.moore-elliott@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Price File Contact (Optional)	Project Leader		Coursey	Yaminah		2152413955					yarminah.coursey@ibx.com	1900 Market Street	5th Floor	Philadelphia	PA	19103	12/07/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Price File Contact (Primary)	Senior Business Analyst, Plan Finder		Kim	Kevin		7633617996					Kevin.kim@optum.com	11000 Optum Circle		Eden Prairie Eden	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Quality Assurance Contact	Director Quality Management		Donohue	Kathleen		2152413277					Kathleen.Donohue@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/27/2018	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Part D Reporting Contact	Manager, Government Markets Reporting		Pippett	Andrew		2152417416					Andrew.Pippett@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	06/29/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Patient Safety Contact	Clinical Pharmacist		Steffes	Michael		2156407557				2152413526	Michael.Steffes@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	12/22/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Payment Contact	Manager, Risk Analytics		Buscher	Harry		2152410806					harry.buscher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	06/17/2015	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Pharmacy Director	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Pharmacy Network Management Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Pharmacy Network Management Contact (Secondary)	Manager, Retail Network Operations		Perez	Felix	M	7632833503					felix.perez@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Pharmacy Technical Help Desk Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy						2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active	8886787015				Medicare Prescription Drug Plan		5	Philadelphia
S6875	Pharmacy Technical Help Desk Contact (Secondary)	Manager, Pharmacy Help Desk		Summers	Todd							todd.summers@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/17/2023	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active	8886787015				Medicare Prescription Drug Plan		5	Philadelphia
S6875	Plan Directory Contact for Public Website			Service	Customer		8886787009					info@ibxmedicare.com	PO Box 7799		Philadelphia	PA	191017799	04/29/2015	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Plan to Plan Reconciliation Contact	Lead GM Data Audit & Sub Analyst		Wyher	Geoffrey		2156407265				2152412408	geoffrey.wyher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	02/18/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Processor Contact	Pharmacy Services Process & Governance Director		Erdman	Kathy		2152412654				2152413526	Kathy.Erdman@ibx.com	1901 Market Street	29th Floor	Philadelphia	PA	19103	04/16/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Reconciliation Contact	Director Risk Adjustment & Data Delivery		Buscher	Harry		2152410806					harry.buscher@ibx.com	1901 Market Street	37th Floor	Philadelphia	PA	19103	03/27/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Reconciliation Contact (Secondary)	Mgr. Gov. Mkts. - Commercial Risk Analytics		Sanders	Sean		2152419420					Sean.Sanders@ibx.com	1901 Market Street	35th Floor	Philadelphia	PA	19103	01/15/2021	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Recovery Audit Contact	Director of Regulatory Performance Management	Ms.	Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Surveillance Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	System Contact	Director  Solution Delivery		Basvapatri	Satish	A	2156407504					Satish.Basvaptri@ibx.com	1901 Market Street	8th Floor	Philadelphia	PA	19103	06/27/2017	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	Third Party Administrator (TPA) Liaison	CPA		Murphy	Stacey		2152413522	23522				Stacey.Murphy@ibx.com	1901 Market Street, 36th Floor	Corporate Accounting	Philadelphia	PA	19103	06/28/2022	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6875	User Access Contact	Director of Regulatory Performance Management		Wyka	Tara		2152413648					Tara.Wyka@ibx.com	1901 Market Street	22nd Floor	Philadelphia	PA	19103	06/25/2019	2023	QCC INSURANCE COMPANY	PDP	Independence Blue Cross	Medicare Prescription Drug Plan		Independence Health Group, Inc.	609	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S6946	Agent/Broker Compensation Data Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/07/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Automated TrOOP Balance Transfer Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Backup User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Best Available Evidence Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Bid Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Bid Audit Site Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	04/27/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Bid Primary Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	CAP Report Contact for Public Website	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active	8773841241				Medicare Prescription Drug Plan		5	Chicago
S6946	CEO - CMS Administrator Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	CEO - Senior Official for Contracting	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	08/25/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Chief Financial Officer	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Chief Operating Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Chief Information Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Chief Information Security Officer	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	CMMI Model Point of Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	CMS Casework Communication Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Complaints Tracking Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Contact for Fraud Investigations	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Coordination of Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Corporate Mailing						8476968500					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway		Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Coverage Gap Discount Program (CGDP) Payment Contact	Finance Director, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	Thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	10/26/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Customer Service Operations Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	DIR Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	DIR Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Emergency Part D Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					bryan.hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Emergency Part D Contact (Secondary)	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Enrollment Contact	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	EOB Transfer Contact	Claims Manager	Mr.	Salgado	Miguel		8476968578				8008861082	Miguel.Salgado@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	10/04/2021	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Financial Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Financial Reporting Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Formulary Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3308886015	Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Formulary Contact (Secondary)	Pharmacy Director		Lopez	Eduardo		7542085867					elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	12/07/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	General Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Government Relations Contact	Chief Executive Officer and President	Mr.	Carlos	Art		8476968510					arthur.carlos@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	08/25/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	HIPAA Privacy Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	HIPAA Security Officer	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539				8555158166	Eric.Annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Hospice Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Interoperability Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Marketing Contact	VP of Marketing	Ms.	Branco	Margaret		7187957495					margaret.branco@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/06/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Medical Director	Medical Director		Rower	Jeremy		5039277667				9528377117	Jeremy.Rower@evernorth.com	6625 West 78th  Street		Bloomington	MN	55439	03/30/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Medicare Compliance Officer	Vice President, Compliance	Ms.	Cornish	Sameria		8432761153					sameria.cornish@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	06/14/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Medicare Coordinator	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Medicare Part D Opioid Overutilization Contact	Director, Clinical & Trend Solutions		Muralidharan	Adrienne		3143131932					amualidharan@express-scripts.com	One Express Way		St. Louis	MO	63121	10/11/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Medication Therapy Management Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867				3304058084	Elopez@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	OffShore Subcontractor Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Online Enrollment Center Contact (Primary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica		7542085865					Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 302	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Part D Appeals	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy	Suite 450	Dublin	OH	43017	07/25/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active	8003443405	733326			Medicare Prescription Drug Plan		5	Chicago
S6946	Part D Appeals Contact (Secondary)	Senior Director, Enrollment & Member Services	Ms.	Velez	Jessica							Jvelez@clearspringhealthcare.com	3601 SW 160th Avenue		Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active	7542085865				Medicare Prescription Drug Plan		5	Chicago
S6946	Part D Application Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Part D Benefits Contact	Senior Vice President, Operations	Mr.	Hebert	Bryan		8132856735					Bryan.Hebert@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Part D Claims Submission Contact	Director -Regulated Markets Medicare Solutions		Dovico	Rosario		9145896300					Rosario_dovico@express-scripts.com	One Express Way		St. Louis	MO	63121	10/11/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Part D Exceptions Contact	Sr. Pharmacy Manager		Schumm	Brian							Brian_Schumm@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	07/25/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active	8003443405	733326			Medicare Prescription Drug Plan		5	Chicago
S6946	Part D Price File Contact (Back-up)	Manager, Regulated  Markets Product		Williams	Stephanie		5135091549					medicarewebsitefiles@express-scripts.com	4865 Dixie Hwy		Fairfield	OH	45014	07/25/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Part D Price File Contact (Optional)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Part D Price File Contact (Primary)	Sr. Manager, regulated markets		Dolfi	Amanda		6147349264					medicarewebsitefiles@express-scripts.com	5151 BlazerPkwy		Dublin	OH	43017	04/10/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Part D Quality Assurance Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Part D Reporting Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Patient Safety Contact	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Payment Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Pharmacy Director	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Pharmacy Network Management Contact	Network Account Director,Retail Strategy		Kelly	Heather		3146921866				8003579578	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	07/25/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Pharmacy Network Management Contact (Secondary)	Vice President, Pharmacy	Mr.	Lopez	Eduardo		7542085867					Elopez@clearspringhealthcare.com	3601 SW 160th Avenue	Suite 450	Miramar	FL	33027	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Pharmacy Technical Help Desk Contact	Director, Customer  Service		Monroe	LaTasha							LaTasha_Monroe@express-scripts.com	13051 N. Telecom Pkwy		Temple Terrace	FL	33637	07/25/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	Chicago
S6946	Plan Directory Contact for Public Website	Vice President, Provider Operations	Ms.	Cuevas	Elizabeth		7542085880					Elizabeth.Cuevas@clearspringhealthcare.com	250 South Northwest Highway Suite 302	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Plan to Plan Reconciliation Contact	Senior Accountant	Ms.	Wrenn	Alisa		2249855588					Alisa.Wrenn@Clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	08/25/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Processor Contact	Sr. Director,  Government Programs,  Medicare		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St. Louis	MO	63121	07/25/2023	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Reconciliation Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Recovery Audit Contact	Chief Financial Officer	Mr.	Littman	Harvey		2249855593				8476923225	harvey.littman@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Surveillance Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	System Contact	Vice President, Infrastructure & Development	Mr.	Annafi	Eric		8476968539					eric.annafi@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	Third Party Administrator (TPA) Liaison	Finance Director, Part D Products	Mr.	Wenner	Thomas		7176230783				8476923225	thomas.wenner@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	10/26/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S6946	User Access Contact	Director, Compliance	Ms.	Wilcox-Lange	Tracie		8476968503					tracie.lange@clearspringhealthcare.com	250 South Northwest Highway	Suite 302	Park Ridge	IL	60068	03/16/2022	2023	CLEAR SPRING HEALTH INSURANCE COMPANY	PDP	Clear Spring Health	Medicare Prescription Drug Plan		Group 1001	689	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S7126	Agent/Broker Compensation Data Contact	National Sales Director		Petri	Sandy		4023515086					Sandy.Pitre@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	01/10/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Automated TrOOP Balance Transfer Contact	Senior Project Manager		Rush	Jamie		3143541103					ESITroopTransfer@express-scripts.com	One Express Way		St. Louis	MO	63121	04/14/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Backup User Access Contact	Director		Curtis	Christine		4023514308					christine.curtis@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Best Available Evidence Contact	Director		Simon	Blake		2146207186					blake_simon@express-scripts.com	1707 Market Place Blvd		Irving	TX	75063	10/19/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Bid Audit Contact	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Bid Audit Site Contact	Director		Curtis	Christine		4023514308					christine.curtis@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Bid Primary Contact	Senior Actuary		Herink	Allie		4023513708					Allie.Herink@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	06/27/2023	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	CAP Report Contact for Public Website	Director		Curtis	Christine		4023514308					christine.curtis@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	CEO - CMS Administrator Contact	President & CEO	Mr.	Buechler	Bradley		4023514962					bradley.buechler@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	12/23/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	CEO - Senior Official for Contracting	President	Mr.	Buechler	Bradley		4023514962					Bradley.Buechler@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	10/01/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Chief Financial Officer	EVP, CFO & Treasurer	Mr.	Hrabchak	Rick		4023502503					richard.hrabchak@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	08/29/2019	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Chief Operating Officer	Senior Vice President	Mr.	Ganow	Jeff		4023513838					Jeff.ganow@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	09/23/2021	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Chief Information Officer	Executive Vice President, CIO	Mr.	Lechtenberger	Mike		4023518345					mike.lechtenberger@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Chief Information Security Officer	Vice President, CISO	Mr.	Palimenio	Al		4023516144					al.palimenio@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	CMS Casework Communication Contact	Director		Simon	Blake		2146207186					blake_simon@express-scripts.com	1707 Market Place Blvd. Suite 390		Irving	TX	75063	02/08/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Complaints Tracking Contact	Director		Simon	Blake		2146207186					blake_simon@express-scripts.com	1707 Market Place Blvd. Suite 390		Irving	TX	75063	02/08/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Contact for Fraud Investigations	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Coordination of Benefits Contact	Director		Tierney	Dan		2012695234					daniel_tierney@express-scripts.com	100 Parsons Pond Dr		Franklin Lakes	NJ	07417	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Corporate Mailing						4023513965					rick.elliott@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Finance		Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	08/08/2019	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Customer Service Operations Contact	Manager		Davidson	Regina		7722362766					Regina_Davidson@express-scripts.com	10045 South Federal Highway		Port St. Lucie	FL	34952	04/14/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	DIR Contact	Compliance Consultant		Sims	Rob		4023511516					rob.simsjr@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	07/30/2021	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	DIR Contact (Secondary)	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Emergency Part D Contact	National Director, Managed Care Pharmacy		Anderson	Michelle		4023513616					michelle.anderson@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	03/23/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Emergency Part D Contact (Secondary)	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Enrollment Contact	Director		Andrejew	Anna		2012695686				2012697093	anna_andrejew@express-scripts.com	100 Parsons Pond		Franklin Lakes	NJ	07417	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	EOB Transfer Contact	National Director, Managed Care Pharmacy		Anderson	Michelle		4023513616				4023511516	michelle.anderson@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	03/23/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Financial Audit Contact	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Financial Reporting Contact	Finance Director		Hawkins	Amanda		4023512402					amanda.hawkins@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	07/30/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Formulary Contact	Pharmacy Technical Analyst		Garcia	Shayna		4023518115					shayna.garcia@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	01/25/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Formulary Contact (Secondary)	National Director, Managed Care Pharmacy		Anderson	Michelle		4023513616					michelle.anderson@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	03/23/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	General Contact	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Government Relations Contact	Vice President		Nolan	Jim		4023512944					jim.nolan@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	HIPAA Privacy Officer	Vice President, CISO	Mr.	Palimenio	Al		4023516144					al.palimenio@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	HIPAA Security Officer	Vice President, CISO	Mr.	Palimenio	Al		4023516144					al.palimenio@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Hospice Contact	Director		Simon	Blake		2146207186					blake_simon@express-scripts.com	1707 Market Place Blvd. Suite 390		Irving	TX	75063	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Interoperability Contact	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Marketing Contact	Director		Grace	Annie		4023515674					ann.grace@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Medical Director	Vice President Chief Medical Officer		Pawar	Manoj		4023511776					manoj.pawar@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	05/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Medicare Compliance Officer	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Medicare Coordinator	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Medicare Part D Opioid Overutilization Contact	Clinical Operations Pharmacist		Chachas	Cynthia		4023515027					cynthia.chachas@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	01/25/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Medication Therapy Management Contact	Director		Aarrestad	Kay		8137507389					kaya@aspenrxhealth.com	401 E Jackson Street	Suite 3300	Tampa	FL	33602	05/23/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	OffShore Subcontractor Contact	Director	Mrs.	Curtis	Christine		4023514308					christine.curtis@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Online Enrollment Center Contact (Back-up)	Director, Business Operations		Andrejew	Anna		2012695686				2012697093	anna_andrejew@express-scripts.com	100 Parsons Pond		Franklin Lakes	NJ	07417	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Online Enrollment Center Contact (Primary)	Director		Simon	Blake		2146207186					blake_simon@express-scripts.com	1707 Market Place Blvd. Suite 390		Irving	TX	75063	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Part D Appeals	Pharmacy		Beard	Pat						8555858246	pat_beard@express-scripts.com	8455 University Place		St Louis	MO	63121	01/04/2021	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active	2012692208				Medicare Prescription Drug Plan		5	Kansas City
S7126	Part D Appeals Contact (Secondary)	Pharmacy		Maze	Megan						8555858246	MLMaze@express-scripts.com	8455 University Place		St Louis	MO	63121	01/04/2021	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active	9375804173				Medicare Prescription Drug Plan		5	Kansas City
S7126	Part D Application Contact	Senior Actuary		Herink	Allie		4023513708					Allie.Herink@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	06/27/2023	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Part D Benefits Contact	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Part D Claims Submission Contact	Director		Dovico	Rosario		2012696398					jbetherton@express-scripts.com	100 Parsons Pond Drive		Franklin Lakes	NJ	07417	04/14/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Part D Exceptions Contact	Sr. Pharmacy Manager		Schumm	Brian							brian_schumm@express-scripts.com	5151 Blazer Parkway		Dublin	OH	43017	04/14/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active	6143363326				Medicare Prescription Drug Plan		5	Kansas City
S7126	Part D Price File Contact (Back-up)	Sr. Manager, Government Programs		Dolfi	Amanda		6147613606					medicarewebsitefiles@express-scripts.com	5151 Blazer Pkwy		Dublin	OH	43017	07/30/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Part D Price File Contact (Optional)	National Director, Managed Care Pharmacy		Anderson	Michelle		4023513616					Michelle.Anderson@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	03/23/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Part D Price File Contact (Primary)	Director		Westrum	Josh		4807363132	433132				medicarewebsitefiles@express-scripts.com	7909 South Hardy Drive #106		Tempe	AZ	85284	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Part D Quality Assurance Contact	Director	Mrs.	Curtis	Christine		4023514308					christine.curtis@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Part D Reporting Contact	Manager	Mrs	Hageman	Nichole		3146845034				4023511516	nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	10/19/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Patient Safety Contact	Senior Director		Turner	Kelle		3146846004					KTurner@express-scripts.com	One Express Way		St. Louis	MO	63121	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Payment Contact	Finance Director		Hawkins	Amanda		4023512402					amanda.hawkins@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	07/30/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Pharmacy Director	National Director, Managed Care Pharmacy		Anderson	Michelle		4023513616					michelle.anderson@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	03/23/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Pharmacy Network Management Contact	Network Account Director		Kelly	Heather		3146921866				8773875800	hakelly@express-scripts.com	One Express Way		St. Louis	MO	63121	04/14/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Pharmacy Technical Help Desk Contact	Director of Operations, Contact Center		Liu	Ian							iliu@express-scripts.com	6625 West 78th Street		Minneapolis	MN	55439	04/14/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	Kansas City
S7126	Plan Directory Contact for Public Website			Service	Customer		8558646797					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	06/27/2023	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Plan to Plan Reconciliation Contact	Manager, Health Plan Finance	Ms.	Williams	Kliopetra		3142093068					klwilliams@lumeris.com	13900 Riverport Drive		Maryland Heights	MO	63043	01/03/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Processor Contact	Senior Director		Gibson	Sharon		8052361175					SGGibson@express-scripts.com	One Express Way		St Louis	MO	63121	02/09/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Reconciliation Contact	Finance Director		Hawkins	Amanda		4023512402					amanda.hawkins@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	07/30/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Reconciliation Contact (Secondary)	VP Actuary		Ghiselli	Carl		4023518960					carl.ghiselli@mutualofomaha.com	3301 Mutual of Omaha Plaza		Omaha	NE	68175	07/30/2020	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Recovery Audit Contact	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Surveillance Contact	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	System Contact	Director of Medicare Compliance	Ms.	Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/10/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	Third Party Administrator (TPA) Liaison	Compliance Officer		Hageman	Nichole		4023511516					nichole.hageman@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	06/30/2022	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7126	User Access Contact	Manager		Curry	Helen		4023512367					helen.curry@mutualofomaha.com	3300 Mutual of Omaha Plaza		Omaha	NE	68175	02/13/2018	2023	OMAHA HEALTH INSURANCE COMPANY	PDP	Mutual of Omaha Rx	Medicare Prescription Drug Plan		Mutual of Omaha Insurance Company	699	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S7694	Agent/Broker Compensation Data Contact	Senior Medicare Compliance Officer	Mr.	O'Donnell	Dan		9167599401					dodonnell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	03/03/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Automated TrOOP Balance Transfer Contact	Manager, Client Data Management	Mr.	Vandevander	Richard		3304866339					rivandevander@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	03/03/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Backup User Access Contact	Senior Compliance Analyst		Palumbo	Gina		4402315118					gevans@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Best Available Evidence Contact	Manager, Client Data Management	Mr.	Vandevander	Richard		3304866339					rivandevander@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	03/03/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Bid Audit Contact	SVP, Government Programs	Mr.	Goodson	David		7202529000					dgoodson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/14/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Bid Primary Contact	SVP, Government Programs	Mr.	Goodson	David		7202529000					dgoodson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/14/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	CAP Report Contact for Public Website	Senior Medicare Compliance Officer	Mr.	O'Donnell	Dan		9167599401					dodonnell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	CEO - CMS Administrator Contact	CEO	Mr.	DuPaul	Chris		6175718138					cdupaul@elixirsolutions.com	30 Hunter Lane		Camp Hill	PA	17011	01/18/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	CEO - Senior Official for Contracting	CEO	Mr.	DuPaul	Chris		6175718138					cdupaul@elixirsolutions.com	30 Hunter Lane		Camp Hill	PA	17011	01/18/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Chief Financial Officer	CFO	Mr.	Greenblatt	Rand		8562303242					rgreenblatt@elixirsolutions.com	30 Hunter Lane		Camp Hill	PA	17011	09/28/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Chief Operating Officer	COO, Elixir	Mr.	DuPaul	Chris		6175718138					cdupaul@elixirsolutions.com	30 Hunter Lane		Camp Hill	PA	17011	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Chief Information Officer	EVP, Chief Information Officer	Mr.	Mennen	Justin		7172156991					Justin.L.Mennen@riteaid.com	30 Hunter Lane		Camp Hill	PA	17011	08/25/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Chief Information Security Officer	VP, Chief Information Security Officer	Mr.	Thatavarthy	Ravi		5088931738					Ravi.Thatavarthy@riteaid.com	30 Hunter Lane		Camp Hill	PA	17011	06/15/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	CMS Casework Communication Contact	Manager, Client Data Management	Mr.	Vandevander	Richard		3304866339					rivandevander@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	04/28/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Complaints Tracking Contact	Manager, Client Data Management	Mr.	Vandevander	Richard		3304866339					rivandevander@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	04/28/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Contact for Fraud Investigations	SVP, Government Programs	Mr.	Goodson	David		7202529000					dgoodson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/14/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Coordination of Benefits Contact	SVP, Government Programs	Mr.	Goodson	David		7202529000					dgoodson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/14/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Corporate Mailing						7202529000					dgoodson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Coverage Gap Discount Program (CGDP) Payment Contact	Manager, Group Billing		Mascia	Angelo	A	3304864845					amascia@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Customer Service Operations Contact	SVP, Government Programs	Mr.	Goodson	David		7202529000					dgoodson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/14/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	DIR Contact	Rebate Analyst		Bentley	Rebecca		3308886988					rbentley@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/09/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	DIR Contact (Secondary)	Analyst, Government Programs	Mr.	Houchens	Logan		3308886095					lhouchens@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Emergency Part D Contact	Pharmacy Manager, PBM Oversight		Surface	Kristin		9547672965					ksurface@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/05/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Emergency Part D Contact (Secondary)	Senior Medicare Compliance Officer	Mr.	O'Donnell	Dan		9167599401					dodonnell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Enrollment Contact	Manager, Client Data Management	Mr.	Vandevander	Richard		3304866339					rivandevander@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	03/03/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	EOB Transfer Contact	Manager, Client Data Management	Mr.	Vandevander	Richard		3304866339				3304058081	rivandevander@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	03/03/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Financial Audit Contact	Manager, Government Programs Ops	Mrs.	Glover	Olivia		9547672924					odurant@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/05/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Financial Reporting Contact	Director, Accounting		Sullivan	Chad		4402315118					csullivan@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/18/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Formulary Contact	Director of Formulary Operations	Mr.	Rossi	David		3304866311					drossi@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	03/03/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Formulary Contact (Secondary)	Director of Formulary Operations		Rossi	David		3304866311					drossi@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	01/12/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	General Contact	Senior Medicare Compliance Officer	Mr.	O'Donnell	Dan		9167599401					dodonnell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Government Relations Contact	Senior Medicare Compliance Officer	Mr.	O'Donnell	Dan		9167599401					dodonnell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	HIPAA Privacy Officer	Chief Privacy Officer	Mr.	Palmer	Andrew		7177308272					apalmer@riteaid.com	30 Hunter Lane		Camp Hill	PA	17011	02/14/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	HIPAA Security Officer	VP, Chief Information Security Officer	Mr.	Thatavarthy	Ravi		5088931738					Ravi.Thatavarthy@riteaid.com	30 Hunter Lane		Camp Hill	PA	17011	03/09/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Hospice Contact	Pharmacy Manager, PBM Oversight		Surface	Kristin		9547672965					ksurface@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/09/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Interoperability Contact	Senior Manager		Lantz	Matthew		3304985809					mlantz@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/05/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Marketing Contact	Senior Compliance Analyst		Palumbo	Gina		4402315118					gevans@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	04/28/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Medical Director	Medical Director	Dr	Watson	Dennis		9169412882					dwatson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Medicare Compliance Officer	Senior Medicare Compliance Officer	Mr.	O'Donnell	Dan		9167599401					dodonnell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Medicare Coordinator			Service	Customer		8662502005					customerservicewebmailgroup@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Medicare Part D Opioid Overutilization Contact	VP, Clinical Innovation & Integrity	Mr.	Hosford	Mathew		3304864874					mhosford@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/09/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Medication Therapy Management Contact	VP, Clinical Innovation & Integrity	Mr.	Hosford	Mathew		3304866457					mhosford@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	03/03/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Online Enrollment Center Contact (Back-up)	Supervisor, Client Data Managment	Mr.	Prunty	Ethan		3304866956					eprunty@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Online Enrollment Center Contact (Optional)	Manager Medicare Enrollment		Desai	Mahadev		4699951443					mdesai@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Online Enrollment Center Contact (Primary)	Manager, Client Data Management	Mr.	Vandevander	Richard		3304866339					rivandevander@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Appeals	Supervisor Clinical Operations		McCauley	Angie						3304866402	Appeals@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	03/03/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active	3303449574				Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Appeals Contact (Secondary)	Pharmacy Manager PBM Oversight		Surface	Kristin						3304058081	ksurface@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active	9547672965				Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Application Contact	SVP, Government Programs	Mr.	Goodson	David		7202529000					dgoodson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/14/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Benefits Contact	SVP, Government Programs	Mr.	Goodson	David		7202529000					dgoodson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/14/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Claims Submission Contact	Account Manager		Gudel	Ilona		3308886183					igudel@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Exceptions Contact	Supervisor, CDA		Larkins	Casey							clarkins@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/05/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active	3302859685				Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Exceptions Contact (Secondary)	AVP of Clinical Operations		Lavignette	Amanda						3304864801	alavignette@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active	3308886079				Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Price File Contact (Back-up)	Financial Analyst 3		Wentz	Chris		2169905242					mpf@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/16/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Price File Contact (Optional)	Sr. Manager, Fin Rprt & Analyst	Mr.	Campbell	Timothy		9547672633					tcampbell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Price File Contact (Primary)	Financial Analyst		Kessler	Cameron		2342123100					ckessler@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Quality Assurance Contact	Senior Medicare Compliance Officer	Mr.	O'Donnell	Dan		9167599401					dodonnell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	03/03/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Part D Reporting Contact	Financial Analyst		Kessler	Cameron		2342123100					ckessler@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/09/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Patient Safety Contact	VP, Clinical Innovation & Integrity	Mr.	Hosford	Mathew		3304864874					mhosford@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	03/03/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Payment Contact	Director, Accounting		Sullivan	Chad		4402315118					csullivan@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/18/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Personal Health Record Contact	SVP, Government Programs	Mr.	Goodson	David		7202529000					dgoodson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/14/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Pharmacy Director	SVP, Government Programs	Mr.	Goodson	David		7202529000					dgoodson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/14/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Pharmacy Network Management Contact	AVP Provider Relations and Network Development	Mr.	Dyer	Tim		3304864812					tdyer@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Pharmacy Network Management Contact (Secondary)	AVP Network Development and Operations		Karfeld	Amy		3304864883					akarfeld@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Pharmacy Technical Help Desk Contact	VP of Operations		Conn	Todd						3304868081	tconn@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active	8662502005				Medicare Prescription Drug Plan		5	Dallas
S7694	Pharmacy Technical Help Desk Contact (Secondary)	Senior Director Customer Care		Jernigan	Gia						3304868081	gjernigan@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active	3308886225				Medicare Prescription Drug Plan		5	Dallas
S7694	PHR Beneficiary Contact																	02/17/2021	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan	Elixir Insurance Company	Rite Aid Corporation	627	Yes	Active	8662502005				Medicare Prescription Drug Plan		5	Dallas
S7694	Plan Directory Contact for Public Website			Service	Customer		8662502005					customerservicewebmailgroup@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Plan to Plan Reconciliation Contact	Manager, Group Billing		Mascia	Angelo	A	3304864845				3304864898	p2prec@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Processor Contact	SVP, Government Programs	Mr.	Goodson	David		7202529000					dgoodson@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/14/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Reconciliation Contact	Director, Accounting		Sullivan	Chad		4402315118					csullivan@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	08/18/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Recovery Audit Contact	Pharmacy Manager, PBM Oversight	Mrs.	Surface	Kristin		9547672965					ksurface@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	06/05/2023	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Surveillance Contact	Senior Medicare Compliance Officer	Mr.	O'Donnell	Dan		9167599401					dodonnell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	System Contact	Manager, Client Data Management	Mr.	Vandevander	Richard		3304866339					rivandevander@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	Third Party Administrator (TPA) Liaison	Manager, Group Billing		Mascia	Angelo	A	3304864845					amascia@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S7694	User Access Contact	Senior Medicare Compliance Officer	Mr.	O'Donnell	Dan		9167599401					dodonnell@elixirsolutions.com	7835 Freedom Avenue NW		North Canton	OH	44720	11/23/2022	2023	ELIXIR INSURANCE COMPANY	PDP	Elixir Insurance	Medicare Prescription Drug Plan		Rite Aid Corporation	627	Yes	Active					Medicare Prescription Drug Plan		5	Dallas
S8067	Agent/Broker Compensation Data Contact	Vice President, Government Sales	Mr.	Biesecker	Gary		7172520587					Gregory.Biesecker@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Automated TrOOP Balance Transfer Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Backup User Access Contact	Medicare Compliance Analyst	Ms.	Tremmel	Selina		7175387981					selina.tremmel@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Best Available Evidence Contact	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465811	nicole.peterson@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Bid Audit Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Bid Audit Site Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Bid Primary Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	CAP Report Contact for Public Website	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	CEO - CMS Administrator Contact	President and CEO	Mr.	Shamash	Todd		7175417747				7176518913	todd.shamash@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	CEO - Senior Official for Contracting	President and CEO	Mr.	Shamash	Todd		7175417747				7176518913	todd.shamash@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Chief Financial Officer	Chief Financial Officer	Mr.	Woodard	Ralph		7175417181					ralph.woodard@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Chief Operating Officer	EVP & Chief Operating Officer	Mr.	Heisey	Glenn		7175417288				7176518497	glenn.heisey@capbluecross.com	2500 Elmenrton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Chief Information Officer	Chief Information Officer	Mr.	Frank	Scott		7175417341					scott.frank@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Chief Information Security Officer	Chief Information Security Officer	Mr.	Burd	Aaron		7175416939					aaron.burd@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	CMS Casework Communication Contact		Ms.	Drawbaugh	Cindy		7175416257					cindy.drawbaugh@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Complaints Tracking Contact		Ms.	Drawbaugh	Cindy		7175416257					cindy.drawbaugh@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Contact for Fraud Investigations		Ms.	Livelsberger	Jennifer		7177753756					Jennifer.Livelsberger@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Coordination of Benefits Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Corporate Mailing						7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	171779799	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Coverage Gap Discount Program (CGDP) Payment Contact		Ms.	Beauduy	Tamara		7175416946					Tamara.Beauduy@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Customer Service Operations Contact	Director Medicare Operations	Mr.	Koch	Jonathan		7178292114				7176518873	jonathan.koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	DIR Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	DIR Contact (Secondary)	Actuarial Business Consultant, Actuarial and Under	Mr.	Shafer	Brian		7175416263				7176514214	Brian.Shafer@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Emergency Part D Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7175864604				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Emergency Part D Contact (Secondary)	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Employer Waiver Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Enrollment Contact	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465897	nicole.peterson@capbluecross.com	2500 Elmerton Ave.		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	EOB Transfer Contact	Director Medicare Operations	Mr.	Koch	Jonathan		7178292114				7176518873	Jonathan.Koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Financial Audit Contact	Senior Compliance Specialist	Ms.	Leonard	Kellie		7175417117					kellie.leonard@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	09/20/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Financial Reporting Contact	VP Finance and Controller	Mr.	Hershberger	Josh		7173710410					Josh.Hershberger@CapBlueCross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	09/13/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Formulary Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Formulary Contact (Secondary)	Supervisor, Formulary Operations		Negash	Martha		6127772773					martha.negash@primetherapeutics.com	1305 Corporate Center Drive		Eagan	MN	55121	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	General Contact	Sr. VP Government Programs	Mr.	Fernandez	Frank		7175416062					Frank.Fernandez@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Government Relations Contact	Sr. VP & General Counsel	Mr.	Hopkins	Joel		7175416358				7176514445	Joel.Hopkins@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	HIPAA Privacy Officer	Privacy & Data Protection Officer	Mr.	Stambaugh	Alan		7175417077					Alan.Stambaugh@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	171779799	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	HIPAA Security Officer	Chief Information Security Officer	Mr.	Burd	Aaron		7175416939					aaron.burd@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Hospice Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Interoperability Contact	Senior Director, Information Technology		Blackwell	William		7175417246					William.Blackwell@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Marketing Contact	Director, Marketing	Mr.	Londre	Michael		7175416467				7175402499	Michael.Londre@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Medical Director	Chief Medical Officer & Sr. VP Clinical Solutions	Dr.	Chambers	Jennifer	A	7177038579				7176518665	jennifer.chambers@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Medicare Compliance Officer	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Medicare Coordinator			Wilbert	Tiffany		7175417606					tiffany.wilbert@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	08/10/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Medicare Part D Opioid Overutilization Contact	Senior Director, Medicare Pharmacy Operations and	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue	P.O. Box 779846	Harrisburg	PA	17177	08/10/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Medication Therapy Management Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	OffShore Subcontractor Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Online Enrollment Center Contact (Back-up)	Director Medicare Operations	Mr.	Koch	Jonathan		7178292114				7176518873	Jonathan.Koch@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Online Enrollment Center Contact (Primary)	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465811	nicole.peterson@capbluecross.com	2500 Elmerton Ave.		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Appeals	Regulatory Director	Ms.	Davis	Megan						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Appeals Contact (Secondary)	Regulatory Pharmacist		Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55121	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Application Contact	Dir Medicare Product Development	Ms.	Koch	Connie		7175416768					Connie.Koch@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Benefits Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Claims Submission Contact	Manager, Medicare Pharmacy Operations	Ms,	Cook	Tammy	L	7177038749				7173466836	tammy.cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Exceptions Contact	Senior Director, Medicare Pharmacy Operations	Ms	Leedock	Melissa							Melissa.Leedock@capbluecross.com	2500 Elmerton Ave		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active	8669874213				Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Exceptions Contact (Secondary)	Regulatory Pharmacist	Ms	Emerson	Kimberly						8006936703	clinicalreviewmeddaudit@primetherapeutics.com	2900 Ames Crossing Road		Eagan	MN	55120	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active	8006936651				Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Price File Contact (Back-up)	QA Analyst Sr		Nguyen	Kim		6127776931					kim.nguyen@PrimeTherapeutics.com	Prime Therapeutics, LLC	1305 Corporate Center Drive	Eagan	MN	55121	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Price File Contact (Optional)	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Price File Contact (Primary)	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Quality Assurance Contact	Sr. Director Pharmacy and Clinical Svcs	Ms.	Leedock	Melissa		7175416934				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Part D Reporting Contact		Ms.	Leonard	Kellie		7175417117					Kellie.Leonard@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Patient Safety Contact	Senior Director, Medicare Pharmacy Operations and	Ms.	Leedock	Melissa		7177541693				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Payment Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Pharmacy Director	Senior Director, Medicare Pharmacy Operations and	Ms.	Leedock	Melissa		7177541693				7176514850	Melissa.Leedock@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Pharmacy Network Management Contact	Manager Pharmacy Benefits Operations	Ms.	Cook	Tammy		7177038749				7173466836	Tammy.Cook@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Pharmacy Network Management Contact (Secondary)			Hanley	Megan		6127773969				8778236373	megan.hanley@primetherapeutics.com	1305 Corporate Center Drive		Eagan	MN	55121	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Pharmacy Technical Help Desk Contact	Director, Member Services	Ms	Pretlow	Jennifer							jennifer.pretlow@primetherapeutics.com	Prime Therapeutics LLC 2655 Eagan Woods Drive		Eagan	MN	55122	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active	8888780151				Medicare Prescription Drug Plan		5	Philadelphia
S8067	Plan Directory Contact for Public Website	Medicare Compliance Officer	Ms.	Yu	Gloria		8666882242					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Plan to Plan Reconciliation Contact	Accountant I	Ms.	Beauduy	Tamara		7175416946					FinanceP2P-CASH@CapBlueCross.com	2500 Elmerton Avenue	Mail Drop 3237	Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Processor Contact	Manager, PBM Operations	Ms.	Hanson	Michelle		6127776755					MedicareClaimResearch@primetherapeutics.com	Prime Therapeutics LLC 2900 Ames Crossing Road		Eagan	MN	55121	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Reconciliation Contact	Director, Actuarial Services	Mr.	Baksi	David		7175417317					david.baksi@capbluecross.com	2500 Elmerton Ave.		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Reconciliation Contact (Secondary)	Actuarial Business Consultant	Mr.	Shafer	Brian		7175416263					Brian.Shafer@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Recovery Audit Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Surveillance Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	System Contact	Manager, Medicare Enrollment, Billing & Recon	Ms.	Peterson	Nicole		7175416419				7173465897	nicole.peterson@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	Third Party Administrator (TPA) Liaison		Ms.	Beauduy	Tamara		7175416946					Tamara.Beauduy@CapBlueCross.COM	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8067	User Access Contact	Medicare Compliance Officer	Ms.	Yu	Gloria		7175417278					Gloria.Yu@capbluecross.com	2500 Elmerton Avenue		Harrisburg	PA	17177	03/07/2023	2023	Avalon Insurance Company	PDP	Avalon Insurance Company	Medicare Prescription Drug Plan		CAPITAL BLUE CROSS	41	Yes	Active					Medicare Prescription Drug Plan		5	Philadelphia
S8182	Agent/Broker Compensation Data Contact	Business Analyst III, Medicare Sales Support		Mendoza	Trina		8057136761					trina.mendoza@anthem.com	2100 Corporate Center Dr., Bldg 7	Mail Drop CANP02-C000	Newbury Park	CA	913621400	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Automated TrOOP Balance Transfer Contact	Membership Rep III		McCurdy	Michelle		4083100551					michelle.mccurdy@elevancehealth.com	700 Broadway		Denver	CO	80273	09/28/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Backup User Access Contact	Compliance Analyst, Sr.		Garcia	Christina	M	8058901045					christina.garcia@anthem.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Best Available Evidence Contact	Manager I, Membership		Palfy	Roxanne		3038693337					roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Bid Audit Contact	Actuarial Director		Hart	Mary		3175819752					mary.a.hart@anthem.com	220 Virginia Avenue	Mail Drop: IN205-A351	Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Bid Audit Site Contact	Actuarial Director		Hart	Mary		3175819752					mary.a.hart@anthem.com	220 Virginia Avenue	Mail Drop: IN205-A351	Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Bid Primary Contact	Director, Product Development		Floyd	Cari		5407984087					Cari.Floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	CAP Report Contact for Public Website	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	CEO - CMS Administrator Contact	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	CEO - Senior Official for Contracting	President Medicare Programs	Ms.	McFann	Elena		6822090335					elena.mcfann@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Chief Financial Officer	Vice President, Finance Medicare	Ms.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Chief Operating Officer	SVP & COO GBD	Mr.	Galle	Robert		8607193870					robert.galle@anthem.com	108 Leigus Road		Wallingford	CT	06492	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Chief Information Officer	Vice President & CIO GBD	Mr.	Brock	Jack		9728358900					jack.brock@anthem.com	1300 Amerigroup Way		Virginia Beach	VA	23464	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Chief Information Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	CMS Casework Communication Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Complaints Tracking Contact	Director II, GBD G&A		Sallee	Teia		5136497052				8884581406	teia.sallee@elevancehealth.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Contact for Fraud Investigations	Director, Special Investigations		Utley	Chris		6155043875					chris.utley@amerigroup.com	22 Centrury Blvd., Suite 220		Nashville	TN	37214	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Coordination of Benefits Contact	Staff VP Cost Optimization		Franke	Beth		5025481076					beth.franke@carelon.com	13550 Triton Office Park Blvd		Louisville	KY	40223	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Corporate Mailing						8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Coverage Gap Discount Program (CGDP) Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Customer Service Operations Contact	Staff VP Contact Center		Barrios	Charles		8325840911					charles.barrios@elevancehealth.com	4361 Irwin Simpson		Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	DIR Contact	Program Director		Browne	Nancy		3179197110					Nancy.Browne@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	DIR Contact (Secondary)	Director, Individual Medicare Part D		Caestecker	Mark		8052086090					mark.caestecker@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Emergency Part D Contact	Staff VP, Medicare Pharmacy Management		Arsenault	William		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Emergency Part D Contact (Secondary)	VP & COO - IngenioRx		Helmus	Scott		2013209107					scott.helmus@Ingenio-RX.com	5800 Northampton Blvd	Mail Drop VA28	Norfolk	VA	23502	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Employer Waiver Contact	VP GRS Business Segment		Paik	John		9179227246					john.paik@anthem.com	101 Wood Avenue South		Iselin	NJ	08830	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Enrollment Contact	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@elevancehealth.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	EOB Transfer Contact	Compliance Director, Med Part D/Pharm Oversight		Doss	Jennifer		5137484736				8558419706	jennifer.doss@anthem.com	4361 Irwin Simpson Road		Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Financial Audit Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Financial Reporting Contact	Vice President, Finance Medicare	Mr.	Chervenska	Veronika		8043936491					veronika.chervenska@elevancehealth.com	2015 Staples Mill Road		Richmond	VA	23230	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Formulary Contact	Director, Clinical Pharmacy Operations		Vercueil	Alfonso		9492336807					alfonso.vercueil@carelon.com	4 Varesa		Irvine	CA	92620	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Formulary Contact (Secondary)	Manager Pharmacy Clinical Operations		Kazanfer	Kari		9738851430					Kari.Kazanfer@carelon.com	39 Lynwood Rd		Verona	NJ	07044	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	General Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Government Relations Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	HIPAA Privacy Officer	Vice President, Chief Ethics and Privacy Officer		Robinson	Diidri		5623022326					privacy.office@anthem.com	3080 Bristol Street	Ste 200	Costa Mesa	CA	92626	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	HIPAA Security Officer	VP and Chief Information Security Officer	Mr.	Wilcox	Dustin		4632245212					dustin.wilcox@anthem.com	220 Virginia Ave.		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Hospice Contact	Manager I, Membership		Palfy	Roxanne		3038693337					Roxanne.palfy@anthem.com	700 Broadway	Mail Drop CO0109-0951	Denver	CO	80273	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Interoperability Contact	Director II Technology		Turney	Sheryl	A	2034649969					InteroperabilityWorkgroup@anthem.com	3080 Bristol Street		Costa Mesa	CA	92626	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Marketing Contact	Strategic Compliance Business Leader		Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Medical Director	Medicare Chief Medical Officer		Latif	Omar		8185777721					omar.latif@anthem.com	3080 Bristol Street	Suite 200 CACM00-0000	Costa Mesa	CA	92626	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Medicare Compliance Officer	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Medicare Coordinator	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Medicare Part D Opioid Overutilization Contact	Manager Pharmacy Clinical Operations		Leason	Aneatria		8667876341	6341				CMSRx@Carelon.com	740 W. Peachtree ST NW		Atlanta	GA	30308	07/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Medication Therapy Management Contact	Director of Clinical Pharmacy Strategies		Taylor	Stephanie		7572978692					stephanie.taylor@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	OffShore Subcontractor Contact	Compliance Director		Hodge	Susan		4632692105					susan.hodge@elevancehealth.com	220 Virginia Avenue		Indianapolis	IN	46204	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Online Enrollment Center Contact (Back-up)	Director II, Membership		Nunez	Lupe		8052903467					lupe.nunez@anthem.com	700 Broadway	Mail Drop CO0106-0601	Denver	CO	80273	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Online Enrollment Center Contact (Optional)	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Online Enrollment Center Contact (Primary)	Director Program Management		Salvietti	Kerensa		2035984738					Kerensa.Salvietti@elevancehealth.com	108 Leigus Road		Wallingford	CT	06492	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Appeals	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5133167654				Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Appeals Contact (Secondary)	Director, PharmD Medicare Part D CAG		Zanolli	Mindy						8884581406	mindy.zanolli@anthem.com	4361 Irwin Simpson Rd.	Mailstop OH0205-A537	Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	8144498744				Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Application Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Benefits Contact	Staff VP, Medicare Compliance		Meidl	Chris		4144771533					christopher.meidl@anthem.com	N5108 Fox River Lane		Princeton	WI	54968	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Claims Submission Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way	VA23	Virginia Beach	VA	23464	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Exceptions Contact	Manager Medical Director, MD, RPh Medicare CAG	Dr.	Dearworth	David							david.dearworth@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5133167654				Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Exceptions Contact (Secondary)	Medicare Product Innovation Director		Floyd	Cari							cari.floyd@anthem.com	1226 Sigler Street		Nashville	TN	37203	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	5407984087				Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Price File Contact (Back-up)	Business Change Manager		Mendez	Daniela		3232193390					Daniela.Mendez@carelon.com	1723 Loma Rd		Montbello	CA	90640	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Price File Contact (Optional)	Staff VP, Medicare Pharmacy Management		Arsenault	Bill		7574074167					william.arsenaultjr@carelon.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Price File Contact (Primary)	Business Change Manager		Nicholson-Sampson	Amanda		8053190159					Amanda.Nicholson-Sampson@carelon.com	2716 Brewer St		Lakewood	CA	90712	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Quality Assurance Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Part D Reporting Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Patient Safety Contact	VP/Chief Clinical Officer - IngenioRx		Haines	Colleen		9373710575					colleen.haines@ingenio-rx.com	4241 Irwin Simpson Road	OH0202-A844	Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Payment Contact	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Personal Health Record Contact	Director Reporting & Data Analysis Ops Reporting		Lordan	Vera		6122711925					vera.lordan@anthem.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Pharmacy Director	Clinical Pharmacy Program Director	Ms.	Gibson	Cathy		5132550202					cathy.j.gibson@carelon.com	9130 Cobblechase Court		Cincinnati	OH	45251	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Pharmacy Network Management Contact	Director, Pharmacy Oversight		Warner	Raymond		8054053246					raymond.warner@carelon.com	21215 Burbank Blvd		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Pharmacy Network Management Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler		3135973173					tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Pharmacy Technical Help Desk Contact	raymond.warner@anthem.com		Warner	Raymond							raymond.warner@carelon.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	8333774266				Medicare Prescription Drug Plan		5	Chicago
S8182	Pharmacy Technical Help Desk Contact (Secondary)	Pharmacy Network Management Director		Ingle	Tyler							tyler.ingle@ingenio-rx.com	4241 Irwin Simpson Rd.		Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract	3135973173				Medicare Prescription Drug Plan		5	Chicago
S8182	PHR Beneficiary Contact																	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan	Anthem Blue Cross and Blue Shield	Elevance Health, Inc.	1	Yes	Withdrawn Contract	8004671199				Medicare Prescription Drug Plan		5	Chicago
S8182	Plan Directory Contact for Public Website			Service	Customer		8882307338					DirectoryRequest_MMP@anthem.com	4361 Irwin Simpson Rd		Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Plan to Plan Reconciliation Contact	Financial Accountant		Tran	Phuong		8057131098					Phuong.Tran@anthem.com	21215 Burbank Blvd.	Suite 100 Mailstop:  CA9304-R04H	Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Processor Contact	Director Pharmacy Management		Fowler	Kendra		7573815066					kendra.fowler@Ingenio-Rx.com	1330 Amerigroup Way		Virginia Beach	VA	23464	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Reconciliation Contact	Actuarial Analyst III		Slezewick	Michael		3173627850					michael.slezewick@ingenio-RX.com	4241 Irwin Simpson Road		Mason	OH	45040	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Recovery Audit Contact	Strategic Compliance Business Leader	Ms.	Phillips	Adriana		3053891209					aphillips@elevancehealth.com	9250 West Flager Street	Suite 600	Miami	FL	33174	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Surveillance Contact	Staff VP, Compl Medicare Business Advisory Team		McMillan	Anne		2243407929					anne.mcmillan@anthem.com	1001 Pennsylvania Avenue NW	Unit 710	Washington	DC	20004	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	System Contact	Sr Director Engineering		Khan	Imran		7574098652					Imran.Khan@elevancehealth.com	5800 Northampton Blvd		Norfolk	VA	23502	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	Third Party Administrator (TPA) Liaison	Financial Accounting Database Analyst Sr.		Racine	Max		8058163930					max.racine@anthem.com	21215 Burbank Blvd.		Woodland Hills	CA	91367	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8182	User Access Contact	Vice President, Medicare Compliance Officer	Ms.	Turano	Michelle		8132951367					MedicareCO@anthem.com	4200 W. Cypress St.		Tampa	FL	33607	05/26/2023	2023	AMERIGROUP INSURANCE COMPANY	PDP	Amerigroup	Medicare Prescription Drug Plan		Elevance Health, Inc.	1	Yes	Withdrawn Contract					Medicare Prescription Drug Plan		5	Chicago
S8841	Agent/Broker Compensation Data Contact	VP Government Programs Operations	Mr.	Olson	Paul		6128504331					paul_olson@optum.com	1100 Optum Circle		Eden Prairie	MN	55344	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Automated TrOOP Balance Transfer Contact	Manager, Business Process	Mr.	Diaz	Mario		9494753517					mario.diaz@optum.com	1100 Optum Circle		Eden Prairie	MN	55344	05/26/2017	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Backup User Access Contact	Assoc. Director Compliance	Ms.	Oswald	Sheri		2242311694					sheri.oswald@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Best Available Evidence Contact	Director, Medicare Enrollment	Mr.	Johnson	Kent	E	5187275630					kent.johnson@optum.com	64 Loughberry Lake Road		Saratoga Springs	NY	12866	08/24/2020	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Bid Audit Contact	Medicare EGWP Compliance Officer, OptumRx	Ms.	Shocklee	Beth		3017756358					beth.shocklee@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	05/25/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Bid Audit Site Contact	Medicare EGWP Compliance Officer, OptumRx	Ms.	Shocklee	Beth		3017756358					beth.shocklee@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	05/25/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Bid Primary Contact	VP Government Programs	Mr.	Olson	Paul		6128504331					paul_olson@optum.com	1100 Optum Circle		Eden Prairie	MN	55344	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	CAP Report Contact for Public Website	Medicare EGWP Compliance Officer, OptumRx	Ms.	Shocklee	Beth		3017756358					beth.shocklee@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	05/25/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	CEO - CMS Administrator Contact	CEO, OptumRx	Dr.	Conway	Partrick	H	6176462765					optumrx_chief_exec_officer@optum.com	75 State St	29th Floor	Boston	MA	02109	08/01/2023	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	CEO - Senior Official for Contracting	CEO, OptumRx	Dr.	Conway	Patrick	H	6176462765					optumrx_chief_exec_officer@optum.com	75 State St	29th Floor	Boston	MA	02109	08/01/2023	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Chief Financial Officer	CFO, OptumRx	Ms.	Carey	Kathryn		9522052554					kathryn.carey@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/24/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Chief Operating Officer	Senior Vice President, Chief Operating Officer	Mr.	Violette	Steve		9529314780					steven.violette@optum.com	9800 Health Care Lane		Minnetonka	MN	55343	05/02/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Chief Information Officer	VP Information Technology	Mr.	Charette	Francois		9529175563					francois.charette@optum.com	11020 Optum Circle		Eden Prairie	MN	55344	09/12/2019	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Chief Information Security Officer	Chief Info Security Officer	Ms.	Cardwell	Aimee		6174061087					aimee.cardwell@optum.com	1325 Boylston St.		Boston	MA	02215	05/24/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	CMS Casework Communication Contact	Medicare EGWP Compliance Officer, OptumRx	Ms.	Shocklee	Beth		3017756358					beth.shocklee@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	05/25/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Complaints Tracking Contact	Assoc. Director Healthcare Compliance	Ms.	Oswald	Sheri		2242311694					sheri.oswald@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Contact for Fraud Investigations	Associate Dir, Pharmacy Audit	Ms.	Regalado	Lisa		7633615812					lisa.regalado@optum.com	1100 Optum Circle		Eden Prairie	MN	55344	05/26/2017	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Coordination of Benefits Contact	OptumRx EGWP COB Mailbox		EGWP COB Mailbox	OptumRx		2242311694					ORxEGWPCOB@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/15/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Corporate Mailing						6128504331					paul_olson@optum.com	1100 Optum Circle		Eden Prairie	MN	55344	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Coverage Gap Discount Program (CGDP) Payment Contact	Associate Director Accounting	Mr.	Woldehawariat	Million		9522057859					million.woldehawariat@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Customer Service Operations Contact	Manager, Customer Service	Ms.	Ortiz	Lisa Marie		7148253805					lisamarie.ortiz@optum.com	11000 Optum Circle		Eden Prarie	MN	55344	01/01/2021	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	DIR Contact	Director Accounting	Mr.	Woldehawariat	Million		9522057859					million.woldehawariat@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/25/2023	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	DIR Contact (Secondary)	Accounting Consultant	Ms.	Kolasz	Sarah		7164257146					sarah_kolasz@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/25/2023	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Emergency Part D Contact	VP, Government Programs Operations	Mr.	Olson	Paul		6128504331					paul_olson@optum.com	1100 Optum Circle		Eden Prairie	MN	55344	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Emergency Part D Contact (Secondary)	SVP Chief Operating Officer	Mr.	Violette	Steve		9529314780					steven,violette@optum.com	9800 Healthcare Lane		Minnetonka	MN	55343	05/05/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Employer Waiver Contact	VP Government Operations	Mr.	Olson	Paul		6128504331					paul_olson@optum.com	1100 Optum Circle		Eden Prairie	MN	55344	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Enrollment Contact	Director, Medicare Enrollment	Mr.	Johnson	Kent	E	5187275630					kent.johnson@optum.com	64 Loughberry Lake Road		Saratoga Springs	NY	12866	08/24/2020	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	EOB Transfer Contact	Manager, Reporting	Ms.	Devereux	Mary		6302005745				2242311912	mario.diaz@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/16/2018	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Financial Audit Contact	Assoc. Director Healthcare Compliance	Ms.	Oswald	Sheri		2242311694					Sheri.Oswald@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Financial Reporting Contact	Associate Director Accounting	Mr.	Woldehawariat	Million		9522057859					million.woldehawariat@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	02/17/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Formulary Contact	Manager, Medicare Formulary Development	Mr.	Murphy	Jeff		7176457534					jeff.murphy@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	06/03/2016	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Formulary Contact (Secondary)	VP, Formulary Services	Mr.	Noga	Mark		7178054359					mark.noga@optum.com	2 Enck Circle		Enola	PA	17025	08/06/2015	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	General Contact	Assoc. Director Healthcare Compliance	Ms.	Oswald	Sheri		2242311694					sheri.oswald@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/24/2020	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Government Relations Contact	Senior Director, Regulatory Affairs Optum		Field	Lily		9526874280					Lily.Field@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	03/27/2023	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	HIPAA Privacy Officer	Chief Privacy Officer	Mr.	Granberg	Mitchell	W	9522056259					mitchell.granberg@optum.com	11000 Optum Circle	MN101-E013	Eden Prairie	MN	55344	08/25/2016	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	HIPAA Security Officer	Chief Info Security Officer	Ms.	Cardwell	Aimee		6174061087					aimee.cardwell@optum.com	1325 Boylston St.		Boston	MA	02215	05/24/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Hospice Contact	Director- Prior Authorization Governance.		Mourad	Hala		6308905558					Hala.Mourad@optum.com	1600 McConner Parkway		Schaumburg	IL	60173	03/27/2023	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Interoperability Contact	Sr Principal Proj-Prgm Mgr	Mr.	Ephraim	Mark		9492525524					mark.ephraim@optum.com	2300 Main Street		Irvine	CA	92614	05/19/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Marketing Contact	VP Government Programs Operations	Mr.	Olson	Paul		6128504331					paul_olson@optum.com	1100 Optum Circle		Eden Prairie	MN	55344	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Medical Director	SVP, Chief Medical Officer	Dr.	Dutta	Sumit		3122617807					Sumit.Dutta@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/06/2015	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Medicare Compliance Officer	Medicare EGWP Compliance Officer	Ms.	Shocklee	Beth		3017756358					beth.shocklee@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/14/2020	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Medicare Coordinator	VP Government Programs Operations	Mr.	Olson	Paul		6128504331					paul_olson@optum.com	1100 Optum Circle		Eden Prairie	MN	55344	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Medicare Part D Opioid Overutilization Contact	Clinical Pharmacist		Shah	Purvi		8474144804					purvi.shah@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	06/29/2023	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Medication Therapy Management Contact	Product Manager, Clinical Products	Ms.	Liaqat	Tazeen		2242311722					tazeen.liaqat@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	09/22/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	OffShore Subcontractor Contact	OptumRx Compliance Officer	Ms.	Shocklee	Beth		3017756358					beth.shocklee@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	06/29/2023	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Part D Appeals	Mgr Pharm PA/Appeals	Ms.	Liswi	Dina						8556334651	OptumRx_2nd_Level_Appeals@ds.uhc.com	3515 Harbor Blvd	CA950-1000	Costa Mesa	CA	92626	05/24/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	6514955481				Medicare Prescription Drug Plan		5	San Francisco
S8841	Part D Appeals Contact (Secondary)	Sr, Pharm PA/Appeals Tech	Ms.	Chavez	Kelly						8556334651	RxSolAppealsTeam_DL@ds.uhc.com	3515 Harbor Blvd.	CA106-0286	Costa Mesa	CA	92626	01/07/2021	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	6514955481				Medicare Prescription Drug Plan		5	San Francisco
S8841	Part D Application Contact	VP Government Programs	Mr.	Olson	Paul		6128504331					paul_olson@optum.com	1100 Optum Circle		Eden Prairie	MN	55344	12/08/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Part D Benefits Contact	Manager, Pharmacy Help Desk	Mr.	Summers	Todd		8664431095					todd.summers@optum.com	755 Research Pkwy	Suite 300	Oklahoma City	OK	73104	01/26/2021	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Part D Claims Submission Contact	SVP, Medicare Operations	Mr.	Violette	Steve		9529314789					steven.violette@optum.com	9800 Healthcare Lane		Minnetonka	MN	55343	05/05/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Part D Exceptions Contact	Manager, Prior Authorization	Mr.	Bricker	Bryce							bryce.m.bricker@optum.com	9040 S. Rita Rd.		Tucson	AZ	85746	01/04/2021	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	6126326838				Medicare Prescription Drug Plan		5	San Francisco
S8841	Part D Price File Contact (Back-up)	Manager, Business Process	Ms.	Ericksen	Bryna		8162895323					bryna.ericksen@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/26/2017	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Part D Price File Contact (Primary)	Manger, Medicare Operations	Ms.	Ericksen	Bryna		8162895323					Distro-MedicareOperationsPlanFinder@catamaranrx.co	1600 McConnor Parkway		Schaumburg	IL	60173	08/16/2018	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Part D Quality Assurance Contact	Director, Medicare Clinical Program Oversight	Ms.	Marks	Iny		6303526658					iny.marks@optum.com	5000 Firwood Drive		Canonsburg	PA	15317	08/06/2015	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Part D Reporting Contact	Mgr. IT DT Analytics	Mr.	Zahurak	Peter		2242312075					peter.zahurak@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	06/03/2016	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Patient Safety Contact	Quality Initiatives Pharmacist		Tyra	Michelle		2102782077					michelle.tyra@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	08/09/2018	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Payment Contact	Associate Director Accounting	Mr.	Woldehawariat	Million		9522057859					million.woldehawariat@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	02/17/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Personal Health Record Contact	SVP, Medicare Operations	Mr.	Violette	Steve		9529314780					stevenviolette@optum.com	9800 Healthcare Lane		Minnetonka	MN	55343	05/05/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Pharmacy Director	VP Medical Clinical Operations	Mr.	Calabrese	David		5089441443				5089261308	david.calabrese@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	05/26/2017	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Pharmacy Network Management Contact	Director Network Contracting	Mr.	Hagan	Kyle		3039895288					Kyle.Hagan@optum.com	7120 W Iowa Ave		Lakewood	CO	80232	01/04/2021	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Pharmacy Network Management Contact (Secondary)	Director Network Contracting	Mr.	Somrock	Jason		4242466552					jason.somrock@optum.com	PO Box 9472		Minneapolis	MN	55440	08/05/2020	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Pharmacy Technical Help Desk Contact	Manager, Pharmacy Help Desk	Mr.	Summers	Todd							todd.summers@optum.com	755 Research Pkwy	Suite 300	Oklahoma City	OK	73104	08/16/2018	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active	8664431095				Medicare Prescription Drug Plan		5	San Francisco
S8841	Plan Directory Contact for Public Website	Manager, Pharmacy Help Desk	Mr.	Summers	Todd		8664431095					todd.summers@optum.com	755 Research Pkwy	Suite 300	Oklahoma City	OK	73104	01/26/2021	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Plan to Plan Reconciliation Contact	Director, Accounting	Mr.	Woldehawariat	Million		9522057859					Million.Woldehawariat@optum.com	Lockbox 5818		Carol Stream	IL	60197	01/17/2023	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Processor Contact	Senior Manager, Benefits	Ms.	Casata	Mercedes		6307809152					Mercedes.Cassata@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	04/17/2020	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Reconciliation Contact	Director Accounting	Mr.	Woldehawariat	Million		9522057859					million.woldehawariat@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	02/20/2023	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Reconciliation Contact (Secondary)	Director Accounting	Ms.	Schroller	Linda	S	9492219983					linda.schroller@optum.com	2300 Main St		Irvine	CA	92614	02/17/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Recovery Audit Contact	Director Audit Advisory Services	Ms.	Tilden	Kathleen		6314067862					kathleen.tilden@optum.com	PO Box 9472		Minneapolis	MN	55440	08/05/2020	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Surveillance Contact	Medicare EGWP Compliance Officer, OptumRx	Ms.	Shocklee	Beth		3017756358					beth.shocklee@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	05/25/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	System Contact	Director, Information Technology	Mr.	Trippett	Ken		2242311663					Ken.Trippett@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	01/05/2016	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	Third Party Administrator (TPA) Liaison	Associate Director Accounting	Mr.	Woldehawariat	Million	W	9522057859					million.woldehawariat@optum.com	11000 Optum Circle		Enen Prairie	MN	55344	02/17/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S8841	User Access Contact	Medicare EGWP Compliance Officer, OptumRx	Ms.	Shocklee	Beth		3017756358					beth.shocklee@optum.com	1600 McConnor Parkway		Schaumburg	IL	60173	05/25/2022	2023	OPTUM INSURANCE OF OHIO, INC.	PDP	Optum Insurance of Ohio, Inc.	Medicare Prescription Drug Plan		UnitedHealth Group, Inc.	239	Yes	Active					Medicare Prescription Drug Plan		5	San Francisco
S9409	Agent/Broker Compensation Data Contact	Product Coordinator		Armstrong	Chris		8023713250					carmstrong@bcbsvt.com	P.O. Box 186		Montpelier	VT	05601	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Automated TrOOP Balance Transfer Contact	Manager, Business Process		Diaz	Mario		7143172628					OptumRx-SupportServices@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Backup User Access Contact	Manager, Performance & Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Best Available Evidence Contact	Manager, Enrollment and Billing		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road Suite 200		Glen Allen	VA	23060	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Bid Audit Contact	Director		Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Bid Audit Site Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Bid Primary Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	CAP Report Contact for Public Website	Director		Pickens	Veronica		2483955887					vpickens@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	CEO - CMS Administrator Contact	Plan President	Ms.	Getsie	Pamela		8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	CEO - Senior Official for Contracting	Plan President	Ms.	Getsie	Pamela		8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Chief Financial Officer	SVP, Controller	Mr.	Pisarik	Jason		2486654348					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	VT	05601	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Chief Operating Officer	Managing Director, Operations	Mr.	Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Chief Information Officer	IT Director II	Mrs.	Krause	Amy		3132256638					akrause@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Cieszynski	Brent		3132258766					bcieszynski@bcbsm.com	600 Lafayette East		Detroit	MI	48226	08/22/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	CMMI Model Point of Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	CMS Casework Communication Contact	Compliance Consultant		White	Jasmin		2486654235					JWhite4@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Complaints Tracking Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Contact for Fraud Investigations	Manager		Zasadny	Brian		3132255956					bzasadny@bcbsm.com	600 East Lafayette		Detroit	MI	48226	12/28/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Coordination of Benefits Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	06/01/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Corporate Mailing						8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	200 North Grand Avenue	PO Box 40790	Lansing	MI	48901	12/28/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Customer Service Operations Contact	Director, Workforce Management, Analytics, & Supp		Weber	Julie		3132250555					jweber@bcbsm.com	600 East Lafayette		Detroit	MI	48226	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	DIR Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	DIR Contact (Secondary)	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Emergency Part D Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Emergency Part D Contact (Secondary)	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Employer Waiver Contact	Manager		Nelson	Jessica		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Enrollment Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	EOB Transfer Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880				4192613760	Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Financial Audit Contact	Director	Mr.	Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Financial Reporting Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Formulary Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Formulary Contact (Secondary)	Manager		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	General Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Government Relations Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	HIPAA Privacy Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	HIPAA Security Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Hospice Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Interoperability Contact	Manager		Kingsley	Chris		2484444160					Christopher.kingsley@emergient.com	1000 Town Center		Southfield	MI	48075	06/01/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Marketing Contact	Plan President	Ms.	Getsie	Pamela		8025053449					Pamela.Getsie@VermontBlueAdvantage.com	P.O. Box 186		Montpelier	VT	05601	04/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Medical Director	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Medicare Compliance Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/23/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Medicare Coordinator	Managing Director, Medicare Advantage Compliance		Pickens	Veronica		2483955887					vpickens@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Medicare Part D Opioid Overutilization Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Medication Therapy Management Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	OffShore Subcontractor Contact	Manager	Mrs.	Stretch	Kaitlin		2486654275					kstretch@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Online Enrollment Center Contact (Back-up)	Enrollment Business Lead		Schulz	Bryan		5084390769					Bryan.Schulz@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Online Enrollment Center Contact (Optional)	Manager		Woods	Cheyenne		2484173449					cheyenne.woods@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Online Enrollment Center Contact (Primary)	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Appeals	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8554890646				Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Appeals Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8003443405	733326			Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Application Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Benefits Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Claims Submission Contact	Manager, Business Process		Diaz	Mario		7143172628					OptumRx-SupportServices@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Exceptions Contact	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8554890646				Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Exceptions Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	6143363326				Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Price File Contact (Back-up)	Vice President		Siuta	Lori		2242312298					lori.siuta@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Price File Contact (Optional)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Price File Contact (Primary)	Sr. Business Analyst, Medicare Operations		Vargas	Danielle		4437101262					danielle.wooten@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Quality Assurance Contact	Managing Director, Operations		Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Part D Reporting Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Patient Safety Contact	Managing Director, Operations		Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Payment Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Personal Health Record Contact	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	06/01/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Pharmacy Director	Managing Director, Operations		Manthey	Michael		9897980911					mmanthey@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Pharmacy Network Management Contact	Sr. Account Manager, Network Account Management		Brown	Casey		6126427367					casey.brown@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Pharmacy Network Management Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Pharmacy Technical Help Desk Contact	Manager, Pharmacy PA/Appeals		Bricker	Bryce							bryce.m.bricker@optum.com	11000 Optum Circle		Eden Prairie	MN	55344	01/11/2023	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8554890646				Medicare Prescription Drug Plan		5	Chicago
S9409	Pharmacy Technical Help Desk Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8009221557				Medicare Prescription Drug Plan		5	Chicago
S9409	Plan Directory Contact for Public Website	Work Track Project Manager		Nelson	Jessica		8448395122					Jessica.Nelson@emergient.com	P.O. Box 186		Montpelier	VT	05601	05/27/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Plan to Plan Reconciliation Contact	SVP, Controller		Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Processor Contact	Manager, Coordination of Benefits		Griffin	Suzanne		2486212356					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Reconciliation Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Reconciliation Contact (Secondary)	Corporate Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Recovery Audit Contact	Manager, Performance and Oversight	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Surveillance Contact	Manger, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	System Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	Third Party Administrator (TPA) Liaison	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	200 North Grand Avenue	PO Box 40790	Lansing	MI	48901	12/28/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9409	User Access Contact	Manager, Performance and Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/09/2022	2023	VERMONT BLUE ADVANTAGE, INC.	PDP	Vermont Blue Advantage	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9701	Agent/Broker Compensation Data Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott. Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Automated TrOOP Balance Transfer Contact	Operations Manager, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	Relay.Health@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	11/09/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Backup User Access Contact	GRC & Regulatory Audit Coordinator		Hewitt	Deb		6088285034					deb.hewitt@deancare.com	1255 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Best Available Evidence Contact	Product Manager, IT Client Operations		Matteson	Michelle		9202214104				9202214604	michelle.matteson@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	11/15/2018	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Bid Audit Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Bid Primary Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	CAP Report Contact for Public Website	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	CEO - CMS Administrator Contact	Interm President & CFO	Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	CEO - Senior Official for Contracting		Ms	Erickson	Lisa		9529922753					lisa.erickson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	09/13/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Chief Financial Officer	Chief Financial Officer	Mr.	Ruplinger	Randy		6088274030					hpmscfo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Chief Operating Officer	President	Mr.	Docherty	David		6088274458					hpmscoo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Chief Information Officer	VP Information Technology, CIO	Mr.	Rehberg	Michael		9202214063				9202214563	Michael.Rehberg@Navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/15/2016	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Chief Information Security Officer	Senior Manager, IT Security Network Governance	Mr.	Brandt	Jeff		9202214066					jeff.brandt@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	11/07/2019	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	CMS Casework Communication Contact	Associate Director, PA and Utilization Management		Semrow	Laura		9202214129				9202214629	laura.semrow@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/01/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Complaints Tracking Contact	Associate Director, PA and Utilization Management		Semrow	Laura		9202214129				9202214629	laura.semrow@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/01/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Contact for Fraud Investigations	SIU Director		Monson	Peter		9509921149				6082985863	Peter.Monson@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/13/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Coordination of Benefits Contact	Director, Technical Operations		Brenner	Brian		9202214053				9202214553	Brian.Brenner@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/01/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Corporate Mailing						6088274061				6088274152	hpmsceo.inbox@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Coverage Gap Discount Program (CGDP) Payment Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	11/09/2020	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Customer Service Operations Contact	Manager, Customer Care Accounts		Nett	Danielle		9202214224					Danielle.Nett@Navitus.com	1025 West Navitus Drive		Appleton	WI	54913	04/16/2021	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	DIR Contact	Financial Analyst, Medicare Part D		Seehafer	Angela		9202214098				9202214598	Angela.Seehafer@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/02/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	DIR Contact (Secondary)	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	11/09/2020	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Emergency Part D Contact	Vice President, Government Programs		Backman	Carmen		9202214135					carmen.backman@navitus.com	1025 West Navitus Dr.		Appleton	WI	54913	10/13/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Emergency Part D Contact (Secondary)	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Employer Waiver Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Enrollment Contact	Operations Manager, Enrollment & Eligibility		Sherman	Mandy		9202214083				9202214583	mandy.sherman@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	11/09/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	EOB Transfer Contact	Director, Technical Operations		Brenner	Brian		9202214053				9202214553	Brian.Brenner@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/01/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Financial Audit Contact	Manager - Compliance	Mr.	Herbst	Travis		6088282856					travis.herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Financial Reporting Contact	Chief Financial Officer	Mr.	Ruplinger	Randy		6088274030					hpmscfo.inbox@medica.com	1277 Deming Way		Madison	WI	53717	02/01/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Formulary Contact	Formulary Team Lead		Paddock	Deanna		6087291628				6087292628	Deanna.Paddock@navitus.com	361 Integrity Drive		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Formulary Contact (Secondary)	Manager Pharmacy Operations		Borleske	Amanda		6088282889					amanda.borleske@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	General Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	scott.jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	10/13/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Government Relations Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	scott.jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	10/13/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	HIPAA Privacy Officer	VP Chief Compliance Officer		Aiken	Carrie		6082985763				6082985863	carrie.aiken@navitus.com	361 Integrity Drive		Madison	WI	53717	10/29/2021	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	HIPAA Security Officer	Senior Manager, IT Security Network Governance		Brandt	Jeff		9202214066				9202214566	jeff.brandt@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	11/07/2019	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Hospice Contact	Operations Manager, Enrollment and Eligibility		Sherman	Mandy		9202124083				9202214583	Mandy.Sherman@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	11/09/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Interoperability Contact	Director of Privacy		Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/24/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Marketing Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Medical Director	Medical Director	Dr.	Hirsch	Thomas		6086980440				6087292613	thomas.hirsch@navitus.com	361 Integrity Drive		Madison	WI	53717	03/27/2019	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Medicare Compliance Officer	VP - C0mpliance	Ms.	Koranteng	Milly		9529922090					Mildred.Koranteng@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	02/02/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Medicare Coordinator	Vice President, Government Programs		Backman	Carmen		9202214135					carmen.backman@navitus.com	1025 West Navitus Dr.		Appleton	WI	54913	10/13/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Medicare Part D Opioid Overutilization Contact	Pharmacist, Population Health		Ulloa	Gabrielle		6083101842					Gabrielle.Ulloa@navitus.com	361 Integrity Way		Madison	WI	53717	11/09/2020	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Medication Therapy Management Contact	Program Manager, Clinical Engagement Center		Gadow	Brett	M	6082985790					brett.gadow@navitus.com	361 Integrity Drive		Madison	WI	53717	04/13/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	OffShore Subcontractor Contact	Director of Privacy		Chastanet	Yvonne		9529923957					yvonne.chastanet@medica.com	401 Carlson Parkway		Minnetonka	MN	55305	01/24/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Part D Appeals	Supervisor, Grievance and Appeals		Fritsche	Jacki						6082985881	Jacki.Fritsche@Navitus.com	361 Integrity Drive		Madison	WI	53717	12/07/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active	6082985781				Medicare Prescription Drug Plan		5	Kansas City
S9701	Part D Application Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087					Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Part D Benefits Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Part D Claims Submission Contact	Sr. Manager, Technical Operations		Derks	Bob		9202214404				9202214904	DL-TO-PDE@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	02/01/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Part D Exceptions Contact	Sr. Manager, Clinical Prior Authorization		LeClair	Christophe						9202214676	Christopher.Leclair@navitus.com	1025 W. Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active	9202214176				Medicare Prescription Drug Plan		5	Kansas City
S9701	Part D Price File Contact (Back-up)	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Part D Price File Contact (Primary)			Plan Finder	Navitus		6087291578				6087292578	PlanFinder@navitus.com	361 Integrity Drive		Madison	WI	53717	12/08/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Part D Quality Assurance Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Part D Reporting Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Patient Safety Contact	Director, Clinical Services		Wickizer	Marleen		6087291581				6087292581	Marleen.Wickizer@navitus.com	361 Integrity Way		Madison	WI	53717	02/01/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Payment Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	11/09/2020	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Pharmacy Director	Sr. Vice President, Chief Pharmacy Officer		Eberle	Brent		6087291511				6087292511	Brent.Eberle@navitus.com	361 Integrity Drive		Madison	WI	53717	04/18/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Pharmacy Network Management Contact	Director, Pharmacy Performance		Robinson	Jan		6087291688				6087292688	Jan.Robinson@navitus.com	361 Integrity Drive		Madison	WI	53717	11/09/2020	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Pharmacy Technical Help Desk Contact	Manager, Customer Care Accounts		Nett	Danielle						8665951975	Danielle.Nett@Navitus.com	1025 West Navitus Drive		Appleton	WI	54913	06/09/2021	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active	8662703877				Medicare Prescription Drug Plan		5	Kansas City
S9701	Plan Directory Contact for Public Website	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	scott.jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	10/13/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Plan to Plan Reconciliation Contact	Financial Analyst, Medicare Part D		Seehafer	Angela		9202214098				9202214598	Angela.Seehafer@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/02/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Processor Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Reconciliation Contact	Financial Analyst, Medicare Part D		Seehafer	Angela		9202214098				9202214598	Angela.Seehafer@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/02/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Reconciliation Contact (Secondary)	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	11/09/2020	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Recovery Audit Contact	Vice President, Government Programs	Ms.	Backman	Carmen		9202214135					carmen.backman@navitus.com	1025 West Navitus Dr.		Appleton	WI	54913	10/13/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Surveillance Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	System Contact	General Manager, Medicare Part D Programs		Jacoby	Scott		9202214087				9202214587	Scott.Jacoby@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	Third Party Administrator (TPA) Liaison	Financial Analyst, Medicare Part D		Seehafer	Angela		9202214098				9202214598	Angela.Seehafer@navitus.com	1025 West Navitus Drive		Appleton	WI	54913	12/02/2022	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9701	User Access Contact	Manager - Compliance		Herbst	Travis		6088282856					Travis.Herbst@deancare.com	1277 Deming Way		Madison	WI	53717	05/04/2023	2023	DEAN HEALTH INSURANCE, INC.	PDP	Navitus MedicareRx	Medicare Prescription Drug Plan		Medica Holding Company	439	Yes	Active					Medicare Prescription Drug Plan		5	Kansas City
S9854	Agent/Broker Compensation Data Contact	Director, Finance Operations		Hoeg	Andrea		5153764509					commissioninquiry@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Automated TrOOP Balance Transfer Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Backup User Access Contact	Manager		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Best Available Evidence Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Bid Audit Contact	Director		Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Bid Audit Site Contact	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette Blvd.	MC 1603	Detroit	MI	48226	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Bid Primary Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	CAP Report Contact for Public Website	Managing Director		Pickens	Veronica		2483955887					vpickens@bcsbm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	CEO - CMS Administrator Contact	Plan President	Mr.	Hamor	Briggs		5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	05/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	CEO - Senior Official for Contracting	Plan President	Mr.	Hamor	Briggs		5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	05/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Chief Financial Officer	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Chief Operating Officer	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Chief Information Officer	IT Director II	Mrs.	Krause	Amy		3132256638					akrause@bcbsm.com	600 East Lafayette Blvd. MC 0506		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Chief Information Security Officer	VP Chief Information Security Officer	Mr.	Cieszynski	Brent		3132258766					bcieszynski@bcbsm.com	600 Lafayette East		Detroit	MI	48226	08/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	CMMI Model Point of Contact	Managing Director, Operations	Mr.	Manthey	Michael		2482284724					michael.manthey@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	CMS Casework Communication Contact	Compliance Consultant		White	Jasmin		2486654235					JWhite4@bcbsm.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Complaints Tracking Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Contact for Fraud Investigations	Manager		Zasadny	Brian		3132255956					bzasadny@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Coordination of Benefits Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Corporate Mailing						5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Coverage Gap Discount Program (CGDP) Payment Contact	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	1000 Town Center		Southfield	MI	48075	12/28/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Customer Service Operations Contact	Director, Workforce Management, Analytics, & Supp		Weber	Julie		3132250555					jweber@bcbsm.com	600 East Lafayette		Detroit	MI	48226	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	DIR Contact	VP Chief Medical Officer		Munir	Naim		5153766818					MunirN@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	DIR Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Emergency Part D Contact	Manager, Pharmacy Operations		Zylstra	Jennifer		9544985880					jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Emergency Part D Contact (Secondary)	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	01/04/2023	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Employer Waiver Contact	Manager, Functional Operations		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center	TC1505	Southfeld	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Enrollment Contact	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	EOB Transfer Contact	Director, Medicare Programs		Frank	Jesica		5153767878				8556337633	frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Financial Audit Contact	Director	Mr.	Weicker	Brian		3132259571					bweicker@bcbsm.com	600 East Lafayette		Detroit	MI	48226	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Financial Reporting Contact	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Formulary Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Formulary Contact (Secondary)	Manager, Functional Operations		Nelson	Jessica		2483209946					Jessica.Nelson@emergient.com	1000 Town Center	TC1505	Southfeld	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	General Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Government Relations Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	HIPAA Privacy Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	HIPAA Security Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					klange@bcbsm.com	600 East Lafayette		Detroit	MI	48826	06/17/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Hospice Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Interoperability Contact	Manager, Functional Operations		Kingsley	Chris		2484444160					Christopher.kingsley@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Marketing Contact	Plan President	Mr.	Hamor	Briggs		5152012513					briggs.hamor@wellmarkadvantagehealthplan.com	1331 Grand Avenue		Des Moines	IA	50309	05/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Medical Director	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Medicare Compliance Officer	Vice President, Enterprise Compliance	Ms.	Lange	Kelly		3132258554					medcomplianceofficer2@bcbsm.com	600 East Lafayette		Detroit	MI	48226	03/22/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Medicare Coordinator	Managing Director	Ms.	Pickens	Veronica		2483955887					VPickens@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Medicare Part D Opioid Overutilization Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Medication Therapy Management Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	OffShore Subcontractor Contact	Manager	Mrs.	Stretch	Kaitlin		2486654275					kstretch@bcbsm.com	600 East Lafayette Blvd.	TC 1301	Detroit	MI	48226	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Online Enrollment Center Contact (Back-up)	Enrollment Business Lead		Schulz	Bryan		5084390769					Bryan.Schulz@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Online Enrollment Center Contact (Optional)	Manager		Woods	Cheyenne		2484173449					cheyenne.woods@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Online Enrollment Center Contact (Primary)	Manager		LaMontagne	Amanda		5084399720					amanda.lamontagne@advantasure.com	4121 Cox Road	Suite 200	Glen Allen	VA	23060	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Appeals	Manager		Moran	Vickie							Vickie.Moran@CVSHealth.com	620 Epsilon Dr		Pittsburgh	PA	15238	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	4125263320				Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Appeals Contact (Secondary)	Director		Christensen	Ann							Ann.Christensen@CVSHealth.com	9501 E. Shea Blvd.		Scottsdale	AZ	85260	04/26/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	6023883829				Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Application Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Benefits Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Claims Submission Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Exceptions Contact	Director, Medicare Programs		Frank	Jesica							frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8553440930				Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Exceptions Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8553440930				Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Price File Contact (Back-up)	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Price File Contact (Optional)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Price File Contact (Primary)	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Quality Assurance Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Part D Reporting Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Patient Safety Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Payment Contact	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Personal Health Record Contact	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Pharmacy Director	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Pharmacy Network Management Contact	Director, Medicare Programs		Frank	Jesica		5153767878					frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Pharmacy Network Management Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Pharmacy Technical Help Desk Contact	Director, Medicare Programs		Frank	Jesica							frankj@wellmark.com	1331 Grand Avenue		Des Moines	IA	50309	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8006008065				Medicare Prescription Drug Plan		5	Chicago
S9854	Pharmacy Technical Help Desk Contact (Secondary)	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer							Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active	8006008065				Medicare Prescription Drug Plan		5	Chicago
S9854	Plan Directory Contact for Public Website	Manager		Nelson	Jessica		8557162556					Jessica.Nelson@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Plan to Plan Reconciliation Contact	SVP, Controller	Mr.	Pisarik	Jason		5177085285					jason.pisarik@emergentholdingsinc.com	200 N. Grand Ave.		Lansing	MI	48901	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Processor Contact	Manager, Claims and Recovery Operations		Griffin	Suzanne		3136430780					Suzanne.Griffin@advantasure.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Reconciliation Contact	Senior Analyst, Pharmacy Operations		Zylstra	Jennifer		9544985880					Jennifer.zylstra@emergient.com	1000 Town Center		Southfield	MI	48075	05/31/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Reconciliation Contact (Secondary)	Medical Director	Dr.	Petroff	Thomas		5172455703					Thomas.Petroff@emergient.com	1000 Town Center		Southfield	MI	48075	04/27/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Recovery Audit Contact	Manager, Program Oversight	Mrs.	Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Surveillance Contact	Manager		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	System Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	Third Party Administrator (TPA) Liaison	Accounting Supervisor		Cole	Terrence		5177086127					terrence.cole@emergentholdingsinc.com	1000 Town Center		Southfield	MI	48075	12/28/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
S9854	User Access Contact	Manager, Program Oversight		Martell	Stacey		3138065905					smartell@bcbsm.com	1000 Town Center		Southfield	MI	48075	02/13/2022	2023	WELLMARK ADVANTAGE HEALTH PLAN, INC.	PDP	Wellmark Advantage Health Plan	Medicare Prescription Drug Plan		Blue Cross Blue Shield of Michigan Mutual Ins. Co.	25	Yes	Active					Medicare Prescription Drug Plan		5	Chicago
X0001	Automated TrOOP Balance Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5024768814					HumanaEOBTransfer@humana.com	515 W. Market Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Backup User Access Contact	Compliance Lead		Keffer	Ellen		5024769797					ekeffer@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Best Available Evidence Contact	Associate Dir., Consumer Service		Beasley	Tasha		5024767452					MedicareLINET@humana.com	500 West main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	CAP Report Contact for Public Website	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	CEO - CMS Administrator Contact	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th floor-Humana Tower	Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	CEO - Senior Official for Contracting	Chief Executive Officer	Mr.	Broussard	Bruce		5025803606					bbroussard@humana.com	500 West Main Street	6th Floor - Humana Tower	Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Chief Financial Officer	Chief Financial Officer	Ms.	Diamond	Susan		5024762534					sdiamond@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Chief Operating Officer	Chief Operating Officer	Mr.	Renaudin	George		6153701801					grenaudin@humana.com	320 Seven Springs Way	Suite 200	Brentwood	TN	37027	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Chief Information Officer	Chief Information Officer	Mr.	Deshpande	Sam		5024767255					SDeshpande2@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Chief Information Security Officer	Chief Information Security Officer	Mr.	Raheja	Aman		5024765796					ARaheja@humana.com	321 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	CMS Casework Communication Contact			Beasley	Tasha		5024766134					tcovington1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Complaints Tracking Contact			Beasley	Tasha		5024766134					tcovington1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Contact for Fraud Investigations	Director, Fraud and Waste		Popik	David		9043808114					DPopik@humana.com	8935 Prominence Pkwy	Building 3, Suite 100	Jacksonville	FL	32256	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Coordination of Benefits Contact	Associate Director, Pharmacy Claims		Fessel	Christie		5025804329					cfessel@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Corporate Mailing						5025803830					WShrank@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Coverage Gap Discount Program (CGDP) Payment Contact	Accountant		Ibisate	Paris		5025802845					Fibisate@humana.com	500 W. Main Street	Floor 11	Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Customer Service Operations Contact			Beasley	Tasha		5024766134					tcovington1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	DIR Contact	Accounting Lead		Watson	Gabrielle		5025801522					gwatson@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	DIR Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Emergency Part D Contact	Associate Director, Regulatory Compliance		Licht	Susie	M	5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Emergency Part D Contact (Secondary)	Medicare Compliance Officer		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Enrollment Contact	Director, Enrollment		Bailey	Christy		5025804944					cbailey7@humana.com	101 East Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	EOB Transfer Contact	Pharmacy Claims Lead		Fleming	Brandi		5022623849				5026616361	humanaeobtransfer@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	General Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Government Relations Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	HIPAA Privacy Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	HIPAA Security Officer	Associate VP, Privacy and Ethics		Theiss	James		5025804322					jtheiss@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Hospice Contact	Senior Risk Management Professional		Enriquez	Melissa		5023012619					menriquez6@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Interoperability Contact	SVP, HQRI		Clark	Jessica		5025802864					jclark3@humana.com	500 West Main Street		Louisville	KY	40204	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Medical Director	VP, Physician Review and Market Insights	Dr.	Lueken	Kathryn		8003222758	1024881				KLueken@humana.com	500 W Main Street		Louisville	KY	40202	09/01/2023	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Medicare Compliance Officer	MCO	Mr.	Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Medicare Coordinator	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Medicare Part D Opioid Overutilization Contact	Manager, Pharmacy Claims		Jauquet	Jamie	J	8008951305					OMS_Plan_to_Plan_Sharing@Humana.com	1100 Employers Blvd		DePere	WI	54344	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Part D Appeals	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active	5025809138				Point-of-Sale Contractor		5	Philadelphia
X0001	Part D Appeals Contact (Secondary)	Associate Director, Compliance		Oppel	Cynthia							coppel@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active	5025807929				Point-of-Sale Contractor		5	Philadelphia
X0001	Part D Application Contact	Director, Insurance Product Compliance		Setzer	Ruth		5024760867					rwright4@humana.com	500 W Main Street	19th floor	Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Part D Benefits Contact	Associate VP, Insurance Product Management		Caldwell	Barbara		5025808386					bcaldwell@humana.com	500 W Main	19th floor	Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Part D Claims Submission Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Part D Exceptions Contact	Associate Director, Risk Management		Johnson	Courtnay							CJohnson136@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active	5025809138				Point-of-Sale Contractor		5	Philadelphia
X0001	Part D Exceptions Contact (Secondary)	Manager, Risk Management		Carter	Jonathan							jcarter45@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active	5024682494				Point-of-Sale Contractor		5	Philadelphia
X0001	Part D Quality Assurance Contact	Associate Director, Regulatory Compliance		Licht	Susie		5024762343					slicht@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Part D Reporting Contact	Sr Compliance Professional		Lynch	Carol Ann		5024328302					clynch1@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Patient Safety Contact	Sr Compliance Professional		Piepenburg	Lisa		5024763994					lpiepenburg@humana.com	500 West Main Street	Floor 22	Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Payment Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Pharmacy Director	Director, Risk Management		Renn	Kate		5024762499					krenn@humana.com	515 West Market		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Pharmacy Technical Help Desk Contact			Pharmacy Solutions	DST							cms.partD@dsthealth.com	210 West 10th Street		Kansas City	MO	64105	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active	8008658715				Point-of-Sale Contractor		5	Philadelphia
X0001	Pharmacy Technical Help Desk Contact (Secondary)	Sr Compliance Professional		Stevens	Debra							dstevens25@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active	5025800475				Point-of-Sale Contractor		5	Philadelphia
X0001	Plan to Plan Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915				5025083512	P2PAdministration@humana.com	Humana Insurance Co.	P. O. Box 635600	Cincinnati	OH	452635600	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Processor Contact	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Reconciliation Contact	Director, Financial Planning		Snearly	John		5025803915					jsnearly@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Reconciliation Contact (Secondary)	Senior Compliance Professional		Cooper	Cris		5024768880					ccooper7@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Surveillance Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	System Contact	MCO		Duffy	Conor		5025800428					HumanaMCO3@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	Third Party Administrator (TPA) Liaison	Finance Professional		Hughes	Donald		5026893844					dhughes7@humana.com	500 W. Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
X0001	User Access Contact	Compliance Professional		Barbetto	George		5024769797					gbarbetto@humana.com	500 West Main Street		Louisville	KY	40202	12/29/2022	2023	LIMITED INCOME NET PROGRAM	POS Contractor	Medicare's Limited Income NET Program	Point-of-Sale Contractor		Humana NET Demo	401	Yes	Active					Point-of-Sale Contractor		5	Philadelphia
